Mental Health at AIC Litein

(Cross-posted at, the new home for information about our mental health initiative at the hospital!)

Four years ago, when I was asked by AIC Litein Hospital to start a clinic to deal with mental health, I had no idea how much it would grow. We named the clinic “Tumaini” (the Swahili word for “hope”) in order to reduce any potential stigma or barriers that would prevent people from coming. We started with just 3 patients — I wondered if it would fizzle out or keep growing. But grow it did! Demand increased to the point where we could no longer see patients one day a week or just with one provider.

We are so thankful for the team that Dr. Andy White put together to help advise the hospital on how to move forward in our efforts in caring for people with mental illness and for Dr. Elijah Terer’s visionary leadership as hospital CEO. Our biggest step so far in this journey has been opening an outpatient clinic that is open 5 days a week to see patients with mental illness; as we have increased our staffing and our availability it has helped us see even more clearly how much need there is for competent, accessible, and compassionate services to deal with mental illness.

We still have a long way to go — we are still strategizing about how we could do community outreach and education, support groups, better addiction services, and even inpatient care, Lord willing. But for now, we are so thankful for everything God has done to bring about this outpatient building. If you’re interested in donating to the hospital’s mental health initiative, you can learn more by clicking here.

Below are the speeches that Dr. Terer and I gave on March 10, 2022 when we opened the Nuru ya Tumaini Outpatient Center:

Kabarak University Family Medicine Residency Funding Appeal

The medical needs facing sub-Saharan Africa are immense and complex. With the world’s fastest-growing population and some of the world’s fastest-growing economies, there are ever-increasing needs for medical providers. Many people in rural villages still lack access to basic healthcare for common infectious diseases like malaria, while richer places and urban areas are struggling to cope with the growing burden of hypertension, diabetes, and heart disease.

Most doctors don’t get to do more than one year of postgraduate training, and thousands of doctors trained in sub-Saharan Africa have left to practice elsewhere. While every health professional is a necessary part of making any health system work, doctors are necessary to manage more complex patients, stay on top of the medical literature, and help to keep medical teams organized. Unfortunately, there simply aren’t enough doctors and they are rarely able to get the training they need to do all of these things.

At the Kabarak Family Medicine Residency, we are training family doctors to fill this important and enormous need. Our residents learn the clinical skills necessary to manage a variety of patients over the lifespan — they can handle acute emergencies in a district hospital and carefully manage chronic diseases so that adults can live longer and happier. They can help hospitals use research and quality improvement to make their systems serve patients better.  They are just as capable at building relationships with families and communities in remote clinics to promote healthy behaviors. Our four-year program trains doctors capable of strengthening health systems, not just filling in a slot.

Throughout the developed world, the government pays for all costs of postgraduate medical training. Here in Kenya, only a handful of doctors every year are able to get government sponsorship and those who do get sponsored do not always get enough to cover all of their tuition and living expenses. We are trying to develop long-term funding strategies, but Family Medicine is still mostly unknown in Kenya and it will take time for our graduates to trickle out and help people understand how family doctors can help build better systems wherever they are. We want to ensure that residents are paid throughout their training so that they can focus on their education; to continue, we need your support.

Donations are received by World Gospel Mission, Acct. #125- 35202 – “Kenya INFA-MED General Account“. An IRS tax receipt is issued.  The Institute of Family Medicine (INFA-MED) is our Kenya partner.  If you are giving for a specific resident, please specify on a separate note from your check.  Send your check to: WGM, PO Box 948, Marion IN 46952-0948. You can give online at:

We appreciate your prayerful consideration of support.


Support Kenyan Family Medicine Residents!

Pictured: Rising 3rd-year residents along with faculty in May 2018

making the little things available for little people

The smallest things can be a big deal. Just ask my son, who this weekend had a piece of raw carrot no larger than his thumbnail go into his trachea instead of his esophagus. Maggie and I had just gotten back from an afternoon down at Tenwek Hospital, about an hour from our hospital in Litein, where we were visiting this weekend. Tenwek was instrumental in starting one of the first surgical residencies in Africa and has already trained many African surgeons, including our friend and future next-door neighbor in Litein, Dr. Blasto.

As we walked into the house, my son Leo (almost 3 years old) was enjoying a carrot. Now, we eat a lot of carrots in our household – about 2 kg a week. They’re not messy, they’re healthy, and they won’t spoil your dinner, so that 2kg actually ends up running out after about 4 or 5 days on an average week. My eyes turned yellow when I was younger from all the carrots I ate, and I’m kind of surprised the same thing hasn’t happened to my kids yet.

But on this particular night, somehow (perhaps he was just too excited to see us?) a piece of carrot went down the wrong hole. Leo began coughing and would not stop, no matter how hard I thwacked his back or attempted to give him a Heimlich. He managed to breathe and speak in between coughs, so I knew that he was okay but it was still a little disturbing to hear my child constantly coughing.

Eventually the coughing settled down and the audible wheezing and stridor began. Leo was happy, content, and no longer coughing but as he sat reading a book to himself I could hear him breathe from across the room, whistling and honking with each relatively comfortable breath.


When airflow through one’s lungs is turbulent but not entirely blocked, it produces a variety of weird sounds (mostly high-pitched), which meant that even though the coughing spasms were no longer an issue, there was clearly still something in his windpipe causing some turbulence. Given the physical properties of both the carrot and tracheal tissue, this was an issue that was not going to resolve on its own and would probably just get worse as bacteria built up around the little hunk of carrot.

I called Dr. Blasto for his opinion, which was that we drive back to Tenwek Hospital. Since a foreign body like a piece of carrot that is only partially obstructing the flow of air can rather rapidly move to a position where it completely obstructs the flow of air, he felt it best to get Leo to a hospital where the carrot could be removed as quickly as possible. So an ambulance was called.

 Leo was excited to ride the ambulance, though he was a bit unimpressed by the fact that the ambulance did not light up or make the same “WEE-OOH WEE-OOH” sound that he made in between wheezes as soon as we told him that he’d be riding an ambulance. Dr. Blasto graciously agreed to come along for the bumpy ride; it took us about half an hour (in the dark, no less) to make a journey that we had made earlier that day in twice that time.

Once we got to Tenwek, Leo was evaluated by the medical team there and they decided that since it was late on a Friday night and he was perfectly stable, they would do a bronchoscopy (sticking a tube down his throat to look for the errant piece of carrot) in the morning when they had more staff immediately available. Both he and I were quite tired (and his audible wheezing had stopped after the bumpy car ride), so were glad for some time to rest and relieved that it wasn’t bad enough to require immediate surgery.

We stayed at a lovely guest room for the night. Sleep was difficult for Leo – not sure if the carrot in his trachea was bothering him on and off or it was just an unfamiliar environment, but we eventually managed to get to sleep and then get up in time to get over the hospital. We had to wait a few extra hours because of an emergency our surgeon had to attend to, but eventually Leo got in, got the piece of carrot out of his trachea, and got to the recovery room. We spent the rest of the afternoon chatting with another family teaching in the Family Medicine residency before heading home.


Leo in the recovery room.

One of the worst parts about being a doctor is being aware of all the terrible ways that my child could suffer a medical emergency without any warning: a piece of food in the wrong place, a head colliding on the cement floor, or an infection out of control.  So I know it could have been a lot worse and I’m thankful that it wasn’t, but the whole episode was disquieting. We were miles away from the nearest bronchoscope, just as we were miles away from many other medical interventions that we might possibly need at a moment’s notice.

The human body is as resilient as it is fragile. It is a wonder that our bodies can heal and protect themselves, but the cruel realities of the world are such that many people – especially children – are vulnerable to disease and trauma. We can recover from many injuries and illnesses, but others not so much.

In the West, we usually take access to certain medical interventions when emergencies strike, but these interventions are still beyond the reach of many children. Even those who live near a hospital may still be in danger – last week I saw a child who had been brought to a government hospital in the middle of the night with extremely high fever and rapid breathing that was not even seen by a medical provider. She was later taken to a mission hospital and admitted to the pediatric ICU immediately.

The harsh sounds of my son’s breathing reminded us quite viscerally of the risks of living in a place without quick access to medical care. Yet it also reminded us of why we came to live here in the first place: many of the children around us don’t have a surgeon on speed dial and don’t have someone who will just arrange for an ambulance to speed through the night. If it wasn’t for the work of the PAACS residency doing what our family does except for training surgeons, we might not have had a capable African surgeon ready to evaluate and treat our child right away.  Our work is only a tiny, tangential part of equipping and strengthening the health system here, but we believe that the little bit we can do might better equip health practitioners and the hospitals they work in to better serve their communities.

Our son recovered from his procedure very well and was peeling himself a carrot to eat on Tuesday morning. (Why we left the carrot peeler out where a child could cut himself with it and necessitate another emergency intervention is beyond me.) Our scary little interlude was mercifully short and not nearly as scary as it could have been, but it reinforced for us how tenuous our life is – and how important it is that we are here.


Spring 2017 Writing Roundup

We are now traveling around East Africa in search of a new hospital to work at since Yei seems like it will remain closed to families for the immediate future. We’ll have a big post with all of the places we visited in a few weeks, but here’s what I’ve been writing and recording lately:

Creating a Just and Good Healthcare System– I was invited by the Maryland Chapter of the American Solidarity Party to give a talk about healthcare. Watch Mere Orthodoxy for the full text of the talk, coming soon!

Dorothy’s Place Podcast, Episode #1– The good folks at Solidarity Hall are trying to figure out how to live in community in light of the technological and economic changes that try to push us apart. They invited me to be on their podcast and we had a delightful conversation about healthcare systems in America, South Sudan, and Japan:

In Alien: Covenant, the March of Progress Ends in Death– The first two Alien movies are some of my favorite films, so I was eager to see what Ridley Scott would do with Alien: Covenant. I enjoyed the movie, but I also found a lot of themes relevant to technological ambition, our cultural infatuation with Science! and medical ethics.  As one of my friends likes to say, “The gods of our age are death and fruitless sex.” Alien: Covenant is about the endgame of those gods.

Dangerous Territory Feature Review– My friend Amy Peterson recently released her first book, Dangerous Territory. It’s part memoir, part examination of contemporary missions issues, and really worth reading overall. Maggie also really enjoyed it, if you’re wondering!

The Insanity of Autonomy- This is a post on my Mere-O sub-blog that further developed my thoughts in a Christianity Today article about a new Gallup poll about morality. I talk about how there’s no way to “win” any culture wars if our culture sacralizes autonomy — especially if our other political commitments reinforce this!

The Christ and Pop Culture 25: Nintendo Switch, S-Town, and Silence– I was back on the Christ and Pop Culture podcast talking about the most important things in pop culture this year. Naturally, I won by defending the film Silence, although quite frankly we kind of knew Silence had to win from the get-go and my co-hosts did an admirable job fighting a battle they knew they were going to lose.

What Political Theology are You?– Yes, I helped make a web quiz. Yes, it was fun. Yes, the results are for entertainment purposes only. Yes, you are probably a Liberal Protestant.

What have we been up to?

Many of you following along with us know that we are heading back to East Africa in June. This has been a season of in-between for us, with featuring stages like: recovering from being evacuated, getting into a routine, waiting to have a baby, having said baby, then preparing to return. Now we are in the throes of planning to see people one-last-time (so much grief!) and packing (slightly easier when you’ve launched a family over the ocean once, by God’s grace!). I thought I’d share a little bit of what our time here has looked like…

1. Henry. We had that baby. Gosh he is the sweetest thing. Here, I’ll show you:IMG_8558

For real…


2. Family and Friends. We were so grateful and blessed to be welcomed back into the fold with our family and friends, who let us back in, or came and visited from far away (sometimes multiple times). We were home for Thanksgiving, Christmas, Easter, and a wedding. Obviously, this is the best thing about being home. We have the best people in our life and I am so grateful for them.


3. Work and School. Matthew had the opportunity to complete 9 credits at St. Mary’s Seminary Ecumenical Institute and really enjoyed it. He also worked as part-time faculty at his old residency at Franklin Square, doing some clinic, inpatient, nursery, and OB. It was a good mix for him. I completed a couple of bible credits through BSF this year studying the Gospel of John, and 3 credits towards my BSN.


4. Books. SO MANY BOOKS.

Many people have asked about what we’re doing for Naomi’s school this year and the answer is, mostly, a lot of reading. This is how I have felt about being near public libraries again.

Winter 2017 Writing Roundup

I have been busier lately at my sub-blog at Mere Orthodoxy, including a post about 5 different options for fixing American healthcare (including blowing it up!)  As we prepare to return to East Africa, we hope have more to write here! In the meantime, here’s what I’ve been writing lately:


In Violence We Trust?– People often talk about “senseless” violence, but violence makes a lot of sense for people who feel insecure. I explored the relationship between violence, trust, and security and how we can use these ideas to reckon with the problem of inner-city violence in America.

Green Card Holders in the City of Man–  With refugee resettlement and immigration in the news, the Bible is being deployed frequently in our debates (but not always thoughtfully). I wrote about how we might get beyond prooftexting in wrestling with the challenges these issues present to God’s people and their place in the modern nation-state — as well as the world that the Bible anticipates.

“The poor will always be with us” is no reason to cut Medicaid– Congressman Roger Marshall recently applied some… interesting exegesis of Jesus’ words about poverty and Medicaid. I gave a brief response for America magazine about the challenges poor people face in obtaining preventive care and what it will really take to care for all of our bodies.

Living and Dying Well: A Vernacular Podcast– Zac and Sally Crippen invited me to be on their podcast (which is well worth listening to if you enjoy stimulating conversations). We had a great talk about death across cultures, dying well, and a richer understanding of bioethics in medical education.

Making Amends: Eve Tushnet on Addiction in Our Time– Eve Tushnet’s novel “Amends” is the funniest book I have ever read, and it is also moving and beautiful and just go buy it already, k?

Black Mirror, Technology, and the Darkness of Our Hearts– The Christ and Pop Culture Digest had me back to talk about my article about Black Mirror and technology’s power to amplify our sinfulness. We had a great chat!

A Social Justice Warrior in King Roderick’s Court– I have really enjoyed becoming familiar with the work of Plough Magazine and couldn’t miss the opportunity to join them when they hosted Rod Dreher in New York at an event about the Benedict Option. They also pulled together a great panel to respond to Rod, so I explored some of their excellent responses.

Civics is not LARPing– This was supposed to be a sub-blog piece, but I accidentally published it on the Mere Orthodoxy main site. Whoops! I’m glad it was one of the better ones: trying to figure out how to increase civic engagement and cultivate virtue in our peculiar political environment.

Go To Church LOL: An Impertinent Catechism– Everything you ever wanted to know about why Christians and the Church are so awful and why you should go to church even if it’s full of bigots.

Comfort Detox: Free for CaPC Members– Once you know that the stuff you’ve always wanted and the comfort you’ve always worked for isn’t enough, what next? Erin Straza’s book “Comfort Detox” explores this question, so I wrote about it for CaPC (it’s free with a $5-a-month CaPC membership!)

Summer/Fall 2016 Writing Roundup

Been a while since I posted a writing roundup– the craziness of our transition and other things going on kept me from writing at my normal pace, but things are picking up and I have some more big pieces in store for early 2017.

Is Addiction a Disease? Yes, and Much More– My final scheduled contribution for Christianity Today got upgraded from a column to an essay, complementing the cover story on opioid painkiller addiction. There’s often a simplistic binary between viewing addiction as “a disease, just like diabetes” versus a moral failing. I think the biological aspects of addiction are fascinating and help illuminate our understanding of the moral & spiritual aspects of the disease– as well as point us to how we can work together to stop it. I also got to talk about Suboxone and methadone in a Christian publication, which is pretty cool.

The Babadook: Sometimes, Self-Care Just Isn’t Strong Enough– We went through a lot in South Sudan. It doesn’t really compare to the suffering that our East African friends and colleagues went through, but it was enough to shake us. When Maggie got evacuated with the kids to Uganda, I watched The Babadook and found it a very compelling reflection on grief and the scars we bear.

9 Ways to Share the Cost of Cultural Engagement Now That Books & Culture is Gone– Books and Culture was a great magazine, and I’m sad to see it go. So much of our current crisis of discourse relates to the fact that great magazines and compelling, thoughtful discussion just isn’t supported and read widely enough. I provided some suggestions for people who want a better discussion about culture.

There’s Nothing New Under the Black Mirror– On a similar note, I used Black Mirror to talk about how technology and social media dehumanize us– and a few more suggestions for publications that might help us think and talk differently.

Do We Really Need More Breast Cancer ‘Awareness’?– I wrote this column for Breast Cancer Awareness Month in October. There’s an overemphasis on awareness in our discussions of health, where I think the concept of attention is far more useful to consider. We don’t need more information about disease (or our sin, for that matter)– we need to attend to our bodies’ needs and discipline ourselves to care for them.

When the Neighborhood Changes– We’re inclined to think of “gentrification” as a dirty word, but everyone wants their neighborhood to get better. How to do so is a bit more complicated. I focused on how we can focus on building and reinforcing neighborhood institutions so that gentrification empowers residents rather than displacing them.

Member Offering: Os Guinness’ Impossible People– When you join Christ and Pop Culture, you get free ebooks and albums every month in addition to access to the Members-Only Facebook group, which is a real breath of fresh air in the social media morass. It’s a great deal! I wrote the blurb for one of these giveaways, Os Guinness’ book Impossible People.

A Pro Life Third Party: The American Solidarity Party– Our agonizing election is over now, but now is a great time to join the American Solidarity Party and call for a holistic pro-life approach to politics.

A Trump Presidency Would Hurt the Pro-Life Cause More Than Hillary– Another election-related piece, all I’ll say about this one is: I hope I was wrong.


Vision, passion, commitment, & calling

As most of you know, our family was evacuated from South Sudan a few weeks ago because of security concerns. We’d spent 9 months slowly acclimatizing to life there: learning how to live in a very different environment, practice in a very different hospital setting, and minister in a very different culture. Our language skills had progressed to the point where I could converse with most patients in the hospital about their routine complaints and we were excited to start planning for some new ventures to meet patient needs.

And then we had to leave.

If you’ve heard us talk or followed my writing for any length of time, you know that I’m a pretty vision-driven person. Maggie is more of a “details” person (thank God), but we wouldn’t have gotten married or done half the things we’ve done if she wasn’t also animated by a strong sense of purpose and calling. We were led first to Sandtown and then to South Sudan by this sense of calling, making a lot of sacrifices and taking a lot of risks along the way.

I don’t want to overemphasize what we’ve suffered because it pales in comparison to many others that we know and love, but it is hard to leave behind friends, family, and a very comfortable income to move to a place where cobras crawl up on your front porch and armed men randomly attack innocent people. It takes a certain degree of vision and passion to overcome the inertia that would otherwise keep us in a more comfortable place and to sever or strain our connections with people and places that we had come to love. Without a sense that what we are doing truly matters in an eternal and transcendent way, it is nearly impossible to conceive of making the sacrifices we made, much less put in the years of preparation we did to accomplish them.

We learned quickly once we got there that vision and passion have limits. We were about as well-prepared as we could be (in no small part thanks to the people who had come before us and faced certain challenges we never had to face), but it was still very difficult and we had a lot of our own unique challenges to deal with. In particular, I was finding that the vision and passion for medical education and discipleship were necessary to get us to South Sudan but wouldn’t provide the same animating force for my day-to-day life once I was in the field.

The routine disappointments of cross-cultural miscommunication, the personal flaws that were only magnified in our setting, and the more jarring traumas of death that are simply realities of life in a mission hospital were never going to fit in a presentation like the ones we gave dozens of times as we raised funds to go. I’d spent over ten years preparing for this life, but actually living it was still a steep learning curve. A vision like “training and discipling health care workers in a place where thousands die of preventable causes” was a great thing to aspire to, but a very difficult standard to judge myself by every day.

The spiritual friction this struggle created had to be eased somehow, so I found myself withdrawing into books, games, and social media. I don’t think any of those things are necessarily bad in moderation (especially in our case, where social media helped us stay connected with people we loved back home), but I was not good at moderating. I never neglected my work or my family, but I was missing out on a lot of opportunities to love and be loved—which, of course, only made me feel worse and emphasized the discrepancy I felt between how I spent my time and the vision that I’d cast for myself over all those years.

I discovered that I was the same terrible person in need of Jesus that I was back home, and it was good for me to wrestle through some of the struggles that I had put off up until this point. (I suppose I had expected that my problems would somehow improve on their own after moving overseas- ha!) After some counseling and good conversations, I began to work out some practices and disciplines that would make me content with how I used my time and not drive my wife crazy.

It became difficult to maintain any regular practices or disciplines when things started to fall apart around us, especially when we decided in July to send Maggie and the kids to Uganda for a few weeks. Simultaneously, the push of our vision and passion ebbed simply because the needs of the community and the capacity of the hospital changed as the situation became more dire. We were no longer attempting to build a better health system by training African health care professionals; we were trying to keep a hospital open in a place where the basic institutions of civil society were falling apart. We often discuss the difference between “relief” and “development” work—we were moving from the latter to the former very quickly.

In this rapidly changing work environment, my grand aspirations had to take a backseat to simple faithfulness. Someone that I was trying to minister to could be forced to flee tomorrow; the hospital could close overnight. I had to ask myself, “how should I be faithful to what God has called me to today?” That was a lot easier than judging myself for not living up to everything that a decade’s worth of vision and passion were driving me towards.

Now I am forced to ask that same question, but with a very different answer. On August 30, 2016, being faithful to what God had called me to meant taking my small children out of a place where the risk to their life could no longer be ascertained with any certainty. The potential good we could do (the population we served at the hospital fled in huge numbers) was diminishing while the potential harm that could come to us at any time was rising. On every day since then, faithfulness has been a matter of waiting and praying while going through the necessary steps to remain here in America for the next several months while we wait for our baby to be born.

We don’t know what’s next. We hope and pray that we can return to South Sudan in Spring 2017 and if we can’t, we’ll find another place where a doctor and a nurse can serve by training and discipling health workers. Until then we’ll have to figure out how to be faithful servants where we are.

Vision and passion are great things, but without faithfulness they are ethereal (at best) or harmful (at worst). I look forward to living in a place and doing work that lets me pursue our family’s vision and live out my various passions, but right now that simply isn’t where God has led us. While the hurting places of the world require more people with vision and passion to go to them, what every place needs is people who are willing to be faithful where they are.

Scenes from everyday life

The last month has included an evacuation and a visit from family. It has not exactly been normal, but there have been some really good moments in between stressful times. IMG_6779

Relaxing with Samuel and eating some sugarcane


Green beans! — count as a luxury here and Naomi’s face says it all!


Orange and pink flowers in the front yard– inside is a nice bed of mixed lettuce. Another food luxury!



the flock enjoying a nice pumpkin


at the top of Murchison Falls with Aunt Keller


visiting the nurses. Susan put on an ABC video– can you tell which two are siblings?


Enjoying the climbing frame in Arua with friends


young lions on safari


cheeky monkey enjoying the splash pool


scouting for giraffes on top of the safari van with Aunt Keller


enjoying medida (millet morridge) with Evans



One intense face to close things out…

Spring 2016 Writing Roundup

Lots of references to Viagra in these pieces!

Health is About Way More Than Weight– My latest Christianity Today column is about how the Church can deal with the obesity crisis– by focusing less on the actual numbers and more on ameliorating the problems that cause us to overeat or smoke in the first place.

Strength in Weakness– I really liked Andy Crouch’s new book, Strong and Weak. Though I still think his last book, Playing God, needs to be read by more people!

Our Drugs Addiction– This CT column from May takes on the pharmaceutical industry’s preferential treatment of the rich. and what anyone can do at their doctor’s office to help push the system in a better direction.

How Then Shall We Work? Medicine– I participated in the Comment symposium on technology and the professions, focusing on medicine. I discussed how electronic medical records demonstrate the foibles of using technology to make things better. I still wish we had been able to use the original title, “User Error” but it didn’t quite work in the print layout.

What West Baltimore Needs– The American Conservative wanted a retrospective look at the events in Baltimore last year, so I wrote about how the immediate response to the unrest was a picture of our disorganized and dysfunctional approach to helping struggling urban neighborhoods. I also pointed towards some of the ways that we could do better as I explored the costs of dealing with the culture that helps poverty stay entrenched.

Benedict and Jesus– If you’re not tired of the Benedict Option discussion, I jumped in again to go back and forth with Alan Jacobs (who ended up replying here).