A Prayer for Them and for Us

This was a prayer that I prayed and wrote on one of the flights back to the US, probably from Frankfurt into DFW.  It still holds true for me this morning as I contemplate the good people and our experiences back in Swaziland.  And in terms of what this blog is all about, I wonder about and pray for their abilities to bring shalom, justice, and goodness into the lives of those with whom they converse.

Please join me today in praying for them as well.

Dear Lord:

We are soon to touch down in Texas. Not long after that we will pull into our own drive way, unpack, see family, and sleep in our own bed.

 

We will re-establish our long held rituals, eat our own food, and rejoin our church. Slowly we will probably adapt to our own time zone after a few nights of less than normal rest. 

Lord, you know me. You know me well. You were there before, during, and after my birth. That was a long time ago. You know that I will re-acclimate with baseball, football  internet, unlimited wifi, and Buddy the Boxer. 

And we both know and understand how the rituals and routines in Swaziland were so different. The flat, foods, accents, worship styles, greetings and other acts of respect, and so many other things compelled our focus and drew upon our energies. We have been in those places before with other people groups, but still, you know of the changes though temporary that we experienced. 

My life will go back to normal. 

Charla's will go to normal. 

 

Or will they?

 

Can we really return to normal. 

Can we go about our daily walks unchanged by Swaziland and African Christian College and its students?

 

You know, Jesus of Nazareth, what it was like to enter the spaces and places of humanity. Charla and I now know something of entering the spaces and places of people from across Southern Africa and even from across parts of the US.

 

I am uncertain as to how those three weeks will change Charla and me. You know her well, and she'll be shifting through it as well. 

 

I will be formed in different ways by those people and our encounters. As I said in chapel on Friday as we wrapped up the two week class schedule, I was born to be a teacher and a healer and I felt reborn to do the same. I am clueless as to what those words meant, but they came out anyway. 

 

How to begin to process it all? Where to begin? How to begin? 

 

The very idea that the students recognized the inadequacy of their medical systems, the woeful state of behavioral healthcare, and the never before thought of possibilities of creating structures for the integration of those two is staggering. 

 

They know that beyond the unique cultures of their six countries, their homelands and their people have things in common. People live in extended families, people get sick and recover or do not, and medical conditions enslave the diseased and those who love them. 
 

I will remember those ten students. I will remember Charla partnering with me in teaching those students, and her even demonstrating those practices with us. 

 

I will remember wrestling with understanding each other. I will remember the unique greetings, the warmth of the students and others, praying in chapel, sharing meals and conversations with them, chatting about important matters in our flat over coffee and cookies, and watching and listening as they grappled with complicated ideas of the theory and practice of medical family therapy. 

 

They love you, Lord, they worship you expressively, and they love their homelands and their people. They will not return to make a lot of money, though some may. They will return to their people to share the love of Jesus with them by doing this important work of offering hope in Your name. 

 

So, Holy One of Israel, God of Abraham, Isaac, and Jacob, and God of Admire, Ncobile, Veronica, Clide, Charity, Prudence, Tendekai, Judith, Julia, and Tadala, annoint them with your power and Holy Spirit. Give them eyes to see and ears to hear and wisdom for doing your holy work. 

Finally, Father, may the seeds we sowed within them spring up in works of service far beyond anything that we could ever dream. 

Through the sweet name of the risen Lord, 

 

Amen 

Screening for the Unknowns

The “Medical Family Therapy: Cross Cultural Implications” course that I taught in Swaziland on the campus of African Christian College in August and September had a number of modules. Some modules were just read, think, and apply.  Other modules were heavy on application. One of those modules was on the use of screening inventories in behavioral health settings.

Screening inventories are used to rule out things that are not there and to rule-in things that are there and demand clinical attention. They are most frequently brief inventories. Preferably, they are less than ten or so items.  The inventories we learned were the ACE(Adverse Childhood Experiences), the PHQ-2 and PHQ-9 (measuring depression), the GAD-7 (measuring anxiety), the ORS/SRS system of Dr. Scott Miller which measures the challenges of the person since the last session as well as the evaluation of the session that is just ending. We gave some attention to the Marital Attitudes Scale and a recent publication by Hinson, Hargrave, Northrup, and Robertson (2017) though it is longer, i.e., 48 items that assesses the client’s commitment to the marital relationship.

The learning process included reviewing the literature, hearing me lecture on each screening inventory, and then completing, scoring, and interpreting the results on oneself. We then role-played giving each inventory to a client. This was no small task as the students were learning the inventories for the first time as well as processing one’s own unresolved issues. Obviously, we spent much time discussing the scores, their ratings as low, moderate, and high, and how to address personal concerns.

In view of our stated theological orientation of bring shalom into a broken world, these inventories and the students’ abilities to use them and use them well can help to create shalom for people who are broken or broken hearted. The inventories do not address how well one is, but rather how wounded one is.  On the one hand, the absence of a high score, or the presence of a low score suggests that one is doing well in terms of that which the inventory measures, but in integrated healthcare settings, people are generally going to be more troubled than less troubled.

If a therapist knows what the problems are, then a collaborative relationship can be created so as to address the issues. A caring, compassionate, and fully informed clinician can ease a client’s anxieties about discussing matters that are personal. A person who is trained in how illnesses can impact the family can be useful on the “front-line,” so to speak of the health and well-being of clients.

 

 

The students seemed to gravitate to Dr. Scott Miller’s ORS/SRS system. Here is the link for more information on this topic: https://www.centerforclinicalexcellence.com/. Dr. Miller gave the students permission to download and use his materials and the students were thankful for the access to these materials. The Outcomes Rating Scale is simply a four-item, ten-point Likert scale, inventory that the client fills out immediately prior to the consultation.  This inventory assesses the challenges of the person’s life and it orients the therapist toward what needs to be worked on.  At the end of the consultation, the Session Rating Scale is completed.  Again, it is a four-item, ten-point Likert scale inventory that assesses the quality of the therapy session that is just ending. This is immediate feedback from the client to the therapist and helps to keep the process positive and constructive.

The ACE, or Adverse Childhood Experiences, inventory could be pivotal for their settings and homelands.  There is must loss, conflict, and trauma that defines the worlds from which students come.  They are familiar with suffering and grief.  They learned that the more trauma a person experiences in his or her life prior to the age of 18, the greater the probability of experiencing various medical conditions.  Addressing just the medical conditions is inadequate.  It is imperative that clinicians address the underlying trauma that prompted the rise in the number and severity of the medical conditions.

These students love their homelands, their church, and the Lord. They are convicted about serving God these unique ways when they return home. These tools are a hands-on way of serving the needs of people by assessing their lived experiences.  When they do so, they are bringing about shalom in their broken worlds.  How our world needs shalom.  Shalom in Africa and shalom in America. That is exactly what we all need.

 

 

Coming and Going and Being Sent: Thuma mina (Send me)

In the early morning hours, these words from a psalmist of old are striking, “I know that the Lord secures justice for the poor and upholds the cause of the needy. Surely the righteous will praise your name and the upright will live before you.” Those are the last two verses of psalm 140, penned by David. I find them striking.

An application of that text also resonates deeply. For those two weeks that we were in the presence of ten African students from six African countries deeply penetrated my soul. The course was an upper division elective.  They were either third year counselling and psychology students, or they were second year students. The syllabus was daunting. They would have to read a lot, ponder a lot, learn a lot, and apply a lot. 

Here is what the syllabus said:  This elective in the psychology and counselling track is designed to orient students in the discipline of medical family therapy and its potential applications in their countries of origin. Consideration will be given to the cultural context from which she and he comes. Theory and practice of working collaborative healthcare settings with individuals, couples, and families in which illnesses are assessed and treated.

Here were the course objectives: 
 

1.         Students will learn and articulate the biopsychosocial/spiritual model
2.         Students will learn principles and practices of medical family therapy as a
            discipline with application to her or his country of origin
3.         Students will acquire basic information relative to illness and family
4.         Students will practice engagement with medical personnel in primary care clinics
5.         Students will develop a preliminary model for working in the country of origin
6.         Students will maintain an annotated bibliography for daily readings that include
            engagement questions and applications
7.         Students will learn the art of constructing both a genogram and an ecomap

The human part is that these ten students were prepared for this course. They could write well and speak English well. They had a clear vision for returning to Malawi or Zimbabwe or Tanzania or South Africa or Swaziland or Zambia and serve God and the people of their homeland.

They know intimately the impact of trauma on their lives and the lives of their families. They know well the impact of HIV/AIDS, or TB, or cancer, or any number of other health conditions.

They had just never put all of these things together, things such as “how does a trained therapist conceptualize and engage a person and a family in which illness is pervasive,” or “how does one work to alleviate pain and suffering in the marginalized who have socially unacceptable illnesses,” or “how can serving those with health problems be service to God,” or “how does illness or disease come to be the central organizing principle in families,” or “if we could develop one, what would an internship or a clinic look like that had both behavioral health and a focus on illness of its patients,” or “how could a ministry in the church create a focus on behavioral health and medical needs of the people in its community.”

By reflecting on those questions, learning theory and practice of medical family therapy, role-playing curb-side consults or “friendly handoffs,” and a myriad of other things that occur in collaborative care clinics, they caught the vision for what could happen in their homelands. It was riveting to see how they grasped the ideas and practiced, and how they reflected upon applications in her or his country of origin.

On Monday of this week an internship that captures these principles and practices started at a clinic not far from the campus. Dr. Bob Whitaker, long-time medical missionary in Nigeria and now medical missionary in Swaziland, had agreed to work with Lynn Rhodes and one of my students to develop an integrated care focus. May God's grace shine upon that effort.

Justice and righteousness have a lot to do with the motivation to learn and apply those things.  A theology of shalom, justice, and righteousness undergirded the class. Shalom had been broken in the garden. The breakup in families and the breakdown in health of family members and community members were signs of that violation of shalom. Bringing ones’ self into the mix of pain and suffering, just as Jesus emptied himself as He entered our world, is a meaningful attempt to re-create shalom insofar as we can re-create it in this broken world, and as we point to the ultimate healing when the Lord comes again to claim His own.

Yes, I believe God cares for the mistreated and those for whom justice has not come. I believe my job and the jobs of my students is to bring about justice and righteousness insofar as we are able. We validate stories and we convince people that they are worthy as we engage, listen, and validate.

That can happen in communities from which my students come in Africa.

 

 

 

Here in the Red and White Tent

Here in the Red and White Tent

Waymon Hinson

August 27, 2017

Here in this tent

            We are singing

Here in this tent
            We are praying.

The one at the top of the hill

            Striped red and white.

Here in this tent

            He preaches truth and grace
Here in this tent
            He translates with enthusiasm and rhythm.

The one at the top of the hill

With the two-holed toilet down below.

Here in this tent

            They dance as they sing
Here in this tent
            They moved into the isle.

The one down the long bumpy road

We sit and we stand full of people.

Here in this tent

            We are called to finish well
Here in this tent
            We know and worship.

In this red and white tent at the top of the hill

Here in rural Africa.

Voices I Have Heard

Voices I Have Heard

Waymon Hinson

August 31, 2017

*“Get out of bed
This is no time to sleep.
You must get prepared
Your promises to keep.”

**“Just a few more minutes

If you don’t mind
I’m pretty well prepared
For class this time.”

***We have come from afar

And we love what we do
To share our ideas
And to apply them through you.

Two weeks are too short

You’ve captured our hearts
Prayers for all that you’ll do
Long after we depart.

The Lord has called you

From yourselves he has saved you
Enter the broken spaces
There will be many such spaces.

Family therapy in clinics

People are broken and sad
Your sacrifices and preparation
Will make those hearts glad.

From Malawi Tanzania and Zambia

You have come to learn
To Zimbabwe South Africa and Swaziland
Someday you will return.

Your country of origin

You know quite well
HIV-AIDS diabetes PTSD depression
And all such manner of hell.

Charity Edith Tadala Admire Julia

Bring about shalom
Tendekai Prudence Clide Veronica Ncobile
And help them find their way home.

We are not called

To fix everything we see
Just a cup of cold water
With Baba we are free.

*“Dr. Hinson tell us more.”

Your faces implore.
**“Just take what you know
Into a good therapist you’ll grow.”

***We’ll soon say goodbye

Until in the forever we meet
Do well with your callings
There familiar faces we’ll greet.
______________________
*Students’ imagined voice
**Professor’s imaged voice
***Professor’s ponderings

Swaziland and ACC: Things We Experienced, Things We Learned

Two weeks ago today Charla and I were into the second week of teaching "Medical Family Therapy: Cross Cultural Applications" to ten students at African Christian College. She had already met with three groups of women and had given out the sets of hygiene kits made by her and her friends from the Park Avenue Church of Christ here in Denison. Today we are continuing the daily and even hourly reflections about the trip. Here are a few of them.

#1: Thanks to many, we were graced with $5,435 in contributions. We are very thankful.

#2: With those contributions we were able to get there and back, give textbooks to students and the library, and prepare the hygiene kits. Those who received the kits and those students who received the books were unanimously grateful. On the first day of class when we were discussing the syllabus and the required readings, they were surprised that the primary textbook was for them to read and even to write in.

#3: Ten students attended the class from six African countries: Malawi, Tanzania, Zambia, Zimbabwe, South Africa, and Swaziland.

#4: Forty-six hygiene kits and sets of underwear were given out.

#5: The students were prepared, well read, skilled at writing and expressing their thoughts and opinions, and participated well in classroom discussions and role-plays. Each student was required to report upon her or his country of origin and the status of medical care and behavioral healthcare, all of whom said each was non-existent. Each was required to articulate an uninformed opinion as to how he or she could integrate the two in that country. This was before the class even started.  Then, at the end of two week class, each again spoke as to how the integration of medical and behavioral health could be integrated. The papers were amazing to say the least. Not only had they more than adequately captured the principles and practices of medical family therapy, but their vision for returning to their homelands and working was inspiring.

#6: The ten students come from different countries and different living situations. Some are from "way down in the village" and others are from larger and more modern towns. Each student expressed a clear vision for taking an integrated approach back home and were even developing strategies to do so.

#7: These students love God and are called into the service of the King of Kings and long to serve God back home.  They have one more semester of academics and internship and then they will go home. Their commitment to their countries, families, and church was inspiring.

#8: Worshipping with them in chapel every day was inspiring. Eating with them in the dining hall and sharing their traditional foods was enriching and enlightening.

#9: Hearing them express their gratitude for us coming and teaching was inspiring.  Their words of "I never knew that before," "I never have heard of these things," or "I believe I can do this back home" were deeply encouraging and meaningful. Several of them talked about the seeds we had planted and how in the generations ahead, those seeds will develop and grow. Already, at least one student is encouraging ACC to have this specific course taught every other year.

#10: It was a humbling experience to work in the English language with these students while knowing that their languages were unique and beyond our comprehension, that their cultural contexts were things that we could not understand, and that they understood well from whence they had come and to what they were returning. Charla and I worked hard to hear them well and to understand them, and to a one they seemed grateful that we cared enough to work that hard.

#11: Even as we speak, there are conversations taking place as to how to create an internship site within which at least one student can continue to learn the art and science of providing integrated health care in a medical clinic. One particular physician, Dr. Bob Whitaker, whose clinic is in Manzini, interviewed with us in class and has expressed an interest in this as has the lead faculty member at ACC in the counseling department. He is Lynn Rhodes. I was encouraged by our conversations.

Since this report could go on quite longer, let me summarize by saying that those three weeks in Swaziland and on the ACC campus with its students, faculty, and staff provided experiences beyond our imagination. When asked what it was like, the only thing I could say was, "It was amazing. It was life-changing. Thank you for asking."

Teacher: Ode to My African Students

I believe that Shalom has been broken and continues to be broken between us, God, and other human beings. If that is the case, then our calling is to bring about Shalom insofar as we can with each encounter, conversation, post, therapy session, or meeting.  We have just returned from a three week trip to Swaziland in which I had the amazing opportunity to teach principles and practices of medical family therapy to undergraduate students at African Christian College. We attempted to establish on the first day of class a theology that informs work as a therapist.  That begins and ends with Shalom and with work as a spiritual enterprise as Christians are designed to be bi-vocational. As we do that, we are bringing about justice or righteousness into this world and into those encounters.

The next few posts will attempt to honor those students and that setting in Swaziland as these students attempt to bring about Shalom, righteousness, and justice in their lives and work.

 

Teacher: Ode to My African Students

Waymon Hinson

August 23, 2017

 

Teacher
            of pupils
            over many years, decades, even centuries

            perturbing minds

                        challenging ways

                        encouraging perspective changes

Teaching

            ideas and principles

            mountains and valleys

            peaks and hilltops

            of engagement and resistance

 

Teaching

            toward change

            distressing stability

            mounting with persistence

            the drip of boredom and sameness

 

Teaching

            across three states

            students domestic and international

            languages dialects and idioms

            pronunciations and quiet and bold

 

Teaching

            in Africa

            Swaziland six countries ten students

            shaping them

            or are they shaping me

 

Teaching being taught