I am an MD in SoCal. Earlier this year, I was asked to see an RM referred to me by a colleague who is active member of his ward. There are no internists in this or adjacent stakes, so for internal medicine needs, members have to consult gentile physicians. (there are nearby LDS dermatologists, and one pediatrician and one Ob-Gyn---who must have LDS patients from a 30 mile radius!). My colleague works in ER and is often asked for referrals by members. I do take it as a compliment that he sees fit to refer member friends to me. He knows I know a lot about LDS culture, but he attributes that more to my having lived in Utah for one semester in college than to extensive involvement in an ExMo bulletin board!! The feedback he has been given by member friends was positive.

The RM was not feeling well and had been in the Far East. He was only a few days home from mission, so I suspected they wanted a check up before his church health coverage ran out. I suggested some blood tests (chemistry panel, thyroid, blood count) and some stool parasite tests.

He never got the tests done because he received an invite to go snowboarding in Utah. While there, he fell and fractured a vertebra and had to be hospitalized at Univ of Utah Med Center. They brought him home, but he couldn't function because he could not get adequate pain control (every time you brethe, it causes severe pain if you have a fractured vertebra and squished disk; if you use a binder, you can get collapsed lungs, which did happen). I put him in the hospital and ran the tests I'd ordered a few months back but which the patient had not done.

I found him to be severely anemic (blood count 1/3 lower than normal). The doctors in Utah had assumed he'd lost blood due to the accident, which was reasonable to assume in the beginning, but the fact that a healthy 21 year old had not raised his blood count two weeks later cast doubt on that assumption. I probed further and discovered that his folate level was the lowest I'd ever seen in a living patient, and the first time in my career that I discovered folate as the cause of someone's anemia (I always order it, always comes back normal). B12, thyroid were normal. Iron was very, very low too.

We got the pain under control and added folate and iron to his diet. Parasite screen was negative, however, he recalled having taken an antiparasitic drug given to ALL missionaries in the field before they returned home. he did not know the name of the drug, but his parasite tests were negative. This led me to believe that parasites were common enough for the mission's medical director to routinely treat all missionaries before leaving the field. The possibility that he has some parasite that caused iron loss cannot be ruled out. What I can't figure out is why they didn't treat the missionaries on a routine, PERIODIC basis? Why only just before returning home? (Write your own answer here).

Asking more questions, I learned that for two years he lived on mostly potatoes and cabbage!! No meat, no green vegetables, which explains the low folate and iron levels. I explained to the parents that in this young man's case, he probably did NOT have some disease of malabsorbtion, but rather than he was in a state of partial malnutrition/vitamin deficiency. THe mother had tried to send vitamins to him but usually they were confiscated by customs in Asia. I was sort of amazed that TSCC didn't provide some sort of vitamins to prevent this. Anyway, his counts returned to normal after several months of therapy and his color is good and he's gained some weight (6'4" and like 160 in the hospital, now closer to 200).

One other thing we learned about the church health plan, which did cover him several months after return, probably because they WISELY sought care within a few days of return, and then the church was on the hook until the problem was resolved. You send the claims to an address ("Missionary Medical Plan") at the COB, but they are processed by a major PPO administrator, which I believe was First Health or PHCS (Private Health Care Systems). His initial office visit to me was covered with a $20 copay, but hospital charges were subject to a deductible of $1000. Because my office submitted charges to SLC before the hospital or the orthopaedist did, my entire bill (under $1000) was not payable by the insurance and was marked "patient responsibility".

This also means that his stay at Univ of Utah Med Center probably wasn't covered, because he was there for a week and surely his bills would have exceeded $1000 rather quickly; the only other explanation would be if the church plan DID cover the accident but Univ of Utah was a month behind in its claim submissions, which I think would be unlikely. The most likely explanation is that the accident that landed him at Univ of Utah was NOT covered by church insurance because it was a post-mission accident, not related to or caused by the mission. However, my notes each day in the hospital made careful mention of "malnutrition/folate deficiency/iron deficiency", which WAS mission-related. Although the family had to pay my bill due to deductible, the hospital's bill (presumably much larger) would have met the deductible by a large margin and most likely was paid out by TSCC. It appears that TSCC is self-insured (you send the bill to "Missionary Medical Plan" c/o some address in SLC) and that the PPO administers the plan for TSCC (and gets negotiated discounts within its PPO network).

We have treated missionaries in the office from time to time and usually Missionary Medical pays the entire bill. We were amazed that a $1000 deductible existed for hospital stays. OK, this kid's stay was part accident and part mission-caused illness, but what about a recent RM with a serious mission-acquired illness with NO accident, where the family cannot afford a $1000 deductible?

Wow, makes me wonder if that is why I felt so weak and crappy most of my mission in Japan. My weight got clear down to 140 lbs at one point (I am 6'1"). I can relate to the cabbage and potato diet. We ate mostly rice and cabbage. Not much meat at all. I never felt nourished over there until we broke the rules and starting eating with investigators and members.

Yeah, that's right, in my day it was AGAINST the rules to eat with the members or investigators. I guess that inspiration thingy is kind of fickle.

Long, long time lurker, first time poster. Grew up in a heavily Mormon town, and I'm a great-great-great-(etc) granddaughter of founders (glad we were excommunicated before I got to earth).

My SO didn't grow up with Mormons, doesn't have the family history I do. Apparently, also, where we live now (which is mostly where he grew up), they are FAR less aggressive. I was personally surprised when a group of missionaries moved in a few doors down and they were just nice neighbors, never once stopped by for a chat. Gave one of my dogs a pet when I was walking him (not the best idea, because my chosen dog breed is prone to biting, but their intentions were good and they never were bitten--thankfully). And that was it. That never would have happened where I grew up. The missionaries would have been trying very, very hard to initiate contact. SO didn't understand why, when the subject first came up, the hairs on my arm stood straight up.

Still, though I loathe the religion and everything it stands for, I feel bad for the kids. I told my SO, don't be surprised if you come home to find them being served dinner at our table. Some may decline the offer of a good, home-cooked meal (the only kind of meal we eat here), but some won't. The inner mother in me won't let those young men come to our door without at least offering to feed them, even though I make it clear that I have made my religious choices and won't be changing them. It makes me furious to see those young men having to live like that. Heck, even if they wanted to make a weekly thing of it, I wouldn't mind. I'd rather know they are getting some nutrition, even if I have to provide it.

As a first-time poster. And to acknowledge your generosity!

Aw, no need to thank me. It's just what should be done, if one has the means. If one cannot, of course, that's okay! But I just cannot sit by and do nothing when I have the ability to do something.

I have seen some posts about missionaries in the states who gain weight, but I've honestly never seen that, no matter where I've lived (and I've lived in widely varying environments and regions). I'm sure it does happen; I just haven't seen it yet.

What I often do see are kids who are trying to hide the misery. Their cheekbones are showing. Their eyes are a bit sunken. Their skin is extremely dry. They don't seem comfortable at their current weights, which suggests a recent loss. Plus other minor signs of the early stages of malnutrition. I was born with a medical condition for which vitamin/mineral deficiencies are a common result, so I've had to watch for early signs throughout my life. I guess I just recognize it more quickly with a casual glance. Depresses the hell out of me to see healthy young people go through that. Putting their bodies through this is absolutely needless.

I am, to this day, still tempted to put in an order for the Book of Mormon just so they'll start sending missionaries all the time (they used to do that where I'm from--do they still do that if you order it?). Seriously, whoever comes gets fed! Roast beef and vegetables. :)

what kind of dog is known for biting? i have a chow chow...and a lot of people are afraid of them! and PT,,, this guy was 6'4" and 160??????????? damn i am 6'5" and was at 195 after being admited to the hospital for ... type2.... my Ha1c was 20 at time of admittance...OUCH... people told me i looked like death warmed over.... so at 160lbs..... he would have been blown away by some high winds! wow!! thanks for the story.... oh and i have a pain....nah...just kidding! :)



Edited 1 time(s). Last edit at 12/09/2010 01:26PM by bignevermo.

Missionaries serving in the Russian Far East could not expect to be fed by member families very often. They were too poor and struggling for survival. I don't know the food allowance for that mission, it may have been scaled up or down from the US allowance of $125-130/month to reflect the cost of food in that region. I was given the impression that what he ate was all he could afford. Whether he went hungry, or whether he ate adequate amounts (to fill the stomach of a 6'4" active twenty year-old) of food with poor nutritional value, I don't know.

As a missionary I had to take that same medicine for parasites (at least, I'm assuming it was the same or similar to what this young man you treated took). I don't know what it was called but it was awful. I took it right after I arrived in Brazil. It left a super bitter taste in my mouth for days on end and everything I ate tasted nasty. I lost about 20 pounds the first couple months I was there. I got down to about 52 kilos (not sure the pounds), I've never been so skinny before or since. I always connected the weight loss to that medicine because I didn't have much of an appetite for a long time after taking that stuff. Whatever it was, it was super strong. I also lost weight because we probably walked an average of 6-7 miles a day, maybe more I really don't know it was A LOT. In that same first area I lived in we missed a lot of meals, many of the members who were supposed to feed us didn't have the funds to do so. And our money never seemed to stretch far enough.

A lot of missionaries in my mission (Northeastern brazil) got sick frequently for various reasons. And usually we'd call the MP's wife and she'd tell us to go to the pharmacy and buy penicilin (sp?) or amoxicilin (they're cheap and over the counter in Brazil). That was her solution for almost every ailment. I got a horrible case of gout (at least that's what I think it was) in my foot at the end of my mission. It was super swollen and felt like it was on fire for days, I couldn't walk. I never saw a doctor. She just told me to take amoxicilin and had the elders give me a blessing. It eventually got better but I had walked on it swollen and aching for weeks before I finally stayed off it. Missionaries are brainwashed into thinking that suffering like that is just part of real missionary work, that a good missionary keeps going. I did until I literally couldn't walk on it anymore.

Sounds like you took praziquantal, nasty stuff. It works but makes you pretty sick. Not sure if this is what my patient took, since I don't really know what kinds of parasites are prevalent in the Russian Far East. He didn't complain of major side effects from it, though, so it could have been something milder. I think most of his problems stemmed from malnutrition.

This really upsets me. What do they do with the extra money they've saved by eating below their budget? Had a friend who lived for a year and a half on one bowl of rice a day in S. America on his mission. He also contracted some rare parasite and got lost so much weight he was somewhere around 100lbs. They wouldn't send him home or provide him with any medical care until he collapsed and almost died on his mission. He was totally incapacitated for years after he got back. I am sure his parents had to foot the entire bill for his ongoing treatment.

My understanding is that the missionaries (in the USA) are given about $130/month for food....this was a recent (documented here by numerous parents) decrease from about $145/month, even though the $400/month paid by family remained the same. This was seen as a sign of tough budgetary times at TSCC, possibly worsened by the Billion Dollar Mall in SLC. Many of these parents were sending extra funds or gift cards to their missionaries, though whether their mail is opened at the mission home, who knows. I know some missionaries set up debit card accounts before leaving, so that parents can deposit extra funds to that account if they are running low on food. Poorer families may not have this luxury.

TSCC pays their rent for them. The missionary does not receive the $400 directly. It goes to COB and supposedly eliminates the cost difference between expensive and inexpensive mission areas (the cost is "averaged" across all missions). In a sense, those in low cost areas (Latin America, Africa) are subsiding missionaries in more expensive areas (Japan, Europe, etc.).



Edited 1 time(s). Last edit at 12/08/2010 02:49PM by PtLoma.

Well how much would a bowl of rice cost? A 1lb bag is what.. $0.90 in the US, and probably much cheaper in S. America? Lets be generous and say a bowl of rice in Brazil cost $0.20 a day. I'm sure the church would have budgeted more than $6 a month for food. Where did the extra money go?

It's only a guess with financials that are never released. But what we are told is that all missionary parents pay the same $400/month regardless of local costs to "average" the expenses across all missions. Quite likely, missionaries in low cost areas are subsidizing missionaries in high cost areas. In the old days, missionaries paid differing amounts based on local costs, and the cost difference could be considerable depending on the mission.

There's nothing quite so comforting as seeing the "'Word of God'" being spread to the nations by an organization that's more concerned with their bottom line than the health of their missionaries. My parents attend a Southern Baptist church that believes strongly in missionary work and they have over a million dollars budgeted for missionaries every year. They don't demand payment FROM the missionaries, they twist our arms to give more so that they can give TO the missionaries. And utahmonomore, from the few tbm mishies I've encountered I'd imagine that they'd see this as a lack of faith or discipline. God only knows why.

Are they allowed to spend extra food money on souvenirs? I have no idea how mission finances work, but the three guys I know really well who are RMs all came home with lots of neat things. One who went to Brazil bought a guitar.

It gave me a bit of pleasure to know that the LDS Church at least was on the hook to pay all of this kid's hospital expenses in California (if not in Utah). Because he hadn't completed a medical evaluation BEFORE the accident, the abnormal blood tests in Utah were assumed to be a result of the accident. In retrospect, they probably were abnormal BEFORE the accident, but the chance to document this was lost by his not doing the tests I ordered for him when he first returned, but he felt tired and weak on that first visit.

Maybe eventually the Utah hospital was paid by the church ftoo, but I would have to assume maybe not because the bill for my hospital services was applied toward his deductible----unless Univ of Utah was VERY late submitting its charges, in which case my bill would have been the first charge applied against the $1000 deductible.

His upper middle class family paid the bill and apparently this was not a hardship, but not all families have this kind of dough. Medical expenses are NOT deductible unless they exceed 7% of your gross income in a given year, and then they are only 50% deductible. So a blue collar LDS family whose child is hospitalized shortly after mission for a mission-related problem would be facing a $1000 bill that they cannot deduct on taxes, unless a creative accountant figures out a way to bundle this with the deductible $400/month contribution.

I'd have thought that in Japan, missionaries would be able to afford some fish or other seafood. Perhaps not. This young man's mission was in the Russian Far East (Vladivostok mission) and he said food was scarce even if you had lots of money. He went two years without eating meat or fresh veggies, save for cabbage. Clearly a case of malnutrition. I put him on a high protein/high carb diet with supplemental iron and folate. I see him back later this month (home from college) with repeat blood tests to be sure the anemia and folate issues are resolved. My hope is that he's filled out some. Prior to mission he said he weighed 210, so seeing him at 160 was pitiful. I'm sure there are some overweight elders who can afford to shed some pounds, but at 6'4" he was not overweight before he left for mission. He was an active surfer and snowboarder and so active he couldn't really put on much fat weight.

For parts of my mish I think we definitely weren't eating right. By the end of my two years, I had gained back about 10-15 lbs or so (I expect I was eating a lot better the last 6 months or so). But for a lot of it, we were just eating rice, cabbage, etc. Not much meat actually for a lot of it because of the cost. I really felt like crap for months at a time there...and I never felt full. Eating with members and investigators the last few months gave us a more balanced diet I am sure.

I was in Japan back in the mid to late 70's. We ate ok. Lots of rice and spaghetti. Mugi (cracked wheat) for breakfast. Not much meat though. Oh, and ramen. Lots and lots of ramen. A lot of times it was a prep issue -- don't take a lot of time making good food because it eats into contact time.

I was always skinny in before my mission, but I never gained weight there. When I got back I was still about 130 at 5' 10".

Oh, and we ate as much mimi pan (bread ends) as we could get for free from the bakeries because otherwise it just went to feed the dogs.

I've heard of some stateside missionaries who gain weight on mission, sometimes a lot. Now and then you see feature pieces on BYU athletes (usually football players) who came back from mission overweight and out of shape. It seems that these larger missionaries never get sent to the Russian Far East or other places where they'd starve; they seem to get placed stateside. There is a greater chance of being invited to dinner in the USA, and if one is an elite BYU athlete, such a missionary might become a minor celebrity within the assigned ward, resulting in more dinner invites than average missionaries, thus also benefitting his non-celebrity companion who would also snag an invite.

As far as the ones who return overweight are concerned, either they get lots of dinner invites with piles of food on the table, or else the family is sending them extra covert money, or else they have no cooking skills and only prepare high fat, high carb menus.

Perhaps with the cutback in the food allowance down to $125-130, this is now less common, but DesNews and Mormon News used to run faith-promoting articles about BYU football players coming back from missions all the time, as if this was "news".



Edited 1 time(s). Last edit at 12/08/2010 04:32PM by PtLoma.

Have any mishies thought about getting food stamps? They would each get at least $189.00 or, is that just NOT allowed?

PtLoma, keep in mind too these kids are riding bikes for hours on end every day, requiring even more calories to sustain themselves.

Correct. I don't think they had cars. So their calorie requirements go up even more.

we had to pay ALL our own medical expenses. I was borderline asthmatic and had neck injury from High School football, so I should have been going to the doctor.

But I always waited until I had full blown Bronchitis for about a month before I saw a physician. I suffered a lot not only from the asthma, but from the radiated pain into my shoulder from the neck injury. I had no money allocated for medical expenses.

Now I see the church for what it really is, I get angry that I fell for it so many years and suffered needlessly for a cult that would not provide so much as health care for those providing them with a free "sales" force.

Due to secret financials, no one knows whether the church's direct expenditures for the missionary program (providing transportation to/from field, MTC operation costs) come directly from the church or are funded by the $400/month donation from families. In some lower cost areas of the world, one would think that housing and food cost LESS than what the family is contributing, leaving additional funds to cover airplane tickets and MTC. I would not be surprised if TSCC negotiates airline discounts the way giant corporations do, with Delta being the most likely international carrier given SLC's Delta hub. Delta operates a flight from SLC to Paris each day (integrated with Air France's Paris hub). Many international routes have been dropped in the current economic crisis, yet the SLC-Paris route seems to have done rather well. I wonder how much business Delta gets from TSCC on this route?

Wow, things have changed a bit...

While serving a mission in Canada I chipped my front tooth during a zone conference wrestling fest. When I went to the local mormon dentist who happened to be cleaning the teeth of one of the APs (Assistant to the President), he took one look and said that it gave me character. So I virtually served the remainder of my mission with a badly chipped front tooth.

I can only wonder what it would have been like to have a real health problem.

LOL!!

The ER colleague of mine makes sure they are treated right in the ER if they have an accident or injury. I'm not sure how much he understands about who pays for these services (Missionary Medical Plan is a self-funded plan, so it comes out of church accounts---they don't "buy" insurance, rather they pay a PPO to administer it for them.

For post-ER referrals, there is no LDS base of physicians here, other than in Dermatology, so they have to "go Gentile". About ten years ago, I helped an existing patient avoid a mission at his request, using the medical examination as the reason. Problem was, he was playing Div I-A football on scholarship (east coast school, not the U or Y), so it was hard to get him medically disqualified. He did have asthma and had had some ER visits for flare-ups, but I knew that problem was not enough to disqualify. It might prevent him from being shipped overseas or to a rural area, but he probably would have had to serve stateside in an urban or suburban setting.

The solution came after I found an article online in the DesNews about the medical review committee for the Missionary Program. The article said the members were all LDS physicians (duh), but also mentioned that about half of the physicians completing the ten page medical form for applicants were NOT Mormon, due to geography and members living in low-LDS areas. The article went on to say that the committee concurred with the hometown physician 97% of the time, and that this represented one of the very few instances in which TSCC accepts input from nonmembers (i.e. one of the few situations in which TSCC follows the advice--97% of the time--submitted by nonmember, in this case the hometown doctor of the applicant).

Looking at the application, there was a release of information section that released the info to the Medical Review Committee, but not to the church at large. I.e. it appeared that if info leaked out beyond the review committee, an applicant could sue under the HIPPA privacy law. So I knew what I wrote would not come back to haunt him locally.

I decided the best tactic would be to use the "psychological assessment" section to help him. He was just fine in terms of mental health, very well adjusted. I wrote "the applicant confided to me that he is being pressured into serving by his bishop and local church leaders, with parents being ambivalent. In addition, his college scholarship will be in jeopardy because his college has no provision for scholarship athletes to take a two year leave of absence. This reticence to serve seems to me a major hindrance against successful completion of a mission and almost guarantees failure." I felt that while a bishop or SP would care less about him losing a scholarship (his parents lacked the resources to pay for college), perhaps doctors would understand. Maybe they did.

They bought that (all true, I didn't make anything up to help him)....all you had to do was use "doctor language", and they knew I'd kept a copy of the entire form in his medical records at my office. The only thing he had to deal with was wagging tongues at the local ward, but by then his parents were semi inactive. I think the story went that his asthma was acting up and for that reason the review committee rejected him.

The reason I found this board was all the research I did online to help this guy. I did not understand all the pressure and bullying this guy was subjected to, but once I began to learn about "the meat" (I knew only "the milk" from a semiactive LDS best friend in childhood), I realized what he was up against. I should also mention I've done two or three missionary medical forms for people who DID want to serve, and of course all of them were healthy and were accepted.

I had an abcess tooth in Japan. The branch president made dentures and false teeth for a living. He was not a dentist. He told me he would take care of me for free. He pulled my tooth and made me a fake one.

I was never told that the church had some type of health plan, I just assumed it would have to come out of my pocket or from my parents.

I still have problems with it because it wasn't treated like an abcess where they do the whole root canal thingy and save the tooth.

I suffered majorly over that.

My ex boyfriend is serving in Charlotte, NC. He should be very well fed over there. The only thing I need to worry about is the gators and Baptists chasing after him.

...and you should. Those Baptists will take a leg off.

I'm in Charlotte and will feed him if I see him. Although you don't have to worry to much about the gators....there aren't any here :)

PtLoma, I'm also an MD, and I read your account with interest, as if it were a case record from the New England Journal of Medicine. As is usual in the NEJM, I was expecting to see some rare parasite or disease I never heard about, and I was appalled to learn that it was just malnutrition. How can a US based church let this happen to the people who are working for them like slaves for free?!!?! It's just unbelievable.

Since I started lurking in this board, and learned what these young men and women go through, I've been meaning to offer to feed some of them, even being a nevermo. But now, I may even offer to help some of them if I see a mishie with a sickly look. Our healthcare system here in southern Brazil is pretty decent, but I've never seen any mishies in public or private hospitals or clinics. I wonder what kind of health insurance they have here, and if they are fully insured. Since my parents live right next to a mission house, I'll try to inquire our nice neighbor the MP over Christmas break, and report back.