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Spirituality in Patient Care

Keith Hanson Joel Sebangan

Conference

Recorded

  • October 26, 2012
    3:00 PM
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I don't know how you see your house might add that my house is my wife is very much involved in the health ministry that goes on we consider ourselves a team we do something separately we do some things together as we began to prepare for this particular talking for that evening this year without being good idea to showcase some community practices where family is involved in so we've ask a couple of positions who I know have been active to share with their family does a first will be a Keith Hansen we had the pleasure of working together as family physicians on the island of Guam for several years and so I know ketone ester well after triggering activity in the chip program in doing in the community and I keep is an active in health education and anxious to help the church mission growth government to turn that over to him first that what doesn't work off all of the of Joel and Gretzky surveying and and that they come from the south-central Oklahoma Joel did not grow up in a Seventh-day Adventist community or home but was converted in the medical school of a medical school at hand it has a passion along with Brett Cielo for his whole life so medicine and bringing Christ into the practice making a difference and he's done since unique things as well and in Graz he will be sharing I is not sharing okay a have been the primary practice ophthalmic practice I've been in Brewster Washington Mister is just a little over an hour south of the Canadian border on Highway ninety seven writing the middle of summer are on the east side of the mountains if you clean it all in Washington state so when I got the invitation to buy talk here I had to say is little bit how with trepidation that I approach this I e-mailed George some e-mails talking about that issue at all no one might I do so Georgia's been very helpful and encouraging advice I'd appreciate working with him since time of Guam got to get together several times since so spirituality and patient care at here in San Diego these are the objectives I had a couple to them that are not in the thing but particularly how this is a scientific portion of the will understanding the need to do spiritual care and recognizing the volume of evidence according the benefits to spiritual care so exactly how do we go about doing it and why should we do it etc. I have several references that I've meant to bring here next to show you once his handbook and I didn't that left him in the room handbook of religion and health this at many of you may be acquainted with it's fairly thick volume and it's actually has I have summarized all the studies that they could find on religion and health and I used to think well there's not very many a few studies and in reality there is probably over four thousand studies that have been published on me to how in the outcomes of that and so what I will be doing today is not picking specific studies showing you the overwhelming evidence of what religion does and what the studies are showing in that respect the second is spirituality in patient care also by Harold Keeney I has had very good book and brings up some cautions as well which I think are worth while on scene next is gray matter how many you've seen the book gray matter so outstanding book it's about it's done by a neural surgeon and interventional neural endovascular neurosurgeon and he now prays with all every patient he tries to pray with every patient I had it starts his whole story of how he started about doing it the first time he went when he tried to sneak in and pray with the patient and get out before the nurses noticed you know and then the whole process of going through getting I see what he did for his patients and then how are the nurses appreciated in the other physicians and his whole process what happens when you have a bad outcome hi etc. so is is very well done and certainly well worth reading and then finally my personal testimony as to what we do in Brewster 's while to get through the scientific portion fairly quickly so that you can do that one of the reasons for doing spiritual care is the statement noticed with by the joint commission accreditation of Hospital organizations better known as J Cole that requires that a spiritual history be taken we note that the word requires that a spiritual history be taken on every patient admitted to the hospital acute care hospital nursing home or seen by home health agency thought and every patient is supposed to have spiritual history done it doesn't specify your offices a lot of times as things develop if it goes in one place is ultimately and up at another and a lot of organizations are I tried to get accredited by J hi so this is very interesting that they require that and then on going along with this as well sixty six to eighty one percent of patients they they would have greater trust in their physician if he or she asked about their religious or spiritual beliefs and you combine that along with this next statement other researchers shown a significant improvement in the doctor-patient relationship when the physician does do that spiritual history and even just doing that just the minimum of asking how are you religious you have a religious persuasion what denomination are you attend church just simple questions like that some studies have shown that that is in of itself if you did nothing else has improved outcomes very interesting because it patients it's not because patients perceive that you care more when you care about what they believe is well so religious and coping religious coping and depression medical real patients who rely and religion to call I thought I'd adapt more quickly to illness and those who do not this is been shown many times patients independent religion are less likely to develop depression and if they do become depressed are more likely to recover quickly from depression in patients who are less religious what about other aspects of spiritual care praying with patients in particular praying with pay is certainly a part of spiritual care and very important part and could also use some ways be a spiritual intervention or you as well this being said there is quite a wide difference between some people 's opinions if you go from Doctor Levy who in some of you pray with every patient to some who raised the concern that a healthcare provider not pray with anybody you know it should only be initiated by the patient never by the healthcare provider will look at this study Illinois study a hundred and sixty primary care physicians one third of them believe that patients might want to pray with them and then put along with that older patients in the same area where the study was done said they when they were asked if they would like their position pray with fifty three percent yes very much so twenty nine percent it said yes somewhat and only five percent said no other studies in medical populations and reported between twenty eight to sixty seven percent have positive attitudes towards prayer so there is a large part of population that appreciate prayer and spiritual so when can you do it spiritual history how do you go about doing it and maintaining appropriate boundaries so the best time some of the best times when you first meet the patient know if you start off with spiritual tone they're more likely to accept it and feel more comfortable with it when you do that so when taking medical history during a new patient examination or taking medical history within hospital admission I was recently trying to pray with him every patient is admitted to the nursing home on some of it if there have no ability to recognize what you doing after some of those may be very good to pray with one instance only so far where I asked the family who had been admitted the patient there their parent who was dying of cancer and I asked if is okay I prayed with them or their parents and they said absolutely not they were offended that I would even ask and I asked about why he said well were Jehovah's Witnesses and our elders take care of that so they did not want me to pray with other different people I've asked to pray with so far the Jehovah's Witnesses are the only ones that really do not want you to pray with them so taking that spiritual history ahead of time and knowing what denomination they are they make a difference I had one of the patient once who said they didn't want to pray they had no interest in spiritual things at all so new patient evaluations when do you take out what part of this is to take the virtual history it fits very well in the social history and then these are these are interesting these questions all these questions religious denomination or a member of the community or the religious beliefs provide comfort for them how such beliefs might affect medical decisions is a patient is prayer in their own life today attend church on a regular basis these are all questions that you could include in your spiritual history and these are all questions are actually on the Jake oversight on the things that you might be able to do asked when approaching the spiritual history so that makes it much more interesting listening to the talks this morning when they raise the concern about you know that someone's getting sued with so it you know you have good support in the literature saying it's very beneficial so appropriate time this is the best time to ask is it okay if I pray with you at times would you want me to initiate the prayer would you like to ask for the prayer would you like to pray together high in certain times noisier admitted to the hospital would you want me to pray for you are with you those are all good times it's their very young nonconfrontational in that setting because you're just getting to know them and also there's not an expected that out you know most people take off and go to the hospital in with my dying doctor might be okay you know are that family calls up an asset so if you pray with him right there in the start to think oh no they might not bad so what about training some experts say never do never pray with them due to the power difference between patient and health care provider data JVC initiated by the patient or by the health private healthcare provider HP stands for instead indoctrinated health care provider so there's this big power differences of their likely not to say no to you but they may have no questions about so if they also some experts advise that you should never do it initiate spiritual activities the patient take her step if you take this attitude are likely never to be asked number one and all but if you find that out in your spiritual history you can ask them you'll was okay I ask you another time to pray with you are a signal I would really like to ask you if it can respect their wishes for that so most patients this is interesting I found this in scientific literature to most patients do not want healthcare providers inquiring disgusting spirit matters tell after they have competently dealt with medical issues so the question is is there some negative outcomes as a result of having prayer with patients I hear some instances psychiatrist to pray patient in Texas state medical and mental health system the prayer confused patient who told his family about it family sued the jury awarded that are ruled against the psychiatrist in favor of the family arresting another one a Christian physician asked the patient to his Jehovah's Witnesses is like when I had the patient refused to have prayer was when we asked why he said if you use the word God in your prayer I would find it very offensive because they want the word Jehovah alewives the mention of God has to be Jehovah and another one a social worker at the hospital placed a track just placed the fact that the bedside of the table of the patient the patient's family who were guess what Jehovah's Witnesses saw the pamphlet when visiting patient upset by this they sued the social worker and the hospital so they are potentials for negative outcomes are negative consequences if physical healing does not occur as a result of prayer the patient may be disappointed or discouraged claiming that prayer was not answered or that God does not care or worse that God is angry and vengeful towards them so the picture of God that you present it makes a huge difference in Canada in their lives and this is another reason and actually this aspect of the David Levy in his book gray matter deals with this factor and people that he had been very negative outcomes and yet he was able to still connect with them in prayer and help them through that particularly in follow-up exams conversion to a different religious group from Christian to Buddhist or Catholic Evangelical Christian for example may cause disharmony anger and pain to other family members and possibly the patients themselves we have to somewhat visit the wise as serpents and harmless as doves I take the view thoughtful about how you do it and how you approach it and I think that interaction at the very beginning when you first getting to know patients can make a big difference in that I personally say this morning his partner pray with everybody but he didn't but whenever he decides partners patients he said would you like me to pray for you in a symbology didn't I would be disappointed I have patients in my office who will come and ask to pray with them at times I don't pray with them every time that they come in but for some quite frequently so this has a lot to do with it was a question was asked earlier about boundaries obtaining patient consent is essential as is maintaining HP 's boundaries asset was taking a spiritual history supporting religious beliefs praying with patient for referring to clergy the author of that book really thinks that the people most qualified and generally you might find that the truest people like chaplains that are trained specifically to care for spiritual needs and hospitalized patients high and many doctors are really trained in that way so how you do that is you have to take very consideration and is one other saying that they had it is the patient's religious or spiritual beliefs that are to be supported not the police of the healthcare provider very important and so if you have opportunity to asking and ask you what we can't I was very close to yours or someone specifically like that and to support them as they see that you care for them perhaps they want to know more about your religion this is what I believe you really seem to be carrying Doctor and I would like that that's exactly what we would like to do that would be I guess what you called this interest the benevolence palatable to these health studies rather quickly have a little time with a little more about what's happened my practice and what these are not specific studies but the number of studies that show a benefit in certain areas for instance in coping depression nearly five hundred studies on case studies report religious coping is associated with better adjustment of five hundred studies on a lot of studies well-being two hundred and twenty four studies in the past ten years seventy eight percent report a positive relationship between religion and well-being the same with optimism not as many studies twenty six out of thirty two but that sixty one percent show benefit quality of life sixty four percent of those studies show positive relationship between religion and spirituality more studies hope is the same thing seventy three percent show greater hope a few more religious social support in two percent of the studies remember this is not how they are how many benefits how many studies show that benefit is not a single study here and there loneliness nine out of seventeen studies not when I first read this one I thought that's interesting that mean that there's forty seven percent of the studies show that they are more lonely and in reality what is the expected rate all of these areas the great majority anywhere from forty three percent up to ninety four percent shall in different areas typically less than ten percent show detriment and then the difference between doses there is no association now on mixed findings or something like that so loneliness shows benefit self-esteem sixty one percent of the studies show benefit from religion and spirituality then we get to depression depression there's a lot more studies done on depression and religion coping than in so many other areas four hundred and thirteen studies two hundred fifteen to sixty one percent show lower rates of depression faster as he saw some of his fourteen out of twenty two clinical trials clinical trials have more significance so lots of benefit from clinical trials as well prospective cohorts the same type of thing so this one nine percent this is show worsening depression so the great majority show benefit just like in all of these areas silicone parts that is eleven percent and higher levels of depression so the great majority of times you see that there is benefit suicide there is also benefit anxiety the same types of benefits and a psychotic disorders the same kind benefit alcohol this is eighty six percent and then when you look at really well done studies ninety percent and these are high enough the same with drug abuse these are high enough that some people is that maybe this should be a public health matter and people should be encouraged to have religious practices marital stability is also much benefited by religion marital stability includes marital satisfaction marital commitment relationship cohesion marital sexual fidelity unless the board separation etc. so that is all-powerful so those all have to do with mental health this is physical health and this is the only one time and go through either love them out the risk factors related to heart disease and if you look at the number of studies are the percentages the great presented images put them all appeared for the interest of time and show there is benefit to religion and spirituality the exception is obesity it seems that there was actually slightly more greater weight with religion spirituality satisfaction I see and diabetes follows closely behind that because so so the question is these all these things does this really relates to less coronary heart disease were not and when you do the more definitive study just like in hormone replacement there was some exotic would be beneficial and then when they get more definitive study there was more cancer there was markedly more stroke at sentencing well with heart disease we find that it's just the opposite heart disease has shown benefits in all sacred benefits sold sixty three percent of the studies out of the nineteenth addition significant inverse relationship so the more recent more religion and spirituality the less heart disease there was only five percent reported increased heart disease and five percent mix findings and then there was that grouping between the children and I wanted to share just one or two things from my own practice test her and I have done lot of programs that has made us lots of friends in the community which is been very helpful I have started praying more with my patient you have me what way matter but there is one part that I think that is the most important thing that you can do to equip your office and then all kinds of things we have booked sometimes out and that lobby and pamphlets had a monitor I would try putting some of the religious type videos and some of that didn't work out very well but the most important thing that you can do to equip your office is your personal preparation that means spending time every day listening to God speaks through his word I listening to the words of Jesus then praying and listen to the Holy Spirit as he promised you who you should pray with our leadership or how you should I involve that spiritual history takes etc. and so for instance my own life I get up early every morning I've forcefully been able to wake up early on my life has been very beneficial at the time when there's not a lot of other things interfering with things that I have to do as I have that quiet time that I been anywhere from thirty to sixty minutes and then I will pray and ask God who should I be praying with today and sometimes in the five or six people sometimes not the end of the day when is the none that I chosen the prey would have to go back into his life where did I resist your voice had enough pain and I find that way I think all I should pray with outpatient and so the next time and I see my may take the opportunity to do with and just one story Lehigh 's visit patients in my practice who came into my practice not too long ago is actually been probably a year or two now but he came in and he I was examining his wife Burkholder something he's he had gotten one of the books out of it and filled these people believe in this Saturday is the sap and that he start had many interactions with them sometimes I'd share some tapes with him encouragement he got connected with other something other people in our church in Bible studies with the pastor has not yet been baptized but most recently has written a saying I consider the Seventh-day Adventist church our church in my wife Yvonne whose marital issues and now coming back to that and so there's been other stories of that as well so that I'm an internal time to Doctor and voted afternoon my name is Joel 's abandonment and this my wife brought Cialis and our son Adam is here with us he sitting in front row we are very busy pulmonary and sleep medicine practice in southern Oklahoma and I also do a little bit of wound care as Doctor Guthrie had mentioned I was converted at the growth and happiness house converted to our church our doctrine saw when I was in medical school and consultants and down I was baptized here in the US and I did my fourth your clinical clerkship and I been blessed with a wonderful godly wife and partner life food not only believes in what I believe in but also strongly promotes it she's been actually the color and wonderful impotence and the growing ministry in our office we open our office about ten years ago with the thought in mind that this is not just to be a medical practice but also a medical ministry totally dedicated to the Lord and as Doctor Hanson touched on the the scientific aspect of spirituality in medical practice were to touch more on the via practical aspect a of spirituality and our objective is to give you practical ways of incorporating spiritual and life skill and interventions in your medical practice and I believe we can better explained by giving examples of real-life stories from our practice in Oakdale all just ideal wood smoke is probably more than any other specialty yacht had a lady who has been coming to our office for her lung problems and she noticed in our waiting room and exam rooms that we have ill health and Bible tracks all over the place and her curiosity made her read some of these tracks and she was convinced that our beliefs are consistent with the Bible and she plainly understood she however was still struggling with tobacco addiction in so doing one of our office visits I'd ask her if I could pray with her for her addiction and she objectively are consented and from that time on just maintained a smoke-free life and I try to pray with and for patients when opportunity arises and it's been my experience that my patients are very appreciative of the Christian doctor who incorporates the spiritual with the physical in fact I have invited her to our Bible studies but since she was about thirty miles away she had just set for Bible studies Bible study guides this is an example of how London is open to spiritual lifestyle intervention of this scenario is not only in the case in our location and Southern locate in southern Oklahoma and a place where there was previously ravenous institution we often encounter preconceived notions of what a younger guy I like however we have found bring change in the receptiveness of our patients over the years as McDonald's in our family matter and I'm headed to share how our whole family is involved in that I don't know Doctor Hansen my wife but I was told that I was pleasantly under so one of the first things we did was to make sure that we had plenty of printed material with spiritual messages available with life picture frames on land examples of the public air in our waiting rooms and all Center examples of Bible verses a short spirit of prophecy quotes so even before their first encounter with my husband they know they will be taking care of my Christian position the time and inspiration tells us that whether the patient is a Christian or not he feels greater security if he knows that his position clear sky at her checkout area as Doctor Nelson had mentioned to we have a rack that we can stop that health and spiritual pocketbooks the design is as free materials and we've noticed pharmaceutical reps are landscape workers employers and of course patients on freezing second comment on your literature there am before we put them all out of our son enjoys putting a sticker on each one with an offer Bible studies and then Witt grounded them together and we ask that the Holy Spirit and God 's angels will minister to each person who picks up these materials God has promised that his Word will not return unto him void in our waiting room and opened the family research library which is a collection of books DVDs and audio CDs Christ said he the light of the world as a people who had been given much lights are medical practices can be beacons of light in our communities and the spread of true life-changing knowledge one afternoon after clinic hours I want to enter waiting room and there was a patient sitting in one of the chairs he was outfitted in black leather and muttered where have handled on the shoulders and looked pretty on my hand is a minor interest cards and I told him about the library had come to open up when he said surprised me yes you are leaving in your library by Don Bassler and he says that is all I listen to on my iPod I'm just grateful that the Lord looks on the heart just judging from his parents I had an unexpected end of the strong spiritual interest so I sent about the richest caveman imagery have in our library when I share this experience with my husband needs on a daily spiritual conversations with injuring his exam visits already so each encounter a hearing you or your family can help the patient is another opportunity to be a witness and can help to lower barriers of spiritual truths after meeting after meeting him I added him and his wife that is seasoned to my prayer list and was thrilled and they both attended the lectures a couple of months later as we chatted afterwards I thought it was very interesting she confided our church is unhappy that we watch the reviewing all the time but we tell our friends we haven't heard anything at the disagrees of the Bible so you can use your office for outreach and spreading the printed word to your patients and other community members Jesus Mister Jones 's real name you can pretty offer first-time day short of breath in fact the first few words that came out of his mouth was I can't breathe help me so needless to say it was an emergency and I needed to admit them to the hospital he was found perhaps there are to reality and pericardial effusion he was also a hundred pounds overweight cardiology consultation was obtained in his condition improved significantly with proper medication and diagnostic and therapeutic and but I discussed with him and his wife lost on hospital the importance of lifestyle changes in combination with traditional medication at first he was reluctant but memories of his grave near-death experience revolutionized banking right away so you understand you know this is southern Oklahoma and I don't know if you've been reading Rick recently but Oklahoma has been consistently and and in the bottom three as far as the overall health in our country he was reluctant until he tried and found out the plant -based diet as palatable as a meat diet but at the same time healthier shortly after my wife gave him samples of yummy food yummy food tasting food during our sample that she can talk about that is and he was hooked and today he has lost about a hundred thousand spent and still fondly jokes about his diet as composed of twigs and acorn the other guys amaze and amuse he's become a spokesperson for us doing our weight loss and cooking seminars and if you want another way to get United Nations letter and let them try something young and helpfully certain samples right in your waiting room my son and I were doing a sponsored link for a long time with his help on this one or two recipes set the table right in our waiting room during clinic time and offer samples along with a printed recipe just to make sure she didn't just make sure you have a jumbo sized sanitizer pump clearly visible for their use and sometimes wear the shirt remained for a sample data entry and no fan of essay that is himself to stand him to write there was a we had an amazing response they love meeting of an important than her know my son is a modified division of my husband that we heard things often like while we never thought something healthy would taste good and I do remember I just mentioned well after after you get a sample of course and the recipes in the part where they can sign up free health newsletter and of course the option of Bible studies and I do remember seeing Mister Jones and the patient has been mentioned checking out after his exam that day and I invited him into the waiting arms of five for example and he grudgingly replied yeah your husband Artie Tonya Hansen and has likely had no choice as you want to start families and you better not try to give me tofu or anything like that even with that shirt on but thankfully we were giving out whole-grain blueberry muffin that banning so little something more familiar and as he sat in the chair munching right in front of me didn't say anything so I just started sharing how my husband and I had gotten interested in health and her journey since that time and I can just see his attitude softening he was much friendlier when he left and then when he came out in the next Congress on the clinic during that time he was bursting with enthusiasm about his newfound lifestyle the resulting weight loss and so each member of your family can play a cooperative role in helping to lower an individual 's prejudice to build their confidence and openness of health seminars would broaden our office for them very well received by our patients and their friends and families you would help cooking classes weight loss seminars smoking cessation classes and special interest held seminars like keeping your brain young and boosting your immune system yoga is an excellent way to build relationship with patients as many will come back for future classes in my check interest in Bible studies as a result we are told in John fifteen five without me you can do nothing but if we are willing to cooperate with God and Hill assistant call labor with him for the precious people brought into our practice were sphere of influence as attending sensations and an artisan help give them ideas on more helpful to see the open of the small natural good start right in our office and this is called Adam 's pantry and not just named after our son but also the first Adam who is given a plant based diet is creator we sell some of our favorite items in price than the smallest possible were even willing to lose money on it since he see it as part of our ministry we felt besides food Christian CDs books DVDs it's very easy to put in a home brochure or an invitation for an upcoming meeting at your church into their bags as we share our families as a product and why we like it it's an opportunity to bond with them and conversations often move from food to other issues patients will share things that they're going through me at the painful loss of a spouse or serious illness that gives you an opportunity to share a word or follow the card in the mail thereby showing kindness and sympathy which helps break down barriers and encourage spiritual openness and arbitration I want to talk about is a would give patient through my fellowship my mentors were in charge of the hyperbaric unit at our hospital so I became interested and would care however I find that many if not the majority of all wound care centers in the United States generally treat patients just from the wound care treatment aspect i.e. enzymatic the breeders collagen dressings or complex silver bladed dressings etc. but rarely approach to patients or the problem from the standpoint of dietary modification and other lifestyle changes Mister Brown again not his real name had been coming to the winter department at a hospital for close to eight years now the same moon I know I wasn't the one involved in his care until June of this year joins diabetic is not compliant he's a smoker is there vascular and so I inherited Mister Brown this complex problem of having this plantar surface wound that was also osteomyelitis which means a bone infection it I believe that the Bert the first verse that deals with wound care in the Bible is in Leviticus Chapter seventeen verse eleven where it says the life of the flesh is in the blood circulating about that you know it's true for every cell in the body without adequate circulation no Oregon can survive and so when I met Mister Brown and he and his wife I told him that the war would heal eventually if you did exactly what I told in addition to doing traditional winter I told that he needed to quit smoking if you need to drink water and water only and eat a plant based diet and I shared that verse in Leviticus without it we dealt with him and I told him that I was to be praying for him but Mister Brown is a very stubborn man and I wondered if he would ever follow my instructions but surprisingly he did is you don't think about it eight years of the same mode not healing you know what what was amazing was within a couple weeks of being off cigarettes and eating a plant based diet and drinking plenty of water it was evident that the circulation had improved because every time I did read the woman it would boost more blood and and I just am about a week ago and it's now about ninety eight percent healed which is even faster than I anticipated this was in June it's now late October and it's ninety eight percent healed and I had anticipated maybe you all maybe a year or so and it would've been better for him anyway as yet been suffering from this four four eight years and so has remarkable healing health suspension notes have confidence and made a Christian doctor but we ought always remember that the purpose of of doing all this is the point him to his maker our God the master healer part of the challenge is identifying which patients have an interest in learning lifestyle principles and how the spiritual openness I put together patient surveying your walking to pick one up from the table appear on this form how spacious is like from classes that I'm interested in attending help topics they'd like to see featured in we also have a section right on their own spiritual interests were patients can sign up for Bible studies we were amazed in just six weeks of using the survey with our patients we had thirty two able indicated they wanted to learn more about different Bible topics or enroll in Bible studies and we receive many health seminar interests we found the best way to use their surveys without a receptionist put one in each chart committees nations and then my husband would haven't personally to the patient in the exam room after he finished the exam before he left the room with instructions for them to fill it out to me that with the receptionist as exciting as it is to get a survey that with Bible study checked off we found that finding the time to follow up on these her interest can be a real challenge you could hire a viable workers some of the pastoral background which we have done in the past however this year we are trying something new how many of you have children in your home of any age anybody here's an idea to get them involved in the follow-up since we homeschool one of our subjects and libel so I thought why not start above correspondence will write out of her home this part of my book on silly drama modern materials and set them up right in our family room and now only getting interested can send out the studies are DVDs within a week as they were sending out her first batch of studies along with a self-addressed envelope for them to send us that he got to be graded my son asked if we had again with the answers we as my family search for certainty losses and as far as I know there is no key but I'm so glad there is it because of the perfect opportunity to think will make a key and together we have done that he is very excited to complete a study and take part in Sunday's lessons all what a blessing to be able to involve your children in ministry on Sabbath afternoons my husband has joined us in sending out some studies so even if you don't homeschool you could make it a family 's out of project if you want some ideas on things the nail on the response to the survey on there are samples of brochures and lessons right here on the table along with some photos of the programs and resources we've shared and you're also welcome to put it pick up a couple of our most popular recipes from sample data and cooking classes here in the book Christian how page five oh three excess and intelligent knowledge of how to treat disease upon hygienic principles will gain the confidence of many who otherwise would not be reached which would be truth in affliction many are humble in spirit and words in favor of the truth spoken to them in tenderness by one who is seeking to alleviate physical sufferings may touch the heart prayer short weighted with tenderest sympathy presenting the sufferings suffering ones in faith the great physician will inspire in them a confidence arrest and trust that will tend to be the health of both soul and body so this afternoon we hope that you been able to glean a you ideas as to how our health message can be shared through resources and programs and how it can serve local and conserve the lower prejudices in the rural returns total munitions I remind you are in this weekend was using my audio verse four amen Adventist medical animals are you would like to learn more about me then please visit www. a manner that I will like there was more free online service please visit www. 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