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Tuesday, April 29, 2008

hunting for mercies . . .

In the last 24 hours as we attempted to leave Uganda, we had a
punctured tire on a fully loaded truck that forced us to drive the
dangerous road to Entebbe in the dark, spent a long time looking for a
place to eat that never materialized, found ourselves unprepared for
the cost of the guest house where we stopped off for six hours, woke
at 2:45 am for our 5 am Kenya airways flight to Nairobi . . only to
be kept mysteriously waiting to the side for about an hour at the
check-in desk until they finally told us our flight to Zanzibar had
been cancelled. Why did we try to go on sabbatical? Weren't we tired
enough already? I have to admit our general response to these
setbacks has been to complain and feel abandoned. Kenya Airways did
send us on to Nairobi at 5 am when they determined they could add us
onto a late evening flight to Zanzibar. We were not relishing 13
hours in the Nairobi airport: think stuffy, airless, broken linoleum
corridors, scant fixed hard plastic chairs along the walls, crowds of
shifty businessmen and confused grandmothers, surly staff. The new
schedule puts us into Zanzibar about 9pm, meaning closed grocery
stores and a long drive in the dark to our rental home.

So when we went to the transfer desk for our new boarding passes, it
was with only the tiniest kernel of faith that we asked if we could
get a day room. What looked like a bleakly hellish day has turned
into an extravagantly undeserved taste of mercy. OK we did have to
fill out six copies of about three different forms with every possible
number, date, and signature, but eventually we ended up with free
transit visas, free day rooms, and free lunch, at a luxurious hotel.
This is not the kind of place missionaries stay. Hot showers, fluffy
beds for napping, football on TV, air-conditioning, fresh flowers in
the tasteful lobby. We were plucked out of tedious discomfort and
dropped into a pocket of peace. A good sign for the three weeks
ahead? After a nap and a delicious lunch, we have hope.

Monday, April 28, 2008

En Route

Stage One of the journey: getting out of Bundibugyo, into the Kampala
decompression chamber, the almost-but-not-quite on leave experience.
Luke personally arranged for a hike over the mountains, inviting a
young German staying in Bundibugyo named Hendrick (the only other
foreigner in our neck of the woods, he's bonded with our team a bit!),
Ashley, Sarah, Caleb, and Scott to join him in the footpath that leads
from Bundibugyo Town to Bukuuku on the Fort Portal side. It is almost
20 km, straight up and straight down, the Bakonjo are not big
believers in the switch-back concept. Before we could leave we had
been called in the middle of the night and early morning to see our
ailing neighbor, so in spite of the efforts to bring closure and tie
up loose ends we left with uncertain and heavy hearts. I drove with
Heidi, Jack and Julia, covering about three times the distance in the
winding ascent over the mountain range's northern spur, and along the
steep winding valley on the eastern side. We took our time since we
knew we'd have to wait for the hikers, and were delighted by a
crashing troop of black and white colobus monkeys jumping over the
truck through the tree tops, and a flock of hornbills rising as we
did. Meanwhile the hiking group set a near-record time of 5 hours
(what happens when you combine teenagers with cross-country
runners . . .).

Over the weekend we took care of some pre-trip necessities, including
updating Jack and Julia's yellow fever vaccines (every 10 years, but a
decade has flown by!) and visiting immigration as part of the process
of updating our work permits (every three years), replaced some ever-
puncturing tires, made bank visits. We are usually in Kampala for
only a day or two on a quick turn around, so having almost four days
and NOT heading directly back to Bundi is unusual, adding the the
decompression effect. Two highlights of being out of Bundi far
enough to pause and refocus, but not far enough to be on total
vacation: we were able to make visits to Matte in International
Hospital's Hope Ward. He proudly announced that he's up to 24
kilograms, being fed porridge and ensure through a jejunostomy tube,
and evidently absorbing his TB medicines more adequately this way. We
took him some art supplies and a math book, imagining his lonely days
in the cheerfully clean and modern (though to him sparse and sterile)

And secondly we were able to take the Jonah family out for a day at
the spectacular pool outside of town where our own mission treated our
team as a Christmas present. Melen and baby Jonah, Masika, Biira,
Magga, Karen, and Sarah. Slowly they began to relax and smile,
splashing in the water, being coaxed into the spacious grass to kick
around a soccer ball, giggling over cards. The younger girls are now
more used to us than the older ones who are in boarding school. Melen
radiates serenity as she oversees her family, she's pretty amazing.
The impact on the older girls though is significant, they are
hesitant, not trusting life in the same way. And they don't want to
talk about Jonah, at least not to me, yet. It at least does our souls
good to extract them for a day from the muddy tumble of inner-city
housing, from the trash-laden noisy streets, and bask in sun and water
and games and togetherness.

We head to Entebbe tonight, our plane to Nairobi then Zanzibar departs
at 5 a.m. Tuesday. Prayers much appreciated once again, for filling
with the presence of God to enable us to love each other, to minister
to each other as we take our rest together.

Wednesday, April 23, 2008

On Sabbatical

And on the seventh day, even God rested, which was meant to teach us a pattern of rest. May will be the seventh month since the ebola outbreak was announced last November, and with the Uganda year-round school schedule giving our kids a holiday, it seems to be a good time to fulfill the wise mandate from our mission leadership that we also rest. Tomorrow we head out, first to Kampala to work on renewing our work permits (the visas that allow us to stay in Uganda year after year) and then next week to Zanzibar. We were looking for remoteness, quiet, water, privacy, visual peace, renewing beauty, and we think we have found it in a beach-front house on the coast of the Indian Ocean. When we were floundering about what to do and where to go, the owner of this home wrote and offered us a great deal for our three-week stay (it’s rainy season, but what can you do about that if your kids are off school in May) that made it very affordable and was worded in such a way that we sensed God’s hand in the opportunity. So for three weeks we will be on sabbatical, just our family. Thanks to visitors and packages we’ve managed to accumulate 22 brand new unread kid/teen great books, which means our readers can devour one per day in between swims in the ocean. That’s our basic plan: swim, walk, read, talk, process, pray, sleep.

First though, we have to make it out of Bundibugyo, which with just over 12 hours to go still feels intimidating and by no means certain. With a few days in Kampala on either side of the three weeks, not to mention a full day of driving just to get to Kampala each way . . .we will be away from home a month. That means lots of planning ahead for the complex web of relationships, workers, patients, team, friends . . . Even our two cows and our dog. It is not easy to walk away, and though we know we desperately need time to focus on our kids, each other, our own souls before God . . . It is not without considerable guilt that we pull away from the glaring needs here for so long. It steels me to know that Jesus did the same thing, even when the crowds demanded food and leadership, he disappeared into the mountains to pray, and I’m sure some children died while he was up there that He could have saved. We do our best to leave contingency plans and supplies, but eventually we have to just go. It is particularly wrenching to leave our elderly and ill neighbor, and we do so praying that he will hold on until we return.

The place sounds relatively rustic and remote, so I have no idea if we will be fully unplugged . . . If so, then come back in late May to visit this site again. In the meantime pray that we would spend the next three weeks in this way (from Marva Dawn’s Truly the Community)
Central to our theology, then, is giving up our attempts to love . . . The first epistle of John essentially describes how love can be without hypocrisy . . Can we grow in love by trying to love more? No, our attempts to love will only end in more frustration and less love. The solution, John implies, is to know God better. This is so simple that we miss it all the time: our means for becoming more loving is to know God better.

Pray that rest would allow us to soak up God’s presence, and in knowing Him better we would return to our life with love.

Sunday, April 20, 2008

April Prayer Letter available

Our latest WHM Prayer Letter has been sent to the printer. For those of you on our mailing list with World Harvest Mission, you'll be receiving your hard copy in the mail with a week or so.

For those of you not on our WHM mailing list, you may download a pdf version (544K) of the letter from the "Downloads (pdf)" link on the right side bar.

The letter includes previously unpublished poetry from Jennifer.

If you enjoy the letter and would like to receive a hard copy in your mailbox, email WHM..

Two Burials and a Wedding

The ratios of weddings to funerals is a bit different here in Bundibugyo than the popular movie title. I would estimate I’ve been to 10 to 20 funerals for every one wedding . . .

Yesterday two of our friends, people who live within a stone’s throw of the mission, buried children. Both had died before receiving medical attention: the first was the boy brought dead to the hospital on Friday. The father of the second called me at 6:30 Saturday morning. His wife had delivered twins at the hospital the day before, and taken them right home. He called to say that one had died during the night and the other did not look well. I was there within fifteen minutes, and had them to the hospital a few minutes later, where my favorite night nurse Agnes was still competently on duty. The grief for one twin had to be put aside to focus on saving the life of the other, so the mother stayed in the hospital with Isingoma while the father prepared for the burial of Nyakato at home.

Then it was on to the wedding: once again the paradoxes so poignantly juxtaposed. And what a day it was. Scott will have to post pictures because the verbal description of the day will not do it justice. We picked up Lynn Leary and her pastor Mike at the airstrip with Pat, back home to quickly change into wedding clothes and decorate the truck with balloons, then on to Ndyezika’s house at exactly 10 (he was very concerned to be punctual) where everyone who could manage piled onto our vehicle. I think Scott counted 20, singing our way slowly to Bundibugyo town, bearing the groom. Meanwhile Massos had taken the girls up to Juliet’s uncle’s home where they bride’s party assembled. Naomi and Liana were flower girls, and Julia and Acacia something like junior bridesmaids. We waited at the church in Bundibugyo town, a crumbly mud-brick but large building that left one questioning whether it was never quite finished or suffered irreparable war damage. The drab church did not matter when the energetic gospel choirs began singing, swaying, clapping. After an hour or more the bride finally arrived, resplendent in white and veil, with her entourage of attendants. Juliet looked stunningly beautiful and happy, and though Ndyezika tried his best to remain appropriately solemn he also broke into the occasional grin. The vows, rings, prayers were pretty much a straight translation from a traditional Anglican service, with the added African element of the attentive best man and matron of honor (our neighbor and friend Buligi and his wife Asita) compulstively dabbing the sweat from the bride’s and groom’s brows, arranging the veil, smoothing imaginary wrinkles or brushing off flecks of dust. Though the service began at a good pace, there were at least three pastors involved in different capacities, a very long but good sermon from Genesis 2 with an emphasis that the phrase “it is not good for a man to be alone” should not be used to justify taking two wives, and an admonition that the families of these two could no longer call them away from each other or interfere in their marriage. There were more songs, offerings, and a very specific and formal process of signing the marriage certificate. Our girls sat patiently up front through it all, smiling graciously again on the way out. Then it was once again chaotic, push and shove, staring onlookers, swarms of kids, trying to prioritize the people into the available vehicles.

By the time we got back to the Community Center for the reception it must have been between 2 and 3 pm . . . There was a diversion to the Masso’s yard for photo ops, the obligatory groupings. Then the reception took another 4 hours or so . . . And as Luke says, was run just like any and every public event that ever occurs here. Major invited guests up on stage in cushioned chairs. Next tier in some decent chairs facing each other across the front . . Then the masses on benches. Everyone sitting still forever, the prayers, the welcome from the LC1, the songs by choirs. The cake was presented and cut and they each fed each other a piece amidst much laughter, then it was basically crumbled into bite-size pieces to make it stretch for the several hundred onlookers, Julia and other bridesmaids serving. Scott was the “Guest of Honor” and in that capacity gave a speech honoring the families and the bride and groom, and pointing to Rev 21 and 22, the hope and beauty that is represented in a wedding being a picture of the “all things new” that God is doing in this world. He did a great job. There was another long interlude while Juliet changed into a beautiful gold gown and then had to ceremonially “search” for Ndyezika who was hidden in the crowd. Later they stood up front, something like a cross between a reception line and the offering at church, people came forward with gifts or money which they dropped into a basin as they shook hands. I’ve never seen so many gifts here, all wrapped in shiny crinkly paper, about half of them from the bride’s family. A CSB student and a CSB teacher each “mimed” (we would call it lip synched) songs played by the DJ in honor of Juliet, and Julia, Liana, and Miss Sarah actually sang “Father we Adore you” with a microphone in front of the whole crowd. By the time the “lunch” was served it was about 7 pm!!!

As soon as people ate the party began to dissipate. At that point we’d been on the go for over 12 hours, kids from the street were beginning to dart in and out hoping for leftover food, and Ndyezika’s friends (including me!) were worrying that the mountain of gifts would be stolen in the gathering darkness, so it was time to get them out. We loaded the entire back of the truck with the loot and the bride and groom and best man and matron into the car, and drove off to their new home. When we arrived some family were waiting, there was a lantern burning in the sitting room of the brand new little cement house that we helped Ndyezika build. Scott demonstrated how to carry the bride over the threshold by lifting me up to everyone’s entertainment, and they entered. We left them there with another gathering crowd, evidently ready to dance through the night out in the grassy yard.

All in all it was a successful day: a beautiful bride well honored, a happy groom whose patience at last paid off, families finally at peace over the arrangement, hard-working friends who spent hours hauling chairs and blowing up balloons and cutting flowers and cooking food. It was a testimony to marriage, to making a commitment BEFORE living together for years and having children, but AFTER finishing school (they were the same ages, 24 and 26, as Scott and I when we got married . . . ). It was an opportunity for our missionary girls to feel included and lovely themselves, to be part of the honored group, to participate. I am haunted by some lingering sadness that the western images of a wedding have so pervaded the African expectation, that the formality inherited over years of colonialism dampened the natural joy of the event. We are praying that the many younger people who witnessed this marriage will aspire to a similar path. And praying for Ndyezika and Juliet. This day was a culmination of many hopes and plans, but also only a beginning. A marriage that has boldly broken old patterns and declared itself before the world and the Lord will definitely come under attack, and they will have a long road ahead. But for today we are all resting in the joy.

Friday, April 18, 2008

More paradox on a Friday . . . .

In honor of Birungi Suizen’s discharge home today, a whopping 8.45 kg and one day short of a full two months in the hospital . . . I led the staff Bible study on Rev 21. Behold, I make all things new. Birungi is a first-fruit of the new world where hunger and tears are no more. He has a long way to go of course. Heidi baked muffins and we had a little party on his corner of the ward, with the seven nutrition patients and their moms that were his neighbors. The rest of the ward, however, is not exactly partying. 35 patients this morning, with two more sets of twins admitted before noon. There is still a little floor space but it is diminishing. By the second hour I was holding onto the fact that I know people are praying for Bundibugyo and praying for me, and I know that Jesus will make it all new, in spite of the misery which seemed to wash and swirl around me. Begging a young mother of a child with AIDS to get tested, to not run away from the hospital with her wilty sad little daughter, to have hope. Ludicrously asking a blind mother of malnourished twins to take them to the lab, as their odd orange starvation hair mingled in their push and shove on her lap for her tired breasts. Trying to engage little Robbinah, who seems to slip downward daily, with sickle cell disease and malnutrition and a mother with AIDS, stick-thin arms holding her cup of milk in her dingy dress that has “I love my Mommy” embroidered on the collar, a costume from another world. Pushing my thumb into the spongy edema that makes a malnourished 5 year old girl’s legs look like they could burst. Tracking down the absent lab man and the key so a deathly ill 3 year old just admitted could be tested for malaria. And on and on and on. Just as we came to the end of the long morning of desperation punctuated by the small rejoicing with Birungi . . . There was a commotion. I came to the door of the ward to find a mildly inebriated teenager holding a very pale boy, the young man sweating with the effort of having carried the kid as quickly as possible for help. “He’s dead, doctor” Margaret sighed as I listened to his chest hoping to hear a heart beat. Nothing. The boy was wearing a school uniform, and missing his front teeth, just like any 7 or 8 year old . . . But he was dead, limp, pale. His mother lay screaming and writhing on the floor, and when I looked up I realized that fighting off tears to the side was the same man Scott wrote about a few days ago (ironically in a post entitled "The Poor Never Get Sick"), a neighbor who just inherited the children of his brother who died of alcoholism. . . This was his actual son, his oldest, named Dan after Dan Herron, a kid whom I’ve treated many times, whom we’ve lived near his whole life. Tragically this was the healthiest kid in the family, there are others who have died or who barely manage to make it through another year with sickle cell, but Dan was tested negative. It seems he was taken to the grandmother’s house this week because school was essentially out . . But not until this morning did the parents learn that he’d had a fever for three days. Malaria most likely, we are having a deadly season of it. So this morning we celebrated one child rescued from the Destroyer, and mourned another who had no time to fight back, who was snatched before we could even enter the battle. Living here, I sense the appropriateness of the last words of the Bible: COME, Lord Jesus.

Thursday, April 17, 2008

2 years and 10 years, milestones and memories

Today is 2 years since my Dad left this earth for Heaven, and 10 years since my nephew Noah left his mother’s womb for this earth.  Two birthdays, both celebrations if looked at from the right perspective . . . But both involved significant pain in the transition, significant change and the perception of loss, significant tears.  I’m thinking about my Dad a lot.  My neighbor John M is only two years older than my Dad would have been, and his immobility (from a hip fracture), his wasting body (cancer), his resilient spirit as bodily functions become problematic and public, his loyalty to us . . . Even his jaunty English cap . . . Remind me of my Dad.  I don’t know how long he has now, Scott had to put in a permanent catheter in his abdomen to relieve the pain of blocked urination, which was another similarity to my Dad’s last days.  As with my Dad, we are part-family and part-doctors, holding his hand and greeting but also taking his blood pressure and managing his medicines.  It is hard enough to walk this path with family, let alone cross-culturally with neighbors . . . Pray for us to do it well.

Wednesday, April 16, 2008

Caring for the Queen

I treated Queen Elizabeth today.  Yes, that was the name of the tiny febrile baby, born in the midst of the hype surrounding CHOGM and the royal visits to Uganda!  Queenie has become a rather popular name around here, and I have a second baby on the ward with just that name (no Elizabeth).  Also saw two babies named after local celebrities today:  Scott, the first baby born on the new maternity ward last July, to an HIV positive mother, his test results still pending but he looks great.  Parenthetically, she received a goat at the goat distribution which she also named Scott.  Scott the goat is providing milk for Scott the baby, who has weaned to try to save him from infection.  Later I dropped in on Baby Jonah, who smiled at me at 5 weeks, which I am sure is a sign of his precocity.  Being named after doctors is much better than one of my other patients, a now-4-year-old former premature baby boy born to an older HIV positive mother.  He was burdened at birth with not only HIV and prematurity, but the name Robert Mugabe.  I was sure his name fit his poor prognosis in life, and had no faith at all that he would make it.  But he’s fine, HIV negative and growing taller, and no one seems to mind that he’s named after an infamous dictator.  Perhaps that is because  names are so unimportant, countless times the parent has a blank stare when asked their child’s name, or their spouse’s name.  One of the services I offer I call “name consolidation”.  Many, many kids have major discrepancies between the names one parent or another or a grandparent use, one name on the immunization record and another name in the chart.  I resolutely insist that the mother choose the two names she wants to stick with and then I cross all the other ones out and rewrite her favorites on all official documents.  Even though no one but me really cares.

Monday, April 14, 2008

The poor never get sick

The angel of Death has racked up a lot of frequent flier miles for visiting Bundibugyo over the years.  

Last week Issac (no real names here), a 38-year old living immediately adjacent to our mission, died of chronic alcoholism.  He led a sad life of scraping by - mostly through stealing stuff from the mission - and squandering what he managed to scrape up.  The saddest part of his tale is what he leaves behind--four healthy kids with no legacy, no nothing.  These kids have been handed over to Charles, his brother, a former house worker to a WHM missionary family who have returned to the USA.  Charles  is unemployed (like 90% of those in Bundibugyo) and scraping by with intermittent manual labor and a subsistence garden.  

Charles showed up at our door on Saturday morning and reported that he now has eighteen mouths to feed two meals a day...and nothing in his pocket with which to buy food in the Saturday market.  I would skeptically brush aside such comments from many, but Charles tends toward the truth in a culture where words are a tool of manipulation and truth is, let us say, not a core value.

Consider for a moment what such a situation must be like. No money in your wallet, no money in the bank, no food in the pantry, no check in the mail, no security whatsoever. And a huge group of people expecting you to provide their next meal.  I'm afraid that the sense of desperation that I would feel in such a situation would reveal a heart of darkness rather than of faith.

So, I asked him to bring a day's worth of elephant grass for our cow and then gave enough cash to buy a day's worth of food for his burgeoning flock...and found him back at my door on Monday morning, hopeful for more work.   Not exactly what I had in mind.   So, after several minutes of agonizing I decided to give him a couple of days more worth of work clearing weeds and brush in our pasture.  Rarely, have I seen more work accomplished per hour.  It looks like he'll finish this job in a couple of days, hoping because of his strenuous efforts that he will have earned the privilege of gaining even more employment in the future.  

While Charles was down in the pasture and I contemplated this situation a week down the road, another former mission house worker, Mark, planted himself on our porch with his tale of woe.  He's not been around he said, because he's not been feeling well.  "So," I said, "you've been in bed at home?"   

"No. Scott, you know we have a proverb in Lubswisi - The poor never get sick."

"I don't think so," I said, "confidently. If anything, the poor are more likely to get sick.  Poor nutrition.  Poor sanitation.  Unclean water.  The poor get sick all the time."

"The proverb means", he said, "that the poor have no time to lay in bed, to recover, to play the role of a sick person.  We must bear our burden of sickness and continue our struggle to feed and clothe and educate our children."

I nodded in agreement.

How long, O, Lord, how long? -Psalm 6:3

Dancing on Monday

Today Birungi Suizen weighed 8.3 kg.  His target for minimum survivable weight for his length was 8kg (though it still leaves him WAY below the minimum size for age).  And he has gone in just a week from standing, to walking, to DANCING.  Yes, dancing.  Pat saw how much he liked listening to our cell phone rings, and managed to find him a gaudy pink plastic toy cell phone that plays obnoxious electronic riffs over and over.  He loved it, held it to his ear smiling and swaying, then stood at the end of the bed holding onto the rail, dancing.  He is the closest thing to the insubstantial nature of prayer taking form.  I’m sure we’ll never know how many people over this world have followed his resurrection journey, how many prayers lay behind those grams accumulating.  He is supposed to stay over target for a week to be ready to go home, something the other little baby boy with TB (Rick Tom, what a great name!) did today, all smiles as we sent him on the way.  My heart still cringes with the possibility that Suizen could fall apart again . . . But for today I rejoice in the dance.  

Sunday, April 13, 2008

A Bundibugyo Weekend: Community and Fatigue

This was a community-oriented weekend, the kind that gives the shalom-sense of rootedness, connection . . . Alternating almost as quickly with the sense that it’s time for a break. When we get to the three-month mark of staying in the district without a Kampala break . . . both of those things happen in varying proportions. I’m more content to be here, more aware that this is home, more appreciative of the little ways that we are included or accepted across improbably deep cultural chasms. And I’m more tired, more ready to take offense or long for relief, to count the hours until a break. Colleagues. Fridays I set aside time for staff meeting at the health center. We do medical topics interspersed with Bible studies, discuss problems on the wards, report on any seminars people have attended, and generally exhort continued effort. This week I taught on meningitis after we lost a six-month-old boy to pneumococcal meningitis (one of the vaccines not deemed essential enough to provide to African children yet). Ugandans are almost universally eager to learn, and I appreciate their enthusiasm. The seriousness of the topic was balanced by their delight in the new jargon “nuchal rigidity” (means stiff neck in medicalese . . . ). Everyone always comes late and I generally start the sessions secretly planning to make the punishing announcement that I’m not putting the time into preparing and attending if they don’t come on time . . . But by the end there are almost 20 staff, and the atmosphere of camaraderie and prayer and commitment makes me willing to do it all again, and I leave cheered, steeled to face the ICU-like atmosphere of my now packed-to-capacity ward. I can tell the midwives are growing to lean on Scott, too. In Jonah’s absence they are calling him regularly (whether it is 3 am or Saturday afternoons) to evaluate difficult labors and take women to Bundibugyo for C-sections. He’s done two with Dr. Sessanga this week, a major step in their partnership as the two general doctors in this district, and one step towards Scott feeling confident enough to do surgery alone. Workers. Friday evening we invited one of our two house-workers and family over for dinner, which we had not done in probably a year. I was convicted by my tendency to value my workers for the way they make my life manageable (washing clothes by hand, doing the first installment of the day’s dishes, sweeping, mowing . . . catching up enough that when I get home from the hospital I can focus on cooking more than cleaning). I resist the time and effort needed to take interest in them for who they are. This man was ill last week, as he frequently is, and we wanted to address some heart issues with him in the presence of his wife. Scott really came through with a loving but clear talk about alcoholism, and a good plan to support abstaining. I think they felt loved by our intervention, time will tell (...he came to church today, for the first time in months!). Neighbors. Our closest neighbor is 76, has for a time survived cancer and a broken hip and severe hypertension, has been completely bed-ridden now for well over a year. This week we thought the end was imminent. Rain caught me when I went to visit, and I spent a good chunk of an afternoon with him, his two wives, his 78-year-old brother, a nephew and two other older ladies, all clustered around his mattress on the floor in the dim room as the rain thundered down. As the day wore on he revived, recognized me, held my hand. We all chatted about the things that most interest my neighbors (marriages and children). It was a rare time of sensing inclusion in the midst of sorrow. By Saturday he was back to his usual self, which is not great, but a relief. Friends. Both Julia and Acacia went to the market with me Saturday morning to find matching white shoes (amazingly, we did, cheaply made heeled sandals) for their wedding garb. They are to be flower girls in Ndyezika and Juliet’s wedding next weekend, so attended a rehearsal later in the day, another taste of inclusion. In between the market and the rehearsal we went to a birthday party Pat had planned for the two daughters of her friend Melija who died of AIDS last year. Kyomugisha turned 7, and Lydia 5. A handful of other kids and the missionary girls all blended in laughter over relay races and lunch. The delight on Kym’s face made the day particularly memorable. Lydia adores Julia, and Julia does a beautiful job of being friendly in the mixture. Pat was called forward to participate in leading a song a church today which she did with good humor, and then got called on to pray too. Her efforts to reach out do not go unnoticed, she is a much loved part of this community. A full weekend of being fully present. But tonight, after two Sunday evening patient consults, I’m counting the days left (11) until we get a break.

Wednesday, April 09, 2008

Casting seeds in tears

Pat led us in prayer this morning, from Psalm 126: Those who sow in tears shall reap in joy . . . using a song sent by Heather:

Those who walk in fields to sow
Casting their seed in tears,
Will one day tread those same long rows
Amazed by what’s appeared.

Seeds, falling, watered by tears. This gives the tears meaning, and even hope, that what we mourn will be transformed, that the mourning itself is part of the transformation.

Six weeks ago I stood on the Paediatric ward to welcome our visitors from the USA, but I could hardly talk to them, because Birungi Suizen lay wasted, bleeding, starving, pitiful. Tears flowed. Today I was truly amazed by what has appeared: he took steps on his own, just a few, but real steps. He eats eagerly now, laughs, cries with passion, jives a bit to a cellphone ringtone, resists the grabs of his baby brother. His transformation has been one of the least likely ones I’ve ever witnessed. I’m glad to have tread that row long enough to see the joy.

Sometimes the tears are not so selfless, just tears of weariness and frustration. Having four preteen/teens can be a storm of hormones, a cacophony of conflicts as they collide in a small house. And their heart issues become more complicated. When Jack and Julia appeared in their new uniforms, they were met at their classroom building by a large group of students on the steps who laughed at them. And while some kids can shrug that off as just the pettiness of the group, the tendency of a small isolated culture to protect themselves from difference . . . It is very hard on Jack who is already much younger than anyone else, who can’t interact on the sports field like my other three kids because of his running-induced heel injury, who is the youngest and more sensitive to acceptance and approval, whose solid frame has become even more strikingly large with his lack of exercise and more likely to draw out malicious teasing. So when he says “I like living here and I don’t care if people laugh at me on the road, but I just want to go to a school where I can be part of the group too . . .” well, that is hard to take. Praying for faith that those tears (his and mine) will bear something of valuable beauty in his life some day.

Monday, April 07, 2008

Monday Milestones

A few milestones of the day, which is only half over . . . .
  • Jack and Julia headed to school in their spiff new CSB uniforms this morning. This year the white shirts, for the first time, have a colored logo on the pockets, with the school motto: The fear of the Lord is the beginning of wisdom. Julia had been on a special overnight camping trip with Acacia and Michael, so Jack was very glad to have her back for school today. Karen commented that the two of them are functional twins, which has become even more true this year at CSB . . . . Seeing them in their secondary school uniforms, it is quite clear that they are growing up.
  • Luke is growing up even higher. I noticed yesterday that he could reach a really high shelf . . So this morning I had him stand back to back with Scott, and yes, it is official, Luke is now the tallest by a half inch. That means he must be a solid 6-1 since Scott is slightly over 6 feet. His life-long goal to be taller than his father has been accomplished. A real family milestone.
  • Birungi Suizen is also growing. He will never be 6 feet tall, maybe not even ever 3 feet tall . . . But he’s alive. Today he was standing with support, holding onto the side of his bed, and broke out into a huge smile when we saw each other. He’s up to 7.5 kg (from 5 kg). The nurses all are so attached to him, in the way that only happens when you’ve poured your life into someone you thought would die, they carry him around the ward and tease him. Annelise came to visit and brought him two match-box cars, which later the delighted mothers of all the nutrition patients were racing across the white tile floor! This child was a skeleton loosely covered by sores and scabs, listless and nearly dead. Now he is laughing, scooting, and today standing. A great Monday milestone.
  • The CSB football (soccer) team will be practicing today, and practicing hard, because they are headed to Arua for nationals in two weeks, having won the district finals 1-0. After the semi-final match result was reversed, CSB faced Good Hope in the finals on Saturday. It was a close game, with lots of angst and energy translating into the ball popping wildly down the field. Usually CSB starts out with a disciplined passing game and kind of unravels as the time goes on, but this time they started out scattered and become progressively more organized throughout the match. The only goal was scored as a penalty kick: a Good Hope player had a hand ball in the box around the goal, which meant that CSB could take a direct penalty shot. They called their own goal keeper, Suula, forward, so it was a keeper-to-keeper showdown, and Suula scored. He also had many, many great saves, so he was a star that day. The only trouble came when the Good Hope choir streamed across the field mid-second-half to rumble with the CSB choir, but the forceful ref calmed them all down. So another milestone, district champions, without Kevin for the first time, a great boost to the confidence of Alex, Kasereka and Ejeku who coach the boys.
  • My last milestone is not at all triumphant, but I want to hold out hope. Maate, the 15 year old 20-kg boy (pictured above), has been in the hospital for over a month now. We thought he had TB, but he is not improving on treatment. Today’s milestone: I got through to the Hope Ward doctor at International Hospital. This is the best hospital in the country, and thanks to the missionary founder and his visionary Ugandan daughter and generous corporate sponsorship, there is one ward dedicated to patients like Maate, who can not possibly afford the care. Maate’s father has not been seen in weeks, his mother is terrified of the trip, and he’s so weak I don’t know what he understands. But I’m praying that they will organize themselves today and find a courageous relative to accompany them, that the referral letter and transport money will be enough to connect him back with life. It would be wonderful to celebrate the milestone of Maate being cured!

Friday, April 04, 2008

Beads over blood

Give me beads over blood any day.

This morning, blood.  My sickest little patient, a comatose 1 year old, lay jaundiced and limp.  After two days of antimalarials and powerful antibiotics, his feverish convulsions had quieted, but he remained weak, obtunded, jaundiced.  As we made our way around the ward, the attentive dad pointed out the bloody stool that this baby had just passed. I suspected this was a pre-terminal sign, and labored over his exam, to find anything we had missed.  I pulled down his eyelids:  now frighteningly pale, the combination of malaria and chronic anemia and now gastrointestinal bleeding conspiring to drain his life.  Our most competent nurse quickly took a blood sample to the lab to get blood as we prepared IV fluids, but within ten minutes he was dead.  This boy’s mother is mentally retarded, she sat expressionless on the bed, perhaps unable to comprehend the loss.  But his father, the one who had carried him in, who had sat by the bedside, who had managed his care, understood.  He began to sob.  I rarely see a man cry here.  The usual post-mortem scene is of wailing screaming women, writhing on the ground, while grim men gather the body and stride off towards burial.  But this mother did not react, and this father had those shoulder-shaking heaves as his tears began to flow.  Mine too.  This boy needed an ICU, instead he had us, and we were not enough to hold on to him in this world.  

This afternoon, a bead, the far opposite end of the spectrum.  Two grandmothers appeared in the kitubbi just as I was heading off.  Sigh.  What now?  I read the referral:  the child they were holding had been send to the operating theatre in Bundibugyo . . . For a foreign body in the nose.  I could have given them transport money, probably what they were hoping for.  Instead I went inside for a flash light and my handy little ear-wax remover, part of the essential pediatrician package, a sturdy pen-like instrument with a small wire loop at the end.  A few seconds later I had determined which nostril held the object, and reached past it with the loop and pulled it out. A bright orange plastic bead, just like the dozens that were braided into this toddler’s hair.  The old women jumped to their feet and began a spontaneous song and dance, they were so happy.  Me too.  This is my kind of problem:  concrete, limited, solvable, with clear evidence and end points.  I laughed with them.  They must have been very worried, and must have been so attached to this little girl, their rejoicing was refreshing.

I have to admit that I prefer beads over blood.  Something I have the tools to handle, something where I can see the problem and make a difference, in a very short time.  No patience required, and little faith.  No broken hearts, no tears, and quick glory.  Why can’t more of my life be like that, instead of convulsions and tears and blood and feces?  Why can’t my problems be as shiny, compact and tangible as a bright orange bead?

Thursday, April 03, 2008

A bit of redemption

Redemption comes piecemeal in our lives, in spurts, with obscure outlines, but tangible nonetheless. Today, redemption looked perky and smelly, in the bleating stubbornness of 51 little goats, yanked by their ropes to follow beaming HIV positive mothers, or bereaved but resilient aunts and grandmothers, home, portable protein. Scores of people across the globe had given up their usual Christmas treats to purchase dairy goats for poor women in Uganda instead, to purchase the hope of feeding one’s child with the daily milk, the means of avoiding infecting one’s precious baby. Amazing. Karen’s vision, supporters’ sacrifices, Lemmech’s footwork, Pat’s advocacy, Stephanie’s organization, Pauline’s competence, Acacia, Jack, and Julia’s goat-wrangling enthusiasm . . . All pieces of that redemption.

More redemption arrived in shoeboxes and duct tape: the long-awaited orthopedic inserts, in triplicate, packages mailed in early Feb, mid-March, and late March, caught in the web of the Ugandan postal system, and spit out in rapid succession to reach us all on the same day. Jack is gliding along in cushioned protection, more hope of healing. We are grateful to our orthopedic surgeon friend, who never gave up and kept mailing. Luke’s face shows good signs of healing, too.

And more redemption, buried in the nuances of a four-hour staff meeting at Nyahuka, camouflaged by inefficiency, wordiness, complaint, and story-telling. In the end there was some positive organizational process, some airing of grievances, some exhortation towards work and responsibility and courage and community. We struggled mid-meeting through the cautionary tale of the UNICEF bicycle disaster (how good intentions can have devastating effects): they donated two bicycles for immunization outreaches, the district person in charge gave the bikes to two male nurses saying that a woman would not use the bikes for work, ignoring the fact that the person who has actually DONE almost ALL the immunizations over the last decade is a female. She responded by a passive-aggressive work slow-down, and now post-bicycles children are not getting immunized. An unhealthy but perhaps unavoidable response to the injustice she so keenly felt. After much begging she seemed to agree to resume her duties today. Happiest for me, a new nurse whose friendship Heidi and I are growing to enjoy, volunteered and was approved by the group to move into a position of partnership and responsibility in the nutrition programs. Mostly good news in this meeting, just my American efficiency which bristles at the long time it takes to reach those decisions.

And lastly, the redemption of a rain-free day, a respite from the drenching, a hot breeze and blazing sun, pizza at a relaxed pace without the threat of impending storms, enjoying team.

Wednesday, April 02, 2008

You know it's going to be a tough day when . . . .

  • when half the team misses 6:30 a.m. prayer meeting, because they just went back to bed after unloading the much delayed (brake failure, road blocked by mud, etc) truck of goats which pulled up to the Masso house at 3 am today!!
  • when the teammates who DO show up report the theft of a significant chunk of money from their house in the last day
  • when Luke wakes up, and yesterday’s bruised nose now clearly moves where it shouldn’t, i.e. It is actually broken
  • when Scott comes walking back from taking the kids to school without the truck he left in (driving them because of Jack’s feet, and the terrible rain . . . ), he had slipped off the slick muddy road into a ditch, stuck on a journey of half a mile . . .
  • when perky Caleb stays home sick with aches and a mild fever
  • when a two-week-old baby manages to collect a half a liter of pus under his scalp, just from a simple infected wound (though the good news is that the baby looks much better after incision and drainage), reminding us of this swamp of infection we live in
  • when we struggle through our first post-Stephanie HIV clinic day

Praying for glimpses of redemption in all this tomorrow.

Tuesday, April 01, 2008

Fools and April and random news

April Fool’s Day is one of those random cultural nuances that Uganda has taken up with enthusiasm.  Over the years my kids have learned to be wary of the day, so they were well prepared when classmates told them to go see a certain teacher (a favorite way to cause embarrassment and confusion).  The national newspapers both carried front page stories of questionable taste making fun of international figures and their religions, stories which seemed almost credible until the last line.  Caleb is still not sure what was happening in one class where a teacher reprimanded the students for not rising when the teacher entered, a theoretically culturally prevalent form of respect that has not been enforced or even mentioned in his class all year.  A joke?  When the teacher told the laughing (?insolent or confused) class to stand for the third time, Caleb was the sole student to obey, which earned him much jeering from the students but then saved him from running a punishment lap around the track.  He would rather have run than have been singled out,  joke or not . . . So when the Pierces told me that their dog had killed a skunk in an epic night-time battle I was pretty skeptical this morning.  But sure enough there was a small dead mammal curled up in their grass:  a white-naped weasel, as it turns out, our first time to see one.  And when Caleb came in this evening and said Luke had cut his lip I also wondered if they were setting me up, but sadly it was true.  He went after a non-ideal pass to score a goal in soccer practice, and the keeper dove at his feet, missing the ball but knocking Luke onto his face.  We don’t think his nose is broken, but he’s pretty scraped and swollen and the blood was impressive.  At least his effort scored a goal . . The boys are practicing hard, because the Saturday loss was annulled when it was proven that three of the opposing players did not attend the school they were supposedly representing.  Probably the most encouraging part of the whole ordeal was that no missionaries were involved in this corruption-busting exercise, it was fully handled by a CSB staff member, who emerged exhausted.  When you consider that this young man possibly had to shame or cross his seniors, possibly even men to whom he is related, it is a remarkable testimony to change that he was willing to do it.  He’s already announced that he will not contest the final match this weekend, no matter what happens!

WHM chose April 1rst as a mission-wide day of prayer, with no April Fool’s joking at all.  Our team prayed through the day, a cross between a marathon and a relay, with individuals and small groups meeting hourly throughout the day 6 am to 6 pm, closing with all of us praying together as a team for each team of WHM missionaries around the world.  Our theme was Isaiah 25, a great picture of our generous God’s feast, of the veil being pushed aside so we see reality.