The Heart of a Teacher

“The Lord God has given me the heart [or tongue] of a teacher,
To know the word that sustains the weary.
Morning by morning he wakens—wakens my ear
To listen as one who is being taught.”
Isaiah 50:4

The opportunities to listen and be taught have been many, but in contrast to previous visits here, I have also been given opportunities to teach. This past week has been particularly rich in that respect.

On Tuesday, I gave the weekly “Continuing Medical Education” for the hospital staff (doctors, nurses, clinical officers, but also it seems housekeepers and maintenance men). I had done that last month, both here in Lugulu and at the district hospital in Webuye, on hospice and palliative care. This month, the topic they had requested was diabetes. I have many diabetics in my practice in Lancaster, and in some small way I came to Kenya to get away from diabetes, but of course it is here as well, and increasing dramatically as diets change. The big challenge is to fashion a simple and reasonable approach from the very limited resources we have; with most of the medicines we have at home not available here, with just one available kind of insulin, and of course the logistics of keeping patients on insulin when mostly they have no refrigeration and little concept of taking medicines for an indefinite period of time.

On Wednesday morning, I gave “the message” for the staff morning devotionals, as I have about once a week since coming. The hospital chaplain has asked me to use these opportunities to “teach the staff about Quakerism” (very few on the staff are Quakers). Always a challenge, but especially when the usual model is a “shouting” and somewhat manic type of oration that is very big on the wrath of God (a recent example: from Numbers 16, where the earth opens up and swallows those who dared to oppose Moses). Not my style…

I talked about the importance of having “the heart of a servant”. I told a story about a cleaning woman in one of American hospitals, who was doing her job of mopping the corridor floor when she heard a confused and distressed elderly patient crying out for his daughter, who had long since left. She put down her mop, went quietly to his bedside, and just held his hand until he quieted down and then drifted off to sleep. And then she went back to her mopping. The question arises, would her supervisor reprimand her, because she had departed from her job description, which was only to clean the floors? I then went on to tell (not read) another story: a man was going down from Jerusalem to Jericho, and fell into the hands of robbers… The priest and the Levite who passed by on the other side evidently felt that their job description did not specify tending to the man in need; their job was to keep themselves pure and holy so they could perform the Temple sacrifices. “But go and learn what this means: I desire mercy and not sacrifice.” The Samaritan saw his job differently: to love God, and in so doing to love the neighbor, the one in need, as himself. We have the example of Jesus, who was willing to do the job of the lowliest servant by washing the feet of his disciples, and who said, “The Son of Man came not to be served but to serve…”

On Wednesday afternoon, my final session with the family medicine registrars in Webuye, I tackled an ambitious topic on clinical reasoning and cognitive errors, with I hope at least some success. For an introvert like me, teaching in front of a group is always tiring, but when doing this cross-culturally it seems to be especially exhausting.

I now need to start preparing for the three day palliative medicine training next week, which will be my last official duty here. It turns out the medical director from Nairobi will not be able to participate, so she has delegated to me the responsibility for several of the talks. The way the training has come together on short notice, with the cooperation of both hospitals, has felt like this is the most important reason I am here.