Medical Missions

Medical Missions to Africa

I have been doing medical missions since 2005 when I first went to Niger with the International Organization for Women and Development. The primary focus of this group is obstetric fistula treatment, patient education, and establishment of a self-sustaining fistula treatment program staffed by the host country. I travelled to Niger annually until 2010 when internal instability made it unsafe to continue. The group's efforts were then directed to Rwanda where I have made three trips, most recently with my wife, Dr. Julia Lee, and our two children. You go expecting to give, but what you realize is that you are the one receiving. I have been exposed to and operated on horrendous defects that you never see in the states, and done so with generally substandard equipment.

Medical missions have made me a much better surgeon than I ever would have been otherwise. They also taught me that I am richly blessed and have given me a perspective on life that one does not get unless they experience a level of existence and suffering they have not previously encountered. It truly makes you appreciate the things we take for granted. That maturation is what I wanted my kids to experience as well as to develop a sense of need to serve others.

In addition to Africa I spent two weeks all over India with Betel International, a Christian drug rehab program with facilities throughout the world. They were just getting things up and running in India and I went to help establish medical care and treatment protocols for the residents. The cleanliness and discipline in the treatment homes is a stark and refreshing contrast to the squalor and chaos outside. The homes are almost entirely self-funded through work in farming, furniture export and other activities. The residents truly are given hope and a new lease on life. It likewise was an uplifting experience.

I have put together some slide shows to give you a feel of what goes on with the medical missions. I will continue to add more periodically.

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    The medical missions to Africa have been through IOWD, International Organization for Women and Development, which specializes in urinary and bowel fistulas in women due to either childbirth, or trauma. I became involved in April 2005 on some of the earliest mission trips and have continued annually since. Initial trips were to Niger in west Africa then later to Rwanda in east Africa. IOWD not only treats fistulas, but trains local doctors in their treatment and prevention and works to establish self sustaining fistula treatment programs. Outreach and education is carried out with the local women as well.

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    National flag of Niger

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    We operated out of the National Hospital in the capital city of Niamey

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    View of the Niger river landing in Niamey.

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    The suburbs of Niamey

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    The largest airport in Niger

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    The control tower. It was different to walk across the tarmac to get to and from the plane, something that never happens in the states.

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    Local vendors. There are no supermarkets. Each shop sells a few items and to get everything on your needs list you have to travel to several shops.

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    A local pharmacy. Note the street vendors.

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    Kids drop out of school early and often. These boys are selling anything they can to make money. Total is the French gasoline company that dominates the local market.

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    Woman selling fritters on the street corner.

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    The hospital entrance. It is a very busy place.

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    The fistula ladies and their kids live in the courtyard of the hospital.

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    Life is slow. Africa is a place-oriented culture unlike the states which is very time oriented.

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    Ladies doing the dishes and laundry.

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    Note each lady has her worldly possessions stacked beside her.

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    Grain and flour drying in the courtyard. The ladies form a community and support each other, sharing food, cooking and cleaning duties.

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    Girls are often tattooed as babies with knife etchings in the skin. These can be filled with Henna to dress up for special occasions as with this girl who lives at the hospital. The henna lasts a few weeks then fades.

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    Some of the kids living at the hospital, Notice the henna tattoo on this young ladies' left hand.

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    Younger siblings are often carried on the back of their elders.

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    The lovely Dr Lee with two fistula ladies and their children.

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    Mariama and Me. Mariama was one of the first fistula ladies cured by the program and works as a nursing assistant for IOWD.

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    Bush taxis, which are Toyota Sienna mini vans, are the main mode of transport from the bush to the city. This one is typical in that it is packed inside and out

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    A country village. The houses are made of thatched grass and woven sticks.

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    Woven grass mats can be used for sides or roofs of houses. Here are some mud brick structures in a more developed village.

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    Traditional Nigerien houses. The yellow containers are used cooking oil containers that people rinse out and use to carry water.

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    Villages often build walls to keep animals out.

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    These houses are elevated both to keep cool and to provide some safety from animals.

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    Dr Joe T mingles with the locals.

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    This market is about 100 km outside of Niamey and is a huge gathering of people with animals and products for sale.

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    Herdsman drive their cattle for days on foot to the market to be sold.

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    It is sort of organized chaos with camels and cows wandering around.

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    An entrepreneur selling everything from cigarettes to candy.

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    A couple of new friends at the market.

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    A kid selling plastic bags filled with water and tied off. Very resourceful.

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    It was impressive watching these men load a cow onto the truck with nothing but a rope and their backs.

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    The cow is hoisted on to the bed of the truck.

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    All in a day’s work.

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    Everything is for sale including this crocodile.

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    Hanging with some kids at a village.

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    My wife getting the feel of how the Nigerien women do it in their kitchens.

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    Water is scarce. The village well is a four-inch PVC pipe through which another length of pipe is lowered like a long cup on a rope.

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    It is withdrawn full of water and emptied into the barrels for everyone to use.

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    An “upside down tree”. As you can see the name is appropriate as it appears the roots are growing upward.

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    Niger is the only west African country with giraffes. We visited a preserve outside of Niamey.

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    The map of the National Hospital. It is a large campus built by the French in the 1920’s.

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    Entrance to the Operating Room area.

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    The equipment was antiquated but functional. We ran two cases side by side separating the two with a screen. This allowed us to operate on more ladies in the limited amount of time we had (two weeks).

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    Dr Sabu (left), chief of surgery at the National Hospital, operating with IOWD surgeons.

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    A fistula between the bladder and the cervix, This was due to a cesarean section. The view is through the abdomen with the dome of the bladder open so that you are looking at the floor of the bladder directly overlying the uterus and vagina. A Foley catheter has been placed through the bladder but is pulled out of the way back outside the bladder.

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    Dr Lee operating on a bladder fistula.

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    Me operating with Dr Abdoulae, the resident fistula surgeon at the National Hospital. Dr Abdoulae is an excellent fistula surgeon and, in my opinion, the best in Niger. He not only has great technical skills but he is passionate about helping the fistula ladies.

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    Fistula ladies waiting to be seen. When the ORs were not in use for surgery, we used them as clinics to examine fistula ladies.

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    A fistula patient after successful closure. She appears much older than her stated age of 20.

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    Mariama helping a post op patient to the recovery ward.

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    Giving meds on the wards during post op rounds.

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    Rounds took us into the courtyard as capacity was overflowed. The patients farther out from surgery stayed outside.

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    Hamadou is the artisan who made the figurine in my office. It is a fistula woman giving thanks to God for being relieved of her suffering. It is hard to imagine such craftsmanship coming from a shop with a dirt floor. Hamadou is great example of overcoming adversity. Notice his legs are withered from Polio as a child, yet he has become a successful businessman.

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    We usually took one day off per trip. Here is a river boat we rode in to see hippos ( it leaked).

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    We also took a camel ride which was quite an experience.

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    Mud bricks drying in the sun from a camel’s eye view.

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    Due to political instability in Niger, we had to stop our mission work. Westerners were targeted for kidnappings and several were killed. It is very sad as I miss the people and the fistula ladies of Niger.

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    It is not quite “out of the frying pan, into the fire” but it seems so going from Niger to Rwanda; best known in the states for the 1994 genocide detailed in the movie “Hotel Rwanda”. Rwanda has come a long way since the genocide and is fairly well developed. Honorable M. Stewart Symington, who was the US Ambassador to Niger when IOWD got it’s start, just happened to have been transferred to Rwanda. He told us of the great need for fistula treatment and prevention in Rwanda and that the Rwandans were anxious to participate and learn. In April 2011, IOWD made its first trip to Rwanda. In February 2012, my wife returned to do fistula work and we brought our children.

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    Flag of Rwanda.

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    We operated out of Kibagabaga Hospital on the outskirts of Kigali, the capital city.

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    In contrast to Niger, Rwanda is modern. The building in the foreground is a shopping mall.

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    In addition to taxis, authorized motorcycles (in green) abound as transportation. One can take a motorcycle ride for about one US dollar but I wouldn’t recommend it. The trauma ward in the hospital is half filled with motorcycle wrecks.

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    Men’s room at the airport is not for those with a shy bladder!

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    View from Kibagabaga Hospital of more well to do neighborhoods.

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    Houses cross the street from the hospital.

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    Some of the poor areas on encountered en route to the hospital. Space is precious in this mountainous country so houses are stacked tightly on the hillsides.

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    Crops are planted on any available space to help with the food supply.

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    Kibagabaga Hospital

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    IOWD doc with a fistula lady.

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    French language is due to Rwanda being a former Belgium colony.

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    Rugged ambulance at the ER.

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    We were transported in a bus which made it very nice. One only had to focus on work which usually started at 645 am and went until 800 pm.

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    Like Niger, fistula ladies live at the hospital.

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    Meetings were held each morning to review the days work and have teaching rounds with the Rwandan doctors and medical students.

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    Some very nice braid work on a young lady employed at the hospital.

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    A girl living at the hospital who wanted to practice her English.

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    The Obstetric ward. Women labored and delivered behind the curtains on the left.

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    The OR is a little more modern.

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    Getting the patient ready for surgery in the OR.

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    Cases are done under spinal anesthesia if possible as it is safer. Here a patient is receiving a spinal from an IOWD doc.

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    Docs about to start a fistula case.

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    Here is a large bladder stone from a fistula patient. Poor urine flow due to a heavily scarred bladder with a small hole caused the stone to form. The tip of the stone on the left was actually protruding into the vagina.

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    We were fortunate to have a Pediatric Urologist on the mission and we repaired a young boy born with bladder exstrophy who was suffering with incontinence. We were able to make him dry by building a urethra sphincter by rolling part of the bladder into a tube. He was dry on my next visit. Bladder exstrophy occurs in 1 in 30,000 births and is a congenital condition where the bladder does not close during its formation, but empties directly outside the body through the abdominal wall. The surgeons did a good job closing the bladder in this child at birth, but he was still leaking through his penis. These children require numerous reconstructive surgeries throughout their lives.

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    On the post op ward with my new little friend. I had communicated with him in the OR prior to anesthesia by drawing pictures (top right) to keep him occupied. After surgery, he drew a picture with short hair and told me he wanted to be like me when he grew up. Those things bring you to tears.

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    A now dry fistula mom with her new baby.

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    Living large with Ambassador M. Stewart Symington at the embassy.

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    Skulls on display at the National Genocide Memorial in Kigali.

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    Arm and leg bones of the genocide victims. The Memorial brings a reality to the suffering we did not appreciate as much in the States.

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    The National Stadium in Kigali.

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    Local bus service is the ubiquitous Toyota Sienna mini van.

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    View of the terrain in Kigali.

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    People walk everywhere which makes driving difficult.

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    Crowded streets.

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    We headed north to see the gorillas. Rwanda has a great gorilla preserve near the border with Uganda.

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    Homesteads and crops on the hill sides.

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    A beehive made of bark. Men climb the trees and flush the bees out with smoke pots to harvest the honey.

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    Some school children we met on our trip north.

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    Third world bricks

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    Rural houses made of mud bricks. Notice the tin roof which, unlike thatch, keeps the occupants dry in rainy weather.

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    A very basic house.

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    A small town along the way to the gorillas.

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    Our gorilla trek group. Our guide in the green cammo was named Patience. Boots were needed because it was very muddy.

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    We had a park ranger (with the AK-47) to protect against poachers, as well as a porter (with the machete) who hacked a trail through the thick underbrush to get to the gorillas. Our group went the farthest out but got to see the biggest gorilla in the preserve. It took 1 1/2 hours to get to the base of the summit and being a flatlander, I was pretty out of breath hiking at 8000 feet.

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    A local woman we met on our hike.

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    Patience explained this is a cowboy shelter. It is made of branches and leaves and acts as a shelter for the farmers and herders from the sudden downpours that occur in the mountains.

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    A mutant earth worm I almost stepped on.

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    This is the largest gorilla in the preserve. He weighs in excess of 600 lbs but moves like lightning over the brush. Patience “talks” to him with grunting sounds which he returns letting us know he is OK with our visit. We get to within about 20 yards and that is plenty close.

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    The best policy is to be quiet, still and try not to look taller than he is or he will take it as a threat to his territory.

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    A cute baby girl put on a show for us.

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    After the gorillas, we went to an exclusive lodge overlooking a series of lakes that border Uganda. It has a helipad for those who don’t wish to endure the bumpy 30 minute ride up winding mountain roads to get there. At $500 per person per night we just had a beverage and enjoyed the view.

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    View from the lodge

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    View from the lodge

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    View from the lodge

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    My friend Abraham who is an enterprising young shop owner that I think will go far. I was introduced to him by the Ambassador’s daughter on my first trip, and he made sure my wife and kids were well taken care of on their visit.

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    One of Abraham’s shops.

Spain Mission Trip

My wife Julia and I and our two children, have recently returned from a marvelous trip to Spain where we visited with our dear friend, and founder of Betel International, Dr. Elliott Tepper. We followed Elliott as he made his rounds, staying at the missions across Spain and Morocco. Betel is a Christian Drug rehabilitation organization that began in Madrid in the 1980’s and has grown to over 70 cities in 20 nations around the world. Elliott is a truly remarkable, energetic and dynamic individual. Born Jewish, he received an MBA from Harvard, and studied at Cambridge. While at Harvard, he was heavily involved in drugs and the counter culture. He had a conversion experience during his time there in the 1970‘s and has been an evangelical missionary ever since.

I had the privilege of meeting and working with Elliott in 2006 when a medical missionary and I went to India to help Elliott establish medical care for the six new Betel centers across India. I was deeply impressed with the transformation that was occurring in the lives of destitute people. Outside was squalor; yet inside, the compounds looked like a Marine barracks. Meticulous landscaping, bunks neatly made and absolutely no clutter of any kind. Every staff member at Betel is a former client. People are given a new lease on life and a new sense of self-worth through loving Christian support and hard work. Care at a Betel is free of charge because they are mostly self-supporting. Each Betel mission brings in revenue through business ventures such as manufacturing furniture and selling it in retails stores, selling second hand furniture, bakeries and cafes and repair shops. However, it is a constant struggle and donations are still needed and appreciated. Each mission is overseen by a pastor and his family who also act as managers of the businesses.

Our goal for our children was to instill in them the true effects of drugs on people, a sense of how blessed they are, and a need to serve others. There is a Spanish saying “El que no sirve, no sirve” which can be translated as “A tool that serves no purpose is useless” or “He that does not serve has no worth.” That message was really brought home by our visits to Betel, Spain and Morocco. We traveled with Elliott from the headquarters in Madrid to Malaga where we lunched with the Betel group. Then we went on to Algeciras where we took the ferry across the Strait of Gibraltar to Ceuta Spanish Morocco. (see pictures) We stayed in Betel Ceuta then traveled across the border to Tetuoan Morocco (picture) to visit some missionaries. We had to be very covert as Morocco has thrown out all the non-Muslim organizations from Morocco. We traveled into the market place, where business is still conducted the same way it was before Christ. (pictures) On the way back, we stayed in Betel Algeciras (pictures) and stopped at Gibraltar (pictures) for a tour of the rock. The kids saw the limit of the ancient world at one of the “Pillars of Hercules”. Amazing how much things have changed.

Back in Madrid, we went to the Gypsy Camp, which is a rundown part of Madrid that the police don’t frequent much. It is the largest drug market in Madrid. We were able to go because Betel brings food and offers relief on a weekly basis and are known and allowed there. The kids saw former well to do business people whose lives had been destroyed by drugs. While handing out sandwiches and pamphlets, my wife and I were able to point out things to the kids such as the neat row of tract marks on the hands and arms of the Heroin addicts. (picture). A former Betel client who had come into a large sum of money and fallen back into a life of drugs came up to us and asked to be taken in. He was–within an hour he was on his way to a nearby Betel facility.

The experience was very rewarding and I hope, it was life altering for our Kids. Julia and I will continue to expose them to mission work in an effort to give them some perspective on life. If you would like more information about the Betel group, you can visit their web site–they also appreciate any and all donations. Visit them at


Mission to Guatemala with Caring Partners International

Betel International Christian Drug Rehabilitation Organization