Tag Archives: Whole-person care

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Seeking wholeness…determined to soar

Editor’s Note: In recognition of May as National Mental Health Awareness Month, Rebecca Swift, LCSW, shares a story about her work as a behavioral health consultant to Siloam’s medical staff as they seek to provide whole-person care for our patients.  Rebecca writes…

I wish I could introduce you to “Samir,” a refugee I met recently. He is a newly arrived refugee to the U.S. – alone – without any family. When I entered the exam room, Samir looked at me with tearful eyes and softly said, “I have no hope to live anymore.” I sat down as he continued saying that he was not sleeping well, was crying every day, and that he didn’t think he would ever amount to anything. We talked for quite a while about his experiences and the normal process of adjustment. By allowing him the chance to share his story and feel heard, I believe we made progress that day.

I attempted to offer some hope for him by arranging for on-going counseling services at one of our local mental health partner agencies. Knowing that he would be coming back to Siloam for another visit in two days, I gave him an assignment which I hoped would be therapeutic for his mind and his heart.

Samir is an artist, so I said to him, “I want you to paint a picture that answers the question, ‘Who am I?’” He stared strangely at me for a moment and then suddenly looked me straight in the eye and said, “I can do that. I can definitely do that!” He left the clinic with a smile on his face and determination to complete his “assignment.”

Two days later, Samir returned to Siloam glowing and sounding like a different person. He brought his sketch pad and a huge bag of other art projects. He sat for thirty minutes with me going over all of his art, showing me all the drawings he had completed from his memory, and then he pulled out the “assignment.”Dove in cage by refugee - 5-2013

I was amazed – what a beautiful picture he had painted! Samir had painted himself as a dove in a cage in his former homeland with evil, danger, and fear surrounding the cage. Then, when he stayed in another country for a brief time, he again felt like a dove in a cage but with less danger, although still imprisoned. Finally, he pointed at the top of the painting. There was a third dove, standing a little taller, with light coming from behind him, and with much more beautiful surroundings. Smiling at me he said, “This is me in the U.S. – I am still in a cage, but I know that good things are coming.”

Samir has been to Siloam a few times since our meeting and each time he is smiling and brings more of his paintings to show us. He is participating in counseling services that were arranged for him after his first visit, and I believe that with time, he will make a new life for himself that is full of hope and wholeness.

He will have many barriers to overcome in order to find wholeness, but the first step is being willing to acknowledge there is a problem and then accept help. One day I expect to see him paint a soaring dove free from any cage.

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Following Jesus

This week, we Taylor University students had the pleasure of having Carl Medearis come to campus and share about his life as a follower of Jesus. In chapel, he briefly spoke about his time as a “missionary” in the Middle East, whichDoezal, James- CHI 2013 began some 20 years ago; with an amused smirk, he remarked that, to his surprise, the Muslims he had initially gone to witness to didn’t have any interest in signing up for a new religion. After a month of failing to “Christianize the Muslims,” he came to the conclusion that he simply wasn’t communicating what he intended to; when he identified as “Christian,” his Muslim neighbors assumed he also meant American, Westernized, and sadly enough, immoral. One person actually responded to Carl’s invitation to become a Christian with shocking refusal: “I couldn’t do that,” he had said, “I love my family too much.” Sadly, in some parts of the world, the label “Christian” has become unassailably associated with hypocrisy and immorality.

Carl continued by telling us how he eventually learned to let go of the title “Christian” (while not, by any means, dissociating from ekklesia, which is central to an identity in Christ). Rather than focusing on religious identity, he discovered that as long as he focused on the person and work of Jesus, people were much more receptive to hearing the Gospel; incredibly more so, in fact. In a quick-and-dirty survey done in Boulder Creek, CO, Carl’s team discovered that when fifty people were asked about how they felt about “Christianity,” fifty responded negatively. Another fifty were asked how they felt about “Jesus of Nazareth,” and this time, all fifty responded positively. Over the next few months, as he shifted his outward identity from “Christian” to “Follower of Jesus,” he found that he was able to more easily able to share about what was at the heart of Christianity anyway: Jesus of Nazareth.

As I reflect on what Carl learned from his engagement with Muslims, I am realizing that the same must be true of my life.  It is not my desire to merely be a “Christian” in some nebulously, perhaps nominally, religious sense; rather, my aim is to follow Jesus. But what does that look like? How do I follow a man who reigns in heaven? In his book Speaking of Jesus, Carl describes the typically Christian lifestyle many people find themselves trapped in as a soccer match. We’re in it to win – to worship God well, to score some converts, and to beat Team Atheism or Team Islam. But if Jesus were to walk in his dusty sandals across the grassy field right in the middle of our game, would I recognize Him? If he looked straight at me and said “Follow me,” would I have the courage to drop what I’m doing and follow Him?

It is my prayer that this summer, the CHI program will help me discover how Jesus is calling me to do precisely this: drop everything to follow Him. I anxiously await the good things He has in store for this team. Please join us in praying for the courage and faith to follow Him in whatever contexts He calls us.

Editor’s note: James is one of six pre-medical students from across the country who will spend the summer in Nashville in a Community Health Immersion.

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“Siloam is of national importance.”

These were the words recently spoken by Steve Noblett, the Executive Director of Christian Community Health Fellowship (CCHF), a national network of 350 clinics committed to living out the gospel through healthcare among the poor.Underserved_Population_in_Primary_Care_Shortage_Areas

Steve shared with us data from a recent national survey.  The survey indicated that only 43 of the 350 clinics provide a rotational opportunity for health professional trainees to obtain credit for a clinical rotation at their site.  Among these 43 clinics, 50% of the training capacity nationally is carried by two clinics: Christ Community Health Services in Memphis and Siloam Family Health Center.

In his blog on “How to Kill a Movement,” Steve suggests that what doctors need to do is to work harder – see more patients – yet, disregard the need to take time to mentor the next generation of health care providers.  This will kill a movement of students who are clamoring to see how the gospel can be lived out through healthcare.

Last year at Siloam, more than 80 trainees gained basic clinical exposure with 32 of the trainees gaining a deepened formal exposure of a month or longer.  This deepened clinical exposure is critical to keeping the movement alive.

This deepened exposure at Siloam models health care for people in poverty, cross-cultural care, and care from a whole-person perspective.

But most importantly, this deepened exposure involves working alongside an interdisciplinary team of Christian providers who have made the personal commitment to mentor the next generation as they share the love of Christ by serving those in need through health care.

It is our hope that through the modeling that the Siloam Institute offers and the curriculum it is developing that all 350 clinics will eventually offer deepened clinical exposures addressing the whole person.

Outcomes of expanding training capacity at faith-based clinics will have practical and spiritual implications which both lead toward the ministry of justice that Jesus preached.

Practically speaking, our nation’s health care system is under duress due to so few doctors choosing to go into primary care and even fewer choosing to serve the poor.  Spiritually speaking, Jesus’ gospel chastises the religious hierarchy for its feeble attempts to care for the materially and spiritually needy.

It truly is of national importance for our sister clinics AND the entire body of Christ to step up and support avenues for mentorship of the next generation to live out the gospel through healthcare among the poor.

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Manzella joins the CHI

We are excited to announce a recent addition to this  summer’s Community Health Immersion 2013 (click to watch a 3-minute CHI video)! This team of 6 pre-medical students will live in and serve a local refugee community along with shadow providers at Siloam and reflect on God’s call to them to pursue a career in medicine.

Siloam community, meet:

Name:  Elias ManzellaManzella, Elias - 2013

Age: 21

Hometown:  Westfield, NY

Undergraduate School:  Rising senior at Houghton College in Houghton, NY.

Vocational Aspiration:  Elias is majoring in biology with a public health minor.  He is on a pre-medical track and plans to become a physician assistant.  His long-term goal is to not only meet the physical needs of patients, but also to minister to their spiritual wellness. “I want to show my passion for other people through what I love doing – humbling myself to serve others.”  He sees pursuing medicine as a way to touch lives and share the love of Christ.

In case you missed the announcement of the other participants, click here for their profiles as well. Interested in receiving automatic updates about their immersion? Enter your  e-mail address to receive blog updates  right to your inbox.

Consider financially supporting this ministry as we plant seeds to share the love of Christ by serving those in need through health care.

 

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Unlearning “Bobble Head Medicine”

bobble head doctor

By Morgan Wills

The case revolved around an experience I had caring for a patient late one night in the emergency room at the VA hospital several years ago. A young man with a history of a brain tumor (a “frequent flyer,” according to the nursing staff) had come in yet again complaining of vague symptoms and demanding an MRI to rule out a recurrence of his tumor. There was no clinical evidence from the workup to do so, and I was tempted to just send him on his way. But a gnawing sense of conviction led me to stay up late and pursue the patient on a personal level in a way which transformed the experience for both of us—and helped the VA team care for him better (and more cost-effectively) in the future.his past Monday I had the chance to share at the first of a series of lunchtime presentations at Vanderbilt Medical School about the joys and challenges of Whole-Person health care (WPHC) Although we write and speak about this concept a lot at Siloam, it was good to have the opportunity to articulate some of this approach in the academic setting as well.

Below are a couple of highlighted principles from what we covered.

1. Most clinicians (including myself) are trained in a way that prioritizes cognitive knowledge and technical competence over human interpersonal skills. This results in doctors who are a lot like “bobble-heads.” You know: the little dashboard toys that bobble from side to side with the movement of your car because of the weight of their disproportionately huge heads? Too often, that’s us! So, like our patients working through the 12 steps, the first step in WPHC is to admit we have a problem!

2. A second, and related, point is that WPHC begins with tending to our own personhood. Mindfulness, or the practice of fostering deliberate awareness of what’s happening inside ourselves, is a key first step. For good and ill, we bring desires, moods, and agendas (some might say, baggage!) to the clinical encounter that inevitably frames what we will find there. There is no such thing as a completely neutral clinical encounter—just more or less transparently personal ones.

In the next installment, we will consider some more principles from this case. In the meantime, I want to leave you with a link that dramatically highlights how our brains filter and/or frame reality. It’s a review of a fascinating story of a non-religious neurosurgeon reflecting on how his near-death encounter helped him to see how our brains can “screen out” spiritual realities that are right in front of us…

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CHI applications due Jan. 28th

Please pass this message to networks of pre-clinical students to alert them that applications to Siloam’s Community Health Immersion are due this Monday, January 28, 2013.

Watch a 3-minute video about the experience of our students last summer.

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Why would a doctor ask about spiritual practices? (Part 5 of 5)

Guest blogger, Laurie A. Tone LMFT, LPC, MHSP, served six years as Siloam Family Health Center’s behavioral health consultant. Today, she continues a five-part series of blogs on the body-mind-spirit connectedness.

Laurie writes…

Welcome back to the series exploring the connection between spirituality and health. We know through research that spiritualityBible - Stethoscope - Siloam Coffee and health share a definitive connection. We can even extrapolate that in Sam’s case (see blog in part 2 of this series) that his guilt, pain, insomnia, and depression are all interconnected. But what does biblical scripture say about this? Are there any references in scripture about the connection between spirituality and health?

While scripture was never intended to be a medical manual, it has some pretty clear references to the connection between spirituality and health. The Creator God has provided through His Word some key principles about His creation and healthful living. While references from scripture should be considered in context, let’s look at the following verses in light of our patient Sam who is suffering from guilt, depression, insomnia and bone pain.

Psalm 32:3 “When I kept silent [about sin] my bones wasted away through my groaning all day long.” Psalm 32:5 continues, “Then I acknowledged my sin to you and did not cover up my iniquity. I said, ‘I will confess my sin to the Lord’ and you forgave me the guilt of my sin.”

Psalm 6:2 “Be merciful to me, Lord, for I am faint; O Lord, heal me, for my bones are in agony.”

Proverbs 17:22 “A cheerful heart is good medicine but a crushed spirit dries up the bones.”

Proverbs 3 also tells us that following the Lord fully will bring health to the body and nourishment to the bones, sweet sleep, prolong life and bring prosperity.

Scripture shares a multitude of references about the connection between spirituality and health and adds to our understanding of the complexity of our integrated beings.

The connection between spirituality and health raises some practical questions regarding patient care. If you were the medical provider for Sam what would you do? Would you prescribe an antidepressant or pain medication? Would you refer him to a religious or mental health provider? Would you even address the underlying guilt as a possible precipitating factor?

While there are no easy answers, patients like Sam make us consider the need for whole-person care.  Healing and wholeness can occur in the various and sundry realms of our being – physically, emotionally, socially and spiritually. In fact, in the New Testament’s list of spiritual gifts, healing is in the plural form -“gifts” of healing (1 Co. 12:4-11).

Although this is the last of this particular series the topic remains on the forefront of the ministry at Siloam Family Health Center and the Institute of Faith, Health and Culture. Patients, like Sam, are a regular occurrence at the clinic and systems are in place through medical providers, pastoral care, social workers and behavioral health consultants to address the myriad of needs patients present.

Please feel free to share your thoughts and stay tuned for future blogs exploring the bio-psychosocial-spiritual connection.

All scripture quoted from the NIV.

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Why would a doctor ask about spiritual practices? (Part 4 of 5)

Guest blogger, Laurie A. Tone LMFT, LPC, MHSP, served six years as Siloam Family Health Center’s behavioral health consultant. Today, she continues a five-part series of blogs on the body-mind-spirit connectedness.

Laurie writes…

In our last post we covered the first 4 reasons why spirituality and/or religion should be incorporated into health systems (see prior blog – Part 3). Helping Hands too croppedThese reasons are based on the summary of research on the connection between spirituality and health presented by Dr Harold Koenig, Director of the Duke Center for Spirituality, Theology and Health (see Koenig, 2012).

Let’s continue the dialogue with reasons five through eight.

*Fifth, religion and/or spirituality are associated with both mental and physical health and likely affect medical outcomes. Health professionals need to know about these influences, just as they need to know if a person smokes cigarettes or uses alcohol or drugs.

Sixth, the kind of support and care that a patient receives once they return home is influenced by religion and or spirituality. A supportive faith community may ensure that patients receive medical follow up. Support may include providing rides to doctors’ offices or in ensuring compliance with medications. Health care professionals need to know whether patients live alone or have access to social interaction and support, which can influence health care decisions, as well as outcomes.

Seventh, research shows that the failure to address patients’ spiritual needs increases health care costs, especially toward the end of life. During end-of-life care, patients and families may request medical care that is often very expensive and may even be futile. Patients or families may be praying for a miracle. They may view withdrawing life support or agreeing to hospice care as giving up or as a lack of faith and belief in the healing power of God. Taking a full spiritual history can allow for meaningful dialogue on end-of-life care thus avoiding prolonged suffering and unnecessary financial burdens.

Finally, standards set by the Joint Commission for the Accreditation of Hospital Organizations (JCAHO) and by Medicare (in the U.S.) require that providers of health care show respect for patients’ cultural and personal values, beliefs, and preferences, including religious or spiritual beliefs. Being aware of these beliefs allows health care providers to both respect their patient’s perspectives and adjust their care accordingly.

Please stay tuned for the final blog entry in this series addressing the connection between spirituality and health.

Reference:

Koenig, H.G. (2012). Religion, Spirituality, and Health: The Research and Clinical Implications. International Scholarly Research Network (ISRN) Psychiatry. Volume 2012, Article ID 278730, doi:10.5402/2012/278730

(* Please see Koenig, 2012 for secondary sources cited)

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Why would a doctor ask about spiritual practices? (Part 3 of 5)

Guest blogger, Laurie A. Tone LMFT, LPC, MHSP, served six years as Siloam Family Health Center’s behavioral health consultant. Today, she continues a five-part series of blogs on the body-mind-spirit connectedness.

Laurie writes…

skeleton walk

Courtesy of: http://www.3ds.com

Do you remember the little song you might have sang as a kid? “The heel bone’s connected to the foot bone. The foot bone’s connected to the leg bone…” and so on. Those connections seem pretty clear but what about Sam’s symptoms (see previous blog – part 2 of 5)? Could they really be connected to his guilt? If such a connection between spirituality and health exists, is there a way to test for it or measure it? Let’s see what the research says:

Dr. Harold Koenig, Director of the Duke Center for Spirituality, Theology and Health, has summarized the research examining the relationship between religion and/or spirituality and mental and physical health (see Koenig, 2012).

In a systematic review, Koenig identified 3,300 quantitative original data-based studies from 1872 to 2010 examining the relationship between religion and /or spirituality and health. Empirical evidence shows a strong connection.

In fact, Koenig reports that the majority of studies report significant relationships between religion and/or spirituality and better health. Such evidence behooves the medical community to do a better job of integrating spirituality and health.

Dr Koenig has identified at least 8 reasons why spirituality and religion should be integrated into medical practice. In this post, I will address the first four reasons.

*First, many patients are religious or spiritual and a vast majority have spiritual needs related to their medical or psychiatric illness. Most of these needs currently go unmet. The unmet spiritual needs, especially if they involve religious or spiritual struggles, can adversely affect patient health and may increase mortality independent of mental, physical, or social health.

Second, religion or spirituality influences the patient’s ability to cope with illness. In some areas of the U.S., 90% of hospitalized patients use religion to enable them to cope with their illnesses and over 40% indicate it is their primary coping behavior. Poor coping has adverse effects on medical outcomes, both in terms of lengthening hospital stays and increasing mortality.

Third, religious or spiritual beliefs affect patients’ medical decisions, such as those with serious medical illnesses and especially those with advanced cancer or HIV/AIDS. Some decisions may conflict with medical treatments and can influence compliance with those treatments.

Fourth, doctors’ own religious or spiritual beliefs often influence their decisions about care provision. Some of these decisions may include the use of pain medications, abortion, vaccinations, and contraception. However, doctors’ views about these matters and how they influence their decisions are usually not discussed with the patient.

Please stay tuned for Part 4 of this series for reasons 5-8 of why, according to Dr. Koenig, religion and /or spirituality should be integrated into medical practice.

Reference:

Koenig, H.G. (2012). Religion, Spirituality, and Health: The Research and Clinical Implications. International Scholarly Research Network (ISRN) Psychiatry. Volume 2012, Article ID 278730, doi:10.5402/2012/278730

(* Please see Koenig, 2012 for secondary sources cited in the first through fourth points)

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Why would a doctor ask about spiritual practices? (Part 2 of 5)

Guest blogger, Laurie A. Tone, LMFT, LPC, MHSP, served six years as Siloam Family Health Center’s behavioral health consultant. Today, she continues a series of blogs on the body-mind-spirit connectedness.

Laurie writes…

In part one, I wrote about how patients’ spiritual life impacts their physical well-being.  Now consider the following case:

Sam (not his real name) is a 56-year-old male who presented in the clinic with a chief complaint of diffuse body pain. He also reported for the past two months he felt fatigued, had poor sleep Check Engine light - 1-2013and poor concentration, low energy, poor appetite with a weight-loss of about 10 pounds in the last month, and just had an overall lack of desire for life. He also reported feelings of excessive guilt over things he had done. On further investigation, Sam reported that he had been stealing from his employer over the last three months. His family needed the money to pay the rent or they would have been evicted.  No one suspected him because he had worked for the company for many years and is good friends with the boss.

Since he began stealing Sam hadn’t slept or eaten well. At the time of the medical visit his symptoms were worsening and he began worrying that he might have bone cancer. His father had died of bone cancer a few years ago. Sam thought God was punishing him for stealing. After putting off his medical visit for weeks, mostly because of fear, Sam decided to seek medical care.

He had thorough visits with his medical provider. All his medical exams were negative, lab results within normal range and they found no evidence of any disease processes.

What do you think Sam’s diagnosis is?

a)      bone cancer

b)      depression

c)       thyroid disorder

d)      muscular dystrophy

If you guessed depression you are right. Sam was suffering from major depression brought on largely from the stress of guilt. His spiritual beliefs were in conflict with his actions resulting in distress. His ruminating guilt disrupted his sleep to such a degree, that after several months of insomnia, it led to a depressive episode. But interestingly enough, it wasn’t the other symptoms of depression that brought Sam into the clinic – it was the physical pain.

Pain, which is a common symptom of depression, is often like a “check engine light” indicating something is wrong under the hood. In Sam’s case there was indeed something going wrong “under the hood.” The good news for Sam is that by addressing the spiritual, emotional, physical and social areas of his life he was able to get the help he needed.

Sam is a good example of how we are integrated beings. It is impossible to separate out the spiritual from the physical. Stay tuned as next time we will address the connection between spirituality and emotional health.