“Mountains Beyond Mountains: The Quest of Paul Farmer, a Man Who Would Cure the World” by Tracy Kidder

 

 

When I heard the news a little more than a week ago that Paul Farmer had died of a heart attack in his sleep, I immediately ordered a copy of this book that I had read shortly after it was published in 2003.  I was immensely impressed and inspired by this story then, and as I re-read the book I was inspired again, maybe even more so now.  Makes me want to know the rest of the story.

The author, Tracy Kidder, accompanied Farmer to many of the places where he made such an impact in the lives of thousands, through his tireless work to both treat disease in situations of extreme poverty as well as to create public health systems and models that were adopted by many countries and international health organizations. 

Back when I read this book, I was traveling around the world trying to do my bit to improve the lives of poor people through development projects.  Paul Farmer was also traveling to many counties, especially Haiti, Peru, Russia, and Chiapas state in Mexico, but I must admit that his passion and seemingly endless energy and intelligence far out strip any thing I ever contributed to our common endeavor.  I never ran across him even though we traveled to many of the same countries.

The book tells the story of Paul Farmer up until he was about 42 years old.  When he passed in Rwanda, he was just 62, and was spending time there teaching at the Hospital and University of Global Health Studies he founded.  His specialty was infectious diseases, especially tuberculosis and AIDS.

He and several others founded the organization Partners in Health, which initially was to raise support for the hospital and rural health program he established in the central highlands of Haiti, where some of the poorest of the poor in this hemisphere live. Now PIH works in many more countries with astounding success. The PIH model is one of accompaniment and forming partnerships with local organizations and governments.  That is same the approach I was promoting during the years I was with Lutheran World Relief, Heifer International and Agros International.

So much has been written about and by Paul Farmer. It is available on the internet, so I should not try to cover too much of his life and legacy in this short review. He was a visionary and humble, even as he gained international fame.  He was happiest when trekking out for hours (mountains beyond mountains) to visit the sick in shacks in the Haitian countryside.

He earned his MD from Harvard Medical School at the same time as he finished a Doctorate in Anthropology from Harvard. During his career he kept one foot in the US medical system on the staff of Brigham and Woman’s hospital in Boston and taught at Harvard Medical school.  The other foot was in Haiti, and later with the poor in other countries. 

I was intrigued to learn that he got much inspiration from Liberation Theology, which had arisen out of left leaning theologians of the Catholic Church in Latin America in the 1960 and 70s.  He was raised a Catholic but did not subscribe to much of that doctrine in later years, but certainly adopted the Catholic teachings on justice and service to the poor. 

One of the tenets of Liberation Theology was to take the “Preferential Option for the Poor” – which in Farmer’s shorthand was O for the P.  He said this:

The basis of our preferential option for the poor is to say: I accompany them not because they are all good, or because I am all good, but because God is good.

Many other Paul Farmer quotes can be found on the internet.  One that I have heard many times is this one, but I didn’t realize it came from him. 

If I am hungry, that is a material problem; if someone else is hungry, that is a spiritual problem.

If you are in market to be inspired in this world of seemingly endless injustice and poverty, I recommend this book. 

Jerry Aaker, March 2022

 

Getting Back on Track

This new year of 2022 did not start out as planned.  Today I am five weeks out from a complicated major surgery, two hospitalizations, and a slow and painful recovery.  I had been having bouts of fatigue for months.  But, with medical professionals who got to the root of the problem and good care, I am gaining strength for today and hope for tomorrow. 

On this Valentine’s Day I am so thankful for Judy, the love of my life, the one who has carried me through some rough patches these last several years.  When I have felt listless and lack of purpose, she has been here to do almost everything for me. It has tired her out, but she is strong and full of compassion!

I recently read “Yes to Life” by Victor Frankle, who wrote: …that someone is tired and exhausted, is not enough of a reason to stop in their tracks.  Rather, everything depends on whether carrying on does have meaning, which makes it worth overcoming and continuing to live despite persistent ‘world weariness’.

Thank you, Judy, for your love and caring.  And thanks to so many friends and family for their words of encouragement and prayers.  

My Day With Nurse Ratched

 

 

I was introduced to my nurse for the day at 7am shift change.  Awakened from deep sleep by blindingly bright florescent lights from the ceiling above.  Half awake, I heard the night nurse, “This is Jaime your nurse for the day.”  I said, “Hi”, looking at her blankly.  They moved on.  I was now awake – no more getting back to sleep.

I’d been on Morphine for pain, a very small dose on request.  Every nurse the last 3 days just gave it to me without question.  There has to be an interval of 3 hours.  At 7:30 I asked Nurse Jaime for my pain med.  It had been 7 hours since my last dose.  She looked at me like I was a drug addict.  “I’m going to do an assessment”, she said.  She listened to my lungs, looked at my feet and asked my pain level.  About 7 was my reply.

Morphine is very addictive was her comment.  A refrain she repeated throughout the day.  I told her it’s on my orders and the pain is quite intense. She responded that Morphine could cause constipation and confusion.  Did you have a BM yesterday?  She had me there.  No BM.  I have not had food for 3 days so what is there to pass?  After a few more fruitless comments I asked if she was denying my request.  I’m not denying it, I’m doing an assessment she replied.  I was tired and said, “Okay; forget it.”

I asked for pain meds at least 2 more times during the day without success.  Once I woke up and saw Nurse Jaime was talking to Judy.  I again asked for Morphine.  She could not give it because I was sleeping - it was too risky.  I said, “But I’m not sleeping now.”  “What’s your pain level?”, she asked.  My reply was about 8.  She stared at me. I asked her if she’d checked the chart of pain levels of 1-10?  I had studied that chart in the ER a few days ago.  I reminded her that 7 to 9 is extreme pain.  Her response was that a number is not everything!  I can give you Tylenol.  I accepted her offer.

Later I was woken up again by bright lights in the ceiling.  She had urgency in her voice.  “I see your wife has left. Do you live far from here?  She needs to come get you.”  I thought it was midnight and something drastic had happened I couldn’t understand.  It was only 3:30 pm and I was being discharged.  Within an hour I was saying my fond goodbyes.

Judy drove me home where I fell into my recliner, exhausted.  I took a couple Tylenol.  Reflecting on the day, I asked Judy what was the name of the nurse in the movie, “One Flew Over the Cuckoo’s Nest”?  I looked it up.  Her name was Nurse Ratched!

Jerry – Feb.2,2022

P.S. I might be confused, but I’m not constipated!

We Are Blessed: A story I read to my family on Christmas Eve, 2021

 

On Christmas day four years ago, Judy, Henry and I were at a Christmas dinner at the home of our friends Inez and Greg in Cochabamba, Bolivia.  Also at the table were Inez and Greg’s daughter Christina, husband Tyson and their two children.  It was a wonderful time of good food and conversation that moved from topic to topic as such dinner conversations do. 

I don’t remember much of what we talked about except for this:  the word “Blessed’ came up – perhaps one of us saying we feel so blessed for good health, or some such thing.  Tyson took exception to use of this word; said he didn’t use it.

A bit about Christina and Tyson.  They had moved to Bolivia with no organization supporting them, just some friends and churches who promised to send money for their living expenses.  In Cochabamba they set up several programs for abandoned children, including an orphanage for kids off the streets – kids who had no one to care for them, some who had lost parents to AIDS.

So why do you object to the word Blessed, Tyson, I asked?  He said he thought about it like this. If someone who has good fortune and prosperity says they are blessed, what about those with the opposite experience?  Those we see living on the edges of society, like the abused children in their orphanage - Are they cursed? Maybe his point was that we are not any more deserving of being “blessed” then the one who seems to not be blessed.  I didn’t have an answer then but have thought about that question many times since.  And it has come to me that the kids they care for ARE blessed!  Blessed to have this young couple to care for them, feed them and love them.

Looking at the question of what it means to be blessed the Hebrew and Christian Bible says something like this:  a favor or gift given by God that brings meaning and purpose to life.  And I believe that gift comes to us by grace, not deserved, but given.  Just as Jesus was a blessing to Mary and Joseph and all of us – a gift from God.

I usually use the term blessed sparingly but intentionally.  But here I will use this word freely and often to express my feeling that we are blessed to have a wonderful family.  Blessed here and now in this place at Christmas, but larger than that we are blessed that we are actually here on earth, living and enjoying life. Let me tell you about three blessings Judy and I received during our lifetime, our children, and a bit about their first Christmases.

 Bret’s first Christmas was a quiet and peaceful gathering with us and a few friends in Saigon in 1967.  But just a month later we were in the center of one of the biggest battles of the war, right there in the city – the TET offensive.  Sounds of war all around us.  I was not overly frightened but have to admit we were worried, because Bret was not in good shape physically – he was somewhat undernourished and sick, and we were concerned.  But one of many serendipitous happenings and encounters in our lives was to find a good doctor from the Seventh Day Adventus hospital in Malaysia after they evacuated from Saigon, and with his skill and the help of friends who cared for Judy and Bret, he fully recovered. 

There was another serendipitous encounter several years later when we lived in the Amazon jungle in Peru.  Bret, about 4 years old, had terrible pain in his gut – and screamed throughout the night with every spasm.  We could give little comfort.  But it so happened that our friend, Dr. Jim, was only a few miles from us and we rushed him to that jungle hospital where Jim quickly diagnosed the problem and within minutes Bret was undergoing emergency surgery which literally saved his life.  Another doctor friend in Lima, when he heard that story, said we were fortunate – he said he doubted we could have found a doctor in all of Peru who would have diagnosed that condition so quickly and done life-saving surgery on the spot.  We were blessed that Dr Jim was there – the right person, at the right time, and right place - if not, it all could have been very different. 

We wanted to have another child, so we looked far away to Korea – to the Holt Children’s Service where a social worker in an orphanage in Seoul picked out just the right little infant girl to send to us. Mr. Kim brought her all the way across the ocean and placed her in Judy’s arms in the Portland airport and when they arrived home in Boise, Bret’s first words to her were, “hi, Sookie”.  It could have been different – not all babies thrive and survive in orphanages.  Lani was weak and sick when she came to us.  But she soon was thriving in our family.  We were blessed to have this wonderful gift from God placed in our home.

 Lani’s first Christmas was in Mexico – where she took her first steps, and we enjoyed the Mexican custom of Las Posadas following Joseph and the pregnant Mary on a donkey as they went through the streets of Cuernavaca searching for a posada – an inn.  Lani won’t remember that, but I remember carrying her on my hip as we sang songs and walked along with the procession. 

Daniel was born in the same jungle hospital in Peru where Bret’s life had been saved.  His first Christmas, though, was on the farm in Minnesota where we celebrated Christmas eve with his grandparents Arnold and Inez Aaker.  That might have been the last time we had traditional Norwegian fare for the Christmas eve meal with my mother, lutefisk and lefsa and all the other trimmings, so much enjoyed in the Aaker family. My mom and dad were so happy and felt blessed to have us safely at home.  We were blessed to be there with them.  That was the exact time that a huge earthquake destroyed the city of Managua, – an event that changed the direction of our lives and pointed us in the direction of Nicaragua for the next many years. 

We were visiting in Albuquerque in 2002 when I got the most shocking phone call of my life.  I was in the backyard of Bret’s little house on 13^th St and Daniel was on the other end of the call, He said, “Dad, I have cancer in my eye”.  We were stunned.  How do you respond to that?  You respond with prayer and action.  Thus began a long and torturous journey for Daniel and for us as we tried to support and accompany him. 

Another serendipitous encounter happened.  The doctor in Seattle brought Daniel’s case to a conference and someone there told him about two Doctors in Miami who were experimenting with a novel treatment for this exact cancer, and with some success.  The doctors’ names were Dr. Tse, and Dr. Benedeto – the Italian word for “blessed”. 

We and Daniel headed for Miami.  After several weeks of Dr. Benedeto’s care and very painful treatments, Daniel flew back to Seattle and we drove the long road back to Minnesota, arriving on Christmas eve to our cold and undecorated farmhouse.  I remember that as a dark, lonely and somewhat forlorn Christmas and felt guilty thinking of Daniel going home alone to an empty house in Seattle to recuperate, having to look forward to the next chapter – surgery to remove his eye.  We had prayer support from many and give thanks now that Daniel is with us.  We are blessed.

And then you wonderful grand kids came into our lives, one at a time, or in one case two at a time!  And now two babies in the next generation, as well.  You were all born healthy – ten toes and ten fingers – cause for giving thanks to God, but we know that others who are not born healthy are not a curse but also a blessing.  Life is precious.  What a blessing for grandparents to see you grow in mind, body and spirit toward your God-given potentials.

And we have welcomed with joy Sarah, Rachel and Fil.  You have your own families and stories, and we rejoice to have you as part of our family story, as well.  There may not be many more times when we are all able to gather like this for Christmas, so I say, take in how blessed this time together has been and continues to be.

Colin (age 7) has been learning in his Bible stories class how to give a blessing to others.  Maybe he wants to share how he does that?  (Colin made the sign of the Cross and said, “mama, I bless you in the name of the Father, Son and Holy Spirit.”)

So, let’s give a blessing to each other.  Put your arm around the one sitting next to you, and simply say “May God bless you.  I love you”

Jerry, Christmas, 2021

 

 

 

 

 

 

Reading in 2021

 

I am not a fast reader but had time this year to read 32 books.  After completing each book, I write a short review of each and give it a score ranging from minus, neutral, +, ++.   Obviously, there are a few with a minus score get discarded before page 50. 

Here are my ++ books for 2021.

Cold Mountain by Charles Frazier; The Book Woman of Troublesome Creek, by Kim Michele Richardson; Grapes of Wrath and East of Eden by John Steinbeck; Ordinary Grace and This Tender Land, by William Kent Krueger, The Best Short Stories of Fyodor Dostoevsky (my favorite is The Peasant Marey); The River of Doubt: Theodore Roosevelt's Darkest Journey and Destiny of the Republic, by Candice Millard; Anxious People, by Fredrik Backman; The Mapmaker's Wife, by Robert Whitiker; and The Premonition, by Michael Lewis 

Just a bit about this last one.  For a non-fiction book, this reads like a page turning detective story. Lewis is quite the storyteller!  He recounts the years leading up to the current pandemic starting in the George W. Bush administration when some very smart people were gathered into a team to develop the national pandemic response plan.  Bush had read Berry's book on the 1918 pandemic and saw the urgency of planning for the next one. The book is a fascinating story of behind the scenes medical, public health and computer modeling visionaries who continued to work on preventing the worst-case scenarios of what was surely coming - the next pandemic. One of the main characters, Cherity Dean, in the California Public Health Department, had a premonition of it's coming even before it arrived in the US.

At the beginning of the Covid-19 pandemic recommendations and models from these problem solvers met with a wall of resistance and ignorance from the establishment, including the CDC, the Whitehouse and other politicians who didn't have the courage to make hard decisions quickly to avert the coming damage.  The CDC fumbled the ball in the beginning by not coming out with a testing program and tool for testing. We have all heard about how the Trump administration zeroed out the budget for the pandemic planning team, and (thanks to John Bolton) that team was all fired.  

Turns out that the US was not the country best prepared for a pandemic.  Lewis refers to Carter Mecher, one of these behind-the-scenes individuals as redneck epidemiologist and says this is a book about "superheroes where the superheroes don't win the war".

As we know, there is not a happy ending to this story.  But it is fascinating and encouraging to know that there are some very bright people out there working on solutions who are doing it for reasons other than fame and money.  Probably many of them in state and local public health departments who just need good direction and a cohesive national health policy to do their jobs. 

This story shows the correlation between politics and pandemics and how science is often not allowed to do what is required. 

Garfield: History I Did Not Know

 

There are gaps in my knowledge of American history.  For one, neither in school nor

subsequently did I learn much about the period from Presidents Ulysses Grant to Teddy

Roosevelt, except that it was the time of the reconstruction after the Civil War, a pretty

disastrous period, especially for the freed slaves in the South. 

Reading Destiny of the Republic: A Tale of Madness, Medicine, and the Murder of the

President, by Candice Millard, filled in some of that gap in my knowledge.

This book takes readers through the life of James Abram Garfield’s rise from near

nothing to the Presidency of the United States, and his assassination at the hands of a

delusional mad man who thought he received a divine revelation to kill President

Garfield.

James A. Garfield was one of the most extraordinary men ever elected president. Born into abject poverty, he rose to become a scholar, a Civil War hero, and a renowned and admired reformist congressman.  He was a prolific reader of classics, science and philosophy, and an eloquent speaker.  Nominated for president in 1880 by the Republicans against his will, he didn’t campaign for himself.  Nor did he do so earlier when he ran for the Senate – spending a whopping $150 on that campaign.  He literally was born in a log cabin in rural Ohio, with extraordinarily effort he got an education, and was a college President by the time he was in his mid-twenties.  

He was highly intelligent, articulate, and compassionate.  The treatment of blacks may have been much different if he would have had the chance to serve out his term.  During his brief time as President, he engaged in a fierce battle with the corrupt political establishment.   But four months after his inauguration, a deranged office seeker tracked Garfield down and shot him in the back. Incredibly there were no secret service body guards for presidents at that time, nor for many years to come. The shots didn’t kill Garfield. 

The drama of what happened subsequently is a powerful story of a Washington in turmoil. The unhinged assassin’s half-delivered strike left the wounded president as the object of a bitter behind-the-scenes struggle for power—over his administration, over the nation’s future, and, hauntingly, over his medical care. A team of physicians administered shockingly archaic treatments to disastrous effect. As his condition became worse he suffered excruciating pain for over two months, though he remained kind and uncomplaining throughout.  

One image that grips the attention is doctors repeatedly inserted unsterilized instruments and fingers into the wound in search of the bullet.  Alexander Graham Bell, the inventor of the telephone, worked around the clock to invent a new device capable of finding the bullet.  It turned out that the bullet was lodged in a place the doctors never looked, and Bell’s invention could not find it because the doctor in charge refused to search on the opposite side of where the bullet had entered Garfield’s body.

The time when Garfield was lying deathly ill and injured in the White House and after his death people in all parts of the nation were in anxious vigil and mourning (even, apparently, Southerners).  It was a time of a united nation.  Both of my Aaker grandparents, Olaf and Ellen, were born in 1880, the year James A Garfield was elected the 20th President of the USA.  My Romo grandparents were about ten years old that year.  I wonder how much was covered in their history lessons in country school about the Garfield presidency.  Though I don’t ever remember talking politics with my Aaker grandparents, they were probably Republicans. But then being Republican meant something different in those post Lincoln, Garfield, Roosevelt days. Candice Millard writes a very readable and well researched story.  I recently read her first book, River of Doubt: Theodore Roosevelt’s Darkest Journey, and found that an equally engaging story I also knew little about.  I give her an A+ for both books.  September 16, 2021

 

Inspiration in troubled times

“I do not busy myself with great matters,.... Rather I have stilled my soul….like a weaned child on it’s mother’s lap”  from Psalm 132

What are these “great matters” that trouble the mind?  Just within the last few days...

A UN report on climate change that says humanity is on “red alert”

The Taliban taking over in Afghanistan with lightning speed after the longest war the US has ever waged, 20 years of blood and suffering - spent treasure and lost lives.

An earthquake in the poorest country in this hemisphere with a death toll of over a thousand and rising.  

Migrants by the tens of thousands arriving at the Southern border and the turmoil and anguish of so many with raised hopes, and others with fear of this “invasion.”

Wildfires raging across the West resulting in scorched earth and lost homes for many.

The outcome of any of these great matters won’t be changed by my fretting and worry, but I do pray and watch from afar. And look for signs of hope.  I look for calm and the presence of the Spirit and inspiration. Yesterday was an inspirational day!

 I was inspired by the courage and compassion of Dr. Eva Mora from El Paso.  We listened to her talk at Las Placitas Presbyterian Church about the work she and many volunteers do to get help to the migrants arriving and waiting in shelters in Ciudad Juarez across the border.  It is a work we support through the “Dignity Mission” headed up by Jack and Cheryl Ferrell from that Church.  They had a vision that started with just a few “dignity kits” and now has channeled thousands of kits and tens of thousands of dollars worth of needed material aid to countless migrant families from Central America.  Those are families from villages I used to work with in Central America.  They have come to the wrenching decision to leave their homes and take a chance on getting safely to the US.  Many don’t make it, but others have hope because of Eva Mora and a network of supporters from around the country.. 

Eva Mora said we should not be dismayed and overwhelmed by the great need - but persevere. Wait for the prompting of the Spirit for your purpose and look not only at far away places but also to those neighbors closest to us.  

Another thing inspired us yesterday - words about wisdom and the Bread of Life from Pastor Christa, and a song I was not familiar with but found myself humming the rest of the day.  I found there are lots of You tube recordings.  I love this one by the Notre Dame folk choir.  It is inspiring to see young people sing like they really believe it!

I Am the Bread of Life - Toolan | Notre Dame Folk Choir