Community

Cambodian refugees

 

New arrivals, Carroll Street

The Cambodians would come into Dallas-Fort Worth International Airport a few families at a time, clutching their papers, benumbed and exhausted. Their journey across the world had taken them through war, genocide, and refugee camps before it ended in Dallas.

For most, the journey began around 1975 (“Year Zero”) when Cambodia fell to the Khmer Rouge and the entire population of ~7 million people was forced into brutal agricultural labor in the countryside. By 1979-80, when the regime fell, around 2 million people had been murdered or starved to death. Many of the survivors fled to Thailand where they were put into primitive refugee camps. From there the lucky ones were sent to America or France beginning in 1980.

They were met at the airport by caseworkers from refugee agencies such as the International Rescue Committee, Catholic Charities, or by church groups. They would be taken to a slum apartment furnished usually with a few mattresses, a small table, two chairs, some pots and pans, dishes and utensils. There would be a 50-pound bag of rice, a chicken, some fish sauce, and

Apartment on Carroll Street

a few other staples. Welcome to America.

When sponsored by a church the circumstances were less dire as there was usually a committee of church members who would help in various ways. Most families came in expecting to go to work within a day or two of arrival. The lucky families would have someone in a job within a few weeks.

In some locales like Long Beach, California and Lowell, Massachusetts refugees were placed on welfare, food stamps, and Medicaid. In Dallas and Houston they received meager refugee assistance support for 6-12 months and then were on their own. Problems related to resource poverty were compounded by the third world rural background of many Cambodians and the myriad problems of genocide survival, grief, and PTSD. The fact that in Cambodia many of the leaders, intellectuals, businessmen, and clergy had been murdered was a problem in terms of community adaptation. Really, Cambodian refugees lived extraordinarily uncertain and stressful lives.

Inside apartment – family living here for several years

A few thousand Cambodians were resettled in the refugee neighborhood in Old East Dallas centered around Fitzhugh, Carroll, Bryan, Annex – an area with low rents and high vacancy rates. Apartment buildings had 20-40 mostly one-bedroom/one bath units less than 300 square feet/unit. Typical living situations would be families of 4-6 people in each apartment. In living rooms and bedrooms there would be mattresses on the floor with curtains around them if for adults; children would share mattresses, there would be a table, an altar of some kind, posters from a popular Cambodian movie. Window air-conditioning units might or might not work. They were hot in summers, cold and drafty in winter. (Placement in distressed urban areas or “hyperghettos” was the norm for Cambodian refugees across America.)

Language was an important issue among Cambodian and other refugees. Often it was children who were best able to speak English and translate for their family. This created stress within families as it placed children in a more powerful position than adults and it called upon children to be involved in adult and sometimes embarrassing or very personal matters. Few health care providers, police departments, or other official organizations had Cambodian language capabilities, so there were real problems in interactions.

War and radical

Dinner

communist rule had shattered many families. In some cases families had been recombined by the Khmer Rouge or by circumstances in the flight from Cambodia or in refugee camps. Many households were headed by widows. All of this created stress and hardship within families and within the community.

Recycling aluminum cans was always a way to make a little money

Infants and small children were cared for within families and if parents were working, children were cared for by older women. Breast-feeding was common and thanks to one dedicated volunteer, many women and infants were enrolled in WIC (Women Infants and Children nutritional program). School-age children were enrolled in area schools. One elementary school in a wealthy neighborhood was able to count Cambodian children toward their required minorities enrollment. In the early years, Cambodian children were seen by teachers as generally quiet and respectful students. There were several missionaries in the community focused on youth and two scouting groups led by volunteers. As time passed, some middle and high school students gravitated toward gang life – refugee children had hard, stressful lives, too.

Women and girls mostly wore colorful flowery sarongs with tops that were sewn by themselves or shirts from the second-hand store. Men wore checked sarongs at home and pants and shirts in public. (Within a few years of arrival community leaders, especially Christian preachers discouraged wearing sarongs as too foreign or something to be ashamed of.) Many older women chewed betelnut; men smoked cigarettes as soon as they could afford them.

At 1604 Annex

People shopped for food at one of several Vietnamese stores on Fitzhugh or Bryan. There was a larger Vietnamese store on Capital near Carroll. Those with transportation would shop at an open-air Saturday market in West Dallas where live chickens and fresh produce could be bought. As soon as possible people who could planted gardens with lemon grass, basil, mint, bitter melons, etc. Meals were taken with families sitting on the floor.

Jobs were difficult for Cambodians to find, even for the more educated. Language barriers, transportation, cultural dissonances, ways of interacting, lack of phones, poor physical and mental health status, and other factors made finding and holding a job challenging. In all cases, pay was poor. Exploitation sometimes occurred such as people working for a few weeks, then being fired with no pay.

Although many people needed healthcare and other assistance, often all they got was tuberculosis screening. Prenatal care was difficult to obtain, family planning was non-existent, sick care was almost impossible to obtain, medications were a mystery to get and understand how to take, and few Cambodians could take off the full day necessary to receive care. Health care providers had little, if any cultural awareness or even awareness of the unique health issues among Cambodians. Volunteers stepped up to fill the gaps as best they could.

The first patient at the East Dallas Health Coalition Clinic – the clinic was started in the Fannin Elementary school nurse’s office

One of the consequences of Buddhist clergy being murdered by the Khmer Rouge was that in many respects Cambodian refugees had few spiritual resources, especially in the early years. Evangelical Christian missionaries, Cambodian and American were quick to step in with answers to fundamental questions like, “Why has this happened?” After a few years a Buddhist temple was established for worship and important ceremonies.

That’s how Leslie and I and others found them in 1981. Struggling. Desperate. And still maintaining integrity and dignity.

Leslie at work in her office, the floor of someone’s apartment

Stories from the streets and la clinica

I found this document by accident in a random place on my computer. Reading this over now I am struck by how religious I was when I was writing then. I recall that almost everyone I knew who was involved in refugee health at the street or community level was religious or seriously humanist. We were all doing the best we could.

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These are dedicated with gratitude to our volunteers – without whom the clinic and mission could not happen. Some dates are inexact. Last update 5/2005

Waiting for clinic to open

Witness: Every Wednesday at Zaragoza Elementary school we hold parent education classes in the front of the school cafeteria. Every week during those classes the school brings in special needs students to the back of the cafeteria for breakfast. By special needs, I mean those with Down syndrome and other such problems. Week after week, month after month, and now, year after year these children are a witness. What witness?

  • Of the children themselves, setting out on a long and difficult journey, of which they have no knowledge and few resources … the girl in the wheelchair, a beautiful and haunting sight; the boy who struggles with his walker and his limitations; the girl with Down syndrome whose laugh sounds so normal; the tall thin girl, kind of staggering and lost …
  • Of the caregivers and teachers who, with consistent (and unsentimental) kindness, care for children who at times are not easy to care for and in so many ways are disconnected.
  • Of the parents, bringing their tragic children to this school, this place of Hope … last week, a big handsome man, waving and smiling with love at his darling girl with Down syndrome.
  • Of a society that tries to care for the least of these.

So, here’s to you, children, caregivers, parents, and school (and the society it represents and teaches). Thank you for showing me this love and beauty. Last week, right before we left Zaragoza, Cesar Termulo, a fine young doctor who gave the class that week said to me, “Right now, prayer is of utmost importance.”

Trust in Him at all times, O people; pour out your hearts before Him; God is a refuge for us. Psalm 62:8

Blessed are the poor in spirit, for theirs is the kingdom of heaven. Blessed are those who mourn, for they shall be comforted. Blessed are the meek, for they shall inherit the earth. Blessed are those who hunger and thirst for righteousness, for they shall be satisfied. Blessed are the merciful, for they shall obtain mercy. Blessed are the pure in heart, for they shall see God. Matthew 5:3-8

Take heart daughter; your faith has made you well … Matthew 9:22

Waiting room

Amen (10/2004)

Going back to the question of eternal things … this is written by Lindsey, a high school student who is one of the Agape volunteers: Three friends and I stayed at, and worked in, the Long Yan Orphanage with the 17 special needs kids. They ranged in age from 4 to 18, and there were only 2 Chinese nannies per 12 hour shift to watch over them. Most of the kids didn’t have names. We gave them each a name that seemed to fit – Jason, Isaac, Daniel, even Bo. I will tell you about one of the 17 who won our hearts; we named her Annie. She thirteen years old, but was unable speak, sit up, or move from her wooden pallet. She was painfully thin and always restless.

We thought she was severely retarded and unable to understand us, but still we sat with her and talked to her, just to pass time. One afternoon after we’d been there about a week, Jessa, my good friend who lives in China and speaks Chinese fluently, was sitting with Annie just talking to her. As she switched from English to Chinese, she saw Annie become very alert, looking up at her with her brown eyes. She asked, “Annie, can you understand me? If you can understand me, open your mouth.” Slowly, Annie did so.

After that, she and Jessa worked out a system of communication and Jessa could get Annie things she specifically wanted. And every day, Jessa told Annie about Jesus.

The last day we were there, Jessa was sharing the gospel with Annie again. She decided to ask Annie if she wanted to pray and receive Christ. When she asked her if she wanted to, Annie opened her mouth- her way of saying yes. Jessa led her through a simple prayer and when she said, “Please forgive my sins and come into my life.” Annie began crying and crying. After a time, she calmed down and was filled with a peace I had never seen in her before. Jessa told her, “Annie, you’re my sister now. I’ll see you in heaven!” Annie looked up at her and squeezed her hand really hard.

Bobbie Baxter, MD, Agape founder and medical director

After I got home, I learned that Annie died three days after we left the orphanage.

Meeting Annie changed my life. I can’t wait to see her again in heaven. All the orphans taught me more about God’s heart. Since I’ve been home, I’ve found so many verses in Scripture about how He cares for the helpless, for the fatherless. One of my favorites is Psalm 10:17-18, “You hear, O LORD, the desire of the afflicted; you encourage them, and you listen to their cry, defending the fatherless and the oppressed.”

(I know Jessa & Lindsey will take no credit for what happened, but I want to note that however it happened, they heard, encouraged, and defended the afflicted with hope where there was no hope.)

Grace: At la clinica we started this week doing physical exams on children just removed from their family(s) because of abuse. Case workers from the residential facility where the children will live (Jonathan’s Place) bring new children to Agape for their intake physical. There were 13 last week, but I expect fewer next week. It’s strong. Because in Texas, it takes a lot of abuse for a child to be removed from a home, what with all our “family values” – yeah, right. As much as the children, this is for the staff at Jonathan’s Place. What follows is from an email I sent to my son after the first day:

Chris Wynn, our chaplain, now gone to Colorado, fall 2004

“So when I was writing (to someone else) I was thinking I wanted to tell you. But since its you, I’ll say more: The people (caseworkers) that were with the children were all young (of course): Katy has been at it for three years & is very intense & real; Keisha started two months ago – shy, nice; Ashley came in late – she feels really solid. Sometimes I wonder, what did I do to deserve this – to be around people like this. Not to lay religious on you, but it can’t be anything but grace. And isn’t that a beautiful idea. End of email. The second day there were eight more children. This time Chris, a young man, intense, sweet-natured, solid. And Ashley again. High compliment to say, I’d take her on patrol. Reality is they’re taking me on patrol – lucky they’re short patrols. Students & I trying to get up to speed on exams, learning what we don’t want to learn; the students are doing a good job.”

Had lunch at Grace with students and Andy Macha. Was telling him about the situation with Jonathan’s Place – some of the emotion – and he gave me a teaching. From the perspective of his 16 years with Child Protective Services he talked with us about balance & perspective with the goal being to be better able to do a good job. 9/2003

Humbled – again: Last week was humbling. Actually, in this work, most weeks are humbling – if we pay attention to what is happening around us, with whom we are working, and what we are doing. First, there was a family from Chile. The wife was a university-educated midwife in Chile and is now working in a day care center. The husband was an executive financial analyst and is now driving a truck. Then there was a five-year-old boy without parents in the home. He is cared for by his 18 year-old brother who is not doing that bad a job. A woman brought in her feverish four-year-old daughter. Her husband, an engineer, has been out of work for a year and has come to Dallas to go back to school. Several people in the family have been ill, and they spent all their money on the first three people who were sick. We treated a 56-year-old dispossessed farmer from Zimbabwe. After losing his life’s work he is starting over in America. There was a two-year-old child with flaccidity, decreased intelligence and development, and the sweetest nature; and the most beautiful parents seeking, seeking that which cannot be found – hope for recovery. Ah, Valeria, beautiful one. And finally there was a 16 year old who brought her grandmother in. The grandmother is from rural Mexico and is unable to read or write. Her granddaughter works with us as a Saturday volunteer and is planning on going to Baylor or TWU to major in nursing. From generation to generation, country to country, hope to hope – how can we be so fortunate to do this work.

Consuelo and her grandmother

Eternal Things: Awhile ago a former student challenged me to focus more on the eternal. I was not sure how to do this, but my respect for her is such that I’ve kept it in mind, waiting, I suppose, for a sign. I know that we do the work of the Samaritan; and I know there is scriptural basis (in all religions) for such work, but it just seems like what we do. About a month ago we were asked to help care for Mr. S., a man with terminal illness. Mr. S. was a Parkland patient with no insurance or Medicare. The deal we worked out was that the Parkland nurse practitioner would see him several days a week and we would go on Tuesdays and Thursdays so the Parkland NP would have a break.

Mr. S. lived with his son and daughter-in-law, their three children, his wife, and toward the end, his two sisters – all in a two-bedroom apartment in South Dallas. The daughter-in-law did nearly all the care for Mr. S., and the sisters took care of the children, cooking, and so on. What a magnificent job the daughter-in-law did! What a wonderful family.

Last Thursday we were there, changing his dressings and getting him cleaned up. By this point he had gangrene in both feet and pneumonia; and the cardiac insufficiency that brought him to this point was worsening. Clearly he was close to death. As always, when we finished with the physical care, we had a prayer with Mr. S. and his family. Lupe (the Agape promotora) prayed with us and for us and as always, we were touched. Mr. S. died at home that night. I thought about the time we spent with Mr. S., and especially the last day and the last prayer. I think that was an eternal thing. 4/2002

Hands: I helped serve communion at Grace a few days ago. People came up to the front of the church and knelt and I served the wine while the pastor and a Cambodian girl served the bread. All kinds of hands – slender, soft, calloused, children, old – one man had a lot of prison tats and another (Asian) had a cross tattooed on the back of his hand. Later I realized that he was part of the Burmese (Karen tribe) family sponsored by Grace. I talked a little with him after church and learned that he worked with Dr. Cynthia Muang on the Thai-Burma border. Dr. Cynthia is a hero of mine. Small world. 11/2004

Thank you: My friend Chuck was playing poker last week and was dealt a straight flush! He showed up at Bible study with a check for la clinica. Here is my thank you letter to a good man.

Refugee camp where Dr. Cynthia worked

“Thank you very much for your generous donation to the Agape Clinic. I think a lot about what we are trying to do at the clinic and why and whether we are wise in our work and our stewardship. The answers to the questions usually come from our patients. Here is what you are investing in …

Last week a woman came in with a complaint of several months of abdominal pain. She was seen by a nurse practitioner student with translation assistance from a 15 year-old neighborhood girl.

The NP student’s path is not all that different from mine – she is 50 years old and has worked in hospice for many years; and is in the NP program as a means of getting ready for the rest of her life. The neighborhood girl’s path – at least early on – is also not that different from mine. She is in trouble and working out court-ordered community service hours.

They were all in the exam room for a long time. Finally, the NP student came out and told me that the patient had been raped coming across the border some months ago, is having symptoms of pelvic inflammatory disease, and is depressed. She had never told anyone before now and was deeply distressed (meanwhile, the 15 year-old was sitting with the patient). We can treat PID presumptively, but this woman also needs HIV and other testing. So, we helped her get an appointment to a women’s clinic; set up for Lupe, our lay health promoter (salary paid in part by First Presbyterian), to go with her to the appointment; had a pretty intense prayer with her; started her on Paxil and pain medication; arranged for her to see a counselor; and moved on to the next patient.

The point (I think) is that all these strands (volunteers, students, troubled youth, donations, community, prayers, and more) come together in this safe place where mercy is practiced. Every one of the strands is critical. Thank you.” 7/2003

February 2004: It’s been an intense several weeks. It began with a child who had been raped and was dealing with it. Dealing with it! She had two very sad little sisters and was holding and comforting them. I don’t know what to think of that – there is more than one way. The whole thing just very sad.

I went to a party where pretty much everyone from Common Grace Ministries was. I was a lot better off when I left than when I came. I’m really grateful to have been there. The thing about most of the people there was that they live lives seriously dedicated to Christ. Toward the end of the evening we sang songs like …

Let the poor man say I am rich in Him
Let the lost man say I am found in Him
And let the river flow
Let the blind man say I can see again
Let the dead man say I am born again
And let the river flow
Let the river flow

Last week the students on outreach saw a family with a history of several generations of violence and gang life. The focus of the visit was a child with uncontrolled asthma. Last year the mother’s boyfriend put a gun to the child’s head and pulled the trigger. The gun didn’t fire but lives already off-track swerved suddenly way out of control. The boyfriend is in jail, awaiting trial, but the child is having serious problems that are intensifying as the trial date nears. The dangers this family faces are short-term (this deal is not like litigation and some of the players are deadly) and long-term (how can this child stay out of gang life or a psychiatric hospital?). So here is what we did:

  • Started the child on preventive asthma care and taught the Mom how to better care for the asthma and allergic rhinitis.
  • Set the child up with same-day psychiatric care – the sort of care the Mother had sought unsuccessfully for months.
  • Worked to ramp up support from other providers.
  • Started the Mom on antidepressant/antianxiety medication and made psychiatric care available to her through our psychiatrist.
  • Started the Grandmother on hypertension medicine.

Then we prayed together, “Father, Thank you for bringing our lives together in this moment …” We’ll follow-up next week.

Later in the day Esmeralda’s Mom came in. Esmeralda was killed in a fire Christmas 2002. I’ve known her Mom from around for 7 or 8 years. I had not seen her since the funeral.

Estevan Garcia and me

A man came in seeking antibiotics, diabetes, and pain medicines. He had been discharged after 2+ weeks in Parkland with deep diabetic ulcers high up in one leg. He had been given a prescription for Levaquin (30 days worth – very expensive) and several other medicines and was unable to buy them. He had been off the Levaquin for several days – a dangerous thing to happen. We were able to (1) take care of the medicine and (2) accompany him on a six hour visit to East Dallas Health Center and help with registration and obtaining needed supplies and medications. This may save his leg. Leslie, our social worker took the lead on this and one can only stand back in awe at what she was able to do.

Last week we saw 102 sick patients; had 28 women receive mammograms (through UTSWMC); screened 40 people for HTN, DM, BMI, asthma, and so on; started treatment on several of them; held a class on women’s health for about 35 women; taught several classes of children; made 9 home visits; taught 8 nursing students, one seminary student, one FNP student, and one faculty member; participated in several miracles; and more. Thank God

Sadly Ridiculous: Rudy is eight years old. He was sent home from school on a Monday because he had tinea capitis (ringworm). His mother brought him to us Friday of that week because she was unable to register at the East Dallas Health Center (EDHC). That’s five days of school missed for ringworm! We treated him with medications supplied through a grant from the Open Ring Class and he is now fine and back in school. 2000

Community garden. Student on outreach

Frightening: Mrs. T. is 52 years old. She has diabetes, hypertension, and problems related to these, e.g., decreased kidney function, peripheral neuropathy, and other problems. Typically, she goes for days to weeks without medications, thus compounding her problems and hastening her first and inevitably early heart attack or stroke. We supplied her with some of her medications, spent a lot of time teaching her about the illness and self-care, and worked to get her registered at EDHC. She is now registered and receiving quality low-cost care. 1999

A Long Time: Mrs. C was a 58-year-old Cambodian woman who had undetected cervical cancer when we found her in door-to-door outreach. She lived in a one-bedroom apartment with her husband and three children: an eleven-year-old son with Down’s, thirteen-year-old daughter who provided most of Mrs. C’s care, and a fifteen-year-old son who was sent to prison midway through the course of care. Her husband was an alcoholic and not involved in her care. One of her neighbors, Pheng, took care of Mrs. C’s children much of the time. This was not a small thing, as Pheng lived in a two-bedroom apartment with her husband and five children.

Mrs C had a terribly difficult life. She grew up poor and in her middle years survived war, torture, forced labor, and became a refugee several times over. When I met her she was an alcoholic and abusive to her children. Mrs. C spent most of her days and nights lying on a small couch in the apartment living room.

Students and faculty were instrumental in the cancer being diagnosed, played a critical role in getting the patient through two courses of treatment (surgery and radiation), and took responsibility for her home care following crises related to very severe complications of disease, treatment, and her own well-hidden alcoholism (septicemia, stroke, seizures, bowel obstruction, malnutrition, and dehydration). For two years, Mrs. C received at least three home visits each week. She agreed to hospice care about two months before dying.

It was clear to all concerned that Mrs. P was spiritually bereft and without hope. Using both Buddhist and Christian translators, we tried counseling and to address hope and other spiritual issues in several different ways. Although she was nominally Buddhist, she refused offers of transportation to the temple. On several occasions she accepted gifts of objects sacred to Buddhists, but after a few days would put them away. Several Christian missionaries visited on a regular basis and although she did not resist these visits, neither did she respond to them. Everything we tried seemed to fail. She did, however, seem to appreciate our efforts to care for her and her family. The only thing that we saw that affected her was when one day a nursing student knelt unbidden beside Mrs. C’s couch and prayed. Although Mrs. C understood little of the prayer, tears began to run down her cheeks as the young woman prayed. Afterward, Mrs. C whispered, “Thank you.”

Schistosomiasis lesion

The week before she died I went out of town for a conference. I returned late Sunday. On Monday I left for work early so I could see Mrs. C first. I walked into her apartment and at that moment, she died. Two hours after she died, the only people left in the apartment were her daughter, one of Pheng’s daughters, and a gangster friend, Ranny. Ranny suggested that Mrs. C should have “something pretty” on. So we removed her clothes, bathed her poor wasted body, and dressed her in a pink T-shirt and her best sarong. Approximately 1996-98

Waiting room. Leslie on phone

Strange People: In the course of outreach, one of the students made several visits to an apartment where a 60-something year old woman lived with a younger man and woman. The younger woman was very seclusive and every time we were there she had blood in her mouth (but no other evidence of trauma), and would not let us close enough to determine what the problem was. In conversations with the older woman we learned that the man (call him Jimmy) was “helping” a 10 year old girl who lived nearby. Over several weeks the story came out that the girl had a bad home life. Her mother lived with two men and was intimate with both. The girl was afraid of one of the men and so spent as much time as she could with Jimmy. She bathed at his apartment and at least once a week she spent the night with Jimmy, sleeping with him on a fold-out couch. According to the older woman, Jimmy and the girl liked to wrestle. Needless to say, when the story came out we took quick action. I remember the student on this case saying in a very serious way, “Mr. Kemp, I think there may be a problem here.” We talked with a detective of my acquaintance and he went after Jimmy and brought Child Protective Services in on the case. I do not know the final outcome, except that the girl was removed from her mother’s home and Jimmy disappeared. Good work, Dear student. 1995

Connections: Jessica came to the clinic with severe onychomycosis. We had enough itraconazole (a very expensive drug) to give her one pulse, which we did. We then contacted a dermatologist who gave us enough to finish the treatment. The last time we saw Jessica, her fingernails were growing out with no sign of infection. This was a good thing, but Jessica is not really the point of the story. Through the process of treatment, we noticed that Jessica’s mother, Maria, seemed distressed. We asked her what was going on and learned that she had no money, her children were going hungry at school, and her husband had been deported. Lupe, our lay health promoter helped get the children signed up for a lunch program and we were able to give the Mom some money. Here is the point of the story: Because someone noticed that something was wrong and Lupe was helpful, one of the neighbors called Lupe in the second week of December, to tell her that the Mom had been killed. The neighbor, Cecelia, took care of the children for eight days until enough money had been donated to send the Mom’s body back to Mexico.

The point for all of us is that we need to keep paying attention to what else is going on around us besides physical illness. Because someone noticed, we were able to participate in sending Maria home. 2000

A Hard Spring: In the spring of 2000 we (Baylor Community Care) lost significant medical services, had to move the clinic twice, were burgled, and an important working relationship came to an end. In our most difficult times in late spring and early summer, we were down to seeing 10-12 patients in one clinic session/week. Though it was a painful time, what stands out the most to me about this time is the people who stayed with the work: Estevan Garcia, Sharon Lehmann, Leslie Kemp, Alison White, Martin Hironaga, Debbie Schwartz, Lupe Springer, Martha Sanford, Marilyn Hightower, Kathryn Marshall, and Edwin Read. What a team! We are now part of the Agape Clinic, our situation is vastly improved, and the team remains largely intact.

Outreach in the community garden

Pentecostal: I was in an exam room with a patient and a student. The patient was a Mexican woman who worked in a chicken processing plant. Her job was hard and entailed repetitive pulling and twisting (of what, I hate to think). As a result, she had a repetitive motion injury. She was treated with an NSAID and encouraged to talk with her supervisor about changing her task at work. The patient had some personal issues as well.

The student was a Pentecostal. I realized that while our medicine would be helpful to the patient, what would ultimately be most helpful would be the Spirit-filled presence and prayers of a person like the student. I feel something very real and fundamental about the Pentecostals who work with us – and there seems to be more of them as time passes. What a glorious time this is – when Presbyterians, Pentecostals, Catholics, Methodists, Baptists, and others can work together for the Glory of God – somewhere between heaven and earth.

Tattoo: During a clinic session at Midpark Place (an early clinic site in the Kurdish community), I fell into conversation with an elderly man who had brought a Russian Jew to the clinic to pick up medications. I noted the elderly man had a faded series of numbers tattooed on the inside of his arm, horrifying proof he had been in a nazi concentration camp. In that same room at that same time there were Baylor students (mostly Baptist), Catholic volunteers, Kurds (mostly Muslim), an Armenian family (history shows that Kurds participated in the attempts to exterminate the Christian Armenians 1894-1915), and a Buddhist caseworker. Moments like this help me remember the beauty and power of this work. 1997

Reach Clinic: Awhile back a woman brought a 22 month-old girl in to our clinic. The child had two problems: (1) a “rash” that turned out to be genital warts and (2) a prescription for a medication for the warts. The medication cost $140+ and the woman could not afford it. She had been given the Rx at a clinic (the Reach Clinic) that treats children and infants who have been sexually abused. Dr. Garcia called the clinic and was told that the prescription can be filled there and an appointment was made for the woman to bring the child in next week. We followed-up and discovered that the woman did not keep the appointment. After several more contacts back and forth, the child got back to the Reach Clinic and received her medication. Not everything is at it seems initially and sometimes people need a lot of encouragement. 2000

Home Visit (from a student’s clinical log): Thursday, my partner, April and I went to visit a patient with diabetes, lupus, and hypertension. She was noncompliant with her medications she was supposed to be taking; and was taking at least one medica

Window at Grace Church where clinic was

tion (hydrocodone) that was intended for someone else. She said she had been taking the hydrocodone along with her medications when she remembered and she never looked at the name on the bottle to see if it was hers. There were 12 out 24 pills left in the bottle. She said after she took the medication she felt very tired. She told me about something that happened last week that I found very interesting. An Angel appeared to her when she was sick and said, “Come on. It is time for you to go you are very sick”, and Ramona (the sick lady) said, “No I am not ready to go.” Still in Ramona’s dreams she can see the Angel’s beautiful eyes and she feels that she is having an out of the body experience and the Angel is carrying her. I asked Ramona if she had ever asked Jesus Christ to be her personal Savior and to forgive her of her sins. She started crying and said, “Yes I have.” I then asked her if she and her friend would like to pray. They both said yes and we all joined hands and I prayed for them. I referred Ramona’s friend to Parkland, for pain and discharge from her left breast. She called while I was there and made an appointment for that day. 1999?

Split Shift: I was seeing a ~50 year old woman with diabetes and an inf

“Not too tall”

ected toe (Those go together – horribly in some cases.). Somewhere during the exam I realized she worked at a major hospital. I was irritated. We are a small overloaded mission clinic serving people who have nowhere else to turn; and of course this woman had insurance. I told her we would take care of her infected toe and tide her over with oral hypoglycemics. But she should use her insurance and see a private doctor or go to the hospital clinic. While I was getting her medications, she told Lupe (our promotora) that she worked for a temp service and did not have insurance. Lupe told me when I came back into the exam room. I felt small – so much for my cheap irritation. I asked the woman to come back in the following week first thing in the morning, fasting, so we could get a better picture of her blood glucose. She then told us she worked a split shift – 6-10a and 4-8p. Have you ever worked a split shift? It is really hard – you’re never really off. So this is the life our patients lead – very, very hard; out of meds half the time; putting up with irritated clinic people. When she returned three weeks later (no diabetes meds for the last two weeks) she told Lupe she actually did have insurance, but did not know how to use it. This also is the life many lead – paying (top dollar, I might add) for something they cannot use. She is scheduled to return next week for a blood glucose check and help from our social worker to be able to use her insurance. 2001

On Columbia … There are women walking children to school

You are the salt of the earth … you are the light of the world … Matthew 5

Not that far from Desolation Row

Shotgun house. He lived with a prostitute in the front room of a shotgun house off Woodall-Rogers Freeway near downtown. (A shotgun house is a narrow one-story shack that could theoretically be cleared with one shotgun blast through the front door.) In the course of being treated for cancer he suffered a radiation injury that caused triplegia, paralysis of both legs and one arm. The other arm wasn’t much good. When he came home from the hospital the woman put him on a bedpan and left him there for a day or two. When I got there the skin over his coccyx was intact, but was kind of purplish. Within a few days the skin began to change color and underlying tissue began to break down and soon there was a large (~10 inches in diameter) and growing decubitus ulcer (down to the bone). I would clean the ulcer and we would talk. He was bitter about what had happened with the cancer treatment as I recall, but he had been a hard life before the illness and injury and he was mostly accepting or resigned, or so it seemed to me.

From time to time when I was there, the woman would bring a trick through his room on the way to her room. She was a heavy drinker and often smelled of liquor. She was sweet-natured and pretty in her own way, and I liked her. Teaching her to care for him was a real challenge.

The ulcer got bigger and bigger and after a few months he died. A couple of years later I saw the woman on a corner in another part of town and stopped to talk with her. She was drunk and smelled pretty strong. She asked me if I wanted to have sex with her, but I said no thank you and gave her some money. That was the last time I saw her.

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Eggnog. He lived alone in the Cedar Springs projects. He had head and neck cancer (squamous cell carcinoma) with many tumors in the nodes of his neck and down into his chest. He had a mattress on his living room floor and he got around by crawling from one room to another. He had difficulty swallowing and was unable to take any solid food. He liked eggnog, which was fine around Christmas, but problematic after the holidays. I went to quite a few stores to find the last of the eggnog. After that he had to make do with protein drinks, which at the time were not as readily available as they are now.

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Burned. There had been a gas shortage and two brothers decided to hoard cans of gas to sell at a big profit. He lit a cigarette and the gas exploded, burning him over most of his body. After months in the Parkland burn unit he was finally discharged. He didn’t do his exercises and ended up with his arms frozen in a flexed position. He had no fingers, no nose, no ears – every part of his body that protruded had been burned off. He was pretty much all scar tissue.

He lived alone the same Cedar Springs projects as the man with head and neck cancer. His wife would come over sometimes and would throw his meals-on-wheels food on the floor. When he walked he would stagger; when he went out the children in the projects would throw things at him and call him names.

I don’t know what happened to him.

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A prayer. The promotora de salud (lay health promoter) and I went to see a woman with far-advanced cancer. She was in a coma and had gangrene. She lived in one of those barren outlying Oak Cliff pink brick apartment buildings where gangs pretty much ruled. The main thing we were there for was for the promotora to pray for the patient. We were there at her bedside – the patient and her daughter, the promotora, and me, all holding hands. Everything was in Spanish, except when the promotora leaned over to me and whispered, “I think her toe just fell off.” It had.

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Dressing change. There was a homeless man who hung around on Bryan Street. One of his legs had an old injury that was chronically infected. The lower part of the leg was markedly enlarged and hard and suppurating. He refused to go to Parkland, the county hospital.

At the time, my students and I were operating out of the “police storefront” at the corner of Bryan and Annex. The police had banned the homeless man from coming inside after he had used their toilet to have a huge and hugely malodorous bowel movement.

He would come to the storefront every week and one of the students or I would change the dressing on that leg. It was literally a weekly dressing change that involved cutting away the old exudate and blood-soaked dressing and putting on a new dressing. He would sit on the bench of the picnic table or a retaining wall outside the storefront for someone to change the dressing. I thought the maggots might be what was keeping him alive. I was surprised at how fast maggots can move.

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Staying home. Ms. Brown lived in a sparse one-bedroom apartment with Mr. Escalera. She had rheumatoid arthritis, was home-bound, and in fact, mostly bed-bound. I recall that the first time the students and I turned her over a multitude of cockroaches scattered out from under her back. She had several health problems, especially the pain from RA. She was a nice woman with a good spirit and was very strong mentally. While the students were in the bedroom with Ms. Brown, Mr. Escalera and I would sit at their little kitchen table, talking and him smoking. I marveled at how he was able to keep her at home – get her to the bathroom, take care of food, clean the apartment, everything. After a few years there were changes made in where and how the students and I were operating, and we quit seeing Ms. Brown. Ultimately, she developed cancer. She never told anyone and she just wasted away in her bed. I saw her a few times during the course of the illness, but she refused any assistance other than the home visits. My friend, Alison, the missionary also became involved. We all did exactly what Ms. Brown wanted, which was to help her never leave her home in her little apartment.

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The students. When I refer to “the students” I mean the Baylor students who were in my community health clinical groups. Each semester I had two groups of eight students. Very few of them had ever been exposed to the levels of poverty and unmet health needs they were immersed in through  this work in refugee communities. They worked with me as partners in learning about community health through providing community health services. The students operated in two-person teams in designated neighborhoods. They learned about community health through finding people with problems and alongside the patients, solving the problems – and never just referring people to somewhere else.

As much as possible, they went through “the healthcare system” with patients; students learning, for example what the Parkland OB clinics are like: a waiting room with 50-100 plastic chairs; waiting room floor sticky with spilled soft drinks and baby formula, Cheetos, whatever; maybe 16 exam rooms around the waiting room (my memory is clouded re some details); someone shouting/mispronouncing patient names (you better not miss hearing your name called); and once in the exam room, being seen by a different person on every appointment (expect another vaginal exam); being sent out from exam not having any idea what next.

Eventually, as we developed the Agape Clinic (a-ga-pe) as a community resource, the students spent more and more time in the clinic, though we never abandoned the home visits and community outreach. In the clinic students had responsibilities that rotated week to week – triage, manager, exam rooms (5), pharmacy. As was the case with the outreach/home visits/district health model, students had significant responsibility and autonomy. Oh, what a job they did!

Here is a description of the work, in the streets https://ckjournal.com/in-the-streets and more on the Agape Clinic https://ckjournal.com/agape-clinic-recollections

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On San Jacinto. In one of the apartment buildings in the 4000 block of San Jacinto there was a Vietnamese woman who had some unspecified mental health problems that were manifested in part by her yelling and sometimes fighting with neighbors. She had a dream one night that her apartment was filled with Buddhist and Catholic religious statues. She began putting religious statues in her apartment according to the dream and as the apartment was filled, she quit the yelling and fighting. She became something like a fortune-teller. Although she didn’t have any outstanding health needs, I would stop in at her apartment when I could. She would fix coffee for the two of us and we would sit at her kitchen table and talk.

In the same building there was an old Vietnamese couple living with a teenage girl named Thuy who was deaf and mute. The man had a stroke. He survived but was completely incapacitated. By some miracle he ended up in a nursing home just a mile or so from the apartment. His wife would walk to the facility every day to bathe and feed him. When he died the funeral service was held in a South Dallas funeral home. I remember his wife and Thuy ended up on their knees on the floor in front of the coffin, wailing and falling out. After school Thuy went to work at Fiesta groceries and did well, as far as I could tell.

In the same building there was a Cambodian woman who was married to a White man who was somehow involved in drugs. One day Leslie called me and said I should come to her office right away. When I got there the Cambodian woman was sitting under the conference table in Leslie’s office. She had appalling stitched lacerations on her body. Two men had come into the apartment and stabbed her husband to death, raped her, and slashed her. She had been taken to the ER and when they were done with her, a missionary named Chuck brought her to Leslie’s office. I went to her apartment to let the police know where she was. I remember how polite the homicide detective was when he questioned me (everyone is a suspect in their world). I remember that there was an amazing amount of blood on the bed, floor, walls, and even the ceiling.

In the same building there was a Lao family – three generations in a small apartment. They had pigeon cages covering several windows with the pigeons free to come and go to the outside world and a sliding door on the inside. At night whenever someone wanted they could open the sliding door and reach into the cage – pigeon for dinner. Eggs, too. The same family had a big aquarium filled with popcorn and big grubs eating the popcorn – grubs for dinner.

Across the street a widow with two sons lived in an upstairs apartment. One day the brothers were arguing over a bowl of rice. One of them stabbed the other, who fell out the window and died.

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Get-away. The students ran across a 16 year-old girl who was living with a man in his mother’s second-story apartment on Virginia Street. The girl wanted to leave, but the boyfriend and his mother wouldn’t let her. The students talked with the police, but they had already been in contact with the girl and she was uncooperative. Now, she said, she had to get out. The police wouldn’t help, so the students and I came up with a plan for the students to make a home visit and distract the mother. While that was happening in the living room, the girl was throwing her possessions (in three black plastic trash sacks) out the window to me waiting down below in my blue Toyota pick-up in the driveway between two apartment buildings. The girl then walked out of the room she shared with her boyfriend and followed by the students, walked out of the apartment to the alley where I was waiting. Away we all went to the police office. One of the police officers bought the girl a bus ticket to LA where she had family in Compton. She was back with the boyfriend in about a month.

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A man with a gun. In one of the apartments on Annex Street a Chinese woman from Vietnam ran a little store out of her apartment. People could buy soft drinks, snacks, and the like. One of her daughters had a large nevus (mole) on her face. The mother told her daughter the reason she had it was because in a previous life she had wasted her husband’s money. A dermatologist at Children’s Medical Center Girl decided it was appropriate to remove it surgically.

On the day of surgery I went to the apartment to drive the girl and her mother to CMC. The girl got in the truck first and said, “My mother says there’s a man with a gun in our building.” I said, “Tell her to get in the truck now.” The girl said, “There’s the man.” Sure enough a man was walking towards us and he had a pistol (like a .357) stuck in his jeans. I reached across the girl and pulled her mother into the truck and was backing up across chunks of concrete and curbs and whatever. Meanwhile, a man in a white car picked up the man with the gun. I drove around the block to the police storefront and told them about the man and several of them took off toward the apartment. We went on to CMC, where preoperatively they gave the girl a fentanyl sucker which pretty quickly got her all smiley and goofy. The surgery went well. The guy with the gun got away but an hour or so later got into a gunfight with the police on Central Expressway.

Planning hospice – spirit

I found the first explication of what I was trying to trying to do for most of my life. It is in a memorandum written in 1978 to Elsie Griffith, the executive director of the Dallas Visiting Nurse Association. At the time, I was working on planning and implementing the VNA Terminal Care Program, which was foundational for the first hospice in Texas. In hospice we focused intensively on managing physical symptoms at the end-of-life, such as pain, nausea, shortness of breath, etc.; and on supporting families. The subject here is the spiritual and ethical structuring of this work. It’s hard to believe I sent this and that Elsie accepted it and believed in the vision. Here it is, exactly as I sent it:

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June 9, 1978

To: Elsie Griffith

From: Charles Kemp

I feel a strong need to express something that is difficult to express— namely, the spirit which I think should be part of our terminal care program.

I hope we all recognize that the way we die in America is generally poor. To illustrate this let me tell you about a situation I am presently experiencing: Several weeks ago someone called me to say that a friend of theirs was dying of cancer of the breast metastatic to brain, ribs, spine, abdomen, etc. and would I see what I could do to help. The person in question is a 41-year-old woman (Jan) whose 2 teenage daughters live with her husband in another residence. Jan’s mother has been taking care of her for about 7 months and is physically and emotionally exhausted. If relief is not forth coming, Jan will have to go to a nursing home. We have been helping with home health aides and nursing but it’s not enough.

I went to see Jan on a Friday night before I left for a week in California. I found her to be in excruciating pain and to have paraplegia. There were only a few hours left before I had to leave town and although I tried, I could not find any relief. When I returned from California I called and discovered that Jan was on the way to a nursing home.

After visiting her once and seeing what the situation was I committed myself to stay with her 2 nights a week. I can’t say exactly why — I’ve never done this before — sometimes something happens when people meet or when situations present — maybe I ‘m seeing me or my wife — or maybe I have the need to stay grounded (as much as is possible) in the reality of dying as I plan for helping people die as humans.

Staying in a nursing home at night is a strange, sad, and sometimes bizarre experience:

Me: “She needs something for pain”
Nurse: “I don’t work that hall.”
Me: “Where is the other nurse?”
Nurse: “He’s gone.”
Me: “When will he be back?”
Nurse: “15 minutes.”
Me: “She’s really in a lot of pain.”
Nurse: “I don’t work that hall.”
Me: “Are you saying you won’t do anything?”
Nurse: “I don’t work that hall.”

At midnight an aide walks in, turns the light on and off and starts to walk out. I ask her what she’s doing. “Checking the light.” — and out she goes.

Ice pitchers are filled at 5:30 A.M.

And much more. It’s a kind of dumb, passive brutality.

I know you’ve heard and seen a thousand variations on thig sorry tale. You know about the terrible loneliness and dehumanization of dying. You have in your possession some scientifically-oriented things I’ve written about this. So probably I’m trying to touch you with something that is touching me very deeply: The spirit of the terminal care program:

To be touched and to be able to touch people who are lonely and afraid. To be not afraid to feel. To work from the mind and the heart. To experience the personal loneliness and fear that lies within (us all). To care enough not to need to be the hero. To work through the family. This is difficult for me to express. I’ m not looking just for increased services; I’m looking for something that will touch people at every level.

When these things are happening, the people (nurses, aides, social workers, doctors, volunteers, etc.) who are experiencing them need to have to have an incredibly strong support system.

I tell you, I am committed to planning and operationalizing a program which will give what is needed. And I’m firm in my knowledge and belief that this spirit I have so inadequately expressed above is vital to meeting the needs of people who are dying.

Thank you,

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Jan went home a few days later and she died peacefully at home a few months later. She was a brave woman.

The night in the “dumb, passive brutality” of that nursing home was inspirational to me. I’m not saying that over time my colleagues and I ended the ugliness, but at least for people with end-stage cancer, ALS, and other afflictions there are now much kinder, more supportive, and more clinically effective options all across America – and that’s exactly what we were aiming for.