The International Emergency Epidemic Response Team (including reps from WHO, Ug MOH, MSF-Swiss, and UNICEF) flew in on a MAF Caravan and spent 7 hours on the ground in Bundibugyo yesterday. The District Director of Health, Dr. Sikyewunda, invited me (Scott) to participate in all of their site visits and meetings. The WHO rep, a sharp, experienced, epidemiologist emphasized in the first meeting of the day with local govt leaders that this seems to be a new (fifth) strain of Ebola, atypical both clinically and genetically from previously identified strains. A more non-specific clinical syndrome (fewer specific hemorrhagic signs) will make the containment of this epidemic more challenging, he said. That first meeting also revealed a lack of consensus on what public health message should be disseminated to the pubic. Will schools, markets, basic health services be shut down or curtailed? Hand-shaking cease? There was no debate about the answers, only a request from the experts to wait for their final assessments.
The visit to the Ebola Isolation Units at Kikyo Health Unit and Bundibugyo Hospital consisted of physical assessment of terrain, potential tent and gate locations, patient traffic patterns, water and latrine availablity, and staffing evaluations. Surprisingly (to me), not one member of the International Team donned protective gear in order to lay eyes on any patient. Their mandate, they said, was logistical assessment not clinical management. At Kikyo Health Unit, the staff and community seem much less aware of the ramifications of the Ebola diagnosis. People milled around the grounds of the Health Unit gawking at the entourage with its six vehicles and foreign visitors.
At Bundibugyo Hospital a significant portion of the hospital staff have gone AWOL or called in sick. A few brave nurses volunteered to staff the Isolation Unit, previously built by MSF for Cholera Isolation. During our discussion of potential layouts of an expanded unit at Bundibugyo Hospital, I received the short message on my cell phone that Dr. Jonah admitted himself to the Mulago Hospital (Kampala) Isolation Unit with fever, headache, and vomiting (and a history of contact with Ebola cases). Up to that moment, we had all expected Jonah to return today to resume his active role in the assessment and management of this crisis. Not possible now.
The last meeting of the day served as a Summary Wrap-up. Each expert presented their assessments. Basically, the plan of attack involves four arenas of activity: Surveillance (case identification and contact tracing), Clinical Case Management ( the resource-intensive task of setting up complete and safe isolation and management of patients with the disease), Logistics (management of all the stuff required to manage this crisis—UNICEF said there is 35 tons of supplies on the way now), and Social Mobilization (the massive task of educating the general population about the disease and measures necessary to control it).
I realized this morning that there are, in reality, two related emergencies. The Ebola Epidemic trumps all as the primary crisis. However, there is a secondary Medical Staffing Emergency in this District. Our only two Ugandan Medical Officers lay ill, presumably from Ebola. The official Ministry of Health initial press release revealed 51 cases and 16 deaths. That’s a 31% case-fatality rate. Nearly three-quarters of those afflicted may survive (according to the official numbers). So, our doctors may survive, but are likely to be out of commission for weeks.
Yesterday as I left the Wrap-up meeting the District LC5 Chairman (Governor) asked me to go to the Bundibugyo Hospital to attend to a woman in labor with a “hand coming out.” This mother delivered the first baby of a set of twins at Nyahuka Health Center in the middle of the night, but the second baby got stuck in a transverse position and ended up with an arm prolapsing through the cervix. Two options existed. Referring her to the Fort Portal Regional Referral Hospital, a brutal three ride in the back of a pick-up truck for an exhausted anemic woman in labor...or a Cesarean Section. I’ve been trying to resurrect my C-Section skills under the tutelage of Dr. Jonah for the past several months, but wasn’t really planning to fly solo quite yet. By faith and prayer, Scott Will and I did the surgery. It was smooth, controlled, and though very stressful, also enjoyable to be able to complete the surgery and save the life of the mother (I had confirmed by ultrasound that the baby was dead before the surgery). This type of situation happens on a weekly basis at Bundibugyo Hospital. 150 deliveries per month, on average, occur at Bundibugyo Hospital. At least 2-3 week need surgical delivery. I cannot be the one to shoulder this responsibility alone. I have also been asked to replace Jonah as the Head of the District Clinical Epidemic Task Force. This will require some work initially, but the MSF Team will be able to take the clinical load almost immediately.
Bottom line....
We desperately need at least one more physician at Bundibugyo Hospital who can do emergency operative obstetrics. The District has failed miserably in recruiting doctors even before Ebola. The likelihood of a Ugandan Medical Officer volunteering to come to Bundibugyo now seems slim and none. I have appealed to MSF to recruit a doctor from their ranks to come and do non-Ebola hospital work (they are sending two already to manage the Ebola cases).
Please pray...
For Dr. Jonah, Dr. Sessanga, Joshua Kule (a senior Physician Assistant), and Fred (a nurse)--health workers who have all fallen sick with symptoms of Ebola this week.
For another doctor to come in and serve at Bundibugyo Hospital.
For Jennifer and I as we balance the responsibility of leading our team and being involved in District-level response and planning.
For Jennifer and I...for our health. We have personally examined patients (using some protective measures—but not the head-to-toe suits which are on the way), but I do not believe our exposure has been to the level of our Ugandan colleagues.
For Bundibugyo. It’s another bad rap for a disdained district. We know, however, that God has a special concern for the poor, the lowly, the despised. He has not forgotten or forsaken us.
Scott and Scott have been gone all day with the team from WHO, MSF, Ministry of Health, and UNICEF. So there will be more to report when they return. This group landed on our airstrip this morning, to assess the situation for a day so they can decide how to send in supplies. We’re still waiting for the cavalry to arrive. Meanwhile the MAF pilot has hung out at our house, and I’ve been at the Nyahuka Health Center. We had one patient admitted to the isolation ward but she probably just has malaria. I had an hour-long meeting with the staff, who are understandably nervous.
And with good reason. I just got off the phone with Dr. Jonah. He had gone to Kampala on personal business a few days ago. Yesterday he had a headache, and today a bit of fever, so he admitted himself to Mulago Hospital’s isolation ward. We are hoping that his illness is not related, but I think he was wise to put himself there, so that he does not infect others. PLEASE pray for him!!!
The mysterious disease that has infected people in Bundibugyo was this morning revealed to be Ebola virus (verified by the CDC-Atlanta laboratories). 79 cases have been identified since August, with a 43% death rate. So far all cases have come from a village area called Kikyo, which is 25 km from our mission, or through direct prolonged contact with patients from that area. Ebola is a panic-inducing word. We are treating this news with sober respect, but thought we’d put out a few facts proactively.
- Ebola is a filovirus. There are four subtypes: Ebola-Zaire, Ebola-Sudan, Ebola-Ivory Coast, and Ebola-Reston. Yes, Reston, the latter is from monkeys who were imported through Dulles airport, but did not cause any human infection. Our epidemic does not seem to fit any of these four strains and so may represent a new form of the virus. The good news is that it seems to be slightly less virulent.
- This is the 17th documented outbreak of Ebola since 1976. Almost all the cases have come from Africa. The most recent Ugandan outbreak was in the north of the country in 2000; the most recent outbreak at all was in DRC Congo from April to October this year.
- The patients we are seeing look ill, but not that different from most patients. The Hollywood version is not what we’re seeing. Most people just have fever, vomiting and diarrhea, some with a rash and some with conjunctivitis (eyes red). A few have bleeding.
- More than half of people are recovering, with very basic care. We have met with two nurses who took almost a month to pull through but are OK now. The clinical officer Julius who has managed the majority of the patients is OK.
- We consider our non-medical team members to be at low risk. The virus has never been documented to spread through the air to infect humans. The mode of transmission is direct contact, touching body fluids or soiled linens or blood, or by contaminated instruments such as needles. Unless this strain is very different from other Ebola strains, people who are not sick do not spread the disease. We won’t contact it in our homes, or in normal daily life.
- The health care workers of Bundibugyo are the ones at risk. We want to support them in every way possible, with gloves, masks, bleach, bandages, IV fluids, etc. Thankfully the World Health Organization, the CDC and MSF (Doctors without Borders), organizations with great experience in this kind of epidemic, are aware and will arrive by air tomorrow to help. We as doctors are taking every possible precaution when we see patients to avoid becoming ill.
- Our Overseas Director Paul Leary is ready to field any questions about our team (info@whm.org); more medical information can be seen on the Ebola Information page on CDC web site.
- I’ll update the blog regularly with more information too.
Please pray for our doctors and other health workers. Dr. Jonah is in Kampala now, but he saw quite a few cases before he left, as did Dr. Sessanga. Scott has attended to many of these patients already. Pray for us to wisely support the health system in our district, to graciously care for the ill, to be alert to any danger to our team and children, and to advocate for the best possible response that Bundibugyo can receive from international aid workers.
Sometimes around Christmas we find that people are looking for meaningful gifts to give their families. This year we have a great idea: give a goat. For $110 you can purchase a dairy goat. They are a bit smelly and loud to keep in your yard, and you probably prefer your milk clean, cold, pasteurized, in a plastic bottle in the fridge. So instead of sending you the real live goat, you’ll get the little locally hand-crafted ornament pictured above, to hang on your tree. And a family in Bundibugyo will get the goat. A baby whose mother has died, or one whose mother has HIV infection, will be able to drink the goat’s milk, possibly the difference between living and growing up, and dying in infancy.
For more information, check out <http://www.bundinutrition.blogspot.com> (also a link on our sidebar). Briefly, you can either mail a check to : World Harvest Mission Donations Processing Center, Box 1244, Albert Lea, MN 56007-1244; or go on line to this link <https://www.whm.org/donate_online?DESIG=12371> to donate. Be sure to designate Uganda Infant Diaconal Fund (BundiNutrition) #12371 on your check. Karen Masso will eventually get your address from the donation list, and mail you the ornament, but if you’d like it earlier to put on your tree or give as a gift just email her (masso@iname.com) so she can send it to you. All donations are tax deductible.
Jesus’ birth was announced to shepherds; he spent his first hours on earth in the company of goats. It is our prayer that this project will enable 75 more babies to get the calories and protein they need to live, and allow 75 American families the blessing of celebrating Christmas the way He did.
Our dear teachers, Miss Ashley and Miss Sarah, posing today with Caleb, Julia, Jack, Louisa and Joe. We had a planning meeting today to consider how to incorporate twice as many kids with the same two teachers: Gabriel and Quinn add in for Kindergarden, Lianna and Naomi return to 3rd grade and Acacia to 5th, Jack, Julia and Caleb all continue but juggle schedules with CSB classes, and Luke lands back on RMS post-O levels to study math and literature . . . We’re clinging to the promise of strength in weakness! Or fun in chaos!
I generally slog out my days in the kilometer between home, school, and hospital. So it was a bit like a field trip yesterday to go with Scott, on the motorcycle, leaving the kids with teachers and self-supervision and the hospital in Scott Will’s capable hands. We zipped up to Bundibugyo first for the opening of a two-day seminar updating midwives and clinical officers on care for HIV-infected pregnant women. Pamela is a saint, a brilliant one, organizing the training for about 40 people and pulling in a doctor from the Ministry of Health in Kampala to join us. (It was fun also to note that about 8 of those had been sponsored in their medical training by us through WHM in some way). There are about 13,000 pregnancies per year in our district, and the Kwejuna Project has worked to strengthen prenatal care for all of those women. But the 400 or so who are HIV positive are our main focus, and now we are going to be able to give them a more complex regimen of antiretroviral medicines that will further reduce the risk of transmission to the baby.
From Bundibugyo we headed to Kikyo, which is about 25 km from where we live, perched on the side of the Rwenzoris. It is a small settlement that we had never visited before, but we went yesterday to see patients who are suffering from an unknown disease. The clinical officer there, Julius, could use prayers. He’s a competent, faithful, hard-working guy who has been caring for many very ill people. It seems that over the last few months a new infection has arisen in this area. Jonah first became aware and started investigating a few weeks ago, thinking at that point it might be a typhoid fever outbreak. But the tests for that were negative, as were tests for scary things like ebola and marburg viruses, and since then the government has sent people to collect more blood samples. Scott has been seeing some of the patients at Bundibugyo Hospital, but we had not reached Kikyo, the place with the most cases, until yesterday. We are still waiting for results from samples that were sent to South Africa and presumably the CDC, but it seems to be a viral illness, more severe in adults, with a long course (a month), some person to person transmission (nurses and care-givers have become ill), and a significant mortality rate (over 20%). It may be winding down already, there were only 7 patients in Kikyo and 2 in Bundibugyo as of yesterday. Key symptoms are fever, vomiting, diarrhea, abdominal pain/tenderness on exam, conjunctivitis, big spleen, rash (late, not all), and in a few patients bleeding particularly in the urine, some pulmonary edema (but that might have been secondary to over-treatment with IV fluids) . . . . One recovering nurse had peeling hands and feet. We’ve had lots of ideas about possible etiologies, but nothing quite fits all the data, so we’re hoping for a real answer from the tests soon. Meanwhile most of those receiving supportive care are recovering. It is causing some concern among people around here, and of course lots of rumors of poisoning, witchcraft, etc. You can pray for us to know our calling here . . We prayed for the patients which was much appreciated, examined, offered suggestions, appreciated the work of the staff, arranged for more IV fluid, and will keep making phone calls to follow up results.
From the epidemic we went back to the seminar, where Scott taught the afternoon sessions, and then back home. Riding a motorcycle in Bundibugyo is a bit like riding a horse, gripping with the thighs, bouncing out of the seat, the exhilarating breeze and the anxiety of losing control! I was grateful for the opportunity to soak in the sunshine (a rare day of that!), feast my eyes on the beauty of the mountains, wave at children who rarely see a mujungu, interact with medical staff from other units, and see Pamela and Scott in action.
Third Culture Kids celebrate American Thanksgiving, but consider it normal to actually kill the turkey and certainly don’t miss the opportunity to collect its feathers. Sometimes I think my kids are pretty insulated from Kibwisi culture, but when I saw them take the turkey feathers and sticks and turn them into the kind of staff one would see a traditional dancer carry, I realize something is percolating in there. . . Then the day after Thanksgiving Caleb came back from his cross-country practice with pockets full of grasshoppers. They had run to the airstrip, where the vast expanse of grass has become the central hunting ground for grasshoppers, newly in season. The team spent a long break collecting as many as they could, removing their wings to carry them back live for a nutritious snack. Caleb fried his in oil, and we all crunched them, sort of like a shrimp tail . . .Earlier that morning I had seen one of our kwashiorkor patients with a handful, so thought this could be a great way to get a little free protein. So after dinner we snagged Scott Will and the kids and drove back to the airstrip in the dark, on the theory that the grasshoppers would swarm in front of our headlights and be easy prey. Not so, they dove down into the grass when they saw us coming. It was still fun to be out in the dark (unusual and no doubt frowned upon by the security men), full moon, breeze from the motion of the car, laughing and jumping out to trap as many as we could. The take was not nearly enough to bring to the crowded ward, so we fried up this batch too, for desert.
In what is now becoming a tradition, the kids wrote Thanksgiving poems. I can’t find Julia’s right now, but here’s Jack’s, which is also along the theme of protein, but from a unique angle. I guess part of being a third culture person is being able to identify with others, even the main course!
The day was here, turkey’s doom.
I was to be taken away very soon.
They came for me on a big red horse,
Then the man took out is purse.
He handed my owner the money for me,
And when I called out they ignored my plea.
Then everything whirled around like a tornado
And I fainted right then and there don’t you know.
When I awoke I was with a mad beast
Soon to be killed for a great feast.
Alas the killing of me came time
And they chopped off my head with an axe so fine.
There my poor life came to a stop,
But at least I was enjoyed with the season’s crop.
Today is the actual Thanksgiving Day . . . So I saved the best for last, my man. Right now Scott and Jack are out in our truck turkey hunting . . . No, not in the woods, they are looking for the home of a friend of ours who claims he has a humongous bird he’s happy to sell us. We proactively bought a turkey some months ago but as of yesterday he only weighed a whopping seven pounds, not exactly a feast for the 20-some people we’re expecting. Hopefully they’ll be back soon, to do the gruesome killing with a panga or knife. He’s already got a big pot of water on the segili (charcoal burner) outside so he can scald the dead turkey, making feather removal more efficient. Then he'll clean it, dress it, and grill it on our Weber grill. While the turkey is roasting he’ll be dealing with other issues, such as the current list of : helping the district plan the December 1st World AIDS Day celebration that promotes sexual faithfulness, overseeing three charitable house construction projects (a widow, an orphan, and an elderly friend who all have house crises), meeting with team mates who are leaving for prayer and debriefing and review, wading through a ridiculously expensive bureaucratic process to get a lawnmower imported to keep our airstrip functional, fixing team bikes and his motorcycle, evaluating referrals of complicated patients, meeting with elders regarding wedding negotiations for one of our boys, coordinating with MSF (Doctors without Borders) to get supplies for a mysterious epidemic the district is investigating (not so close to us, but we want to help), and that is just a few of the things I’ve actually seen him up to in the last 24 hours. Add to that holding me together in the midst of team transition and goodbye . . . There is no one else like Scott. I’m thankful for him!
Yes, dogs, not very a very spiritual sounding praise, but there it is. Angie and Star may look like ordinary yellow labs, but they may also be guardian angels in disguise . . . We have been here more than 14 years now. That’s the marathon pace, not the sprint. And Angie and Star help set the pace. On Saturday, for instance, there were about a dozen kids at my house: two classmates of Luke now on holiday reading Hardy Boys, two classmates of Caleb studying for exams with him, four young kids giggling with Jack and Julia as they beat drums and played Christmas carols, and a few other assorted acquaintances. Without the dogs that number could swell to 50 or more at the drop of a hat, and then my kids would retreat into the safety of their room. Instead the friends they know and want to be with also know the dogs and are not afraid of them, while random passers-by on the road take a look at the two big white dogs and decide to pass on. Angie and Star are part of what makes this house a home, what makes my children long to come back here in spite of the lure of distant luxuries. Angie and Star are part of the reason I can stay here alone when Scott has to travel, providing at least an illusion of security and decent sleep in spite of armed military patrolling nearby.
Angie is now 11 1/2 years old. It has been a decade since we ran for our lives with her . . . She’s getting old, arthritic, sleeping a lot. Star is still a bouncy 7-year-old, the liveliest puppy of the litter whom we took on Luke’s longing against the advice of the breeder that we choose a calmer family dog. Star and Jack have grown up together, the dog and human sides of one wild soul. God gave Adam the animals right away, before he even had human companionship. I’m thankful for our dogs.
Today I am thankful for team. We’re in the end-of-the-year process of annual reviews, which is a good time to reflect on how God’s faithfulness has brought us through a year. Today we met with Stephanie—a year ago she was just settling in and trying to figure out her plan and calling, meeting barriers and disappointment on funding prospects, and dealing with some unexpected changes in personal plans. Now a year later we can look back with amazement and joy to see what God has done: a chicken project producing eggs for malnourished kids, sustainable protein in the form of ground nuts being farmed and locally ground into paste, two outlying health units with trained staff and new kids enrolled in pilot outpatient programs, a dozen kids getting lifesaving milk on the inpatient ward and dozens more who’ll be helped this week through the ART clinic, even little Chance going home today a perky smiling 7 kilograms, back on the road to health, and even the personal disappointments do not look so drastic now . . . Plus a year ago we didn’t even know that the Massos would be on an HMA, but God provided Stephanie to learn from Karen and then take on her time-consuming administration and supervision of the whole BundiNutrition program.
Our team has pared down in the last few weeks and will soon tighten again. But those who are here continue to work and cry out and cook and live and love . . . Pamela is running a last hurrah massive TBA training and party tomorrow at the Community Center, a chance to say goodbye to these148 older ladies who attend to most of the deliveries in Bundibugyo. Pat is gearing up for more services to HIV positive people through a new program. Kim has been visiting two local primary schools weekly to encourage the teachers in redemptive approaches to their students, and has two different overnight visits planned with local families this week. Sarah and Ashley teach our kids every day, and find time to sing Christmas carols with little neighbors or coach girls’ soccer. Scott Will sees dozens and dozens of patients weekly, CSB students and HIV positive adults and pediatric admissions, and when he comes up for air from that he organizes games for the crowds of loitering children the rest of us would like to chase home! And in spite of constant illness and threatened discouragement the Barts are hanging in there to finish the CSB year strong. We have a great team of people who press on in weakness, who pause to enjoy the beauty of life here, who long for relationships and meaning and real impact, and who are willing to create community in a tough place. I’m thankful for our team.
Today I’m thankful for traveling mercies . . . That phrase that echoed in old-fashioned prayers in our church growing up, and Anne Lamott uses to describe the grace which carries us through this life’s journey. Specifically I’m thankful that Luke made it to America, a mercy not to be taken for granted as a missionary coming the other way to Fort Portal got temporarily stranded in Dubai, and even vehicles trying to get to and from the airport in Entebbe have been stranded by flooding here. This trip called life involves lots of bumpy roads, detours, washed out bridges and impassable mud, so I’m very thankful when we get to rise above the muck and fly smoothly. How quickly I forget the grace which sustains us every day, until near-disaster lurks close enough to realize how blessed we are. That came this week as Savannah had her first febrile convulsion, she’s better now, but seeing one of our mission kids limp and pale is always a reminder to be thankful for the hourly traveling mercies which carry us along.
Luke was up for 40 straight hours on this trip from Bundibugyo all the way to Grammy’s house. Maybe he’ll be a doctor after all . . .
The season of Thankfulness is good for the soul. So I will try to blog thanks this week. Today I am thankful for my kids. I’m thankful that Luke, who was once a preterm little baby refusing to eat or sleep . . . Is now nearly six feet tall, able to write long essays in subjects ranging from physics to poetry, and is right now independently flying to meet his grandmother. I’m thankful for Caleb, who has spent the entire morning in the front room with two class mates, two batteries, scraps of wire, paper clips, and switches, doing experiments and studying for his upcoming end-of-the-year exams; who cheerfully runs four or five miles in second-to-last place as a member of the cross country team; who steps up to the absence of his dad and big brother by organizing his siblings or by sweeping up after dinner. I’m thankful for Julia who went down to play soccer with the Christ School girls she calls friends yesterday even though the coach was sick, who decided to surprise her brother Caleb by totally organizing his room while he was studying, who wrote her Dad a birthday poem, who delights in partnering with me for the care of the family. I’m thankful for Jack who wants to be a chef and helped me create a spectacularly successful semi-Italian chicken and pasta dish with fresh basil last night, exclaiming over the flavors and cheerfully picking, washing, stirring, sautéing, then eating with gusto; who reads voraciously; who solves problems speedily; who wants to be and do everything his brothers are. Children are living testaments to grace, there is no way to deserve loyalty or even the company of the people they are growing to be, but here they are, mine.
Double Scott Birthday tonight—two prime number birthdays, one in the decade of the 20’s and one in the 40’s, for Scott Will and Scott Myhre, who not only share a name, good looks, medical know-how, adventurous spirits, and godly hearts, but also have Bdays in the same week . . . Superb pizza as usual, homemade ice cream straight from the cow (who was mooing through the fence as we ate, to the delight of the twins), cakes courtesy of team mate Kim, and a fun party game where everyone got a bag of goodies I wrapped up from the Gray’s cupboard clean out (best prize: Trader Joe’s dark chocolate chips!!). Caleb put together an amazing Keynote (Mac version of PowerPoint) presentation to honor his Dad (with help from his siblings, including poetry by Julia). It was a fun family night, one that was needed after a heart-sapping week of goodbyes and troubles.
We also honored Luke who will finish his last of 19 exams tomorrow! Computer Theory. His dream was to relax in a hammock and read Lord of the Rings straight through as soon as exams were over, all three volumes, pausing only for food. . . . So we had bought him a beautiful Ugandan woven hammock as a gift to celebrate this milestone. However instead of lazing in the hammock he’s having his best friends over for dinner and a sleep-over and then they all get up early Friday to drive out. His class mates will stop in Fort Portal while Scott and Scott take Luke on to Entebbe to fly out to America. My baby is going across the ocean alone, to cheer his Grammy and be pampered post-exams.
This week we read from Acts 7 in church, where Stephen recounts the history of Israel. The portion we read described Moses, and in one of those moments of Holy Spirit presence in church I saw myself so clearly. Moses was a fixer. He saw injustice and he jumped in to fix it (v. 23-28). He was about my age then, and trying to do the right thing. But his people did not appreciate or accept his interventions! God had to take him through his own personal wilderness years (40 of them!) before he was ready to really lead, to hear the voice of the Lord and to respond. Then the one whom the people rejected became the one whom God chose to end the oppression of His people, but in God’s time and God’s way, not Moses’. I want to be more like the 80 year old Moses than the 40 year old, broken of my assurance that I see the right and willing to lay aside my solutions and wait upon the Lord. This has been a theme of God’s teaching for me this year. . . .
So I was ready to go into our annual reviews with our team, the time we meet with each person and talk about the blessings and challenges of 2007, goals and dreams fro 2008, very quietly, afraid of pushing my own agenda. Then this morning I read Ezekiel 33: the watchman who sees trouble ahead but remains silent is guilty.
It was good to find these two Scriptures in two consecutive days. I want to wait upon God’s timing and direction, trust Him to address injustice, let Him lead and use me as He would, in Bundibugyo and with our dear team. But I also want to be faithful to speak out. Wisdom means discerning when to be Moses hanging out in the desert until God dramatically works; and when to be Ezekiel actively addressing wrongs.
This morning the Gray family pulled out, three kids, 9 trunks each weighing exactly 50 pounds, strollers, car seats, shoes and juice cups, the fruit of two weeks of careful sorting and packing. It seems like we had just stood in the driveway waiting to welcome them back from their unexpected four-year detour through Grant’s surgeries and therapies (though it is well over a year ago now). That welcome day was one of dancing and rejoicing, songs and delight. . . And the expectation that now they had made it through their difficult trials and were ready to invest in building a life as a family in Bundibugyo. Instead today we stood in the same spot, with tearful hugs, sending them back to uncertain plans and possibly the end of their African journey.
This departure was unanticipated and abrupt, but Pat managed to help them pull together a major feast of goodbye. Yesterday afternoon 350 guests, friends from 18 years of ministry, gathered for a few speeches, thanks, laying on hands and prayer, and then a meal. Pictured above you’ll see Grant in front of the massive pot used to cook the pilau (rice and meat); the Gray family being prayed for; and Julia with Chase wearing the hat she crocheted him for Christmas (which is bittersweet, because measuring for the hat project was instrumental in our realization that his head was not growing normally . . . ). Pray for them, for Chase to be healed, to grow and develop and talk and walk in ways that bring God glory. Pray that the Grays would experience Jesus more fully in the way of the cross, the path of suffering. Pray that we would too, because we are suffering as well, losing our neighbors, team mates, friends, maybe for the foreseeable future. Pray most of all for their Ugandan friends, who are not used to goodbyes, to moves, who don’t have email and international travel to keep in touch with distant friends. Pray that we would all sense the comfort of God’s presence.
What single guy would NOT want to join this team??? Why in the world is this one leaving??? Sigh.
The MAF plane took two tries to lift off from our somewhat soggy, hand-slashed (still waiting for our replacement mower since the old one was destroyed in August . . .) airstrip as a misty cloud moved down the mountain to envelop us in rain. Whew. Thankfully they are safely in the air and en route to Kampala, then tomorrow back to the US. Last night we had tearful prayers, a very funny video put together by Luke, gifts, reminiscences, pizza of course, and ended the evening with a wild game that was part “ghost” (tag with a blindfold) and part dancing to the Shrek soundtrack. This week is a season of goodbyes, with the Gray departure still looming. I think I’m unable to take in the reality of it all, though moments do break through, today for me it was seeing Caleb cling to Scotticus in his goodbye hug, the realization that this life of intense relationship and inevitable departure takes a chunk of my kids’ hearts too.
Click on the “Flicker Picture Sets” for the latest slide show posting . . A farewell intramural track meet yesterday to celebrate the new track and bring closure to Scott Ickes’ hard work. We were the only parents cheering . . .but it was really fun to see both our biological kids (Caleb and Jack) give their all, and some of our students and friends successfully race. My favorite moment was when Mutegeki, who walked on barefoot for the race (he’s not on the team) beat everyone in a 200 yard dash, the kid who was suspended earlier this year and has had a rough time. A little affirmation, hopefully will keep him on track . . . .
Rounds on the paediatric ward and the nutrition clinic on Tuesday, from top to bottom:
Tumusimwe—this little boy has a wheezy tuberculous cough and skinny little limbs, trying to recover from the TB which killed his father and left his teenage mother a widow.
Bacecura—this little boy has Kwashiorkor, and as he’s begun to drink milk over the last week his massive swelling has subsided, leaving the malnourished shell, the first step. He’s lost about three pounds already, which is a lot for someone who only weighs about 20. Pray for him to gain strength.
Chance—one of my favorites, his parents are dead, his aunt breast feeds him though she’s pretty desperate herself. He’s holding on to life but only tenatively.
Ngonzi—another favorite, with his AIDS and TB and his sweet, careful but lame mother. He’s waiting for ARV medications, to rescue his immune system from a CD4 count of 60. He’s over a year old but only weighs 5 kilos (11 pounds!).
Evarette—both parents died leaving her with this grandmother. She’s feisty and just beginning to head towards recovery.
Maskia—another orphan cared for by her grandmother, improving.
Ahebwa—sweet and tiny, this baby’s young mother is afraid to tell the family that her husband died of AIDS because she knows she’s positive too, and does not want to be thrown out. Problem is that there are four other oblivious wives and collected children all living still, in Congo.
Robert T—nestled skin to skin, we call this “kangaroo care” for low birth weight infants. He is his mother’s 13th child, and the 12th was also malnourished getting help from us. Sigh.
All of those are getting nutrition help, but there is one more picture of a mystery case. This boy Mubiiru Morisi is 7. He fell ill almost 2 years ago when he was admitted to the hospital for two weeks with fevers and sleepiness and weakness. Since then he’s had dwindling strength, poor weight gain and growth, and swollen legs, and I’m not sure what is wrong with him.
Then there are three of my dearest little outpatients who came back for follow-up today, all of whom have been prayed back to life as people read their stories on the blog:
Kabugho—the baby whose mother died of TB and AIDS right in front of me, and who was nearly dead herself a few weeks ago, still with those penetrating big eyes, not giving up on life!
Masika—after one week at home her weight is up again, and she looks great!
Makuni—still gaining weight too at home, back for a check-up.
Last but not least a few pictures of the missionary crew today:
Stephanie—the woman who pulls it all together for BundiNutrition!! It is a lot of work to arrange food, transport, staff, teaching, patient evaluation, records, fund-raising. She’s amazing.
Julia and Miss Ashley, volunteering their time on their day off of school, made the work go quickly.
Pat was investigating MUAC’s , mid arm circumference.
And my life continues to be improved by the presence of Scott Will, PA from Baltimore.
The Stanbic Bank branch in Bundibugyo was robbed Saturday night, to the tune of 1.3 billion shillings (half a million dollars). This is cocoa season, so buyers are coming into the district, which means money is flowing as the lorries of cocoa roll out over the muddy road. The story is that two women approached the two police guards posted by the bank and offered them drinks which were drugged. While they slept the perpetrators (or thugs, as they are referred to in the newspaper) used crow bars, acetylene torches, and the conveniently located keys to the vault to get in and out with the money. This is a town where hundreds of people live within a stone’s throw of the bank, and the process could not have been silent. This is a district with ONE ROAD and a place where NO ONE drives at night, yet when the police set up road blocks they failed to find the guilty cars (there were two). We are sad for the bank manager who is a friendly and competent lady, and for the disruption this will likely bring to our ministries and projects as the bank recovers. Meanwhile today Jonah is involved in meetings to investigate a mystery gastrointestinal epidemic striking people in Kasitu/Kikyo (not too near us). The difficulties of disease investigation and the success of a brazen bank robbery both are reminiscent of what it must have been like to live in the western US 150 years ago . . . .
The overnight get-away to Semliki Safari Lodge was . . . .words can not express. The place is an oasis of beauty, both the wildness of nature and the order of a luxurious manicured lodge. We were guests of the managers, along with a photographer and his wife who were shooting reams of photos for publicity, and a travel agent checking the park out. Amazingly the photographer’s other job is a full time doctor at the Infectious Disease Institute in Kampala, dealing with AIDS, and his wife started the very successful Beads for Life project which creatively enables the poorest of the poor to start their own businesses. They were a delightful surprise and I hope friends we can keep up with. We always enjoy the manager couple as well, so it was a nice mix of much-needed down time for us as a couple, and of good company, fine wine, gourmet food, peace and quiet.
But as we drove back through the slick mud, leaving the cheerful ambiance of the SSL behind, I felt like we were emerging from story-book Africa back into real Africa. The cavorting kob were replaced by crowds of kids, rusted bicycles, overloaded pick-ups, soldiers and guns. And as soon as we walked into the door we began to get some hard news. None as hard as this past week’s news about Chase, but still not what we hoped for.
First, my mom can’t visit for Christmas as planned. Her back surgery was too extensive and her recovery will not be complete by that time. This was a big blow to all of us. It is still sinking in how much of the next couple of months of life were revolving around that expectation. We are all grateful she was able to have the surgery, it was much needed, but the loss of the anticipated trip is hard.
Then Ndyezika walked in with his exam results. The good news is that he passed more things than last year, and does not have to repeat any classes. The bad news is that he has to re-take 2 of the 5 exams, either later this month or in February. He’s a relentlessly optimistic guy, but even he was pretty sad, commenting that he had hoped just this once God would bring him all the way through, but in his life it never seems to happen that way. It was hard for me to accept as well. More uncertainty, more waiting, another potential failure looms ahead. The same day we got a letter from his fiancée's family expressing their willingness to enter negotiations, and detailing a long list of expenses that will be associated with her bride price. Now we have to choose our “mukwenda”, the go-between who will negotiate for us. It is good news that they are willing but we know it will be weeks or months of financially draining expectations to meet. And we will have to walk carefully between our role as his guardians who are wealthier than he could ever be . . .and raising the bar so high for a church wedding that everyone else continues eloping.
Those are the two big disappointments, but it’s also continuously raining, a very demanding patient showed up early this morning, the power is shutting off the internet, I got news that my sister’s car was stolen (along with all their credit cards, house keys), and the week ahead looks like a long vale of tears as we say goodbye to Scotticus, Amy, and the Grays. The tomb is definitely empty, and it feels like the body was stolen . . . We need prayer as a team in the midst of November clouds to hear the voice of Jesus, putting it all into perspective, that though things are not unfolding according to our hopes and expectations our God is still in control.
“You will find rest for your souls” . . . In a week (a month, a year . . . ) that has held much burden, we are grateful to have the gift of rest. Friday morning Scott and I will head out for Semliki Safari Lodge, a luxury tented camp of the wealthy colonial genre improbably located in the savannah around Lake Albert within the boundaries of Bundibugyo District. It is about two hours’ drive from our home. The managers have volunteered in some public health initiatives in their area which allowed us to connect, and they graciously invited us to come for a night. This will be the third (or fourth?) year we’ve been able to take this little break, and we really look forward to it, being away from patients and responsibility, soaking in the beauty of Africa with all the harsh reality smoothed out. Even God rested on the Sabbath, how much more we need to do so. Last night I finally got a shower and pajamas and just about had dinner ready when Jonah came to consult on a newborn baby. I knew he really wished (though he wouldn’t say it) that I’d come back to the hospital, but I was so tired and felt that I needed to care for my family (and truthfully myself too) instead, so I told him what should be done. I felt a bit guilty for not going myself, and somehow I just knew that this morning I’d find that the baby had died. It had. Probably my presence would not have made a difference, but most people don’t have to face death as a consequence of resting . . . So that experience both leaves me more ready and eager for a real break, and aware of the cost of resting too. The kids are staying home here with Scott Ickes, who finishes his one-year term next week, so it’s a farewell party of sorts. We don’t leave them often, or lightly, though now that Jonah is around that is not quite so scary, but sometimes I realize there is no 911, no ER, and anything can happen. But anything can happen every day, and usually does, whether we’re here or not.
Though the time is not long, only about 36 hours, God can meet us in that space. We’re praying for true rest, which is more than just a break from work, the kind of rest that lays down all burdens but the yoke of Jesus, that hears only His voice calling our names, the kind we can enter into together and emerge from strengthened for the next stretch.
