the sustainability of mercy

(we need to buy a guy a leg)

My view hiking after clinic earlier this week. Sun poking through the clouds, and a good reminder of God’s grace and love for the world.

Dear Friends,

Rainy season has finally descended upon Guatemala, bringing cooler temperatures and greener scenery after an incredibly hot and dry spring. I’m happy to report that the gang violence has somewhat diminished in Zone 3, and between that and the change in weather, people are feeling a little bit calmer.

I wrote about this patient a couple of years ago… this photo is from that time when he had finally had his right leg amputated after over a year of festering infection that eventually threatened his life. He has advanced diabetes, and his right leg was hit by a motorcycle which caused a fracture plus open wounds that just… never fully healed. I had treated that infection numerous times, sent him to the hospital. He disappeared for a year or so and when he came back to clinic on this day in August of 2022, I had to leave the room to cry in the bathroom. He’s my age, has three kids the same ages as ours, and the dejection on his face and my sense of failure in the thing was just too much.

The rest of the story is less awful though. He kept coming to clinic, and we eventually got his diabetes more or less under control. He hasn’t succumbed to kidney failure or blindness the way some of my amputees have, and has seemed more hopeful, possibly even joyful at times. His wife sells food on the street to make ends meet, and one of his kids is working to help out as well.

Earlier this year, he came to clinic on crutches for the first time. For anyone that has had to use crutches may recall, they are a tough mobility choice long-term. He told me he was trying to stay in shape and that sitting in the wheelchair drove him crazy. He asked if I knew anyone that could fit him for a prosthesis so he could get back to working and providing for his family.

Incredibly enough, there is just such a place. Transitions is a non-profit ministry in Antigua that builds prosthetics and customized wheelchairs, and I was able to take him there for an appointment in April. After six weeks of physical therapy, he had a follow up appointment this week and they were able to set him up for prosthesis fitting. Feels like nothing short of a miracle.

The prosthesis will cost $3300 to build, and I need to raise that money ASAP. (The same sort of custom prosthesis would cost easily ten time this amount in the United States, so this feels like a really good deal.)

Here’s the thing, and why it has taken me so long to put this email together… Paying for these sorts of things isn’t sustainable, and it gives me heartburn because I wonder how many other guys are out there, just like this, that need help connecting with and funding a prosthesis.

We are also out of insulin in our clinic since late April, and don’t think we’ll be able to restock until at least July, leaving over a hundred of my patients that rely on insulin to either buy it or just go without and risk medical catastrophe.

I heard a talk recently on the three-legged conundrum of “Good Samaritan” ministry work. There are three components: excellence, sustainability, and compassionate care for the poor. You can really only have two things at one time. If you do work with technical excellence and sustainability, as many large secular NGO’s do, you sort of lose the compassionate, granular care for the poor. If you do compassionate care for the poor with an eye on sustainability, that usually means you operate on very limited resources and the excellence suffers. (This is where I’ve been for the last six years in this diabetes adventure.) However, if you provide compassionate care for the poor with excellence, you will have sustainability problems because that requires resources that just don’t exist in the local context.

Christian missionaries doing thoughtful development work often get hung up on the idea of sustainability. There are lots of mission projects that depend entirely on funding from abroad, and will necessarily fold whenever the foreign missionary retires/dies/quits/burns out. This seems like trauma upon trauma, and serious malpractice in terms of colonialism and regard for human dignity. We have tried so hard to avoid those mistakes, primarily by submitting to national leadership in all aspects of our work, and trying to only work within the confines of Guatemalan ministry work.

I don’t think it’s working out all that well, though, and the moral injury of standing by and watching catastrophe after catastrophe unfold in the lives of my patients is burning me up. Burning me OUT, to be honest. I don’t think this is what Christ has called the church to— He modeled a non-sustainable method of healing the sick, feeding the poor, pounding the pavement, washing feet, and ultimately crucifixion for the people he loved. Over millennia, the sustainability of the church’s work is the persistent generosity and love of God’s people for the world. —Of your and my generosity and love for the people of Guatemala, to be real specific.

To that end, we are pivoting a little bit. I’ve opened a separate project fund at Serge to collect funds for the diabetes program, and am hoping to maintain a healthy balance as a backup resource to cover gaps in the normal care we provide at the clinic. We have usually either pulled from our ministry fund (in our family account), or used extra money we had saved to pay for these sorts of things, and it’s stressful to wonder if we will be able to cover school tuition in the fall if we shell out for extra insulin and a leg prosthesis in June. Honestly, I hate asking for money and it makes me nervous to bother people that already generously underwrite the costs of our work here to pay for something else, but I am reminded that God owns all the cattle on all the hills, and that His generosity really is boundless. Many of you (certainly not all!) have deep pockets, and deep reservoirs of generosity. I have heard many of you say over and over, “if you need anything more, just ask.”

A page from our family morning devotionals, from Every Moment Holy by Douglas Kaine McKelvey.

So: here is the link to the fund. Because it is a special project, the administrative fee is lower than for our general fund, and I will give specific receipts to donors so you can see exactly how funds were utilized (i.e. meds, or labs or the aforementioned leg prosthesis).

I also want to say that we very much need our regular giving to continue. This is a side-thing, an extra resource we feel called to build in order to improve project excellence and tangible good in the lives of the people we serve. My faith is feeble, y’all. I am reminded, to my shame, that there is so much resource in the hands of heroically generous humans, that give to us and give to other small projects that just couldn’t function without that help. It’s my lack of faith that has avoided asking until now, and I am sorry I haven’t really given you the opportunity to be involved more substantially until now.

We’re grateful to you all, and I am reminded over and over that we are incredibly blessed to be doing this work in this way, as a community of believers working toward the good of God’s people and for God’s ultimate glory. Honestly, makes me want to weep.

I’ll send a proper update with more family news next time, and until then, we are affectionately yours,

Abbie & Jeff