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Monday, June 30, 2008


Scott and Luke headed out under the crescent of a waning dawn-tinged moon this morning for Kampala with Kim, Nick, Jesse, Katie and Michael.  Unfortunately, they had to go in a vehicle with the hood held on by a bungee cord and hourly bolt-tightening checks to make sure one of the loose wheels does not fall off.  That’s because this vehicle is MORE reliable than the one that nearly subverted my trip last week:  after much work, Michael and Scott prepared it for a test run last night, but it overheated without ever leaving our driveway.  And that’s because they had to leave me the MOST reliable of the three, our truck, which had three flat tires within the last 24 hours but still beats out the other choices.

The group is heading to Mundri, Sudan, where the Massos hope to establish a WHM team presence by the end of this year.  And the unsettled, edgy feeling I have today reminds me of that the team will not just materialize, there is cost involved. All three Masso children are moderately ill, not a great way to be left with a single parent, one with the first really significant asthma attack of her life.  As soon as they pulled out Jack, who had had a better weekend, began to spiral downward, and only went to school by faith, pocketing a verse from Psalm 23 to read and memorize when he felt the waves of sadness coming.  CSB was attacked by theft on Friday, someone breaking two padlocked doors and getting into a safe, someone who was incredibly lucky and brave or who knew just what they were doing.  So a school already in debt, already struggling, now losing another couple of thousand dollars. Our RDC is mobilizing people to awareness in case the anti-LRA increased pressure by MONUC in Congo sends any rebels our way (no real threat, just being cautious, but not the kind of thing one wants to hear).  Some of the UNICEF milk is now expired and patients showed me maggots in their packages today, just as the nurses I sent for training to Mulago called to say that in spite of my visit and verbal affirmations from Kampala that it would be fine, now that they are there the Mulago staff are expecting to be paid “something” to allow these two nurses, their own Ministry of Health colleagues, to observe and learn.  Aren’t we all trying to help starving children here?  Just to remind us of that reality, the latest admission, a 15 month old boy, severe malnutrition (6 kg--of which a fair amount is edema) Owera came in with his burning fever, listless gaze, scabby skin.   His father died with AIDS last year, and his mother finally gave up on the meager slow help she was getting elsewhere and came to Nyahuka to try and save his life.  And I hope hers, while we’re at it.  My patience wears thin and I was not so pleasant to two men asking for money and medicine, stopping me in the hot sun as I huff back home on my bike.  I feel overwhelmed already, and my guys have only been gone six hours.  In short, it is a morning that screams, “the world is not right”.  

But we head out on a wobbly wheel, believing that the Kingdom is still coming.  Needing prayer for our hearts mostly:  that hours and days of boxing with the devil, of pleading phone calls, of sympathetic listening, of weary prayers, of plain old sweaty gritting it out, will see the results.  That the cost will not prove more dear than the beauty to be revealed, in Nyahuka, in Mundri, in us.

Saturday, June 28, 2008

Shooting Dogs

In the midst of being tossed about  in the sea of life’s sorrows here (see post below) we do still have our dear interns, and one of the ways we generate awareness and discussion of African issues is to watch a few movies after team meeting on Thursday nights.  One of the best:  Shooting Dogs (2005), set during the first tragic days of the Rwandan genocide in April 1994.  This movie got little play or attention compared to Hotel Rwanda, but it is a hundred times better.  Grittily real but grappling with redemption, it follows the true story of 2,500 Tutsi and moderate Hutu refugees who sought protection from the UN in a Catholic school compound.  It was produced by BBC Films.  The frame story is of a British career missionary priest and a young teacher year-long volunteer.   This movie is not for the weak of heart:  the violence of genocide is not glossed over.  But it asks very clearly:  where is God in the midst of this tragedy?  How should missionaries, powerless citizens, or foreign soldiers respond to flagrant injustice?  

As painful as the movie is, I’ve watched it several times, and each time I find it profoundly moving.  Many reasons:   it is based on actual events that occurred only a few hundred miles from our home, while we were living here, and contains many scenes that are familiar, from the dusty roads and chattering children to the agonizing scenes of evacuation and survivor guilt.  And because many of the actors and producers are actual witnesses and survivors.  But mostly because it provides a modern-day picture of the Gospel.  The Christ-likeness of the priest would be remarkable even in a Christian film, let alone a BBC secular production.  I won’t give too much away, but in this viewing what really stuck with me was the final scene.  He is driving a truck full of hidden Tutsi children through the dark streets of Kigali and meets a road block manned by a former school contact whom he knows.  As the man with the gun accosts him, he says “The amazing thing, Julius, is that I feel nothing but love for you.”  The first time I saw this I found that line unbelievable and corny.  But since it is witnessed by a survivor, it is probably true.  This time I saw it with hope.  That in the most extreme moment, a person who has chosen a cross-path, can actually be supernaturally filled with enemy-love (hesed) even as Jesus was.  

Our trials here represent cup-sized empty pots in comparison to the life-and-death whole-scale societal implosion of 1994 Rwanda.  But if God was present in the midst of that suffering, surely He is able to meet us in ours.  Because in the end, the reason the priest stays is that he finds the desperation of the tragedy makes God more real than ever.   This is the longing of the songs of lament:  relief, yes, but more deeply to meet God in the sorrow.  

(NOTE: a comment under this post by an informed reader says that this movie was marketed in the USA under a different title: 
Beyond The Gates (2005)). 

Friday, June 27, 2008

The Party's Over

For a few days we rode the crest (Bdays, good decisions, hopeful connections, healed patients) but we’ve now been thrown back against the unyielding rocks of reality. Death.  Yesterday morning as Heidi was weighing patients before rounds, and I was evaluating a dehydrated baby an off-duty nurse had pulled me aside to see, a family burst into the ward with their semi-conscious 6 year old son.  He began to vomit a putrid blood-tinged bile, and pass foul bloody stool.  Within a minute we had cleared out the treatment room, gotten gloves and IV supplies, and Heidi and the other nurse began to work on IV access.  The family gave a story of a grandmother who had just died, then this boy became suddenly ill the day before with headache and fever, and even blood in his urine.  A year ago I would not have been as concerned, but post-Ebola our awareness of the nearness of disaster has been forever heightened.  And our staff acted quickly, carefully drawing lab work, preparing the isolation ward (which has been closed for months), treating the patient’s symptoms.  When the malaria smear, sickle cell test, and other labs all came back negative we knew that the sudden onset and hemorrhagic symptoms warranted reporting the case and sending samples.  Sadly the child died about an hour after he arrived.  So the rest of the morning we had edgy staff, tangles of phone calls, a loudly wailing mother, and the  sad task of decontamination and bagging this small body.  The chances that this case will turn out to be anything worrisome are very, very remote:  his age, his location far from the other cases in the past all suggest that we were merely seeing the agonal last hour of a more common disease.  But I found the whole process profoundly tiring, dredging up the memories of the uncertain days of last December.   I found out that Heidi is made of strong stuff, calm in crisis.  I found out that once I got people on the phone, the mention of “bleeding” and “died” and “Bundibugyo” in the same sentence gets action.  Within two hours a blood and skin sample were delivered to the district for forwarding by the surveillance officer to the lab at the Uganda Viral Research Institute in Entebbe.  Results will take a week.   Discouragment.  Our youngest is struggling.  He was sick more than a week ago with an impressive rash, and now feels profoundly tired and sad, sort of a post-viral blueness exacerbated by the you-don’t-belong nature of his stressful school life, the spiritually dangerous nature of this place, anticipated grief in changes in the family as Luke moves towards boarding school, and mostly by his own discouragement that his calcaneal apophysitis (the heel problem) has still not fully healed.  I am used to a clash of wills.  I am not used to a heart-wrenching helplessness of a sobbing child.   Depletion.  CSB has its daily draining needs, 99% of which fall upon the Pierces, but as their team leaders and friends we ache here too.  Income (student tuition) has NEVER (since the inception of the school) covered Expenses (primarily Teacher Salaries and Student Meals).  This gap has been growing and now looms menacingly. Then this week they analyzed the food allocation more closely, and realized that as the numbers of students had expanded over recent years the protein provided in the diet had not kept pace.  When David saw that they were getting less than 20 grams of protein a day (instead of a good adolescent minimum of 50) he doubled the purchasing of beans and ground nuts.  An appropriate move, but a move based on faith and not on money in the bank.  Many schools in Uganda have been hard hit by the escalating food prices, and a season of relative drought.  We are not exempted.  Almost every day there is another challenge, and the ever-present background of debt makes each one more difficult. Demands.  One of our team Bible study questions this week was : Where are you, and where does God want to take you?  I had an image of treading water.  There is an occasional crest of wave when prayers are answered, when vision clears, when the ride is exhilarating.  But mostly I’m down in the valleys between the waves, pumping and paddling to merely stay afloat.  Progress is elusive.  Every hour of every day brings another needy person or undone deed.  The demands of life in Bundibugyo are endless.  Taking the time to advocate in Kampala and to spend on a fun activity last week means that this week I feel even further behind than usual.   But this morning in Psalm 88 I read:  “You have afflicted me with all your waves”.  What if I’m not treading water, but I’m enveloped in the very substance of life that God has sent?  What if the answer to “where is God taking you” is a wilderness of water, a dragging expanse of death, discouragement, depletion and demands?  What if He has allowed this for good, because what I really need and want is Him?  A theme of our study:  all true worship begins in wilderness.  Not in spite of wilderness, but because of it, because we need the gasping clarity of the struggle to stay afloat in order to know God’s grace. The party seems to be over, but I have a thin lifeline of hope that it’s just beginning.

Thursday, June 26, 2008

Happy Bday to Me: wild nerves but generally unshockable

My kids, with Miss Kim’s help, put together a sweet folding book of family pictures, then Pat surprised me with a bag of dark-chocolate-covered-expresso beans from Trader Joe’s when I went into the exam room to see my HIV positive patients.  I’m sure that was the best thing that ever happened in that sad room.  There was a note saying “you need Holy Spirit to meet to be a strength in weakness. .  . but a few espresso beans can help.”  It was my turn to be prayed for at our weekly prayer meeting too, and Scotticus burned me a CD of a new artist (we over 40s need help to not get too stodgy, though Luke’s card assured me I was “sparky” and Jack’s was also very encouraging). We had a quiet family dinner and enjoyed a cake Scott made.  He and Julia both wrote me poems!  I’ll share Julia’s below, since Scott’s is at least PG-13.

My mother is amazing
With four kids daily raising

She helps a starving child
Comes home with nerves wild

The cook of the best food,
In a much cheerier mood.

Bad cases does she doctor
But Maate has yet to shock her

She’s a beautiful crazy mother,
And I’d like no other.

Tuesday, June 24, 2008

Miracle of medicine, surgery, hope, and prayer

Maate is being healed, slowly but surely.  This is the 15 year old boy, Luke’s age and Liana’s size, who was suffering from severe abdominal pain and wasting thin-ness a couple of months ago.  We thought he must have TB but he did not improve on the medicines.  His patient perseverance really got to my heart, and when he began to deteriorate more rapidly we could not bear to watch him die.  The International Hospital of Kampala, founded by missionary Dr. Ian Clarke, has the best care in the country and one ward dedicated to providing free care for a limited number of desperate people.  Many people prayed for Maate and the Hope Ward of IHK agreed to admit him in late April.  

It turned out that he did have TB, but the TB was located in the linings of his intestines, making it difficult for him to absorb both food and the medicines that would save him.  Doctors at IHK inserted a feeding tube that bypassed the worst area, and allowed the drugs to begin to do their work.  We visited him twice in Kampala, as did other team mates, he looked so out of place on that shiny new ward, a lost soul in a big city.  But he did get better, slowly.  When he was discharged back to us a month ago his weight had crept up from 19 to 22 kg, but his pain was much less and his fevers gone.  Now after a month of nutritional rehab (thanks to UNICEF milk) he’s up to 27.4 kg today, and officially discharged.

He’ll have to complete months of daily anti-TB drug doses, but his returning muscle and ever-present smile are signs of hope.  He and his mother walked to see us from the Congo border today lugging a jack-fruit almost as big as Maate as a way to say thanks.  He’s planning to re-enroll in school next term.  I don’t know what plans God has for this boy, but the visible sign of “all things made new” is enough for me.  I heard staff commenting that he should be named Lazarus, one who was raised from the dead.  In the midst of many struggles and disappointments, seeing someone like Maate transform from a skeleton to a boy, is a miracle that keeps me going.

Golden Girl

Miss Ashley turned 23 on June 23rd, which makes this her golden birthday, a little slice of American culture I did not learn until my team mates here introduced it (your special Bday is the the one when the day and the age you are turning match . . ).

Perhaps appropriate that it should fall while she is here.  There is a haunting Edgar Allen Poe poem called El Dorado, where the knight is searching for the land of gold, and goes “over the mountains of the moon, into the valley of shadow, ride boldly ride, the shade replied, if you search for El Dorado!”  We are definitely over the Mountains of the Moon and deep into the valley of shadow here.  Interesting that this is where we find true gold, far from “home”, in a place of shadowy distress.  Ashley has been one nugget of that gold for us as she teaches the team kids and coaches the girls’ soccer team, or just hangs out with our family as a friend.  The Pierces planned a surprise pre-school breakfast party for her in the morning, and we joined in with the Massos and her housemates for an evening complete with special lava cakes (her mom sent a mix for her favorite dessert all the way to Africa . . .) and gifts.  And that is the real gold here, the community formed in the valley of shadow.

Sunday, June 22, 2008

Advocacy efforts...

Jennifer's efforts at advocacy for the children of Bundibugyo have not been in vain...
Uganda's Monitor newspaper picked up her concerns in the article below...

On mountain climbing, and swords to plowshares

There’s a day coming
When the mountain of GOD’s House
Will be The Mountain-
Solid, towering over all mountains.
All nations will river toward it,
People from all over set out for it.
They’ll say “Come,
Let’s climb God’s Mountain . . . .
He’ll settle things fairly between nations.
He’ll make things right between many peoples.  
They’ll turn their swords into shovels,
Their spears into hoes.
No more will nation fight nation;
They won’t play war any more.
Come, family of Jacob,
Let’s live in the light of GOD.
Isaiah 2 (from The Message translation)

Michael arranged a hike for the interns yesterday, and since my kids were tagging along and I had been away for three days, I went with them too.  We started in Kakuka, at 4,000 feet, what had always seemed to me to be a high and distant town, the last habitable spot before Uganda blends into Congo on the slopes of the Rwenzoris.  Three interns, Kim, Michael and Acacia, and four Myhres (Scott stayed back with Jack who is still trying to recover from his heel injury), two park rangers (required) and six soldiers from two different camps.  The mountain trails are rarely traveled from this side, and the park was, many years ago, the territory of elusive rebel bands, so tourists are required to inform the proper authorities and accept security escorts.  We wended our way along the Lamia river as it flowed from a fold of the hills, the seemingly random border that divides Uganda from the chaotic Eastern Congo.  Our trail ascended past scattered mud homes, gardens of cabbages and beans, the occasional goat or stand of coffee trees.  Compared to the densely populated valley around the mission, these slopes felt peacefully spread out.  At 6,000 feet we entered the forest, and the Rwenzori National Park, leaving all signs of human habitation far behind.  Our goal was a junction called Kakole, at almost 8,000 feet in the bamboo, where the path meets another trail from the Kasese side.  We walked single file on the narrow muddy trail, our arms in front of our faces often to protect us from the damp bushy overgrowth.  Sometimes the trail was so steep and slick we fell, or grabbed roots to almost crawl upward.  It was a strenuous, muscle-taxing, gasping sort of walk, 5 hours up and 3 hours back down.

But well worth it.  The forest shimmers with a thousand greens, from giant wlid banana leaf fronds to spiky prehistoric ferns to feathery bamboo.  Thunder rumbled, echoing, reminding us of the mystery the Rwenzoris held for the people who have lived for generations at their feet, the place where the gods create rain and send it down. As we went higher we passed into the mist of clouds, and then later the drenching of rain.  Ridges overlook deep and unexplored valleys.  Birds call from hidden roosts.  There were hooved prints in the mud, a forest duiker, and probably monkeys watching, but we never saw any animals.  The terrain is vast and dense, nearly impenetrable, thick with the buzz of life and the richness of regeneration, sprinkled with the delicate colors of wild flowers, hiding untold beauties.  

This morning as I read Isaiah, I thought more about why God uses mountains to describe His dwelling.  I think He had something like the Rwenzoris in mind.  Not bald hills, not tame rises one climbs in a car on a paved highway.  No, real mountains, mountains that wrinkle and rise in confusing patterns, with hidden valleys and sheer drop-offs, with rewarding vistas and abundant life.  Mountains that would take a lifetime, or more, to really know.  Mountains where danger and beauty, risk and reward, mingle moment to moment.  

Perhaps it was the presence of the heavily armed guards that made the risk palpable, even though we were quite safe.  (A parentheses:  unlike any popular media portrayal that comes to mind, the UPDF we usually encounter are serious and professional, competent and alert.  The battalion has the nickname “Mountain Sweepers”.  These men carry ropes of bullets and heavy guns but they are the good guys, the ones that ensure that the unrest in DRC does not spill into Uganda, the ones that ensure that rebels who would terrorize civilians can not move with impunity through the anonymity of the forests.)  And here the image fragments a bit.  As we move through our literal mountains, there is danger of exhaustion or illness, of injury or disorientation, or theoretically of attack.

No so on the mountain of God.  There risk remains, but the risk is that of losing self and finding Goodness.  When we finally climb that mountain, the 30 caliber bullets will be melted into ornaments, the AK-47’s will be flattened into hoes.  In God’s presence there will be no evil, no need for armed escorts, no playing war.  Just climbing, further up and further in, to explore His presence.  And again I am reminded of the main theme God seems to be impressing upon me this month:  we only experience as much grace as we risk needing.  Setting off on the trail which is almost too steep and long for my strength puts me in the place where He can reveal His vastness.  The reality of the mountains does not change, but only by risking can I encounter that emerald beauty.

Thursday, June 19, 2008

On Advocacy

THE ROAD, EARLY: Scott’s post from yesterday eloquently puts that day into words.  Heidi and I left home at 9 am, did priorty-only hospital work and were on the road at 10:15.  We arrived at our destination in Kampala twelve hours later about 10 pm, and only by the grace of God, the prayers of the powerless (I started the day on the ward asking a widowed grandmother of a motherless baby to pray for ME since I pray out loud daily for them), and the chivalry of my husband who sacrificed his entire day to our rescue.  Please try to picture Heidi and I, with Melen and baby Jonah, peering under the hood of an unfamiliar borrowed car, discussing in Lubwisi mechanical issues I don’t even understand in English with a motorcycle mechanic who materialized out of the nearest village slightly inebriated.  But even in that hour or two, we saw some amazing mercies.  We broke down 50 meters from a pay-to-use phone kiosk, probably the only connection within many, many miles.  Within minutes people we knew in a hospital truck stopped, gave intelligent opinions (including chiding me for not checking the water in the radiator like any decent African driver before a trip) and offered to take Melen on her way, since she was trying to get to Fort Portal and back the same day (still chasing the paperwork for Jonah’s estate).  In the midst of trudging back and forth to the nearby village to get water and use the phone, the young man who owned the phone kiosk became my self-appointed assistant.  I could hear his friends, the ever-present idle crowd of men, teasing him.  And he turned to them and said something like “Of course we are helping her, she is our person, don’t you know she works here in our district for us all these years?”  It was a very sweet moment for me.  How many times have I seen our own need call out kindness, the opportunity to be helped a moment of connection?

THE ROAD, EVER ON AND ON:  Once Scott saved us and switched cars, we bounced along to Fort Portal, where we did have one moment of panic when the truck would not turn on after refueling.  But it turned out to be a loose battery connection from switching batteries from car to car (so we’d have the only functional one) . . .and so we went on.  I don’t usually drive, and felt pretty nervous about the responsibility.  But I thoroughly enjoyed talking to Heidi more than we’ve ever had a chance..  We knew we were so late by this time that we pressed on without stopping for food or drink or anything else.  But our rush was not enough to get us to Kampala before dark.  The last hour and a half were nothing short of harrowing:  darkness unbroken by street lights, so only the narrow field in our headlight beams was visible, the crumbling road pocked by random deep hidden potholes, swerving to maneuver around them, while trying to avoid head-on collisions with oncoming road-dominating suicidal trucks on a fragment of tarmac that is not wide enough for two vehicles, being blinded by the oncoming headlights, and just to make things interesting the sides of the roads packed with pedestrians, bicyclists, the occasional cow, students, last-minute market shoppers, carts, you name it, all seemingly dressed in the darkest clothes possible.  And to make it even more interesting, we were right behind a fuel tanker for a good while, the kind that regularly blows up in accidents here.  At one point a mountain of dirt, no doubt intended for road repair, appeared in our lane suddenly out of the dark, and if Heidi had not yelled I might have hit it.  But she kept her humor, I kept my focus, and somehow we survived.  We were so exhausted by the time we arrived we could barely eat and fall into bed.

THE APPEALS:  We were up early today to re-enter the traffic struggle, an hour-and-a-half of inching progress, futilely whistling policemen, cars driving the wrong way in lanes that don’t exist, swarms of boda-bodas cutting in between the bumpers, in short Kampala.  Our first stop was UNICEF, a brand new beautiful building with security and buzzers and air conditioning and desks and phones . . . Not exactly what we’re used to.  But we dressed up and tried to be confident.  Our contact there put us at ease, and within an hour we had worked out an agreement for them to supply our nutrition unit with about 9 thousand dollars worth of special formula per year.  Small in the UNICEF world, but huge for us.  Instead of being cut off, we are expecting a supply to arrive next week.  Hooray!

From there we found the nursing board, the initial impetus for the trip.  Heidi had been scheduled for an interview at 11 am.  We checked in with the receptionist, and sat to wait. The lady on the phone had told Heidi it would take a few minutes.  A half hour later we decided I should proceed with the day’s tasks and come back for Heidi.  It turned out to be a wise decision, since the 11 am interview happened about about 3 pm..

Meanwhile I found the Mwanamugimu Nutrition Unit at Mulago Hospital, the national referral hospital.  There is something about the open-air, single-story clusters of colonial-era African hospital wards that I love in spite of the peeling paint and scant resources.  Here disease is not glossed over or sterilized:  hungry kids are lined up and intent staff are going about their daily tasks as if it is perfectly normal to mix milk in plastic pails and cook porridge in charcoal-blackened pans.  Because it is.  I stumbled upon Save-the-Children-UK filming documentary footage of malnutrition in relation to rising global food prices, and then spent some time with the staff.  I came away impressed by the articulate and competent nutritionist in charge, and having a connection of sorts for sending our staff for better training.  

Heidi was still waiting.  So from Mulago I found the Clinton Foundation office, where I had a very pleasant meeting with the young program director.  He listened to the needs in Bundibugyo and then pulled out a pen and calculator and committed to sending 150 cartons of plumpynut, a ready-to-eat  food supplement the foundation supplies to HIV positive malnourished children, next week!  It turns out he’s changing jobs next week, so the timing was very providential.  I was beginning to have that feeling that the angels had put a sign on my forehead:  give this woman whatever she asks for.

Heidi was still waiting, so riding the crest of the prayers going before me, I next found the EGPAF offices. I never do this kind of moving about town .. . . So they were all surprised to see me instead of Scott.  But I explained that we had not been able to follow the newest guidelines for the treatment of HIV-infected mothers and babies because we lacked baby-formulations of AZT . . . And came away with 20 little boxes, a good start.

THE HARD NEWS:  By this time it was late afternoon, and Heidi called to say she had finally been seen by the board.  It seems they liked her paperwork and her presence, but there was the little detail they had forgotten to mention that she’d have to spend two months interning in a hospital in Kampala supervised by one of their registration board nurses if she wanted a work permit to continue nursing in Uganda.  This was shocking news to all of us, and we’re still processing it, since 2 months without Heidi sounds pretty bleak to me, and two months in Kampala alone sounds pretty stressful to her.  But after God opened the doors so decisively at UNICEF, Mulago, Clinton Foundation, and EGPAF . . It was hard not to suspect that even this apparent setback had a purpose we do not yet realize.

FINALLY:  We finally got a bit to eat, a “breakfast” of falafel at 4, and managed to knock off some shopping and errands for team mates.  One of the freedoms of being without kids:  we had ice cream instead of dinner to wrap up our second 12-hour intense day.  

I started the day with a Psalm about justice for the fatherless and widow, and ended the day having witnessed that Justice in motion.  

The Vav

Scott here.  In the middle of my ultrasound clinic yesterday Jennifer stopped in to say goodbye as she headed for Kampala  with Heidi to visit the UNICEF office, trying to persuade them to continue to supply us with the therapeutic food we need for our malnutrition patients.  Of course, I expected life to notch up to "hectic" level.  We survive because we are a unit, juggling the myriad responsibilities of patient care, team coordination, and the seemingly endless list of general life maintenance tasks required to live in Africa (...last time I tried to flush the toilet there was no water which led to a two hour comedy of errors including eradication of a colony of biting ants just so I could touch the outside water valve connecting us to Michael's gravity water line).   

An hour and a half after she left, just as I finished my last ultrasound case, Jennifer called.  "The car just stopped and steam poured out from under the hood," she said.  She drove the Bartkoviches old car (~11 years old) so we could  equip it with new tires and put the machine into the hands of our young teachers.  We discussed lots of possible scenarios, including various explanations and solutions to the overheating and various car swaps.  She accepted the challenge of refilling the radiator while I got on the road to come and assist.   A half hour into my journey towards her, I found the road blocked by two trucks (one broken down and one which got stuck in the mud trying to pass) so I turned back to use an alternate path.  In the meantime, Jennifer called to say she got the car started again and we agreed that she could proceed.  I headed home, but halfway home, she called to say "We're halfway up the mountain and the thing died again."  So I turned around and headed back towards her.  Thirty-five kilometers of bone-jarring, bolt-loosening, washboard, cobblestone road to hurry over and ponder...why.

We're currently in a 10 week study of Michael Card's A Sacred Sorrow, a book subtitled Reaching out to God in the Lost Language of Lament.  His thesis:  Lament (weeping, protesting, complaining) to God is the path to worship of God. Eugene Peterson in the Foreward says, "...learning the language of lament is not only necessary to restore Christian dignity to suffering and repentence and death, it is necessary to provide a Christian witness to a world that has no language for and is therefore oblivious to the glories of wilderness and cross."  

After nearly 15 years in Bundibugyo, we continue to seek to understand the mystery of pain and suffering.  Immersed in the ocean of it nearly from dawn to dusk.  Yesterday alone:

I told the wife of our house-worker that their 15 week baby-in-utero was dead....

I found a three year old child who's shoulder (proximal humerus bone) was gone, eaten by infection...

I received three requests for financial assistance, for the mere basics of roofing sheets, chairs in the home, and secondary school fees....

We've studied and prayed, trying to comprehend the purpose of pain, to see it through the lens of the Scriptures, to develop a "theology of suffering".  The general response here is to explain through blame.  Usually a curse, a relationship out of kilter, ancestral spirits creating havoc.  

A Sacred Sorrow is not an apologetic for the existence of evil in the world, but rather a biblical examination of the real world response of several of the giants of the historical Judeo-Christian faith (Job David, Jeremiah,Jesus).  It seeks not to answer or justify, but merely to lend a hand to those who grieve.   

David's struggles in the wilderness led to a whole host of Psalms of Lament (Psalms 5, 13, 22, 28, 31, 38, 51, 55, 59, 69,109).  They all begin with his complaints, his struggles, his desperation.  But there is in each one a sudden transition, a switch in focus from Self to Elsewhere.  The sixth letter of the Hebrew alphabet, the vav (also spelled waw) marks the "crossing of the line" from whining to worship.  It always seems sudden and to me inexplicable.  This is what I want to does that happen?

Yesterday while I jostled and bumped towards a dead car, I wondered...  "What is the point of this?  This is a colossal waste of my time."  My head and throat ached from an annoying viral URI which had developed in the morning.  I was diverted from my work and kids to hours of struggle and frustration.  Compared to Job, of course, I could not complain, nevertheless I did.  

I did finally reach Jennifer in the mid-afternoon on the mountainside, gave her our reliable LandRover so she could proceed to Kampala.  I creeped back toward the mission in the crippled Nissan.  I broke down another half dozen times and arrived home at dusk, dirty, thirsty, yet thankful.  Thankful because it could have been worse?  I suppose partly.  Somewhere along the road, though, in the midst of my grumblings, I realized that I did have a need, a hunger.   I remembered David's imprecations which melted with "disturbing clarity" into worship.  My annoyance also morphed somewhere into something else.  In some way, I realized that I had no where else to go.  The path of pain seems to lead either to despair or worship.  I choose worship.

(N.B.  "A Sacred Sorrow" has an accompanying "Experience Guide", a booklet which leads through 10 weeks of readings in Job, the Psalms, Jeremiah, and the gospels. Both get five star ratings from Bundibugyo).

Tuesday, June 17, 2008

Pots, deep and numerous

About a week ago the passage about the widow who collected her neighbor’s pots and found them filled with oil sank into my mind and heart, with the realization that we only see as much grace as we risk needing.  

Like faith, risking the need for grace is a concept that sounds noble but feels a bit like death.  And as so often happens, when the Spirit supplies such a direct message, the need to grasp onto that truth follows close behind.

So though it is only Tuesday, the depth and volume of my week’s empty clay pots feels cavernous.  

It could have something to do with the fact that our 23 bed ward is crammed with 37 patients, a half-dozen of whom should be in an ICU with their sky-high malaria parasite counts or purulent brain fluids.  It could also be related to the fact that yesterday we confirmed that over 30 kilos of sugar and a similar amount of beans have slowly leaked out of our nutrition store in the last two months, a cup here and a bag there spilling into a life-threatening hemorrhage of dishonesty.  Or the fact that a few hours after the painful meeting in which we asked for the staff to return their store key . . . We got a disturbing email from UNICEF that not only canceled their visit which we had prepared for that day, but also implied that the one disbursement of amazing therapeutic milk powder they had bestowed in April would not be repeated because we were not following their rules closely enough.  Since the stock had dwindled and we had been led to believe for the last six weeks that the next shipment was imminent, this was quite a blow.  In between these two gaping potholes, the entire S2 class from our school (actually the ONLY class in which I have no biologic or sponsored children, so it could have been a worse shock) was dismissed temporarily after another meal disaster was met by student wildness and rock-throwing.  In the process of processing that yet more issues surfaced of envy, abusive behaviour, layers of disrespect and misunderstanding.  Sigh.  The empty jars lined up rather quickly.

And underlying all these dry vessels, the reality that some major family changes are imminent.  Last week Luke was offered a spot at Rift Valley Academy, a missionary boarding school in Kenya, for 11th grade beginning in August. Though I’ve had our kids on waiting lists for years for vague future spots . . . The chances of one opening in high school are usually slim.  So not until now have I had to face the risk and loss of that separation.

As these pots collected, though, the oil began to flow. First and foremost, we stand in awe of Luke’s readiness to give RVA a try.  He’s made the decision to go, with our blessing, in a mature and sensible manner, one that shows he is more ready than we are for this milestone.  Then the dismissal of the unruly students proceeded smoothly and has already made a difference in the school’s atmosphere.  We continue to pray for real conflict and reconciliation skills to grow out of a grasp of the Gospel at CSB.  Then the nursing staff worked incredibly hard to shoulder the burden of overwhelming disease, and two of our best nurses showed up (surprise!) on break from their further schooling to pitch in and help.  And lastly, after a day of emails and phone calls and indecision, UNICEF agreed to meet with Heidi and me on Thursday morning to work out an agreement that will allow continued cooperation.  

So that flowing oil actually opens another gaping pot, I have only driven to Kampala without Scott a couple of times, and do not feel confident about the challenges of the next few days, or about leaving my kids or the hospital ward.  The collaboration which brings resources to desperate kids means I need to risk needing that grace, but I’d appreciate prayers for the trip and for immersion in oily grace.

Sunday, June 15, 2008

A tribute to his dad on Father's Day... from Luke

The doctor and his wife in Bundi live
With their four sweet little kids

Feeding and healing the hungry and poor
Ultrasounds, accounting, surgery and more

He's a mobile banker
Free money for those who have a hanker

A pizza chef of great acclaim
Never are two ever the same

Grilling tender quality steaks
Then delicious tacos he makes

On safari (a different mode)
"A willager on this road?"

He protects his family at Campsite 2
With a slingshot and a cooking pan too

He even has a small farm
One goat, two cows, he shows his charm

But they stamp and butt
They chase to cut

But he milks them still
So that we drink our fill

Sewing and super-gluing our lacerations
Trying to prevent macerations

And when the dangerous Ebola he did see
He stayed and and helped and did not flee

On muddy roads treacherous
In Clifford he comes to fetch us

Global digerati a techno master
He has a Mac that's always faster

An avid photographer Nikon d200
Some people ask, "how is he funded?"

He has a strange need for fire
Burning and exploding till the situation's dire

First his face, the kitchen burnt
The trash pit; you'd think he learnt?

My dad is the very best
Trial by fire
He has passed the test.

A Day of Celebration: striving for Peace and Purity

Bundikyora Church became an official congregation today as three elders took vows to strive for the peace and purity of the church.  I like that phrase, the balancing of righteousness with graceful love.  After decades of patient work by the mission and by Ugandan evangelists,  of teaching and training, of living and working and waiting, there are now three fully-formed Presbyterian churches in Bundibugyo.  Today’s milestone was especially poignant, as this was the location of Rick Gray’s and Greg and Beth Farrand’s effort to live in tents half-time in order to be more fully invested in the lives of the people of this village.  Their experiment ended when the ADF attacked in 1997 just a few days before the elders were to be interviewed.  Now 11 years later their dream became a reality.  Scott read from 1 Chronicles 29 as he spoke, and the parallels are interesting.  King David wanted to build the temple, and though he put in much effort and planning, God did not allow him to see the accomplishment of his vision, but rather delayed until his son Solomon reigned.  Rick, Greg, and Beth are no longer present as missionaries here, and their work passed into the hands of their “sons” in the faith long ago.  This group continued to struggle and meet when the village lived in an IDP camp; we remember visiting when a paltry dozen or so people gathered in a half-built school room.  So It was a privilege to see, at last, the glory of this day, where a couple hundred people crammed the shelter constructed beside the mud and wattle tin-roofed church.  Streamers of toilet paper, bright balloons, three choirs, enthusiastic drumming, and hours of ceremony marked the milestone.  As Scott reminded them, the temple was built by the offerings of the tribes of Israel, because they gave from loyal hearts.  And this church also rests not only on the vows of the new leaders, but on the faithfulness of the congregation.

We biked to this village, almost 10 km, with Michael and Karen this morning, leaving our kids in Luke’s care (Scotticus thankfully pitched in too), probably the first time we’ve done a “couples” outing leaving the kids behind.  The quiet plantations of cocoa trees punctuated by bustling villages, the rutted tracks, river crossings, tricky puddles, and breathtakingly steep hills . . . It was a beautiful but strenuous ride, fun to be out, to be pedaling, to be alive.  But besides the adventure aspect of biking to church in a dress through the mud, two things about the day really  stood out.  First, after the three new elders were “sworn in”, their first act was to wash the feet of their three wives.  Each knelt on the ground before his wife and held her foot, pouring over water and sort of baptizing her in the name of the Father, the Son, and the Holy Spirit.  It was a powerful image of servant leadership, a shocking stance to take in a culture where women are basically owned by men.  

Second, after the ceremony, we sat in a big circle to eat, scooping sticky rice from huge platters and topping it with salty steaming chicken.  And I realized afresh the depth and length of relationship that binds us here.  In our circle:  Bhiwa and Topi, Josephu and Rose, Charles and Mary, Kisembo (his wife Jessica just had a baby and could not come), Joyce, Pat, Michael and Karen.  These are the people whom we have worked with for so long, and it was a celebration not only of the newly-organized church, but of the culmination of the partnerships we share.  Our striving together for peace and purity has not always been easy:  we have walked with some of these people through the deaths of their children, through alcoholism and abuse, through infidelity.  But we’ve also walked with them through forgiveness, recommitment, and faithful perseverance, never letting go of purity even as we all seek peace.  Amen.

Cross-cultural Fun

In case anyone out there is  wondering, if you find yourself with a half-dozen young African doctors-in-training coming over for dinner, the hand-down (literally) best entertainment is Speed Uno.  I think Lydia Herron introduced us to this version of the game, which includes lots of switching of hands, changing of the order of turns, and enough random off-balance special-case scenarios to keep everyone on their toes.  And the ever-popular rule that whenever a 5 is played, all players slap their hands into a pile in the center, with the last person on top having to draw five cards.  Through obscure machinations an OB-GYN doctor who teaches at Mbarara University ( the second major medical school in the country, after Makerere) arranged for six young med students who are just completing their studies and awaiting placements in internships to spend a month or two in Bundibugyo!  We invited them to come for dinner, to talk about their lives, their goals, what it means to serve in a remote place.  They were personable and confident young men, comfortable with each other, friendly, from several corners of Uganda.  After eating we introduced them to Speed Uno, and that broke any residual barriers of reticence as they laughed and teased each other and tried to win.  We gave them “The Purpose Driven Life” to structure their 40 days in Bundibugyo around seeking God.  Don’t know what will come of any of this . . . We certainly need doctors, so if any sense a calling to return we’d be thrilled.  But in the meantime we had a rare evening of riotous cross-cultural card-playing fun.

Saturday, June 14, 2008

Part and Parcel, Ear to Ear

I found myself yesterday afternoon in a long and tedious meeting which Scott was supposed to attend by virtue of his appointment to a community-based committee that manages the health center.  But he was being overwhelmed by 25 ultrasound referrals at the hospital (either the overzealous referring of unsure visiting doctors-in-training here for the month, or the passive-aggressive action of the usual ultrasound staff refusing to screen out the routine cases and only pass on questionable ones to Scott, in protest against action to stop them from illegal surcharges, or divine opportunities for him to serve and teach . .. he was never quite sure).  While I struggled with the restless sense that the hours were slipping through my hands leaving much left undone, I found I could not easily slip away.  For one thing, these are the people among whom I have spent most of the last decade and a half, and I care about the issues they are raising.  For another, the elected official chairing the meeting made me sit right beside him and gave a speech about how we are “part and parcel” of the community and the work.  Sigh.  So I listened and even challenged or supported various points.  Instead of “shoulder to shoulder” the idiom for cooperation I heard was “ear to ear”.  Sort of an interesting picture of us here, ear to ear with our colleagues, a meeting of the minds and a cooperative physical pushing against disease and poverty. The day only got more ear to ear as it drew to a close.  A couple of newly-weds came to greet us, and as we chatted I reflected on the privilege of moving from a relationship of parent/sponsor to one of colleague/friend.  Am I getting old?  I guess so.  Perhaps the wisdom of age or the whisper of the spirit, I decided to offer the wife prenatal vitamins, sensing she might need them soon if not immediately.  I called her aside and learned that her last period was two weeks before the wedding . . . So we did an impromptu ultrasound with our portable machine, and once again had the fun privilege of introducing new parents to the waving limbs and fluttering heart of their tiny fetus.  But this time it was not American team mates, but Babwisi friends, with whom we could share the same joy, and hug, and pull them into staying for dinner with our family.  And the due date:  Christmas Day.  Fun. By the time we cleared up from dinner and the long day and got the kids down to Friday night clubs at school (they attend games club where Jack teaches his friends great short English boggle and scrabble words, crafts club where Julia nestles in with the girls and learns to crochet and knit, and math club where Caleb reluctantly rises to the challenge of interesting problems) . . . We were exhausted, and ready to relax, settling down on the couch with Luke after about 14 straight hours on the go.  But as soon as we hit the couch there was knocking on the door, a bit ominous in the dark.  Particularly when the dark face at the door is covered with blood.  Our neighbor Buligi and his wife stood there with a knot of relatives, and we immediately sat Buligi down.  His face had been mangled from a motorcycle accident.  Scott ended up taking him down to the health center to do a little plastic surgery by flashlight with the cheerful and competent help of the theatre nurse, who was one of our original “Mother and Child Survival Project” community volunteers more than a decade ago.  Buligi’s is the second case this week of stitches in the operating theatre after a motorcycle accident:  the other was our lab technician.  Both are responsible adult men with one wife, married in the church, with jobs, families (which makes them far from average).  They are not reckless teens out for joy rides.  One was taking blood samples to the central lab, the other coming from taking soap to his boy at a boarding school.  But the crowded road, the meandering goats and pedestrians, the deep rusts and jagged loose rocks, the sharp turns and bushy roadsides . . . Make for danger.  So Scott ended the day ear to ear with our worried neighbors and our hospital staff, part and parcel of the night’s work.


There is an interesting comment on the post about DDT, from someone who identifies himself as a coffee buyer and concludes that the concept of an entire district losing its “organic certification” is patently false. The middle-man cocoa buyers are bullying the farmers with this threat. I find that quite believable: perhaps it is this way all over the world, but the bullying culture seems well developed in Africa. On the surface the society seems relatively peaceful to the outsider, the strong clan identification and respect for elders. But underneath, there is violence and fear. Older kids bully younger ones, a huge problem at our boarding school in past years (though one we’re fighting), as new students find themselves surrounded and threatened and relieved of their stashes of sugar meant to sweeten their morning porridge, or of their pocket-change meant to buy pens or soap. Teachers bully students. A friend told Luke last night that his teacher told him that unless he stopped playing soccer in the afternoon break time, the hour and a half of exercise and recreation that breaks up the long school day, he was going to fail that teacher’s class. Men bully their wives, and parents their children, using beatings or withholding food to assert their power. Staff bully patients, berating them at times for disturbing their peace. Families bully their relatives when they accuse each other of witchcraft and extract expensive fines and rituals for peace. Harsh words, raised hands or sticks, coercive threats, turn the interaction into one of power and abuse. So the idea of cocoa buyers pressuring farmers with the threat of boycott seems quite real. And with most bullying, one must query what the bully seeks to gain. A lower price for the product, and a higher profit margin? A political point scored against a government policy? Or just a sense of control? And perhaps that points to the reason the culture of bullying thrives in a place like this. When the vagaries of international trade and exploitation of resources have depleted a continent, when the ravages of disease and drought lurk around the corner of every month, when daily survival is a struggle and the outcome by no means certain, people want a small sphere in which they feel some sense of security. They want some way to manipulate the world in their favor. So from the hungry teen all the way up to the shady businessman, the stronger pushes the weaker, and feels stronger still. Sounds like something out of Ecclesiastes, another lament. And a warning to my own heart. Lament lays the injustice before the throne of God, rather than bullying the bullies into submission.

Wednesday, June 11, 2008

Wrong Birds

Last night at midnight we were awakened by shouting men, a revving motorcycle, clapping, barking. We tried to ignore the noise but it escalated, and we began to wonder if thugs were bothering the Mukiddis. We went out to the porch and saw flashlights shining through our hedge, and heard a large rock rustle through the trees and thud into the grass. Star was going wild on her leash. Scott yelled at the group of men to go home to bed. They answered “Doctor, we are chasing a wrong bird. We don't like it.” Luke has lately noticed a Verreaux Eagle Owl sometimes roosting in our tree. It seems this bird is associated with evil spirits, and all our neighbors had gathered to scare it off, a collective action of noise and desperation. Evil abounds, but people have been deceived into fighting useless battles.

Tonight we will chase evil in a different way, though some clapping and gathering will be involved. We have planned an extended prayer time for our team, beginning with lament, naming and mourning the evils and then turning to God in worship, praying for the Kingdom to come. We will use Psalm 22, the words Jesus echoed on the cross. The cry that begins in despair ends in faith, and we hope to make that journey tonight, honest protest, engagement with God’s presence, and hope for the future. The psalm ends like this:

The poor shall eat and be satisfied;
Those who seek him shall praise the LORD.
May your hearts live forever!
All the ends of the earth shall remember
And turn to the LORD;
And all the families of the nations
Shall worship before him.

Posterity will serve him;
Future generations will be told about the Lord,
And proclaim his deliverance to a people yet unborn,
Saying that he has done it.

Tuesday, June 10, 2008

On the politics of health

Scott was called by the top elected official in the district to join with the district health leadership and all other NGO’s in evaluating progress in the fight against AIDS.  He carefully compiled the numbers, extrapolating population data and comparing statistics from the health centers to show that our HIV prevalence among pregnant women remains low (3% or slightly less), but the Kwejuna Project has had a significant impact on the care those women receive.  Since its inception four years ago, the percentage of women in Bundibugyo who receive any prenatal care has risen from 49% to 72% (we were actually up to 80% pre-ebola, so have some lost ground to recover this year).  That’s 72% of 13 thousand pregnancies . . . A lot of women.  The percentage of women coming for prenatal care who were tested for HIV went from 0% to 98% in the first two years and now hovers in the mid-80’s (slippage in interest and supply shortages).  The number of male partners tested has increased from 8 (yes, 8 men in the whole district) to over 2,000 . . . Still less than half of new fathers, but a steep incline that indicates major shifts in practice.  Pre-Kwejuna men were never even seen within a mile of a prenatal clinic!  But perhaps the statistic that most significantly indicates a strengthening of health capacity in our district:  health-unit based deliveries have tripled in number and risen in percentage of all deliveries from 19% to 33%.  Most women still deliver in their mud-walled homes alone or attended by their mother-in-law, but more are accepting the oversight of trained midwives in a half-dozen equipped birthing centers.  In a place with high maternal and neonatal mortality, this trend has the potential to save hundreds of lives every year.

At the same time, major world AIDS programs had convened meetings today in New York, a far cry from the Bundibugyo conference.  I heard on BBC tonight that while progress is being made, less than a third of people who need to be on anti-retroviral drugs world-wide have access to treatment.  New infections still outpace capacity for care.  Countries like Uganda can not meet demands, though they spend almost 10% of their budget on health (relatively more than the US) the actual outlay per person is very very low.  Nation-wide the doctor:patient ratio is two hundred times thinner than in the west; in Bundibugyo it is two thousand times more desperate.  And so we struggle on, seeing some hopeful mile markers passing,  but painfully aware of the distance still to run.

Scott’s meeting started two hours late (surprise) which was not just the lethargy of Africa-time.  Instead, a peaceful protest had disrupted the town.  Demonstrators spoke and marched against the new government policy to spray houses with DDT as a way to combat malaria.  Here the politics of health becomes very murky.  Will small amounts of residual DDT lead to environmental catastrophe, as in Silent Spring?  How does a country weigh environmental cost against the deaths of thousands and thousands of children from malaria?  Is sounds very politically incorrect to support DDT . . . But most of those voices come from places like America, where we no longer fear malaria, because we wiped out the anopheles mosquito.  Is it fair to forbid Uganda to do the same?  While I would like serious data to wrestle with these questions, the protestors had more practical concerns. Over the last decade Bundibugyo’s economy has been driven by cocoa.  It is now a major cash crop.  And the biggest cocoa buyers have made it clear that if any DDT is sprayed anywhere in this district, ALL farmers will lose their “organic” certification.  As Luke pointed out, being “organic” is one of the only things that Bundibugyo really has going for it, one of the few up sides of isolation and poverty.  The price per kilo of cocoa would be almost cut in half if the organic label is removed.  That means almost half of most family income would disappear. So will the health benefits of decreasing malaria transmission be lost in the doubling of poverty?  A very reasonable question.

Health is a political concept.  Today’s protestors were arrested as anti-government, since there is no real distinction between policy and person.  Disagreement is equated with disloyalty.  The wisdom of Solomon is needed for these impossible choices, for parents who are trying to survive by choosing between the income that allows them to pay school fees for their older children, and the marlarious soup that drives the younger ones into disease and all too often death.  A cruel irony that choosing against spraying may mean that the very child whose education the cocoa-money would have funded may instead be the next one in a coffin.  

A Tuesday Lament

Kwikilija Jakobo, age 6, died this morning, killed by inefficiency, apathy, corruption, poverty . . . I walked into the paediatric ward at 8:30 and his distraught mother pushed her way into the front, waving papers from Bundibugyo. In a reversal of referral patterns the staff at the district hospital had referred him to our smaller health center with the scrawled note “severe anemia ? Cause . . History of having got treatment in Bundibugyo Hospital, there no blood and for possible management by medical officer.” I took that to mean that the hospital was out of blood, no surprise, since our lab staff had failed to obtain the weekly supply from Fort Portal and the hospital administrator had twice this week sent for blood from the regional blood bank there but been told it was “finished”. In a classic waste of time and money, the patient’s condition probably deteriorated further because of being sent to Nyahuka, when a phone call would have confirmed that there was no blood at our health center either (or even a short conversation with any other staff would have revealed that patients with the same problem had been transferred earlier that day in the opposite direction).

First I called the regional blood bank’s officer . . Only to be told that the earliest we could get blood would be tomorrow. Upon further questioning he claimed that the entire western region’s blood supply was nil, because they had run out of bags. BAGS????? Whose fault is this? Is it the blood bank staff who fail to notice that they are using their last carton of heparinized sterile bags to store donated blood? Is it a corrupt or careless staff member who pockets the money for new supplies, or just forgets to process the order? (Evidence of both in other items this week, a disbursement of medicines listed as being worth more than twice as much as their real value, and hospital staff “borrowing” medicine from our health center to supply AIDS patients at the main hospital because their requisition forms were “lost” so that they ran out of medicines). Is it an entire country living on the margin with no reserve, so that one week the stock of an essential item can simply be gone? Is it poor communication, is it the barrier of deplorably maintained roads, the lack of fuel to transport personnel and supplies? Is it an over-zealous AIDS testing policy which, as in western countries, takes the risk of viral transmission in transfused blood from 1 in a thousand down to 1 in a hundred thousand, never mind the fact that the risk of a child dying from anemia increases from 1 in 100 to 1 in 10???? We live in the epicenter of sickle cell anemia in the world; we live in a valley where malaria is so endemic that almost 90% of children have some level of parasites in their blood; we live in a district where iron deficiency is universal, where diets are poor and intestinal worms remove tiny increments of precious heme on a daily basis.

So Kwikilija, like so many children before him, dwindled, until his heart could no longer metabolize enough oxygen to keep the watery blood circulating in his body, even as we scrambled to try and save his life, too little too late, the wailing relatives throwing themselves on the ground in grief. Raw lament from his mother; anger and frustration from me. I struggle with how to enter the fray with Jesus-style table-turning zeal, but without my own prideful self-righteousness hurting those who are already victims of injustice themselves. How to allow the waste to wring my heart, without hurting others.

Sunday, June 08, 2008

Weekend Snapshots

15 Filthy missionaries, climbing through vertical gardens, loose dirt, and misting rain to reach Ngite Waterfall, a spectacular crash of loud frigid water.  The filth disappears as we plunge into the powerful force of the river.  A great way to spend a couple of hours, away from the clamor of Bundibugyo, the fold of the mountains and the hidden world of loud, cold beauty.

Thousands of polio vaccines, dispensed over two days, all along the Congo border after a wild-type polio virus infection was confirmed in the chaos that is Congo.  Dutiful Bundibugyo parents line up to protect their children.

Handfuls of friendships, which we cling to over the years, as five of our teenage-boy-sponsored-students spend an evening with us, animated conversation, a short Bible study on becoming godly men, a frank discussion of school issues.  Some of these boys have been hanging around our house since they could walk.  They are our kids’ primary friends here.  We end the evening with an episode of a TV show in which anti-terrorism special forces rescue the world . . . Later the boy who became Luke’s closest school friend, in a Fort Portal program for A level, calls just to greet.  These cross-cultural connections are difficult to nurture, and we do not take them for granted.

Two babies in trouble:  one, the only surviving twin of Michael’s right-hand water-man, who presents on a Saturday evening with an incarcerated hernia.  Because I know the parents, the recent loss, I send him to the surgeon in Bundi urgently, but warn them that the bumpy ride might temporarily solve the problem, remembering being in the same situation with Jack many years ago.  It does, but he’s admitted anyway to treat the fever and wait for surgery.  Then this evening baby Jonah, who has nothing more than a cold, but like his mother we consider the irreplaceable value of his little life, and worry over every cough and every fever.  We all decide to put him on weekly malaria prophylaxis, as if he were a foreign visitor.  Maybe we should address the injustice that puts all babies here at such a severe malaria risk, maybe singling out one baby is unjust.   But our inability to solve all the problems should not paralyze us from addressing this one precious life.  We err on the side of mercy and caution, even if it isn’t fair, and give him a four month supply of our expensive prophylaxis.

Hot rolls, long walks . . . The privilege of hosting 20-somethings, 3 university students and one grad student, includes heart to heart talks about life, and having appreciative audiences for food.  Looking over plans for nutrition research, and passing on hard-earned understanding of superstitions.  Enlarging our family tent pegs so that new faces join our worship, or speed scrabble.

Jars, a whole village’s collection, in 2 Kings 4, gathered by a widow and mysteriously filled with oil.  In the morning’s sermon the young preacher quoted William Carey’s “Expect great things from God, attempt great things for God . . “  The oil flowed to fill every pot she brought, the abundance equal to her vision and industry.  A great picture for us:  we will only see as much grace as we risk needing.  

Thursday, June 05, 2008

Shall we not accept adversity?

183 women to whom the Lord gave life, and then adversity, spent the day with us on the mission. For most, you would never guess that a fatal and incurable disease defined their participation, as they greeted each other, bustled about in their brightly wrapped kitengis, balanced babies on their hips, laughed. For a few, the gaunt faces and shabby clothes reflected their struggle against the relentless HIV virus and the social ostracism that follows it. They came early in the morning to establish their place in the registration queue, clutching the tattered books that confirm their positive tests. We talk to each one individually, enquiring about their children, their spouses, their access to clinical care, their desire to take a break from child-bearing. We weigh them and their babies, offer testing to confirm whether or not the virus has passed on. They have the option to enter a side room in groups for prayer, an acknowledgement that our practical hand-on help is incomplete, that their social and spiritual pain runs deep, that we come together before the mysteries of God to plead for their survival. Our three interns and assorted other team mates joined them, a Kingdom picture of the young and educated and healthy and privileged sitting side by side with the weak and poor and sick and marginalized, all equally dependent upon the Mercy.

183 women, most with a child or two, or a sister or husband, sipping the hot porridge provided, waiting. Then Scott preached to the crowd from the book of Job. They gasped when he dramatically described Job’s mounting losses, and listened intently when Scott explained Job’s laments. We are studying this as a team right now, and what story is more appropriate for a couple of hundred people with AIDS? Job encourages the sufferer to mourn, to ask questions, to protest, to struggle. But Job also points to an endpoint of faith: holding onto God for who He is, even when life is not neatly explained by action and consequence, even when the innocent must endure great sorrow. This book goes to great lengths to refute the pat religious answer that sickness is a punishment for bad behaviour. And that is good news for 183 women who need to hear it.

Lastly, the food. The draw of the day is the provision of supplemental food: about 50 pounds of beans, a few liters of cooking oil, and a couple of packets of salt, plus a generous cash assistance to transport all of the above home. The purpose of the food is to strengthen the body’s immune system, to prolong the life of the ill, to ease the burden of the disease, to compensate for the lack of energy to wrest calories from the soil of a labor-intensive garden. But the food does more than that, it is a concrete reminder that God has not forgotten these women. Our former team mate Pamela, who organized these distributions for the two years she was here, continues to make them possible by raising the money to buy the food from a caring small group of people in her church in New York City.

Yes, these women accept adversity, with more patience than I would manage, with more of a Job-like grasp that life is not only a series of good gifts. It is a joy to be a small part of the process, though, of mixing a good gift back into their adversity.

Wednesday, June 04, 2008

Good News All Around . . .

My mom’s eye surgery went well, the doctor did not find the feared hole in her retina, which means her recovery will be more straightforward and she can hope for improvement in her vision within the next month.  Some of our dearest family friends came to stay with her this week, my aunt and uncle will be there soon, and my sister over the weekend.  Missionaries need rather extensive support teams, people who can fill in the gap we leave in our absence.  We are grateful.

Two new WHM Africa missionaries were approved today:  Nathan Elwood, who graduated from college a whopping three days ago, is the newest member of the Bundibugyo team.  He’ll spend about two years here before grad school, contributing to public health and education and we hope using some of his soccer and musical skills as well.  We are praying that he can raise support quickly and arrive with Jason Blair.  We need the help:  with Pamela gone, tomorrow’s major Kwejuna Project food distribution has already almost done Scott in, and it hasn’t even started yet, thousands of dollars of beans and oil and salt, medical care and family planning, weight monitoring and encouragement in the Gospel, provided to well over a hundred families.  Nathan was in the same application group as Physician Assistant Scott Will, who served here for six months this past year, including through the entire Ebola crisis.  In an “outside the box” attempt to accommodate his interests and our needs, he’ll come to Bundibugyo for a few months initially and then shift his focus to Sudan.  We see our teams as integrally related, and look forward to forging this unique partnership with the Massos and the other Sudan appointees, allowing personnel to move back and forth a bit as opportunities arise and needs shift.  Scott Will is like part of the family, so we are very glad to have him headed back in this direction.  His support-raising will depend upon WHM being approved as a partner with MedSend, an organization that attempts to free young medical grads up to serve in areas of poverty in the world by taking over debt repayment for school loans while the person works overseas.  We hope that if this works for Scott, it might encourage other newly-graduated doctors, nurses, PA’s or others, to join our fields.

Between team meeting, intern orientation, ART clinic, new nutrition admissions, setting up plans and projects for the summer, kids’ adjusting back to the new school term, patients, neighbors with needs, dinners to cook, and emails to answer . . . It has been a full half-week.  I became very aware over the day today of the teamwork that I often take for granted, and thankful for the friends with whom I labor:  Heidi organizing reports to be sure patients get their treatment, Pat counseling a newly diagnosed AIDS patient, Scotticus working to connect us with sources of nutritional help for patients, David peacemaking and preaching and supervising at school with Annelise thinking creatively about funding and discipleship, Karen accounting for money and making sure the new chicks survive while feeding her neglected neighbor kids as they go through crisis, Michael designing an improved airstrip drainage so that we don’t have planes landing in puddles again, Sarah’s music lessons with Acacia and Luke at school resulting in a haunting duet performed after team meeting tonight, Ashley juggling multiple grade levels and inspiring girls to play soccer, Kim putting aside personal interests and plans to serve the team by planning for the interns . . . And all that was just today.  We have an amazing team of people pursuing deep knowledge of God even if the path takes them through deep waters of challenge.  Sometimes I think our role is mostly to not get in their way too much!

Anyway, much to be thankful for on both sides of the ocean, at the end of a long day.

Tuesday, June 03, 2008

Family prayer request

Please pray for my mom, Judy, who will have delicate surgery on her eye at Hopkins on Weds 4 June.  She has lost significant vision from an “epiretinal fold” and we hope that this surgery will arrest the deterioration, and that her recovery will allow her to travel as hoped to Uganda to visit us in August.  I want to see my mom, but I mostly want my mom to see!  Thanks.

Monday, June 02, 2008

Martyr's Day

June 3rd is a national holiday in Uganda, commemorating the murder of 26 young men in 1885 who refused to recant their new Christian faith when the Baganda King, Kabaka Mwanga II, decided that their allegiance to King Jesus threatened his supremacy.  Dozens of others were similarly killed for their faith over a period of about two years, including the Anglican missionary, Bishop Hannington, who had been sent to establish the protestant church in Uganda.  The current Archbishop of the Church of Uganda, Henry Luke Orombi, says:

Tertullian’s oft-quoted statement “The blood of the martyrs is the seed of the church” is the story of the faith in Uganda. On his first visit to Uganda in 1885, the Englishman and missionary bishop James Hannington was martyred as he tried to cross the river Nile into central Uganda.  . . . Before they killed Hannington, on October 29, 1885, he is reported to have said, “Tell the Kabaka that I die for Uganda.”
Less than a year later, on June 3, 1886, the king of Buganda ordered the killing of twenty-six of his court pages because they refused his homosexual advances and would not recant their belief in King Jesus. They cut and carried the reeds that were then wrapped around them and set on fire in an execution pit. As the flames engulfed them, these young martyrs sang songs of praise. Far from eliminating Christianity, the martyrdoms had the opposite effect: If the faith of these martyrs was worth dying for, then it must also be something worth living for. Christianity began to spread like wildfire.

An inspiring and sobering story, and one that repeated itself in the 1970’s when other faithful Ugandans were murdered by Idi Amin because their loyalty to God superseded their tolerance of his crimes.  As missionaries we still upset the balance of power, we are a destabilizing force in many ways, people whose very existence challenges the traditional system of cause and effect, check and balance, calls into question the word of the dictator when it conflicts with the word of God.  We should strive to study the culture and respect and preserve most of it, to introduce God’s word in appropriate ways.   But it is the courage of the citizen, the ordinary man or woman who makes a life and death choice, that changes the country.  Bishop Hannington and others introduced truth, but it was the lives and most particularly the deaths of these young men that set Uganda on a path of change.  Ironically, we tend to think that major dramatic power-display miracles would be the way to convince a nation to embrace Christianity, would be the mark of God’s presence.  But in the case of Uganda, the victory came through death, through what looked like defeat as a powerful king cruelly disposed of those who dared to take a stand for faith.  

We work and pray, but it is the death of the martyrs, from chief page Charles Lwanga in 1885, to Archbishop Janani Luwum in 1977, to our friend Dr. Jonah Kule in 2007, that yields growth and change and life.  The way of the cross.

The Interns Have Landed

Three smiling interns, Katie, Jesse, and Nick, and one very relieved Scotticus piled off the Cessna 206 in between lightening flashes and in the midst of standing water. Their saga began when it was raining too much in Kampala for MAF to meet them at Entebbe, so they were sent by road to the smaller MAF airstrip at Kajjansi. They had to sort through and leave more than half of the luggage behind due to weight restrictions, increased by the weather and the grass airstrip. Then when they finally did take off, the weather became worse. Visibility fell from five miles to two to less than a half mile as our valley was socked in by heavy clouds. We stood on the airstrip in the pouring rain trying to call MAF on the phone. Once we could hear the plane and catch a glimpse of it flying low over the trees, but they could not see us. It seems the GPS coordinate they had for the strip was off by a bit . . . Finally the pilot spotted the airstrip and made a splashy landing. Since the interns had never done this, they were confident and happy as they disembarked, whereas a more experienced Scotticus knew that it was not normal for the pilot to tell the passengers “see if you can see the road or any landmarks down there”.

These university students will spend the next two months here (June and most of July) encountering God in a different culture, and adding a bit of their own sweat and tears to the Kingdom progress as they teach, pack medicines, weigh babies, share the Gospel, conduct interviews, play sports, and generally serve. They are always a breath of fresh air for us, just not usually such a cold and wet breath!

Sunday, June 01, 2008

More than words

God is strong, and he wants you to be strong. . . This is no afternoon athletic contest that we’ll walk away from and forget about in a couple of hours.  This is for keeps, a life-or-death fight to the finish against the Devil and all his angels.  Be prepared.  You’re up against far more than you can handle on your own.  Take all the help you can get, every weapon God has issued, so that when it’s all over but the shouting you’ll still be on your feet.  Truth, righteousness, peace, faith, and salvation are more than words.  Learn how to apply them. (Ephesians 6 from the Message)

This passage formed the text for the morning’s sermon, and when I read it in the Message it sounded like a letter written directly to our team.  This is for keeps, the struggle against lies and hate and hunger and abuse.  We need all the help we can get.  Truth and faith are more than just words.  

In what is now becoming a second-term trend, the students at CSB began to protest last night when their dinner was burned beyond edibility and the cook berated them for their uneducated tastes in refusing to eat the food.  The Pierces and leadership team rallied prayer and wisely met with students this morning, but by that time one staff had been hit by a rock thrown in the dark (by the GIRLS’ dorm no less) and the students had boycotted breakfast (which was at least a non-violent collective action).  The issues are many, and deep, way beyond bad food, beyond the “afternoon athletic contest” level of conflict.  It is no small task to procure and cook food for several hundred people three meals a day on a dollar or less per person, in a primitive setting (no power, cooking over wood fire, no cold storage, no supermarkets, no wholesale warehouses . . ).  This is complicated by the global crisis of rising food costs, the Ugandan school culture of violence, the prevalence of corruption, even the strained historical cultural/tribal relationship between the majority ethnicity of the students and the minority previously dominant ethnicity of the caterer and some staff.  Add to that personality and unwise words and frustration, and the mix is volatile.  

While that was brewing over the last twelve hours, a long time friend and neighbor arrived in the dark last night saying his child had died, a 4 year-old-ish girl we had treated for malaria a couple of hours earlier.  Thankfully she was only temporarily dead, a convulsion from the severe malaria.  Scott injected her and Karen brought her down to the hospital this morning for more treatment.  Pat’s elderly friend is languishing there because a troublesome newly-appointed medical worker assigned her care has missed work the last two days . . . In spite of the fact that on Friday I brought a newspaper article to the staff which said that absenteeism was now being considered corruption, stealing a salary without doing the work.  A smug local primary school teacher read the Scriptures in church today much to our sadness since his infidelity and polygamy are destroying his family, we feel he should not be given any spiritual leadership role.  

And I sense the battle just as intensely in my own heart, in my quick-to-judge views and intolerance, in my protective indifference to the needy who are impinging on my Sunday rest.

In short, this is a fight to the finish, and we are up against more than we can handle.  The timely sermon pointed us to prayer.  Please join.