October Update

Dear friends,

Hurricanes- wow. Our family is relieved to report that we are well and remarkably physically un-ruffled here in Santiago after Hurricanes Irma & Maria passed by. Having just witnessed the devastation in photo and story from Harvey and early accounts of Irma on the more eastern Caribbean islands, the uncertainty of the closeness of the storm paths to our city created a significant sense of stress in the several days leading especially up to Irma. Our own history of water entering our home from more minor rains did not help, along with a real concern about the overall level of emergency preparedness of our DR home.

Irma initiated us, and by Maria, we felt more prepared emotionally and practically. When radar predicted that Irma’s eye would pass near our closest beaches an hour away, the final 48 hours before her visit brought an endless list of small preparatory tasks. Food, drinking water, candles, matches, chlorine, tarps, tubs of water in the bathtubs, and cleaning the ever present trash on our streets from the gutters on our block. Then sand bags (below pic) at both doors, gas for the car and for cooking. God provided throughout, including with 6 bags of avocados from our tree for our church to distribute, equally relieving us of what our North American minds predicted would be green bullets pummeling our windows.09-07-2017_09-050
We urgently questioned each cashier, neighbor and pastor on their level of preparedness for the storm. While everyone was in agreement that people in low lying homes with zinc roofs should leave, only the wealthiest/most educated of our acquaintances seemed to purchase anything extra. Nick became frustrated encouraging people to prep, for the number of shrugs and laughs he received for his concern. The individual lack of preparation felt alarming, though we were thankful that the city was clearing brush and released water from the dam nearby.

On the other hand, we gathered some new clues about resilience in numerous hilarious memes that passed through our Dominican chat feeds throughout both storms. Check out this video of a popular song intoning “Maria, se fue,” if you are up for a good laugh. This humor combined with other forms of top-notch preparation could have been a decent model for how to cope with disaster.
Thankfully, the DR was spared the brunt of both storms. Both brought moderate wind and rain at our house, and power loss for about a day (Pic- play courtesy of the sunlight, with sand bag decor). Because the DR actually schedules power outages weekly already given poor infrastructure, this was an extra pain but not a new stressor to acquaint ourselves with. Maria brought more rain, and even broke a retaining wall on our block, pushing a foot of water continuously through our neighbor’s house into the already flooded street. Maria collapsed several bridges in our city, and certainly, the expected unequally heavy burden on those living in the low lying areas where no one willingly chooses to dwell did occur, and assistance is needed. Several Nazarene families in other cities sadly lost their homes. As a whole however, our island is overwhelmingly grateful and well compared to our Caribbean neighbors.

Our church leaders still cannot make contact with several churches in Puerto Rico, and your prayers and support for the region are requested. Certainly being an island significantly complicates aide. Pray for ease of legal and physical access so that neighboring countries like ours can easily help, and for the lifting of communication, gas and infrastructure barriers that are keeping for example some of our pastors from visiting their own churches and from reaching one another to coordinate and receive aide that is/could be arriving at the ports. Here is one very damaged Nazarene church (Cataño), and we’re glad to report that our denomination has gotten food, water and some supplies through as well as funds this week. Pray for wisdom and kindness for those coordinating services at all levels, and for the hospitals.
Cataño PR church
Please also pray for some friends in our own neighborhood who were vulnerable even before the storms. David actually showed up at our house in the middle of Maria, swathed in plastic, seeking food for his partner and 1 year old. We were reminded once again of how wealthy we are, that we could easily still hand over a candle and matches, a tarp, food and diapers from our supplies, even as we were supposed to be hoarding for the emergency. Thank you for your partnership that allows us this level of general stability!! Both this family and another migrant worker, Jean-Claude, have become more frequent solicitors of food as they simply cannot find enough gardening work to meet basic needs.

Teaching. Finally, on to non-crisis news. Nick started teaching an orthopedic physical therapy class 3 weeks ago, with a great group of 8 students. They have some very packed days of learning ahead, having lost 10 hours of class with the hurricanes. Yesterday one of their patient’s broke down while reporting the loss of her house in the storm. More news and pictures from teaching next time.

We are grateful. We are able to continue to be active agents in our own family’s wellness and in the health of those around us. What a gift! Mateo turned 1 in August, and wants to precariously scale couches, etc like his brother. We’re so glad that Laurie’s parents will visit in October! We also find ourselves praying, stewing and mourning regularly over international news of hateful speech and threats of war that feel thick and enveloping in a way our own US generation may not have experienced previously. Let us be firm in prayer and find ever new and additional ways to act in love collectively, dear ones!! Sending our love and care today.
Peace to you!

Posted in News

August 2017 – Mentorship and Mangoes


August Greetings-

Mangoes as big as Mateo’s head are swelling on one of our backyard trees. On another, avocados dangle low like pairs of jade earrings from a well-seasoned ear. We are in an amazing fruit season here in Santiago, and Nick can even glean a few passion fruit, cherries and avocados from his trail runs. Our fruit glut is tempered by the cowering effect of the heat, which pushes us into careful file behind other pedestrians walking gingerly along thin, street light shadows while out and about. The water runs warm at our kitchen sink lately, where we don’t typically have hot water. Summer is here.

After much study, Nick, Denise and Pamela were able to deliver a continuing education course for therapists in the region. This was the culminating event of his mentoring time at their clinic. Nick was satisfied to experience the hoped for higher level of dedication to learning the material that occurred even in the week before the event, when the eustress of presenting for peers clicked into gear and heavy practice and good questions emerged during prep time. We thank God for these opportunities!



Fall ministry came into focus after an extended meeting with the physical therapy department chair at PUCMM University. Amid hashing out visions of international university partnerships, advocacy and continuing education efforts emerged the news that she will pursue a doctorate in physical therapy from the U.S. next year. We pray this exciting dream will come to fruition, as it will be the first Dominican therapist with this level of education not only at our university, but as far as we know in the DR. Nick was also scheduled to teach his usual orthopedic clinical rotation for the fall with 8-9 students, and has started preparations.

Family Life
07-16-2017_14-46_0839_1-e1502205287962.jpgAt 11 months, Mateo walks while flashing a 6-toothed grin! We’re grateful to have rediscovered a river about 15 minutes from home that is now perfect for our current explorers, and nice and shady to boot. We scrambled through our first 5k as a family last month.  Daniel has nicknamed Mateo, “Matato.” and Daniel is called “Baba” for now. Lastly, some of our missionary friends returned from an extended spell away, and we’re grateful to return to a weekly preschool which also provides encouraging friendships.

Thanks be to God for continued health and direction in this Dominican life.Thanks for your continued support and your own news! Love & Peace to you,

Nick, Laurie, Daniel & Mateo











Posted in Dominican Republic, Med Send, Nazarene, News, Physical Therapist, Physical Therapy, Republica Dominicana, Santiago

June 2017 – Clinic mentorship and success with potty-training

Happy June!

We hope this note finds you thriving despite the heat in your various homes across the US. Mateo sleeps in the one air conditioned room of our house, so we are beginning to get creative with fans, mid-day showers and a blow up pool so we don’t melt away in the humid Caribbean heat!

May marks 6 years in the DR, and as I write this, it seems harder to notice unique cultural and ministry things to share with you readers. Not, apparently, because they aren’t occurring, evidenced by the voice that just rose over the tin of the kids, shouting, “Run, run woman neighbor! Fresh chickens! We chop its head and pluck its feathers right before your eyes! Don’t miss out! Hurry, hurry veciiiinaaa!” We must finally be growing more accustomed to our adopted home.

Nick’s clinic mentorship continues to go well. We’re paring down in-clinic training hours and rolling the relationship into what we hope will be ongoing as-needed mentorship support over time. Nick, Pamela and Denise are gearing up to give a continuing education class on the clinical reasoning and evidence based techniques they have been reviewing. Though medical professions in the US are required to take continuing education courses to maintain licensure to practice, Dominican professionals are not, so we’ve encouraged these opportunities wherever possible. Collaborating on a presentation cross-culturally can be much more work than simply teaching it solo. In this case it means extra communication to bridge gaps in knowledge and bring in evidence that is thus far only readily available in English. But as always, the aim is the long term impact- the formation of therapists that can not only provide quality care, but teach others in the future.We’re hoping that these two therapists may make a good team to support in providing more continuing education courses in Santiago over time.

Spring typically provides an outcropping of one-time ministry tasks related to US short term teams in town. We’ve enjoyed the opportunity to interact with and orient physical therapy teams from two universities, and got to collaborate with another class via Skype this week.  Pray as we transition into summer and a new school session- Nick meets with the PUCMM University PT program director this week to discern the best direction of his efforts for the rest of the year.

After a month or two of toilet paper, poop and pee everywhere, Daniel is mostly accident free and in underwear during the day! He seems raring to go with various learning tasks, and we feel challenged to keep up while Mateo keeps our hands full. Daniel has funny sayings related to his bilingualism, like insisting that he “touches” his toy piano, because you “tocar el piano” in Spanish, not “play” it. Mateo is a sweet 10 months old next week, and wants to spend most of his day walking around with one hand held. They remind us hourly that taking turns and sharing toys promises to be the life-long challenge that most of us still struggle with, in one form or another.

Thanks so much for the various ways you sustain and keep up with us – notes, prayers and donations! We continue to appreciate your friendship and news so much. Sending love, gratitude and God’s peace,
Nick, Laurie, Daniel & Mateo

Posted in News

March 2017 – Developments in the Clinic & Family


This March finds us in a new clinic partnership, where Nick is keen on supporting recent advances in physical therapy education as they roll into patient care practices in the clinic.

Thank you for your prayers for a clinical partnership ripe for implementing change. Working with Denise and Pamela has been super encouraging thus far! These therapists opened their own clinic 2 years ago, after struggling for the freedom to provide patient care at the quality they wished. If you can believe it, they’ve gone up until this December without paychecks (living with parents, etc.), trying to get it off the ground. It is one of only a few therapist-owned clinics in our city.

Now they are able to give 1:1 patient care, whereas at some clinics, therapists might regularly juggle 2-4 patients at once!  After some time working on PT development, we can see how attending multiple patients at once not only contributes to poor patient care, but doesn’t allow the therapist to improve in the clinical skills that the community needs. At their own clinic, Denise and Pamela have been able to initiate therapy evaluations- where they can contribute their clinical judgement on a patient’s care, vs follow often generalized and non-specific protocols from referral sources.

140e77e7-0547-4f74-98b8-bac46625e4deSince Nick started collaborating last month, the therapists began daily treatment notes. Any health care provider reading this knows how tedious documentation is- but imagine not writing down what you did with a patient during the visit, and how that would affect your ability to progress their care, or track if what you were doing was working. They’ve also spent time learning functional outcome measures and orthopedic special tests, which help distinguish the source of orthopedic related pain. Therapists here learn a small amount of evaluation skills in school. But for a variety of complex reasons, few are actually able to develop the skill of forming a professional opinion on a patient’s condition, let alone share it with the health care team, or act upon their judgement in the clinic. Patients’ health suffers for it. Pray that this slow process of learning clinical reasoning skills would really blossom in Denise and Pamela. Their dedication to extra reading and ability to demonstrate new knowledge during patient care has thus far been outstanding! Both therapists are the newest adjunct faculty in the PT department here, so we’re hopeful that supporting them will translate into much more than even their own patients’ improvements.

Inner Workings of Development
As our ministry partners, reflect with us for a moment about how we engaged in this new ministry move– What does it mean that we try our best to follow development principles in our work? Right now, it looks like Nick offering to provide consultation to this clinic for a nominal fee of  ~$125 for a month of individualized training and recommendations. We hoped this would ensure that the therapists were interested and engaged in the teaching, since they have a clear financial stake in it. We actually started out requesting ~$210 for the month- a good deal for a Dominican therapist’s time. After hearing of the financial hardship of the clinic, we reduced the price and bartered a requirement for the therapists to provide a continuing education course on what they learned to their colleagues. This turned out to be a better plan than just payment! The discussion also allowed for conversation around the concept that we are here in the country as missionaries, under the reality that God calls us to love our neighbor with our time and money, not just make as much as we can for ourselves.

Finally, Nick pitched the idea with a “consultation services” agreement, giving them a variety of training options they could alter and choose from, further allowing therapists to own and engage in the process. This particular clinic represents a miraculous combination of therapist willingness and a setting where the therapists themselves have the administrative ability to make the changes they wish to see. We’re not sure if this model could be as successful in another clinic, bogged down by administrative restrictions. Thanks be to God for this opportunity!

God’s Provision
Once again, God has provided through you for another year of ministry in the DR. Thank you so very much to the many faithful and several new financial partners in this work. You are a great blessing to us as you pray and support, allowing us to lean into what God has for us to do here in the DR. Thank you, thank you, for your love and sacrifice.

Family Notes
This last month has been an icky one with illness and sleep. Mateo had his first fever. This would have probably been an urgent care or weekend office hours visit in the US, but, none of those are available here, and protocols for some of the mosquito borne illnesses require blood work with a timing that entailed a Saturday ER visit. The only lingering effect has been a return to sleep patterns of waking every 1-2 hours at night… Ooff! Following this, a few of us were hit by a vomiting bug last week. Please pray for health for our family. We could definitely use some more sleep, personal and marriage time- if that is a thing anywhere in the world for parents of young children:). We are focusing on the discipline of gratitude to get us through!

Mateo is sitting and furniture standing now at 7 months, with tons of smiles, except for the camera. Laurie turns 36, Daniel 3, and our marriage turned 8 within a month’s time! It has been great fun to listen to Daniel’s Spanish take off, and less than great fun learning to take turns with toys:). We recently enjoyed a fantastic day on Mateo’s first (and successful) trip to the beach.

We continue to pray for you as well as our US country of origin. May God give us wisdom and strength to engage with our neighbors in love, wherever we find ourselves in the world. Sending our love- Happy March to you!

Nick, Laurie, Daniel & Mateo

Posted in Dominican Republic, Med Send, Nazarene, News, Physical Therapist, Physical Therapy, Republica Dominicana, Santiago

December 2016 – Possessional Burdens and Evolving Ministry


Dear friends and partners,

In our Catholic Worker circles from the Midwestern US, a true and delightful story popularly surfaced. It is hope for this Advent season, and a good antidote to the pulls of consumerism. It goes something like this.

One Friday evening, the local priest called Tom up, saying that a man had showed up at church needing a place to stay, and well, what should we do. Tom was the person at church who everyone knew they could count on to respond to “that kind of stranger,” at any kind of time. But Tom already had plans that night. He looked around his apartment. He thought about his good plans. He got up, and said aloud, “Good bye, T.V. Good bye, dresser. Good bye, coffee maker. Good bye, painting.” He called the priest back and said, “Bring our friend over. I’ll be out tonight, but he’s welcome to stay.” And stay he did.

d7649f07-181d-43ed-972e-81a4ed9648fbAfter acclimating the fellow to the extra bed and showing him how to work the TV, Tom invited him to the food in the fridge. “I’ll be out for the evening, so make yourself at home!” When Tom crossed the threshold of his front door, he was struck by an intense sense of freedom, as if a huge weight had been hoisted from his shoulders. He realized for the first time the control his stuff had over him. With the help of a stranger to give Tom proper perspective on his stuff, a hint of the freedom Jesus refers to in scriptures burst in.

Reflection & Challenge
Similar to a “the kingdom of God is like…” parable, Tom’s story likewise evokes both warmth and challenge. What a life-giving way to live, for both the stranger and for Tom! Could I let go of my possessions that courageously? How can I continue to release my grip on my stuff?

Now 5.5 years into international living, we see even more layers to this story, and they point to our responsibilities and connection to the stranger worldwide. Notice the basic safety in Tom’s home that is available to offer. Then there is the stuff that must be owned in order to be given up- an extra bed! We also remember the relative ease of acquiring or replacing stuff that accompanied our life in the US, where there is excess to spare. If we gave away our stuff, or if it was stolen from us… a replacement grill, dresser, or chair (in my experiences) might even be thrown out on a curb to pick up, or you could buy that still nice TV at a thrift store. At worst, for likely many of us reading this newsletter, we wait or save up until Christmas for the stuff we want or need.

Comparing this story to our Dominican friends, we think of Leidi (remember her?). She still manages to give joyfully in ministry, after giving in much less empowering ways during the numerous break-ins her peep-holed, wooden and tin roof home endures in the dense city. Then there is the far worse instability that folks like those in Aleppo and elsewhere face. Inequality in access to stuff and safety is all too easily found, both within in the US and outside of it.


Nick recently discovered one funny example of being mindful of one’s neighbor here – share your toilet seat!


Let’s be mindful together of the complexity of our U.S. privilege this season: the relative power we have to own stuff, our overall state of safety, and then the undesirable power stuff can hold over us.Then let’s celebrate Jesus’ birth together by investing courageously in neighbors both near and far away. Jesus was so wise in leading us strangers to each other, knowing that we each have life-giving lessons to offer the other.


Annual Appeal: Partner with Us!
We encourage you to join us for another year of health development ministry in the Dominican Republic! You friends, aunts, PTs, teachers, electricians and nurses are the fuel keeping our ministry running. Thank you for your great faithfulness. In addition to the monthly support many of you send, we need $7,800 for 2017.


Will you join with us in prayer and tax-deductible giving?
Click HERE to donate!


6b028cbe-8126-465a-866d-f584963131c9Prayer & Focus
Next year we hope to shift some ministry time from theory at the university to physical therapy practice in the clinic. Pray with us as we continue to discern the best place to use our time:

*The PT curriculum updates we collaborated on continues to roll out this year, and there is plenty to do still at the university (PT student leadership + program director, top).

*Assuring sustainability through local partnerships: pray for new, engaged therapists to partner with in Santiago clinics! Key to the success of advances in curriculum is the receptiveness of hospital and clinic staff and administration to putting it into practice in patient care.

*Our family: With the addition of Mateo, and two still in diapers, pray we would settle into satisfying family rhythms. Pray that our variety of needs would be met. We’re thankful for how we have already settled in!

We’ll continue to pray for you- for your own needs, and in thanks for the many ways God brings hope in our world through your lives. Thanks for your partnership- we’re grateful for you! Love and Peace,

Nick, Laurie, Daniel & Mateo



Posted in Dominican Republic, Med Send, Nazarene, News, Physical Therapist, Physical Therapy, Republica Dominicana, Santiago | Tagged , , , , , , , , , , , , , ,

November 2016 – U.S. stay and immigration update


Dear friends and partners,

Finding our DR Footing Again
The humidity punched back as we left the air-conditioned airport, arriving home to the Dominican Republic a few weeks ago. Power outages, mosquito nets, old car troubles, and motorcycles with rear ending habits have tugged us backward since our arrival, but our own bed, the embrace of Spanish praise songs and church folks, and neighborhood boys who still remember the way to our door propel us forward.

We are still in the throes of newborn baby rhythms, all familiar yet unique this second time around. “Barnacle” is one of 3 month old Mateo’s nicknames during this happy-when-held phase of snuggly coexistence. We are grateful to be home, and blessed with the returning wherewithal to write you an update again. We apologize- it’s been too long.

If your memory needs jarring, Zika arrived in the DR in the middle of our first trimester of pregnancy, and our Nazarene missionary board whisked us back to the states within 2 weeks. It took another 2 months to hear results that we were clear of Zika (!). Thank you for your prayers, understanding and support during that weird and vulnerable time. Nick’s parents opened their home in Omaha, NE, followed by a stay with Laurie’s family in CA, where Mateo was born in August. After some struggle with Mateo’s visa, we made it back to the DR in October. What would have been about 3 months of already anticipated US “home” assignment, Zika and parental leave turned into 7.



Presenting research at Inmed’s Exploring Medical Missions conference in Kansas City

And Catch Up: US Highlights
In Omaha we enjoyed reconnecting and collaborating with our friends and colleagues at Creighton University, who also work in the DR. In May, we did a poster presentation at a medical mission’s conference on research we completed early in our time in the DR, and finally finished a research paper on the same. We offer you the runners up prize in the “Research and Innovation” category as a hopeful sign that this work you partner in receives some quality reviewing, for which we’re grateful. Nick’s sister also married in May! We then spent time fulfilling our own professional continuing education requirements, giving talks and reconnecting with you, the many church, friend and family cohorts who make our Dominican health development ministry possible. We were happy to be able to see many of you!


Privileged Immigrants
“[God] defends the cause of the fatherless and the widow, and loves the foreigner residing among you, giving them food and clothing. And you are to love those who are foreigners, for you yourselves were foreigners in Egypt.” (Deut. 10: 18-19)

We spent many immigration-friendshours working through immigration issues these last months. As you US readers navigate post-election decisions on immigration, and as we ponder with you how to love foreigners together, we offer you some details from our experiences as food for thought.

We have felt the effects of our relationship with a less developed country, in addition to experiencing basic human vulnerabilities this year. Zika may not have provoked a sudden move for this pregnant woman had we been in a more developed country, where window screens are the norm and public policies educate and fumigate against the spread of disease. We were very privileged to afford to leave suddenly. We knew when we left that our temporary residency status would expire while we were gone, but the immigration department had no advice for preventing what we knew could be a problem upon returning.

While in the US, Dominican elections occurred, which always results in comprehensive new appointments in government jobs (even more extensively than what occurs in the US). This caused a doubling of the processing time for Mateo’s first-time visa (applicants must apply from their home country), during which the rest of our visas expired (can only be renewed from within the DR)(Ugh!!). The unofficial (government employee) advice was to go ahead and return to the DR with a tourist visa, and seek an exemption given the circumstances, or leave the country shortly again to obtain the required passport stamp for residency.

After this season of relocation, our family with young-uns was not excited about this prospect. Last week we traveled to Santo Domingo and renewed the rest of our visas but were denied the exemption. However, we were advised to just go ahead and remain in the country without Mateo’s visa until our next natural departure, on the premise that the Dominican government would not split up a family, and would understand the circumstances. To be honest, if we were not of privileged, desirable US origin, (if for example, we held Haitian passports), we would have not felt as relatively safe as we do to follow this advice, knowing we will not be racially profiled as others are in deportation raids.

Beyond thanking you for your prayers for this (somewhat) resolved visa crisis, we relay the details in an effort to raise awareness of the complexity that is many an immigrant’s context. We are confident that our story drastically pales in comparison to the complexity and difficulty of most immigrants today, though it does reflect the influence of public health, economy, race and politics on individuals and migration patterns. We ask your prayers for continued government graces with our visa status, and that all immigrants would receive a welcome, respectful of the challenges often causing their flight.


Sharing with Pasadena Mennonite Church

Thank you for sticking with us in our many transitions this year. A special thanks to Pasadena Mennonite Church (below), for their extensive hospitality to us visitors surrounding Mateo’s birth. Please pray for discernment as we refocus our ministry plans with fresh eyes after some time away. Also, please consider joining us in this work in prayer or financial support. Stay tuned next week for our annual appeal, and for an encouraging story to counter the consumerism pulls that tend to hit hard heading into Christmas. Happy Advent to all!

Nick, Laurie, Daniel & Mateo


Posted in Dominican Republic, Med Send, Nazarene, News, Physical Therapist, Physical Therapy, Republica Dominicana, Santiago | Tagged , , , , , ,

Christmas 2015


Merry Christmas from the Kietzman-Greers!


Physical therapy professors at Christmas party

We write with a mix of sad and glad tidings this Christmas! We’ve had a lot of fun these last few weeks with a university Christmas party, a wedding, and presents and dinner at our church’s child sponsorship ministry. But, the Grinch also tried to steal Christmas this year at our house!
We first had a wonderful two nights up in the “campo” rural mountains with two families. We were especially glad to spend Christmas there this year as one of the dads passed away recently. Happily, we survived a day of unrefridgerated pig roast leftovers (not enough electricity there to support fridges)!

Upon returning home on the 26th, we found that the entire set of bars on Daniel’s window had been chiseled out of the cement wall. Someone had entered and stolen a laptop and money from a recently cashed university paycheck and emergency funds, among other smaller things. At first I (Laurie) felt mostly peaceful that at least we didn’t have a ton of stuff worth stealing, and thankful that this didn’t occur while we were home, as it has with others we know. Later that night though, the feelings of our personal space being violated, and the realities of cleaning up, replacing things, and realizing we need to be wiser to prevent this in the future set in. Nick hardly slept. By today, we are regaining a sense of normalcy in our home.

Thanks for listening and praying. We would much rather have shared what we have with these folks in ways that were more life-giving to us both. May this renew our urgency to live lives faithful to the scriptures together, loving, serving and sharing what we have with one another, so that stealing may never feel like anyone’s only recourse.

Finally, this robbery has added around $1,800 to the $6,500 remaining in our budget needs for next year. If you have ever considered giving to health development work in the Dominican Republic, your partnership is especially welcomed and appreciated this year. Peace and Joy be with you this season!


Posted in Dominican Republic, Nazarene, Physical Therapist, Physical Therapy, Republica Dominicana, Santiago

2015 Annual Report & Appeal

Nick's PT students

Dear U.S. partners,

“Ernesto” is a teacher being treated by Nick and his students. He had shoulder surgery after years of chronic shoulder pain and no access to therapy. After surgery, he was unfortunately not referred to rehab for 5 months. He then had to move 2 hours from home to find treatment, and is now clocking 8 months of recovery time during which he hasn’t been able to teach. By the time Nick’s students took over his care 2wks ago, he could once again hardly move his shoulder. Lack of regulation in education and no licensure or continuing education requirements for physical therapists means that the quality of the care he receives has varied widely between therapists. Just this week, Nick and his students were approached by a coach requesting that only they provide therapy for his baseball player, after seeing improvements following just a few days under their care. Real changes in the quality of therapy are needed.

In many developing countries, rehabilitation is the last leg of health care services to appear. Perhaps survival of an accident or illness is now possible, but without adequate rehab, some individuals may never walk, return to work or provide for their families as they previously could. Countries that have been able to develop rehab programs may find that professionals leave for better lives elsewhere after graduation. This reality boils down to Ernesto’s real life challenge of accessing quality care, and a real financial loss for his family. Pray that God’s kingdom would come on earth as it is in heaven, in our tiny segment of it promoting health and healing in the DR.

Support health development in the Dominican Republic here

Evolving Ministry
What started 4 years ago with an exploratory needs and assets study turned PT students: journal clubinto a commitment to the local University’s physical therapy department. God provided a willing team of Dominican therapists to revise the program’s curriculum during our first two years here, obtain approval from the deans last year, and go live this coming school term. We are so excited to see this implemented, after 10+ years of stagnant curriculum with some very important topics missing! Thanks be to God for opening hearts to change and growth, and allowing for the amazing local partnerships that are so important for development to endure. Positive relationships have also allowed us to provide faculty continuing education, teach student courses and support growth of a professional organization during the last 3 years. Please pray specifically that PT professors will continue to have time and energy to acquire the new knowledge necessary to put the changes into practice, and that they would see the love of God in our labors.

Finally, pray for discernment in our continued support of the local and regional Nazarene church. Over the years this has included projects like weekly teaching at a local child sponsorship program, treating church and community members, and writing a discernment tool for where to plant churches.

Thinking of you
This December marks 4.5 years of health development work here in the Dominican Republic! In May we were asked to give our testimony at a Nazarene church in the capital, and realized that our testimony is bound up in yours.That’s right- we talked about you! You are pastors, health care servants, missionaries, international peace-keepers, prayer warriors, protesters and sacrificial givers of all kinds who have taught us what it means to love and serve the Lord. Thanks for your witness to us! And thanks for continuing to support us with your friendship, finances and prayers.

 Money as Blessing: 2016
As you may be aware, we are funded almost completely by your gifts as families and individuals. In case you are wondering, part-time teaching activities brought in $3,500 this year. We are full of gratitude for your sustaining support!

Given ongoing donations from a faithful team of monthly supporters, we need to raise an additional $14,000 of tax deductible support for 2016.  Will you partner with us?  5 donors at $25/mo, 7 donors at $50/mo, plus 7 donors at $100/mo could cover the need. Any level of support is welcome, as 1/3 of our budget still comes from single gifts from old and new partners throughout the year. While raising support is challenging at times, it allows us to continue serving, teaches us openness and trust, and concretely connects us to you. Thanks be to God!

 The Home Front
We are close to having a 2 year old in our family, and the mix of exhaustion and joy that Daniel brings has doubled our laughter. Raising Daniel is indeed the most prolonged, intense lesson in patience and being present in the moment that we have yet to experience.Thanks so very much for journeying with our family with your multi-faceted support!

What a good God we serve, and what good company we have serving with you. Love,

Family Pic 2015


Nick, Laurie & Daniel Kietzman-Greer

Posted in Dominican Republic, Med Send, Nazarene, News, Physical Therapist, Republica Dominicana, Santiago | Tagged , , , , , , , , , ,

October 2015 – Update: Compassion

Nick's PT students presenting during a clinical rotation

Nick’s PT students presenting during a clinical rotation

Greetings to you this fall! This week we found a real pumpkin at the store (!), so are feeling a bit of U.S. culture in what is otherwise a holiday-sparse Halloween and Thanksgiving season in the DR. We hope this finds you well, thanks-giving and costuming here shortly.

Prayers for discernment
Ministry life continues to evolve uniquely each season. We frequently make choices about whether to engage in new partnerships, committees, projects or teaching. This week it was choosing to respond to requests for money for a wedding, oil for a meal, string to fix something, and petitions on 4 different days from a man whose fruit stand we frequent, whose business is failing with rising food prices. Please pray that our ministry discernment would always stem from compassionate wisdom.

Compassion: Lesson, prayer and practice
In “The Way of the Heart,” Henri Nouwen calls us to compassion with the following story from ancient church history, from monks called the “desert fathers” who lived in solitude. Nouwen writes, “Much of our ministry is limited by the snares of our own judgments. We classify people as very good, good, neutral, bad, and very bad… Those whom we consider lazy, indifferent, hostile or obnoxious we treat as such… These self-created limits prevent us from being available to people and shrivel up our compassion. ‘Do not judge and you will not be judged yourselves’ is a word from Jesus that is indeed very hard to live up to. But it contains the secret of compassionate ministry.”

“A brother… committed a fault. A council was called to which Abba Moses was invited, but he refused to go to it. Then the priest sent someone to say to him, ‘Come, for everyone is waiting for you.’ So he got up and went. He took a leaking jug, filled it with water, and carried it with him. The others came out to meet him and said to him, ‘What is this, Father?’ The old man said to them, ‘My sins run out behind me, and I do not see them, and today I am coming to judge the error of another.’ When they heard that they said no more to the brother but forgave him.”20150827_080954

We continue to discern how to engage well with our young friends Simon and David, who are still not attending school. After several weeks of rejoicing with us that they were in school, we learned that they indeed had still been refused admittance for lack of documents. Perhaps the boys made up this story because they felt bad they had nothing better to report. Their dad confirmed both financial and legal challenges, in part complicated by their late-mom’s Haitian background.

Human lives are complicated, and we trust God to infuse us with compassion to direct our time and energies well. Aside from these service perspectives, we recognize that sometimes being kind can be easier to strangers than to the people in our own homes. In this too, we pray for daily graces for us all!

Physical therapy education
Nick is heavily involved in teaching students this semester (his students presenting, above). Many excellent chances to guide important content in clinical education have popped up, making this term fuller than anticipated. Pray for energy for Nick to take advantage of key health development moments and make it till Christmas!


Family Life
Nick turned 34 October 20teditedh! Daniel continues to grow his dancing and speaking skills, and is learning to assert himself effectively at 18mos. We are amazed at our ever intensifying love for him! Sadly, we also must report the death of René Acosta, our supervisor and national ministry director, as well as the passing of Antonio, who was Nick’s campo dad back in 2004 during his first DR trip. Here we climb to visit Antonio and his grand kids, past the roads where our car can chug. Thank you for being with us in spirit, financial support and prayer, in all of these DR life events!


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July 2015 – Immigration Reform & 4 years in the DR

2015 July Update

PT department 2015

PT Teacher Appreciation Dinner

Every week, Nick runs past a group of early morning worshipers singing hymns in Creole at an open air church. There were about 30 faithful congregants, that is, until this month when the group dwindled to about 10. Last week, a lone man remained, lifting his voice to the Lord from behind the pulpit.

Immigration Reform continues here in the DR, and several have asked about the reality on the ground. The most truthful thing we can say is that it is complicated and difficult.  Global refugee figures are at their highest since WWII, and 1 in every 122 people is either a refugee, internally displaced, or seeking asylum. We are unclear as to which category people being displaced by this law will fall, but the bare bones of the current immigration situation is the following.

In 2013, a Dominican court determined that although the Constitution provides citizenship as a birthright to anyone born in the DR, it would retroactively remove this right from people born between 1929 and 2010 whose parents were undocumented migrants.That means grandparent-aged people are affected (!). We newly understand that there are actually many countries that do not provide citizenship rights simply upon birth in a country (as does the US), so it may be particularly the retroactive piece that is especially harmful and condemned internationally.Many people with Haitian heritage have faced discrimination for decades, but now some find themselves stateless as the law goes into effect, having never set foot in the country to which they will be displaced.

We ourselves spent several months living here illegally 3 years ago. Despite having turned in all of our paperwork in ample time, the date by which we were legally residents was surpassed by the time the government took to process our case. It is hard to imagine then, that the DR could accomplish processing ~260,000 documents within a recent 150 day window granted to help those affected. While we were here illegally, we were not all that worried. We can only assume that the privilege of coming from the US, instead of Haiti, along with the color of our skin were part of why there was very little danger of being deported. Under today’s laws, we still get by without harassment. On Sundays, police officers with rifles routinely stop us on our way to church, but not once have they asked for our documents.

David & SimonMeanwhile, our darker skinned brothers and sisters face intense profiling. Potential consequences to not having documents have for a long time included things like difficulty utilizing health insurance, or obtaining entrance to education at all levels. Hardship varies widely- we know some kids who enter school without papers, and others who are blocked.With the current law, the new reality includes deportation, often without one’s belongings (helpful video). Please keep the DR, Haiti, and displaced people everywhere in your prayers and communications to your politicians.

Health Development
work continues in bursts of project completion during these summer months. Nick continues planning a continuing education conference, Laurie carries on with the University’s research committee, and Nick is preparing to teach again in the fall (PT dept, top pic). We were invited to give our family testimony at a church’s kind celebration of DR missionaries in May, and finished an online training course on “Whole Person Care.” We are super excited that the new physical therapy professional organization (below) is now in a position to begin work on a physical therapy practice act, the support of which was one of our initial ministry goals. The eventual formation of a law binding physical therapists to certain levels of quality and education has the potential to protect the public in many ways, including improving health care. We are praying hard that all parties will come together agreeably to move forward on this document that can affect long term wellness.

Prof meeting 2015
Family life. We celebrated 4 years in the DR with a 3 night vacation in May, hosted by 
Christian Hospitality Network
. We saw for the first time the beaches of the famed eastern side of the island that you all see in commercials- wow! At 15mos, Daniel continues to delight us with smiles, high fives, waving and frequent applauding at any small inspiration. Better sleep at night hasn’t hurt either! Nick completed his 5th ultramarathon (50k) on trails last week. Lastly, “David” & “Simon” (pic above) continue to drop by daily for food, and the hopeful plan is that they will actually attend school in the fall!
Please receive our love and appreciation for your friendship, and our thanks for your own updates as well!  Peace to you!
Nick completing 50k trail race!
Posted in News

April 2015 – Developments in Education & Our Neighborhood

David 2

Happy Easter season! Christ is risen indeed. We thought of you much during this season, missing some of the familiar faith and cultural practices from home. While the gains we made in taking Sabbath rest during Lent were all but lost during a month of intense university paper grading, we are getting back on track again and it is good! Here’s a glimpse at March and April’s varied ministries.

David newlsetter April 2015David & Simon (names changed) continue to pop by our house most days of the week. We are sad to say we have not made any progress wading through the complex situation surrounding getting them to attend school. In the meantime, we are happy to say you are providing many yards of string for trash bag kites, and numerous glasses of milk & crackers. We have also discovered they do not know the alphabet. There are numerous ways we want and feel the need to participate in their lives, and your prayers for their educational, spiritual, emotional, and physical growth are appreciated. David & Simon provoke growth in us as well, as we wrestle with ourselves often to offer them needed connection space at the random times the doorbell chimes.

PUCCM journal club 2015

Journal club

Meetings, conferences, meetings! Both the professional and student physical therapy organizations are reviving themselves, and it is exciting to support them. In 2012, Nick was on the founding committee for an annual rehabilitation conference (OTFOL- for orthotists, occupational, physical and speech therapists), and planning meetings have resumed for the 2016 conference. Creighton University physical therapy is here for their annual one-month rotation, and it was a blessing to lecture on PT in the DR and hang out with other US professionals during their stay. We facilitated a continuing education lecture that allowed Dominican PT faculty to learn peripheral nerve testing and treatments, a useful skill that is scheduled to be taught for the first time in the new 2016 curriculum we continue to labor over.

Laurie w teses papers 1 editEducational development: Here is Laurie with papers in hand after leading a journal club one night. While grading over 600 pages of undergraduate research work, a “development” question continuously came to mind that may interest you many readers working in academia. How much scientific research in how many fields is possible or desirable for smaller or less developed countries to accomplish? Our university really wants to up its emphasis on research, but with very few PhD faculty across departments, and with BA level student-led projects, we are feeling the need to encourage a focus on being good consumers of research vs. trying to produce it at this level. Simply having time in the curriculum to both introduce writing and research fundamentals and catapult each of these skills to the mastery level needed to make research usable on the public level is quite challenging. However, with a very limited number of graduate degrees available in any field in the country, how will the DR (or other countries in similar situations) produce data that is quality enough to be useful locally or globally, as would be ideal? Hmm. #Ponderingsofthemedicalmissionary

Personal notes. Nick’s parents came to visit their 1 year old grandchild for 9 fantastic days. Daniel now loves the beach and water, and will run/fall right into it gleefully if not detained. Laurie turned 34 just prior to Daniel turning one on April 9th. Daniel’s celebration picture shows some of our closest friends from ministry, church and missionary communities. Our friends David & Simon declared for weeks that they were coming to celebrate Daniel’s birthday. How do you suppose an unaccompanied child makes sure that he gets to an ice cream sundae party on time? He walks over an hour early and says- is it time to come yet?? All is well here in the DR, God be praised. Grace and peace to you in your own lives of love and ministry! Abrazos,

Nick, Laurie and Daniel

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February 2015- Immigration & Privilege

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A word from Thomas Merton: “There is a pervasive form of contemporary violence…activism and overwork. The rush and pressure of modern life are a form, perhaps the most common form, of its innate violence. To allow oneself to be carried … Continue reading


2014 Annual Report & Appeal

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Thank You for another year of partnership. Let’s take the long view and revisit some highlights of what we’ve been up to together in the last 3.5 years in the DR in Health, Faith and Community Partnerships. Health: Physical therapy … Continue reading

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November 2014 – Lights On!

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¡Llegó la luz!   This phrase can be heard shouted several times a day by children and shopkeepers alike in the dense, poorer neighborhoods of Santiago. “The lights have arrived!” has indeed proven a significant blessing for our household this month. After 5 … Continue reading

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August 2014: Inequality & Development: A Snapshot

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Dear Friends, A new Subway restaurant and some very bad (30hr/wk) power outages have forced us to reflect yet again on inequality and development in our DR context. The necessity of Gospel actions of mercy & justice easily comes to mind. We’ve seen many small signs of the DR’s … Continue reading


June 2014 – Returning home with Daniel

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Greetings from the Dominican Republic! We’ve made it back home to Santiago and are settling into life here. Immigration After Daniel was born, obtaining immigration paperwork became our avid hobby, and your prayers for a speedy completion of his residency … Continue reading

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March 2014

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Dear partners and friends, Greetings from California! We have arrived and are settling in for our son’s arrival in < 2 weeks! We are quite well and enjoying anew some of the everyday pleasures of the urban US, including: 1. comparably excellent health … Continue reading

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2013 Annual Update

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Thank You for another year of partnership. Together, we have learned much and worked hard! Parish Health Care: Providing physical therapy for pastors, grandpas and moms who can’t afford it, or who don’t have access yet to the quality of … Continue reading

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October 2013 – Vocation and Our Newest Blessing

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Greetings, family and friends!Hope this finds you well and with cooler fall weather.  We write amidst our most busy season in the DR yet! We have each picked up a physical therapy (PT) course at the local university, are in … Continue reading

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August 2013 – Facilitating a reflective church

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Dear friends, Last week, a few shouts quickly churned into a storm of angry voices outside our house. A mob had gathered, and several young men with make-shift wooden clubs searched urgently for another young man. He was enough like … Continue reading

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