OTA International Trauma Forum 2013 (Phoenix)

 In September, I was fortunate to attend the Orthopedic Trauma Association's national meeting in Phoenix, AZ to present some research on treating femur fractures in Kenya and Ethiopia. The best part of such meetings is the relationships and connections that are established and strengthened. The meeting was session after session of great information regarding the latest treatment recommendations for patients with fractures.The day before the official meeting, I presented my paper at the International Trauma Forum where surgeons from around the world discussed the best ways to address very difficult surgical problems. However, it wasn't all work. Paul Whiting, pictured below convinced me to go with him to explore the Apache Trail in the Tonto National Forest. I must say...I was impressed!

LtoR: Paul Whiting, Dr Zirkle (Founder of SIGN), Me

Tonto National Forest

I hate politics!

Roosevelt Dam

Beautiful scenery...minus the big guy in the middle and the powerlines!

SIGN Conference 2013 (Richland, WA)

The SIGN conference is easily one of the highlights of my year! A couple months ago in the middle of nowhere central Washington, around 150 orthopedic surgeons from multiple countries gathered together for a decade-long conversation over how to bring about 'equality in fracture care throughout the world.'  SIGN, a surgical implant company that develops implants used in developing settings that are offered free to patients, has the unique ability to bring people together from all geographic corners of the world, varied religions (or lack thereof), multiple languages and cultures, and different levels of training. The SIGN conference is in some ways a return to the very reason that many in the healthcare field chose to become physicians in the first place - taking care of patients! Many of the surgeons at the conference come from developing countries - nations where the average annual income is often less than $2-3 US dollars per day!

Orthopedics here in the United States is heavily influenced by industry, a two-edged sword of resourceful creativity to make surgeries simpler and more effective and also a market-driven, money-making machine that contributes to high healthcare costs. At most national conferences, industry holds a very prominent place and there are swarms of reps trying to sell the latest and greatest invention to anyone with deep pockets. The SIGN conference is different. 150 surgeons from dozens of countries - many of them low income countries - gather together for an international orthopedics conference on improving ways to treat patients with horrific injuries with whatever resources are available. There aren't companies peddling super-expensive gadgets and gizmos - just a bunch of people in the middle of nowhere Washington state devoted to caring for the poorest people on the planet!

Thankful Busy-Ness

We have much to be thankful for in our home! Life with three young boys is the antidote to boredom and keeps us on our toes. Much has happened in our lives that we are grateful for, and I hope to update you on a few of those things with this post. We are certainly blessed!

• Another year older... Garrett turned 7 years old back in July and Bryan turned 4 in late October. We have a 2nd grader, a Kindergartener, and a preschooler in our home. Garrett is doing really well in school and improving leaps and bounds with his reading (something we are thrilled to see). He is doing swimming lessons every week and loves the chance to compete with himself about how far he can jump off the diving board, how long he can stay under water, etc. Luke is loving Kindergarten and his teacher. He is thriving as we expected all while keeping his hilariously vibrant personality. He just finished his first season of Upwards Flag Football and will be happy to tell you about his touchdowns if you ask him :) Bryan is doing preschool 3 days/week and loving school. He officially off the size charts at the doctor's office and itching for his chance to get on the soccer field. Competition is ripe in the Stephens' household. (Oh, and Jenn just turned 32 a week ago too! I'm still in my fourth year of being 29)
• Thanksgiving 2013: We celebrated Thanksgiving this year just as a family here in Michigan for the first time in our marriage. I had to be in town to work so we decided to forego our traditional trip to Elkhorn this year and spend our last Thanksgiving in Michigan here with friends. Unfortunately our plans were torpedoed by a sick little boy but we still had good food and great family time. We really missed Elkhorn but it was still a nice holiday!
• Final Days in Michigan: We can now see the light at the end of this tunnel and it brings with it both exhilaration and grief at the departure that is coming. My final day of residency is June 30, 2014. We will then move to Saint Paul, MN during July so that I can start my fellowship on August 1, 2014. Five years is the longest Jenn and I have been in one place and what a special place this is! Goodbye will not be easy. We are soaking up weekend trips around the city and the region knowing our time is limited.
• Global Medical Missions Conference 2013: Jenn, Bayleigh Laster, and Bethany Laster made the trek to Louisville, KY to stay with our friend Amber Ratliff for the largest medical missions conference in the world! An inspiring weekend with great conversation and big dreams amidst a wonderful community of servants.
• "Bring Samuel Home" - Our dear friend Amber Ratliff (who hosted for the Medical Missions Conference) is adopting a 5 year old boy from China and we have been thrilled to be a part of that journey to bring him home. Her/Their story can be seen at Amber's blog
• Orthopedic Residency: Residency is going really well though incredibly busy! The past few months have included trips to Memphis, TN for a surgical approaches course, Richland, WA for the SIGN Fracture Care International conference, and Phoenix, AZ for the Orthopedic Trauma Association conference. Being in my final year of residency is nice in that I get some degree of choice in what surgeries I participate in. I am learning more and more each day and loving (mostly) it! There are days when I am so ready to be done and others where I get a sudden rush of anxiety about being done so soon. With seven months left, that probably means I'm right where I should be :)
• Unexpected Opportunities: While at some recent conferences, I have had the chance to make connections with other surgeons from around the world. The desire to work in developing countries and offer high quality orthopedic care is gaining more and more traction with various national orthopedic associations. As part of my residency I am required to do three research projects. My project last year dealt with treatment of femur fractures in Ethiopia and Kenya, and I was fortunate to present the project at a couple of conferences. Conversations at those conference have now turned into the opportunity to contribute to a book on orthopedic care in the developing world, a chance I would have never chosen otherwise. My passion is international orthopedics - particularly orthopedics in low resource settings. These chances, along with another research project involving tibia fractures in Kenya, Ethiopia, and Pakistan, have in a sense fallen into my lap! Though it makes for a busy stretch, I am grateful.
• Africa: Jenn and I continue to feel God calling us to be involved on the continent of Africa. We have developed many special friendships there and continue to pray and seek ways to be involved. I am headed to north Africa next month to visit some dear friends and to explore what God is up to there and how we might partner with him in the future. We - as a family - are also planning on spending a significant portion of time in African at the end of my fellowship year in Minnesota before starting work in Tennessee. We would appreciate your prayers as those plans and dreams are worked out over the next year or so.
• Upcoming Trip: Besides my trip to north Africa, Jenn and I are planning to be at the International Healthcare Foundation's Medical Missions Seminar in Fort Worth, TX in mid-January. I will be doing a short presentation on common orthopedic injuries. It will be a good weekend of reconnecting with friends and family

We are certainly blessed! Sorry for the length of the email and I promise future posts will have more pictures. :)

Hope each one of you had a blessed thanksgiving season as well! Blessings...

Will Gray: His Greatest Performance

Last night (Friday, July 26), Will Gray passed away. Will was only 33 years old and yet he leaves behind a legacy of vibrance, passion, and grace that many have marveled over during the past few months. As his wife Angie and her family, Will's parents Johnny & Barbara and extended family, and thousands of friends witnessed his journey with cancer, Will gave perhaps his greatest performance. Gifted with a rare ability to lead from a stage with the world watching, Will chose daily to fight the pain, fear, and hopelessness of a dreaded disease with love, grit, and grace placing his faith in the God who brings life from death, wholeness from brokenness, and hope from despair. And though we grieve Will's death, our tears and broken hearts are not too far removed from the laughter, the smiles, and the joy that permeated every part of Will's life and will continue to live on in the lives of the countless people he touched. Very few people live with a tangible grace and passion that blesses all who encounter them. Even fewer are capable of showing the rest of us how to die with that same tangible grace and unquenchable passion for those things in life which are most important.  Will, from those of us that knew you (and many far greater than I), we join our Father and your Father in proclaiming, "Well Done!!"      

www.GoTeam Gray.com

A Dream Come True!

Very rarely do people get to fulfill a dream first verbalized fifteen years earlier as a college freshman. A few weeks ago, I got to do that very thing. As a freshman at Lipscomb University, I dreamed of one day become a physician and moving back to the sleepy little town in west Tennessee I call home.  On Tuesday May 28, 2013 I signed a contract to return home to work as an orthopedic surgeon at Henry County Medical Center beginning in late fall 2015! We are very excited about the opportunity to return home to live, work, and raise our family in what I consider to be one of the greatest places on the planet.

Signing my HCMC contract with Jenn & Tom Gee, CEO

People have often asked me where I am from and I usually tailor the response based on who I'm talking to. I usually start with Paris because it's the closest real city but I can soon change to calling Springville and/or Elkhorn home if people are familiar with the area. I left when I was 17 years old to attend college and by the time I return, I will have been gone an additional 17 years. Since leaving I/we have lived in Nashville, Abilene, Kansas City, Dallas, and Detroit. The thought of Elkhorn sounds wonderful for so many reasons! :)

Between now and then, we have a couple years and alot of dreams to pursue. I have one more year of residency here in Detroit and will graduate from there June 30, 2014. We will then move to Saint Paul, MN where I will be doing a one-year fellowship (additional year of training in a certain specialty) at Regions Hospital focusing on neck and back surgery. We are super excited about that year (with the exception of the sub-zero degree winter temps) and what God has in store. That fellowship will end July 31, 2015 after which we will move home to west Tennessee. However, prior to beginning my practice there in Paris, Jennifer and I have prayed about and are planning to spend a significant amount of time (2-3 months) overseas doing mission work in east Africa. We have always wanted to spend a longer chunk of time doing such work and be able to expose our young boys to a world much larger than they are aware of. We covet your prayers as that trip continues to materialize. I plan to begin work in late 2015, Lord willing.

Henry Ford Macomb Hospital (Clinton Township, MI)

Regions Hospital (St Paul, MN)

Tenwek Hospital (Bomet, Kenya)

Henry County Medical Center (Paris, TN)

We are incredibly blessed and grateful for all this coming together and we hope to be a blessing to Henry County and the surrounding area for many years to come!

Seek Justice...

One current trend among today's churches (and particularly our youth) is a pursuit of justice for the marginalized and oppressed among us - the poor, the enslaved, the trafficked, the orphaned, etc. Social media,  the internet,  ministry pages, and non-governmental organization (NGO) websites are replete with causes wanting and deserving attention from the world. "Social justice" is a rallying cry for people across the nation, religious and not, seeking a solution to the many wrongs around us.

People's pursuit of justice for their cause is as varied in approach as the number of causes, with obvious differences in the level of commitment required. Some people load their Facebook page with as many 'Likes' of justice organizations as they can (but in actuality 'do' very little). Some read books about justice and write blogs. Some change their lifestyles to fit with new realizations about certain injustices in the world such as some good friends who chose to only buy American-made clothing in order to insure that they were not unintentionally supporting companies that used children as slaves to make their clothing. Some jump wholeheartedly into making people like Kony famous. Some decide to adopt. Some move their families toward less desirable parts of town and have the audacity to allow their children to go to school there as well. Some move to the other side of the globe. All do so in the pursuit of this thing called justice.

Deep down there is something innate within each of us that is fulfilled only when we wholly seek the good of the person next to us, especially the person who cannot repay. Amidst all the selfishness within our hearts that so often dictates our actions, part of being truly human is the ability to see the other as equally and fully human. When we see a human being digging through a landfill for lunch, something gnaws at our core because it just isn't right! In a world with so many problems, how do we begin to understand what questions to ask and what steps can be taken to right the wrong as both individuals and communities.

A helpful starting point can be to unpack what we mean when we speak of justice and try to provide a framework for encouraging one another to pursue lives in concert with a just world. I recently revisited a book by Chap Clark, a teacher at Fuller Theological Seminary who has devoted his life to working among youth. In one of his books, Deep Justice in a Broken World, Dr Clark describes three very simple yet helpful levels of response - physical, relational, and systemic - to injustices. The physical response is the most natural response - a response to fix what's broke! A need is identified and the need is met, with or without developing a relationship with the people being served. The relational response seeks to know and develop relationships with the recipients in order to learn from them and partner with them in trying to solve the problem at hand. Friendships are developed because a priority is placed on listening rather than doing. The systemic response is one which attacks the systems in place that perpetuate the brokenness and injustice of our world. Here, what Clarks calls deep justice is attained often after a long, messy, exhausting journey alongside people. He argues that all three responses are good but not all three are equal.

Clark makes the following comparison between what he calls "shallow service" and "deep justice," calling those who wear the name of Christ to seek justice by asking deeper and messier questions.

Shallow service makes us feel like the 'great white (or whatever race) savior' who rescues the broken. Deep justice is reached when God does the rescuing through his diverse community. Shallow service dehumanizes the receivers. Deep justice restores dignity. Shallow service is something we do for others. Deep justice is something we do with others. Shallow service is an event. Deep justice is a lifestyle. Shallow service expects immediate results. Deep justice requires a commitment to be present for the long haul. The goal of shallow service is to help others. The goal of deep justice is to remove obstacles so others can help themselves. Shallow service focuses on what our ministry can accomplish. Deep justice focuses on how to work with other ministries to accomplish more. Shallow service involves serving food at a homeless shelter. Deep justice asks why people are homeless and hungry...and then acts.

"When I feed the poor, they call me a saint. When I ask why the poor are poor, they call me a communist."
                                                            - Bishop Oscar Romero (martyr)

Paul Brand & The Gift of Pain

There is a list of people long since gone that I would love to sit down with over a cup of coffee and pick their brain.  I envision sitting for several hours (with an additional cup of coffee or three) captivated by stories of success and failure, joy and sadness, trial and error, despair and hope, dreams come true and dreams altered by circumstances out of their control. I would ask of their dreams for the future, what they would have changed given the chance, what advice they would give to people such as myself, and how they managed to align their priorities. What made them tick? The list includes people like John Wooden - legendary basketball coach, author, and teacher. Martin Luther King, Jr.- preacher, activist, and advocate of justice. Mother Theresa - servant to the poorest of the poor and saint. The list could go on and on.

Paul Brand is on the short version of that list. One of the most difficult decisions medical students have to make while going through their training is what field to pursue. For some this decision is based on length of training. For others it is based on the financial reward of a specific field. For others it is a calling of sorts and simply the 'right fit.' When I became interested in orthopedics, one of the major obstacles was the ability to use orthopedics overseas in mission settings. Orthopedics in the United States is heavily dependent on technology and sophisticated instrumentation that is simply too expensive and not available among the world's poor. During this decision process, I was given a book by a friend called Fearfully and Wonderfully Made, a book written by Dr Paul Brand sharing his insights into a life of mission work as an surgeon, specifically hand surgery. It was that book that pushed me toward what I felt God was calling me to do.

Dr Brand took a special interest in lepers. Thankfully leprosy (today called Hansen's Disease) is far less prevalent compared with history. Leprosy is referred to often in the Bible as a disease of the 'unclean,' preventing its victims from participating in society. Lepers could often be disfigured and cast away from their families and friends into a life of isolation and despair. Today, we know that leprosy is caused by a bacteria - Mycobacterium leprae - a bug in the same family as tuberculosis. Leprosy is best known for its disfiguring tendencies of the skin and yet one less known aspect of leprosy is that it attacks the body's peripheral nerves - those nerves in our arms and legs.

Lepers suffer from complete numbness as well as weakness and loss of function. People infected with leprosy lose what Dr Brand called 'The Gift of Pain." Without the presence of sensation, the human body has no way to know if what it is doing is causing self-harm. I remember reading Dr Brand's stories of lepers who would have their toes literally eaten off by rats during the night and not know it because they could not feel their toes. A leper does not know he is developing a blister on the bottom of his foot or holding a glass too tight, both of which can cause ulcerations and eventual necrosis requiring amputation. The Gift of Pain, thought strange to label as a gift, gave the person back the ability to interact with the world safely without further self-inflicted harm. To have no pain was not the utopian life we sometimes ask for but rather left one in a state of helplessness as their life was slowly taken from them. Dr Brand devoted the majority of his career to caring for lepers, refusing to believe they were any less important than any other individual on the planet.

I hope heaven has a coffee shop that I can sit down at with Dr Brand.

What is Structural Violence?

'Structural violence' and 'structural sin' are relatively new additions to my vocabulary. I first encountered the concept in a book by Dr Paul Farmer (Pathologies of Power, Univ Calif Press, 2005) who sought to provide insight into the causes of global poverty by using first-hand accounts from his trips to Russia, Mexico, and Haiti as concrete case studies for such exploration. Having spent over two decades of intentional and thoughtful work among the poorest people in the western hemisphere, Dr Farmer's words have a poignant quality lacking in many textbooks and other treatises who seek a 'neutral' and objective place from which to write. Farmer makes no such claims.

I am openly on the side of the destitute sick and have never sought to represent myself as some sort of neutral party. Indeed, I have argued that such 'neutrality' most often serves, wittingly or unwittingly, as smokescreen or apology for the structural violence described here. (p.26)

Via a hopeful anger and a fierce loyalty to the poor, Farmer exposes the far-reaching impact of abuses of power and the pathologies it spawns - poverty, disease (HIV, TB, cholera, etc.), deprivation, economic despair, lack of health care, and injustices ad nausea. These 'human rights violations', he argues, are not the problem but rather symptoms of a deeper and more sinister problem rooted in the human heart - the belief, whether conscious or not, that some people in the world matter more than others. Such a belief creeps into our hearts, our interpersonal interactions, our language, our social and political systems, our international policies, and so on creating systems, governments, and structures than enable such 'structural violence' to thrive with the poor and powerless seeing more than their share of negative consequences.

The biblical narrative names this fundamental problem as 'sin.' First encountered in the Genesis story, humanity's insistence on self-rule and refusal to see itself in its appointed place in the community of creation shatters the harmony, joy, and inter-dependence of the creator's design exposing everything and everyone to the effects of 'sin.' No part of creation was spared sin's pathologies and since then, our systems and structures at every level have been vulnerable to the selfishness and greed so deep within the human soul. 'Structural sin' remains, however, a difficult notion to grasp in large part due to the western influence of individualism. Sin (and spirituality as a whole) is viewed as a private matter to be handled in solitude and its effects therefore are perceived to be limited to individuals involved. 'Structural sin' casts a much larger net over our families, our communities, our churches, and our governments acknowledging that sin has spared no corner of creation. Yet the effects of sin are felt more harshly by those without the luxury of spiritualizing their situations. Dr Farmer defines the poor as "those whose greatest task is trying to survive." Such poverty means death, often an early death, for far too many. Sin means death and it is not simply a problem for the individual but a cosmic, permeative affront to the Creator that has managed to infiltrate every nook of our social, political, and economic systems.

Thankfully, the biblical story offers hope in face of seemingly impenetrable darkness. Jesus' most famous prayer - "...may your kingdom come. May your will be done on earth as it is in heaven" - points to the good news of a new way of life found in surprising places such as prostitutes, terrorists, tax collectors, lepers, poor widows, and simple fishermen. Within this kingdom, the rich and poor, powerful and weak, sick and healthy, male and female, popular and marginalized are equal. This is why they call it good news for the world. In this new reality, 'structural sin' is exposed by an inextinguishable light within a community committed to justice, love, and peace. And little by little, Jesus' prayer comes true - heaven is found here on earth and God's purposes are accomplished.  

I am still wrestling with this idea and above are my preliminary ramblings on the matter. Does the idea of 'structural violence'/'structural sin' make sense? If so, where have you seen this play out? What concrete examples of 'structural violence' do you see and what examples of 'structural redemption' (i just made that term up) have you seen? How can we become more attune to such injustice in our midst and have more honest discussion? Would love any thoughts, critiques, or further conversation. 

Blessings....

Global Health & Liberation Theology

I wanted to share a link to a video of a dialogue between Paul Farmer, MD and Father Gustavo Gutierrez. 

Dr Farmer is one of the most inspiring men I have encountered (though never met) who continually challenges notions of how healthcare should be provided in impoverished settings. In his owns words and the words of the organization he helped found - Partners in Health, he seeks to offer a 'preferential option for the poor.' He is a Harvard-trained physician anthropologist who has spend the majority of his professional career working in Haiti, the poorest country in the western hemisphere.

Father Gutierrez is a Dominican priest who has lived in Peru the majority of his life. He is known as the father of 'Liberation Theology,' a perspective seeking to relate the story of Jesus to people living on the outskirts of society. In his words, the fundamental theological question of liberation theology is how to tell someone living in the midst of poverty, social injustice, and oppression that God loves them and favors them.

Both these men came together on the campus of Notre Dame University last year to discuss the commonalities of liberation theology and the pursuit of global health. Though it is a lengthy video, it is well worth the time and will give the person seeking to connect medicine and theology plenty to chew on.

"Re-Imagining Accompaniment: Global Health & Liberation Theology 
http://kellogg.nd.edu/ford/newsevents/DoD.shtml

A few quotes from the discussion to whet your appetite!

- " Understanding poverty as structured evil and understanding how it is perpetuated is not the same as fighting it." - Farmer
- "Theology is a reflection about life, not a religion. Theology must always be in dialogue with the contemporary context and historical conversations." - Fr Gutierrez
- "Poverty is a human issue, not an economic issue." - Fr Gutierrez
- " We live in one world, not three." - Dr Farmer
- " Poverty is not some accident of nature but the result of historically-given, and economically driven forces." - Dr Farmer 

Enjoy! Blessings...