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Tuesday, August 26, 2008

Sacrificial Bonds

As is often the case, I entered the ward this morning with a heavy heart, expecting to be met with the news of Rick Thomas' death. Instead I spotted his mother's canary-yellow startling dress, and saw her combing her hair. I reasoned she would only be doing so if he was alive . . and peaked around the corner. There sat his father, holding Rick Thomas (pronounced Licky Tomasi). I RARELY see a father sitting on a patients' bed holding a child, especially not if the mother is also present and could be doing it. It struck me that his life-saving gift of blood also served to bond him to the child. I was amazed. The little boy was barely breathing yesterday, limp, bleeding from the rectum. Today he was alert and interactive, wanting to eat and drink! That is how love is. A parent's sacrifice only serves to make him more attached, more invested. A parent does not blame or resent the child for being needy, but in filling that need deepens in love for the child. A good parent, at least. And this is a very real picture of God's love for us. He poured out His own blood to save our lives, and now He wants to hold us on His lap.

Monday, August 25, 2008

In Praise of Fathers

Today I was struck by the love of several fathers for their children. Men in Africa, as elsewhere, do not always get a great reputation for parenting, too often absent or uninvolved. But today I noticed some amazing fathering. One-year-old Rick Thomas was one of the last patients I saw mid day, newly admitted to a mattress on the floor of the overflowing ward. I recalled months ago how he had revived from a dwindly danger to blossom into a smiling kid when his TB was treated and he was given food. Sadly his mom defaulted on the last month of his six-month medicine course, and he came back severely anemic, febrile, barely alive. His depressed mother had just buried her own father over the weekend, and now her son was slipping away. With a hemoglobin of 2.2 gm/dl he needed an urgent transfusion, but there was no blood of his type in the fridge, and after phone calls I ascertained there was none in the whole district. He would not survive transfer. The lab explained it was against policy to transfuse unbanked blood, and I generally agree, but this child was clearly dying, soon. I offered my own blood, but they wanted to test the parents first, for a better match. His mother did not match, but his father did. He tested negative for HIV and agreed to donate. A father can't go much beyond giving his own blood directly to his child. I'm praying he makes it through the night. When I got home, I found Nkabona Robert in the kitubbi with is parents. HIs articulate and smiling father had been extremely dedicated during Nkabona's two week admission last month for encephalitis. This boy had also been on the verge of death repeatedly, and we were all amazed that he survived. But he bears the neurologic scars of his brain's inflammation, a seven-year old whose speech does not quite make sense and who's restlessness may indicate hearing and vision deficits. While we were traveling with my mom, a European woman approached us after seeing the World Harvest sticker on our truck, and asked if I was Dr. Jennifer. She runs a rehab center through the Church of Uganda for kids with disabilities in Mbarara, and had seen my name on patient referrals and followed our blog and prayed for us during ebola. She encouraged me to send patients for occupational and physical therapy, so I decided to start with Nkabona. I offered transport costs and half of the nominal admission fee, asking the father to raise the rest. He said he could not feel "settled" until his son was improving, and agreed to take him. This will involve considerable effort and significant cost, but his concern is for his child. While we were organizing this, another father came with his 21-year-old son. This man is older (our age!), has started two schools himself and is now working at another as a teacher of geography. When his son Baluku was in primary school here, all of his teachers told his father that he should get him into the best school he could, because Baluku had real talent. So this father worked and saved and worked and paid, and managed to fund a really decent secondary education for his son in Fort Portal and Mbarara. Baluku had great scores, probably the best I've ever seen in math an science from a Bundibugyo-born student. He had been admitted to medical school, which was his father's dream (the father told a story about taking a pregnant woman with a partially delivered dead baby to the hospital in Bundi and watching her wait in pain and neglect for 8 hours to see a doctor, and his vow to do something about that). The LC5 referred him to us looking for scholarships. Because of his great potential we were going to personally pay half his med school costs, but the father could not raise the other half, having pretty much expended himself on the secondary fees. So they had decided to settle on a cheaper course for nursing. They came to bring Scott a rooster and thank him for his help thus far. It was a real dilemma, but this dad seemed genuinely involved and disciplined and responsible, and the boy pleasant and eager, so we agreed to try and find more funding to put him in medical school. Three fathers, each willing to do whatever it takes to help his son. And one more. Scott has done an amazing job of getting Luke ready for RVA, ordering the required clothing and reading through all the paperwork, making sure we have the fees, and providing the little extras (like a phone) that will make Luke feel settled. Tonight he went further. I had lost the name tags we are required to sew INTO EVERY ITEM of clothing, bedding, linens, etc. Though I had finished about 2/3 of the task, I still had a long way to go, dozens of socks and pairs of underwear, and no name tags. We thought they had been accidentally thrown away. Our trash goes into a deep smelly pit, 20 feet deep, steep dirt walls and rotting gunk on the bottom. Scott took a ladder and climbed down in to look for the tags. That's a real father. Sadly he could not find them. We asked our team to pray and scoured the house one more time, and there they were, right in the box where they should have been, previously unseen though almost everyone in the family had looked there already. It was a relief and a good faith-shoring-up experience to pray and then find them. Scott's experience, and the other three dads, point out that it is more the effort, the willingness to sacrifice, to get dirty, to be inconvenienced or poorer for the good of one's child, that defines fatherhood, not necessarily the successful outcome. Because love is in the action, whatever the result. Rick Thomas may still die. Nkabona Robert will probably never be normal. Baluku may or may not become a doctor. And the foray into the trash pit was heroic but ultimately fruitless. Still each self-sacrificing action was memorable and meaningful, because each embodied real love.

Sunday, August 24, 2008

Sprouting Grain

"Unless a grain of wheat fall into the ground and die . . ." Today (note: Friday, this post got lost in cyberspace a few days . . . ) a delegation arrived from Kampala, a nutritionist and a community mobilization expert. They worked with Ministry of Health and a new collaborative USAID-funded program to improve nutrition for people living with HIV. People had told them to come and look at BundiNutrition . . . so three very pleasant and efficient men with notebooks and smiles showed up and asked a hundred questions. We toured the inpatient nutrition ward, telling individual stories. I showed them the eggs from the chicken project and the locally-produced g-nut and soy-pastes. They looked at the tedious records we keep each week, documenting the numbers of beneficiaries. Then they sat with Baguma Charles and Pauline, as well as Scott, to hear about Matiti and the Triple-B initiatives. Lastly they visited a production team. When they wanted to know how much weight children are gaining on our RUSF (ready-to-eat-supplementary-food) equivalent, I whipped out Stephanie's published article with its tables and numbers. At the end, the Ministry of Health man (with a m'slm name) looked us in the eye and said something like "I travel all over Uganda and I want you to know what is happening here is really remarkable, and we appreciate the work of your mission." Several thoughts: One, that we have an amazing team, and I wish that they could have been here to hear some positive feedback. Stephanie's efforts continue to bear fruit, and it is an honor to hear others recognize the uniqueness of the effort.. Karen, Heidi, Pat, Scotticus, and many others have labored to get BundiNutrition to this point. Two, I find myself dreading this sort of visit, anticipating (as with UNICEF) reprimand for all the ways we fall short of the ideal. So to receive unsolicited thankful feedback was very nice. And three, these visitors are part of a growing flow of interest in Bundibugyo, which I attribute to Dr. Jonah's death from ebola. Since ebola I notice that people in Kampala are more aware of Bundibugyo, more respectful and sympathetic to the challenges here. A year ago I don't think MOH and USAID would have chosen to come here. Now we are first in line for help. I'm not sure what will come of this visit, but possibly more resources for the HIV-infected and malnourished. Rumors abound of doctors about to be assigned to Bundibugyo. We are involved in sponsoring two new medical students and know of a third who received funding. Like the milk from UNICEF, these are all grains sprouting from the life laid down last December. Spring is on the way, even though it is technically August.

Pouring In . . .

We have fallen into a good school vacation rhythm this week. The boys we sponsor hang out every day, Luke's two best friends from Fort Portal have been staying with us for four days, and my kids are having a good time. They read and do math/science reviews together in the mornings, then move to cards and games. When I get home from the hospital we all eat lunch, which I am having cooked in mass quantities (usually a dozen or more mouths to feed) daily by my competent and efficient neighbor Asita. After lunch we do a short Bible study, then the group has been voluntarily attacking our pitiful garden. Scotticus will be relieved to know it has been resurrected and transformed. Lastly they all play soccer for a couple of hours, preferably with Miss Ashley joining in. Since all of my students are on the school team, it is a pretty intense game. I am really thankful for this time of relatively normal life, for the relationships we have, for the opportunity to exhort and encourage, for the semblance of acceptance my kids have in this group. These kids are the future of Bundibugyo, and beyond. It is a great privilege to pour a little of ourselves into them.

Wednesday, August 20, 2008

Grace for Orphans

B.G. has been a friend of our family for the last decade, beginning as
a little boy who hung out in our yard and played in the sandpile or
kicked a football. After his father and then grandfather died, his
uncles conspired to take over his father's land and leave him without
any inheritance. His mother remarried, and her new husband did not
want to take on another man's son. So B.G. was bounced between
relatives, at times staying in a room from which served as a bar for
customers of his aunt's alcohol brewing business. He finished at the
top of his class in primary school, and was the second boy we sent to
Christ School (following Ndyezika). Six years later he was one of the
handful of students from Bundibugyo who completed A Levels with
University-entrance-worthy scores. Though we have all long hoped that
our CSB grads would receive government scholarships under a quota
system, this has not panned out. The quota slots have been whittled
down year by year, and are gradually being phased out. In the
meantime students who have studied in more equipped and prestigious
schools in the cities come back to Bundibugyo to sit for the final
exams, and so displace the truly needy. So when B.G. received his
scores, we were hesitant about his opportunities. We encouraged him
to apply to some programs, and were cautiously optimistic when he
received several admission letters, though still ambivalent about the
cost. But with the press of visitors, interns, work, family, etc.
this summer, we did not carefully read the fine print, and with B.G.
being an orphan from a rural area trying to understand rules and
procedures . . . we missed the deadline for the down payment to secure
his position in our top choice, Uganda Christian University in Mukono
for a Bachelor's in Library and Information Science. By the time we
all realized our mistake, and sent him to belatedly pay the fees, it
was too late. He was told to try other programs. So we did. But the
other programs were all at satellite campuses, or night school, or
degrees with no relevance to his interest in computers and information
technology. Accepting the consequences as justice and a good lesson
would have been an option, but we were not quite ready to give up. As
a last-ditch effort I began emailing the admissions office and making
phone calls. Last week I connected with a woman who agreed to hear
our case. I explained that he was qualified for admission but that
living in Bundibugyo made it difficult to meet the deadlines, and
begged for mercy. She said she would take the case to the committee.
We all prayed.

Friday we got the good news that B.G. was forgiven, that he could
begin the program in September, in Library and Information Science as
he had hoped! He has been giving his testimony to anyone that will
listen, including the fact that he witnessed others trying to bribe
their way into the school and being turned away. I think that it is
rare for a kid here to have someone believe in him and push for him
when everyone else had accepted defeat. And to see clearly that God
changed a beaurocratic system, over-ruled the rules and let him in, by
His power and not by corruption. We are studying 1 Timothy this week
with our students/kids. In the first chapter Paul makes it clear that
the law does not change hearts, but that grace and mercy do. When
Paul experienced a merciful encounter with Jesus on the road to
Damascus, he emerged a changed man. As our students experience mercy
from God, grace from the authorities in their lives, and I-believe-in-
you kind of perseverant love from missionaries, it is our hope that
their lives will be changed too. B,G. has a legacy of alcoholism and
failure, deceit and loss, from his childhood. But God has given him
grace, and we pray that he will become the kind of leader our district
here needs.

Tuesday, August 19, 2008


An elusive concept, but after six days of strenuous travel I am grateful to be in our little house in Bundibugyo tonight.  My weary soul looks forward to being here, at home.  Some highlights of the week  :
+SWIMMING with a hippo:  yes, we jumped into a crater lake at our first stop, the water was chilly and refreshing, but as we surfaced we noticed a broad shiny head with twitching ears peering out of the reeds about 30 yards away.  Lake Ninyabulitwa is mysteriously home to a lone hippo.  We took a small row-boat clear across the lake with Grammy, who was a real trooper in roughing-it kind of travel.  Seven of us in a double cabin pick-up over dirt roads with only the bushes for bathroom stops . ..
+HIKES, and more hikes.  We took an hour trek to a garden-like viewpoint above the lake the next morning.  This was a warm-up for two more strenuous hikes.  Mt. Sabinyo, an extinct volcano on the southern border was probably the most beautiful trek we have ever done anywhere.  God gave us a cool - breeze, clear sunny day to hike from about 8,000 to nearly 12,000 feet (officially 3669 meters), through bamboo and then forests hung with feathery moss, above the tree line into the rare equatorial alpine habitat of lobelias and tussocks.  At the top-most point we could stand in Uganda, Rwanda, and Congo at the same time.  The 14 km of steep scramble did not phase Luke and Caleb, but Jack and I were pretty beat by the end of the 8 1/2 hours!  Lastly this morning as Scott headed to Kampala with my mom, the kids and I were joined by two of Luke's friends, as well as Ashley and Sarah, to hike back to Bundibugyo over the Bwamba pass.  We saw a handful of blue monkeys, were enveloped in cloud on the topmost ridges, and then descended into the valley of Bundibugyo.  It is a other-worldly way to come home, and the kids once again did great, about 15 km of steep up and down in 5 1/2 hours.
+ANIMALS, up close.  We took my mom game driving in Queen Elizabeth, and were basically charged by an irrate elephant.  Later Luke the Lion Spotter found us two groups of lions, both moms with young ones.  He's amazing, the rest of us would never have noted the distant silhouette of brown ears in the tall grass.  It was very fun to take a picnic breakfast to the savannah, and to take Grammy on one of our favorite family adventures.
+GAMES--except the hikes, we were able to take my mom on all our adventures.  Whenever there was a lull in the travel action she played games with the kids.  This was a good week of conversations and togetherness.  We all soaked up the privilege of spending our days together.

Home.  As we spent the last two weeks with my mom, the reality of the cost that missionary families bear really pressed in on me.  We make choices that affect our kids, but also our parents.  Because of our life and ministry here my mom does not get to see her grandchildren the way she would like, or live within an easy visiting distance.  It is a high cost she pays, made higher by being widowed.  I had a cross-stitch over my bed as I grew up that read "Heaven is my Home."  We try to carve out a reflection of that Heavenly home here on earth, but having families divided by oceans is one way that we fail.  So while I am relieved to be back home in Bundi, and to have this place that my children consider to be their home, I realize that the very fact we have settled here for so many years destroys some of the dreams of "home" that the rest of our families in the US have had. And that is hard.

Tuesday, August 12, 2008

Grammy on the Go

We head out in the morning to take my mom on a six-day tour of western Uganda, so the blog will be quiet. . . but keep praying! For good family focused time as we go. For the many patients left behind, some like little Kato tantalizingly close to cured, others like Bwambale frightenly fragile. For the loose ends we have not quite wrapped up. For our student Basiime Godfrey who MAY have a chance to go to University (pray for a merciful decision from the registrar to forgive a missed deadline . . ). And for our hearts, stretched, needing a bit of rest after the non-stop summer, having to say goodbye to my Mom next week too. Beauty and quiet, distance from demands, in these we hope to find the healing presence of God.

Oh, the Places You'll Go!

Luke graduated today. We realized a bit belatedly that the term-end at RMS (Rwenzori Mission School) was in effect a major milestone for him, his last day of school in the little four-room school house with the other missionary kids, after 10 years of study. I was so thankful for our team, who rallied to plan a ceremony for him. We all met at noon, sang both the Uganda and the US national anthems in true-third- culture-kid combination, then hummed Pomp and Circumstance while he walked down the short path to the door and received a lovely diploma Miss Ashley had made. We prevailed upon her to recap the great speech she gave as guest-of-honor at her old high school's graduation in May, and as the last of a long line of faithful teachers here she rose to the occasion (Miss Sarah, who actually TAUGHT Luke since January, was accompanying her parents to Kampala and missed the festivity, which is a bit sad since she actually suffered through Paradise Lost and Precalculus . . . ). I took the Dr. Seuss book and re-worked it for Luke (opening line: Congratulations! Today is your Day! You're off to Great Places, to begin RVA!). Then we distributed a stack of old photos to everyone, and made a timeline of all the teachers and team mates and milestones of the last 15 years so that people could take turns taping up old photos from the Heather era all the way up to the current year. Interestingly Luke included his favorite Christ School teachers as well. AFter prayer we enjoyed cookies and samozas provided by the team. I wanted that closure for Luke, a recognition of the transition, and a concrete moment for the younger kids to understand life's trajectory. But though we planned for Luke, I think the hour gave testimony to the rich history of this team, to the many faithful and capable teachers who have passed through, to God's provision, which encouraged all of us. Mission schools can be tricky, as JD used to say . . . after all we care more about our kids than other aspects of our ministry, so if you throw together 3 or 4 or 5 families with their different educational priorities and expectations, it requires prayer and grace and lots of plain old work to make it run. I'm thankful to say our team has risen to the occasion, and though Luke's education is truly unusual . . . his "graduation" today is a testament to the fact that it has worked.

Sunday, August 10, 2008

August Prayer letter available for download

Our August 2008 WHM Prayer Letter is available for downloading (pdf file format) through the sidebar link labeled "Downloads".
More on pain, suffering, sorrow and a review of the summer's ministries...and lots of color pictures.


Having a visiting family member from America is an important event in our lives, as a family and a mission. And with Grammy in residence we have become a popular group! On Friday we were treated to a feast at Ndyezika and Juliet's new house, which somehow ballooned to involve both a passel of uncles and cousins from Ndyezika's side, and an equal contingent of CSB teachers and friends of Juliet's. Grammy presented Bibles to the newlyweds, we told stories of our long history together, everyone who had attended a boarding school away from home gave Luke advice, and we ate piles of rice and matoke and cassava and potatoes, sombe and cabbage and gunts and meat, as the light ebbed out of the neat little house and candlelight illuminated our faces. Saturday we enjoyed various team-mates coming by as well as an impromptu lunch on the porch for seven of the young men whom we sponsor with school fees, because they had been released from their school term that day. In the evening Melen and her youngest three kids joined us for dinner with Ashely, Pat and her two "nieces", the daughters of her friend who died of AIDS almost exactly a year ago. Many friends lined up to greet Grammy at church, and tonight we'll be hosted by our neighbors in her honor. It is nice to take a pause in the press of life to just acknowledge the significance of relationship, to look back at the blessings of the many years. We are thankful that my mom's health and energy have held up so far, it is no small feat to thrive in Bundibugyo after two major surgeries in the last year. And though she is getting a heavy dose of grandchild attention and connection, her presence for two weeks perhaps makes the painful reality of the many years of separation more visible.

Friday, August 08, 2008

Gracious encounters

We received an official delegation this afternoon, Monday Julius and his bride Alice, accompanied by his three brothers. They came to thank us for our support of Julius during Ebola, for our contribution to their wedding, and mostly for choosing him to be a recipient of the Dr. Jonah Kule Memorial Leadership Fund scholarship for medical school. Scott reminded them that the money does not come from us, though we'd love to sponsor him ourselves, but from the many people who gave in response to Dr. Jonah's death as a way to continue his dream of providing medical care to the people of Bundibugyo. We had baked a celebratory cake, and after sharing tea and visitng, we prayed for them. Alice is beautiful, articulate, confident, a midwife working at a Church of Uganda Hospital on the other side of the Rwenzoris. Julius is one of the most pleasant, hardworking, and trustworthy young men we've encountered. What a privilege to be a small part of God's provision in their lives, to see them at this young stage and hope for the many years of faithful service their marriage and professions will afford Bundibugyo.

Thursday, August 07, 2008

Juno and Jeneffer

Contrasting stories: the hollywood version was in a DVD we saw this
week, the story of teenage pregnancy, a cute saucy articulate 16 year
old who chooses to carry her surprise pregnancy to term and give the
baby up for adoption. Juno is a great character, and while the movie
has some raunchy moments it generally chooses life by acknowledging
the incredible value of an unborn baby, and sympathetically portraying
the longing of a childless woman who waits to adopt, and the paradox
of being a normal teenager who is required to also be a responsible
adult. The movie asks the question: can two people really love each
other for life? And answers with hope, in spite of all evidence to
the contrary. And the baby ends up well cared for and loved while the
teenagers are figuring all this out.

Now the Bundibugyo version. Jeneffer also showed up this week, 15,
quiet, on the margins, dutifully bringing her scrawny infant for
care. We weighed him in at 1.45 kg, not even three pounds, though
he's more than a month old. She agreed to stay admitted with him, but
on the second or third day it dawned on my that she was sleeping on a
bare hospital mattress with no sheets, and had none of the usual
clutter about her: no pans, no food, no relatives, no extra clothes.
The nursing staff got her story for me: she had been a primary school
student, living with an aunt after her parents divorced, and agreed to
sex with a secondary school boy who promised to marry her. When her
aunt saw she was pregnant she angrily ejected her to the care of the
boyfriends' parents, who were not so thrilled. He went to school
every day and she dropped out. Eventually she ran away to her
mother's home (about 10 km), but her mother had remarried and the step-
father was not interested in taking in the pregnant teenage daughter
of another man. So they told her to leave, and she went to her
father's house. Here the reception was not hostile, but her father
lives across the border in Congo and is busy with his new wife and
family. So among these four homes (aunt, boyfriend, mother, and
father) there is not one single adult who seems to have noticed that
this is a girl with a starving baby and no help, that she came for a
check-up and never returned. Meanwhile she sits on her bed on the
Paediatric ward, half-heartedly breast-feeding her pitiful skeletal
little boy and spooning milk formula into his mouth when the other
mothers take pity and allow her to use their pans to boil water. I
help her with some food and blankets, one of the nurses sometimes
brings her a meal. I don't think she expects the baby to live, and
I'm not sure I do either.

The contrast must carry some clue . . . in the America version the
girl is smart, goes to school, gets medical care, has friends and
family who support her. She makes some bad choices, and some good
ones, and life goes on. Her pain is another's blessing, which carries
seeds of redemption. In the Bundibugyo version, the girl's bad
choices define her and seem to defy her any chance of escape. The
proverbial African family which should provide a safety net for her
landing has instead been found to have holes, and she has fallen
through, dropped by her relatives, by the education system, even by
the medical system. No one is looking very blessed at the moment,
least of all her child. Juno is aggressive and active in pursuing
what she thinks is right, even at high cost. Jeneffer is passive and
fatalistic in waiting for help that trickles her way. I have often
read that poverty is the lack of choice, and this seems to hold in
this story. How can we give Jeneffer choice, which is probably more
important than giving her milk for her baby? And is it fair to try to
get her to take hold of a life that is so massively stacked against
her? Does she have real options, or only illusions of them? When I'm
dealing with a mother the age of my oldest child, it is a wake-up call
that something is very very wrong. Both girls would have done better
to wait for sex until the commitment of marriage in the context of
maturity. But they didn't, and I'm interested in the contrast in what
happens then. I suspect the girls' fathers are key in the contrast,
and the disconnect between fathers and daughters in this culture is
one I have not thought enough about.

Wednesday, August 06, 2008

Arrivals and Departures

After dreary and drenching days on end, today the sun broke through in time to firm up the grass airstrip just enough for a very important landing. My mom, Judy Aylestock, and Sarah Reber's parents and sister arrived, and midwife-intern Larissa Funk departed. It is a world- intersection moment when our families can set foot in Bundibugyo. Melen, my two neighbors, Ndyezika and Juliet, and church elder and friend Bamparana all formed the Ugandan welcoming delegation, and almost our entire team came as well, for a swirling crowd of hugs and tears, of joy and emotional overload. In the excitement of travel there was not much rest, so today we are allowing them to catch up before the grand tour of Bundibugyo starts tomorrow. It has been more than five years since my mom last reached this far (my parents' last trip stopped in Kampala) so the kids and the trees have both grown quite a bit . . as well as the house (we added a porch/room on the front). Praying for a meaningful visit for all.

Monday, August 04, 2008

HIV/AIDS Awareness

Data can drive programs, decisions, push money in the right direction,
move hearts and minds. So in that spirit, here is a fascinating web
site called Global Health Facts, which compiles data from the UN and
from individual country reports, and maps and ranks it for meaningful
thought: This
particular link takes you to children living with HIV/AIDS. I was a
bit surprised to realize that Uganda ranks fourth among the over 200
countries and territories of the world in absolute number of kids with
HIV. The adult prevalence is higher in southern Africa, but the sheer
number of infected kids centers here, right where we are. There are
lists and maps and numbers for maternal mortality, childhood
malnutrition, TB incidence, malaria (where Uganda ranks NUMBER ONE in
case rates, with 477 cases per 1000 population . . .meaning half of
the people in the country suffer a case of malaria every year, and
fourth in the world in the number of deaths from malaria). This kind
of data should of course drive health services. Why not send the
doctors and nurses and malaria medicines and hospital equipment and
public health research and educational outreach to the epicenters of
disease? Well, the maps for health workers are actually the INVERSE
of the maps for disease. Uganda ranks 129 of 135 countries with data
for physician coverage, with 0.08 doctors per 1000 population, and
only 39% of births attended by skilled personnel. I hope that medical
schools and mission agencies spend time reviewing data like
this . . . .


This may help you understand some of the challenges of accessing care in Bundibugyo.  A year ago Jack injured his heels by running cross country, too far and too hard, in poorly-padded used tennis shoes.  He was a big strong 9 year old running with mid-adolescent kids. Though we did once go on line to look for age-related distance limits . . .he is the kind of kid that pushes, and is able to do too much.  Plus we did not take his occasional complaints of pain in his feet seriously enough.  By the time we realized it was a problem, he had done damage to his growth plates.  Thanks to our good friend who is an orthopedic surgeon we learned his diagnosis, calcaneal apophysitis (Sever's disease).  And his treatment:  rest, no running, pads in his shoes, stretching exercises.  For months we've been slowing him down (we even tried crutches briefly to keep him still), no football, no sports, no hikes, always banning bare feet or hard shoes.  For an athletic kid like Jack, the result has been frustration, and it probably has significantly impacted his ability to enter into school life and have friends, and been part of his general discouragement.

The good news is that this disease will go away as he reaches adulthood and stops growing . . . but that is still a long way off.  It has been hard for him to be patient with the slow process of healing.  Recently though we've seen the benefits of his rest and his heel pads, and he has not had nearly as much pain.  So he has been allowed a limited amount of activity .  And our doctor friend in the US suggested follow-up xrays.  Since Jack is very worried about all this, and looking for good news, we really wanted to comply and get films.

Sounds simple.  No xray film in Bundibugyo.  So a month ago, our only weekend out of Bundibugyo this quarter, I went to two hospitals in Fort Portal with Jack.  In one the xray machine was broken.  In the other there was a line of patients a mile long, and we had a car full of people waiting for us, so we had to give up.  So then Scott bought a box of xray film and took it back to Bundi.  The xray tech has been unavailable, and the machine only works when the generator is running which is a few hours a week.  Finding an overlap between the xray and Jack's school schedule has not been easy.  We thought we had one today.  But no fuel for the generator.  So we had to drive to Bundibugyo in the rain, buy 10 litres of diesel fuel, find the xray technician, give him the box of film, get the generator started, and take the pictures.  Just revving up the machine and arranging it all took over an hour.  When the films were finally developed they were a bit light . . . the tech apologized that the chemicals for developing were old.  

A simple xray of the heel is never simple.  The staff say that the fuel issues stems from the fighting between politicians, which is freezing all the bank accounts for the district, so the hospital has no money. We have resources and resolve, but you can imagine that for most people the barriers of film, fuel, and passive-aggressive foot-dragging, would be too high to surmount.

We are praying that Jack's heels are healing . . . that he will be increasingly able to move normally, good for body and soul.  But the dreary process of accessing care also reminds us to pray for justice, for relief, for the many who wait for help and healing that never comes.

Sunday, August 03, 2008

On the difficulty of aid

Bundibugyo has received thousands of insecticide-treated mosquito nets from UNICEF, bundled in bales with labels from as far away as Japan, hefted on ships and trucks, stacked in warehouses and then heaved into pickup beds, unloaded at health centers.  What could be better than handing out protective nets to pregnant women and young children, preventing the most vulnerable from being infected with malaria parasites?  Malaria remains the number one killer in Bundibugyo, as in most of sub-Saharan Africa.

But getting the nets hung over the sleeping forms of the unborn and recently-born and about-to-give birth is more difficult than one might think.  A few months ago the hospital administrator was jailed, accused of stealing hundreds of the nets, to sell. Since then the nets do seem to be making their way to the health centers as intended.  But yesterday the staff launched into their litany of complaints about this program.  If even they can not hand out a free boost to their fellow citizens, no wonder we struggle.  Here are some of their observations:
  • Women who are pregnant take the nets back to their parental home, not to their husband's home where they are living.  This points out the tenuous nature of marriage:  the net belongs to the woman but since she is a temporary member of her husband's household, she risks losing it.  Also she considers it his job to buy the net that protects his unborn baby, so why should he be let off that hook by UNICEF?  So the nets given to pregnant women are not slept under by pregnant women.
  • Women return for maternity multiple times using new names or saying they lost their card, so they can acquire more free nets.  Perhaps not a tragedy if they were hanging those nets up over more of their children . . .but the story is they can easily sell them to merchants.  
  • Many people never take the net out of its bag.  It becomes more of a talisman, a symbol of protection or wealth, that would be spoiled by actual use.
  • As the program gathers momentum, the sense of entitlement grows, and when the "man with the key" was gone last Monday the nursing assistant feared being practically lynched by the angry crowd of pregnant women!
  • The lure of a free gift brings many people to the clinic (generally good) but also many who don't belong there (not even really pregnant), which in a marginally equipped system means that the resources are diluted and those women with real medical concerns can be lost in the crowd.

I asked for one bale of the nets to be kept in the Paediatric Ward store, and I am now dispensing them at discharge to kids who are admitted with severe malaria.  My reasoning is that the parents have just narrowly escaped losing their child and will be motivated now to believe the risk is real and therefore use the net, the net will be going to a house which we know harbors malarious mosquitoes, and the child is particularly vulnerable to fatal consequences from re-infection.  Still, it would be ideal to follow these kids a week later and see how many are actually sleeping under the nets.  In a house made of mud bricks or wattle walls, how easy is it to hang a net?  In a house plagued by rats, how many get chewed through?  In a home where mattresses are shoved side by side on the floor to accommodate many kids, how easy is it to hang and use only one net?  

Yes, there are difficulties, even in giving away something as straightforward as a mosquito net.  But these issues are not insurmountable.  Attitudes can change.  The same parents who beg, borrow, and steal to manage school fees for their kids can learn the value of a mosquito net.  We all want the same thing:  a thriving, live child who grows up to his/her full potential, whose mother survives her subsequent pregnancies too and stays involved in his/her life.  A few ounces of filmy white netting can be the wall that shuts out death.  It's aid worth giving, even if it is difficult.

Saturday, August 02, 2008


Jack and Julia made a count-down calendar to Grammy's arrival on
Wednesday. Every day they tear off one more number from the back of
the door, and spend the rest of the day saying : "Guess what? ONLY
FOUR MORE DAYS . . . ." The excitement builds. And I'm thankful that
in spite of spending 14 of our 15 years as parents on the continent of
Africa, our children securely sense their connection to all of their
grandparents, aunts, uncles, and cousins. Our sense of family spans
the thousands of miles, but the countdown to a real hug is still sweet.

Dragon lumps and deeper unveiling

We will finish Voyage of the Dawn Treader tonight, in our second or third time through the CS Lewis Narnia series.  These books are always fresh with Lewis' grasp of reality, seen more clearly in the imaginary worlds.  In this book a boy named Eustace is inadvertently pulled into the adventure with his cousins, and Eustace is not a nice boy.  He's self-centered, complaining, wimpy, and often just plain mean.  He sneaks off from the others and ends up in a dragon's lair, where his greed turns him into an actual dragon.  When he emerges, he is big, lumpy, scaly, and frightening.  In fact at that point his physical form reflected the truth of what his heart was like all along.  This chapter coincided with our Sacred Sorrow chapters on Jeremiah, where Card points out that God's judgement on Jerusalem is to simply make visible what was already spiritually true, the city had lost her true glory.  And it coincided with my turn to share prayer meeting with Annelise, who suggested that we organize our prayer requests under the headings of "unveiling" and "inviting" (I found out later that her intent was more along the lines of beauty and Song of Solomon, but that's OK).

The Spirit used this coalescence of readings and thoughts to unveil the dragon lumps in my own heart.  Many missionaries point out that the challenges of living cross-culturally, or in poverty, or under constant stress, do much to make our sin more visible.  Eustace was always beastly, but he didn't really know it until he saw himself as a dragon.  And I've always been judgmental and impatient and self-concerned, but Bundibugyo makes it much easier to confront those issues on a daily basis.  Being pushed to the limit can be a good step towards pulling back the surface of nice-ness.  When Mackline died in my care, another kid named Christopher dwindled from what I think was basically a slow poisoning by his grandmother's herbal enemas, and I watched yet another child gasp his last agonal breaths this week, I was left with a sense of failure and sorrow and discouraging, scaly, desire to run away from it all.

But in Eustace's case, the unveiling down to the dragon layer is not the final unveiling.  Later he meets Aslan, the lion who pictures Jesus in the stories.  At Aslan's instruction he peels off the dragon scales, but every time he does so he finds another layer of hard, ugly dragon-flesh underneath.  Finally he allows Aslan to use his sharp claws and go deep, removing all the layers of dragon.  And underneath is the new Eustace.  The real Eustace.  A frightened, lonely boy who no longer wants to be isolated by his mean-ness, a bright child with a kernel of courage who wants to be loved.  

The unveiling of judgment (making visible what was spiritually true) allows the unveiling of healing (ripping off the hard crust of sin to reveal the true soul God made).  The untame lion may seem to wound, but he really frees.  There is a hymn which says:
When through fiery trials thy pathway may lie
My grace all-sufficient shall be thy supply
The flames shall not hurt thee I only design
Thy dross to consume and thy gold to refine.

And there the "inviting" comes in.  What we really need, is the Presence of God.  Card's book points out that it is rarely what we ask for, but always what we truly need.  All the burning and washing, peeling and pain, are simply means of removing the barriers between us and God.  

Friday, August 01, 2008

Whom shall I fear?

I read Psalm 27 this morning for staff Bible study at the Health Center.  About 20 people come weekly, and we alternate between spiritual and medical topics.  Scott had challenged us as a team to take the teaching from Sacred Sorrow and try and apply it in our lives as cross-cultural missionaries.  My first study for Ugandans was on Job, and today we looked at David.  Background Bible literacy is low (not surprising for a place where the Bible does not yet fully exist in the language), so I had to tell a few stories to show that even though David was a King he suffered:  he was haunted by enemies, often on the run in hostile wilderness places, plagued by his own lusts and sins, grieved the loss of a baby to illness and a grown son to armed insurrection, betrayed, and at the end of his life ill and infirm.  But in all of this he held onto God, tenaciously, honestly, in lament as well as in praise, often alternating between the two in a single breath.

Psalm 27 is one of the places where David's bold faith and naked pleas come together.  He talks a lot in this Psalm about fear.  So I asked the staff to go around the circle listing fears, and here is a sample of what I heard:  evil spirits, sickness, death, famine/hunger, war, inability to provide for children, poverty never getting better, being cursed by jealous people, AIDS, malaria.  All of these fears seem quite reasonable here, because all are things that most of our staff have experienced.  It struck me that I was sitting between a man whose child I had watched die this year, and a woman who is ostracized because she is from another tribe.  But then I asked them to look at the Psalm, and consider what David's worst fear was.  Surprisingly it was something that none of us mentioned:  the fear that God would abandon him.

Is it my presumption that allows me to overlook this fear?  Does God ever hide His face?  If our personal sins cause God to withdraw, then how do we explain the most poignant expression of God-abandonment in history, Jesus' cry from the cross "My God, my God, why hast thou forsaken me?"  God turns away from our sins.  But does He also obscure HIs presence, veil His face, to build our faith?  To show us our true appetite is actually FOR His presence, not for His gifts?  He seemed to lead David often into places of wilderness, where the gaping chasm between what we hope for and what we experience looms painfully.  In the wilderness David learned true worship.

The psalm ends with this:  wait on the LORD.  Not on answers, solutions, relief.  Wait on the unveiling of the presence of God Himself.