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:

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…

November Writing Roundup

Another busy month! (Don’t worry, I can’t keep up with this pace much longer, either.)

My Neighbors’ Health Is My Business– The debut of my Christianity Today column! It will run every other month and focus on public health.

Why Should A Straight Person Care About Spiritual Friendship?– I’ve loved the Spiritual Friendship blog for a while now, so I was pleased to chime in when Wesley Hill, one of the editors asked me to write about why. Of note, Wes also interacted with a lot of my work from last month in this piece on community-building and sharing homes together.

Create Space For Singles– One of the things I’ve learned from Spiritual Friendship is how hard life in the church can be for people who aren’t called to marriage. I wrote about how families should take the lead in welcoming singles into our homes and lives.

The Right Thing Has A Real Cost– Matthew Lee Anderson put together an essay on “moral idealism” that riffed on my post on Planned Parenthood and Medicaid post a few months back. I took his ideas and ran with them, describing the political and social welfare policies by which pro-lifers might aggressively pursue an end to abortion in America.

Changing The World Requires Changing More Than Your Avatar– I still would have preferred to title this one “A Long String of Tweets in the Same Direction”, but oh well. It’s about how it’s perfectly okay not to empathize about every tragedy and the importance of finding a few things– or even one thing– beyond your immediate concerns and dedicating yourself to it.

The Hunger Games is the YA Dystopia America Deserves– Myself and two other Snake People chatted about power, redemption, and media in Mockingjay and The Hunger Games. We were not impressed, particularly since there’s still a  warmongering presidential candidate who does cutesy interviews with Lena Dunham.

Life lately


Phew! It’s been a busy few months. I am terrible at remembering to pull out my camera, but I did manage to snag a few photos of our goings-on:

Enjoying a crepe brunch on Labor day– lots of savory fillings and good company! We love our Baltimore friends.




Spending as much time as we can with family:


Celebrating Naomi’s 3rd (!!) birthday with a gift of books and pierced ears:IMG_4507

Getting surprised by a lovely visit from our dear friend Kez– she came to our church and we got to go on a long, leisurely bike ride just catching up:


Leo learned to roll over!


Two visits from Auntie Renu. We even got to meet her parents!IMG_4569


Oh, Naomi.

Have you always been about the sass, or does it just seem so?

Let me think.

\naomi ++ 008 (11)

My baby girl is three today. Fierce, determined, with a major nurturing side.


So many of our days involve me wanting to bang my head directly against the wall well before the hour of nine am. As well as prayers thought-shouted to the heavens for wisdom and patience.


They are also filled with intensely beautiful moments, which just seems to be the reality of life.


Motherhood has split my soul open and broken my heart in so many ways. It daily reminds me of the truth of God, and my own constant need for grace.


I’m so glad she came to us first.



a brief disclaimer on missions, fundraising, and causes we love

As our family prepares to serve overseas in a country that is very poor & politically unstable country, you will probably hear me make some comparisons between the developed world and the developing world. I’ll also be asking for money and prayer all the time as well as occasionally insinuating that other people from America could join us overseas. Mostly, the point of this will be to help you understand just how bad off things are there so that you will pray for us and pray for the people we’re working with. Here’s what that doesn’t mean:

1. It’s all about money

Trust me, I know: As a citizen of the internet, I see things all the time asking me for money. Many are incredibly good causes. Most of our family’s giving still goes to personal friends in full-time ministry, and I suspect it’s the same for many other people. However, sometimes folks give because of a less personal appeal (I sure have) and we’d like to take advantage of that if we can. We feel called to a particular place and vocation to serve, but we need thousands of dollars a month to live on in order to do it. We wouldn’t ask anyone for money if we didn’t think it would be used prudently to bless thousands of people in South Sudan who need good maternity and pediatric care, but we understand if maternity and pediatric care in South Sudan is not your thing (see #2 below.) The only reason we’ll talk about it a lot is because it’ll pretty much always be needed to keep things running or make things run better.

2. You should feel guilty if this doesn’t move you

Everyone has their own calling and their own God-given passions. If you’re being disobedient to a call God is placing on your heart, that’s a good reason to feel guilty. If you just don’t feel like reading my harrowing updates about dying children or you have other things that are more important to you that are getting your money, that’s not a reason to feel guilty. (I recommend checking first to make sure that God isn’t placing a call on your heart, as such calls are often easily missed in the insanity of modern life.) I’m glad we live in an age where technology gives you the privilege of participating more generously than ever before, and we’ll never make it without lots of people reading, praying, and giving. You don’t have to be one of them if that’s not where God is leading you, and we can still be friends. I will also not be offended if you unsubscribe from my e-mail list or stop following me on Twitter (although if you have feedback for how to make my emails or tweets better reading, feel free to share before you do!)

3. There aren’t problems in America to be fixed

I am proud to say that I’ll continue to be working at Healthcare for the Homeless until we leave (sub-disclaimer: nothing I say on this blog or social media represents their official viewpoint, as I hope you might be able to discern), but the sad reality is that they’re hiring because the needs of the homeless in Baltimore are only increasing. I have heard people say that they can understand poverty elsewhere and appreciate the importance of fighting it overseas, but there are so many resources available (maybe too many) to the poor here that they have little sympathy for domestic poverty. Such a viewpoint is, quite frankly, uninformed but easily correctable. We aren’t going overseas because the work is done in Baltimore, we’re going because we believe God wants us to go elsewhere and He has more people here who can do the things we’ve been doing here than He does there.

BmMMFxACMAACNlsProportion of physicians by country. Source: WHO, 2006

4. Other causes aren’t important

I love great music. It has helped me through some tough times in my life and it has been a part of some of my best experiences with friends and at church. I have given plenty of money to artists that I love to listen to because I want to support them in what they do and can keep doing it. There are many artists who feel judged for pursuing a life of creating, especially if their art doesn’t have an explicitly Christian focus. I think this is silly; it is good to create things that are beautiful or that tell the truth in ways that stick with us. Heck, even great video games have been part of my self-care for a while; what’s more frivolous than video games? Entertainment is a part of our lives and thus part of our culture– if we’re going to spend money on it, we should spend it on the best things. We should still spend more money on helping to keep people in other countries alive past their 5th birthday, but hopefully you can see the difference between the two sentiments.

Similarly, injustice in America is bad (see point #1) and events like the death of Eric Garner expose the importance of working for justice in America and disavowing complacency. However, it is still important to recognize that Brown’s death is horrific because we have a standard of justice that the majority of Americans can expect; in many other places around the world, extrajudicial killings and other severe miscarriages of justice like his are quite commonplace. This discrepancy doesn’t make his death less deserving of attention (or our justice system less culpable), but it does make other deaths more deserving. The Locust Effect elucidates this distinction (as well as how our country went from a very unjust system of law enforcement to a more reliable system in less than a century.)

5. There aren’t people in other countries solving their own problems

One of the great things about going overseas at this point in history is that we get to learn a lot from those who came before us. One thing we’ve learned is that when outsiders do all the work, locals are disempowered. So, then, a big part of our job is going to be equipping locals who are already serving and working for the good of their own people so that they can be more effective. Just because we got on a plane (or moved into the ‘hood, as the case may be) doesn’t make us heroes. There were locals working in poor places before we showed up and they’ll be there when we leave. Some have even chosen to stay when they had the option to leave, which is a pretty powerful testimony if you ask me.

6a. You’re inadequate because you’re not doing what we’re doing

I hate this one because I know folks are usually trying to be nice when they say, “I could never do what you do and go help those people over there!” Really. I appreciate the sentiment. But it’s bad theology– because if you’re a believer in Jesus, then barring any serious illnesses or unrepentant sins, the Holy Spirit could equip and empower you to live in a hard place and suffer hard things. Really! I promise! And I can make that promise to you because it’s the same one that we’re clinging to in order to survive the hard times in our hard places when we feel inadequate to do what we’re doing. Because we feel that way sometimes, too.

6b. You should feel guilty for your comfortable lifestyle

I’ve never heard this one stated in this way, but I have heard people try to defensively downplay the role of sacrifice in Christian living. I already wrote about this elsewhere, but I am going to give every individual I meet the benefit of the doubt and assume that God has called that person to the station and vocation they’re currently in (unless they have said something recently about “persecution of Christians” with reference to a waterfowl fiefdom and they don’t pray through Voice of the Martyrs regularly. Again, an easily correctable deficiency! ) Given the mismatch between the needs of the world (including poor rural and inner-city areas in America) and the blessings held by wealthy Christians, the only conclusion I can draw is that some believers are hidin’ it under a bushel, burying their talent in the ground, and packing their bags for Tarshish. But that is between you and Jesus, not between me and you. God’s call to each of us is unique, but the faithfulness He commands us to is anything but. Besides, we can’t go without a strong home base of support.

7. We’re special

Man, I’d really like to think so. It just ain’t the case. We’re obedient to our call, just like my neighbors C.W. & Amelia who stayed in Sandtown or my doctor friends who are providing great care for their patients in a small town or the moms I know who are raising their kids. We just think that God has called us to be faithful in a different culture, that’s all.

With that said, we hope and pray that your participation in what we do– whether it’s just by reading or by praying and giving– is a blessing to you.

Proximity, Vulnerability, Faith, & Love: This We Believe

The Family Medicine Educational Consortium (an organization that I love being a part of!) hosts an annual “This We Believe” contest modeled off of the NPR “This We Believe” project, featuring family physicians sharing their beliefs and how those beliefs affect their work (a tremendous example on the subject of dying given by one of my mentors on death can be viewed here.) I was honored to be one of three award winners for 2013 (check out the others here!) this year and the following is an expanded version of what I presented in the plenary session at the FMEC Annual Conference on 11/3/13.

I believe that transformation requires proximity.
I believe that proximity requires vulnerability.
I believe that vulnerability requires faith & love.
When I talk to a patient or my wife or anyone else that I want to have a conversation with, we have to be engaged with one another, and usually this requires physical distance. If we’re on the phone or Skyping or FaceTiming, there must be no other distractions. If my attention is drawn elsewhere—by my pager, by my cell phone, by something moving in the periphery of my vision—we’ve lost that proximity. We can diagnose an illness over the phone, fill a prescription with a fax machine, or we can even blow someone up from another country. But we can’t take off a mole or remove their appendix—much less get to know a person for who they are—unless we get close to them.
           If we can’t even really exchange ideas without practically being face-to-face, we certainly can’t change people from far away. While medical technology proliferates and invades every patient encounter that we have, family physicians in particular still have that all-important trump card that is suited for every clinical scenario imaginable: the patient-physician relationship. Technology can help our relationships. It can also kill them. The people who get money and glory as technology proliferates may tell you that technology is neutral; that’s nonsense. A scalpel isn’t neutral; it’s usually dangerous unless it’s held by the right person and pointed in the right direction.
           Any technology which puts more distance between us and our patients has the potential to cause more harm; while the most obvious recent examples of this are electronic medical records I am more particularly fascinated by the automobile and the airplane as technologies that purport to bring people together but also enable them to be further apart.
           It used to be a lot harder for doctors to go from one country to another—whether it was physicians coming from countries with less developed medical systems to study in more technologically advanced countries or physicians from here going there. Now a capable and brilliant doctor from anywhere in the world can leave his already under-resourced home country for a more secure position, and the capable and brilliant doctor from an over-resourced technological Mecca can pop in anywhere in the world for a week to hand out some antibiotics and then go home. I hope you can see who is the benefactor in these situations.
           Similarly, it used to be that you just about had to live in the same place where you worked; now you can live, work, worship, play, and be entertained in different places without the ties of proximity to hold you down. There are, of course, advantages to this—but now the disadvantage, particularly for us doctors, is that we have the freedom to be disconnected from the everyday concerns of our patients and the local history & knowledge of the places where they live, work, worship, and play. We can discharge our duties as a physician and simply be a cog in the machine.
           As Wendell Berry (a farmer and writer who has done much to advance this line of thought) once said, “A community is the mental and spiritual condition of knowing that the place is shared, and that the people who share the place define and limit the possibilities of each other’s lives. It is the knowledge that people have of each other, their concern for each other, their trust in each other, the freedom with which they come and go among themselves.” Every community has its own local history, its own assets, its own weaknesses. In every place, there are people who are fierce advocates for their neighbors who disadvantage themselves for the sake of others and there are people always looking for an opportunity to take advantage of someone else.
         In my own community of Sandtown in West Baltimore—where the average life expectancy is 65 years young and the infant mortality rate is triple the national average—the needs of the community can only be appreciated by people who take the time to listen. My neighbors have been assaulted by surveys— a hazard, I guess, if you live close enough to multiple academic centers. They have had a lot of people pop in to ask a few questions and then go. They have not had a lot of people come in to mentor them, to develop leaders, to suffer with them. True compassion literally means “suffer with.” As I have piloted a mental health outreach in my neighborhood and tried to find leaders within the community to deal with the severe emotional and behavioral issues that make up the day-to-day reality of inner-city Baltimore, I have had to share in the sufferings of my neighbors, especially within my church. Yet my presence nearby gives me the ability to connect with people that I would not have otherwise.
           My long-term goal is to go overseas and teach at a family medicine residency in an under-resourced country. I want to give physicians in these places the opportunity to become leaders among their own people without ever leaving and reverse the trends that suck the local resources away. While there are a lot of excellent medical education opportunities that are short-term in nature that use technology to its absolute highest benefit, anyone involved a residency can attest that if I want to really see residents flourish, I’m going to have to live there. One such residency in Afghanistan has seen a lot of turmoil, but it is through those experiences that the physicians are bonded to their community.
           If we want to see change in a community, we have to be there. Physically. And if not physically, then our hearts and minds and eyes and hands and our pain must be there. This brings up vulnerability. Proximity requires vulnerability. You have to expose yourself to the risk of being hurt—something that everyone who has ever invested in a patient-physician relationship knows.
           I think it is certainly possible to do a lot of good at a distance. I think that good boundaries are essential, as we must carefully search where vulnerability is indicated. Like the scalpel, it can destroy a patient and their community or save them. Yet when I look at—for example—the School of Public Health at a very well-recognized university in my city and the neighborhood just a block away and the hundred years of history that have transpired between them, I have to suppose that we have drawn our boundaries a little too far.
           Vulnerability requires faith & love. There is on one hand, the faith that every now and then, your suffering will be obviously worth it and your sacrifice will yield fruit; when we see patients that we stayed up late for or argued with their insurance companies on behalf of that are living healthier we can rejoice. And I do think that is an enormous benefit. Yet we also must know that such a scenario won’t always play out, indeed, we could end up more hurt than ever before.
           C.S. Lewis once said, ““There is no safe investment. To love at all is to be vulnerable. Love anything, and your heart will certainly be wrung and possibly be broken. If you want to make sure of keeping it intact, you must give your heart to no one […] The only place outside Heaven where you can be perfectly safe from all the dangers and perturbations of love is Hell.”
           I’m sure that using the word “love” regarding a patient-physician relationship may raise a few eyebrows. However, even the most detached and cautious doctor has felt love towards a patient—not love as a mere emotional sentiment, but as a guiding commitment to care for someone appropriately regardless of the cost.
           I take care of a lot of people who make bad decisions. Many of them involve the greatest proximity you can have with another person. Many times that decision makes another person. Many times I wonder to myself as I’m talking to someone, “why on earth would you give such a sacred part of yourself to this idiot who doesn’t even have the decency to hold your hand while you’re giving birth?” I am terrified by the number of people who are like this.
           I was born at the hospital that I work at. My parents were those people, broken people from broken families. They had no idea what they were doing when I was born. They were loved abundantly by others who gave and gave, which in time transformed them into parents who could love me. But that knowledge—that very, very local and proximal knowledge—always teaches me that I could very well be the second generation sitting in my office, having just brazenly impregnated a woman without any regard for her well-being. That component of vulnerability—the humility to admit that the love I have received has changed me and put me on the doctors’ stool and not on the examining table—is difficult and a fine line must be walked when cultivating relationships with patients. But it can be done.
           How? I can only tell you my answer. You’ll have to figure out your own. For me, I am inspired by meditating on the fact that “The Word became flesh and dwelt among us.” Jesus became flesh and moved into the neighborhood.  He suffered on our behalf—because of his enormous love—to transform our human community. His death & resurrection sealed the promise of victory over death and suffering. His righteous life was not just an example for us of how incarnation leads to transformation– it was righteousness lived on our behalf that we inhabit as we trust in Him for the forgiveness of our sins. Martin Luther King Jr. said that “The arc of the moral universe is long, but it bends towards justice.” We can know that’s true because Jesus did it first.
What we do as a community is imitate that willingness to suffer on the behalf of others and receive the transforming work of the Holy Spirit that helps us learn to suffer well. When we find our vulnerabilities, weaknesses, sins, and suffering that we experience, we take them to Him. Even when we fail our patients or our patients fail us, we’re guarded from cynicism and despair because we know that we’re just on the near side of the arc of history– and we’re still getting closer to victory. My tiny little part in that victory is helping people in my neighborhood find mental health care and teaching residents overseas.
This we believe.