Everywhere Has Its Pros and Cons

 Being in the US, there are constant reminders of the similarities and differences between here and the islands and even mainland East Africa.  One of those areas is healthcare. It can be easy for everyone- Americans, mainland East Africans and islanders— to be down on their own healthcare systems for different valid reasons.  

Learning to Drive in the US

Once when we told an East African that we often came to his country for our healthcare, he was absolutely shocked! His impression was that the healthcare in his country was either poor quality or too expensive (if not both). We let him know that compared to the islands the quality is very good and compared the the US the costs were inexpensive.  Sometimes comparison changes your perspective. 

This week we have been reflecting specifically on getting prescription meds.

No one can deny that the US has a huge number of highly trained doctors and specialists. In the US, there is the best, cutting-edge care of the world.  But access, wait times and cost are concerns.  Also, the system of medical insurance is known for its fine print and run-arounds. We experienced it this week as we spent a great deal of time on the phone and computer— on hold, being forwarded to new people, being asked to call new numbers, sending messages through online portals, receiving denials and trying again. We still don’t have our daughter’s new medication— even though it was prescribed three weeks ago. 

In comparison, East Africa has a growing number of specialists and some good quality care— but it is generally in private hospitals that are too expensive for most local people (though cheaper than the US). Some medications, treatments or specialists are not available. Access is less of an issue.  Our daughter was able to see a specialist right away and started a good treatment plan. Payment for meds is pretty straight forward there.  We front the money and are usually reimbursed by insurance in a relatively quick time. But every time we had to get the meds from the pharmacy it was a pain. The medications being specialized, meant the pharmacy had to do special orders which meant included longer waits and more hassle than promised. Then when it was time to try a new treatment— the options weren’t as good— the depth of treatment options couldn’t compare with the US. But at least there were some options— on the islands neither specialists nor medications would have been available at all. 

The islands don’t have much. The healthcare system is improving, but there are still many types of specialists, even basic types of diagnostics, treatments and medications that are completely unavailable. Funding and maintenance of hospitals is lacking and medical staff often go without pay. On the flip side, access is much quicker and easier, if you have the money and know what you want/need.  There are fewer hoops and approvals required on the islands.  Normally, you can show up at a private clinic and just ask for the test or appointment you want and have it done immediately. You don’t necessarily need a prescription for meds either.  As long as you know the name of the medication and the amount that you want, most pharmacies will give you what you ask for—no questions asked. The problem is not permission but availability.  Several times we have walked around the capital to different pharmacies with the name of a medication written on scrap of paper, asking at each one if they have it.  If the medication is not common, more often than not we won’t be able to find it. But in those cases when we can, normally the price will be a small fraction of the cost of what you would pay for the same meds in the US—without insurance!

Each place has ways in which their medical systems could improve. We are so thankful for those on the islands trying to improve the healthcare there.  We are thankful for all the treatments, procedures and diagnostics we’ve been able to get in East Africa.  And now we are thankful that our daughter has access to the specialists and treatments that she couldn’t find elsewhere… and we’ll be even more thankful once the insurance approves and pays for her new treatment!

Anniversary Hike

PRAYERS ANSWERED
We made a huge dent in our to-do list this week— we are thankful that what is left feels a lot less daunting. We are thankful for reconnecting with family and old friends in the Boston area, including a fellowship on Sunday. Our two older kids successfully passed their permit tests and got their driving permits and have had some beginning driving lessons with Tom. We are thankful for our 23 years of marriage and getting some time to take a little hike for our anniversary. 

PRAYERS REQUESTED
We have had repeated difficulties navigating the speciality pharmacies and insurance to get Grace’s new medication. Please pray that it can be sorted soon with the three parts: doctor, insurance and pharmacy so she can start her new treatment soon. She has now finished the meds we brought from East Africa, so we need to figure something out this week. Megan and the boys leave in just one week and it will be a full one— pray for our continuing stamina and good use of time. Tom and our daughter have two weeks before they head to MN for her college orientation. She would like to get her full license before then— pray that she can have good chances to practice driving and get more comfortable behind the wheel. The islands are preparing for a major meeting at the end of the month of the translation projects from all three islands— pray for the planning and logistics of that gathering and for those traveling from abroad. 

Bringing Stuff

 Part of being a good friend in Island culture is bringing gifts for people when you return from your travels.  In the past we’ve tried to think of small gifts that we could give to multiple people— t-shirts, flashlights, candy—Small gifts (so as to avoid too much added weight to our luggage) and not too expensive (as we usually needed a lot of them).  

Catching a soccer game on West Coast

But that has changed over the years.  As our friendships have deepened, the expectations have deepened.  Some friends expect better gifts, others might not ask us to spend more, but to facilitate their spending.  What do our top gift requests look like these days?

Medicines:  Medicines are a funny thing.  There are many medicines we can get in the island for a fraction of the price of what we would pay in the States.  But there are other medicines that cost a great deal more and are often very hard to get.  We currently have requests for diabetic blood testing strips, topical pain medications, and fixadent (the stuff for dentures).  The medicines can be an expensive gift, but most of the time, we are happy to get them.  We know there is a need for them, so it feels like we are really helping out.  Medicines also tend to be small, which is nice for packing.

Phones:  I would say the number one thing we get asked to bring people is phones.  Most of these are hoping to get a smart phone as a gift.  The funny thing is, they don’t like iPhones.  Apple products aren’t very compatible on the islands where everything is android.  We always do our best to bring back at least a few phones for friends (often used), but if new phones an expensive gift and we wonder about the precedent we are starting.  But it’s true that the quality and price for phones in the US is much less than what people would pay on the islands, so it is not an unreasonable request.

No one asked for a puzzle

Tablets:  This has been the surprise request this time around.  Not only that we’ve had so many people request them, but that a number of people have said they will pay for them themselves.  They are simply asking us to be the middlemen—to help them find a good product at a good price and deliver it to the islands.  So this time around we find ourselves playing the role of Amazon delivery services!  Why all the excitement about tablets?  Sadly, we think they are mostly coveted as child-minding devices.  All the people that have requested tablets have young kids and have requested the durable ones that can show kid cartoons.  Though we don’t mind helping out a few friends—especially if they are willing to pay for it, a tablet is not an easy thing to travel with as it has to come with us in carry-on luggage, and at some point it starts to look a bit suspicious.  We’ve set a limit to the first 3 who asked for them.

So part of our limited luggage allowance will be given over to these gifts.  In case you were interested, some other requests we’ve had both presently and in the past include:  an xbox, a power wheels (yes, like one of those cars that toddlers drive around in!!!), reading glasses, purses, a hair cutting kit, dictionaries, cameras, water bottles, big screen tvs, backpacks, shoes, boots, uniforms, rain gear, seeds, luggage, and laptops.  Some people have better sense of what is easily transported on an airplane and what isn’t.  We know that we are sure to disappoint a good number of people, but we’ll try to have something for them.  “Sorry, I didn’t get you that big screen tv you wanted, but here’s a T-shirt.” 

PRAYERS ANSWERED
We made it safely back to the East Coast— we are thankful for the wonderful week on the West coast. Megan’s lip and leg are mostly healed now— we are thankful that the injury was not serious. Our younger son turned 14— we are very proud of all the ways he is growing and for the fun and loving young man he is. 

PRAYERS REQUESTED
We’ve had news that an island brother (and good friend) lost some family members to a boating accident when a group was going to another part of the island for a picnic. One of those lost was a child. Pray for this family in their grief and that our friend might be able to be a light and comfort to his extended family. Megan and our boys only have two weeks in the US— pray that they could get our to-do list done while also having rest and good time with family. Pray for our daughter and older son as they both have appointments to get driver’s permit. There was a taxi strike on the islands this past week— the strike appears to be over for the moment but things still seem volatile on the islands. Our colleague has been struggling with her solar system (a recurring and exhausting problem)— pray that she can get the right advice and parts so that she can have consistent power. 

Like Limes

 
pedagogy |  noun (plural pedagogies): the method and practice of teaching, especially as an academic subject or theoretical concept.

A lot of my (Tom’s) work these days in the area of ESL involves training English teachers.  The training consists of 8 classes about an hour and a half each with lots of practice.  The members of the class (between 10-16 members) are all required to practice teaching their fellow classmates in every class.  The lessons may seem very basic to a Westerner, but for many islanders these classes are often surprising, strange and unorthodox. 

Tom with teachers training class

A few months ago I was conducting the training in a village about 2 hours away from the capital.  The ones organizing the training were able to procure a classroom from a public elementary school.  The training would start near the end of the day, but not before classes got out, so there were always a pile of kids peeking into our classroom to see “the foreigner.”

Working with English programs, I rarely go into public schools.  It was a reminder of what education looks like for a lot of islanders.  As I walked into the building I witnessed one teacher hitting a 10 year old girl multiple times with a piece of electrical cord for tardiness.  As I passed down the hall and looked in the individual classrooms I noticed that every teacher held a switch and in one case was actively using it.  I have been told by many islanders that corporal punishment is ubiquitous in islands schools, but it was a little disconcerting to see it in action.  Corporal punishment is not only administered for bad behavior but for incorrect answers.  Answer a math question wrong, get a swat on the palms or shins. 

How different to then sit down with my class and tell them to absolutely NOT beat their students, insult their students, or make their students afraid.  Instead we talk about how to make the classroom a safe space, where we lower stress, stimulate speaking, accepting and encouraging mistakes and trying to make it fun.  These ideas are nothing short of revolutionary!

I think that’s what I love so much about teacher training: not only are we giving them better ways to teach English, but we are giving them better ways to teach.  Many of the teachers I am training are young, and they catch on quickly.  They’ve also experienced learning in this new way and have seen its effectiveness and enjoyed the atmosphere. (Most of the teachers we train have already gone through all of our English classes with teachers trained in our pedagogy.)  But for older teachers it can be hard to accept.  Even some younger teachers who already have some teaching experience using the island pedagogy will struggle with this positive approach.  

Enjoying bike ride in US

That was the case with one of the teachers I was training in the village school.  Though only in his late 20’s he was already a seasoned teacher and as I was teaching about encouraging mistakes, and making the classroom safe, he raised his hand and said, a bit sheepishly,

“Teacher, you know it’s very different here…What you are saying is very different…We have a saying here…among the teachers… ‘Students are like limes.  They need to be squeezed.’”  As he said it, he made the gesture of a squeezing, downward thrusting fist.

The picture is vivid.  Squeezing the juice out of a lime takes strength and pressure.  The result is perhaps a teaspoon of juice.  The rest of the lime, the peel and the broken capillaries are of no use and discarded.  I thought of a teacher thinking about a student in that way.  As if there is only a little bit of intelligence or useful thought inside the student’s mind and that the only way to get it out is to squeeze and beat them.

How differently I view students.  If I were to create my own proverb, I would say, “Students are like plants, they need time and attention, sunlight, watering and pruning, but with patience you will get an abundance of fruit.”

As a final reflection on our ‘revolutionary’ teaching pedagogy: Where did it come from?  People may argue about it but I’m inclined to think it comes from the teacher who said, “A farmer went out to sow his seeds…and some fell on good soil” and “I am the vine; you are the branches. Whoever abides in me and I in him, he it is that bears much fruit” and “Do not become weary in doing good, for at the proper time, we will reap a harvest, if we do not give up.”  Even in English teacher training course, the great teacher has lesson for us.

PRAYERS ANSWERED
We are very thankful that we made it safely to the west coast and have had a good weekend reconnecting with family and friends here and sharing some about the work on the islands. We are thankful for technology that allows us to stay connected with our friends and colleagues back on the islands. 



PRAYERS REQUESTED
Pray that education on the islands would improve and that all would have the opportunity to learn and thrive. Pray for the island economy— many finish school but still are not able to find paying jobs. Hashiri continues to message Megan regularly— she is coming to the end of an unpaid internship which rarely lead to paying jobs, pray that she could find good and regular employment. We have heard reports of increased crime on the islands— pray that this pattern would stop. We are still working on getting our daughter’s specialty meds— the process being complicated by all our travels. We have time, but pray that we can get it all figured out without too much stress. Pray for Megan’s healing after a scooter accident left her with a badly bruised leg and a fat lip. Praying that our remaining days with Megan’s family would be a fun and restful time.