Ebola Hero admitted to Medical School

On December 16, 2007 we lauded several heroes of the Ebola response in
our blog, one of which was the Clinical Officer who spearheaded the
response at the very epicenter of the epidemic, Julius Monday. He
fearlessly put himself in harm's way for the good of his patients all
the while managing not to contract the dreaded disease himself. In
the midst of The Plague he chose not to run but to care for the sick
and the dying, both before and after he knew the lethal identity of
the viral agent. His clinical acumen, compassion, and endurance
caught our attention and after the epidemic was over we publically
promised (at the District Ebola-Free Celebration) that if he could
garner an admission letter to one of either of the top two medical
schools in the country (Makerere or Mbarrara) that we would privately
sponsor him through the newly established Jonah Kule Memorial
Leadership Fund.

Well, by God's grace that day arrived today. Julius called me from
Mbarrara with his Medical School Admission letter in hand- jubilant
and thankful. "Thanks, thanks, thanks Doctor Scott for your prayers!"

It is a long road he faces. Five years to complete the degree and
then another year of internship. Six years is a long time. It's
still a struggle to face the travel on this road without Jonah, but
Julius is one of the sprouts that we see coming to life from the death
of Jonah's grain of wheat. I look forward to seeing the heavenly
accounting: the lives saved, the suffering snuffed, the compassion
extended by Julius Monday in the memory of our colleague and friend.

Please pray for Julius Monday.

Paradox Tuesday

The two smiling, thriving girls whose malnutrition had been cured went home today.  Both had been transformed from stick-figures to plumpness, from lethargy to life.

But two others died.  Including Mackline, the pitiful orphan who came too far too late.  Her first sips of milk and ORS threw off her precarious balance, and the life drained out of her.  The other death was of an infant with AIDS--though he had tested negative a few months ago, and his mother weaned him, he must have become infected in the last month, and he dwindled to death in the short course of a week, in spite of IV antibiotics, fluids, and milk.

While the two celebrants packed their belongings to return home from their weeks of hospitalization, Mackline's aunt wept lonely tears as the staff helped her bundle her things for her trek.  And that is the way the battlefront looks.  Victories and defeats mingling together, from bed to bed.  Birungi Suizen came to greet us all today: a whopping 10.8 kg (he used to weigh 5!), he is actually getting close to being a within-normal weight for his age.  But as we passed him around, digging up candy from pockets and teasing him, smiling, remembering the miracle of his life, another patient returned, the withered premature infant of a 15-year-old mother, 1.45 kg.  Will he look like Birungi Suizen one day?  Seems doubtful.

The two deaths made me review our records:  58 admissions for nutrition in the last two months.  6 deaths.  About 10%.  Of those six, four died within the first day, all children who came from distant reaches of the district, too late.  The other two were born to mothers with AIDS.  So do we need more case-finding outreach?  Better initial stabilization?  Is 10% the devil's toll, the inevitable margin of loss?  Much of me rebels against that defeatism, but I admit to feeling that way at the moment.  There is great value in professionalism (doing the best we can with our resources, first do no harm, and all that), but we as doctors, and as westerners, can also live with the delusion of being able to save everyone.

So, as always, walking the paradox.  Rejoicing with those who rejoice, weeping with those who weep, examining my own heart to know if I have been negligent, fearful of what I might find, weary of the war.

In celebration of provision

Scott unloaded the UNICEF boxes over the weekend, so these stacks
greeted me when I opened my medicine store today. I quickly unloaded
the new scale and length board and set to work measuring everyone on
the ward. After rounds I got all the boxes onto shelves, since they
can't be stored in contact with the floor. The disbursement we were
sent almost perfectly fills the store room--I remember when Scott
built it that I was thinking it was way too big to be of use, but God knew that
we would need the space. Just like He knew we'd need the food for the
continuing arrivals of the desperate. Today's newest patient:
Mackline, not yet a year old, whose mother died in a village on the
other side of the mountains (2 hours' DRIVE from here) and who then
ended up in the care of a great aunt in Ntandi (more than ONE HOUR
drive away). She is more than three standard deviations below normal
weight, and a good portion of that is the edema fluid that has
accumulated in her protein-deficient tissues.

Some of the packets spent only a matter of minutes in the store before
going right back out to feed the hungry. Week before last (Faces of
Hunger and Healing, July 16) I posted pictures of children who were
cured, and at the bottom of the list an anxious girl clinging to her
mom, and a hungry little girl holding her red cup. Those two should
be discharged within a week, the first now smiles and laughs and
greets me, the second is up from just over six kilos to NINE today!

From the hospital I biked straight up to Karen's for our semi-monthly
nutrition team meeting. As Karen prepares for Sudan, she is getting
all the accounting in ship shape to hand over to Sarah while we wait
for more team help. Sarah majored in economics, and with Luke going
to boarding school and Acacia to Sudan, half of her teaching time is
being freed up. We were all relieved when she volunteered to step
into Karen's role tracking and distributing the $65 thousand a year
that flows through BundiNutrition into four major areas: direct
purchase of food for the malnourished, dairy goats for milk for babies
whose mothers have died or who are HIV-infected, the chicken coop for
eggs and demonstration garden for fodder, and the salaries of the
three extension workers who manage the nitty gritty of all this.
These funds come from you, our friends, people who organize their
friends to buy goats or who decide to invest in the Kingdom by
providing food for the least of these. Every month about 150 kids get
some kind of help: nutritious eggs and beans or gnut/soy paste, goat's
milk, in addition to the UNICEF food. Some are HIV-infected, others
are orphans, some have mothers who are unable to manage, all are in
need of a boost to cling to life. That's 150 families who directly
experience the provision of God, and many more who are related to
those and see what is happening.

And amazingly, if all pledged funds come in, we should have exactly
what we need. Just like the store being exactly the right size. This
week one of our donors wrote that God moved her to give a bit above
her pledge, and a few months early . . . Over and over we see evidence
that it is God who cares for these children, and God who provides, who
anticipates the next Mackline and makes sure that there is milk. We
merely watch on the sidelines and give you commentary so that you can
also rejoice.

Re-Creating

The root of the word recreation is to become re-created, to have that
breath of life re-breathed into the soul. For me, that is facilitated
by the isolation and beauty of nature. It did not take much
convincing to get the four single WHM women to join a 24-hour camp-out
in the rainforest this weekend. We piled our gear in Pat's car Friday
afternoon and headed for the Ituri Rainforest, set up in a clearing in
the woods, grilled vegetables and marinated chicken, told stories
around a blazing campfire (and learned Larissa is a bit of a
pyromaniac), and scurried for the shelter of an old Myhre family tent
(which we had to resurrect with pirated poles) when lightening and
wind threatened a storm. In spite of the rest of the district's
drenching we slept peacefully dry! Saturday morning we hiked through
the boggy forest. As usual most of the animal life was jumping
through the canopy: five different species of monkeys on our hike,
plus a few squirrels and rare birds. Closer to the ground we saw only
prints in the mud: sitatunga, bush pig, forest elephant, buffalo,
baboon. The hike took us by two hot springs, sulfurous steaming
moonscapes where boiling water bubbles through the crust of the
earth. Our guide told us that the local people used to sacrifice
children there to thank the gods of the springs for the salt they
collected. A stark reminder of the grip that fear and evil have held
on this place that we love, Bundibugyo.

By mid-day Saturday we were back to real life, including a brisk trek
through the Nyahuka river to reach the family home of a nurse friend
whose father had died. The burial was over but we found the family
still sitting exhausted on dried banana leaves scattered on the mud
floor of their house. . . . I went because I remembered how much I
appreciated the many, many friends who supported my family when my
father died. The situation was a bit similar, with Rose being the
oldest, the medical daughter, who helped take care, but in her case a
stroke had debilitated her father for many years. Like us there was a
mixture of relief that her father's suffering had ended, with the
sadness of missing him.

Last but not least, the highlight of the weekend for the Myhre
kids . . . every Sunday afternoon we play a little game of family
soccer for about an hour or so in the yard. This year we've had the
tremendous advantage of Miss Ashley's skill and Miss Sarah's efforts,
so that when we play adults vs. kids it is a pretty even match. Scott
treated us all to team jerseys his last trip to Kampala, so the final
photo shows us post-game, a bit muddy and sweaty but definitely re-
created!

Accounting Heroes

Do you know who blew the story that King Leopold of Belgium had turned Congo into a personal kingdom run by slavery?  An accountant.  A clerk at the shipping docks added up what went out to Congo, and what came in to Belgium, and concluded that the balance was not in Congo’s favor.  This led to the awareness by the rest of the world that rubber was being obtained by drastic measures (including cutting off the hands of those who did not tap enough trees).  

So accountants can be heroes, particularly in the world of aid, of missions, of development.  This post is a small tribute to some of those heroes.  Jerry and Dwight in our Sending Center.  Scott, David, and Karen, who manage tens of thousands of dollars each, carefully planning, tracking, submitting receipts, being responsible for Kwejuna project, CSB, and BundiNutrition.  Michael, at least we hope soon, handling money for development in Mundri, Sudan.  And Scott again, because all the miscellaneous and sundry needs of team and widows and projects and orphans pass through his hands.  All of these people do lots of other things too, but their non-glamorous desk time may be the most important.

Where are the brave accountants, the careful people who are patient enough to sit at a computer or use a calculator, to save the world?

On weeping, waiting, and hope

Read the following list of woes and guess where in earth it is referring to:  loss of land to foreigners, scarcity of drinking water and firewood, forced labor, bad government, famine, widespread rape, slavery, proliferation of orphans and widows, breakdown of community life. Sounds a bit like Africa, particularly the immediate areas around us in Eastern Congo, Sudan, Rwanda . . . But it is actually straight out of Lamentations chapter 5, a description of the fall of Jerusalem.  In the face of that destruction Jeremiah weeps and waits, for hope.

It’s been a weeping and waiting kind of week here, actually a weeping and waiting kind of life. And usually I think I’m waiting for solutions, for answers, for change.  But Lamentations says we are waiting for hope.  Waiting for a glimmer of God’s presence.  Because that is what we really need, even though I think we need much “more” which is actually much less.  Like food for the hungry and justice for the poor and rest for the missionaries . . .

Pray that in the spurts of relief and answers we would not be satisfied with less than God Himself.  Pray that hope would come.  Here are some glimpses of it this week:

• Right now Scott has a truck full of UNICEF supplies, heading back from Bundibugyo.  It was touch and go.  He went to their office in Kampala which seemed to trigger the release of the goods, but they were sent via a UNICEF driver to Bundibugyo and mistakenly off-loaded at a district store.  By the time we traced them we worried that we would never see them again . . .but all is well.  A major answer to prayer.  The most severely malnourished inpatients will be drinking this milk powder for months to come.
• Thanks to vision from Michael, persistence from David, and footwork from Kasereka, CSB was able to obtain three UNICEF water tanks that were donated to the district for school use.  These are worth many thousands of dollars, freeing other CSB funds for the many other needs of the school.  Amazing.
• A friend from UVA days is funding the salaries of the three nutrition extension workers for three years.  Wow.  This allows our ongoing donations to go for food, and allows the sustainable parts of the program (chickens producing eggs, goats producing milk and more goats, gardens producing food) to be built and secured.  We are so grateful.
  

Many days, like Jeremiah, I feel that this calling is too much, that we are “caught between a difficult God and the service of His impossible people” (loosely quoting from the Card book).  Then we get generous friends and amazing supplies from unexpected places, and it is a brief parting of the clouds to keep us moving forward.  Weeping we wait, and hope does arrive.

Cooking class and Dr. Seuss socks

It’s only Tuesday . . . But Monday was a week in itself.  I walked in the ward, early, alone (well, no staff, but not really alone).  As I read through the nurse reports I realized that baby Precious had died during the night.  I heard people referring to her as “Precious” so I’m glad her name defined her in her very short life.  I was then almost finished with weighing all the patients when a father rushed up at the end of the line to put his 3-ish year old daughter on the scale.  He was sweating, having carried her from a village quite a few miles of steep paths away.   As soon as he unwrapped her still form for weighing, Larissa and I whisked her into the treatment room.  In his hurry and distress he had not realized that she died somewhere along the way.  She had no heartbeat, not even a flutter of breath, fixed glassy eyes, cold skin.  Women wail in a very scripted way, and their mourning I have come to expect and predict.  But this young dad had rushed so earnestly that he arrived a good 20 minutes ahead of the rest of the clan, so when I told him his daughter was dead he was stunned and alone, and his spontaneous tears really got to my heart.  By this morning three more kids had died, all with a final pathway of anemia.  We are still struggling to keep up with the blood supply (which is why I welcomed the recent blood drive at Christ School!).  I find myself sometimes hesitating, not wanting to care too deeply about yet another frail fragment of humanity that is so easily lost.

And that’s why today’s nutrition clinic was particularly encouraging.  When I finished inpatient rounds I went around the corner of the ward to the porch where we distribute outpatient food to help Pat, who is filling in for Heidi while still doing most of what she usually does.  Pat was there, but all eyes were on the cooking demonstration being led by a young man we just hired to help with BundiNutrition.  Charles Baguma just completed a degree in social work at Makerere, which makes him part of an elite cadre of University-graduate Babwisi.  But there he was with his pans and spoons and the riveted attention of 20-some grandmothers and caretakers.  Thanks to his interning with Scotticus, he was ready to teach them.  He showed them how to mix the gnut/soy paste with cooked matoke to form a nutritious mash.  Then he made everyone go wash their hands and took spoonfuls around the crowd, for each kid.  What fun to see little Mariam munching away on the protein!  And my morning was complete when one of the two great-grandmothers who are breastfeeding their orphaned great-grandsons returned.  Baluku was barely over 2 kilograms a few weeks ago, and is now close to 4.  But what really made me smile was the fact that he was wearing the most glaring purple and green striped pom-pommed socks which came up to his thighs, an accessory straight out of a Dr. Seuss book, and NOTHING ELSE.

This lions are quarreling

“And we are just here in the grass.”  That was how my neighbor described the atmosphere in Bundibugyo District.  The civil servants, those nurses, teachers, accountants and administrators, who depend upon government-issued salaries, are on edge.  They do not want to take sides in the major political strife that is occurring, because they are not quite sure which side will emerge victorious.  And this is not about which side is right, at least not for them.  It is about survival.  Corruption is assumed to be rampant, truth is assumed to be elusive, success in life is assumed to be tied to patronage, so the path of wisdom is to lay low in the grass until the lions achieve some truce.

I’ve been reflecting on the role of the outsider, people like us, in this place.  More and more I see that a major aspect is that we ARE outsiders. Yes, we try to learn the language, to achieve acceptance, to work within, to build relationships.  But our other-ness carries a measure of safety and a measure of power for change.  My life does not depend upon which of the lions dominates the other.  My income does not depend upon staying in the good graces of the governing political party.  My relationships don’t carry any weight of bribes asked or owed.  

That independence sets us apart. It means the school can fire teachers who abuse female students, even if that teacher would happen to be related to a man of power.  It means that our nutrition programs hand out food to children who are marginalized and malnourished, not to those who are relatives of the health workers. It means that we can speak against injustice without fearing a curse.  For some, it means we can be trusted.  For others, it means we can be dangerous, because we are harder to manipulate.

Last week I was filled with indignation, I won’t say holy indignation, because I now my anger does not carry the fully righteous mix of truth and compassion that it should.  But I was confronted with two-year-old child who had become progressively lame, with a gibbus back, probably due to spinal TB, a treatable condition.  I had arranged for transport from our own donors (equivalent to about a month’s salary here) to get her to a decent hospital for neurosurgical evaluation.  I asked her mother to call her father to come in and contribute some token amount, for a meal along the way, so that he would also own the decision to seek care.  He was a relatively well-off man with three wives and a fish-trading business.  He refused to give his wife and child a single shilling, telling me that he had nothing.  As confidently as I could in Lubwisi I cautioned him that God sees his heart and actions and cares about the life of even this child.  And I advised the mother to seek support from her brothers if her husband refused to help.  She requested discharge and a few days later came back with her brother and her own savings to embark upon the journey towards healing her child.  But interestingly, even though she was going with her brother, her husband was there to see her off.  I think he had begun to doubt his refusal to help.

It is anti-cultural to put the power of money and motion into the hands of a woman when her husband is not in agreement.  Was this wrong?  I hope not.  I hope it was an example of the way the Gospel frees.  I hope it was a small stand to show the mother of this child that she was a valuable person who could act to help her child.  Certainly Jesus was not intimidated by the religious establishment of his day, which made him a dangerous person too.  But I am very , very aware that I am not Jesus, and all of my struggles for justice are tainted by pride, by a judgmental heart, by incomplete understanding of the real story.  I can only pray that while the lions quarrel, we can give a hand up to some of those cowering in the grass.

Prayer Requests for the Team

“Arise, cry out in the night, at the beginning of the watches;
Pour out your heart like water before the face of the Lord.
Lift your hands toward Him for the life of your young children
Who faint from hunger at the head of every street.”   Lam 2:19

Jeremiah wrote these words watching the suffering of Jerusalem at the hands of invaders.  Scott has been leading our team in a study of lament, which challenges us to cling to God.  As we also bear witness to the harrowing effects of sin and sorrow, we invite you to cry out in prayer, to pour your heart before the Lord.

1. For the life of children.  Would you pray specifically for Christ School, as we near the end of the second term?  We all knew it would be a rough summer with the transition in leadership, and we praise God that the riots which erupted this time last year were avoided, that in spite of a major theft, struggles with the food service, shortfalls in funding, and student suspensions for misconduct . . .the Pierces have weathered their inaugural term with grace, vision, and even a spark of humor.  Please pray specifically for the staff and missionaries to have wisdom to teach and model godly sexuality.  When you take over 300 pubertal human beings emerging from a culture where sex is viewed as a commodity for transaction and an essential component of normal body function . . . Well, we realize that the spiritual beauty of the creation of humans as male and female, and the spiritual safety of the placement of sexual relationship within the commitment of marriage, is lacking in these students’ minds and actions.  This has become starkly apparent this week as we cared for a girl who nearly bled to death, possibly from a botched abortion.  Pray for their lives.
2. Who faint from hunger.  The pediatric ward has been running at 150% of capacity for most of the summer.  Rising food prices, unreliable weather patterns, dissolving family safety nets, increasing awareness of the hope of help . . All have brought many more desperate children to our attention that we have the resources to care for.  Praise God that the team of former missionary Scotticus, summer interns, and Ugandan university students conducted an illuminating evaluation of the BundiNutrition programs which confirms the wisdom of expanding the use of locally produced peanut/soy paste that Stephanie pioneered.  We distributed another batch of Matiti project goats (organized by Karen), and another round of supplementary food to HIV-positive women and children (still funded by Pamela’s advocacy, in absentia).  PLEASE PRAY that UNICEF would confirm their commitment to provide milk-based therapeutic food by signing their agreement and sending our next shipment THIS WEEK.  Pray for Heidi, my right hand help and friend on the front lines, who has to spend two months’ “internship” in Kampala for her nursing license, and for me to persevere, to see the fainting revive and live.
3. At the head of every street.  Bundibugyo is more of a maze of paths than a grid of streets.  And the political system reflects that obscurity, with funds and accountability being hidden behind twists and turns.  Yet your prayers are beginning to shake things up.  In the last two weeks, a crisis has boiled over, pitting one seemingly “good guy”  against some entrenched local corrupt politicians. Three fairly influential and notoriously dishonest civil servants were “interdicted” (fired) this week.  Would you please KEEP PRAYING FOR JUSTICE to prevail?  For the Lord to hear the cries of the hungry and remove from power those who embezzle their aid?  For a true turning to the Lord in the hearts of the people, so that they rely on God and not on stealing for their security?  Your prayers have the power to bring about real change in Bundibugyo.
4. Pour out your heart.  The season of sorrowful goodbyes cycles around again, as Katie, Jesse, and Nick finish their internship and depart tomorrow with their leader Kim.  The Massos have tentatively scheduled their long-anticipated (but I admit serious denial in my own heart) departure for Sudan in the beginning of October.  And very close to home, Luke will enter Rift Valley Academy’s 11th grade class the first of September, our oldest off to boarding school.  The waves of grief are building once again.  Pray for hope, for the daily assurance that God leads and loves even in loss.  We had hoped for another couple (the Clarks) and two more single guys (Jason and Nathan) to be here by now, picking up some of the threads that will be left dangling as our team fabric is torn with these departures as well as the others over this year.  Pray for their support to come in God’s timing, and for us to recognize mercy in the apparent delay.
   

Thank you for being our watchers, those who cry out in the darkness and strain to see the dawn.  We know that your prayers are moving in the lives of students, hungry families, politicians and team members.  

Precious, not pictured

I was asked to name a baby today.  Her weary mom seemed out of ideas on her 9th child.  Or perhaps she did not want to bind herself too closely to this tiny and deformed little girl.   I had been called by the midwives to examine the baby, and found a full term but very small baby with a cleft lip and palate, missing skin on the back of her scalp, a small extra sixth finger on each hand, and a huge omphalocele, which means that her bowels protruded in a sac of membrane extruding with her freshly cut umbilical cord.  This is a classic combination for the highly lethal Trisomy 13.  In a rural African health center, what can we do for her?  Cover the gaping abdomen, keep her warm, and offer milk.  Not much more than that.  Though I debated taking the same aggressive referral risks that saved the little girl Kabajungu in the picture below, I decided not to send this baby anywhere.  Her prognosis with full Western medical care is a 50% mortality rate within the first month of life.  So who am I really helping if I push the family to take a long and uncomfortable journey to an unfamiliar place, to struggle in a dysfunctional medical system, and probably return empty-handed?  Still, it is hard to make the decision to pursue comfort and palliation and not surgical correction.  I feel the heaviness, the gravity of such a decision, and the draining tiredness of having to make it.  I’d rather not.

When I was filling out her admission forms and asked the mother for a name, and she told me to choose one, I thought for only a few seconds. Precious.  My Lubwisi falters on matters of the heart, so I called a nurse to help me explain that the name symbolizes that this little girl, even with all her problems, is precious in the eyes of God, whether she lives a few hours, days, months, or decades.  The testimony of friends from Chicago whose son Micah died of lethal congenital anomalies the day he was born came to my mind:  from the perspective of eternity, a life of 7 hours and a life of 70 years are the same, both immeasurably short, and both infinitely precious, worth the attention and love and sacrifice of God.

And while part of me would like to take a photo of Precious for scientific purposes, I decided that on this post she should not be pictured.  Because her earthly body at this moment is a very distorted picture of the eternal reality of who she is, of what she will look like when she is made whole.  The privilege of watching bodies become whole is one of the greatest ones I have experienced here, but this time I will have to wait for Heaven.

Faces of Hunger and Healing

From rounds today:

Kabajungu Margaret, the little girl who was dying of an intra-abdominal lymphoma last year, against all odds and through much struggle, cured.  Back for follow-up, shyly smiling, a reminder that sometimes it is worth taking a risk.

Mariam, discharged today:  she was admitted in early June shortly after her mother died of AIDS.  In spite of being HIV-free herself, and receiving gallons of UNICEF milk, she poked along with daily fevers and listless crying, until we realized that she was probably infected by TB.  After a few weeks of therapy her weight has increased by 50%, she’s smiling like a charmer, chubby-cheeked and home in the care of her grandmother to finish her six month course of tablets.

Biira:  It took five weeks to turn her around, and I had often said (in despair) that my life would be complete if I ever got her to smile.  She was an edematous lump, refusing to drink milk, never moving much, depressed and dwindling.  TB therapy also proved to be her turning point.  Monday she broke into a huge grin.  It was like witnessing the breath of life entering the clay of humanity.  She has come alive.

But others still have far to go, sipping their formula, clinging to their too-soon-pregnant teenage moms or their weary bereaved grandmothers.  I hope in another month the pictures at the bottom will be transformed like those first three.  Faith means living between the acknowledgment of our scabby hungry weakness and the promise of milk-rich health.  Hanging on between hunger and healing.

Thoughts about Vacationing in Uganda

Uganda, the pearl of Africa, tropical beauty, open-faced friendliness, relative stability, fantastic scenery and spectacular wildlife.  And we actually live here.  So why vacation anywhere else?  As we get ready for a visit from my mom in August, I’m trying to make reservations for a few days of in-country travel, and it has been an eye-opening experience.  We are not the only ones who have noticed that this is a great country.  There has been a subtle but steady growth and shift in the tourist industry that I’m realizing is not all for the best.  Like the rest of the world, vacations in Uganda are polarizing between the very cheap and the outrageously expensive, with nothing in between.  We are looking for privacy and beauty, and those two things are becoming almost unreachable. The very cheap:  backpacker hostels and campgrounds, or local lodges, frequented by Europeans, Americans, and Australians between 18 and 30 years of age, people who want to feel like they are really roughing it.  A few roaches, loud music, an active bar and internet connection, rarely-cleaned communal bathrooms, add to the sense of adventure.  Entire truck-loads of tourists can pull in and pitch camp within the hour.  These places are not all bad, but since we LIVE with roaches, noisy neighbors, mud and grime . . . We really look for a little peace and solitude on vacation, a little order and soothing visual peace.   But the privacy and beauty have been bought out by an increasing number of very small, very exclusive, very expensive luxury lodges.  These places are not owned by Ugandans.  They usually have only a dozen (or less) cottages or tents, with private porches, amazing views, perfect plumbing, tasteful décor, and good food.  The owners charge rates that exceed, FOR ONE PERSON STAYING ONE NIGHT, the ANNUAL INCOME of a typical Ugandan.  I think this is because their volume is low, and the absent owners themselves are living in relatively expensive places, so their profit margin has to be through the roof.  One place I contacted recently had increased from $96 per room in 2003 to $420 PER PERSON PER NIGHT in 2008.  Booming economies in the west, more mature travelers (more of the 35 to 70 crowd), writing off expenses to NGO’s or corporations?  I’m not sure, but it seems that there are new venues every month, usually on land contiguous with a national park, or overlooking scenery of great interest.  Does Uganda benefit?  Yes, but is the ratio just?  Not sure. So where does that leave us?  Two choices.  One is camping in the national parks:  the beauty and solitude are there, but it is a LOT of work (bring your own everything), occasionally frightening, and so not always restful.  So we’re glad for the second option, the Kingfisher Lodges.  These two small resorts are built in a simple but lovely style, have a pool, the food is fair, and the price is reasonable. They are income-generating projects of a former missionary technical school teacher turned entrepreneur, who thus far has kept his rates within reason.   We are grateful.  One is a five to six hour drive from here, and the other is about 9 to 10 hours.  They are frequented by Ugandans too, which means there is a market for family-friendly medium-range, clean, simple, beautiful lodges, if any more entrepreneurs are out there.

Politics in Bundibugyo

Our district is not settled.  Health workers tell us daily that their salaries are not being paid.  They believe that top elected officials somehow stopped payment at the bank, in order to create chaos and discontent, a ripe situation for mass action against the central-government-appointed administrator who is investigating the finances of the district.  It does make sense in a Bundibugyo-logic sort of way.  If a locally elected official has been siphoning funds for years, and then someone comes with the authority from the central government to ask questions and put their nose into the records, what better way for the local politicians to protect themselves than to create mayhem and focus it on the investigator, trying to get him thrown out!  The man at the crux of the conflict is the main central-government appointed official who supported Dr. Jonah.  He may not be completely clean of corruption, but sentiment in the health system is that he is the lesser of the evils, and being persecuted by those locally-elected officials who are more corrupt.  On Monday mass protest was averted when the official who was threatened called in riot police with tear gas, and the agitators dispersed their meeting peacefully.  So life goes on.  But for those of us who have been praying for a shake-up of business-as-usual, for uncovering of corruption, for accountability, this may be the beginning of real change.  Jesus said, be wise as serpents and innocent as doves.  That sounds like good advice for living in Bundibugyo where we work with the serpent-hearted while trying to keep our own hearts dove-like.

Number 21, and other numbers more complex

21:  Here is Julia with her CSB girls’ team, sporting the jerseys donated by Miss Ashley’s Covenant College coach.  Ashley gave Julia number 21, her old number, which meant a lot to her.  We are thankful for the little slice of time when Julia can be part of a group of girls as their peer and friend, we’re thankful for the physical exercise and skills, and we’re thankful for the role model that her coach provides in a life surrounded by much that is foreign and harsh.

i, the square root of negative 1 . . . :  Miss Sarah has been coming up to our house every afternoon to share the one copy of the pre-calculus book from which she teaches Luke, striving to get him ready for entering RVA, teaching him a bit about choral music and even getting him to read some pretty dense British literature.  In short, she’s filled a role this year that no one else was quite capable of, and we are amazed and thankful that God put her there at just the right time.

Counting Up

Some moments of beauty, unexpected and undeserved, this week, all the more sweet as they stand in contrast to the rest of life.  There is wisdom in the admonition to count our blessings, it is a way of balancing reality, of turning from a short-circuited drained out electrical system plunging us into darkness, away from a girl Julia’s age with a brain abscess gasping out her last breaths, away from 35 patients on a ward built for 23, away from the terrible tally of 12 deaths in 14 days.  Counting up, forcing a balance in awareness.  So let me start with 7, a Biblical number of completeness . . . .Watch out, this will be LONG, because a lot happens in a week.

Number 7 ---Students.  Today the CSB girls’ football (soccer) team challenged the teachers and missionaries to a match.  Only the school secretary (none of the seven female teachers) was willing to risk the humiliation of playing full field in broad daylight on a market day, so we recruited a few of the older non-team student girls to get our requisite 11-woman team.  We missionaries lost 1 to 0, not bad for our racing hearts and sluggish feet.  I really enjoyed being out on the field with girls from my old cell group, and others I had played with often over the years, laughing and running.  Also a boost to see Julia and Acacia on the student team, pulled into the group.  I was reminded of how much I like the spunkiness and energy of these girls.  Also this week we received one of the most mature and thoughtful letters ever from one of our students, just talking about what was happening in his heart.  An encouraging reminder that boys grow up, that they mature, that the Spirit is at work.

Number  6---Ebola-free, still.  The child whose death raised concerns week before last did not have Ebola or Marburg, all his tests were negative.  This is particularly great news in view of the death this past week of a Dutch tourist who contracted Marburg while visiting caves in the Queen Elizabeth National Park where we just went camping.  I never quite saw the tourist appeal in the advertised “bat-cave” hike . . . But I suspect it has now dropped off all itineraries.  So our relief is tempered by sadness for this woman and her family.  Yet maybe her death will be a clue that unravels the mystery of the reservoir . . .

Number  5---Once a team mate, always a team mate.  Larissa is back, using her holiday in her master’s program in midwifery to plunge back into Bundibugyo health care (or lack thereof).  We are also hosting Scotticus’ fiancee Jane this week, a person we only knew last year in her letters and interesting return addresses as a woman of humor and generosity, and who has now materialized as his bride-to-be.  On Wednesday the Pierces hosted a mock “Introductions” ceremony as a way for us as a team, and a few of Scotticus’ Ugandan friends, to commemorate the marriage.  We will miss his ceremony in August, as well as Becky Carr’s (former teacher) this coming week.  But the return of our friends solidifies the assurance that once we serve here together, the bonds never break.

Number 4 ---Resilient Grandmothers.  Our motherless baby program is designed to rescue babies who would starve for lack of nutritional alternative when their mother dies:  we give a month’s worth of milk while the family organizes a surrogate breast feeder.  We believe in promoting breast feeding, . . .and usually it works.  But over the last two months we’ve had one persistent old lady who has tried and failed to relactate, perhaps because she’s technically a great-grandmother, and comes back every week asking for more boxed milk.  And every week I try to draw a hard line, try to stick to policy, but end up giving seven more days worth with a stern admonition to bring another family member.  Finally she brought a grandson, a brother of the tiny baby’s dead father, and he listened to our program and decided his wife (a young woman with a 1 year old child) could take the baby in.  But then when all this was translated to the grandmother, she shook her head.  She was holding that baby tight, and not about to let go.  Clearly she did not trust her grand-daughter-in-law to care for this child, and clearly she had closely bonded with the tiny remnant of her dead grandson and his wife.  She begged us to give her medicine that would make her milk come.  Pat and I looked at each other.  Should we stick with our rules, which we have set for good reasons?  Or should we throw them out the window and say, what is the cost of a few more months of milk compared to the risk of a broken heart?  We decided the bond between this woman and child was more important than our policies.  We gave more milk.

Number  3---Goats.  They are a bit smelly, stubborn, flighty, small-brained and strong-willed, tugging at their ropes and friskily kicking.  But these bundles of fur mean life for the baby mentioned above, and for many others.  The Matiti project dairy goats, the second wave of animals purchased by the Christmas Ornaments, arrived his week.  They were joined by a dozen or so males which the mission farm in Masaka decided to donate due to the escalating costs of animal feed for them, and their interest in the project after their visit with Karen in May.  So once again we as a mission had the privilege of a goat party, a day where the HIV-infected and bereaved turn their mourning into dancing, or at least a brisk goat-chasing trot, as they hear and see God’s love for their family in a gospel message, enjoy lunch together, and then receive a milk-producing goat.

Number  2---Peanut Butter (and collaboration).  I was raised on it, and now it turns out that ground peanuts mixed with milk, oil, sugar and vitamins, a thick sweet paste called Plumpynut, has become an increasingly accepted form of treating malnutrition.  Problem is, it is a bit expensive to access the commercially prepared product.  So Stephanie came up with the BBB (Lubwisi acronym for good food) program using hand-grinders, locally grown ground nuts, soy beans, and moringa leaves, the vitamin-rich leaves of a common tree.  We have now enrolled four cycles of 25 kids each at two outpatient smaller health centers, where moderately malnourished kids come weekly for a couple of months for growth monitoring, education, and this food supplement.  Part of being a responsible missionary is doing responsible science.  So for the last month, Scott Ickes has been interviewing caretakers, health center workers, observing food preparation in the homes, and generally applying his skills to evaluate the program.  Yesterday he presented his preliminary findings. The program is popular and helpful, kids are gaining weight, but we can do better.  He discovered that most families to not use the paste as a ready-to-eat food, but dilute it with water as they cook it again in a sauce.  This means the targeted child gets fewer of the calories.  I think the most interesting part of the presentation was that he invited the handful of Ugandans we work with, two college-students on break, one recent grad, and the two agricultural extension officers.  While we were aspiring to approximate the international standard of Plumpynut, they pushed us back to stick with a food composed of all local ingredients.  As we brainstormed we used information from two of our nurses as well, and have a new way to try to deliver the product and teach moms to use it, that may give better results.  It was an afternoon of collaboration, of the kind of synergy that academics, missionaries, university students, and community members can generate.

Number 1---You.  Anyone who read this far clearly cares about us, about Bundibugyo, about justice and healing and the Kingdom coming.  I am thankful for the wonder of reflecting on life in words, so that others can be drawn to pray and consider a different reality, the intangibles and the distant truths.  A college friend this week offered to raise money for nutrition, another friend from that era (the 1980’s!) connected us with a potential source of medical supplies.  We are grateful to be one small voice for your compassionate ears.

To Sudan and back again..

PSALM 13

How long, O LORD?

How long will you hide your face from me...?

How long shall I take counsel...having sorrow in my soul daily?

How long will my enemy be exalted over me?

The WHM-Sudan Team sprouted from the vine from the WHM-Bundibugyo Team so it's only natural that we would be involved in the development, formation, and advising of our fledgling Team Leaders, Michael and Karen Masso.  So, last week I (Scott) embarked on my third trip to Southern Sudan and my first to the town of Mundri where our new team will take root.  

From the air  Southern Sudan sprawls endlessly, now a lush lime which will fade to burnt umber in a matter of months.  (Michael's fondness of seasonal change will be rewarded in Sudan where the passage of time is easily marked by the color and height of the grass.)  The Mundri airstrip appears like a light chocolate cross from the sky, because the Mundri-Lui road cuts straight across the airstrip!

The Episcopal Church of Sudan (Diocese of Mundri) invited WHM to partner in the rebuilding, retraining, and  equipping ministries so critical to the healing and restoration of Southern Sudan as it recovers from decades of civil war.  Michael has done a phenomenal job of developing a productive partnership with the Bishop of Mundri.   The ECS staff picked us up from the airstrip, housed us, fed us, toured us, introduced us, and generally hung out under the shade of the big mango tree in the heat of the sultry afternoons.  Their told their stories stoically, but the facts were breath-taking.  The story which sticks so vividly in my mind was told by Peter (not his real name), a 50-something ECS pastor.  He recounted the bombing raids on Mundri which happened as recently as 2004.  They would hear the distant drone of the Antonov bombers, the whistle of the plummeting bombs, and then dive into their hand-dug trenches.  The domestic animals even learned to follow them into the trenches.  The thunderous earthquakes and flying soil followed.  He also described the low-flying helicopter gunships heralded by their low-pitch thumping which flew through Mundri mowing people down with their machine guns.  Forty women and children died from the helicopter guns in the last attack.  (While we were there a mine sweeping organization was combing the river banks for unexploded ordinance).

Not surprisingly these Mundri residents are bitter about the repeated deceptions and murderous betrayals by the northern government.  They said, "We cannot forgive..."

The other experience etched in my memory is of our visit to Lui Hospital, 20 km to the east of Mundri.  Built in 1920 by a missionary, Dr. Frasier, this hospital closely resembles the Bundibugyo District Hospital in size and services.  About 100 beds, 100 deliveries/month, one doctor....it felt so familiar.  Several differences became clear during our tour.  We found two children on the surgical ward with hands bandaged up like boxing mitts.  Two separate hand grenade accidents.  The kids found the weapons and played with them not knowing what they were.  Also, there is a separate African Sleeping Sickness ward, to serve those afflicted with this indolent, but deadly disease.  The most striking finding, however, was that the staff of Lui Hospital continuing to work long hours ... and yet they HAVE NOT RECEIVED ANY SALARY IN TEN MONTHS.  When asked why they keep coming to work, they quietly responded one after another,  "We must serve our people."  Basically, they work for nothing.  The Government of Southern Sudan should be paying them, but has no money in the coffers to do so.  Unimaginable in Uganda.  Even for me.  How would I manage to continue with no salary for ten months.  Would I not slip into survival mode and stop going to the hospital?  Not the Sudanese.  Their sense of duty and service to community, country, and God runs very deep.

In the last two verses of Psalm 13, there is the abrupt transition from Self to Other.  "With a disturbing clarity", David acknowledges God's hesed (his "enemy-love", his mercy) and melts into worship.  We need to pray that as we work to with the people of Southern Sudan to rebuild their country, that we can help them by faith to "cross the line" over to reconciliation and worship.

Paradoxically, home

Coming home is a paradox in and of itself.  My heart is here, but my soul also feels the heaviness of this place.  In fact, as we packed up camp with the interns and prepared to drive back, we later found out that the rest of the team narrowly decided against a full-scale revolt in bagging their return from the Kingfisher (where they stayed while we camped) and extending the heavenly weekend by another day!  I understand that sense of unease, the lingering feeling that just one more day in the little paradise of flowers and order and escarpment breezes carved out by a German missionary would fortify the spirit for re-entering the miasma of Bundibugyo.

But in the end we all returned, the draw of home and the dread of facing problems again all jumbled together as we bounced over the rocky, rutted road.  And the return was both grueling and joyful.  Grueling in the physical and emotional toll (see below).  And unexpectedly joyful, because of Julia and Jack.  They get car sick and we were so crowded that we let them ride on the top of our crazy load of camping gear (tents, cooking equipment, clothes, etc for ten), groceries, cow feed and mosquito nets for HIV-infected families on the back of the truck.  And they decided to wave greetings to anyone along the road, smiling, getting them to wave back.  In Bundibugyo there are A LOT of people along the road.  So instead of “mujungu mujungu” cat-calls or obnoxious curiosity, we entered the district being smiled at and waved to by several hundred people.  They were of course responding to the kids, but from the front seat of the truck we could imagine that the grandmothers shifting loads of firewood to greet, or the dancing children coming home from their gardens, had specifically waited just to welcome us.  It was very pleasant, the sense of being drawn in and celebrated mitigating the anticipation of the problems we would soon face.

This is the place of paradox, moon-washed mountain views seen from the valley of shadow, culture-crossing friendships tainted by misunderstanding, children plumping up on treatment while others gasp their last breaths.  This time was no different, we were once again awash, as we knew we would be, with abundant views of creation splendor and crushing realization of the desperation of the Fall.  Scott struggled all day with the bike of Jack’s that I ran over before I left—unfixable it seems, until we can get new parts, plus the broken toilet and the broken lawnmower, the obscure Ugandan bank statements and the neediness of people who had missed his help for a week.  I plunged back into the health center where the third patient on rounds died right before our eyes, a little twin whom we had cared for with moderate malnutrition and probably sickle cell anemia, who needed a blood type that was not available and whose heart could not sustain him until the proper blood could be found.  Nine patients have died in just over a week, including three transferred from the district hospital with end-stage severe malnutrition who did not even survive one day of treatment.  In spite of all that, it is a relief to be home, to be together after all that edgy anxiety last week, to listen to a dust-dampening sprinkle on my own roof, to sit around our own table in candlelight and laugh.  Paradoxically, we are pilgrims and strangers who have the sense of coming home.

Job's Journey

Mid-summer, we take our interns to the game park.  This is a weekend for them to get away from Bundibugyo, to get perspective on what God is teaching them, to avert their eyes for a few days from the relentless suffering of Africa and be awash it the continent’s beauty.  When Job’s friends exhausted themselves trying to explain his problems in a cause-and-effect obedience-and-blessing universe, God finally steps in (chapters 38 to the end) and basically takes Job on a safari.   Can you hunt prey for the lion?  Can you mark when the deer gives birth?  Did you set the wild donkey free?  Will the wild ox be willing to serve you? Does the hawk fly by your wisdom?

As an answer to Job’s distress,  God’s tour of the wild wonders of His creation seems to point to His power, His beauty, His creativity, His being GOD.

But this weekend, I saw another side to this lesson.  Over and over God takes Job on a journey of the animals and nature to point out:  Job can not control them.  Nature is unpredictable, untamable.  Camping in the wilderness we experience this first hand.   We drove through the park with our interns piled on top of our truck. At some points we were awestruck by the splendor:  in the pre-dawn darkness, a majestically powerful leopard stretching his night-weary limbs, slowly rising, regarding us interlopers and then sauntering off into the bush.  Restless elephants trumpeting, semi-playfully pushing each other in slow-motion splendor with their ponderous strength.  The flash of jeweled orange as a tiny malachite kingfisher flits up from the reeds.  But at other points we drove and drove and drove, watchful, not seeing anything.  A large grey male lion trotted away after barely a glimpse in the distance, lying down concealed in inaccessible bushes, tantalizing but unreachable.  There was nothing we could do to make animals appear where we wanted, or wait for us to see them well.  They are, after all, wild. This is a savannah, not Disney World.  The experience is not humanly orchestrated.  Sometimes we will be disappointed.

Driving home today, I began to think this was the real point God was making with Job.  Yes, nature shows how creative He is.  But what He was trying to point out, is that nature shows how wild He is.  How Other.  How beyond being orchestrated by human desires and ideas.  We want formulas that work, like Job’s friends we want to put our good intentions in and see God’s abundant blessings flow out, measure for measure.  But God tells Job, look around.  You can’t tell the wild donkey where to go, nor can you control the details of your own life.  God is God.  He does not show up on our schedule.  His actions may not correspond to what we would want.

Like Job, we need to be pushed to break out of the mold of a God-in-our-image, a God who acts as we would, who does whatever we plan.  The inexplicable suffering of Bundibugyo and the untamable beauty of the African plain both shake us out of our illusion that we can predict, let alone dictate, God’s actions.  Like the leopard we saw this morning, He defines Himself on His own terms:
I will be gracious to whom I will be gracious, and I will have compassion on whom I will have compassion.  (Ex 33:19)

Driving the Ledge

Well, today I’ll be literally driving along a ledge, the spectacular mountain road that leads out of Bundibugyo.  The kids and team and I are heading out, we will all meet up with our Sudan returnees at a small lodge on the edge of the national park about five hours away, for a long weekend together.  Last night when I was struggling to load the car with trunks and camping equipment, and we heard hissing air from a tire, so I was rushing to get it parked on cement to make changing a tire easier and ran over a bike left on the ground . . .Jack’s, which he uses to avoid walking on his heels . . .well, it was a low point, being eaten by evening insects with a half packed truck, a broken bike, and what I thought was a flat tire, in a day in which four patients (!!) had died.  In short, I keep thinking about the edge, and the path was seeming rather narrow.  But Caleb says the bike is probably fixable, we tightened the cap on the tube of the tire (it would have been the fourth flat this week) and as of this morning it is holding, the kids got the tarp over the mountain of stuff and after prayers and dinner we were all more calm.  Pray for us to rest, in the wild wonder of God’s creation as we visit the park, to get a bigger picture than our daily struggles.  
PS Check out the Macha’s blog:  Nancy’s tumor has shrunk, so that is encouraging news!  

The thing about edges . . .

. . . Is that while standing on them, one is perfectly safe, but the perceived drop to disaster is very real.

Which may be why God likes to take our path along the ledge.

For instance, yesterday morning the UPDF began a training exercise that involved intermittent large artillery which we could hear in the distance.  The main barracks is about 15 km by road from us, though with mountains reflecting sound and our house being on a rise it sounds closer.  This practice is good, in reality, part of that solid rock where we now stand, protected.  But it started literally one minute after I hung up the phone with Scott who was from that moment on unreachable, en route to Sudan.  And in the early morning, the sonic booms of distant guns were for me a peek over the precipice, a gut-tightening recall of times now long past when we did not have a prepared military and when rebels could make forays across the border at will.  I am not falling, I’m standing on the path.  But the view into the Fall is dizzying.  

This is similar to the case of the little boy who died last week, whose blood and tissue samples are now being processed by the CDC.  The real danger of this being a viral hemorrhagic fever is almost nil; follow-up in his village has assured us that no one else is sick.  Again, we are standing securely, but the events of the last year make the view over the edge steeper and more frightening than it would have been.

So it is no surprise, in this context, that just after daylight this morning there was yelling, running, commotion and cries a few houses up the road from me . . . No, no rebels, no real danger, just a goat thief.  By the time I got there most people were laughing, perhaps to cover their anxiety.  The goat had been recovered but the thief got away.  

And though I am distressed by the slowness of UNICEF to get milk to our malnourished kids (18 of 29 inpatients now with severe acute malnutrition, little signposts of no rain and rising food prices), when I plead on the phone I’m looking over the edge and feeling faint, instead of noticing that we do still have enough for another two weeks, and kind supporters who I know will rise to the occasion if nothing happens by then.

A wise friend asked me last night to reflect on the timing.  When I am here alone, my sense of the edge is more menacing, my reserve more strained.  But this is the time to look at the path instead of the drop-off, and be thankful for the Rock on which I stand.  Not easy.