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31 March 2012

Conformed? Or Transformed?

I beseech you therefore, brethren, by the mercies of God that ye present your bodies a living sacrifice, holy, acceptable unto God, which is your reasonable service.And be not conformed to this world: but be ye transformed by the renewing of your mind, that ye may prove what is that good, and acceptable, and perfect, will of God."Romans 12:1,2 (KJV)

For some reason, my Lenten meditations have led me to this passage.  I decided to quote it here in the King James Version for two reasons: one is that that is how I memorised it as a child.  The other is that it uses the word “beseech” and, well, I just like that word!  Just to clarify, the word “beseech” means to “urge” or “implore.”  It’s a word which gives this passage a sense of importance, that this is something that Christians really MUST do. 

A few weeks ago, I heard a sermon (or, perhaps more accurately, a lecture) on “Christianity Lite” in which this passage was used.  The idea was that many of us “go through the motions.” We go to church, we say some prayers now and then, we perhaps enjoy the fellowship but we don’t really RISK anything.  We haven’t surrendered our lives to the service of Jesus Christ. We haven’t allowed ourselves to be TRANSFORMED by God’s spirit working in our lives. 

Then last weekend, I met with a friend whom I had met through the Gay Christian Network.  He brought me some CDs of various messages that had spoken to him in his faith journey.  One was a keynote address to the 2009 GCN conference by the late Rev.Peter Gomes, who had been a professor at Harvard. Rev. Gomes was an African American gay man who grew up in the 1950s.  He loved Jesus and was devoted to preaching the Gospel, the scandalous and offensive Gospel as preached by Jesus Christ himself while he was here on earth. (An excerpt from that speech can be found at GCN Radio on the 28th August 2009 episode.)

I listened to that CD yesterday while driving around the beautiful New Zealand countryside.  Rev. Gomes pointed to this passage in Romans as a call to action for gay Christians.  Interesting and significant, since it had already been on my mind. 

The thing about being a Christian, while at the same time, understanding oneself to be gay or lesbian or in some way “outside of the heterosexual mainstream” (to quote WendyGritter), is that we are given a lot of grief by both sides.  The Church, in many cases, has been a hostile environment for us.  We have been told that, on the one hand, Jesus loves all of us, BUT, on the other hand, we aren’t welcome in the Church unless we try to change.  Sometimes we are told that it’s ok that we are gay AS LONG AS we are committed to celibacy.  But even if some of us have chosen that path, we are then told (perhaps not in so many words) that we are defined by who we sleep with, so if we are celibate, we are no longer gay.  The implication there, of course, is that we must not TALK about our attractions to those of the same sex.  Those are merely “temptations” that must be avoided and overcome.  The clear messages for many of us have been that, not only are we disordered because of our orientation; we are also “worse” sinners than anyone else.  Why, then, ask our gay friends, do we stay?  Why do we put up with the rejection and abuse in the name of Christ? 

That is a very good question.  For me, it comes down to this:  I have come to realise over the years that my sexual orientation, who I am fundamentally attracted to romantically, sexually, and spiritually, is not a choice. I believe this is the case for most people. I have also come to realise that my faith is also not a choice.  This realisation came later out of some very powerful experiences and spiritual conversations with God in which I came through with a very real sense that God had a hold on my heart and my life and was not going to let go.  At different times in my life I have suppressed, hidden, or denied either my faith or my orientation.  At those times, my spirit has been deeply troubled and I have not been at peace.  When, finally, I was able to reconcile those two aspects of my life, and live them out with integrity, I was able to find peace and joy in my walk with God. 

In listening to the testimonies of other gay Christians, I have found that their experiences, while not identical, have within them some version of my own.  We are in a place where we are called to be NOT CONFORMED to what the world thinks of us.  We have been called all kinds of names by the Christian community: promiscuous, idolatrous, God-hating, amoral, rebellious, etc.  By the Gay community, we have been accused of having “Stockholm syndrome,” of identifying with the oppressor, of selling out, of betraying our gay brothers and sisters who have fought so hard for equal rights and freedom from oppression and abuse. 

It’s interesting to note that Jesus was accused of similar things.  The religious establishment of his time accused him of being a glutton, a drunkard, a friend of prostitutes, tax collectors and sinners (as if that were a bad thing), of not having proper respect for the laws and traditions of his faith.  Those who wanted him to be their Messiah were quite disappointed that he took the path of humility and meekness rather than riding into Jerusalem on a white horse, sword drawn, ready to drive out the occupying Romans and save the people of Israel from oppression once and for all.  I’m not at all implying that gay people are analogous to the Messiah.  What I am saying is that, by not conforming to the expectations of the world around us, whether it be the Christian world or the Gay world, or any other sector of the world, we may be closer to walking in the footsteps of Jesus than we ever imagined. 

But there’s more.  We are called to be TRANSFORMED.  I would submit that it is impossible to truly have an encounter with the risen Christ without a transformation occurring.  I am not a Greek scholar, but it is my understanding that the verb tense used is sort of an ongoing one.  The transformation is happening, as our minds are renewed, as our ideas and our beliefs are changed to see each other and ourselves as Jesus saw us.  The remarkable thing about Jesus is that he had a choice.  As God, he created us in God’s image and we went astray. We have chosen our own self-interest over relationship with our Creator.  God could have said, “I’m very disappointed with what I have made, they haven’t turned out as I intended.  Oh well, let them go their own way, I’m done with them.”  But instead, God said, “I love these people I have made SO much; I’m not going to let them go.  I’m going to become one of them, to show them that I know what it’s like to suffer what they suffer, to feel what they feel. Not only am I going to become one of them, I am going to become one of them in the most humble and poor circumstances and I am going to really get to know the outsiders amongst them and bring them back into community with each other and with God. In fact, I’m going to take it the end, to suffer torture and execution as a criminal, though falsely accused.”  Talk about being TRANSFORMED! 

That is the Gospel, the truly good news of Jesus, the Christ.  God wants all of us back in relationship with God.  And to do that, God needs us to continue in the path of Jesus, all the way to the cross and beyond.  God needs us to take the oppression, the pain, and the abuse and transform it into love, repentance and forgiveness.  We are not called to change people’s hearts and minds. That’s the job of God, the Holy Spirit.  We are called to love our enemies and forgive our oppressors.  We are called to set an example of humility and meekness while working for justice and peace for the oppressed.  We are called to preach the Gospel of Jesus Christ that ALL are loved and welcomed and forgiven by God and that we can come as we are to the throne of grace and let God change us according to God’s own will and purpose. 

This is truly good news.  And it is the challenge of the journey of Holy Week.  Today’s collect from the New Zealand Prayer Book reads: 
 “Jesus, when you rode into Jerusalem the people waved palms with shouts of acclamation.  Grant that when the shouting dies we may still walk beside you even to a cross.  Amen.”

What does that mean for us?  Will we conform to the image of the world around us?  Or will we stand out as agents of transformation in this broken and finite world?  Jesus overcame the pain and suffering and was resurrected so that we can know that we are forgiven and reconciled to God and so that we can see that this world CAN be transformed to be what God intended.  When we see in others the face of God, in whose image they were created, we must respond with those acts of love and service that Jesus carried out when he touched the untouchables, spoke to the outcasts, forgave those whom everyone else wanted to condemn and write off. 

I beseech you, my sisters and brothers, to not be conformed to the expectations and images of the world around us but to be agents of transformation as we walk with Jesus in love and service to those who oppress us and those who are oppressed by others.  May God bless your Holy Week journey.  

30 March 2012

The beautiful city of Dunedin

I haven't had much time to write recently, due to being thrown right in to a busy practise and learning all about a different system. Last weekend I had occasion to spend a bit of time in the city of Dunedin so I thought I'd share a few of my pics.  Dunedin is the nearest "large" city, about 120,000 people and a University town.  It's about an hour's drive from Balclutha and it's got a big teaching hospital, so its where we send most of our patients who need specialty care or are too sick to manage here.  It's bigger than Billings, and closer, so I feel like we have quite a luxury in that regard.

Dunedin has been compared to Edinburgh, Scotland, even dubbed "The Edinburgh of the South."  However, I spent a couple of months in Edinburgh many years ago, and Dunedin really does not remind me of Edinburgh at all.  I've checked with a few other people who know both cities, and they all agree.  It reminded me a BIT of San Francisco.  Big hills, beautiful architecture and the bay and the ocean make up the similarities.  Of course, it's smaller than San Fran.  And the architecture and general feel are different.

So, first off, I stayed in a Hostel called Hogwartz.  In retrospect, I suspect the name is meant to be a bit ironic, though I'm really not sure.  It's an old residence for the Catholic Bishop and I suppose it's meant to feel a bit like an old castle.  It didn't, though.  It was very nice and had a nice view of the city, being up on a hill. 

Side view of the church
Front view of church
View of Dunedin and the bay from up on the hill
Another view from up the hill

I got there Saturday evening and had time before dark to go down to the Octagon and check things out.  Apparently, I missed the big, annual "keg party" in which about 10-15,000 students (perhaps the entire student body) are out on the streets drinking and raising a ruckus.  Apparently they like to get up on rooftops and sometimes the roofs collapse.  I guess there were a few injuries, but nothing serious.  I'm grateful to have missed it! 

I took myself out to dinner and had a delicious piece of salmon.  For dessert I had this "chocolate cone"thing: 

A cone of pure dark chocolate mousse!

I also walked around and took pictures of some of the really pretty buildings. The famous railway station:

Showing how far it is to various places from the railway station

And a little information about the station

Then there was the Cadbury factory.  Apparently, Cadbury in New Zealand, and everywhere else in the world EXCEPT the US is committed to eliminating slavery from its supply chain.  Unfortunately, they sold their US operation to Hershey which is NOT showing much concern for the slave problem.  

I didn't get to take a tour, since it was late on a Saturday evening.'s so I will!

Then I went to visit the hospital and the med school.
Yes, they have the same problem here

Pretty mural!

Medical School building

And the "Monkey Bar" across the street

After all that, I put myself to bed to get ready for the 10 am service at the Anglican cathedral. 
Robert Burns sits in front of the cathedral forever

Beautiful prayer from the New Zealand Prayer Book

The service was fairly traditional, with a beautiful choir.  Since the Anglican church in Balclutha is so non-liturgical, it was nice to have some tradition in such a beautiful setting.  Of course, being a newcomer, it's always hard to experience one of the most important parts of going to church: the community.

The "community" part came after church, when I went to do what I had actually gone to Dunedin to do:  meet a friend from GCN called Rob.  Rob moved from the US to Australia about 20 years ago and lives in Sydney.  I met him at the conference in Denver in 2011 and when he found out I was moving to New Zealand, he decided to come over to visit and help ease my transition.  Unfortunately, I didn't pull out the camera once during the afternoon.  However, I found this photo on the internet which pretty much looks like what I saw:

Rob, Patrick (another friend from GCN) and I had lunch next to the ocean and I watched the weather change several times and surfers go in and out of the waves.  Patrick lives in Olympia, WA and I met him last year when we were there visiting Laura's aunt and uncle.  He is an anthropologist who wrote an excellent book called Thou Shalt Not Love: What Evangelicals Really Say to Gays. He used to teach in Dunedin and had brought a group of students back for an anthropological tour of New Zealand.  What a small world, eh?  After lunch, Patrick left and Rob and I stayed and talked awhile longer.  GCN is an amazing worldwide community of committed Christians who are either gay, lesbian, bisexual or transgender themselves or who are allies of those who are.  One of the things Rob told me that I've been pondering (and may have to write about eventually) is that he was once told by a pastor that, in that pastor's experience, gay Christians are almost never "lukewarm."  We're either "all in" or we're not.  I think it's true...we've usually experienced a lot of rejection from the Church and in order to actually stick it out and stay, we have to do our homework and we have to be committed.  

After my afternoon chatting with Rob, I made my way home from Dunedin.  Happily, the next day, Monday, was the Otago Anniversary (see this article on Wikipedia for a wee bit of information) so I didn't have to get up early.  My little journey to Dunedin was quite exhausting!

21 March 2012

From the doctor's perspective

I started to summarise a bit about the NZ Health system in this post.  But I've been thinking a lot about how I might describe MY experience working in it for a few weeks.  Of course, it's only been a few weeks, though I've seen LOADS of patients already.  This is a very busy practise.

The first thing I've noticed is how overall, I am much more relaxed and able to enjoy the encounters with the patients I am, compared to previous jobs I've had.  I recall the words of Ray Anton, the CEO of Clutha Health First, during my phone interview.  He said, "we want your brain to be focussed on taking care of patients, not all that other stuff."  "All that other stuff" is the stuff that has threatened to make me leave clinical practise entirely.  "Stuff" like diagnosis coding, procedure coding, E&M coding, worrying about whether the patient can afford a medication or a visit or a procedure and fighting with them to come in once a year to get their prescriptions renewed.  "Stuff" like documenting to support the coding and documenting to satisfy the lawyers of potentially litigious patients.  I spend so much less time documenting now.  And yet, I document sufficiently (there are some here who don't, for sure).  The subsidies for primary care are on a capitation basis so it really doesn't matter the complexity of the visit. The patient's copay is almost always the same.  So I'm not worried about how many "bullet points" I need to justify billing for what I know I did.  Instead of spending a couple of hours at the end of the day dictating notes or filling in templates in the EHR, I am usually done with the note as soon as I've done seeing the patient.  I look up a diagnosis that seems to fit in the EHR and I put it in.  The only extra "coding" work comes when it's an accident case, and then it's coded on time (so if there's a cast or a dressing change or whatnot that takes longer, it gets billed for more).  Granted, my learning curve is still quite steep with all the different forms, drug names, etc that I'm required to look up or go ask the nurses about every 15 minutes.  But everyone is VERY patient with me.  It seems they are grateful that I'm here and don't mind answering my incessant questions.

As for litigation, it is virtually impossible to sue a doctor.  I think I mentioned that before. It's virtually impossible to sue anyone!  I think in SOME cases that can go too far and there are doctors who get lazy.  In fact, even in other areas, it seems, there could be a bit more concern for safety. A colleague (who is a kiwi but just moved back from years in Canada) told me he was hiking and there was a sign on the track that warned of some loose ground, holes, or something.  He thought MAYBE these pitfalls might be marked but they weren't.  Whoever put up the signed figured that was sufficient warning, even though there might be unexpected holes or loose rock on a track that someone might fall into without knowing they're there.  When they say "at your own risk" they really mean it!

Anyway, the majority of my time is spent actually listening to and examining patients, figuring out what they need and finding a way to provide it.  It's the last bit that is slowing me down at the moment because it requires a lot of learning about the system, what's available in the clinic or the hospital, what can be done urgently in Dunedin, and whom to refer to and how to do it.  I spend a lot of time looking up drug names in the drug book.  I'm working making a list of important numbers, as well as units conversions because it's sometimes hard to work out quickly whether someone's cholesterol levels REALLY are in an acceptable range.

One interesting thing is that patients are required (and expect) to come in every 3 months for prescription refills if they are on chronic meds.  They don't fuss about it AND it give us ample opportunities to catch any problems early and review whether they have good BP control, etc.  Occasionally a doctor will make an exception and let a patient call in for refills but patients know those are exceptions and don't push for those exceptions.  So, although people will come with lists, if you are seeing them every 3 months, the lists are usually much shorter.

I am going to stop there because my lunch break is over and I wanted to post some of these thoughts before I lose them.  I think it's a pretty good introduction to how things are going from my perspective.  Of course, there will be more!  Cheers!

19 March 2012

Trip to the Catlins

On Saturday (the 17th of March) I had my first official day off since starting my job (not counting my trip to Queenstown which was, officially, work and didn’t allow for much time to explore).  I had planned to take a trip to the coast and perhaps drive through the The Catlins.  I didn’t expect the weather to be absolutely perfect—unseasonably warm (for ANY season, here, apparently) at 24 degrees (75 F) and a cloudless sky.  So, I packed a lunch and some warm and waterproof clothing and prepared for an extensive exploration of the area. I took with me a couple of travel guides of the area and tried to make sense of endless list of recommended routes and stopping points.  In the end, it seemed simplest  just to follow The "Southern Scenic Route" out of Balclutha and see where it took me. 

As I drove, the landscape became more and more stunning as I wove through the green rolling hills, covered with trees and cows and sheep, back dropped, as they were, by a color of blue that I’ve rarely seen in skies.  I tried to take some photos but the road is fast and windy and whenever I’d see a particular photo-worthy view, it would be too dangerous to pull over and at the next pullout, the view would be obscured.  So with that whiny disclaimer (after all, with scenery like this, it was almost impossible to go wrong with the photos) I will proceed to describe what I saw and share some of the 300 ish photos that I did manage to take. (One LAST whiny disclaimer: the only camera I have is the 8 MP one on my Android phone.  It’s not bad but it’s not that good, either).
The Southern Scenic Route
For orientation purposes, this is a map of the route and the area:
For a key to the map, click here.  I started in Balclutha, just north of the number 25 on the map and went down as far as the number 6.

As I said, the day was perfect and just driving along the highway afforded breathtaking views of the countryside.

 Just before coming to the little town of Owaka, I stopped at a cemetery to catch a few shots of the dahlias.

Since I had already fortified myself with a large, late breakfast, I decided to motor on through Owaka and stop on the way back.  My ultimate goal was to get back up to Nugget Point by about 5:30 or 6 PM because 2 hours before dusk is supposed to be prime penguin-viewing time.  So on I went and just past Owaka I wound my way up a hill and, lo and behold, at the top was a pull-out .  I looked behind me and saw this:

It just kept getting better and better!  Along the way, there were dozens of places where one could turn off to go to various points of interests or hike along one of the many tracks into the forest, along the river, or out to the coast.  At that point I had to prioritise.  There were a few waterfalls that, by their description in the travel guides, I would not want to miss.  And, of course, there were the penguins.  So I made the relatively random decision to travel down as far as McLean falls, partly because the track to the Falls sounded so lovely and partly because there is a place there called “The Whistling Frog CafĂ©” which sounded like a nifty place to stop for lunch.  Having said that, I made one more stop at the Florence Hill Lookout, which was right there on a lefthand pullout, so I couldn’t resist.

The Lookout is between two peninsulas

There's a peninsula to the south

and a peninsula to the north
and cows in between!

It was an overlook just past the town of Papatowi.  I couldn’t take a photo of the sign leading into town (too dangerous) but it’s “tagline” said “Where forest meets sea.”  The view from Florence Hill Lookout exhibits that quite nicely.  In fact, there it is…thick groves of trees right up to the sandy beach.

With that, I got back in the car and continued the  beautiful, winding drive south to McLean Falls.  One of my guides says, “The 22 metre falls on the Tautuku River are often described as the most spectacular in the region.  The walk to the falls, though uphill, is not too steep and is very pleasant.”  I wasn’t disappointed!

The trail took me through a very “wet” forest (the temperature was several degrees cooler and I was surrounded by ferns).  

A very odd tree growing every which way, sort of reminded me of the trip through the rainforest in Mexico
Sun shining through the trees

I saw bits and pieces of the falls at first,

and then I reached the top and saw this: 

After I returned from seeing McLean Falls, I headed back toward the main road and found The Whistling Frog.   

and had a scrumptious bowl of seafood chowder (with fish, shrimp, mussels, and a variety of other delights) and a “lucky” flat white.

The cafe was also filled with really funky artwork which was for sale (and so it seemed tacky to photograph it).

Having decided that this was as far as I was going to go, I took a moment to plan my trip back.  One of the “must sees” was Purakaunui  Falls but before stopping there I decided that Lake Wilkie sounded interesting.

While on that walk, I heard a variety of  very interesting and very unfamiliar bird songs.  I hope to convince my dad to come over sometime and help sort out what these birds are!  I couldn't see them as I’d left the binoculars in the car, this time. 
Lake Wilkie
On the way back up the road, I saw some of the coastline from a different perspective.
 and stopped to take some photos of the rocky cliffs plunging into the sea.

The beach at Paptowi
 I took a short detour to the beach at Papatowi
and then I made my way to Purakaunui Falls.

The guide calls this “a true icon of the Catlins”,and “one of New Zealand’s most photographed waterfalls.”  I took quite a few, myself, and picking just the right ones to include was not an easy task.

More ferns on the track to the falls

My next stop was Owaka, a cute little town with some beautiful gardens and a few odd quirks.  

  Someone apparently had a teapot collection that got out of hand.  It has now become Teapotland.

Coming from Montana, it’s fascinating to see roses and lilies in bloom this time of year.  Remember, it’s pretty much autumn, here, now.  It would be the equivalent of seeing these in bloom in September in the Northern Hemisphere.  Maybe some places, but not Montana!

Ok, so I know you’re anxious to see the penguins.  Unfortunately, due to the quality of my camera, this is a part of the trip you’re just going to have to trust me on.  Some of my family members will remember my trip to Malawi.  We took a river cruise and waaaay off in the distance were some elephants.  At that time, I didn’t have a decent camera either (I need to get a decent camera, don’t I?) and the running joke forever after was I would point to a tiny black dot in the bush and say, “Look, can’t you see? It’s an elephant! There are elephants!”  The fact is, there really were elephants, but you really couldn’t see them in the photo.  Same with the penguins.  They really are there, and I really saw them with the binoculars, but you really can’t see them in the photos.

After leaving Owaka, I followed the signs to Nugget Point, which took me to the “penguin hide.”

Penguin "hide"
 It was a short walk down to the “hide” which was full of tourists. One thing about brilliantly beautiful weekend days is they DO attract lots of tourists.  The problem is, penguins are quite shy and of course they must know they are being watched by dozens of people, even with the hide there!  Anyway, the tourists were looking at a pair of penguins in the grass up on the bank, which I got a good view of with the binoculars, then we saw another one waddle out of the water to join them.  There it is, see?  That tiny speck just up in front of the brownish blobs (which are rocks and seaweed).

 And there, in the grass, there is a grayish-white speck?  That’s the pair of penguins.  By this time the other one had found it’s way up the grass and it’s standing in the bottom right corner of the picture—a whitish blob just in front of the shrubby plants.  You’re just going to have to trust me on this one…or better yet, come see for yourself!

"The Nuggets" which, in the setting sun, look like nuggets of gold
Having achieved my one goal for the day, I made my way to the Lighthouse at Nugget Point.  Nugget Point is named for the “nuggets” of rock that sit out in the water.  Along the walk up to the end of the point, and the Lighthouse, there are steep, plunging cliffs off to the side and, with binoculars, I was able to see cormorants (which they calls “shags” here), fur seals and elephant seals.  Again, they were too far for the camera to pick up. However, I did photograph some quite excellent views.

A butterfly on a sign

Down below the track, around this little pool of water, there were some seals resting.  You might just be able to make out some dark blobs just on the edge of the water.

Seals, see?

Another view of the Nuggets

Incredible blue water
By this time, the sun was starting to set,

 and my phone/camera’s battery was about dead.  So I got back in the car and made one more stop at Kaka Point, which is a tiny beach town about 25 km outside of Balclutha.

Kaka Point

And with that, I turned my car back toward home and put my very tired body to bed!

I have many more photos, some good, some not so good.  And there are many more to be taken, preferably by someone with a really good camera and some photography skills.  However, this should give you a rough idea of the spectacular day I had in the Catlins and the stunning surroundings that are very close at hand to my new home.  I’m open for visitors!  Just let me know in advance so I can take time off work.