Sunday, July 5, 2015

The Most Important Thing –July 2015

Dear Friends and Family,
                I’m missing you all but enjoying the home that God has given me here in Curahuasi.
Lessons take awhile to sink in.  I feel like this season of my life God has really been letting 1 Corinthians 13:1-7 sink in and helping me it apply it to aspects and areas of my life.
                My version:
“If I could speak Spanish, Quechua, Aymata, and German perfectly, but I didn’t love others, I would only be a noisy gong or a clanging cymbal.  If I could speak the perfect spiritual truth in to the lives of my patients and others, and if I understood all of God’s secret plans about whether my patients will heal and live and if I possessed all knowledge about the body, illness, and what is the underlying health and spiritual problem of my patients and those I encounter during the day, and if I had such faith that could just pray and the people are healed, but I didn’t love others, I would be mothering.  If I gave everything I have to the people of Peru and given up 6 digit salaries in the US and even sacrificed my body by never sleeping or resting and just care for the people, I could boast about it, but if I didn’t love others, I would have gained nothing.”
And how does this “love” that it the only thing that God asks from us look? 
When I’m truly living and serving with this kind of “love” I’m: “patient and kind. Never jealous or boastful or proud or rude.  I never demand my own way.  I’m not irritable, and never remember who’s wronged me.  I don’t rejoice about injustice but rejoice whenever the truth wins out.  I never give up even though I keep failing, never lose faith (even when though my friends no show me all the time and frequently don’t follow through on their word), I’m always hopeful, and endure through every circumstance of fatigue, over working, and call.”
Ask any resident or missionary doctor, this type of love for those you serve and care for each day is hard to maintain when you’re overworked and run ragged.  The only answer God’s given me to achieve this love is more time with him alone in nature, in prayer and in the word each day.  Also after reading the book “Sabbath Rest” I’ve begun blocking off a day to enjoy the small things of life, not do any of the have-to’s and watch as the world (and Diospi and Peru) doesn’t fall apart because I’m not “working.” As God said in Exodus 16: 28-29 when the people disobeyed him and went out to collect mana on the Sabbath, “How long will these people refuse to obey my commands and instructions?  They must realize that the Sabbath is the LORD’s gift to you.”
It’s been a good lesson to learn here before I go to other parts of the world where maybe parts of my immediate “world” actually do partially fall apart, or at least have to wait a day so that I can spend some extra time with God.
This has revolutionized my perspective on my days.  This last six months has been a joy.  As my Spanish and cultural understanding improves my relationships continue to grow deeper and deeper with the Peruvians I work and go to church with.
The Church

Sunday morning bible class.  It starts at 8:30am Sunday morning so that it’s done in time for church, because currently the church is only one room.  Before the owner let the church use the room next door during services for the kids class, but now the building next door is rented by a furniture store.  Please pray that the church can find a better location at a reasonable price so that the children can learn in their class while their parents learn from the pastor.

Lunch at the new Chinese (Chiefa) restaurant after Sunday morning services.  From left to right: Esther is an ICU nurse from Austria, Dana is a nurse anesthetist from Germany, my mom and my dad (who visited for the month of May).

From left to right: Jemerson the pastor of the church I’m attending,  Juvenile who works as a nurse at Disopi, and Glicerio a member of the church.

Left to right: Dad again, Me, and David one of the professors at Diospi’s school (which is now kindergarten through 8th grade).


The IEP had another medical/evangelical outreach trip.  This time to a town called Antilla.  The main way to travel there is in camiones (these trailers pictured above) because the road is so bad.  We went by private trucks because I’ve had too many patients because of camiones that rolled over, and the aunt of Rosemerry (one of the government nurses that attends the IEP) was killed within in the month because a camion rolled over.  In a camion its 5 hours standing (because they stop to pick up loads/supplies).  But you can imagine how hard it is for the elderly people and those with small children to travel to larger towns.
                There’s a local health post in Antilla, but they have the only pharmacy, and because the road is bad they’re usually pretty limited in their supplies.  The government is able to  staff the health posts because they decide where nurses work.  And all doctors have to work on year in a rural setting before they can do their residency.  The hours of the health post are Monday through Saturday 8a-7p and Sunday half day.  The staff works 20 days or so and then has their free days.  They had advertised before we arrived, so that when we got there there were more than 100 people for me to see (impossible).  The doctor at the health post ended up helping me see patients.  We were there a Saturday and a Sunday.  The nurses at the health post knew the people and who was from the farthest away (elderly, widows, and single mom’s had come from 3-6 hours away walking) and helped decide who we would see.  It was a great set up because the health post staff was greatly encouraged, the people had more confidence in their doctor afterwards, and the health post told me they’d check up on any patients with chronic diseases that needed to be followed but would never travel all the way to Curahuasi.

A group of 15 members of the IEP church went. Mostly young people, but an older couple whom where a hoot too! From left to right: Mark is an American premed student interested in missions who came and worked with me for almost 2 weeks.  Anna is a volunteer from Germany.  Dana is a German nurse anesthetist.  Donna is a Peruvian nurse from Puno.  Esther is an Austrian nurse.  Marcos is the traveling pastor who works at Diospi Suyana Hospital. He visits patients in the villages and helps them connect with churches or form churches in their village if there isn’t already one.  He’s who knew about Antilla.  Antilla has a Catholic church, and the only evangelical church is an Assemblies of God.  The older couple. David. Me. Rosemery a nursing student working in the government health posts. Sarah is a German nurse. Sadith is a pervian lab technician from Arequipa who works at Diospi.  Jemerson the pastor of the IEP church and Miqui who works in IT at Diospi where with us but not pictured here.

Above: Marcos trying to decide who gets to see “the doctor.”  To the right: Mark seeing what I do all day.  He enjoyed most surgery and previously was thinking about ortho.  He spent most of his time at Diospi with the surgeon.  We’re all hoping he’ll come back in 10 years as an orthopedic surgeon.

Jemerson, the pastor, is in the middle/back in the photo on the left.  Again he is translating for me, since most of the patients only spoke Quechua.  He loves it because he gets a lot of opportunities to share the gospel because Jesus is the only real solution for the majority of their problems which include stress, anxiety, and rage.

While some of us were taking care of patients, others in our group had a program planned for the children (photo on the left).  In the evening Saturday, after clinic we had a program with a skit, games, singing and a short lesson for the whole village.
  Sunday, after a couple hours of clinic we attended the local evangelical church.  They were so honored to have us.  As is typical in the Quechan culture, every single one of us were invited to share a word or our testimony with the congregation.
                Prayers for Tuesday night prayer group at the church, young adults group Saturday night, and our up coming church retreat next weekend [we’re going camping and white water rafting :) ].

Monday Night Woman’s Group

Monday night is always a surprise.  Sometimes there are many young girls, other days young adults, other days older women, and other days an even mix.  Coming from a culture of control I have learned to trust God with whom he brings to the group and who arrives early, taking advantage of knowing them and their needs, and where they are in their journey of faith.  Various are from Catholic backgrounds.  I’ve prayed a lot about where to start with them, and what’s the most important difference and point that I want to make/truth I want them to realize.  It comes up a lot.  I often start by asking them what’s the biggest difference between Catholic and evangelical.  Many times the answer, “the worship of saints and Mary.”  I reply, that’s a sin, but that exists in evangelical church where their idols are food, sports, power, position, beauty, etc.  From reading and studying the biggest difference I see…what makes the teachings of the Catholics a different “gospel” is that they teach we are saved by Jesus’ death on the cross AND our works.  This is the central deal breaker and what makes what they teach wrong.  So when I talk to them I highlight this difference, and then encourage them to seek God through prayer, scripture, and meeting with a local church.
                Please pray for our group of women.  That they continue to grow in their relationship with God and that He places his calling on each of their lives.


Before I lived with Lisa from July 2014 until December 2014 when she returned to Germany.  Inessa, a dental assistant from German, returned from her 6 month sabbatical in January 2015 and we’re currently living together.  In the photo above she’s on the left.  She’s enjoying “Sewing club” with her friends.  Kati is in the middle, a surgical nurse.  Dominick, the husband of Kati is on the right and works in IT at Diospi.

Ultimate Frisbee!
Wednesday nights we still play ultimate Frisbee!  It’s a joy and blessing.  It started out mostly Germans and Americans, but now it’s mostly Peruvians.  It’s a great game because they can all learn how to play in one night, and we’re able to play with kids as young as 6 years together with full grown adults.  We’re still playing in the Diospi Suyana school gym, which we rent each week for $10 (which comes from my project fund) for two hours.  We usually play 5-6 per team because the gym is not that big.  Some nights we form up to 3-4 teams and rotate a new team in after each point. 

My parents came to visit for the month of May.  It’s nice because I have an excuse to travel and get to know Peru and the different areas that my patients come from.  The patients that come to Diospi come from all over southern Peru, the jungle, and as north as Lima.  Peru is interesting because it has such a variety of climates.  There’s coast, dessert, sand dunes, jungle, mountains, etc.

Me with my parents in Nasca.

The Nasca lines on the left (thousands of years old).  Lines from a different culture on the mountains below.

San Juaquin Oasis near Ica.  A natural oasis in the middle of sand dunes.  We all went sand boarding (including my parents) in the sand dunes.  It’s like snow boarding, but if you don’t know what you’re doing you just go down on your belly.  Jemerson (below), the pastor came with us, because the support from the church isn’t enough that he ever gets vacations.

                                         My dad and I at the sunset over the dessert.

Colque canyon near Arequipa where you can see Condors (the largest birds in the word).  Miqui (below) came with us on this trip.

Sunday nights
I’m still studying the bible with Rosemery and Dennis.  Both have accepted Christ but both are still hesitant to be baptized.  The teaching about baptism here is super complicated and corrupt.  Many evangelical churches teach that a baptism is for one denomination and often times, one church.  So if you go to a certain denomination and then move and try to go to a the same denomination in a different area they’ll want you to be baptized again.  There’s also a false teaching that you have to study and study and study before you can be baptized.  They separate accepting Christ and baptism.  So Luz, whom I baptized last year, was a believer for more than 10 years.  Various times she’d told the pastor of which ever church she was attending that she wanted to be baptized and they always responded, “lets study.”  And then they never got around to baptizing her.  It was so heavy on her heart, we were reading about the Lord’s super in church one Sunday, she leaned over and said to me, “I’m not baptized.”  I said, why not today.  She said she experienced such joy that she’d finaly be baptized, but when the pastor (Jemerson) found out he said, “let’s study.”  She couldn’t say no to Jemerson, but told me she still wanted to be baptized, and so I baptized her that very day.
  During the hospital retreat a pastor came from Chili and as a result of his teaching several workers at the hospital wanted to be baptized.  So we all went down to the swimming pool in the next town over where all the baptisms are done.  But the local pastors of the churches where the soon-to-be believers were attending couldn’t let the guest pastor baptize them.  They feel like they’re responsible for whether or not the baptism was done right or whether or not the right words were said.  So three pastors all went in together for the baptisms.
   For all of these reasons and also the reason that the family obligation to be Catholic is almost as strong as that of the Muslims (you are no longer part of the family, you’re rejecting the family.  Only they don’t kill you for it like the Muslims) Dennis and Rosemery have not yet been baptized.  Please pray for them both.  For their families and peace within their families.  Pray for them to continue to grow closer and closer to Jesus.

Kid’s Club
I  still help with kids club Thursday afternoons.  Please pray for wisdom on how to teach such a wide age range 3 years old til 18 years old.  Between 60-100 kids, and between 4 and 8 helpers.

Mario and Domingo Asurin
This couple are the owners of the apartment we rent.  They are very sweet.  Before David (one of the teachers at Diospi) and I were studying with them on Thursday evenings.  Since my parents visited and the American Cup we’ve fallen out of the habit.  They have a lot of interest.  Mario has a lot of questions.  They’ve visited the church a couple times.  They’re both Catholic background, but one of their granddaughters and grandsons attend the IEP.  David can really connect with them a lot better than I because he’s from a farm village background like the Asurin’s.  Pray that God continues to put a thirst in the soul of Mario and Domingo and that we can make time again to study with them.

American Group
Friday nights has always been American bible study, but now there are only 2 other American families here.  So now it’s English Bible study because various Germans, Australians, British, Canadians, and sometimes Peruvians attend.  Usually the Caire family hosts.  Prayers for the Caires, for the group, that we continue to grow closer to God.  This group is such a blessing because its one of the few group biblical messages I receive each week in English (which is so much more powerful than Spanish to me).

The Hospital
And of course, the biggest chunk of my time…the Hospital.  These 2 weeks Will and I are the only two general medicine doctors.  Martina will return and then we will be 3 until mid September, when Will returns to the States for a 5 month sabbatical, then we will be 2.  Jen’s (the OB-GYN) and his resident help with call, but that’s still only 4 or 5 in the call pool.  So I work Monday through Friday (though I started taking a day off if I was on call on a Saturday or on both Friday and Sunday call so that I have a chance to rest).  And then call 4-7 times a month (depending how many others are in the call pool).  It’s easy to get over worked but it’s a good balance of complicated sick patients, and healthy patients that have a million symptoms because of their anxiety and just need to hear the gospel.
                The longer you’re here the more you care for local people and build up a reputation for God and the hospital here.  Two weeks ago I rode my bike up with David to study with Dennis and Rossmery.  Dennis was waiting for us and wanted us to go with her to visit a sick neighbor.  So we went.  It was one of Will’s patients (we talk about the cases of the night and also complicated cases during the doctor meeting every morning so I knew about the patient, Policarp).  He was actively dieing of stomach cancer.  Dennis asked me to pray over him and then I sorted through his bag of meds and found the long acting morphine that the other doctors had talked about giving him and told him it was the most important pill to take for the pain (he wasn’t taking any of his meds because of the pain).  I answered a couple questions and the family obviously was relieved because Policarp was too sick to go to the hospital.  He passed away later that week. 
                Another patient Pilar came in two weeks ago when I was on call in with pulmonary edema because of severe anemia of hemoglobin of 4.  We stabilized him and diagnosed him with an advanced stomach cancer with liver metastisis.  We transfused 4 units of blood before the diagnosis was made, which stabilized him.  But after knowing the diagnosis, we decided to not transfuse again because we’re so limited on blood and he still had his actively bleeding tumor in his stomach.  Three days after discharge he came in again (Jen’s picked him up from his house because they were friends of the family) and died 4 days later.  I went to the showing of the coffin/body which happens the day before the burial walking home from dinner because the Curahuasi is so small.  It meant a lot to Pilar’s wife and children (he was 79 yo, and has 6 children older than me), since I’d been talking with them so much the last couple of weeks helping them do the best thing for their dad (in this culture to children play the largest role in making medical decisions for their parents).  In the States when you work in larger cities caring for all your neighbors and the people that you pass on the street each day is rare.  But it’s something special.  And it’s another way for God to get the attention of his lost children.

The Future
Thank you so much for your thoughts, prayers and financial support.  These two years are quickly coming to an end.  I’ve been praying for direction, and currently the plan is to return to the US for a month in January, and then return to work two more years in Peru.  The plan is still very preliminary.  I lack coordination with a longer term mission agency and a new contract with Diospi.  I will need monthly support for these next two years.  Please pray for God’s guidance and that he continues to coordinate all of the changes and transitions that will have to take place.
Bless you all.  Be praying about January.  I’m thinking about flying into Tulsa and then driving south to Texas, and then west to California and then north to my family in Seattle, Washington.  If you live along my potential trajectory, would like me to visit, and would be interested in supporting me monthly for the next two years let me know.  As I get closer to the end of the year and get more of the big details like sending agency in order, I’ll send a more detailed report on monthly financial need/budget.

Thanks.  Love you all so much!
Ari Cale

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