Today's Christian Doctor - Spring 2018

Volume 49 No. 1 • Spring 2018

Today’s

Christian Doctor The Journal of the Christian Medical & Dental Associations

Battling the Opioid Epidemic

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FROM THE CMDA PRESIDENT AL WEIR, MD

FINDING AN ALTERNATIVE IN CHRIST

M

y daughter’s first husband was addicted to opioids. My wife was suspicious, but I had no idea until after they were married…and then bruises began to show. My brave daughter put him through two efforts at drug rehab before she had to leave him due to the trauma. I hate opioids for destroying a young man I prayed for regularly, and I hate opioids for causing my daughter such suffering.

At the same time, I care for cancer patients. I am dedicated to relieving their suffering. Opioids are vital in that relief. I need opioids to reduce the suffering of those whom God loves.

Opioids are both deadly and vital, like many tools we use in caring for our patients.

EARN CE CREDIT

For the first time, we are excited to offer continuing education credits through Today’s Christian Doctor. One hour of self-instruction is available for “Battling the Opioid Epidemic.” See page 21 for more information.

Our country has an opioid crisis with thousands dying each year from overdose and countless more families destroyed by the addictive behavior. I am not personally skilled to know how to fix the problem. Many brilliant people, physicians, lawmakers, advocacy groups and families are seeking solutions that we do not yet have.

As a Christian healthcare professional, I do have responsibilities within the system and at the bedside.

1. I need to be educated and vigilant with my own patients to watch for addictive behavior and to minimize my contribution to the problem by using safe prescribing practices.

2. I need to support my patient and colleague families as they are suffering.

3. I need to work within the healthcare system to develop guidelines and rules of behavior to decrease the systemic risk of addiction and to help those in recovery.

4. I need to avoid overreacting, so that I may still wisely provide relief for my patients when their pain is intolerable.

5. I need to provide an alternative Presence, in Christ, to fill the void that many people choose to fill with pain medicines.

6. At the same time, I must realize that my patients are unlikely to see Jesus if their thoughts are clouded by drugs. Speaking Jesus without removing the cloud is like shouting at the hearing impaired. I need to provide the best scientific help possible to help my patients overcome their addictions.

Opioid addiction is both a physical problem and a spiritual one. As in many other issues with healthcare, Christian healthcare professionals are equipped and mandated by Christ to deal with both. In this edition of Today’s Christian Doctor, Dr. Stephen Manchester shares how he found ways to balance addressing both physical and spiritual problems with opioid-addicted patients in the clinic he served at in Ohio. His experiences offer us a wonderful example of how to address the connection between opioid addition treatment and spiritual journey.

We are called by God to place our hands on the whole person and, through God’s power and the presence of Christ, redeem them from the talons of Satan. God bless each of you as you work with your patients, with their families and with CMDA to do so.

Transformed Doctors ➤ Transforming the World www.cmda.org 3

TO DAY ’ S C H R I S T I A N D O C TO R

contents

I

VO LU M E 4 9, N O. 1

I

SPRING 2018

The Christian Medical & Dental Associations ®— Changing Hearts in Healthcare . . . since 1931.

26 22 ransformed Doctors, 12 TTransforming the World

34 14 Cover Story

featuring David Topazian, DDS, MBA

30 Classifieds

Battling the Opioid Epidemic

by Stephen L. Manchester, MD, FAAFP

Outlining how you can integrate spiritual care into opioid treatment in your practice

22

L essons Learned: Facing Physicianassisted Suicide

by Rachel B. DiSanto, MD

One physician shares how she learned how to stand up for Christian principles

26

Cultivating Culture

by Ben Palpant

Seeing culture as a garden to cultivate in order to see true change

30

Renewing the Mountaintop Experience

by Bryan Stoudt

How can you apply what you learned on a mission trip in your busy, everyday life?

4 TODAY'S CHRISTIAN DOCTOR Spring 2018

EDITOR Mandi Mooney EDITORIAL COMMITTEE Gregg Albers, MD; John Crouch, MD; Autumn Dawn Galbreath, MD; Curtis E. Harris, MD, JD; Van Haywood, DMD; Rebecca Klint-Townsend, MD; Robert D. Orr, MD; Debby Read, RN AD SALES Margie Shealy 423-8441000 DESIGN Ahaa! Design + Production PRINTING Pulp CMDA is a member of the Evangelical Council for Financial Accountability (ECFA).

Today’s Christian Doctor®, registered with the U.S. Patent and Trademark Office. ISSN 0009-546X, Spring 2018, Volume XLIX, No. 1. Printed in the United States of America. Published four times each year by the Christian Medical & Dental Associations® at 2604 Highway 421, Bristol, TN 37620. Copyright© 2018, Christian Medical & Dental Associations®. All Rights Reserved. Distributed free to CMDA members. Nondoctors (US) are welcome to subscribe at a rate of $35 per year ($40 per year, international). Standard presort postage paid at Bristol, Tennessee.

Undesignated Scripture references are taken from the Holy Bible, New In-

ternational Version®, Copyright© 1973, 1978, 1984, Biblica. Used by permission of Zondervan. All rights reserved. Other versions are noted in the text.

Christian Medical & Dental Associations P.O. Box 7500, Bristol, TN 37621 888-230-2637 main@cmda.org • www.cmda.org If you are interested in submitting articles to be considered for publication, visit www.cmda.org/publications for submission guidelines and details. Articles and letters published represent the opinions of the authors and do not necessarily reflect the official policy of the Christian Medical & Dental Associations. Acceptance of paid advertising from any source does not necessarily imply the endorsement of a particular program, product or service by CMDA. Any technical information, advice or instruction provided in this publication is for the benefit of our readers, without any guarantee with respect to results they may experience with regard to the same. Implementation of the same is the decision of the reader and at his or her own risk. CMDA cannot be responsible for any untoward results experienced as a result of following or attempting to follow said information, advice or instruction.

TRANSFORMATIONS

CMDA WELCOMES NEW SOUTHERN REGIONAL DIRECTOR

Regional Ministries Connecting you with other Christ-followers to help better motivate, equip, disciple and serve within your community

Grant Hewitt, MDiv, joined CMDA as the new Southern Regional Director in 2017. He serves as a connection point for CMDA members living in Alabama, Arkansas, Florida, Georgia, Louisiana, Mississippi, North Carolina, Oklahoma, Puerto Rico, South Carolina, Tennessee, Texas and the Caribbean.

Grant earned his bachelor of science in exercise science at the University of Nebraska, where he met his wife Kelsi and, most importantly, was brought to saving faith in Jesus Christ at the age of 21. Before becoming a Christian, his goal was to attend physical therapy school, but as a result of his conversion, he accepted an invitation to be a pastoral intern for two years instead. The next eight years were spent working at three hospital clinics in the Omaha, Nebraska area teaching and working with patients on medically supervised diet and exercise programs. He directed those clinics for three years before feeling a strong call to redirect his life. In early 2014, following much prayer, Grant and Kelsi decided to quit his healthcare career, sell their newly purchased “dream home” and move 600 miles with their kids to attend Southern Seminary in Louisville, Kentucky.

Western Region Michael J. McLaughlin, MDiv P.O. Box 2169 Clackamas, OR 97015-2169 Office: 503-522-1950 west@cmda.org

Northeast Region Scott Boyles, MDiv P.O. Box 7500 Bristol, TN 37621 Office: 423-844-1092 scott.boyles@cmda.org

Midwest Region Allan J. Harmer, ThM, DMin 951 East 86th Street, Suite 200A Indianapolis, IN 46240 Office: 317-257-5885 cmdamw@cmda.org

Southern Region Grant Hewitt, MDiv P.O. Box 7500 Bristol, TN 37621 402-677-3252 south@cmda.org

When he graduated, he wondered what sort of ministry existed for someone with a healthcare background and a love for discipleship and missions. It was all preparation for his new role serving with CMDA’s Campus & Community Ministries. Grant now lives in Fort Worth, Texas with his wife and four kids: Carter (8), Calvin (6), Evangeline (4) and Levi (2).

GET INVOLVED

Campus & Community Ministries is a network of 78 local graduate ministries and over 280 campus chapters providing opportunities for members to connect and live out their Christian faith in their practices, on campus and in their communities. To find a CMDA chapter near you or learn more about your regional ministry opportunities, visit www.cmda.org/ccm.

IN MEMORIAM STANLEY A. BARNETT, MD, a member of CMDA since 1959, died in his Wheaton, Illinois home on November 12, 2017 at the age of 80. Afflicted with a degenerative neurological disease for 20 years, he faced his final challenge with his characteristic endurance and strength. Stan was born in 1937 in Kijabe, Kenya to missionary parents, and he received his medical degree from Albany Medical College before he signed up for full-time military service with the U.S. Army.

He was sent to Vietnam as a Green Beret in 1965 where he worked as a general medical officer. A deep, unwavering commitment to Jesus Christ marked Stan’s character and guided his life. Though he worked as an anesthesiologist for 30 years and served as a missionary doctor, he found the most joy and identity in enriching family connections and pursuing adventure, such as climbing Mt. Kilimanjaro, scuba diving and carrying the 2002 Olympic torch.

COL. DONALD F. WESTRA, SR., JD, passed away December 18, 2017 at the age of 99. Donald was born on November 8, 1918 in Randolph, Wisconsin, and he served his country faithfully by serving with the U.S. Air Force during World War II. He retired after 23 years at the rank of Colonel. He served as CMDA’s Executive Director from 1980 to 1982, leading the organization through a recovery period and balancing the finances. Following the sudden death of their son Jim after a tragic car accident in 1981, Don and his wife Mae established the James S. Westra Memorial Fund, the ministry’s first endowment fund. That scholarship fund continues to help defray expenses for third and fourth year medical students participating in short-term healthcare missions.

Since 1981, hundreds of students have received scholarships through this fund and their lives have been impacted as they seek to transform the world for Christ through missions.

Transformed Doctors ➤ Transforming the World www.cmda.org 5

TRANSFORMATIONS

JOIN US FOR THE ICMDA XVI WORLD CONGRESS CMDA is a founding member of the International Christian Medical and Dental Associations (ICMDA). Birthed at an international conference in Amsterdam in 1963, ICMDA now consists of approximately 80 member-nations. ICMDA holds a World Congress every four years, and the next of these quadrennial world gatherings will be in Hyderabad, India on August 21-26, 2018.

We invite you to be part of the U.S. contingent at the Hyderabad World Congress.

You will join leaders from CMDA, including CMDA’s CEO Dr. David Stevens who is one of the featured speakers. Located in Central India, Hyderabad is a blend of old and new worlds. It has become a technology center, boasting a modern convention center and fine accommodations.

The city is easily reached by international flights.

The conference is broken into three parts: August 21-23: A special program for students and residents August 22-23: A variety of pre-conference topical tracks August 23-26: Main conference

You can register for any or all parts of the program. Discounts are offered for those who attend the entire program. To register, visit www.icmda2018.org.

EVENTS For more information, visit www.cmda.org/events.

Remedy Medical Missions Conference March 23-24, 2018 • Orlando, Florida Connections Conference April 24-27, 2018 • Ridgecrest, North Carolina CMDA National Convention April 26-29, 2018 • Ridgecrest, North Carolina Voice of Christian Doctor’s Media Training May 18-19, 2018 • Bristol, Tennessee Deer Valley Summer Family Conference June 16-23, 2018 • Nathrop, Colorado Emerging Leaders in Dentistry Symposium June 22-24, 2018 • Bristol, Tennessee Trophy Trout Fishing with CMDA July 26-29, 2018 • Bristol, Tennessee Women Physicians in Christ Annual Conference September 20-23, 2018 • Essex, Vermont Greece Tour September 29 – October 8, 2018 • Greece Israel Tour September 29 – October 8, 2018 • Israel Marriage Enrichment Weekend October 12-14, 2018 • Bristol, Tennessee

MEMORIAM & GIFTS Gifts received October through December 2017

Mr. Stan Sytsma in honor of Dr. John Galloway Ms. Martha Bass in honor of Dr. Thomas C. Bohmfalk Dr. and Mrs. David Sieger in honor of Dr. Tim Carson Mr. and Mrs. Martin Coyle in honor of Mr. John S. Bayon, Jr. Mr. and Mrs. John Esler in honor of Dr. Bill and Mrs. Patsy Lawton Mr. James Robertson in honor of Dr. and Mrs. John Pierce Ms. Cynthia L. Burruss in honor of Dr. Ken Rutledge Mr. and Mrs. George Courtney and Noah Courtney in honor of Mr. Greg Gombar’s retirement Ms. Grace Koppenheffer in honor of Ms. Courtney Bell Mr. and Mrs. David Hanks in honor of Dr. and Mrs. Bruce MacFayden, Jr. Ms. Jennifer H. Hill in memory of Jackie Snyder Mr. and Mrs. Thomas Titkemeier, RPHs in memory of Ken Bostdorff For more information about honorarium and memoriam gifts, please contact stewardship@cmda.org.

6 TODAY'S CHRISTIAN DOCTOR Spring 2018

TRANSFORMATIONS

April 26-29, 2018 • Ridgecrest Conference Center • Ridgecrest, North Carolina www.cmda.org/nationalconvention

T

his is a great opportunity to discover how to “Renew Your Mind” as you fellowship with Christian healthcare professionals, learn about current health and social issues, renew your faith through worship and network with exhibiting organizations.

PLENARY SPEAKERS DR. JOHN BARNETT

r. Barnett has been teaching God’s D Word for 30+ years. As a seminary professor of theology, church history and the English Bible, John’s messages reflect the background of the Scripture from the ancient biblical world and the history of the church.

ELLIE LOFARO

Ellie is the founder of Heart Mind & Soul Ministries. A serious student of Scripture and an observer of culture, Ellie has a unique teaching style that touches the heart, stimulates the mind and nourishes the soul.

HON. JOE PITTS

.S. Representative Joe Pitts served U in Congress for 20 years, retiring in 2017 as a respected statesman known for his strong Christian faith and his commitment to advancing JudeoChristian values in government and society.

DAVID STEVENS, MD, MA (ETHICS)

r. Stevens serves as the Chief ExD ecutive Officer for Christian Medical & Dental Associations. He is the author of Jesus, MD and Beyond Medicine, and he is co-author of Leadership Proverbs and Servant Leadership.

WORSHIP LEADER RYAN KENNEDY

yan Kennedy is an internationally touring Christian R recording artist and worship leader based in Houston, Texas. Ryan has opened and toured with acts such as MercyMe, David Crowder, Sarah Kelly, Christy Nockels and more.

REGISTER NOW

For more information about our speakers and to register, visit www.cmda.org/nationalconvention.

Transformed Doctors ➤ Transforming the World www.cmda.org 7

sued

Are you being by your patient?

Do you think your hospital employer is trying to you?

terminate

Feeling as if nobody cares about you and your problems?

legal

Jesus Christ is always at our side as we walk through times of trouble. And we’re here to walk with you as well.

Isaiah 41:10 says, “Fear not, for I am with you...” (ESV). And Jesus tells us, “For my yoke is easy, and my burden is light” (Matthew 11:30, ESV). Members of the CMDA Medical Malpractice Ministry have gone through medico-legal turbulence just like yours, and we want to help support you through your medical malpractice trial or crisis. We are here to serve you, because we care.

As your Christian colleagues, we provide spiritual comfort, a listening ear, prayers and experience to walk with you through this new and dark path. We don’t provide actual legal advice, but we do walk alongside our hurting colleagues.

Medical Malpractice Ministry Paid Advertisement

P.O. Box 7500 Bristol, TN 37621 888-230-2637 www.cmda.org/mmm mmm@cmda.org

CMDA Ministries List OUTREACHES www.cmda.org/ministry

The core of CMDA’s ministry happens in local communities where healthcare professionals, residents and students live out the character of Christ. Our outreach ministries are dedicated to transforming the lives of healthcare professionals through evangelism and discipleship.

CAMPUS & COMMUNITY MINISTRIES

SIDE BY SIDE

DENTAL MINISTRIES

SPECIALTY SECTIONS

A network of 78 local graduate ministries and over 280 campus chapters providing opportunities for members to connect and live out their Christian faith in their practices, on campus and in their communities. cmda.org/ccm An outreach supporting dental professionals and students as they integrate Christian faith into all aspects of their lives, while providing opportunities for training and equipping. Also includes the CMDA Dental Residency [+] program. cmda.org/dentist

MISSIONS www.cmda.org/missions

A network of more than 80 local chapters to encourage, support and minister to women in healthcare marriages through fellowship, Bible study and prayer. Each local chapter meets the unique and individual needs of its community. cmda.org/sidebyside A wide variety of specialty sections formed to equip, network and provide a voice for CMDA members to their areas of specialty or service. Organized by CMDA members who wish to connect with their colleagues. These sections include: Christian Physical Therapists International, Christian Surgeons Fellowship,

Coalition of Christian Nurse Practitioners, Dermatology Section, Fellowship of Christian Optometrists, Fellowship of Christian Physician Assistants, Plastic and Reconstructive Surgery Section and Psychiatry Section. cmda.org/specialtysections

WOMEN PHYSICIANS IN CHRIST

A ministry that encourages and supports Christian women physicians and dentists in the unique challenges women face. It is a key resource for women in integrating their personal, professional and spiritual lives. cmda.org/wpc

CMDA is dedicated to domestic and international healthcare missions, both shortterm and long-term. We provide opportunities for healthcare professionals to use their God-given skills to meet the needs of others around the world and share the gospel with them.

CENTER FOR MEDICAL MISSIONS

GLOBAL HEALTH OUTREACH

MEDICAL EDUCATION INTERNATIONAL

CONTINUING EDUCATION FOR OVERSEAS HEALTHCARE PROFESSIONALS

HEALTHCARE FOR THE POOR

PAN-AFRICAN ACADEMY OF CHRISTIAN SURGEONS

A program designed to serve domestic and international healthcare missionaries in their work, as well as aid in the recruitment, training and retention of career healthcare missionaries. cmda.org/cmm

An annual 10-day multiple track continuing education and spiritual renewal conference for healthcare missionaries currently serving in international mission outreaches. cmda.org/cmde

A short-term missions program that sends 40 to 50 medical, dental and surgical teams around the world each year. GHO disciples participants, grows national churches, shares the gospel and provides care to the poor. cmda.org/gho We collaborate with Christian Community Health Fellowship (CCHF) in providing healthcare for the poor in the U.S. CCHF has an online directory of medical, dental and behavioral health counseling clinics serving the poor, as well as opportunities to serve. cmda.org/domestic

A short-term missions program that sends around 40 teams to teach in academic or clinical settings to bring transformation by advancing medical, dental, bioethical and educational knowledge while sharing the gospel. cmda.org/mei

A five-year program that trains and disciples African physicians to be surgeons who glorify God and provide excellent, compassionate care to those most in need. There are now 11 residencies at mission hospitals in Africa. cmda.org/paacs

RESOURCES www.cmda.org/resources

CMDA’s wide variety of resources and services help us to fulfill our mission to motivate, educate and equip Christian healthcare professionals and students. These resources and services give our members the knowledge and tools they need to effectively serve the Lord.

CHAPEL & PRAYER MINISTRIES

LIFE & LEADERSHIP COACHING

PLACEMENT SERVICES

COMMISSION ON HUMAN TRAFFICKING An effort to abolish human trafficking through policy initiatives, education, raising awareness and providing clinical services to victims. cmda.org/humantrafficking

LIFE & HEALTH RESOURCES

PUBLICATIONS

MARRIAGE ENRICHMENT

SPEAKER’S REFERRAL BUREAU

MEDICAL MALPRACTICE MINISTRY

STEWARDSHIP & DEVELOPMENT

A network of CMDA’s staff and members who pray for our members. Also includes online recordings of bi-weekly chapel services held at CMDA’s headquarters. cmda.org/chapel

CONTINUING EDUCATION

We offer continuing medical and dental education courses accredited by the ACCME to provide AMA PRA Category 1 Credit™.

We are also an Academy of General Dentistry Approved PACE Provider. cmda.org/ce

ETHICS HOTLINE

An on-call program to assist members facing difficult patient care decisions, provided by Christian physician ethicists. You can easily reach the hotline at 423-844-1000. cmda.org/hotline

EVENTS

A variety of more than 40 topical, local, regional and national conferences and tours each year for training and networking including TRANSFORM: CMDA’s National Convention, the Global Missions Health Conference and many more. cmda.org/events

VOICE

www.cmda.org/issues

A personalized resource with certified coaches who assist healthcare professionals in finding balance in addressing both the professional and personal issues of everyday life. cmda.org/coaching A distribution service for CMDA-produced and recommended resources through the CMDA Bookstore, including Just Add Water, Grace Prescriptions, Prescribe-A-Resource and a variety of other valuable aids. shopcmda.org A ministry that provides four to six conferences per year to address the unique needs and stresses of healthcare marriages, offering couples the opportunity to nurture and grow in their marital relationships. cmda.org/marriage A program assisting healthcare professionals facing malpractice lawsuits with prayer, educational resources and encouragement from a network of healthcare professionals who have faced malpractice suits themselves. cmda.org/mmm

VOICE OF CHRISTIAN DOCTOR’S MEDIA TRAINING

A library of public service announcements on ethical and healthcare topics available to radio stations. cmda.org/psa

An service that encourages and aids CMDA members to be good stewards of the gifts given them by God, with resources to help protect their assets and provide for loved ones while building the kingdom. cmda.org/giving

CMDA is dedicated to serving as a Christian voice, as well as offering valuable resources on today’s current healthcare topics to our members. Our voice outreaches speak for our members to the government, media, church and public on bioethical and public policy issues while also training Christians to be effective advocates themselves.

NEWS RELEASES

PUBLIC SERVICE ANNOUNCEMENTS

An online self-referral speaker’s bureau of CMDA members who can be contacted for local, regional or national events. These recommended speakers are available to address a variety of topics and issues. cmda.org/speakers

We assist our members with information regarding our resources, as well as membership recruitment, renewals and retention. cmda.org/members

STATE PUBLIC POLICY CAMPAIGNS

CMDA’s responses to breaking news on vital healthcare issues resulting in hundreds of media interviews each year. cmda.org/newsroom

A wide variety of informational print and electronic resources published by CMDA to encourage, equip and motivate readers, including Christian Doctor’s Digest, Today’s Christian Doctor, Weekly Devotions and many others. cmda.org/publications

MEMBER SERVICES

AMERICAN ACADEMY OF MEDICAL ETHICS

The American Academy of Medical Ethics is an initiative of CMDA dedicated to preserving and promoting the ethical standards outlined in the original Hippocratic Oath. ethicalhealthcare.org

A recruiting service that brings together Christian healthcare professionals and practices throughout the U.S. to enhance their ministry and advance the kingdom of God. cmda.org/placement

Grassroots campaigns to promote life-honoring legislation and referendums at the state level on physician-assisted suicide, abortion and other issues. cmda.org/publicpolicy

An individualized training workshop for members to learn how to prepare for and give television, radio and print media interviews which offer Christian perspectives on ethical questions and general health topics. cmda.org/mediatraining

WASHINGTON OFFICE

A department of CMDA that serves as a liasion with Congress, the White House, federal agencies and non-governmental organizations in Washington, D.C. Also provides opportunities for federal employment, Congressional testimony and committee service. Includes the Freedom2Care website that is a coalition to advance conscience rights in healthcare and provide other legislative updates and tools. cmda.org/washington

MY CMDA STORY

Dr. Karen Glover (middle) at the 2015 Women Physicians in Christ Annual Conference with Dr. Tiffany Owens (right) and Dr. Karen Russell (left).

“The first CMDA event I attended was the WPC Annual Conference in 2007. At that time, I had already been in private practice in OB/Gyn for more than 10 years. I haven’t missed an annual conference since that first one.

I wish I had been involved with CMDA starting in my medical school and residency days.

In 2008, while both my husband and I were on active duty in different states, we participated in Completing Your Call, a year-long course offered by CMDA. It was through those meetings that I became more aware of the amazing scope of the CMDA mission. I later served as a CMDA state representative for a few years and a local graduate chapter met in my home during that time. I have certainly been blessed by all the friendships I’ve made and the wisdom and teaching I’ve received at the conferences and through CMDA.” —Karen Glover, MD P.O. Box 7500 Bristol, TN 37621 888-230-2637 www.joincmda.org memberservices@cmda.org

JOIN CMDA TODAY You can join Dr. Glover and more than 17,000 healthcare professionals across the country who are part of this growing movement to change hearts in healthcare. Visit www.joincmda.org or call 888-230-2637 to join us today.

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TRANSFORMED TRANSFORMED Doctors

Featuring

David Topazian, DDS, MBA

D

r. David Topazian, the co-founder of MedSend and former President of CMDA, went home to be with the Lord on December 29, 2017 at the age of 86. He dedicated his life to service through spiritual leadership, selfless hospitality, stewardship and healthcare missions.

David was born in 1931 in Greenwich, Connecticut, to Shavarsh and Alyce Topazian. He attended Houghton College and McGill University Faculty of Dentistry in Montreal, where he met and married his wife Deidre. After serving in the United States Army, he completed training in oral surgery at the University of Pennsylvania. In 1961, he opened his oral surgery practice in Milford, Connecticut, where he practiced for 27 years. He also served as Associate Clinical Professor of Surgery at Yale University School of Medicine.

He went on his first short-term mission trip in 1968 and, as he described it, that trip transformed his entire life: “In 1968 I joined about 125 health professionals of all specialties in a short-term mission to the Dominican Republic.

I was 37 years old and had never been outside of North America. I didn’t realize it at the time, but my worldview had changed forever.”

Community Church in Valencia, Venezuela for six years.

During this time, Dr. Topazian served as President of CMDA from 1989 to 1991, the first dental president in the history of the organization. He was also the first president who was, at the same time, a full-time missionary.

During his presidency, CMDA enjoyed a pronounced increase in its international influence. It was during this time that CMDA began receiving reports from its missionary members about a crisis in the mission field: a shrinking pool of long-term missionaries.

David and Deidre continued to participate on mission trips on an annual basis, and each time they went they said a subtle change took place. “We realized more and more that God had a special concern for the poor and so did we,” he said.

“We began to simplify our lifestyle, to consume less, and give more in order to prepare ourselves for what turned out to be full-time missions service. I was able to retire from practice in 1987 at age 56. We left the United States to become selfsupporting missionaries in South America with TEAM.”

“We started receiving reports from missionaries in the field who were overworked, who were due for furlough and couldn’t come home on home assignment because there was no one to replace them,” Dr. Topazian said in an article published by The Washington Post in 2003. He started looking into the problem and surveyed mission boards and hospitals. The results of the survey confirmed the belief of CMDA members that the culprit was the high debt load incurred during training and the need to pay off those loans before serving on the mission field.

In 1988, they joined The Evangelical Alliance Mission (TEAM) as full-time missionaries and pastored Valencia

Dr. Topazian knew that if doctors had to enter into private practice to repay their debts, chances are they would

12 TODAY'S CHRISTIAN DOCTOR Spring 2018

TRANSFORMING TRANSFORMING

the World

get settled into comfortable lifestyles and never make it to places that desperately need them. So after he completed an MBA in non-profit management, Dr. Topazian cofounded MedSend with Dr. Daniel Fountain. MedSend is a non-profit organization that pays the educational debts of healthcare professionals while they serve in mission settings in the U.S. and around the world. In 1994, David and Deidre returned to the United States, where he became the unpaid CEO and President of MedSend. A resurgence in American healthcare missions followed. He continued serving in that role until his retirement in 2007.

“CMDA provided the organizational structure and administrative support for Dr. Topazian as he established Project MedSend and during its formative years, eventually assisting him as he formed a new 501(c)3,” said CMDA Senior Vice President Gene Rudd, MD. “It was a joy to work with such a gracious, humble man…yet a man with a mission and passion to encourage new medical missionaries. These types of organizational emancipations are often difficult, but this was done in a way that honored God. Much of that was due to the grace of David Topazian.”

David’s love for God was the defining focus of his life. In 2001, CMDA awarded the Servant of Christ Award to David and Deidre, an award that honors those whose careers exemplify commitment to medical excellence along with a stalwart faith in Jesus Christ. The eternal impact of the Topazians’ vision and work in developing MedSend is vast. In countless ways, David was truly a servant of Christ, giving the best of his talent, vision and resources to serve people around the world with excellence and Christ-like love.

“More fortunate than most, we have had three careers to date: oral & maxillofacial surgeon; full-time missionary; CEO of a challenging non-profit medical missions organization, each one an indication of God’s blessing. Every successive career has been more satisfying and enjoyable than the last, something we would wish for everyone.”

—David Topazian, DDS, MBA

“Dr. Topazian’s vision and hard work made MedSend a reality and the resulting impact on God’s kingdom has been enormous,” wrote current MedSend President and CEO Rick Allen in a memorial posted on MedSend’s website. “Today, MedSend grants have freed over 600 Christian healthcare professionals to serve people in need throughout the world. We estimate that well over a million people have received compassionate, Christ-centered care through the ministry of MedSend healthcare professionals and tens of thousands have come to faith in Christ.”

“Beyond these many notable accomplishments, Dave Topazian was known for his deep commitment to prayer and the welfare of others, especially healthcare missionaries. I personally know scores of people in whom he invested his life as a friend and mentor.

His family and a large circle of friends and colleagues speak eagerly of the positive impact he had on their lives,” Allen continued.

Transformed Doctors ➤ Transforming the World www.cmda.org 13

EARN CE CREDIT

For the first time, we are excited to offer continuing education credits through Today’s Christian Doctor. One hour of self-instruction is available for “Battling the Opioid Epidemic.”

See page 21 for more information.

14 TODAY'S CHRISTIAN DOCTOR Spring 2018

Battling the Opioid Epidemic

by Stephen L. Manchester, MD, FAAFP

A

s I walked through the park, I heard a man call out my name, “Dr. Manchester!” I looked to see who was speaking, and as he approached he asked, “Do you remember me?”

He did not look familiar so I responded, “Can you jog my memory?”

For the first few weeks after we returned to our home base in Ohio, the local newspaper ran articles on the front page nearly every day about the same subject: opioid addiction. So when I contacted the local community health center where I had previously worked to see if they had any openings, it was not surprising that treating opioid addicts was their urgent, pressing need.

“You treated me for my heroin addiction,” he said. The man then pointed to his wife a few feet away, whom I had also treated. As we spent some time talking, it became obvious they had gained weight during their recovery and looked considerably healthier, which accounted for why I hadn’t recognized them. While they were quite thankful for the medical treatment I had given, the thing they wanted to talk about was their spiritual journey.

They invited me to talk to the behavioral health clinician about the ramping up of a Medication Assisted Treatment (MAT) clinic they had started using Vivitrol.

I wasn’t certain what Vivitrol was; in fact, I didn’t even know that MAT meant helping addicts in their recovery. It turns out Vivitrol is an extended-release naltrexone injection (XR-NTX) that is used to block the effects of opiates and keep those seeking recovery protected while they pursue their behavioral therapies. According to R.L.

My family and I had returned to the United States for a year of Home Ministry Assignment. As a healthcare missionary, finding a temporary workplace that was going to help me catch up on current practices in family medicine was a high priority. I needed to gain more experience and learn the newest treatments, medications and more. The problems facing patients in our small Ohio community were vastly different from the problems I faced on a daily basis while treating patients at Tenwek Hospital in Kenya.

I just didn’t realize how different they had become.

Transformed Doctors ➤ Transforming the World www.cmda.org 15

LEARN MORE

Vivitrol is naltrexone for extendedrelease injectable suspension made by the drug manufacturer Alkermes. It uses naltrexone coated in microspheres that, once deposited in the muscle, will release slowly over a 30-day period. For more information, visit www.vivitrol.com.

Wynn with Wolters Kluwer, “This extended-release opioid antagonist is particularly appealing to patients and providers who are unlikely to access opioid-agonist maintenance treatment such as methadone therapy, or methadone-buprenorphine (Suboxone) therapy and who prefer a relapseprevention medication.”

This gave me pause. After all, I’d been serving in rural Kenya, and I had no recent experience in addition medicine. Nevertheless, the continual bad news coming from my community stirred up compassion in me, not unlike that I felt for my Kenyan patients, and compelled me to participate.

My plan was simple. I was going to continue using the same holistic approach that had become my routine while working at Tenwek for the last 12 years. My goal was to bring healing by addressing each person’s physical, emotional and spiritual brokenness. The old metaphor of a three-legged stool came to mind: if any of the legs are broken, the stool falls over. I just wasn’t sure if this population of patients was open to a spiritual component in their treatment.

My very first patient at the clinic offered me the opportunity to put my plan into practice. After the physical and emotional issues were taken care of, I introduced the need to discuss spiritual care and asked if I could read from the Bible. My patient consented. As I read from Romans 8 about how nothing can separate us from the love of God, I wasn’t sure what response to expect. The patient hesitated, but then she launched into a detailed but important spiritual history, 16 TODAY'S CHRISTIAN DOCTOR Spring 2018

told with great emotion. At the end of the visit, I asked if I could pray with her and she agreed. As she left the room, she was happy to have a plan for her recovery and remarked that she couldn’t wait to tell her mother that for the first time ever a doctor had prayed with her. That encounter was just the beginning. With rare exception, this pattern repeated itself with each subsequent patient.

Because I understood my patients would be in the fight of their lives, I wanted to know the predictors of successful long-term abstinence.

As I searched the literature, I was overwhelmed with references to spiritual wellness including, but not limited to, 12-step programs. Several studies cite the importance of spirituality in addiction recovery. In one study from Alcoholism Treatment Quarterly, the researchers found “that recovering individuals have statistically greater levels of faith and spirituality than those continuing to relapse; also that relapsing individuals show significantly lower levels of spirituality than those in recovery.” Another researcher went on to say that the faith journey in recovery “is often an intense spiritual journey that leads to sustained abstinence.” A study that looked at the attitudes toward a holistic approach for inner city substance-dependent HIV patients found that a large majority of those studied expressed a high interest in receiving spirituality-focused treatment. Incorporating spirituality into treatment is not only beneficial, but those seeking treatment are pleased when clinicians and counselors integrate it into their care.

Armed with this reassurance, I continued. Second-visit patients were read to from Joshua 1:9, “...Be strong and courageous...for the Lord your God is with you wherever you go” (ESV ). Other readings proved to be powerful and comforting, evoking an emotional connection between my patients and God (Isaiah 40:28-31, Matthew 11:2830 and Psalm 23). The goal of these conversations was to assure these children of God that love and mercy, rather than condemnation and shame, come from Him unconditionally. I ended each visit with a prayer and a recommendation of a church or meeting that celebrated and encouraged recovery.

Our team found that by getting to the third consecutive monthly XR-NTX injection, patients were much more likely to continue with the behavioral therapy in the longterm, since they were protected from the effects of opiates.

Because of this, we celebrated the third injection with a certificate, a card of congratulations and a small gift card. Such encouraging interactions are rare for those struggling with addiction, so this un-manipulated, unexpected recognition of their achievement was extremely powerful.

CLINICAL CONVERSATIONS

One of the great challenges in using XR-NTX is that the patient needs to be free of opioids before initiating treatment.

This requires seven to 10 days of abstinence from heroin or oral prescription opiates, as well as up to two weeks or more abstaining from oral buprenorphine. During this time of withdrawal, we used supportive medications. Zofran can be given for nausea, loperamide for diarrhea, an NSAID for pain, doxepin or quetiapine for sleep and clonidine to mitigate the autonomic response. But the symptom concerning my addicted patients most was muscle aches. For this, they can be prescribed 300 mg of gabapentin three times a day for up to two weeks. If a longer time is needed, then a follow-up visit is necessary. The use of gabapentin is somewhat controversial since it has a street value of its own, but in a model of risk reduction, a short, low-dose course was beneficial and certainly increased the likelihood of a successful withdrawal.

The resulting titration pack started with a dose of 0.25 mg the first day and increased up to 25 mg by the eighth day.

Patients found this to be very helpful because it put a clear timeframe on their withdrawal.

On the day of the first dose of XR-NTX, we evaluated the patient’s completion of the withdrawal period. Upon exam the patient had to demonstrate the lack of evidence of autonomic overdrive or intoxication. A urine specimen must be negative for opiates and meet the criteria of a true urine specimen. Observing the patient during the production of the specimen is recommended, despite the resistance from the patients and staff. If satisfied that the patient is opiate-free, the physician should administer an oral naltrexone challenge. If no evidence of withdrawal takes place in 30 to 60 minutes, the first XR-NTX dose can be given. The patient should remain in the exam room for an additional 30 minutes before release. And for the next 30 days, they will feel no effect from the use of opiates.

In the first few months, we found that occasional patients somehow sensed the falling levels of naltrexone in the week before their next dose. This resulted in significant anxiety and made some patients think MAT wasn’t working.

Whether the effectiveness was really waning is not clear, but the problem was easily remedied. We warned patients of this side effect and offered to call in a prescription for

Some patients need more help than this, and a few options remain. For most of our difficult cases, we employed a course of oral naltrexone. Oral naltrexone comes only in a 50 mg tablet. Giving 50 mg or even 25 mg will induce an immediate precipitated withdrawal, which can result in significant morbidity. Titrating up from a very low dose, however, brings the patient through a rapid but controlled withdrawal while, at the same time, starting to block them from the effects of opiates should they relapse. In order to provide this, we found a compounding pharmacy to make and package each dose.

Transformed Doctors ➤ Transforming the World www.cmda.org 17

oral naltrexone to augment their levels when needed. Naltrexone 50 mg daily for the week prior to the next injection always mitigated the effect and was usually only needed in the first three months, if at all.

To avoid hepatic-related adverse events, patients need to have a minimally healthy liver. So on the first visit, we obtained a complete metabolic panel with liver enzymes, CBC, Hepatitis B and Hepatitis C tests. As long as the liver enzymes were less than eight times elevated above the upper limit of normal, they were acceptable candidates for XR-NTX. In most cases of elevated liver enzymes, they would return to normal with abstinence from opioids. In general, all heroin users will be positive for Hepatitis C, so a test that reflexes to viral load and genotype should be used.

Treatment of their hepatitis can wait until they have been abstinent for six months.

SPIRITUAL CONVERSATIONS

The next step in our process was to discuss spiritual wholeness. Major themes that emerged during patient encounters were guilt, shame and broken relationships. These issues need to be addressed openly. For substance abusers, their addiction takes away everything they hold dear, thus many destroyed relationships result in painful emotions. That is why I started with Romans 8, because it assures them of God’s unconditional love. “For I am sure that neither death 18 TODAY'S CHRISTIAN DOCTOR Spring 2018

nor life, nor angels nor rulers, nor things present nor things to come, nor powers, nor height nor depth, nor anything else in all creation, will be able to separate us from the love of God in Christ Jesus our Lord” (Romans 8:38-39, ESV).

Unlike in their human relationships, God doesn’t fall victim to their constant attempts at deceiving, manipulating and stealing. He will never stop loving us! These verses are such a powerful reminder for patients struggling with the damage they have caused.

Women fighting addiction have a special measure of shame since most have used their bodies at some point to obtain drugs. Ann Voskamp wrote a passage about the woman caught in adultery that speaks to this issue, so I shared it with them. Because biblical literacy was typically low with our patients, I prefaced the reading with a brief retelling of the story from John 8:1-11. In The Broken Way, Voskamp says: ...Jesus kneeling down in front of a woman caught in adultery, and it comes like a slow grace, how Jesus handled her critics: He deeply unsettled the comfortable and deeply comforted the unsettled. The woman grabbed by the Pharisees was given what I myself desperately need. Before all the pointing fingers, Jesus looked up at the wounded and rewrote her fate: “ You’re guilty but not condemned. You’re busted up, but believed in. You’re broken, but beloved.”

Whatever you’re in caught in, I make you free. Whatever you’re accused of, I hand you pardon. Whatever you’re judged

of, I give you release. Whatever binds you, I have broken. All sin and shame and guilt and lack I have made into beauty and abundance.

Who gets over a love like this? In the midst of trials, Jesus guarantees the best trial outcome: you’re guilty but you get no condemnation. No condemnation for failing everyone, no condemnation for not doing everything, no condemnation for messing up every day. Who gets over a release like this?

The Bible speaks to the concerns of men as well. One such passage is of David’s sin with Bathsheba in 2 Samuel 11.

After briefly explaining the story, reading David’s confession and prayer for forgiveness in Psalm 51 gave great encouragement to these men. Many of our male patients came from residential treatment facilities accompanied by their recovery counselors, who are themselves often recovering addicts. At one such visit when I shared this passage with the patient, I was surprised when the counselor spoke up and said, “Thank you, Doctor, that was just what I needed to hear!”

THE FIGHT OF OUR LIVES Of the patients I saw during the six months I worked in the clinic, 169 were able to be tracked. Of those, 133 made it through detox and received at least one injection of XRNTX. A total of 89 patients (67 percent) were still active at three months, 55 (41 percent) at six months and 27 (20 percent) at 12 months. Most studies track patients for 12 to 24 months, and our clinic continues to follow up on our patients even though I have returned to Kenya.

While many studies are available regarding XR-NTX, none of them compare to our situation. Our patients were not selected with a statistical study in mind, rather this is a retrospective observational assessment with the intention to treat. These addicts were self-referred, counselor-recommended, court-ordered from our local law enforcement and even sent from neighboring counties. The drug of choice was

After realizing that few of my patients owned Bibles, I started offering them the Recovery Bible or the Celebrate Recovery Bible so they could follow the included devotional plans. It wasn’t long before word got around in the addiction community that I was a spiritual resource, and patients occasionally asked for a Bible before I had a chance to offer them one.

Not all, but most of the patients I encountered were interested in God’s forgiveness, His grace and His mercy.

Praying for patients has therapeutic benefit as it changes their perspective and releases God’s power in their lives. On learning that I was praying for my patients, a colleague asked me for more specific details. I explained that my prayers are very simple and go something like this: “Kind Father, it is a blessing to me that this precious person has come here today and in a small way is allowing me to share in their suffering. I lift this person up to you and ask for your healing touch in their life. I ask that you give grace to face this difficult journey and for power to overcome this bondage. May your peace and grace go with them until our next meeting.” I encouraged my colleague to always use the patient’s name when praying with them, as well as incorporate specific needs that arose during that day’s visit.

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dealing with the epidemic. Former U.S. Surgeon General Dr. Vivek Murthy sent a letter to millions of healthcare professionals in 2016 calling for a “national movement of clinicians” to help fight the opioid epidemic.

In the letter, he wrote, “I know solving this problem will not be easy...But, as clinicians, we have the unique power to help end this epidemic.” He called for healthcare professionals to educate themselves first, screen patients for substance use disorders and connect them with treatment options, managing it as a chronic illness not a moral failing.

primarily heroin, but most were poly-substance, a few were alcoholic, some were on a number of prescription opiates and at least one was using only crystal meth. Patients not retained were difficult to follow and those who relapsed were not always known. Our goal was to have them in active treatment for 12 to 24 months. Some patients transferred into our program already on treatment that was started in other clinics.

A study released in Alcoholism & Drug Abuse Weekly compared usage of buprenorphine versus Vivitrol and showed both had 50 percent retention at six months. While our population was only at 41 percent, among the MAT clinics in communities like “real world” Southern Ohio, our program stood out as significantly more successful.

And in that real world, we are in the midst of the largest manmade epidemic in the history of the United States— the opiate epidemic. According to the U.S. Department of Health & Human Services (HHS), drug overdose deaths are the leading cause of injury death in the U.S. HHS has made prevention, treatment, research and effective responses to rapidly reverse opioid overdoses a top priority to help fight the epidemic.

As healthcare professionals, we are on the front lines of this crisis. Numerous experts say doctor training is key to 20 TODAY'S CHRISTIAN DOCTOR Spring 2018

Christian healthcare professionals should be at the forefront of addiction medicine, because who else is better equipped to redirect patients who have lost their spiritual way? Yes, the drugaddicted patient is masterful at lying, cheating, stealing and manipulating. But if ever there was a group of people who are harassed and helpless, like sheep without a shepherd, it is this population.

And Jesus went throughout all the cities and villages, teaching in their synagogues and proclaiming the gospel of the kingdom and healing every disease and every affliction. When he saw the crowds, he had compassion for them, because they were harassed and helpless, like sheep without a shepherd. Then he said to his disciples, “The harvest is plentiful, but the laborers are few; therefore pray earnestly to the Lord of the harvest to send out laborers into his harvest” (Matthew 9:35-38, ESV).

This Scripture has often motivated me in my ministry at Tenwek, and when I brought it with me to the MAT clinic, the compassion described in it became contagious. At one memorable appointment, a MAT patient told me how just that morning her husband had left her and their child, taking everything, even the diapers. I decided to run to a local drugstore across the street to buy baby supplies for her, but another staff member at the clinic insisted on giving me her debit card to pay for them. This inspired other staff toward acts of kindness, and it resulted in our patients leaving after each visit having experienced a compassion rarely shown to them outside the clinic.

I don’t want to minimize the team effort. Recovery from addiction is achieved through behavioral therapies. Vivitrol is a tool that provides a safety net while patients go to counseling, group sessions and 12-step programs, in addition to committing themselves to spiritual growth. During this time they make apologies, earn back trust and restore relationships. How long the injections continue depends on the progress the patients make in changing their behaviors.

Coordinating all this takes a team, and in our office the behavioral health clinician was the key person to oversee this process, providing invaluable support to the clients and other staff. The CEO of Hopewell Health Center (the federally qualified community health center where I worked), the MAT program coordinator, the nurses and all the staff were supportive of the holistic approach and my attention to spiritual care.

At the end of six months, I had met with more than 200 drug-addicted patients from every walk of life—patients just like the couple who stopped me in the park that day.

Like them, nearly all understand the connection between their addiction and their spiritual journey. And none of them refused my offer of prayer. This experience has convinced me that long-term sobriety is difficult, but without God’s power it is almost impossible. As a Christian healthcare professional, you have the unique opportunity to help your substance-addicted patients access all that the Almighty offers. What is holding you back from representing Him in your practice?

STEPHEN L. MANCHESTER, MD, FAAFP, serves with World Gospel Mission at Tenwek Hospital in Kenya. He and his wife Theresa have been there since 2005. They have three boys: Nick, Peter and Wil. Steve is director of Tenwek’s hospice and palliative care services. He is from Chillicothe, Ohio where he practiced at Hopewell Health Center and the Ross County Health Department for 13 years and has degrees from Asbury University and Wright State University Boonshoft School of Medicine. Follow their ministry at facebook.com/ manchestersoutthedoor.

EARN CONTINUING EDUCATION

1 HOUR NOW AVAILABLE For the first time, we are excited to offer continuing education credits through Today’s Christian Doctor. One hour of self-instruction is available.

To obtain continuing education credit, you must complete the online test at https://www.surveymonkey.com/ r/2018opioidepid.

• This CE activity is complimentary for CMDA members.

• The fee for non-CMDA members is $50.00. For payment information, visit www.cmda.org/cepayment.

If you have any questions, please contact CMDA’s Department of Continuing Education Office at ce@cmda.org.

Review Date: January 25, 2018 Original Release Date: February 25, 2018 Termination Date: February 25, 2021 EDUCATIONAL OBJECTIVES • Discuss how to integrate spiritual care into the daily practice of medicine.

• Describe the use of long acting naltrexone for the treatment of opiate addiction.

• Describe how to help a patient through a period of opiate withdrawal.

• Describe positive evidence for incorporating spiritual care into treatment of the opiate addicted patient.

ACCREDITATION The Christian Medical & Dental Associations is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.

PHYSICIAN CREDIT The Christian Medical & Dental Associations designates this educational activity for a maximum of 1 AMA PRA Category 1 Credit(s)™.

Physicians should only claim credit commensurate with the extent of their participation in the activity.

DENTAL CREDIT CMDA is an Approved PACE Program Provider by the Academy of General Dentistry. The formal continuing education programs of this program provider are accepted by AGD for Fellowship, Mastership and membership maintenance credit. Approval does not imply acceptance by a state or provincial board of dentistry or AGD endorsement. The current term of approval extends from 1/1/2015 to 12/31/2018. Provider ID#218742. 1 Hour Self Instruction Available. No prior level of skill, knowledge, or experience is required (or suggested).

DISCLOSURE None of these authors, planners or faculty have relevant financial relationships.

Stephen L. Manchester, MD; David Stevens, MD, MA (Ethics); Mandi Mooney, CMDA Today’s Christian Doctor Editor; Michael O’Callaghan, DDS; Barbara Snapp, CE Administrator; and Sharon Whitmer, EdD, MFT CMDA CE Review Committee John Pierce, MD, Chair; Jeff Amstutz, DDS; Mike Chupp, MD; Lindsey Clarke, MD; Stan Cobb, DDS; Gary Goforth, MD; Elizabeth Heredia, MD; Curtis High, DDS; Bruce MacFadyen, MD; Dale Michels, MD; Shawn Morehead, MD; Michael O’Callaghan, DDS; David Stevens, MD (recused); and Richard Voet, MD THERE IS NO IN-KIND OR COMMERCIAL SUPPORT FOR THIS ACTIVITY.

Transformed Doctors ➤ Transforming the World www.cmda.org 21

T

he beginning of my medical education was also the beginning of my experience with physician-assisted suicide. I was a first year medical student at the University of Vermont College of Medicine (now the Larner College of Medicine) in Burlington, Vermont in 2000, and I had recently joined the student chapter of CMDA. I was invited by our graduate mentors to attend an informational meeting about Vermont’s newly proposed physician-assisted suicide legislation. CMDA CEO Dr. David Stevens had traveled to Burlington to lead the discussion. It was the first of countless such meetings he has conducted in the last two decades. I remember being simultaneously inspired by the wisdom and courage of my mentors and the CMDA leadership, as well as terrified that I would ever have to step into such a contentious legal battle to defend what I knew was right. I had gone into healthcare to help people, and possibly share my faith, but it had not yet occurred to me that I might be called to participate in controversial, public battles over vital moral and conscience issues in healthcare. As a young woman who grew up in New Hampshire, I was already in culture shock having moved to the progressive hub of one of the most liberal states in the country only a few short months prior. I was seeing the active and open ridicule and intimidation of conservatives, and especially Christians, in every facet of my medical education, and I was scared.

Fast forward 15 years to 2015. Culturally, things went from bad to worse in Vermont during this passage of time.

My closest mentor and dear friend, Dr. Bob Orr, had been challenged and belittled for his faith on a television news program. After a heated and prolonged battle lasting over a decade, physician-assisted suicide was finally passed into law with Act 39, and I was eight years into family medicine practice in rural, impoverished Northeast Vermont. I had continued to be peripherally involved in the fight against physician-assisted suicide legislation, but I had not been one of the physicians taking the lead in the media or in tes-

LESSONS LEARNED

Facing Physician-assisted Suicide

by Rachel B. DiSanto, MD

22 TODAY'S CHRISTIAN DOCTOR Spring 2018

vestigate other states’ experiences. I was asked to testify (via Skype) before this committee, and I decided I had to try. I had no experience and very little faith in myself, but God wasn’t looking for either of those things from me; instead, He was simply looking for faith in Him. The testimony went well, although I was sharply questioned and criticized by the committee chair. CMDA’s partners in Maryland who spearheaded the effort for us were tremendously supportive.

I learned so much through that brief experience. Despite my perceived inadequacies, I found that God is really just looking for us to show up. I might have been tempted to check that off my list and think I had done my good deed in the fight against physician-assisted suicide, but somehow I knew that was only the beginning.

tifying at the state level. Shortly after, some of us in leadership positions in CMDA were asked what advice we would give to other members battling this issue across the country.

It forced me to consider what I personally could have done differently. Though the outcome seemed foregone, as everyone knew the legislature had enough votes to pass it, I felt sad, ashamed and angry that I had not tried harder, had not personally put more on the line.

As God so often does, He quickly brought an opportunity to me to enter the battle in ways I had previously avoided.

Maryland was considering legalizing physician-assisted suicide, and the state legislature formed a committee to in-

In spring 2016, Dr. Stevens approached me to get involved with a somewhat new approach in CMDA’s legal efforts to support healthcare right of conscience. With the help of Alliance Defending Freedom (ADF), CMDA was filing suit as a plaintiff in a case in a federal court in Vermont to protect its members’ right not to participate in physician-assisted suicide. The Vermont law legalizing physician-assisted suicide included an extremely loose clause that stated no one had to participate against his or her conscience, but it did not specify whether a physician was required to refer a patient seeking a lethal prescription. When Dave asked me to join this lawsuit, I remember thinking, “Is this really necessary? I mean, shouldn’t we wait until it becomes a problem and then try to defend ourselves legally? Aren’t we picking a fight where no fight may ever exist?” Having said that (to myself ), I remembered how I had felt a year before when testifying before the committee in Massachusetts. Perhaps this was the time to really put myself out there. I knew God was calling me to step out in faith, but what would my colleagues think? What would my boss think? What might get printed in the paper? Would I be subject to an exposé the way my mentor had been 10 years ago? I was asking these questions out of fear, even though I knew none of those things should matter. Despite my fear, I placed my faith in the One I could trust with my career and my reputation. And during the course of the next 18 months, I became intimately involved in a federal lawsuit that ultimately won a significant victory when the judge ruled healthcare professionals are not required to refer patients for physician-assisted suicide. It was a victory for Vermont physicians who morally oppose participating in physician-assisted suicide. But more importantly, it was a victory for all CMDA members, as it demonstrated we could successfully seek preventative legal action in advance of conscience issues arising. It is a promising new step in protecting the freedom of all healthcare professionals.

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ners about this issue (including one Muslim colleague). It was a unique CMDA is a leading voice in the battle time to be a light in a sort of different against the legalization of physician-assisted way, and God was faithful. In the suicide. For resources and the latest informaend, the patient was unable to find tion about the dangers of physician-assisted suicide to healthcare and your right of conANY local physician willing to help science, visit www.cmda.org/pas. If you want him with physician-assisted suicide to get involved in your local state’s grassroots (and when his wife called Compasefforts, contact communications@cmda.org. sion & Choices, they had nothing to offer her, praise the Lord!!), and so he gradually became more receptive to my advice regarding other methods of palliation and care at the end of his life. I am pleased to say he passed peacefully just this evening at the hospital, having gotten everything he ‘wanted’ out of his dying experience, minus his ability to choose the exact date and moment of his death.

But he did not suffer, did not ‘burden’ his family with a long, drawnAs God always does, it wasn’t long before He led me to out death and was able to retain his dignity to the end. He, an encounter that only confirmed why it had been so imhis wife and his son were grateful for my care, and I was portant to seek this legal action at just the time we did and able to care for him myself this afternoon before he passed.” why it was so important I faced my fears and got involved.

The email I sent to Dr. Stevens in fall 2017 best explains this encounter: As I wrote those words to Dr. Stevens, I was overcome with gratitude to God for His faithfulness throughout the legal process, as well as for the lessons I learned from it. His “Dear Dave, timing is perfect, and as I reflected on what I had learned, I realized this particular patient’s case perfectly answered my I want to thank you and everyone who has contributed original question about why we should bother proceeding to my education and ability to engage with the issue of with the lawsuit. If it had not been for the clear lines drawn physician-assisted suicide over the years. I have had a very by the settlement—the specific protection to not have to real encounter with this issue in the last month. I had an refer patients to a physician willing to provide a lethal pre86-year-old patient with metastatic lung cancer diagnosed scription—I would have likely had a difficult and heated last spring who has been declining this year. He came to me situation with this patient and his family at the end of his this fall seeking physician-assisted suicide via Act 39. While life, a situation we all were eager to avoid. My relationship I always knew roughly how I would frame my objections with the patient and his family allowed me to have these and any conversation with a patient about this, this was repeated difficult conversations, and our mutual respect and my first test, and I found I was so extremely grateful for the his confidence that I wanted to do everything in my power experience of having participated in the ADF case. Specifiand within my moral beliefs to help him allowed him to cally, I was grateful when it came to the idea of mandated trust me to care for him to the end. That, to me, is good referral. My patient and his family were very understandpalliative care. It is not popular in our culture to consider ing and gracious about my respectful refusal to participate, suffering as anything but bad and unnecessary, but when we but it would have very quickly become muddy with regard take the time to help our patients see how even pain and to whether I was obligated to refer him to someone who does suffering can have purpose, and that they will not be alone participate. This was further complicated by one hospice nurse in their suffering, we discover hidden treasure amidst the who advocated/informed the family as much. It was a great pain that might not otherwise have been uncovered. opportunity to educate my colleagues at the office and at hospice, and I was not only grateful for the result of the ADF God loves to bring us full circle. He did that for me case but for the talking points I picked up throughout that in this area of my life. He has also done that for my beprocess. It gave me such confidence in communicating the isloved mentor, Dr. Bob Orr. In fall 2017, Bob was honored sues and also helped me relieve a lot of anxiety in my partby having an ethics lectureship named after him at the GET INVOLVED

24 TODAY'S CHRISTIAN DOCTOR Spring 2018

UVM College of Medicine—the very community where he had previously been attacked now has honored him.

To give the inaugural lecture, Dr. Farr Curlin was invited to speak on one of Bob’s favorite topics: palliative care at the end of life. Dr. Curlin spoke about the ars moriendi (art of dying) or, as he put it, “Living well in the face of dying.” He advocated for our role in medicine at the end of life to shrink, not encompass the entire dying process. He argued that the medicalization of dying for the purpose of totally relieving physical suffering has often done a disservice to our patients by isolating them from their physical, spiritual and emotional supports.

Physician-assisted suicide certainly aims to completely eliminate suffering by eliminating the sufferer. That is why it is so important to not only oppose the legalization of physician-assisted suicide, but also to uphold the Christian principles of the ars moriendi, to help our

patients live well in the face of dying and to see that suffering can contain purpose. Looking back to that scared first year medical student I was back in 2000, I am so grateful that my journey has included these lessons, that I have the privilege of caring for my patients at the end of life and that I have the opportunity to serve my brothers and sisters in Christ through CMDA.

RACHEL B. DISANTO, MD, is a wife, mother and family doctor in a rural community in Northeast Vermont. She practices both inpatient and outpatient medicine, and she enjoys teaching medical students and residents in her practice and at the University of Vermont. One of her passions is healthcare missions to the developing world. She has participated on numerous Global Health Outreach teams and has focused in recent years on teams that help victims of human trafficking. This has led to work in her state on a task force to develop a curriculum for educating healthcare professionals and students about the issue of human trafficking and how to recognize victims in the healthcare setting. She speaks throughout the state to medical audiences on the topic and chairs CMDA’s Commission on Human Trafficking. She also loves serving on CMDA’s Board of Trustees.

Transformed Doctors ➤ Transforming the World www.cmda.org 25

Cultivating Culture A

by Ben Palpant

s every healthcare professional knows, a healthy person is one in whom the whole person—mind, body and soul—thrives. It’s where the constituent parts function together harmoniously, as they were made to do. A healthy diet is prerequisite, of course, to cultivate the whole person’s health, but invasive procedures are sometimes in order.

The same could be said of a healthy culture. In that idealized culture, the constituent parts work together harmoniously so that members of a society thrive and live as God meant them to live. We can draw on parallels with the human person to understand better how to cultivate a thriving culture, but I find it more helpful to see broader culture as a garden that requires planting and weeding, watering and fertilizing. As with all gardens, culture requires soil cultivation and protection from invasive species. Who is called to this good work, but cultural gardeners and every Christian, regardless of profession? This cultural work demands discernment, courage and a high standard of quality. God 26 TODAY'S CHRISTIAN DOCTOR Spring 2018

strikes the human heart courageously, with fervor and velocity. So Christians get to imitate Him by vividly awakening those hearts they can touch, and that awakening can only be done out of the depth of the whole person. That is why Paul charges us this way: “Therefore, my beloved brothers, be steadfast, immovable, always abounding in the work of the Lord, knowing that in the Lord your labor is not in vain (1 Corinthians 15:58, ESV). When Nehemiah rebuilt the city of Jerusalem, he was going about cultural work with “the trowel in hand, and the gun rather loose in the holster,” as T.S. Eliot wrote in Choruses from the Rock.

Steadfast. Focused. Brave. As Christians, we can learn to do the same.

The other day, I overheard a Christian deride “culture” as if it were an object outside of his jurisdiction, outside of his own heart. “Culture” had become a convenient scapegoat for all of his frustrations with our times. He had clearly forgotten or did not realize that culture is the manifestation of human achievement of which he is part and parcel.

people are not generally changed by cultural criticism. The great calling for Christians is to stop complaining and start building.

The church has largely abdicated cultural stewardship in favor of culture warfare, thereby effectively leaving culture in the hands of the church’s enemies who recognize the power of the imagination. As Gregory Wolfe presciently warned in Beauty Will Save the World, if we do not help to build culture by our creativity, if we simply keep criticizing culture, the torn-down gates of our city will welcome a new barbarism. It seems apparent we are now living in that new barbarism and it is our divine calling to reclaim all of it for God’s sake. Be assured, we cannot reclaim something we hate or evade.

Instead of seeing culture as a territory won or lost, I suggest we see culture as a garden to cultivate. Like a master gardener, we can learn what the cultural weeds are and pull them, but we will be nothing more than a human rototiller if we do not learn to replace those weeds with something beautiful and spiritually rich. Like every farmer knows, the fertility of a field depends upon good management of that land, knowing what to plant and when, how to fertilize and which invasive species need eradicating.

Like a son who disowns his family name and critiques his father, this man had effectively removed himself from his society and the aggregate of souls living alongside his soul, to judge the issues of which he is inextricably a part. Instead of recognizing his part in culture and doing something to improve society, he chose the easy way out.

While Jesus demonstrated that there is a time to fight, His ministry is largely one of cultivation and healing. Discord is always easier than healing; criticism is always easier than creation. Sometimes both are necessary, but many people inadvertently adopt a rhetoric of cultural warfare that substantively changes the way we see culture and the way we interact with culture. Instead of building a healthier culture, we only critique it. Instead of cultivating culture, we hunker down and toss grenades. It seems to me culture is not the problem; people who create culture are the problem. Ideologies and desires pass through people and are evidenced in the culture they make. If we want to see cultural change (and we should), then we must change people, and

The Dutch Christian philosopher Henry Van Til believed that culture is religion externalized, which simply means that how we view God (or the gods) determines the kind of culture we build. Christianity is a liberating catalyst for full human thriving, and this cultural freedom work is natural for those who worship the God who frees us from our many slaveries. As Makoto Fujimura suggests in Culture Care, generative people live out Isaiah 61:1-4 in their meditating, planning and preparation and execution of their work.

They remember that the Spirit of the Lord is upon them because the Lord has anointed them to bring good news to the poor. He has sent generative people to bind up the brokenhearted, proclaim liberty to the captives and open the prison to those who are bound; to proclaim the year of the Lord’s favor and the day of vengeance of God; to comfort all who mourn; to console those who mourn in Zion. All of this so they may be oaks of righteousness, the planting of the Lord for His glorification.

Christ is the ultimate fulfillment of Isaiah 61:1-4, of course, but He loves to use people like you and me for the liberating work of reclaiming and rebuilding. People who know what they are about and keep that high vision at the forefront of their minds continue Christ’s work by incarnating beauty in all its mystery, wonder, ambiguity and depth.

One of our purposes in life is to look for beauty, receive it Transformed Doctors ➤ Transforming the World www.cmda.org 27

as a gift from God, and steward it for the life of the world and for His glory. Our ability to image forth this beauty is not simply a divine gift; it is an act with divine magnitude.

It is God’s name in us and at work through us to humanize a dehumanized people and draw them back to their Maker.

As expressed in Gregory Wolfe’s Beauty Will Save the World, Hans Rookmaaker argued that Christ came to make us fully human, not simply Christians, so the Christian understands that the biblical view of liberation and humanization includes all people, regardless of race, creed or gender. For this reason, Christians humanize those around them and invite others into a more human life under the open sky of God’s grace. Beautiful work—whatever form it takes—humanizes and liberates.

We image forth the beauty of God in the little, oftenoverlooked things we do every day. We will image forth that beauty in more and more ways as we become deeper, more reflective people who consider “the lilies of the field” (Matthew 6:28, ESV) along with the broken cedars (Psalm 29:5) and the Leviathan ( Job 41:1). Let us consider the frailty and mortality of man (Psalm 8:4), and behind all these, working in and through and among them, we will see the wondrous hand of God (Psalm 111:2).

True cultural change ultimately takes place on a broad, societal level. The Isaiah 61 passage describes a people group’s

28 TODAY'S CHRISTIAN DOCTOR Spring 2018

commitment to the beauty of restoration. The hope of cultural cultivation is a societal-wide focus impacting every corner of life, including public policy and judicial decisions.

In our desire for communal healing, however, it seems we easily forget where all this change begins. It begins with individuals who take ownership of their small sphere of influence in their homes, school hallways and conference rooms. Lasting cultural change has those kinds of humble, overlooked roots, and we should not expect legislation to fix what isn’t happening at an individual level. Very few of us make public policy, but the great call to cultivate is given to each Christian—whether young or old—and God equips us to make those incremental changes each and every day.

As evidenced by the major recent cultural changes in sexual ethics, public policy comes on the heels of momentum begun long before by individuals who understand the power of story to shape the cultural imagination.

Cultural cultivation can seem like a daunting task, but it is less daunting when we read Nehemiah 3, in which every kind of person was helping build the wall, even a man and his daughters (v. 12) and two men who could only help just outside their front door (v. 23). We do what we can with what we have, don’t we? That is all God calls us to do.

Let us not despair, as this cultural cultivation is taking place all over the world in overlooked corners. For example,

LEARN MORE

As a ministry, CMDA serves patients, healthcare professionals and our culture by serving as an ethical voice to speak to the government, media, church and public on ethical issues facing healthcare today. We rely on individuals who share their time and expertise in coordinating grassroots efforts in their local communities and state governments. To get involved and start using your individual talents to serve Christ and cultivate our culture, contact communications@cmda.org.

a kind of groundswell of cultural cultivation is taking place in little out-of-the-way Christian schools, like The Oaks Classical Christian Academy where I have spent nearly 20 years teaching. It’s a place where parents, students, teachers, administrators and volunteers press toward a common culture of restoration and peace. It is certainly not perfect, but I have learned the value of cultural cultivation by being a part of The Oaks, where the real difficult work involves daily recalibration as we remind each other of the ultimate aims found in Micah 6:8. It’s a place where we try to work to the glory of God, with Christ at center stage. It’s a place where self-sacrifice and thankfulness are taught and practiced.

You can find that same kind of institutional commitment to cultural cultivation at hundreds of schools springing up all over the world. In my opinion, our emotional, physical and financial efforts should go toward supporting those efforts at cultivation rather than worrying about whether we are winning or losing some ethereal “culture war.”

Let us keep our eyes fixed firmly ahead and look to the Author and Finisher of Faith; after all, this entire generative work is an act of faith in a God who equipped us to create and then uses us according to His designs for something which, when seen from the other side, is truly marvelous.

We cannot control the results, but we can control the preparation and execution of what we do for cultural cultivation.

So keep working, dear friend, whatever the work. Keep enfleshing the ideas God gives you, and leave the harvest to the God who gave you those ideas.

Remember, also, that the Holy Spirit is the helper who spurs you on and guides your thoughts, inspiring the bright fire in your heart and mind. Consider yourself the Holy Spirit’s messenger and your words lit from within by His vitality, ready to warm the hearts of men. Or, to put it an-

other way, you are the seed. This mindset of potent smallness is the way Jesus described faith, and it is the way I encourage you to see yourself. You are small but charged with faith. Make visible the latent power of God at work in you generatively. Be the boy with his five rolls and two fish in Luke 9 who is a perfect picture of generative living. Like that nameless boy, we offer the little we have, not knowing whom God will feed, nor how. The Christian’s life is a journey of trust; living by faith, he must trust God to give him purpose and ideas, as well as equip him to form them into a cohesive and beautiful whole. He must live freely from his limited self, knowing it is all God asks him to do.

This, my friends, is the hope we hold most precious—that God will use the gifts He gave us for a good purpose, using our small offerings to generate from cultural decay—in ourselves, in others, in the world around us—something beautiful and good and true…and lasting. To God be the glory for His ultimate cultural cultivation of which we get to be a humble part!

EDITOR’S NOTE: A longer version of this article was originally published in a three-part series by the author at benpalpant.com. Used by permission of the author.

BEN PALPANT lives in Washington State with his wife and five galloping children. He received his undergraduate degree from Whitworth University and teaches at The Oaks Classical and Christian Academy. Palpant is the author of several books, including A Small Cup of Light and Sojourner Songs: Poems.

Transformed Doctors ➤ Transforming the World www.cmda.org 29

F

or our team, it had been—quite literally—a mountaintop experience.

We had enjoyed a week of healthcare missions together on a mountain in Central America. God had welcomed 137 new believers into His family and provided healing for countless others through our humble efforts.

But as I stared out the window on the plane ride home, I began feeling uneasy. How could we—how could I— take what God invested in us during our trip and continue to live that out back home? How could we apply it in our busy and broken everyday lives where we so often just survive?

And then I realized dozens, if not hundreds, of others returning from short-term mission trips might be asking these same questions themselves upon their return to the U.S. after serving in under-developed nations. If you’ve been on a trip with CMDA’s Global Health Outreach (GHO) or Medical Education International (MEI), perhaps you have experienced this same uneasy feeling, a feeling that expands exponentially after you return to the hustle

and bustle of life, practice, school, family, church and other responsibilities.

There’s no easy answer, but here are seven ideas that have been helpful to other healthcare students and professionals, and me, after returning from a short-term trip.

1. EXPECT SOME SETBACKS AND FAILURES

Short-term trips take us out of our comfort zones, and while we are there outside the norm, we often experience a spiritual growth spurt. We learn new ways to rely on God and engage with people. But when we return, as fallen sinners it’s natural to slide back into patterns of self-reliance or simply become overwhelmed with everything going on around us.

Recognizing and turning from unhealthy pre-trip patterns is a sign of God’s grace, but we need to have reasonable expectations for ourselves when we return. If we don’t, we may despair and fall back into doing nothing at all once we fail to integrate our new spiritual lessons into everyday life.

Renewing the

Mountaintop Experience

by Bryan Stoudt

30 TODAY'S CHRISTIAN DOCTOR Spring 2018

2. PRAYERFULLY REFLECT ON WHAT YOU LEARNED

Think through some specific things God showed you about Himself, your host or home culture and yourself. Perhaps you observed a particular injustice or hardship that grieved you. One of our pharmacy students, for example, was in tears as we visited communities without safe drinking water and access to basic healthcare. She allowed her heart to be broken by the pain she saw, and she’s now letting that brokenness shape her journey as she continues in her training.

After returning from a GHO trip to South America, Dr. Matt Montgomery reflected on his time away: “I learned it’s not only possible but necessary and appropriate to share the hope of Christ with our patients. And not just abroad, but at home, too.”

Similarly, Dr. Eugene Wang discovered that “my main job, whether I’m in Ghana, the Dominican Republic or the U.S., isn’t necessarily just treating the sick and broken, but rather to be a conduit of God’s love and truth through the practice of medicine.”

If we ask God to give us understanding in everything, He will, as it says in 2 Timothy 2:7. So pray, raise awareness and continually have honest conversations with the Lord about what you’ve experienced and learned.

After Jesus sent out a large short-term team (72 people), they returned with joy and told Him enthusiastically how even the demons obeyed them in His name (Luke 10:117). Other trips in Scripture did not go as well, like Moses’ interactions with the Israelites in the desert in Numbers 11:10-23. But awesome or awful, God wants to relate to us about the short-term trips we take. After all, through them we are further conformed into the image of Christ.

3. SET A GOAL OR APPLICATION BASED ON WHAT YOU LEARN

Setting a goal is one way to “...not [only] love in word or talk but [also] in deed and in truth” (1 John 3:18, ESV). For example, I know I need to work on my Spanish. I also know that simply continuing with free online apps isn’t enough. I need to diligently seek direction from God in order to figure out what it means to pursue that practically and wisely.

(To do this, using the SMART goal format from Michael Hyatt may be helpful. For more information, visit michaelhyatt.com/goal-setting.html.)

Numerous healthcare professionals make changes to the way they practice after returning from short-term trips. Dr. Steve Bumgarner, an orthodontist, is always struck by “how much we all need the mercy of God, who has chosen to rescue me in my dire situation enveloped by pride, position and affluence. This helps me to lead well, be humble and put Christ and others first. Because of this, we have modified our practice to really focus on honoring God by starting our day with an optional devotion for employees, playing Christian XM radio throughout the office, starting a Smiles for a Lifetime scholarship for treatment to those who can’t afford it, and trying to treat everyone who enters our office with respect, dignity and excellent care.”

As he processed his trip, medical student Mike Gerges could hardly contain his excitement: “This was the best week of my life! Every day I felt like I was living with meaning and purpose.” Although the potential “takeaways” from what he experienced may be less obvious, Mike is praying about what it looks like to live intentionally for Christ even amidst the daily pressures of exams and preparing for boards.

More simply, Dr. Hannah Chow shared, “I’ve learned to be bolder in sharing my faith with patients, family and friends alike.”

4. TAKE AN INTEREST IN OTHERS RATHER THAN FOCUSING ON YOURSELF

After returning from a trip, you’re naturally excited and want to tell others about everything you experienced. And there’s certainly a place to tell others about God’s awesome works, like it says in Psalm 105:2, “Sing to him, sing praises to him; Transformed Doctors ➤ Transforming the World www.cmda.org 31

GET INVOLVED

As a ministry, CMDA is dedicated to both domestic and international missions.

Through our various mission outreaches, we provide opportunities for healthcare professionals to use their God-given skills to meet the needs of others around the world and share the gospel with them. To learn more about joining an upcoming short-term term trip or our other mission opportunities, visit www.cmda.org/missions.

6. STAND

IN AWE OF GOD AND HIS HEART FOR THE NATIONS

Ultimately, our short-term trips are all about God. Although “all the nations are as nothing before him” (Isaiah 40:17a, ESV), “the earth will be filled with the knowledge of the glory of the Lord as the waters cover the sea” (Habakkuk 2:14, ESV). What an utterly amazing privilege that God has included us in His eternal plans for His world. Taking a moment to acknowledge that reality glorifies God and is good for us.

7. B E OPEN TO A LONG-TERM CALL OVERSEAS

tell of all his wondrous words!” (ESV). But also be willing to “...not merely look out for your own personal interests, but also for the interests of others” (Philippians 2:4, NASB). A friend of mine, for instance, said he often waits a day or two after a trip before sharing much with his wife because she’s exhausted from holding down the fort in his absence.

When people first see you after your return, assume they’re going to ask how your trip went. Some will ask to be polite, while others will genuinely want to know more. To serve others and honor God for what He did, sketch out a few good responses to this question that are appropriate to your various likely “audiences” before you return.

5. PRAY FOR YOUR HOST COUNTRY, PARTNERS AND TEAMMATES

God invites us to continue deepening the trust in Him we cultivated on the field through growth in prayer at home. And through our prayers, God is “...able to do far more abundantly than all that we ask or think, according to the power at work within us” (Ephesians 3:20, ESV).

Praying for the people and country you visited is also a great way to get your entire family involved. In addition to what you observe personally during your time in-country, there are free online resources like Operation World (operationworld.org) and The Joshua Project (joshuaproject.net). After returning from my trip to Central America, for example, I printed out top prayer needs for our host country from Operation World, and we prayed through those over dinner.

32 TODAY'S CHRISTIAN DOCTOR Spring 2018

Because we are equally recipients of Christ’s unsearchable riches and grace, as it says in Ephesians 1:3-10, we know there are no hierarchies in God’s kingdom. We’re no more loved if we serve among the most unreached places on earth, and we are no less loved if we stay right where we are.

Still, for some, God uses short-term trips to refocus their practice of healthcare in radical, unforeseen ways. This is exactly what happened to dentist Dr. Michael O’Callaghan.

“In the process of serving, God has graciously re-directed our lives,” Dr. O’Callaghan said. “I left my private dental practice (which I loved) and now have the greater joy of leading GHO teams, plus now I have more time to make disciples and teach gospel conferences to pastors throughout Asia.”

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Are you willing to prayerfully invite God’s re-shaping of your own calling as the result of your own short-term trips?

SO NOW WHAT?

It’s easy to look at a list like this and feel guilty or overwhelmed. But those feelings are not from the Lord, whose Spirit fills us with joy and peace. With God’s help and a little effort, a short-term trip can impact us and those around us for the rest of our lives. Ask God to help you think of at least one small step you can start taking today so that His work in you will continue once you return from your mission trip.

BRYAN STOUDT is a pastor serving healthcare students and professionals as CMDA’s Area Director in Philadelphia, Pennsylvania, where a large percentage of the nation’s physicians come to train. After Jesus, his passions include his beautiful wife, Sharon, and their four children, as well as coffee and running. He writes at bryantstoudt.com and loves to connect with readers online through Twitter (@bryanstoudt) and Facebook (bryanrstoudt).

Transformed Doctors ➤ Transforming the World www.cmda.org 33

CLASSIFIEDS To place a classified advertisement, contact communications@cmda.org.

GENERAL Affiliate Needed — Protect life and bring joy into the lives of couples unable to carry a pregnancy to full term.

The National Embryo Donation Center (NEDC) has reached maximum capacity and needs an affiliate who shares the same Christian worldview and can provide the full range of services currently offered at the NEDC. Nearly 700 children have been born through embryo adoption at the NEDC since it was founded in 2003, and the program has garnered an outstanding reputation with a success rate above the national norm. Affiliate physician must be a reproductive endocrinologist (REI) who is board certified/board eligible. Contact Dr. Jeff Keenan at 865-777-0088 or email jkeenan@baby4me.net. Go to www.embryodonation.org.

Practice for Sale — Established family practice for sale between Seattle and Tacoma. High-net family medicine practice flourishing for nearly 40 years. Proof that the private setting is still alive and in demand. For detailed information, check out https://sellingapractice.com/stevesmith-do/.

Tropical Medicine Course — Clinical Tropical Medicine and Traveler’s Health Course ASTMH accredited. Modules 1, 2 and 4 online and Module 3 in person. Online modules start June 11, 2018 and are self-paced. Module 3 (Parasitology and Simulations) July 9-20, 2018. Sponsored by West Virginia University School of Medicine, Global Health Program and Office of Continuing Education. For more information about course or continuing education, contact Jacque Visyak at 304-293-5916, jvisyak@hsc.wvu.edu or http://medicine.hsc.wvu.edu/tropmed.

MEDICAL Direct Primary Care — North Idaho Direct Primary Care — Practice medicine the way you have always desired. Are you ready to be your own boss as a physician, without the challenges of hospital obligations and insurance hassles?

Would you like to learn more about direct primary care as a viable alternative to the mainstream insurance-driven practice model? If so, we’d like to invite you for a confidential conversation. I am an independent physician seeking a successor for a successful direct primary care practice near Coeur d’Alene, Idaho. My team and I have built the foundation for an entrepreneurial physician to thrive and grow, independent of hospital politics and insurance domination, in a beautiful Northwest setting. We can guide you through a supported transition including options for interim employment and flexible pricing. Email us at office@richardsamuelmd.com or call 208-772-5204 for more information.

Faculty Opportunity — Montgomery, Alabama — Montgomery Family Medicine Residency Program is seeking a board certified family medicine physician to join the faculty. This growing, fully accredited, 8-8-8 community-based program prefers candidates have at least two to three years experience in office-based practice, skilled in hospital and ICU medicine, and be very well versed in all forms of information technology. Typical duties include hospital and ICU medicine, private practice duties, precepting, lecturing, scholarly activities and curriculum management. This position offers a competitive academic salary with a production bonus, as well as relocation assistance. EOC. Community Highlights: Nationally Ranked Magnet Schools in America by US News & World Report. Live in the state capital and enjoy a community alive with entertainment, history, cultural offerings and affordable housing. Numerous golf courses, water sports, hunting, recreational activities, organized youth sports and abundant shopping! Shakespeare Theatre/Museum of Fine Art/AA Baseball Team “Biscuits.”

Montgomery Symphony and Montgomery Ballet Company. Montgomery Regional Airport with easy access to Atlanta International Airport. Contact Physician Recruitment Coordinator Karen Ludick at 334-273-4507 or kmludick@baptistfirst.org for more information.

Family Medicine or Internal Medicine — Montgomery, Alabama — Prattville Primary Medicine has an excellent opportunity for a full-time BC/BE family medicine or internal medicine physician. This quickly growing

34 TODAY'S CHRISTIAN DOCTOR Spring 2018

outpatient/ambulatory practice sees a blend of patients.

This two-physician group has a flexible schedule with an attractive call rotation. On-site radiology and laboratory services provide easy access for patients. Newly trained and experienced physicians will be considered for this employed position. It offers a very competitive salary with base plus WRVU incentive, as well as an attractive benefits package that includes relocation assistance. EOE. Community Highlights: Nationally Ranked Magnet Schools in America by US News & World Report. Live in the state capital and enjoy a community alive with entertainment, history, cultural offerings and affordable housing. Numerous golf courses, water sports, hunting, recreational activities, organized youth sports and abundant shopping! Shakespeare Theatre/Museum of Fine Art/AA Baseball Team “Biscuits.” Montgomery Symphony and Montgomery Ballet Company. Montgomery Regional Airport with easy access to Atlanta International Airport. Contact Physician Recruitment Coordinator Karen Ludick at 334-273-4507 or kmludick@baptistfirst.org for more information.

Family Medicine and OB/Gyn — Seeking stellar family medicine and OB/Gyn physicians in Stephenville, Texas. Stephenville Medical and Surgical Clinic was established in 1929 and is a multispecialty clinic serving Erath, Stephenville and surrounding areas. The clinic has providers in family medicine, pediatrics, OB/Gyn, ophthalmology, internal medicine, general surgery, radiology and urology. The complex includes a 30,000 square foot facility with physicians’ offices, radiology services that include digital mammography, sonography, nuclear studies, BMD, plain films and mobile MRI. They also have an in-house CLIA certified high complexity laboratory on site. MD or DO candidates. Current Texas license is a plus. Family medicine or OB/Gyn residency completion required from an accredited ACGME program. Board certified or board eligible candidates required. Position would be employed by Stephenville Medical and Surgical Clinic and is affiliated with Texas Health Harris Methodist Hospital Stephenville. Competitive benefits and salary will be offered. Texas Health Harris Methodist Hospital Stephenville is a 98-bed facility serving Stephenville and the surrounding communities. Texas Health Stephenville is designated as a Level IV Trauma Center by the Texas Department of State Health Services. The hospital earned a designation as a Breast Imaging Center of Excellence by the American College of Radiology and is designated as a Baby-Friendly Hospital by the World Health Organization and UNICEF. Stephenville, Texas has a population of almost 22,000 and is located about 70 miles southwest of Fort Worth. The leading industry is agriculture, and it is home to Tarleton State University with almost 7,000 enrolled students. Stephenville was named in Norman Crampton’s “The 100 Best Small Towns in America” and is known as the “Cowboy Capital of the World” and the “City of Champions.” Small town life may not be for everyone, but if you’re attracted to small town values, strong work ethics and family values set against the beautiful backdrop of the Bosque River, Stephenville may be the city for you. Sorry, our opportunities cannot sponsor a J-1 visa. For more information, please contact Physician Recruiter Linda Hamar at 214-345-4263 or LindaHamar@ TexasHealth.org. Please mention that you saw this ad on CMDA when you call or write.

General Ophthalmologist — A thriving general Ophthalmology practice in Dover, Ohio is looking for a comprehensive BC/BE physician to join our practice.

Our well-established practice has served this community since 1979. Our office offers state-of-the-art diagnostic equipment, an optical dispensary, a contact lens department and an integrated EHR. We are proud of our highly skilled and professional staff that always put the patient’s care first. There is an excellent ASC on campus, steps from our office building, where we do 98 percent of our cases. The community hospital is less than a mile away. The ideal candidate would be caring, compassionate with patients and staff, have a good work ethic and have a pleasant bedside manner. The family-oriented community is located in beautiful East-Central Ohio with an array of things to do including museums, outdoor activities and Amish country. Please contact Marcia Hines at mhines@

tusceye.com or 330-364-4434.

Primary Care — Seeking primary care providers in internal medicine, family medicine and/or pediatrics (MD, NP, PA) to proclaim Jesus Christ as Lord and demonstrate His love by providing affordable, quality primary healthcare to the underserved. CCH is a growing non-profit providing primary medical and dental care to more than 10,000 patients from 10 counties in Augusta, Georgia.

CCH PCPs provide a full scope of primary care services to patients with complex medical issues in highly uninsured, low-resource populations. Long-term commitment to community, teaching and discipleship valued. For more information and to apply, visit cchsaugusta.org/employment.

Psychiatrist — Thirty-four year respected Christian counseling practice in Columbia, South Carolina is looking for a part-time or full-time child or adult Christian psychiatrist to join us in a multi-disciplinary group, which has great collegiality. We have weekly meetings for education, prayer or encouragement. The psychiatrist would be able to choose whether to accept insurance in-network, and could possibly inherit a part-time practice. Columbia is the home of Columbia International University, (a premier Christian university,) Lutheran Seminary and University of South Carolina, and it is the home of many sports venues and cultural and outdoor activities. Contact Director Dan Shoultz, PhD, at 803-254-9767 or danshoultz@palmettocounseling.com if interested.

Otolaryngologist — Otolaryngologist needed in Lexington, South Carolina — Well-established, highly respected ENT private practice in Columbia, South Carolina searching for an additional general otolaryngologist with subspecialty training in otology/lateral skull base. This full-time position is open to both new graduates and experienced physicians. Our practice strives for ideal patient care in a friendly, pleasant work environment. Serving the greater Columbia area through two locations where we provide comprehensive ENT and allergy services, audiology services including hearing aids, CT scanning. Outpatient surgery is performed in our physician-owned ambulatory surgery center with potential buy in opportunity for physicians joining our practice. We offer a competitive compensation package. The Columbia area is a great place to live with year-round outdoor activities, family friendly community and easy access to mountains and coastal beaches. The cost of living here is relatively low. Theater, symphony, excellent dining, white water kayaking, fly fishing, NCAA Division I athletics and a host of other opportunities for recreation and community involvement are readily available. Send CV to Karen Luper, CENTA Medical Group, PA at KLuper@centamedical.com.

Radiologist – Private imaging center in California Gold Country is looking for a Christian BC radiologist to purchase a successful small imaging center offering 3D mammography, ultrasound, bone density and plain film. All digital. No nights, weekends or call. Ideal location in historic towns of Grass Valley and Nevada City. Recreation and cultural opportunities abound. Great schools and weather.

Employ to purchase and financing considered. Contact Melisa Agness, MD, at melisaagness@gmail.com.

Reproductive Endocrinologist — Southeastern Center for Fertility and Reproductive Surgery (SCFRS) in Knoxville, Tennessee has an opportunity for a reproductive endocrinologist to join our dynamic practice.

We also share a building and coordinate some operations with the National Embryo Donation Center (NEDC).

The NEDC is a non-profit organization whose mission is to protect the lives and dignity of human embryos by promoting, facilitating and educating about embryo donation and adoption. It is critical that the physician who joins the practice be philosophically aligned with the NEDC mission and values. We are offering a very competitive salary and benefits, which will be negotiable and commensurate with experience. SCFRS is located at the foothills of the Great Smoky Mountains National Park. The area’s natural beauty, recreational opportunities, high-quality schools, low cost of living and low crime rate make Knoxville a very desirable place to live, raise a family and work. Interested? Contact Dr. Jeff Keenan at 865777-0088 or email jkeenan@baby4me.net.

CMDA PLACEMENT SERVICES

BRINGING TOGETHER HEALTHCARE PROFESSIONALS TO FURTHER GOD’S KINGDOM We exist to glorify God by placing healthcare professionals and assisting them in finding God’s will for their careers. Our goal is to place healthcare professionals in an environment that will encourage ministry and also be pleasing to God. We make connections across the U.S. for physicians, dentists, other providers and practices. We have an established network consisting of hundreds of opportunities in various specialties.

You will benefit from our experience and guidance.

Every placement carries its own set of challenges. We want to get to know you on a personal basis to help find the perfect fit for you and your practice.

P.O. Box 7500 •Bristol, TN 37621 888-690-9054 www.cmda.org/placement placement@cmda.org

RELYING ON CMDA “For more than 15 years, we’ve relied on CMDA Placement Services to introduce us to mission-minded physicians, physician assistants and nurse practitioners. Many of our most fruitful domestic and international missionaries— those who’ve worked for years in the inner city and among unreached people groups— came to us through CMDA.” —Rick Donlon, MD Resurrection Health Paid Advertisement

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