Carmen Sandiego

Where in the world is....? Or actually, in the U.S. is Alyssa? So I arrived back in Nashville from Peru April 1. And from there I quickly resumed my pre-Peru "routine" of work (as a hospitalist in Birmingham), support raising, and travel - bringing the count up to 20 states since September. But thankfully, as someone said to me recently, I'm a "high-energy" person and actually really enjoy the activity and the meeting up with new and old friends. And I appreciate the opportunity to talk about what I love and share my enthusiasm for this amazing work of God with those I encounter along the way.  The schedule does get tiring, but I'm thankful God knit me together for this part of the journey as well as for the time ahead on the ground in Burundi. And I've been so blessed by the hospitality, encouragement, friendship, and financial support of so many over the last few months.

Pictures from April:

 I shared a bit of my story and vision with West End Community Church in Nashville at all three services this weekend. What an immense blessing to me this partnering church has been and continues to be!

 Medical friends in Birmingham with a shared passion for serving the "least of these" around the world

 Stopped in New Orleans for beignets (harbinger of good food to come in France!) on my way to speak to Christian medical students at the Louisiana State University medical school. Also spoke to pre-med students at LSU in Baton Rouge. Loved the enthusiasm of these students as they asked insightful questions and visibly desired to serve God through medicine around the world. 

 Sweet friend and fellow med-peds doc Trish (and roommate during residency)

 After seeing the Amazon River in Peru, I was interested to see (and touch:)) the Mississippi River in Louisiana.

 So, "B" cities - Birmingham, Baton Rouge, Boston. :) Loved spending time with my long time friend Shannon (from college - another former roommate!) and her husband and four children in Cambridge and Boston. Above picture taken at Boston Commons pond.

 Clara and I ran the Boston Marathon in 89 degree temperatures up Heartbreak Hill - for about 5 minutes. :) Wow, those real runners were amazing! What an amazing example of perseverance!

 Shannon and I drove up to New Hampshire one day to hang out with another college friend and her boys who recently returned to the U.S. after living in India.Well worth the drive to be together!

 Lots of fun time was spent on playgrounds in Boston! (where the above picture was taken)

 I'm so thankful to be in the States for all the festivities leading up to my youngest sister's wedding in June. We enjoyed a fabulously special wedding weekend just the girls in Charleston.

My mom, sisters, and I - love these women!

And finally, friends visited Burundi last week and emailed pictures of the construction of the guesthouse at the hospital - where we'll live our first few months until our homes are built. Looks like it's coming along well!

So, what's next? Another week working in Birmingham and then I'm off to Colorado for five weeks of missionary training and language acquisition training at Mission Training International. Thanks for continuing to follow along on this journey. Please continue praying for me and my team!

Safe

Is it safe there?

This is probably the most common question people ask me when they hear I'm going to Burundi. It's a difficult question to answer. Burundi has been relatively stable for the last 5 years or so since their civil war ended, but relative means a lot in that part of the world. Compared to living in suburban America, there probably is increased risk of robbery, rebel activity, disease, and war. But in residency in 2009, my house was broken into and my computer was stolen in Birmingham, Alabama, so location doesn't mean everything.

It's interesting to me, though, that safety is the first thing most people think of. And I consider it as well and take precautions as much as possible - leaving valuables behind, not traveling after dark or alone, taking malaria prophylaxis and getting vaccinated for diseases like rabies and yellow fever.

But why is safety such a big concern? Does the Bible speak to this? I realized this week that the reason Peter denied Jesus was because of concern for his own safety - legitimate concern, too, as one of the people who asked him if he knew Jesus was a relative of the guard whose ear Peter had cut off. I'm guessing they would have been happy to crucify Jesus' followers along with him. But Peter was afraid of harm, so he fell to temptation and denied knowing his Lord. The result: Peter went out and wept bitterly. Jesus, of course, knew this would happen, but his response was to pray for Peter that his faith would not fail, to die for even that sin of prioritizing personal safety over declaring belief in Christ, and, after his resurrection, to demonstrate his love for Peter in giving him the responsibility to care for his flock.

Shortly thereafter Peter preached to thousands, was imprisoned for his faith, and ultimately was crucified. Read Peter's words below, likely spoken just a month or two after he denied Jesus.

Acts 4:9-12, 19-20

            Then Peter, filled with the Holy Spirit, said to them, “Rulers of the people and elders, 9 if we are being examined today concerning a good deed done to a crippled man, by what means this man has been healed, 10 let it be known to all of you and to all the people of Israel that by the name of Jesus Christ of Nazareth, whom you crucified, whom God raised from the dead—by him this man is standing before you well. 11 This Jesus is the stone that was rejected by you, the builders, which has become the cornerstone. 12 And there is salvation in no one else, for there is no other name under heaven given among men by which we must be saved.”...But Peter and John answered them, “Whether it is right in the sight of God to listen to you rather than to God, you must judge, 20 for we cannot but speak of what we have seen and heard.”

So what made the difference? Peter sounds like a different person, fearless and full of faith, unconcerned for his safety. A sermon I heard in Boston recently answered this question for me: the dramatic change in Peter was a direct result of the Resurrection. If we truly believe that Jesus conquered death and was miraculously raised to life again, our lives will look different. In faith we will trust and boldly proclaim that death has been conquered and thus it now lacks its sting. As a popular Easter song proclaims, "the glory of God has defeated the night."

I'm not suggesting we cancel our health insurance or wander around in dark alleys unnecessarily, and I still intend to get vaccinated against meningitis before heading to Burundi, but I am considering more these days what it means to count the cost. What does it look like to follow Peter's example and disregard personal safety for the Kingdom of God as a result of belief in Jesus' resurrection? 

Gorgas Graduation

 Hard to believe it's only been a week since I arrived back in the U.S. from Peru. Life quickly resumes its frantic pace - especially as I worked three night shifts already since returning. I did want to post these graduation pictures, though. We thankfully all earned our Diploma in Tropical Medicine and Hygiene. Complete with graduation ceremony and besos and abrazos all around! Quite possibly my last graduation, and the culmination of an enjoyable but pretty intense course, so definitely worth celebrating! 

This is the second floor of the restaurant - thankfully they had another section that was above water!

 My housemates throughout the course - Calle Porta girls, AKA "casa de seis chicas". Thankfully we all really enjoyed one another and got along well!

 Anindita, Christine, and I with Dr. Warrell - the renowned expert in all things tropical, as well as in the Queen's English! :)

 One last Group 1 picture (our clinical rounds group). I learned a lot from these colleagues and will definitely be emailing them when I'm stumped with cases in Burundi!

 Group D - lab group. We bonded over differentiating so many minute details of malaria and other parasites under the microscopes - as well as through the snake and spider and more "macro"-scopic labs.

 DTMH (Diploma in Tropical Medicine and Hygiene). Three of the course faculty - Dr. Legua, Dr. Freedman, Dr. Montes

 Our ride to the restaurant where the graduation ceremony was held

 Dusk over the Amazon. I'm thankful for these friends and look forward to our paths crossing around the world in the future.

Dan, Gary, Christine, and I at the Iquitos zoo. Translation of the sign: Thanks for your visit!

Happy Easter!

Happy Easter! Thankful to be enjoying the beautiful springtime on this resurrection celebration here in Birmingham. After two years without seasons beyond rainy or dry, I had forgotten how beautiful and renewing the spring is - even though I missed most of winter while in Peru! In honor of Easter, I wanted to share with you one of my favorite resurrection songs - which just happens to have been written by my teammate Eric McLaughlin! I would also highly recommend reading N.T. Wright's book "Surprised by Hope: Rethinking Heaven, the Resurrection, and the Mission of the Church." Through the unprecedented and unsurpassable transforming power of the resurrection, God continues to make all things new - and proclaiming and living that redemptive power and transformation to God's glory is the reason why we're still here on this earth. Read a summary of the book from our team blog here.

We Will Rise With You

(download)

There's a hope to which we hope within this night

Anchored in the morning death was put to flight

That this groaning of creation

Waits not vainly for salvation

He will come and will put all things to right

Our Bright and Morning Star is making all things new

Banishing the powers of hell he overthrew

And his kingdom ever growing

From the smallest seeds he's sowing

No dark corner left without the light shot through

We will rise, we will rise with you

When all the heavens and the earth are made new

And finally, to be all that you made us to be

And all that you've redeemed

We will rise with you

So we hope in that which we don't always see

It's broken in, but it's yet to be made complete

But this fractured world around us

Is not always the way it was

And it's not the way that it will always be

So we work and play under this sun and rain

Knowing that our labors in him are not vain

Working in us is his power

Holding us up every hour

Til in just an instant we will all be changed...

Sunrise over the Indian Ocean

The Amazon

 Peru contains such a vast variety of ecosystems - dry tropics in Lima, high jungle near Cuzco, mountainous Andes, and the Amazon rain forest. We traveled to each of these regions as part of our tropical medicine course as different tropical diseases flourish in different climates. Last week was one of my favorite locations - the jungle on the Amazon River. There are no roads to Iquitos. Thus any traveler (or vehicle) comes in on a boat or a plane. We flew and then traveled around in these moto-taxis once we got there - they offer a great breeze in the heat and opportunity for fully experiencing the sights, sounds, and smells of the city. Not so great in a downpour, but better than walking!

One of two hospitals we rounded at in Iquitos. Much more limited resources than in Lima, especially as this is the maximum care available for these patients. Many have traveled hours by boat (one patient traveled 24 hours on a boat!) to get there. Flying them out to Lima is too expensive.

Boy with Dengue Fever (mosquito borne illness)

Boy who needed mechanical ventilation for several days in the ICU for severe chicken pox (no varicella immunization available in Iquitos). Despite the limited care available, though, thankfully the boy was improving by the time we saw him.

Following are pictures from the market in Iquitos. We learned about some of the herbal remedies patients usually try before seeking medical care.

Fish or bananas?

Fried maggot. Evidently if it moves, you can eat it in the jungle. I decided no thanks on the maggot, though!

Herbs

Sumona and I with jaguar skin

Live monkey (just a few booths down from a dead howler monkey that was being sold for meat)

Slums of Belen in Iquitos

These kids are having a great time swimming, but unfortunately are exposing themselves to all sorts of diseases in this water mixed with sewage, animals, etc. Maybe I know too much now!

Waiting for rounds at the second hospital we visited in Iquitos

Faculty members: Dr. Gotuzzo, Dr. Freedman, Dr. Barros, Dr. Legua, Dr. Montes, Dr. Warrell

Little boy with leptospirosis - probably from swimming like the boys in the above picture were doing in water mixed with rat (or other animal) urine. He's improving with treatment, though.

Rounds with Dr. Legua

Deformities in a leprosy patient. It's very rare to see these deformities now as treatment options have improved. This patient was treated almost 50 years ago.

Another leprosy patient (with a different type of leprosy). This patient is currently undergoing treatment and likely will recover fully.

Even now, leprosy carries a stigma in the affected communities around the world. I don't really understand why. It's not very contagious. It's not sexually transmitted. Now it's treatable. Thankfully, Jesus didn't care about stigma - that carried by leprosy or by any one of us when we feel shame for things beyond our control, or even for things we feel responsible for. He proclaims good news to all. He experienced the shame of the cross so we don't have to.

"And behold, a leper came to him and knelt before him, saying, “Lord, if you will, you can make me clean.”And Jesus stretched out his hand and touched him, saying, “I will; be clean.” And immediately his leprosy was cleansed." Matthew 8:2-3

And Jesus answered them, “Go and tell John what you hear and see: the blind receive their sight and the lame walk, lepers are cleansed and the deaf hear, and the dead are raised up, and the poor have good news preached to them. Matthew 11:5

We visited a malaria study village. I liked this educational decoration - the mosquito will find you! With our new tropical medicine knowledge, we applied and reapplied more insect repellent than I've ever seen a group use before! No dengue for us!

We visited the Amazon during the rainy season and flooding was evidently at its worst in decades. This standing water is of course ideal for mosquito breeding leading to increased rates of dengue and malaria in the community.

Note the outhouse building on the left - draining directly into the river. These houses are built on stilts but you can't see them cause the river is so high.

Boat parking lot

Looking at a slide from a malaria patient in the malaria study village

Papaya tree

Jungle!

Flooding - don't think this moto-taxi will be used anytime soon!

I had a few hours before my flight on Saturday, so some friends and I went to an animal shelter for injured or at risk manatees. The manatees are transitioned gradually until they are released back into the Amazon River.

Manatees evidently enjoy papaya - so cool!

Jaguar in the Iquitos zoo

Capivara - otherwise known as R.O.U.S. for you Princess Bride fans (Rodents of Unusual Size)

Another photo of the Belen slum. Belen means Bethlehem in Spanish. Reminded me of Jesus humbly coming to an impoverished, dirty stable because of His love for each of us - from the least to the greatest. "Your attitude should be the same as that of Christ Jesus: Who, being in very nature God, did not consider equality with God something to be grasped, but made himself nothing, taking the very nature of a servant, being made in human likeness. And being found in appearance as a man, he humbled himself and became obedient to death--even death on a cross!" Philippians 2:5-8. Great reminder for each of us this Passion Week.

Amazon River