Tuesday Topic: Decisions about Medical Care

Topic suggestion from Karen: How have you made decisions about how to approach medical care while overseas, and often in locations with poorer health care? How have you decided when to seek treatment in your host country and when to head back to the US?  How has God led you in this?

(If you would like to pose a “Tuesday Topic” question, please email it to formissionarymoms@gmail.com . Provide your blog address if you would like to be linked to, and specify also if you would like to remain anonymous. Thanks!)


18 Responses to “Tuesday Topic: Decisions about Medical Care”

  1. 1 Jess in Europe May 18, 2010 at 2:44 pm

    Less than two weeks ago, my husband had a heat stroke while running in the 1/2 marathon here in former communist Europe where we live. No one helped him as he was lying on the ground trying to get someone to give him water. He went into shock. Finally when an ambulance did come, they took him to a psychiatric hospital because he had told the people to tell the kids and me goodbye and that he loved us because he really thought he was going to die. He then tried to share the gospel with them so he was declared crazy.
    When I was finally reunited with him, the psych dr. asked me about his mental health. I asked her what happened, why he was in the psych hospital, and what they had done for him. All they said was “nothing, go home”.
    So now, I’m convinced that should we have a medical emergency where we can get treatment elsewhere, we’ll be going. I could have been a widow at 29 with two preschoolers and 5 months because no one treated him medically.
    And, truly my husband is 100% sane.

  2. 2 Richelle May 18, 2010 at 5:44 pm

    This is such a hard decision – and in general, unless God has clearly led, we’ve chosen to treat in our host country while recognizing that the medical care, while significantly more affordable, will be different and sometimes of a lesser quality than what we would expect in the States or in a more developed country.

    Right off hand, I think of two specific examples. Our 4th child, about 3.5 years ago, became very sick with resistant malaria and resistant bacterial and amoebic dysentery. That was the sickest I’d ever seen one of my children. She lost over 30% of her body weight in less than a week and couldn’t even lift her hand off the bed, she was so weak. While we were scared regarding the outcome and had many advising, even pushing, us to medically evacuate, the Lord gave us a peace that the best place for her to be was right there, where we were together as a family and her siblings could come to the hospital each day to love on her and try and encourage her. After 10 days in a grimy, local clinic they finally deduced, somewhat through trial and error, the correct combination of medications and she began to improve and our family life was able to return to normal more rapidly than would have been the case with a medical evacuation. It was also a huge encouragement to see how our Nigerien friends as well as missionary friends ministered to us during that time.

    When we discovered we were pregnant with our last child, once again, everyone recommended that we return to the States for her delivery. I’d had two wonderful deliveries there, however this time, there was a significantly higher risk that they’d have to take the baby by c-section because of health complications for me; there was no place in the country equipped to deal with a preemie or a baby that couldn’t breathe on its own. I was prepared to stay and have her there – in fact, that was my preferred option, but when the Lord provided plane tickets on donated frequent flyer miles and a place of unbelievably low rent 3 minutes or so from the hospital for me and three of our children, and a very strong recommendation from our immediate superiors, we felt that the Lord had clearly spoken. So that time, we made the decision that I would come home with part of the family and my husband would remain in Niger with the kids who were enrolled in schools.

    So, that said, I think the key is learning to discern God’s will in each individual situation. My daughter’s situation was so much more critical than mine ever was. We did almost lose her, but the Lord healed her body right there in Niger. For me, He clearly directed a return to the States and everything went beautifully… I could have stayed and had no issues. The Lord clearly graced my body with the ability to carry and deliver another baby without complications or any medical intervention – yet for reasons we don’t know, He clearly brought me back to the States

    My temptation is to think that God always wants me to see out where the best is available and accessible, that that is my right and something I should pursue adamantly for my family. Reality, though, is that the best always is right there with me, for He is always with me and He IS my “shield and exceeding great reward.” I have to trust Him and continue learning to trust Him more readily and completely each day and submit to His sovereignty, which often does not agree with my plan. And that is most hard when it involves my family… my husband and children and their welfare.

    All that said, when we make medical decisions, we collect as much information as possible. We’ve built a relationship with a particular doctor/clinic and while we don’t always appreciate how she does things, her “bedside manner” can drive us crazy and she’s made some amazing mistakes while caring for our family, we’ve chosen to continue working with her. Mistakes and all, we do think she tries her best and is a good doctor, – what more could we ask, especially realizing that medical science is not as exact as we’d like to think? We want and prefer to work through the medical system available. And then we pray… literally, we’ve learned so much about what it means to “pray without ceasing” in those scary medical times, and try to discern God’s will moment by scary moment – and then to obey right away, without questioning, exactly as He has directed with a gentle spirit and sweet attitude once we know what it is that He is directing us to do.

    Hope that makes sense… it is a continual decision to choose trust, even when it isn’t working out how I’d hoped…

  3. 3 Laura May 18, 2010 at 9:43 pm

    This is a very real question for us right now as we countdown 11 weeks until we head to our mission field in a remote region of Honduras. Do we need evacuation and medical insurance? We are partnering with 3 homes for orphans and vulnerable children, but are not under the administrative umbrella of a large mission organization.

    We have 4 children under 10 and are open for suggestions. We are within a 1 hour flight to a city with a hospital. Would love any information wise women would like to share.

    Blessings in Christ,

  4. 4 Ashley L May 19, 2010 at 11:23 am

    I agree so much with what Richelle said in the sense that we need to seek God’s leading, and that it may or may not be what we expect. I think that about the entire decision of living overseas. If safety were of utmost importance, it would not be wise for most of us to be living where we are. We base our choices on where we live on a different criteria, that being God’s will for our life. Though of course I don’t believe that by following the will of God to a place with poorer health care that He will make us immune to all potential problems, I do trust that by following His will, we will receive His best for our lives and that He will give the wisdom, strength, and provision needed to navigate the challenging situations that may come up.

    I do also believe though that God has blessed us with so many options as missionaries these days, and that it is a gift. 100 years ago people would have had little to no choice about where to receive treatment, but today there are so many advancements that make it possible in many circumstances to have more choices available. This is a blessing and something I think that is intended for us to make use of when individually led to do so.

    One factor for us also is price. We have both private and public options where we are and the public care is almost free. We have chosen private care for more major things, and public care for basic things like immunizations. Often even in a situation where we might be comfortable going with the public health care, the massive inconvenience of the system is prohibitive. It saves a ton of time to go to a private clinic, even though it costs a bit more. Since we have both options, we have to weigh the decision about whether to save money or to save time, both of which are valuable.

    Laura, as for looking into evacuation insurance and such, I know there are ways to purchase it individually, but I am not sure of the price. Also, there are some great classes that you can take through the Red Cross on first aid and CPR and such that give some good basic skills for treating emergencies on your own until professional treatment is available (some classes are even available online). Even though we have always been close to hospitals and such, I took some classes just in case, knowing that the ambulances and other systems are often not as fast as we would hope. You likely have much wiser and more informed people to advise you, but I also know that some doctors upon understanding your situation will write prescriptions for basic general antibiotics and other very commonly used multi-purpose prescriptions for you to take over with you just so you. That way you can have them on hand if needed.

    And Jess, I am so sorry to hear about your scary experience! I am praising God that he is ok, but that must have been so terrifying.

  5. 5 aliciafox May 19, 2010 at 4:12 pm

    For a little over 4 years we lived on an island with virtually no health care. Trusting the Lord to care for us physically was a huge area of growth on my part! I am a nurse (emergency/ICU)and so I’m always imagining and picturing the absolute worse scenario. We had to leave the island to have both our kiddos. The nationals travel to the capitol island for the last 8 weeks of their pregnancy, but we chose to go back to the US and be with family. (we didn’t know anyone in the capitol to stay with, so it would have been more expensive to go there. Plus we had free health care in the US)

    One of the things that’s been really helpful for me is to have a good relationship with our family doctor in the US. I have all his numbers and can call at any time. I’ve even showed him my kids rashes via skype! My OB doctor has been just as great and I can call or email him with questions. (great for many nights of regular contractions at 28 weeks pregnant!) Both doctors have sent antibiotics back with me to have on hand for just in case scenarios.

    Now we’ve moved to an island that has 2 hospitals (1 private and 1 public) and many different doctors. Now I actually have to make a decision about where to receive care, where as before we didn’t even have a choice! Immediately after we moved here I had a miscarriage and am so thankful that there was an OB doctor with ultrasound in the office to know what was going on. My daughter had an infection in her leg a few months ago and for the first time I could just take her to a pediatrician instead of calling back to the US and diagnosing over the phone.

    If the Lord blesses us with more children, we will have to make a decision about where to have the baby. I believe that it will be by the leading of the Holy Spirit. As many have said, each situation has to evaluated on that level. God often calls us to do things that don’t make sense or seem like the best scenario. This is true in health care and in all other areas of life.

  6. 6 Richelle May 20, 2010 at 3:42 am

    Laura – if you don’t already have it, check out the book “Where there is no doctor.” We’ve relied on it many times to help figure out symptoms, whether we needed to seek medical care and how urgently, etc. It is available for download on line: http://www.hesperian.org/publications_download_wtnd.php .

    With our organization, we are required to purchase health insurance – but it is only useful for our family (8 kids, ranging in ages from 18 mos to 14) when we are on home assignment; because it is a catastrophic plan and it takes them 1.5 years on average to pay out on claims when they do, even that is debatable! 😉 Some insurance companies already have a med-evac component to their plan for those overseas.

    We also have evacuation insurance, which I feel is significantly more valuable. Most medical evacs from our place of service take place on commercial airlines (i.e. last minute ticket – the really expensive kind), first class with a doctor accompanying the patient. We hope we never have to use it, but are thankful for the insurance because then we feel free to make decisions without the burden of wondering how we’d ever pay the 10s of thousands of dollars a med-evac would cost.

    That is our experience – have just prayed for you as you make decisions for your family.

  7. 7 Laura May 20, 2010 at 11:31 am

    Richelle – Thank you for your prayers, most of all. And thank you for the great link and information. It is encouraging that you would take the time to do so! I’m heading over right now to your blog to visit :). Laura

  8. 8 Andrea May 20, 2010 at 5:53 pm

    This is an interesting topic to me because for me it is a delicate balance of faith and forethought. Let me explain. While on the field in 2007 here in Mozambique our youngest son fell down a 60 foot dry well. He survived and we praise God that he did not have any head injuries or spinal injuries. He did have two broken legs and a dislocated left elbow. It was a terrifying experience but the presence of God was tangible and we know that Nate is only alive because God saved his life. We had to drive by van 2 hours across a country border into Zimbabwe to get to a decent medical facility. They did surgery the next day to put his legs back in order. He spent two weeks in the hospital with one of us sleeping on the floor next to him. The country of Zimbabwe at that time was going through it’s own craziness but God provided miracle after miracle for our family. There was no way he could have successfully been treated in Mozambique and most likely would have died from the trauma without appropriate treatment. They casted his legs and sent us back to Mozambique. But because the casting materials were so low quality his cast did not hold and his femur bone “slipped” and healed incorrectly. We then consulted via email and photos of xrays with orthopedics in the USA and were told to come back immediately as he would need corrective surgery. We did return to the US and Nate became a patient of Shriners Childrens Hospital. He had his first check up two months after arriving in the US and we were shocked to be told he would definitely need corrective surgery but they couldn’t do it now because it would cause more damage or have to be redone again. So intstead we made an appointment for a four month follow-up like instructed. But praise God when we returned four months later our sons leg had miraculously been healed and his bones were in proper alignment. The doctors were baffled but released us to return to Africa. I guess my point is this…we now have medical evacuation insurance for our family because you never know what may happen but we also know and trust that God is ultimately in control, our healer and our provider for everything. May I suggest a ministry called Equip International. They have a course for missionaries specifically to prepare you medically to care for your family on the field with non-western medicines or supplies availabe. They are located in North Carolina and I am so grateful I attended before moving to Mozambique. You can check them out at http://www.equipinternational.com They are also willing to provide consults for opinions with several medical professionals they have relationship with for missionaries serving on the field dealing with medical problems.

  9. 9 Laura May 21, 2010 at 2:30 am

    Andrea – Thank you so much for that link. We are going to contact them just to see what we might learn before we leave in August. Blessings, Laura

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