Let the ashes fall…

img_mouseover3Ash Wednesday has been one of my favorite days in the church year ever since I first discovered it as a Freshman in college. This year I am reading the daily reflections from the Ignatian Solidarity Network, which can be found here: http://ignatiansolidarity.net/blog/2016/02/09/ash-wednesday-standing-on-ashes/#comment-24480. The focus of these reflections is A Lenten Journey Toward Racial Justice.

The questions posed at the end of today’s reflection were:

  • What does it mean to repent for the sins of the past today?
  • Our own past sins?
  • Our country’s?

My first thought in answer to these questions is, “I don’t know.” But I also know that that’s not good enough. I work in a Community Health Clinic in Tacoma, WA as a Nurse Practitioner. Most of my patients are victims of our nation’s and our world’s sins. Many have recently been released from prison, and many have stories of abuse, neglect and addiction. “I don’t know” isn’t good enough.

I remember noticing that my interactions with patients of color were different than my interactions with white people a few years ago when I was still in graduate school. There was one patient in particular, a middle-aged black man, who brought this reality to the surface for me. During our 20-minute visit I could not figure out why I couldn’t get him to say what he wanted. There were so many disclaimers in both his verbal and non-verbal communication, and his statements were oozing with an air of apology. As a student, I gave report to my supervising healthcare provider and shared about my experience in hopes that she might have some insight or wisdom to offer. Her response was to explain my experience by labeling this man a “seeker of pain meds.” While that explanation made things easy for her, it felt wrong, and somehow dirty. I felt dirty.

So for me, repentance today means not making those moments easy. It means sitting in the discomfort and filth of those moments. It means struggling with my power as a white, educated woman. It means recognizing and wrestling with the position of power I have as a healthcare provider. And it means listening. It means hearing the brokenness in the stories of my patients and accepting that the stories are messy. It means fighting the urge to tidy up the stories I hear so that I can go home feeling good.

As I go through my day seeing patient after patient and hearing their stories, I will listen. My prayer is that there is space for healing in the hearing of the stories, and in the acknowledgment of the sins that are woven therein. I pray that as I remember the sins of my country’s and my community’s past, and witness the continuation of those sins, the ashes of repentance would cover me, cover us.


Love your neighbor as YOURSELF.


I’m five weeks into a new job and I love it. I can honestly say that I feel like the luckiest person alive to do what I do. As a Family Nurse Practitioner resident at Community Health Care here in Tacoma I spend my days learning how to, and practicing how to partner with people as they move toward a healthier self. I spend so much time and energy focusing on other people and their needs. That’s a good thing, right?

Yesterday I noticed myself developing a headache toward the end of the day. I realized I was parched and hadn’t taken the time to refill my water bottle or empty my expanding bladder. I stopped, breathed deeply, went to the restroom, filled my water bottle, and noticed two thoughts floating into my consciousness. The first was something Ben, my husband said to me a while back. “I feel like I get your leftovers sometimes.” Ben spoke those words to me almost two years ago and they cut right through me. At the time I was angry with him for saying what he said. After all, I was working my ass off trying to survive graduate school so I could do my part to change the world once I was done. Couldn’t he see that? Two years later, post graduate school, and post many, many counseling sessions I have realized how much truth there is in those words. I often get my own leftovers, let alone having anything left to give my partner. I’m really good at what I do, and I’m passionate about what I do. It feels good to do well at my job, but I need to remember to maintain a sense of self in the midst of it.

The second thought that floated into my mind as I took a moment to notice my own needs was, “Love thy neighbor as thyself.” A friend of mine recently shared a reflection that focused on the latter part of this quote. The call to “love your neighbor” is why I do what I do, but I too easily forget about the part of this ancient commandment that instructs me to love myself. This commandment does not say, love your neighbor instead of, or better than yourself; rather it says “love your neighbor AS yourself.” If I neglect myself, my efforts to take care of others will always be lacking. I am learning that the most authentic and complete love and care for others must grow out of a deep love and care for myself. Easier said than done. I can love others so much more readily than I love myself.

So, my prayer this day will be for grace as I learn to love and care for myself so that I might more completely love and care for those around me.

Promises to My Future Patients

I start my first job as a Nurse Practitioner tomorrow. I’ve been anticipating and ruminating over this next chapter of my life all summer. Without intending to, I began a list in my head of promises to my future patients. They are as follows:

  1. I promise to listen. I can’t do my job well if I don’t know your story. You are the expert on you. There will be times when I fail at this, and I ask your forgiveness in advance for the times I make assumptions and discount your story. I will strive to make you to feel heard and seen.
  2. I promise to remember how vulnerable it can feel to be a patient. I remember being a patient when I was 18 years old and had no idea what to expect. I will remember that feeling and do my best to make you feel comfortable.
  3. I promise to let you define what health is for you. My idea of health is not your idea of health. My job is to help you set your own goals, and then to walk with you as you strive to meet them.
  4. I promise to be patient with myself and with you. Slowly by slowly, brick by brick we will walk together toward health. This one is hard for me. I am used to jumping in with both feet and running hard. Then, I burn out. I will try to slow down.
  5. I promise to take care of myself. When I enter into a space with you I want to be present, and in order to do so I must tend to my own needs. I’m still learning what those needs are, but I will do my best to meet them as they arise so that I might be wholly present with you.

Thank you in advance for sharing your stories with me. I promise to cherish them always.

Dance with me. Hope with me.

Natalia-Koren-Circle-danceI spent three days of my spring break listening to people at a global health conference speak about the unspeakable violence of health inequity in our world. I say violence because the inequity includes millions of unnecessary and preventable deaths. On the last morning I heard Dr. Paul Farmer, who had returned from Sierra Leone just yesterday relay the tragic death of one of the only two surgeons in the entire country. He died from Ebola. Let’s be clear about the fact that the magnitude of the Ebola outbreak was absolutely, without a doubt, unnecessary and preventable. Sierra Leone is home to a large supply of rubber; yet a major failure in the effort to slow the spread of Ebola in that very country was the lacking supply of rubber gloves provided to healthcare workers on the front lines. While you and I are driving around on tires made from rubber, physicians and nurses in Sierra Leone are going without gloves. Violence. There are solutions, but they require preferential treatment of the poor. They require that humanity radically change her priorities.

I left the conference with a jumbled mess of ideas and emotions in my mind. I walked a mile through Boston’s atrocious spring weather to the Isabella Stewart Gardner Museum in hopes that maybe some beautiful art would offer some clarity; I was not disappointed. For reasons unbeknownst to me, a kindhearted museum employee invited me into a Boston Children’s Chorus concert for which I had not purchased a ticket. Maybe she sensed that the music inside was just what I needed. This choir is made up of children between the ages of 7-18 and spans races, religions and socioeconomic status. The theme of the concert was “Conflict and Courage.” It provided a luscious space for me to both acknowledge the feelings of anger and despair I feel when I think about the gross injustices of our world, and allowed me to cling to the craziness of hope. Coming from a science focused conference, I was struck by the power of art to penetrate so deeply. Following are the lyrics from two songs sung by this beautifully diverse group of children. The first offered me space to grieve and the second encouraged me to remain hopeful.

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Slow down.


I had coffee with an Ethiopian student from the School of Nursing the other day and I asked him what he missed about his home culture. His response was simply, “time.” I understood fully. He went on to explain that when he was living in Ethiopia he could stop and have coffee and chat with a friend for an hour in the middle of the day. I experienced the same while I was there. Even though I had a ton of work to accomplish, I still had time… time to think, time to talk, time to sit. In my first week back from Ethiopia, I sensed myself wanting to jump back into the rat race of life here, and I have been trying to resist every since. This quarter I have had rural health rotations, which has made life a bit busy with the weekly 9 hours of driving. On the up side I have cozied up to some great podcasts. Right now I’m sitting in a cabin in Winthrop, WA by myself. I don’t spend much time by myself. Sometimes I’m alone at home, but there is always a checklist of things to do while I’m there. Rarely, if ever do I just stop. I could have driven home tonight, but I decided to live into the value of slowing down, so I’m spending the evening alone in the woods. When I first arrived it felt a little awkward. I’m used to Ben putting the music on and then together figuring out what the evening will look like. Tonight it’s just me. I eventually settled into the space quite nicely. The crackling fire is doing a fine job of keeping me company. I know my life won’t always afford me the space to embrace being alone, but I’d like to try and take the moment’s when they come.

Monastery Rehab

I’ve been meaning to write about this for a few weeks now, but leaving Ethiopia and arriving in Tacoma has monopolized my time. My thoughts returned to monastery rehab last night as I watched a film entitled, Calvary with Ben. The film chronicles a week in the life of an Irish priest. It’s a week of particular importance for the priest, as an unknown congregant has declared that he will kill the priest in a week’s time (don’t worry, you find that out in the opening scene of the movie). The movie weaves its way through the stories of the flawed congregants, as well as the imperfect priest.

Calvary brought my thoughts back to a trip that Kate and I made to Bahir Dar before we left Ethiopia. We had a unique tour guide who lead us around Lake Tana and walked us through a couple of island monasteries. At the second monastery, we were greeted by the warm smile of a young monk. At the conclusion of our visit we were invited to share a meal with the monk. Our food and “beer” were blessed by the head priest and we ate our fill of injera and shiro. Our guide informed us that he knew these monks well because he had sent addicts from town to this monastery in order to dry up. I found this news unbelievably encouraging.

As the film last night reminded me, our world is full of hurt, struggle, and pain. This is where the church must exist, in the midst of the mess. The church is a place for pain, hurt, struggle, questions, confusion, ugliness, and exhaustion. “Come to me, all you who are weary and burdened, and I will give you rest.” Christ does not speak of solutions or answers, but rather simply promises rest. Respite and repose are what is offered rather than ease and explanations. I think there are moments of clarity to be found within the space of rest, but that is not the promise. Simply rest.

I imagine the battered and defeated addict, carrying all of her hurt and pain onto this island monastery and finding “rest for her soul.” No judgement and no easy solutions. Ah. Sweet Jesus, that’s what it’s about. Thank you for the places and spaces in this life where we find rest. I pray for those who are plagued by grief, strife, and struggle, may they find your rest. May your church around the world be a place that provides divine rest for all those who voyage through life.


Lunch with a monk.


Our tour guide.


Lake Tana

Poverty and Ideas

I had dinner with a newly arrived, German anesthesiologist the other night. It often amazes me how much I have to talk about with someone I just met, when the context is an overseas one. He is working to enhance the education of anesthesiologists here in Ethiopia. I asked him, casually how things have been going. After thinking for some time, his response was two-fold. He first said that sometimes he feels like he can’t quite figure out why he’s here. The people he is supervising seem quite well qualified and he is quite unfamiliar with the drugs and equipment they are using. “What do I have to offer?”

The second part of his answer went something like, “what is wrong with Ethiopia?” He is currently reading a book called Cutting for Stone, which takes place in 1940’s Ethiopia, a fantastic read if you haven’t found your way into it already. We were agreeing that the vivid images in the book seem not so different from what we are seeing today, more than 70 years later. So, why can’t countries like Ethiopia get it figured out?

I started doing some digging and not surprisingly the main issues repeatedly mentioned as responsible for Ethiopia’s current situation were pervasive poverty largely due to corrupt governments and “crony capitalism,” coupled with a long history of conflict. Well, what are we supposed to do about that?

Today I read an article about the city of Camden, NJ, which mentioned that 40% of Camden’s residents live under the poverty level. Ironically, that is the same percentage of Ethiopians living in “poverty.” Now, obviously “poverty” in the U.S. is vastly different from “poverty” in Ethiopia. I doubt very many Camden residents are living on $1.25/day. The point is, “poverty” is everywhere. None of us have it figured out.

Of course I have no answers to the problem of poverty, just ideas. But I guess the world runs on ideas, doesn’t it? Even those who claim to have the answers, really only have ideas. But answers always starts with an idea.

I think my German friend’s two-fold answer to my casual question was perfect. He both recognized that he doesn’t have all the answers, while at the same time allowing himself to wonder just what the answer might be. That is the birthplace of ideas.



A single mother working at a local NGO to support her family.


A group picture from the first SCOPE steering committee meeting here in Gondar. Some ideas were born there.


Kate, the other SCOPE fellow and some of the members of the steering committee brainstorming.

Notice the Beautiful Things

A recent increase in rainfall altered one of my routine morning runs a bit. I arrived at the river, which I usually cross easily by stepping on the largest stones jutting out of the water, only to find that the water had risen and my usual path was obscured by rushing water. I watched as men and women of all ages walked across the river through the water. I really didn’t want to get my running shoes wet. Soggy running shoes are fine at the end of the run, but I wasn’t even half way through yet. Suddenly, I spotted my savior. I man of 50 years or so had been standing on the edge of the river peering hesitantly at the other side. He was carrying what looked like a couple of very heavy bags, one in each hand. Just when I expected him to turn around and admit defeat, he started across the river. He hopped from stone to stone and was completely dry when he made it across. All I had to do was follow his footsteps.

I laughed a little to myself as I started across the river in the shadow of the man with the bags. My shoes stayed dry. I never listen to music or podcasts when I run, so I was alone with my thoughts as I continued on. The man from the river lingered in my mind and reminded me of how often we discount those from whom we have the most to learn. We approach a situation and immediately start sizing it up, assuming that we are equipped to determine the best way to proceed. I spent close to 5 minutes standing on the edge of the river attempting various paths across before I looked up and realized that I could learn from the unassuming old man next to me; a man who has likely lived with this river every day of his life, rainy season after rainy season.

Working for the summer in a country scarred by wars and pervasive poverty, I have often felt overwhelmed. The man with the bags reminded me of a lesson I have gleaned from a number of my grad school classes. People are resilient. Learn from their resiliency. When I see a person or persons facing a seemingly insurmountable obstacle I immediately start thinking about how they should maneuver through or around it. Instead I must sit and watch. I do myself, and them a disservice if I fail to notice what is already working.

As I walk through a clinic here in Ethiopia, I am tempted to focus on the lack of running water, the unreliable electricity, the seeming disarray, and the fact that most of the patients probably should have presented for care days ago. Then I watch a pregnant woman receive care. I watch her HIV test turn negative and her blood pressure read within normal limits. I watch the midwife warn her about the danger signs of pregnancy and childbirth and instruct her to return to the clinic as soon as possible if she develops any of them. I watch a nurse hold a sick child and prescribe antibiotics in order to hasten his return to a healthy state. She may be saving his life. I think to myself, “there is a lot that is working here.” I want to make it look “pretty,” but in reality there are a lot of beautiful things happening right in front of me. I can hear my professor’s voice saying, “notice those beautiful things.” Okay, I’ll try. The next time I come to an impassable river, I’ll look to those around me and notice how they are getting across before I decide I need to build a bridge.

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A beautiful woman at the Dabat clinic.

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A beautiful face at the Dabat clinic.


Ethiopia FB-860I just returned from the Simien Mountains where my soul found the expected respite that has always greeted me when I wander into the mountains. Breathtaking views, playful monkeys, elegant hawks, vibrant flowers, fresh breezes, cleansing rains, and the smell of wild thyme, which speckled the hillsides, were our companions. I found myself wishing I could bottle the smell of the thyme. My virologist friend, who traveled with me, assured me that people are working on making that very thing possible, but the technology just isn’t there yet. Plenty of pictures and videos were taken, but those things never quite capture the entirety of an experience. The physical moment of being present in a place can never be fully detained. Mountains have always played an important role in my life. From family vacations to summer jobs I have sought their company. On the rare occasions when I meditate, I often find myself trying to find my way into the mountains where I am afforded clarity of thought and peace of mind. It’s a place I know well because I have been there often.

During my down time I am reading a book called The Plague by Albert Camus. It is about a small port town in Algeria that is stricken with the plague. At one point in the book, the town’s doctor who is charged with fighting the incurable disease, is listening to the radio and hears the emotional cries of cities and towns, near and far, ringing out their support for those confined within the walls of the town. In response, the doctor’s thoughts point out the great chasm that separates those who are suffering within the city’s walls from those who sit comfortably outside of the sufferers’ world. He speaks of the, “incapacity of every man truly to share in suffering that he cannot see.”

We live in a world filled with suffering. Suffering people can be found in every corner of every place. During my quiet time in the mountains I found myself reflecting on the value of experiences where I have been afforded the opportunity to sit with those who are suffering. In the same way that a picture will never bring me the full experience of sitting on that mountain top, a news story or a book will never tell the whole story of suffering. We are incapable of comprehending suffering from a distance. I have to touch it and smell it in order to recognize its complexity and have my thoughts and actions changed by my encounter with it. Time and space may explain the distance between ourselves and the suffering of the world, but we also have a choice. We can choose to see it, to be affected by it, to be changed by its reality.

My thoughts as I left the mountain were dominated by thankfulness. I am thankful for the opportunity to see not only the suffering but also the incredible resiliency of the people here in Ethiopia. My hope is that my eyes will remain open to both the suffering and resiliency of all those with whom I come into contact, whether half way around the world, or right in downtown Tacoma.

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Taking in the view and enjoying the monkeys.


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Girls in Addis playing futbol.

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The end of a church service in Lalibela.

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Beautiful church in Lalibela.

It is worth it.

Her age is 20 years. The skin on her face is dark with a golden hue, and is as smooth as well churned butter. She is shy, but I can see a fierceness burning beneath her averted gaze and sweet smile. I feel awkward asking her questions but there is so much I want to know. What are her days and nights like? What tasks consume her time? What thoughts consume her mind? What are her worries and cares? What are her passions and loves?

The mother is at the Azezo Health Center for an antenatal care visit. The child growing inside of her took form 28 weeks ago and this is her first visit. You can see the love she has for the child in the way she strokes her belly with her hand. You can see her love for the child when you imagine her trudging an hour through the mud to cover the ground between her rural dwelling in the hills and the health center where she seeks care for herself and her baby. You know it is not easy for her to come. She has another little one at home to care for. Her daily responsibilities are vast and consuming. She came because she knows it is good.

The midwife asks her questions about her health history. “When was your last menstrual period? Do you have any chronic illnesses? Have you ever had malaria? Do you use an impregnated bed net? Can we test you for HIV?” She answers with single words. “Yes, no…” When she lies down on the exam table the midwife manipulates her swollen belly as she attempts to determine the lie of the child, and estimate the gestational age. The small room is crowded and two eager midwifery students gaze on and drool over every word their wise teacher offers them. I know what it’s like to want to know everything, to want to learn it all right now. But don’t forget about the person lying in front of you, I find myself thinking. Be present with her. Be curious about her.

After she is done in the exam room I walk in silence with the mother through the waiting room filled with cries and coos as mothers holding and feeding their brand new infants wait in the immunization line. We walk outside and across the muddy grounds, which try to steel my slip on shoe from my feet once or twice. We arrive at the window of an adjacent building. The lack of a common language prevents us from sharing words, but we communicate with touches and smiles. She offers her blood and urine to the laboratory technician for examination then sits outside on a covered bench to wait for the results. It’s warm and sunny and she invites me to sit next to her. Kefyalew, our trusty translator arrives on the scene and we begin a brief conversation. She delivered her first baby at her mother’s home as is customary in her village. I say a quick prayer of thanks that the delivery was free of complications and that mother and child are alive today. She says she wants to deliver her second baby at the health center and I offer my encouragement in support of her decision.

Her lab results come and we walk back to the exam room to present the completed lab slip to the midwife who has a few more questions and teaching points and then she is free to walk back home through the mud. We say good-bye and I head back to the University Hospital in a bajaj.

This mother carried her pregnant belly an hour through the mud and postponed the duties that will surely await her when she returns home, for a 30-minute visit at the health center. Is it worth it? Does she really need to make the journey again in 6 weeks for a similar visit? She is healthy and her baby appears to be healthy. There was nothing abnormal in her labs. She would probably be fine delivering at home by herself again. But what if they did find something? What if her blood pressure was high, or the baby was breech, or her HIV test was positive… She must come back. I pray she comes back. I pray she tells her friends and neighbors to come. I pray this prayer on behalf of all those whose lives have been altered due to the lack of this care. I pray that the work I am involved in here sees the realization of its intended effect, and brings more women and children to health centers for this precious care. Is it worth it? It is certainly worth it.


A fierce mother seeking care for herself and her unborn child.


A group of priests and religious women who have been trained in the importance of ANC, HIV testing, PMTCT and related topics. They refer pregnant women to the local health centers for care. Their passion for their work is inspirational.


A healthy mother and her baby.