Didn't Expect Derick Dillard to be the First Duggar to Crack

Being a son-in-law of the Duggar clan brings an entirely new level of crazy into a young man's life.  Jim Bob and Michelle Duggar have been used to micromanaging their 19 kids lives for decades and have received accolades for their reproductive prowess in the form of a television show, ghost-written books, publicity tours and public speaking gigs. 

Yeah, Jim Bob and Michelle's aura of wholesome Americana got dinged when their insanely negligent handling of Josh's repeated molestations became public knowledge - but I doubt that those revelations changed the family dynamics.  After all, the revelations were not new news to the people who lived through those years.

The tricky bit for sons-in-law is supporting their ever-growing families financially while still receiving some level of financial support from Jim Bob and Michelle. 

• Ben Seewald works for Jim Bob and in a variety of manual labor style jobs.  Austin Forsyth works for his parents at a campground.  With the minimal education both of these young men have, they are pretty well trapped into family businesses especially since their wives are having children.  
• Jeremy Vuelo has always worked outside of the Duggar penumbra - and Jinger and Jeremy seem to be doing fine financially in Texas so far.   
• Derick is in the most frustrating position of them all.  He has enough education on paper to support his family as an accountant - but decided to become a untrained, minimally supported missionary in El Salvador.  When their mission folded, Derick and his family moved back to Arkansas to pursue a year-long course in "ministry".   This has placed Derick and Jill back in the middle of the Duggar clan - and in the middle of the family stresses.

Earlier this year, Derick posted some insulting tweets towards Jazz - a transgender teenager featured on another TLC show.  Personally, I suspect the reason Derick and Jill were not prominently involved in the upcoming season of "Counting On" had more to do with that than anything else.  TLC will swallow a lot of crazy, insulting things from their TV stars  - but Derick was a two-bit minor character on a show that struggles to get advertising revenue.   Either way,  Derick attempted to walk back his generalized hatred of transgender people by claiming that he was denouncing the way that TLC and Jazz's parents earned money off of a teenager.

Needless to say, the internet pointed out that Jim Bob, Michelle, Jill and Derick did the exact same thing.  Pot, meet kettle....

In the middle of the tweetstorm, Derick blurts out that Sam was in the NICU for two weeks - and that his reading comprehension isn't the best in the middle of the night.

No, Derick.  PM was telling you that earning money by filming Israel and Samuel was using your kids to earn money like Jazz's parents and Jill's parents did.

The vast majority of people are unaware that NICUs - and pediatric hospitals in general - have donated funds to cover the costs of meals for parents without a lot of income.  My husband and I received a standard $5.00 voucher in our "Welcome to the NICU" material.  We told our social worker, however, that paying for our own meals was not a financial hardship and that we would prefer the money be saved for families who had farther to drive or less income available.

Personally, I think Derick and Jill should have gotten the lunch tickets in part because they must have a large bill coming for Samuel's stay.   We had no bills for our son's stay - but that was because Michigan has a Medicare program that is called "Thirty Day Medicare" that automatically covers children who are hospitalized for 30 consecutive days or more regardless of parental income.  Since Jack was in the hospital for 108 days, we qualified easily.   The Dillards, on the other hand, had the costs associated with Jill's C-section and 14 days of NICU care.   That's easily $250,000 in hospital and doctor bills if they are uninsured.

As the spat continues, Derick explains that he asked TLC to cover some of the costs of Israel's failed trial of labor and C-section.

Obviously, TLC wasn't interested in paying for medical claims that were expressly excluded in the contract that either Jim Bob signed on behalf of all the members of his production company (a.k.a. his biological children, their spouses and their children) or that Derick signed...but missed the details.

Either way, Derick's pissed about the relative lack of cash that's come his way from the show.

I know the likelihood of Derick or Jill ever reading this is low - but if you do - think about making a break from both the Duggar clan and natural childbirthing.  Derick, be an accountant.  I'm sure you can find a way to help people while earning a decent income for your family.  If you've decided that you want to work in ministry, get a real theology degree from a reputable college and enter a seminary.  Stop doing bait-and-switches like inviting LGBTQ people to an outing for the purpose of trying to get them to realize how sinful they are or offering English tutoring to Middle Eastern university students (read: Muslim) to also expose them to fundamentalist Christianity.   That's not how Jesus worked and is beneath his followers. Jill, get a GED and apply for a nursing program.  You can go to school and take any remedial classes you need while the boys are small.  There's a need for certified nurse midwives - highly educated women and men who handle uncomplicated pregnancies under the supervision of an OB/GYN.  It would take you a while to work up to that level but that would be a real accomplishment that you could be proud of.

To Jill (Duggar) Dillard From One Mother to Another

Hi, Jill!

I think you've started to realize that you grew up in a cult.  IBLP and ATI taught you that adoption was extremely dangerous spiritually but you have spoken of being willing to adopt.  Those same teachings implied that men with beards and long hair were possessed by the devil but your husband has experimented with a variety of lengths of hair and beards.

You are learning that the world has more options available and that's a good thing.  I want to warn you, though.  Growing up in a high-demand religious movement like IBLP or ATI (or Vision Forum) puts you at higher risk for being pulled into other high demand groups.  My concern is that you are ensnared in the most risky form of natural childbirth (NCB) ideology that conflates an unmedicated home birth with being a good mother.

IBLP/ATI/Vision Forum promise people that following "Biblical" rules will lead to happiness, fulfillment, and a life free from pain or trauma.  Jill, you know that didn't work in your family.  The rules that were supposed to protect you and your siblings instead provided cover for your parents to abdicate their responsibility to seek help when Josh admitted to molesting you and Jessa.  The rules didn't stop Josh from molesting three other girls - and neither did your parents. Your parents were too invested in chasing the limelight of fame for having a lot of cute, well-behaved kids to act like parents.

NCB fits the same pattern.   Facing labor, delivery and raising a child is frightening.  Pregnancy and children take whatever illusions we have about control over our lives and dash them. You saw your mother's last two pregnancies end with Josie being born at 25 weeks and Jubilee's stillbirth which has to make the thought of starting a family more nerve-racking than normal.  Believe me; I get it.  I grew up in a family where my twin and I were born very prematurely and our middle brother died in infancy.   NCB offers a seductive lure; labor and delivery will be safe, painless, and empowering as long as women follow the right rules.  Women need to learn the right mental state by meeting with their midwives during pregnancy.  Labor coaches should be picked by their ability to support your goal of birthing at home.  By laboring without pain medication or medical support, women will realize their personal strength and feel empowered by the memory of a triumphant vaginal birth to a healthy baby.  Thanks to following these rules, the mother and baby will bond instantly, breastfeed perfectly, and everything will be great.

It's a nice dream - but is a dream worth the lives of your sons?

Israel's birth was a comedy of errors.  His water broke before you had contractions and you thought you saw meconium.  You chose to labor at home for the next 48 hours.  I wonder if you realize today how dangerous that choice was.

• Once the amniotic sac has broken, there is a risk of bacteria that normally colonize the vagina migrating into the uterus and causing a potentially life-threatening infection in Israel.  The longer the time the membrane has been ruptured, the higher the risk of infection.  Most doctors would want to be sure that Israel was tolerating labor well and that you weren't showing any signs of an infection before letting labor progress past 24 hours after the membranes broke.  
• On top of the risk of infection, meconium staining in amniotic fluid can be dangerous.  Meconium is the first bowel movement passed by an infant.  The danger with meconium is that a baby who is distressed before birth will instinctively gasp for air.  The gasps draw meconium down into their trachea.  When the baby is born, the meconium can obstruct the baby's breathing or go into the lungs leading to pneumonia or scarring.

After 48 hours, you went to a hospital with a labor and delivery department.  I hope that you told them the truth about how long your water had been broken and the fact you thought you saw meconium.  I hope that the reason they let you labor for another 24 hours was that Israel was doing fine on continuous monitoring and neither of you were showing signs of infection.   

Your shock when the OB/GYNs told you that Israel was breech was memorable.  You spent 70 hours in unproductive labor trying to birth a baby who was in a position that could not be delivered vaginally.   You agreed to a C-section and gave birth to a giant 9 pound 10 oz baby boy who was as healthy as a horse. 

There is a bit of irony in Israel's birth; trying for a home birth with a midwife increased the chances of him being born by C-section.  Some OB/GYNs are willing to try a procedure called an external version on breech babies.  Near the end of the third trimester, you'd get an ultrasound to check Israel's position.  If he was breech at 36-38 weeks, the doctor could give you an epidural and attempt to roll Israel from the breech position to a vertex position.  The advantage is that Israel would have been around 6 pounds 10 oz to 7 pounds 10 oz and more easy to wiggle into the right position.   Not all OB/GYNs do external versions - but the 13 OB/GYNs in the practice I went to did them if a woman wanted to and was a good candidate.   If an external version couldn't be done, at least you would have had time to plan mentally for a C-section and would have missed 70 hours of labor.

The reason Israel's birth was a comedy instead of a tragedy is because Israel was a strong, healthy baby before birth.  His placenta was working well and giving him enough oxygen between contractions that he could tolerate being cut off from oxygen during the contractions over the course of nearly three days.  Israel benefited from some good luck, too.  He didn't have any issues from meconium inhalation and didn't develop a massive infection during the long labor after his waters broke.

Perhaps you hoped your dream home-birth was merely being deferred until your next child.  But, Jill, even midwives admit that a home birth after C-section (HBAC) has a 383% HIGHER chance of stillbirth than a "normal" homebirth.  The stillbirth risk of a HBAC compared to a low-risk hospital birth is 1185% higher. 

Truthfully, I doubt you realized the risks you were taking - but you saw the outcome when something went very wrong during Samuel's birth.

I wondered a bit when I heard that Samuel had been born.   All that your family had stated was that you were in labor for 40 hours before having a C-section.  I've had several friends and family members who had successful and unsuccessful vaginal births after C-sections (VBACs) - but no one was allowed to labor more than 16 hours prior to vaginal delivery or C-section.   Maybe you found an OB/GYN with a very laid-back approach to VBACs - or maybe you tried a vaginal home birth after C-section (HBAC).

Alarm bells really started ringing, though, when I saw the picture of Derick holding Samuel.  Derick was wearing the standard hair-net and disposable sterile gown that support people get decked out in for a C-section.  Samuel was wearing a diaper, a nasal cannula, an IV in his right arm, three monitor leads, a blood pressure cuff on his right leg and an oxygen saturation lead on his left foot.   Samuel, in other words, was wearing the standard outfit of a NICU baby. 

The pictures released from the hospital look like two parents enjoying a new baby - but NICU parents know the signs.  I recognized the monitoring cords on Samuel trailing around Derick; Jack had the same ones.  Jack also had the little bit of reddened skin on each cheek after the stickers that hold the nasal cannula were removed for a bit.    Samuel and Jack shared a dislike of weaning off oxygen and having their little fingers take a bluish tint when they got tired during a wean. 

The picture of Jana cuddling Samuel was adorable - and brought back memories of schlepping Jack around the house with cords that weighed more than he did.    Honestly, I don't know how you managed a newborn on oxygen with a curious toddler in the house - but you guys managed somehow.

You have been blessed with two little boys who survived rough starts in life.  If you are blessed with another pregnancy, please do not risk your child's life and your own life by attempting a home birth after two C-sections!   Find a local obstetrician and let them decide if you are a candidate for a vaginal birth after two C-sections at a well-equipped hospital.  If the doctor recommends a repeat c-section, be grateful that we live in a time and place where the operation poses few risks to you or your child. 

A vaginal birth is not worth a child's life - or yours.  

Samaritan Ministries is Going to Kill Someone - Part Two

In the first post in this series, I discussed the scary requirement that women who have ectopic pregnancies while on Samaritan Minstries health-care cost-sharing plan undergo "watchful waiting" and forego removal of the pregnancy until either the fallopian tube ruptures or the baby's heartbeat stops.   This is extremely dangerous for the mother because a ruptured fallopian tube can cause massive internal bleeding - and makes no difference in the outcome for the baby because the longest a pregnancy can survive in a fallopian tube before a rupture is 16 weeks which is two months prior to viability.

There are two other items in the "Maternity and Newborn Care" section of Samaritan Ministries that give me pause - and I need to give some background on how coverage works to explain my concerns.

Samaritan Ministries has two levels of cost-sharing coverage available.  The cheaper version is called "Samaritan Basic".  In return for a lower monthly cost-share amount, families have an inital deductible of $1,5000 for each medical issue that they need to cover (or have discounted by the doctor) before needs can be shared.  Once that basic benchmark is reached, 90% of the remaining cost is covered.  The older version is still available as "Samaritan Basic" and for ~$200 more a month, families receive a lower deductible of $300 a month and 100% of the remaining need is covered.

Here are the two sections that concern me:

Home Births—Home births have the $300 Samaritan Classic and $1,500 Samaritan Basic initial unshareable amount waived, and are not subject to prorating (see Section VI.D) because they reduce overall maternity costs.

After Cesarean—The $300/$1,500 initial unshareable amount is waived for a vaginal birth after cesarean (VBAC).

I have grave concerns about the morality of offering women a monetary reward in exchanged for increased risk during labor and delivery.

I believe that home births should be legal - but I also believe that women should be informed of the much higher rates of injury and death for both the infant and mother in the rare case that a condition or situation occurs where rapid, trained medical care is needed.  The vast majority of home births will end with a healthy baby and a healthy mother because statistically most births are uncomplicated.  The tricky bit is that there is no way to screen pregnant women perfectly to determine who will be able to deliver at home safely and who will have a delivery complication prior to delivery. 

 Within the CP/QF community, Jill (Duggar) Dilard and Jessa (Duggar) Seewald have attempted four home births - and ended up hospitalized after three of them.

Jill had her water break with Israel and was in labor for 48 hours at home before going to the hospital.  (Laboring for 48 hours after membranes have ruptured without medical care is a bad idea;  the longer the membranes have been ruptured the higher the risk of an infection beginning that could have bad outcomes for Israel.)  At the hospital, Jill and Derick were surprised to find out that Israel was in a breech position that could not be delivered vaginally.  Jill had an uncomplicated C-section with Israel.

Jessa's labor with Spurgeon was straightforward if extremely painful.  The baby was delivered without any problems, but Jessa lost a lot of blood when the placenta was being delivered.  Her blood loss was severe enough that she had to be transfered to a local hospital for treatment.  Thankfully, she didn't have any retained placenta pieces and the bleeding stopped easily.  Now, the Duggar spin is that the blood transfusion she received the next day was simply a precaution because she was really tired after birth - but blood transfusions are never a standard occurance after giving birth.   By comparison, I came into the hospital with poor blood volume due to HELLP syndrome when my son was born, bled fairly little during his C-section and never needed a transfusion.  Don't get me wrong; I felt like shit-warmed-over for the first week after his birth and needed wheelchair transportation if I was going farther than a few hundred feet - but Jessa Seewald was worse off than I was.

From my point of view, telling pregnant women that they should giving birth away from trained medical professionals, pain relief, antibiotics, blood transfusions, operating rooms and emergency support for their newborn to save money is absolutely sick.

There's a question I have as well - will Samaritan cover the entire medical cost of a home birth gone wrong without proration, deductibles or maximum?   As nasty as home birth side-effects can be for mothers, the side-effects for babies can be catastrophic.  When a baby is born after oxygen deprivation or meconium inhalation, the medical treatments add up fast: three days of full-body cooling with 1:1 or 2:1 nurse to baby supervison, oxygen support through a ventilator, CPAP, or ECMO, neurological testing, blood work, dealing with feeding issues... a baby can rack up $10,000-$50,000 in charges per day.  Don't forget:  Samaritan - unlike commerical health insurance or  Medicare  - doesn't cover durable medical equipment once the kid is discharged.  My son went home on a medical-grade monitor and oxygen from a concentrator.  Those are rented at $300 per month each.  That doesn't include the disposable items he needed like nasal cannulas, NG tubes, specialized tapes to stick both to his face.    Samaritan does cover 45 days of home nursing care - which won't last long a baby goes home on a ventilator. 

The second issue surrounds vaginal births after C-sections which is shortened to VBACs.   VBACs carry a higher risk of side-effects to both the mother and infant.  The most concerning issue is that the scar from the previous C-section will rupture.  To qualify for a VBAC, women need to have a scar that is entirely contained in the lower section of the uterus.  These type of scars have a 1% chance of rupture during a VBAC so women who want to attempt a VBAC need to do so in a hospital where the baby can be monitored and an emergency C-section can be done if a rupture occurs.  A uterine rupture carries a higher risk of postpartum bleeding leading to a transfusion or an emergency hysterectomy.  Very rarely, the baby suffers injury or death from oxygen deprivation between when the rupture occurs and when the baby can be delivered by C-section despite being in the hospital.

I would hate for a woman to feel compelled to try a VBAC for finanical reasons; that seems cruel to risk serious complications because a family badly needs money for other things. 

My largest concern is for women who decide to try a VBAC at home.   Having a VBAC in the hospital mitigates the risks of bleeding and rupture by having an operating room and mass blood tranfusion protocol immediately available if the baby shows signs of distress.   Havign a VBAC at home raises the risk factor exponentially.  First - not all women who have had a C-section are good candidates for a VBAC.  Because my son was born very early, I have a scar that reaches into the upper section of the uterus.  These types of scars have between a 6-12% chance of rupture during labor.  Spacing between babies is also important for VBAC candidates; a pregnancy conceived earlier than 18 months-2 years after a C-section more likely to have a uterine rupture because the scar didn't have time to fully heal before being stressed by the next pregnancies.  Since home birth attendants are almost never OB/GYNs or CNMs in the US, mothers who are being cared for by non-medical professionals prior to a home birth may not be screened appropriately.  Second - if a rupture or catastrophic bleeding occurs, precious time is wasted in transporting the mother to a hospital, getting her stabilized and starting a C-section.   This can directly lead to the death of the baby or the mother.

A New Ministry for the DIllards: Saving El Salvador from Gangs - Part Three

In previous posts, I've highlighted why I think the Dillards are unprepared for dealing with gangs and why SOS ministries is placing volunteers at undue risk.

In this post, I'd like to discuss how SOS Ministry hurts the local population (including Jill, Derick and Israel if they choose to remain in the country.)

My information is based on Carissa's blog posts along with SOS's online mission trip information combined with my experiences working in an urban district with many immigrant students, basic web searches of sites like the US State Department, the Centers for Disease Control, Wikipedia, and a heap of common sense.

What does El Salvador Need?

Let me throw an additional resource into the mix.  The CIA World Factbook is an incredibly useful tool for researching countries.  I'm going to compare three countries: El Salvador, the United States of America and Denmark.

Improved infrastructure: Sanitation Controls

While most of the population has access to safe drinking water, 25% of the population does not have access to safe sewage disposal systems.  The prevalence of bacterial/protozoal diarrhea and typhoid are directly related to underdeveloped sanitation systems.   Getting rid of those two endemic health issues is as simple - and costly - as building sewers and septic systems.

Educational Systems:

Students in El Salvador will - on average - receive 25% years of education than students in the USA and 36% years of education fewer than Denmark.  (Side note: The USA does not have a great educational record.  We have a disturbingly high drop-out rate in high poverty areas.)  Education is free, but class sizes are very high and funding is very low.

An additional problem is that the university system in El Salvador was severely damaged during the civil war due to murders of faculty and students.  Replacing the loss of human capital will take several decades and is affecting the country's ability to train doctors, teachers, and engineers.

Medical Systems:

God, where to start?

• 204% higher infant mortality rate than the USA
• 7.5% shorter life span
• 55% fewer doctors than the USA; 68% fewer doctors than Denmark 
• 62% fewer hospital beds than the USA; 68% fewer hospital beds than Denmark
• Endemic infectious diseases occur.
• 1,100% higher rate of childhood malnutrition than the USA

Is SOS Ministries providing change in infrastructure, education, or medicine?  I see no evidence that they are.

Are Jill and Derick Dillard adding any informational or resource capital to infrastructure, education or medicine?  No.  

(For those who are wondering, Jill's midwifery "certification" is inadequate for use in developed nations where advanced medical support (EMT) is a short phone call away.  Delivering a woman in El Salvador with her training should be criminal.)

But Mel, what harm are they doing?  They're just passing out clothes and toys.

 The road to hell is paved with good intentions.

•  Africa's local clothing market has been destroyed by well-meaning charities.  Every T-shirt, jeans or shoes handed out by SOS Ministry is a job taken away from El Salvadorans.
• Every toy handed to a child is a job taken away from El Salvadorans. (Logically - Salvadoran children were playing with something before SOS Ministries showed up.  Why not support those workers?)
• Every dollar spent on clothes or toys is a dollar NOT spent on school materials, teacher education, new infrastructure, medicines, doctors or hospitals.

Let's think about those good intentions for a second.  Who really benefits? 

•  The volunteers get some warm fuzzy feelings for handing out second-hand clothing and toys - but they aren't really changing anything.
• The locals get free clothing and toys - but is that what they want?  Has anyone from SOS Ministries asked them?  SOS was invited - allegedly - to help run a recreation center to keep the kids out of gangs.  How does a duffel bag of used T-shirts keep the kids out of the gangs?

•  El Salvador has a large textile manufacturing sector that is churning out cheap clothing that will go to the USA and be returned as second hand clothing.  While I enjoy the irony - a cheap T-shirt may well travel more than I ever have - my amusement is not worth the waste of capital involved in using money to buy shirts made in El Salvador in the USA and bringing them back to El Salvador.  

There are better ways of doing this.

My church supports an orphanage in Ecuador for children who are HIV-positive who have no one else to care for them.  One group of professionals - doctors and nurses - heads down several times a year to help the local community medical workers.  If you want to go, you need a RN or a MD/DO.

Not an RN or MD/DO?  The rest of us raise funds.  We use the money to purchase medical goods and devices that were not easily available in Ecuador.  Other things that the children need - clothing, toys, household goods, food - are purchased locally (i.e. in Ecuador).

We do send duffel bags of materials down to Ecuador - but it's full of anti-retroviral drugs, sutures, feeding tubes. oxygen masks - things that are needed, but not accessible

Derick and Jill, it's time to grow up.

• Play-acting in hopes of saving souls is forgivable in pre-teens, but shameful in grown adults. 

•  Real missionary adults have skills - they are teachers, nurses, doctors or engineers.  They know how to raise money and disburse the money in ways that help the recipients rather than soothe the egos of the givers.  They speak the language fluently.  

•  Real missionaries take care of their health and the health of their children.  What are your plans for getting Israel vaccinated against rabies and typhoid?  He's at high risk of exposure  of typhoid right now and will be at extremely high risk of rabies exposure when he can walk/run since little kids like animals.  Did anyone at SOS ministries bother to tell you that?  Did you bother to check yourselves?

To paraphrase 1st Corinthians 13:11, when you were children, you thought and reasoned like children.  When you are an adult, you put childish things aside.

New Ministry for the DIllards: Saving El Salvador from Gangs- Part Two

I'll admit it: SOS Ministries scares me.

I've read through Carissa's blog post about her trip and I've read through all of SOS's online mission trip information.  SOS Ministries is playing a dangerous game that is likely to hurt the local populations they allege to serve and the volunteers they bring on the trips.

Let's start with the potential dangers to volunteers. If you sign up for a short-term mission trip through SOS, you will be sent to El Salvador like the Duggars were.    The website has a PDF file for applications.

The application has

• One page of basic personal information 
• One page of writing about your credentials as a Christian
• One page where you write your testimony
• One page describing how to write a testimony....
• A health release for minors
• A medical release for adults
• Emergency contact information.

I'm going to hazard a guess that the real driving force to determine who goes on the trips is the ability of the person to raise the cash involved.  A two-week trip would cost $950 not including airfare or incidentals.  I've never flown to El Salvador, but some basic research showed that it would cost me around $600 for a round-trip economy class seat from Michigan.  I could knock the cost down slightly by driving to Chicago, but I would end up paying the difference in gas.  That's $1550 per person so far.

They have a mission trip handbook posted as well.  I've read something like this before when I traveled with a youth group for a mission trip.  What worries me is that our mission trip was to Beaver Island, Michigan to help a small, elderly congregation of a Christian denomination with various projects at the church and in the community that they couldn't physically do.  In other words, grunt work well suited for high schoolers in a location where the worst illness you could get is giardia - and only if you drank water right from a stream and had bad luck.

My health concerns:

• SOS Ministry recommend tetanus and Hepatitis A shots.  The CDC recommends those plus Hepatitis B if there is any chance of accidental injury and typhoid if you are staying in homes.  The ministry doesn't require any proof of the recommended vaccinations or even proof of being up-to-date on the standard MMR, DTAP,  chickenpox or polio.   In other words, you could end up getting very sick from this trip from preventable diseases carried by other volunteers.

• SOS Ministry mentions bringing bug spray.   Malaria is not currently an issue in El Salvador, but dengue fever is endemic and currently experiencing a spike.  If the travelers are not careful, they could end up very ill. 

• SOS Ministry recommends bringing diarrheal medication but "no special medicines" are required.  The CDC, on the other hand, recommends talking with a doctor about carrying antibiotics to treat traveler's diarrhea.  A prudent traveler would also think about oral rehydration therapy powders since even healthy adults can get bad dehydration quickly during a bout of bacterial diarrhea.

My cost concerns:  

• Passports are $110 dollars for people over 16 years old and $80 for people under 16 years old.

• The cost of traveler's vaccines from the Health Department in my area is 
• Consult for an individual is $55.00 or $75.00 for a family of two or more people.
• A DTaP shot is $58 dollars.
• A Hep A shot is $56 dollars.  A Hep B shot is $62 dollars.  You can get both in a single vaccine for $86 dollars.
• Typhoid is $66 dollars for the oral vaccine or $78 dollars for an injection.
• Total additional costs: $0 (if they got the Hep A/Hep B series, are up to date on Tetanus, and don't know about typhoid) - $277 (needs one of all the vaccines).

• Cost of treated bed mosquito netting if you don't like the idea of getting dengue: $30.00.
• Cost of prescription for Ciprofloxacin 500mg for 3 days between $4-10.00

• Cost of having a cell phone in El Salvador: $40.00 with no data for 100 minutes.  Going over 100 minutes is 0.25 cents a minute instead of $1.79. 

• An unknown amount of cash needed for "love offerings" and "emergency needs that frequently come up during mission trips".  I have no idea what that means, but I would want at least $200 in cash and some form of credit if I was an adult traveling there.  (Side note: If I were running a trip, I'd add an additional $50-100 per person to put aside for emergencies/gifts to staff and tell the volunteers to bring no more than $50.00.  I don't want my volunteers to become marks.)
• Each traveler is supposed to bring one-half a suitcase of their personal belongings and 1.5 suitcases full of "ministry" materials that they purchase out of pocket.  This includes medicine/hygiene items, Bibles, shoes, clothing for give-aways, and toys for children.  Ignoring my feelings about four of these categories (next post, Mel...breathe.....breathe......) , that's a whole lot of items to purchase.  Conservatively, I'd guess I would need $200 of used clothing to fill a duffel bag or $400 of Dollar General medications for my low and high estimates.
• Grand Total: $1840  to $2,591 with the low end being an experienced traveler with up-to-date vaccinations and the high end being a first-trip adult.

My safety concerns:

• The State Department has had a travel warning up for El Salvador since at least  2014.  Between 2010-2014, thirty-four US citizens have been murdered in El Salvador.  (In a semi-comforting note, the State Department points out that US citizens aren't being targeted per se; El Salvador is simply extremely dangerous. Yay? )

• I would strongly urge anyone traveling to El Salvador to register their trip with the State Department.   El Salvador could easily become unstable at any point; if it does, the US government needs to know where you are to get you out.  If the USA doesn't know you are in the country, they can't get you out as quickly.

• SOS Ministries says they have health staff in El Salvador.  What exactly does that mean?  Do the leaders of the trip have complete traveler's kit or should I be sourcing Epi-Pens and suture kits with my doctor?
• How dangerous are the gangs in the area?  Carrisa's blog has conflicting reports.  The gangs want to end the cycle of violence and are willing to stay out of a community center so the kids can have somewhere to go.  That's a good sign and means that the local area is probably pretty stable.  On the flip side, her second blog post makes it sound like they were under government protection and wild pre-teens would have slaughtered them all if the local gang leaders hadn't protected them.  (Yes, often young gang members want to show that they are hard enough by hurting or killing someone.  They usually target OTHER young gang members - not unarmed tourists doing daft skits.) IMHO, Mike - the leader of the ministry - was overstating the danger since the locals look very relaxed and are letting their children roam freely.  On the other hand, if Mike is horrible at reading local conditions he might be leading the volunteers into genuinely dangerous areas.

What could $2000 do?

• Fund Doctors without Borders to help fight the dengue fever epidemic in Central America

• Protect 200 families from malaria in Africa through Nothing but Net.

• Pay for two sheep, four goats, one heifer,two llamas & one community animal health worker through Heifer International.

• Fund $24,000 worth of school supplies (thanks to corporate donations) through World Vision

New Ministry for the DIllards: Saving El Salvador from Gangs- Part One

Jill and Derick Dillard have headed back down to El Salvador and mentioned in passing some of their prayer requests:

Please keep the following prayer needs in mind as you go before the Father:

• That the political instability and violence of the region would be such that we could make the transition effectively.

• National and local elections – that God would put authorities in place who would honor the Word of God and His people

• Prison and gang ministry. Many of the men in Central America are in custody for gang involvement, leaving the gangs themselves as the primary influence of many children, especially young boys, who, sadly, tend to follow in their fathers’ footsteps. By God’s grace and the prayers and fasting of his people, this deadly cycle can be broken and this land healed.

I'm going to assume that the first bullet point is a poor grammatical construction.  I suspect the Dillards want us to pray that the country has little or no political instability or violence rather than descends into chaos.  (My husband isn't as optimistic as I am on that point....)

The bullet point about "Prison and Gang Ministry" gave me chills.  Do the Dillards understand what they are getting into?  No.  They can't.  Presumably, they have the laughably naive beliefs espoused by Clarissa on her blog which essentially run that Good Christians (TM) will suddenly realize that gangs are evil, magically reject gangs, and everyone will be happy forever after.

It's none so simple. 

First big idea: The USA's history of nation building in Latin America is horrifying.

In the 1980's, El Salvador was on the verge of a civil war.  The US government was terrified that communism would take hold in Latin America. The United States supported the Salvadoran government who eventually destroyed the opposition while destroying the country.  In a country of 5.3 million people, 80,000 were killed and over 500,000 were refugees by 1990.  (One of the murdered people is somewhat known in the USA: Archbishop Oscar Romero.)  Some refugees tried to get into the USA as refugees; most were denied legal entry.  Without a legal way to enter the country, many crossed over as illegal immigrants.  While in the USA, some of the disenfranchised young men who had seen horrific violence in their home country became gang members in established US gangs like the 18th Street Gang (or Barrio-18). Others joined M-13 which was a gang created to protect Salvadorans from other American gangs.  These gang members were caught for a variety of crimes and deported.   In doing so, the USA managed to export two extremely violent gangs (Barrio-18 and M-13) while allowing the government to massacre civilians.

Second big idea: Nothing about gang life is simple.

I haven't talked about my teaching experiences much on my blog.  I have a lot of positive memories, but I also have bad memories.  I started teaching when I was about 25. My first teaching job involved working with students who were actively involved in gangs.  Here are some things I learned quickly:

• You are exposed to gangs your entire life.  More than once, I saw a cutely arranged picture of younger siblings of students dressed up in play clothes.  The boys were dressed in the gang's color - like their fathers and brothers - and throwing gang signs.

• If you are male and live in an area with gangs, you have two choices: join a gang and have protection from other gangs OR be a potential victim of all the gangs.

• Schools were safe zones because the gangs decided that the publicity of school violence was bad for business - but teenagers don't always obey gang rules.

• Getting out of a gang is hard - but not for the reasons most people assume.  
• See, your entire family are probably members of the same gang.  If a relative is hurt by another gang, you will be expected to enforce retribution.  If you don't, your entire family is at risk.  
• For a lot of my students, the gang WAS their family.  They didn't have anything like an intact family; hell, most of them had been in and out of foster-care and various relatives homes for years.  Being in a gang gave them a sense of purpose, belonging and safety that was missing from everywhere else in the world.

What does this look like in Western Michigan?  Here are a few stories with names and identifying details changed:

• Darius was a young teenager who liked to talk trash - to everyone.  Seriously, the kid never stopped picking at other students.  In the classroom, he was pretty easy to keep quiet - he wasn't a defiant kid by a long shot - but he'd start jabbering away within seconds of the end of class.  Darius was in my classroom one day when another teen who I'd never seen walked in the room.  The other teen grabs Darius and starts beating the crap out of him.  The other teen had several inches of height and probably 30 pounds on Darius.  Another student, Marcus, jumps up and starts fighting the other teenager which gives Darius a chance to move to safety.  Marcus and the other teen were pretty evenly matched and exchange a few body blows before my principal who was in the nearby room comes in and separates the two of them. (The entire fight happened in less time than it took me to write that paragraph.  Thankfully, no one was armed.)  Long convoluted story short: "Other teen" was snuck into the building by a fellow gang member to beat up Darius because Darius was picking on "other teen's" girlfriend.  Darius would have gotten the crap beat out of him if Marcus hadn't intervened.  Why did Marcus intervene?  Marcus and Darius were in the same gang.
• Jack was a young man I met at that same school a few years later.  He was a slightly older student who had a little girl in OH he doted on.  He's show me new pictures of her frequently.  Jack was also set up to join the military when he graduated.  Since the Iraq and Afghanistan wars were at their peak, I was very worried.  One day, I asked Jack if he was aware of how dangerous Iraq and Afghanistan were.  Jack looked at me and said, "Miss, I know they are both dangerous and that I could die there.  I also know that if I go back to Ohio I will be dead within two years because I'll get dragged back into the gangs.  The way I see it, if I die in the Army, at least I die in a way that my little girl can be proud of me - as a man."  I know Jack made it into the Army and I hope he's still alive.

• Lamont was a fast-talking freshman.  He struggled a bit in school because his reading level was low and he enjoyed running with the gangs. He was there every day while he was on probation and surveillance; his attendance slipped when he got off probation and eventually he dropped out at age 16.    One day, he was in the wrong place at the wrong time and got shot in the head with an injury similar to Kathy Giffords.  He's now paralyzed and has the mental skills of a two-year old.  I doubt he'll live to see 30.

• In one of my first years of teaching, I had a male student named Luis.  He didn't talk much and was always watching the room like he expected something bad to happen.  Luis was also freaking brilliant.  I gave students a chance to test out of courses by exam.  He sat and passed a freshman level Physical Science course and a Biology course. We developed a cordial relationship in part because he had a dark sense of humor and so do I.  He was involved in a local gang and I thought he might be doing drugs. I had asked him if he was doing drugs and he swore he wasn't.  Honestly, I didn't believe him, but he seemed touched that I asked.   He passed my chemistry class without being in class most of the time, then dropped out.  It turns out  I was partially right; he wasn't doing drugs.  He was dealing drugs.  Luis was shot and killed by a potential client according to the police.  The word around school was that the murder was organized by a different gang.  Either way, he was 18 when he died.   

This is in a fairly prosperous area of the USA.  If gang life is this hard here, how much harder is it in El Salvador?

Third main idea:  Badly acted skits by sheltered gringos will not stop gangs.

In the Dillard's photo page, there's a picture of Derick participating in what looks an awful lot like the "Things that Separate Us from Jesus" skit mentioned in Clarissa's blog.  (Both of them have a person wearing the "Scream" costume minus the mask surrounded by poorly staged white people with Hispanic people watching from a safe distance....)

Bluntly, SOS Ministries could be doing these skits anywhere in the USA.  If accepting Jesus is all you need to avoid gangs, why aren't they doing this in Muskegon, Grand Rapids, Detroit, Lansing, Chicago or anywhere stateside?

• They aren't doing them because they would be laughed out of their venue. (Seriously.  My students - even the kids from far less rough backgrounds from later in my career - would have been in tears because they were laughing so hard.)  
•  They aren't doing it because they would be rejected by people living in the areas as amateurs.  Badly acted skits are age-appropriate for junior high students and acceptable (although sub-par) in high school students.  Jill and Derick are in their twenties.  Doing a crappy skit won't win souls for Jesus; you'll simply provide a few minutes of free entertainment while destroying any credibility you had.
• They aren't doing it because the community members who are trying to change lives would call them out as the dilettantes they are.  In the US, someone would have a sit-down talk with Derick and Jill about their lack of suitable training in education, ministry, health care or infrastructure and give them the options of getting more training or getting out of the way.  (In English.)