discharged with hope

It's something your taught never to do, in the hospice world, don't predict how much life some has left. We don't know the number of breaths one will take. But, I suppose, after being in the field of death and dying for sometime, you've seen enough to start to feel you know when someone is nearing death.

Well, I guess there are many things that have surprised me in working with the palliative care program here. Many things have been heart-wrenching but this one thing has been amazing. Nothing short of miraculous.

We're in the process of discharging 5 of our patients (that's a third of our census. We're wee.) Discharging them because they are no longer declining. They no longer seem near death. That's great you might say but the thing you have to get is that almost every patient we start on our program is ill-- VERY, very ill. Typically we don't start anyone unless we feel they are going to die in the not so distant future, unless there is major intervention from the Lord. But, far more often than I ever expected, it's looking different. And, it surely isn't from amazing medical interventions we provide! Oh, no. It's been about love, about education, about consistent visits that gives value to a previously unvalued life. It's reminding them and showing them that there is always hope. I think if you sat with 5 of our dear patients they would tell you a story that you'd find hard to believe...

...one's a story of a boy, 6 years old with osteogenesis imperfecta (ie brittle bones). He used to cry in pain. By getting regular Tylenol and simple teaching with his family on how to care differently for a child with this disease, he got a wheelchair and in is in school for the first time in his life...

...She's HIV + and had TB. A stroke put her in the hospital with right-side hemiparesis. For a long time the family struggled with "embarrassment" that she was totally dependent in her activities of daily living. I'm pleased to say that her sister-in-law took it upon herself to give this woman the medicine she needed, keep her clean and feed her. She's now borderline overweight and cared and loved by her family. Her tears have been turned to laughter...

...We still don't understand the situation with this teenager, at some stage he had severe abscesses which lead him to several operations "taking out bone" leaving him with deformed extremities-- walking only with sticks. I can't explain what happened with him-- regular Ibuprofen, a Story teller (audio device with stories and songs), weekly Bible stories from a children's Bible, lots of laughs and friendship. He now is working with his uncle, hopes to go back to school next year and is walking WITHOUT sticks! Praise HIM!!!...

...Then there's a middle aged man that needed to be educated. He needed to understand his disease, the importance of medicine compliance and to be empowered to care for himself. Previously having gaping wounds on his legs, he's now often not home and we see him driving by on his motorbike...

...And finally, I remember taking this one on knowing we would not have long to care for her, she was so close to the end. With a wound on her inner thigh she could not walk. She had a flat affect, a malnourished child and a lack of hope. Wound care, disease education, songs and stories,  listening ears and words of life seem to be the cure for this dear woman. Life is now hers, may it be for many years to come...

We may not be seeing someone rise up and walk the moment after our prayer but we're seeing a lot as we walk with each of our patients. Whether they're discharged from the program or discharged into their eternity we are honored to share the Gospel, share words of life and share our love with them. And perhaps, the best thing about our job is that either way, we share hope!

Thank you Lord for your promises!

pain to peace

I wish you all could have been with me today, when we walked into that little house, to see him there, laying in pain. Nursing school 101 burns you out on "pain being the 5th vital sign". I could name you the non-verbal signs of the pain assessment in my sleep. And, if I were to explain this to a novice, I'd have pointed to this patient. Textbook.

 All the clues were there-- facial grimacing, moaning, restlessness. If I had to give it a number, we'd be pushing a 10! (1 being no pain, 10 being the worst imaginable). In America, we'd be calling in the order for morphine and I'd be confident pain relief was on it's way. We did what we could. We re-positioned, we encouraged rest. And then, I thought, he needs a new storyteller (the audio device we use to share Bible stories and songs in the local dialect). Despite the fact that he had destroyed his previous one, this was the time he needed distraction the most. I ran to the car to grab one. We turned it on and as he heard the words of his language, he alerted saying, "where is that, I need it." He reached out his hands, we gave him his player.

My friends, the whole situation changed. He relaxed. His facial expression changed. What was a grimace turned into a relaxed smile. He no longer moaned. He no longer was reaching out for his wife. He had found peace. He held the player in his hand next to his ear. When his edematous hand got tired, he switched to his other swollen hand, never  allowing the hope to be more than a few inches from his ear.  If I were to have to chart his pain now, his number would have significantly dropped. To a 3? A 2? Could I really say that his non-verbals now tell me he's a 1? The evidence proved itself on this visit. We did little but the resources did much. HE did much.

We finished our visit, gathered our things. Headed on our way. I left in awe. A holistic approach-- the beauty of not just thinking about pharmacology! Friends, I wish you could have seen it. The hope and peace was tangible!

Come for a cup of coffee...I'd love to show you the picture or walk with you to see yourself.

Peace.

Tribute: our old friend

"Have you always been this joyful? Laughing so much?"

"Me? Joyful? I never even used to talk to my wife!"

Yes, these are the exact words we heard from this man months after we started caring for him. He became one of our most enjoyable visits. We would laugh, sing and joke together. He held the history of the land in his years. He remembered when the road we drive on did not exist. He helped in clearing the forest to create the road during the colonial days. It then was the main thoroughfare, then after the civil war, the bridge was bombed out and never repaired and now it's our one way dirt track. The dirt track that takes us to these treasured souls.

He was a bit of a medical mystery to us. I'm not sure he'd ever been to a doctor. He'd surely never seen a stethoscope. He reported that his leg had been so swollen and caused him so much pain that he could hardly walk. The pain and body itching kept him up at night. It grieved him, that because of this ailment, he wasn't able to be in the field helping put food on the table for his wife and family. He's one of the few patients that we have that has only one wife. And, once he was feeling better, the joy that they had in the presence of each other was evident. If he was resting, she was shelling her beans near by-- they liked to be together. They loved each other. 

One of the most beautiful things was the simple interventions we were able to do to help improve this man's quality of life. It was impossible for him to get to any sort of health care facility so for us to arrive at his home eager to help was a real blessing for him. And, the response that we saw from giving him calamine lotion, daily Tylenol, Epsom salt soaks for his leg and something to help him sleep at night, turned him into a new man. And fit him back into his old trousers that hadn't fit over his leg in years! Wow!

 Yes, these simple things improved his life but may I share that what REALLY changed him, as a man, was his having his very own audio story-teller. He cherished this bit of God's word and songs of praise. One day when we were visiting and trying to do an interview with him, he wouldn't turn the audio player off. So, in order to get his attention we asked to have the audio player. Well, that didn't work either! He was so concerned that we wouldn't give it back to him that NOW he couldn't concentrate on what we were asking because he wouldn't take his eyes off of his audio player. Yes, he cherished the word of God in his shirt pocket more than life itself. On one visit he was so sad because the cat had knocked the audio player off the roof (while solar recharging) and it no longer worked. He reluctantly let us take it so Chad could repair it. He didn't want to miss a week, a day, of not being able to hear the Word of God! 

We were delighted to be reunited after my 7  months away from Mozambique. I thoroughly enjoyed seeing him, despite a decline, we were pleased at how he was still doing. Laughing and joking with us-- singing and dancing...

...remember when he said he never even used to talk to his wife because he was in so much pain? Praise the Lord!

I took this video last Thursday. I share it because I know he'd be so proud to to have people see it. He was full of joy. As we left last week he said, "Next time you come, I'm going to be dancing on my feet!"

Well, he is right, this week he is dancing on his feet, only he's dancing on golden streets!! Maybe he knew that in a weeks time his body would be healed to fullness and he would be in the presence of His Glory!

We will miss you our old friend. Thank you for all the laughs and all the praises that went up from your home! We praise the Lord as we imagine you dancing on your feet this week! Thanks for sharing your life story with us!

Until...

Tribute 2: a family man

You can tell a lot about an individual from their family.
This patient I only got to see a couple of times upon my return.
From that I learned--
He was a family man.
He cared for and provided for his family.
Many were there, surrounding him on his last day.
Not only were they present out of social obligation but they were present with concern.
And, to see the care and responsibility that his oldest son was already taking on tells me that his father has been his role model, his example, his hero.
This man has obviously worked hard,
on each visit there was produce and harvest busily being prepared and distributed--
not easy horticulture in this desperate land.
After our last visit we didn't know what to pray.
His situation was bleak, his diagnosis grim, not just in Mozambique but it would be anywhere.
What we knew was we didn't want this big, strong man to lose his dignity,
To have to be cared for like a child,
for too long.
We knew this provider would struggle with these changes.
So we prayed, I prayed, asking for mercy and freedom from suffering.
Then, within 36 hours of our last visit, he took his last breath.
To be home with his Father, I pray.
And left in his legacy are his beautiful children,
some being teeny, tiny replicas of this strong, stoic man.
May they not soon forget the care, love and concern their father had for them and their future.
I wish it had been different,
I wish there had been more thorough, wise treatment for this man,
his days weren't meant to be this short--
he had much to teach
and he taught well.
What a privileged it was to know him and to advocate on his behalf.
You are remembered in our hearts.

Tribute: my little guy

To you it may just be a statistic. Besides, what's 1 lost in the mass of 1.1 million who died of AIDS in 2013 (WHO). And, it's far away, they should know better, we have our own problems, whatever it may be that makes you feel separated, far from and really, not connected to problems on the other side of the world. Well, dear friends, I'm here to say, they're not just a number. There's no dignity in regarding a soul as a statistic.  We each have a story to tell. We each have a purpose to share. There are stories that must be heard. Our patients that we care for deserve to be known, they are NOT just a number, far-away....

Tribute #1: MY LITTLE GUY

Born somewhere between 2005 and 2007 he lived with his mother and father. His older brother was there, perhaps others. I'm sure as he learned to walk, he learned to work at the same time. Hauling water, gathering fire wood, cooking over the fire, working in the field. I know he loved his sudza (similar to corn flour grits) and dried fish. I don't know when he started to be sick. Too early though, I know that. I wonder if he ever got to be a kid, carelessly playing, learning, loving life? When I first met him I pegged him at age 4. I was several years off-- blinded by his malnutrition, skinny legs, tumored face and broken soul. By this age he likely had already cared for and watch his mother and father die. And then, finally, grandma was called in-- to step up to care for this critically ill child. She did the best she could despite being sick herself.

Dear friends, he wasn't just a sickly child. That's not his story. He was who wiggled into my heart and the hearts of everyone who got to meet him. He had a tenderness, a gentleness that was paralyzed by a disease that held him back. He was so excited to receive an audio player with Bible stories and songs of faith. Within weeks he had all the songs memorized. And in a few months he was reciting a-long-with the 2 hours of Bible stories-- delighted to hear the word of God in his mother tongue for the first time. His grandma never took him with her to church. He listened to his player so much that within a year the speaker was worn out, we replaced it for him. The thing that grieved me so much about my 2 year involvement in his life was that he wanted his situation to be different. He didn't want to not be able to help his grandmother. He wanted to go to school. He wanted to play with friends. Of course he didn't want to be excluded from other children because he wasn't well. He wanted more than anything for his situation to be different. When asked what we could pray for, he requested, "Please pray that I don't have to take my tablets anymore." I cried with him many times because I too wanted his circumstances to be different.

There were periods when we had glimpses of all that he was meant to be. When he was well enough to be vivacious and full of zeal. Like the time when we came to visit and he was "out" but, as we walked to his house we heard his audio player playing and he came running from behind us. Chad called out, "He's coming from behind you." There he was, chasing us down, winded but ready for his visitors. Or, the time that he saw us walking up to his house and he came out of the veranda chanting, "Sister Dara! Sister Dara!" We would sing, we would dance, we colored and told Bible stories. His million dollar laugh and smile was worth anything that I may have had to sacrifice to be in Mozambique and to start a palliative care program.

We sat with him for hours at the hospital waiting to be attended. We fought to get his cardiac situation checked into. The doctors did all they could. Grandmother did the best she could. He gave us memories and confirmed again and again that yes, this work is worth it, even though it's hard.

I didn't get to see him in his last days. He couldn't hold on until we got back despite asking when Sister Dara was returning. He was fully aware of his situation of injustice until his last breath. The morning before he died he told his grandmother, "Vovo, I'll never live old enough to build you a new house (as would be culturally expected of him)" his was tired of the fight. He passed away a couple hours later.

Our team grieves over this lose. My heart will weep for years because of the love I got to experience for this one. And, may I tell you what a blessing it is that one soul from Remer, Minnesota gets to tell the story of one soul in Cafumpe, Mozambique. Two distant worlds with one loving Father-- caring equally for each of us.

My little guy, I'll see you on the otherside! I'm so glad you're no longer in pain. Tell Jesus we can't wait to be with you both and oh, will we dance!

No, he was not a number.

we miss you already

 Dear Friends and Family,

You have been so good to us. We have been so blessed by being "home". As we head back to our other home we go with hearts divided. We love you and know that our prayers will bind us together. It's bitter-sweet to have so much love spread around the world...until we meet face to face again

WE MISS YOU ALREADY!

We love you! Thanks for your love and support.

The VBs

(Amazing pictures courtisy of on3 photography)

happy birthday Mvura Ya Upenhu

It's hard to believe that 15 months ago one of my biggest dreams became a reality. Now, after spending the last 6 months sharing about it, I'm eager to get back and dive in again. I've been in awe of how it has all happened with such blessing. After I pour my heart out at church after church, many people come to me and say "it must be so hard what you're doing." And yes, it is. It is so hard. But that's why I do it. That's why I have found some amazing young Mozambicans to do it with me. Because, if we don't, who will? Any good thing that we can do is more than our dear brothers and sisters would have without us. I can't imagine not doing it because it "might be so hard." That's why we do it and, as a result, I think we're blessed most of all.

 This little boy hears Bible stories and sees his first book on our visits. In addition, he gets assessed and treated physically. He knows he's loved.

 This elderly woman who is close to forgotten gets her hair washed and cut by girls who show her love. We sang together and laughed. She too knew love until her last day.

 We drive as far as my little car can go and we walk. We talk about real life in Mozambique. Sometimes we sing, we laugh and we bring light into the darkness. May they know we are Christians by our love.

 These two have seen so many changes in their lives. Their country has been through war, they've seen natural disasters, they cling to hope and oh, how they deserve the GLORY that they one day will dwell in. We've been blessed to love them.

 And, oh how blessed I feel to have trained and work with these ladies. With plenty of their own struggles and challenges they spend their days carrying other peoples burdens and struggles. Lord, bless them-- they bring the love.

 And then, only the Lord could have worked it to bring another Hospice of the Valley nurse to the same area in Mozambique to lead the program while I cam to the US for 6 months! Not a day have I worried that the work was suffering in my absence.

 Of course we realize that change and community transformation comes with education. This day one woman's life was changed. By hosting this community meeting her friends faced their fears and realized that they could care for their friend, even in the presence of disease. The church and family/friends rallied after being educated and we actually had to discharge our patient because she improved and no longer need us! Praise the Lord.

(this is the future site of our office, please consider helping make this a reality! Donation info at bottom)

So here we are-- 15 months later. We've cared for 31 patients through that time and currently 15 patients are receiving basic holistic care through our program. We couldn't be more blessed to do the work! What an honor it is, I wouldn't want to be anywhere else!

Born from a couple hearts just wanting to care, Happy Birthday Mvura Ya Upenhu (Living Waters) Palliative Care!!!! We bless you and all the hope you will bring with God's word in the years to come!

If you would like to send a "birthday gift/support" to this "compassionate care" project please do so on one of these links:

https://asmtoday.org/africa/ (click donate and choose project: compassionate care)

https://www.rca.org/node/6594

If you have any questions please feel free to email me directly!!!! We need your partnership!

hope in cancer?

I wondered what it'd be like, the first time we three "besties" got together again. The first time we're all married women and mommas. What will we talk about? A teacher, a nurse and a missionary. We won't be talking about the latest crush. No more having to analyze "he said", "she said". (Thank goodness, we wasted enough hours of that in the past.) A bit of me was nervous, but mostly so excited to remember the past, to laugh 'til our tummies hurt, to sing Sheryl Crow and Kid Rock, to share about our families.

There was also an unwelcomed burden coming to our girls weekend. I'd much rather have been back in the dorm staying up too late eating Slap Shot pizza. Sometimes I wish we hadn't grown up so fast and now have to try to be "responsible" and face the tough stuff of life. Besides, when did that happen? But, we had to face it. We needed to talk. Even though we all hate it. 

Cancer. Blah, barf a little. I didn't want to talk about it and it was never welcome. We had to talk about it, not just as a hot medical topic but how it's affecting all of our lives. Twelve years ago when our paths "parted" (in vicinity), none of us would ever have dreamed that this would be what we had to talk about. So many unanswerable questions. So many tears. So much you'd like to change. So much that I wish would just go away. Forever. Forgotten.

I guess this is supposed to be my "line of work". And yes, it's something I think about and have worked alongside for a long time. But, it's so much different when it's so close. And my "knowledge" just confuses.They don't teach this in nursing school.

All I can find to encourage is that there's must be hope. And this is from what I've learned in life in the past 12 years. Never was it taught. 

There has to be hope. If we lose hope we're left with nothing. But, darn it, I don't know how to hope when the hope may not be on this side of heaven. This isn't something I just thought about last week. It's something I'm ALWAYS thinking about. In Mozambique, we hold suffering babies and I look for the hope. We sit with abandon men, we look for hope. I hold hands with ostracized young woman muddling around for words of hope. I walk through the "normal" impoverished world and wonder where hope is.

When my questions are so big, all I can do is look at my experiences, and hope. Although, I've never dealt with cancer, the promises of my Father don't change, no matter what struggle we're facing. My hubby shares about Revelation 7 and I know, yes, this is the HOPE that we're looking for-- "Never again will they hunger; never again will they thirst. The sun will not beat down on them, nor any scorching heat. For the Lamb at the center of the throne will be their Shepard; 'he will lead them to springs of living water.' 'And God will wipe every tear from their eyes.'" Yes, that's it! That's definitely the hope we need. But, what do you do when that doesn't feel like enough? When the today hurts too much and hope feels far away?

There's so much I don't know. I don't get it when life throws you something you'd like to send right back out of your ballpark. I don't like that "bad things happen to good people". One thing I do get is this... God hates cancer, he hates AIDS, he hates poverty. Death was not in his original plan. But, since the beginning, since there was sin, we now have to figure out how to deal with all of these difficult things.  But to me, it's crazy that, until today, we still don't know how to do it well. We don't know how to hope for our eternity. I don't and it frustrates me that no one is teaching us how. And, we still don't like to talk about it.

 This takes me having to trust my good Father to a new level. 

As I write this, I don't have my conclusion prepared. I don't have much figured out but there a are few nuggets I keep coming back to. Hope doesn't always mean cure. It doesn't always mean miracles of physical healing (yes, we know God can and does do this). There has got to be so much more to hope because God is our redeemer. Jesus washes us white as snow and that means my yucky thoughts and my sinfulness is forgotten every morning (and then I get out of bed and have to ask again). But, it's there, every single day. Hope can restore our relationships. Hope can give me strength to face the seemingly intolerable. And then, at the end of it all, hope will bring me to my eternal paradise where I won't even remember all of this pain. Hope is deeper than we allow ourselves to understand. Hope is forever. It's not only until our last breath. 

And, then, if there's one last thing that I've scratched the surface of understanding it's this-- God uses all things for good and for his glory. When we think that Satan has infected us with his wicked ways, we MUST remember, we just must, that God works "all things for the good of those who love him" Romans 8:28. All things. But, once again, it may not be on this side of heaven, this sinful, yucky side that is so confusing. We must HOPE that as we learn to TRUST Him that one day it will all be okay-- for all of those who love Jesus. And then, we will see how good it all was!

May this some how be enough to help us with our difficult yesterdays, today's and tomorrows. I do believe it is. It must be.

That's my prayer. And, while we wrestle with these questions and answers, we cherish every minute we have together. Ever photo snapped, every giggle shared and every toast lifted! I love you cherished ones! 

(Please lift up my dear friend in prayer. )

hello phoenix

If you're in the Phoenix area here comes your chance to hear about the new and exciting hospice/palliative care project in Mozambique. Come join us on Friday, January 22nd at 7pm. Email me for more information (darajeanhillstrom@gmail.com). Nede's got hugs for all and it's time you meet my "better half!" Stories, a video, photos will be shared, plus snacks and beverages! Please join us!

We're waiting to see you!!!!

We love you ARIZONA!!!!

merry christmas, happy new year

Feeling very grateful for this time and these people.

Very Merry Christmas

Best Wishes for many blessings in 2016!

Much love to you!