Angels' Desire

The angels, I am certain, were hovering around Bundimulinga church
this morning in an expectant shimmer of trembling mystery, desiring to
look in (1 Pet 1). Suffering and glory and faith tested by fire,
these are the beauties which angels are said to marvel over, and which
have been improbably encased in the mess of human stories. This
morning's service was long (and felt longer because we were awakened
at 5 am by an emergency call, woman in labor bleeding to death, come
quickly . . . but by the time Scott got down there the woman had
amazingly delivered a healthy baby and both survived. Good news but
little sleep). And today's service was hot. Very hot. Dry season
is here in full shining force. Luke is longing for the coolness of
Kenya, sweating through his shirt without even moving. There was a
fundraiser for the choir to buy uniforms which generated an hour of
auctioning off the various gifts people donated: mostly sugar cane
stalks, pumpkins, oranges . . . but also one very small live white
rabbit in a cardboard box (went for 2,000 shillings) and one brand new
bright yellow Kwejuna Project T shirt donated by Scott (by far the
most popular item, went for 12,500 shillings!!). There was the usual
singing and sermons, greetings and announcements, and we were
admittedly tired and less than comfortable. But the show-stopper of
the day was the testimony time. A primary school head teacher, who
looked familiar to me but whom I do not really know, stood up front
with his Bible, and proceeded to give the most beautiful testimony of
repentance I have ever seen in any church. He began by saying that
though he had become a Christian in 1992, he felt he was truly being
born again today. He read several Scriptures to show that he needed
to repent to God, to the church, to his children, and to his wife.
Then instead of the vague "If I have done you any wrong please forgive
me" kind of weak semi-repentance, he boldly told his story, saying
that he had pursued two extra-marital sexual relationships over the
last few years, and describing the terrible impact on his wife, and on
his life. He actually got down on his knees, and his wife came up
front, and when he asked for her forgiveness she granted it. The
elders came forward and prayed for both of them, and their young
child. Bhiwa hugged the man so hard he lifted him off his feet, and
the women in the congregation were cheering they were so amazed. When
it was all over the wife stayed up and asked if she could sing. She
was too overcome to speak, but she stood in front of the church and
sang solo a song about Jesus on the cross while a tear rolled down her
cheek. Then in the prayer request time three other men stood up, none
with specific repentances like this but all three asking the church to
pray that they would be convicted by the Spirit and change as this man
had!

I can say that in many years of going to church, what we saw today was
very,very rare. We enter this season of Advent looking for Jesus, and
today I think we had a glimpse of His reality and presence. This is
what the angels long to witness, the birth of the baby and the battle
being won, the defeat of sin and the power of healing. Pray for
Vincent and Jane, for the long process of rebuilding trust and forging
a real marriage from these broken pieces.

Christmas Goat Giving

We are so thankful for more than 100 families who received dairy goats in 2008, funded by the generosity of our friends and supporters in America.  Once again this year we are offering the Give-a-Goat opportunity.  For $130 we can purchase and transport a specially bred dairy goat here in Uganda, train a family in its care, give them a few tools for constructing a simple shed, and then allow them to take the goat home.  Thanks to this project, many children who otherwise would have starved, can thrive—drinking the calories and protein they need.  Most of our recipients are babies whose mothers have died, or whose mothers are infected with HIV/AIDS and therefore need to wean them from potentially infectious breast milk. 

Your donation is a gift to a family which is about as close as one can come in 2008 to that of the homeless and wandering parents of the infant Jesus, living on a slim margin of survival.  The first 100 donors will receive a hand-made African Christmas tree ornament which symbolizes the real gift of the goat.  Please put it on your tree to remind you that Christmas is all about incarnation:  love in bodily form, God becoming human and needing milk, your generosity translating into a real live animal and its milk.

The mechanics:

1.     Use the "Give-a-Goat" button on our sidebar (or at www.whm.org) to donate by credit card.  This is the simplest and fastest method, and allows our colleague Ginny Barnette in the Sending Center to quickly confirm your donation and address and mail you the ornament.  Here is the direct link : http://whm.org/project/details?ID=12375

2.     Send a check to WHM Donation Processing Center, P.O. Box 1244, Albert Lea, MN 56007-1244, writing "Goat Fund  12375" on the memo line.  Since the processing and return of the information to Ginny could take a couple of weeks, you may want to email her (GBarnettte@whm.org) in order to be sure you receive the ornament before Christmas. 

3.     If you would like the ornament mailed to a DIFFERENT address than the one on your credit card or check, you must also communicate this to Ginny.  A card will be included with each goat describing the program.

 

Four Thanksgivings

Four more things for which I give THANKS: Luke, the loyal-- He touched down on the airstrip today with his mop of 3-months-away-from-home thick hair and his ever-taller frame, giving hugs and receiving the enthusiastic greetings of family and team.  His first term grades show us that in spite of his peculiar and patchy education, he had managed to learn something and can hold his own in an American system, though in some classes the teachers commented that it took time for him to adjust.  We got to read a children's illustrated story he wrote for Creative Writing class (about Hasty the Chameleon), and see a 99% grade on his BC Calculus final.  His photo and graphic design were chosen for the invitations to his class's major social event in February, the Senior Banquet.  He's growing up, in full-term spurts that are all the more evident by his absence. Caleb, the healed one--I am thankful for quiet healing.  In a nothing-short-of miraculous way, he is suddenly growing.  For those who have known us, you may remember that Caleb suffered serious illness from chronic gastroenteritis during his first two years of life in Uganda, and completely stopped growing for a while.  After a major Hopkins work-up including intestinal and liver biopsies and growth hormone testing, the conclusion was that he was just like most African kids, preserving his life and his brain at the expense of the rest of his body in a sea of sickness.  So we settled in for a life of shortness, as he re-set from being a huge baby to a slight child.  Suddenly, though, he's growing.  On Thanksgiving Day we measured:  5 feet 7 and 1/4 inches, taller than me, pretty much exactly where Luke was at the same age, leaving the 10th percentile way behind and closing in on the 90th.  I thank God for this amazing gift of healing. Julia, the brave-- Yesterday Julia and Acacia took Wibble the goat back to his pen at the Massos after our rodeo.  Suddenly Acacia cried out, Julia, come, help. A baby goat named, somewhat confusingly, Cow, had fallen into the Masso's trash pit and could not get out.  Trash pits in Africa are not nice places.  I have never actually been IN one, and never hope to be.  But the goat was in trouble and her friend was distressed, so Julia climbed down into the hole dug deep for trash, lifted the little goat named Cow, and managed to push him up and out.  Our heroine, the shepherdess. Jack, young Abe--Also at our party last night, Barbara had the idea of asking Jack to recite the Gettysburg address.  He had memorized it for school this year, and reminded us of the values that make us proud to celebrate Thanksgiving. Bravely he stood in front of the crowd of 29 and delivered the famous speech.  Jack has had a tough year, the youngest in the school, injured and unable to play sports, desperately missing his brother.  It was good to see him able to speak, to laugh, to gnaw on his turkey leg with his friend Ivan by his side, to dazzle us all with his articulate rendering of the address. These are four amazing kids, I know I'm not objective, but today I just want to be thankful for them.

The Best Thanksgiving Rodeo Ever

Tonight we go to bed tired but full, not only of food but also of the blessing of community. From the dramatic sacrifice of the turkey this morning (spouting blood, wings firmly held down by the scalpel- wielding Scott) to the last hour of the late night, sitting out on our brick patio by candlelight guffawing over Heidi's acting and Nathan's chagrin as we played "basket of nouns", it was a day to remember. Hospital rounds were as quick as I could make them (this is after all NOT a Ugandan holiday) and then the rest of the day was devoted to cooking and cleaning. The clan gathered at 4, all 29 of us, team and visitors reciting a Psalm of Thanksgiving responsively (136) and then delving into the feast. It is truly amazing what creative and motivated people can come up with in the way of American traditional cooking in Africa: apple pies to mashed potatoes and gravy, we had it all. Barb decided to inject some Texas culture into our mix, and with barely an hour of digestion we were out in the yard as the sun sank into pink, for sack races, an egg toss, tug of war, even a game to capture the flag of a bandana tied to a real live goat. A couple of Ugandan friends stopped in and got drawn into the fun, and dozens others were quite entertained from the path I'm sure. Then dessert, the first official Christmas movie of the season (Charlie Brown Christmas), a short goodbye and thanks to the Ryans, some washing up and at last the game. I am thankful for our team today.

Thanksgiving

The original Thanksgiving was a raw sigh of relief, an acknowledgment of survival, and a tribute to the cross-cultural relationships that made it possible. Amen.  Like the pilgrims, we can look back on this year and soberly reflect that survival was not a given.  We can remember the colleagues that have fallen at our side, some to death like Dr. Jonah, others to illness, attrition, weariness, and changing life plans. But also like the pilgrims, we can say that, by God's enduring mercy and unfathomable disparity of action, here we are a year later, even though some others are not.

 Last night the Pierces hosted a party in their yard, the entire staff Christ School and our team circled in the lantern-light to give tribute to the year gone by, and to say goodbye to Madame Betty, deputy headmaster and faithful teacher for the last 5 years.  There were skits and speeches and the requisite food, starlight and cake and an ending song of praise.  Today we will have a more American Thanksgiving dinner at our house, the live turkey a few hours ago causing a ruckus being chased by the dog who was being chased by the kids who were being chased by me . . . I am struck by the way that feasting occurs right on the edge of death, by the courage of the pilgrims to initiate a banquet having so closely averted famine.  Sharing food and wine and fellowship in a place where disaster hovers . . .that seems to be in the spirit of Thanksgiving.  And in the spirit of the Lord's supper, the intermingling of eating and drinking with the impending reality of death and sacrifice.  So today will be another poignant milestone.  Two years ago the Pierces were brand new to our team, and Dr. Jonah ate Thanksgiving dinner with all of us in their home, he had not yet moved his family back out to Bundibugyo.  I remember him seated by Julia, participating in the game of telephone we played with messages around the table, laughing.  Last year we were aware of the mystery disease, but the announcement of ebola was still a week away.  This year we have much to be thankful for, perhaps even moreso because of our awareness of the nearness of that line between survival and sadness. Give thanks to the Lord, for his mercy endures forever.   And nothing else really does.

Through the river and through the woods...

Sunday morning Skip and I (Scott) mounted our trusty steed (Honda 200 XL) and hit the dusty trail.  Ten kilometers of weaving between mud holes and even fording a small stream.  To do that we shared the one pair of boots that I wore -- first Skip traversed the stream and then threw the boots back across the stream so I could use them to push the motorcycle through!

We trekked to Bundikyora New Life Church, the last stop in Skip's Sunday Sermon Series.  The small mud-walled, tin-roofed building held a capacity crowd who came to swivel and sing, twist and shout in praise of God.  At one point in the service the entire sanctuary was one big cloud of dust from all of the  gyrations and jumping.  Skip (who has written a book entitled Worship) said he had never experienced more joyous worship.

Skip preached from Matthew 4 on The Temptations of Jesus.  He tied in the Temptations of Eve from Genesis 3 and helped people to see that the temptations were basically the same...the lust of the eyes (we want what we see) and pride (we want to control our own lives, to be our own gods).   Finally, he exhorted us to see that Jesus is the only One who has ever successfully resisted temptation and we need to receive his success as our own by faith.

Afterwards we were seated in a small dank mud house where we ate a lunch of heaping plates of rice and beef.  We were left by our hosts to eat alone, surrounded by dog-eared  posters entitled  "Queen Elizabeth's visit to Uganda",  "Manchester United Football 2009" and "The last days of Saddam Hussein".  After a post-lunch debrief with the church leaders of all the challenges before them in leading and growing their small body of believers we headed home.  

As Skip dismounted the motorcycle upon arrival he said, "Now that we're home, I can admit that that ride was the scariest part of my Ugandan adventure so far..."

Our bizarre life

While we were welcoming Karen and the kids (see below) Scott was
attending to two Members of Parliament, who were making a tour of
Western Uganda and had selected Nyahuka Health Center as one of their
stops. The Honorable Jane, who as Bundibugyo's MP has been a strong
advocate for us and for CSB over the years, accompanied the Honorable
Christopher, who represents Kasese now, though he was born locally,
and is the brother of the King of the Bakonjo. So in one of the
bizarre twists of our normal life, Scott found himself called upon to
tour them around and then make a speech. He's good at that kind of
spontaneous problem-presentation, narrowing down to a few concrete
points which the politicians might actually be able to address:
change the formula for health center funding from catchment area
(geography) to patient volume (population), which would then give NHC
75% to 80% of the level of funds given Bundibugyo hospital, instead of
5%. And streamline the district service commission, which Scott
boldly identified as an epicenter of corruption and inefficiency. In
response, he got to sit in the public meeting and hear the Honorable
Jane tell everyone that it was "a miracle Dr. Scott is even alive" in
reference to our ebola experiences, and commend him for his work in
Bundibugyo over the years. Politics, yes, but also I think God often
sends these encouragements out of the blue when we shake our heads at
our problems and wonder if we're in the right place.

I thought I had dodged the whole hooplah, but as I walked into my yard
from Karen's welcome party the official vehicle carrying the MP's
pulled in behind me. They had decided to pay a personal visit to our
home, so we sat and chatted some more about ensuring Melen received
Dr. Jonah's workman's compensation, while they drank cold sodas.
Scott gave everyone Kwejuna Project t-shirts, and even sent one for
President Museveni to whom they will report the findings of their
visit on Monday.

We can be dressing the wounds of a widow, feeding an orphan, and
greeting a parliamentarian, all in the same hour, all in the same
space. Bizarre.

Reunions

In a life that contains way too many goodbyes, the reunions stand out, sweet and strong.  I can see now Julia hugging Acacia when she left, and when she returned yesterday.  Karen and kids touched down about noon on the airstrip, enveloped immediately into the community that has missed them.  Naomi and Quinn almost popped in the moments of anticipation, and the friends have been inseparable since.  Karen told us all the story of their first two weeks, with photos.  I think my favorite part was the way the airplane pilot making a landing mid-stay just "happened" to bring them a load of fresh vegetables, right when they had reached a low point of feeling desperate about the lack of food choices.  I remember only vaguely now the way Uganda was in the early 90's, the sense of burden in collecting and cooking enough calories to sustain a family, but this challenge looms large for Karen.  The diocese of Mundri has welcomed them warmly, and we rejoice to hear their opportunities and dreams.  Last night, we had the fun privilege of hosting ALL the team kids for dinner, and movies and cake.  A taste of the final feast of the Lamb, the reunion of all reunions.  

Ebola in the News

Just in time for the one-year anniversary of Ebola, the open-access Public Library of Science journal on-line has published research that arose from our outbreak.  Here are two clips from news reports today:

From Science News:

A species of Ebola virus that emerged in Uganda in November 2007 is unlike any other, scientists report in the November PLoS Pathogens. A team of U.S. and Ugandan researchers collected and analyzed blood samples from people infected in and around the town of Bundibugyo and found that last year's outbreak of hemorrhagic fever there resulted from a previously unknown Ebola species, tentatively called Bundibugyo ebolavirus. The virus infected roughly 100 people, of whom 37 died, says virologist Jonathan Towner of the Centers for Disease Control and Prevention in Atlanta.

From AFP:  

The newly-discovered species came to light after VHF erupted in the townships of Bundibugyo and Kikyo in November 2007, says the study, authored by US and Ugandan doctors.

The US Centers for Disease Control and Prevention (CDC) tested 29 blood samples, which were negative to high-sensitivity tests tailored to the three known strains of Ebola virus. But the samples tested positive in an older, broad-spectrum antibody assay. Intrigued, investigators pulled apart the pathogen's genetic code to see what they had snared.  Using ultra-fast sequencing technology, they decoded the virus' genome in a matter of days, finding a variation of 32 percent compared with the three existing strains.  Of the 149 suspected cases of Bundibugyo ebolavirus, 37 were fatal, translating into a mortality rate of 36 percent.

The wide genetic divergence between the strains has major implications, the authors say.  It will require the invention of new diagnostic tools to detect outbreaks and could complicate the quest for vaccines and treatments.

So as the hot winds of drier season blow us into December, and my kids begin playing Christmas carols, I find my heart and thoughts harking back to the events of last November.  It was a year ago next week that we went to Kikyo and saw patients ourselves, and days later that the outbreak was confirmed to be Ebola.  Christmas and death have become inextricably intertwined.

Kwejuna Day

Yesterday the quarterly distribution of supplemental food (20 kg ofbeans, 3 liters of oil, a kilo of salt) drew a record 230 HIV-infected women to the WHM Community Center. Most had a baby or relative in tow, so imagine the chaos of about 500 people milling through our various stations, reuniting with friends, comparing experiences and admiring each other's babies. Each is interviewed first by a health worker or peer educator, to document her status and be sure she is enrolled in ongoing care and treatment. Each is weighed and measured, to collect data on nutritional status. We scrutinize the outcome measures for the babies, and have a temporary lab set up for either sending blood spot samples for viral testing or immediate antibody screening. Each woman is offered family planning on the spot, too.

Most  importantly, all have the opportunity to enter a side room in small groups for prayer. Skip and Barb poured out their hearts to woman after woman, hearing their worries, lending a compassionate ear, laying on hands and praying. Theses women carry heavy burdens of rejection by their families, abuse in their marriages, anxiety about who will care for their children when they die, weakness as they deal with their own declining health. Being heard, and being interceded for before God . . . these are gifts that the Ryans and Pastor Kisembo offered.

Finally there was a message to all: a sack of beans and a cup of oil given to the dying, God's miraculous provision to the widow that aided Elijah reflected in the present reality, a gift that can multiply into grace for many. Each woman was then called forward to receive the food, and a generous "transport" allowance (cash) to get it all home.

A LONG day, person after person, so much brokeness. Yet these are always celebratory days too, giving good-news test results to most, seeing growth and survival. And witnessing the partnership of a former team mate who advocates, a generous supporting couple who finances, nearly our entire team at work, a dozen health workers who give their all. We are grateful.

By any road

The over-night trip to Semliki Safari Lodge was, as in past years, exactly what we needed. Peace and privacy, sun and a small pool, the raucous sounds of monkeys in the trees outside our spacious tent in the night, morning birds and coffee on the porch, long talks,excellent food presented in civility. And this year the treat of going with Skip and Barb Ryan. Who would have believed that thesepeople who seemed a short step down from deity when we were in college 25 years ago would now be spending a retreat sharing focused attention, love, concern, and prayer . . . would now be our friends?Amazing.

The trip home, as it often does, threatened to thoroughly erase the restoration of the almost two days away. All was well until the very top of the mountain switchbacks, when our right rear tire blew out.  Scott got the truck to the side of the precarious road and jacked up in a few short minutes, he's had so much practice. Then we found outthat not one, but BOTH of our spare tires were flat. These were tires that had been repaired, one in Kampala at the premier tire centre, but inexplicably over the journey on the roof rack had lost their air.

Even for us this was a new situation: six tires, only three usable, so stuck. It was not long before the first truck stopped and let Scott add on to the mountain of matoke and clutching passengers, with the two spares, to the nearest village (about a half-hour away). Meanwhile the Ryans and I sat on the tailgate reading books in the dusk of the deserted mountain road, until Pat and Nathan came along, also returning to Bundibugyo from an EGPAF meeting in Kampala. To make a very long (HOURS) story shorter, Barb and I ended up getting a ride home with Pat, in the dark but at least in time to get my kids from the Pierces and to bed. Nathan and Skip waited for Scott to bring a spare back by motorcycle in the dark, discover that our new jack was not functional, wait for another good samaritan to lend a second jack, change the tire, have it go flat again, get a the second spare on, have the car fail to start, finally get it started, have the second spare begin to leak air, and at last have the angelic driver of the good samaritan truck wedge a pebble between the tire's tube stem and wheel rim that maintained enough air to carry them home at about 10 pm.

This morning I read this quote" The Lord is glorified in a people whose heart is set at any cost, by any road, upon the goal which is God himself. A man who is thus minded says, 'By any road!' Amen, but our road has quite a few bumps, jolts, mires, and treachery. And flat tires, dust and delays. Praying we can stay on track.

rest and small things

Rest: I am profoundly in need of it. Scott too. For the last several years we've taken a night away in November, ostensibly for Scott's birthday, to the luxury tented safari camp inexplicably located only two or so hours from our home. It grew out of a friendship with the managers, and has become a lifeline which we could not otherwise afford but desperately need. So readers-who-are-pray-ers can ask that the next 36 hours be a time of focus inward, a freedom from the every-ten-minute demand and crisis of normal life, a refreshment of beauty, quiet, sleep, and soul-connection. And pray that we make it through this day to reach our rest! Today I found 43 inpatients on the 25 bed ward, in other words an insane and exhausting crush of sickness and sadness. Plus two phone calls in the midst of rounds, one from Mulago and one from Mbale, were I have sent patients, whose needs still reach me. Near the end I came to little Mbabazi Kristine, whose mother has remained cheerful throughout more than a month of struggle over her dwindling life. Not so today, today her tears began to flow, and she asked to go home. Heidi had the good idea of introducing her to her across-the aisle neighbor who once looked the same and had the same diagnoses, but is now a solid chunk of a boy. I don't know if she was convinced to persevere, but I begged her to stay. Slogging through all this and trying to think clearly and compassionately in two languages pretty much wears me out, some days more than others, and this was one of them. Add to that concern for team mates and their hearts, treading fine lines that I fail to navigate well that require listening and supporting without fixing and answering, absorbing the angst of four kids entering exam periods, embracing my limited-ness and living in the hands of an all- powerful God . . . well, I'm ready for a break. and hoping that no sudden illness or disaster keeps us from it.

Small things: we had an extended prayer time last night, for the coming Day of the Lord in Bundibugyo, a time of repentance and vision for God's purposes . . . based on the book of Zechariah. In preparation I have been reading and re-reading the book, full of fantastic visions and poetic truths. It was not until prayer time, though, that the phrase jumped out of chapter 4: "For who has despised the day of small things?" This comes right after "Not by might nor by power, but by My Spirit, says the LORD of hosts." Rather incongruous, God of the angel armies in His power commending us to notice the small things. So today I offer a brief testimony to a few small things, mostly because in my tiredness I need to remember the fragility of redemption's visible presence in the muck of now. The best: Fransini smiled. Again. This baby was essentially dead last week, a tiny bit of orphan with a dedicated grandmother who was gasping with pneumonia so distressedly that we resurrected a long- disused generator to get power to the old oxygen concentrator . . . and now he's smiling. And we're matchmaking him to his six-month-old wisp of a female counterpart, Malyamu, who dipped down into the realms of death last week too, but has now revived. Both just reached 4 kg milestones (a 25% improvement on their descent to the 3ish range), and both smiled at us, little human eyes looking for interaction in spite of their hungry suffering. 

One more anecdote...this afternoon, I dropped in on a nutrition seminar completely organized and executed by our three extension workers, a small group in the grand scheme of addressing world hunger . . .but 26 community members, men and women, young and old, had gathered to discuss team work and community development, chicken eggs and sustainability.  And best of all, we merely encouraged and observed, it was Lemech’s vision.  

Fransini and Malyamu, the prayers of a team mate, the pink clouds at dawn this morning, my kids who selflessly encourage us to go for this jaunt of a vacation without them, a bite of bread an sip of wine that partake of the reality of Jesus, these small things I do not despise.

About Blogging

During tonight's phone conversation with Luke he said, " You need to update your blog, it's pitiful" (meaning he's missing home and he wants news and photos). Caleb's reply from a poster he saw on-line (using his usual filing-cabinet brain to retrieve an appropriate quip):

Blogging . . never have so many with so little to say

said so much to so few.

Ah, out of the mouth of babes.

Too much of a good thing?

When we moved here in the 1993, Uganda's population was HALF what it is today.  We are living in a country whose growth rate is among the handful of the highest in the WORLD, exploding before our eyes.  The good side of this is that Ugandans value children, value family.  The bad side is, that like any good thing, children (or more accurately multitudes of children) should not become the goal of life.  Only with a goal of God Himself in the center of life can we avoid country-wide indifference to the plight of children and killing of the almost-born (America) . . . or country-wide pursuit of fertility at the expense of the already-born (Uganda).  Every culture has its blind spots, certainly. In the US we accept limits on some good things (consumption of red meat or ice cream, for instance) but not others (pursuit of sexual gratification).  This week I sat at the bedside of a smiling but starving baby, whom we were trying to rescue with milk.  Her mother's lethargy and reduced lactation became more explicable when she confided that her surgical wound from delivery (C-section) remained unhealed after 4 months.  Yet the baby's father, a man in his 60's, was resistant to the idea of family planning.  I tried to reason with him that having a child every year, and all of them dying, did not help him as much as a child every 3-4 years who lives . . . don't know if he bought my logic.  Decisions about sexuality and reproduction are rather personal, but the implications and effects ripple out, sometimes into a tsunami which engulfs innocent children and suffering women and desperate men.

Grammy's Appendix

We were SHOCKED to learn this morning that my mom was in the hospital, having just had her appendix removed! She was experiencing some abdominal discomfort for a little more than a day, went to get it checked out, and a CT scan and few hours' wait later she found herself being wheeled into the operating room. Thanks to my sister we found out by the time she was recovering, and were able to talk to her on the phone. As I went on rounds seeing my Bundibugyo patients an hour later, I felt the familiar frustration of being pulled into the needs of these patients and absent for the needs of my own family. But there are a few things I am very thankful for: first, the good medical care my mother received. Second, that she bravely went through the whole procedure on her own but did not feel lonely, that she can experience the peace and presence of God. Third, that our amazing church friends are faithfully and willingly picking up the role that we are unable to fill. And lastly, that we now have cellular phones, so that instead of finding out a week later that my Mom was ill, I merely had to talk my way through the hospital switchboard operator and two nursing stations to track her down right in her hospital room! Last week I called my hospitalized aunt as well. It is no substitute for being there in their hearts, but it helps ME to be able to hear their voices, standing amidst cocoa trees on the equator and chatting with them in their high-tech hospital beds in Virginia!

Happy Birthday to My Man

Today we pause to celebrate Scott's life. He is a man that can lead a Bible study or a worship song, perform a surgery, fix an engine, plant a garden, compose a photo, milk a cow, balance an account, score a goal, paint a picture, tell a joke, cook a dinner, debug a computer, or build a house. A recent good-read was The Time Traveler's Wife, a book I liked because the woman in the title got glimpses of her husband as an older man, and she liked what she saw. I met Scott 28 years and 1 month ago . . . and though I thought he was good-looking and athletic and smart then, I had no vision of the depth which would mature in his character and skills. So today, a tribute to true love, and to my man.

A Tale of Two Babies

We hosted the EGPAF (Elizabeth Glaser Pediatric AIDS Foundation) team for a 24 hour Bundibugyo tour: a distinguished emeritus Duke Pediatrician, a sharp young Ugandan doctor whose practical compassion always refreshes me, a former Ministry of Health doctor who actually understands the protocols and systems and can relate to our staff, and a woman who, as Scott says, is "in charge of Africa" (not an enviable task) meaning she runs the prevention of mother-to-child transmission programs for the foundation. Plus two amiable drivers. All enjoyed pizza courtesy of our team last night, and then spent today touring our programs. Interestingly there were two approximately 1-year-olds admitted to teh Paeds ward who exactly illustrate the spectrum of the problem.

First, Mbabazi Christine, who will turn one later this month, and barely clocks ten pounds, febrile, fussy, wide-eyed. Her mother is a soft-spoken second of three wives, and has already watched her first child die. When she went for antenatal care this time she claims she tested negative for AIDS, but lost her records. She probably feared the stigma, and chose to hide from care. She did not take the medicine which can reduce the risk of transmission. She did not get treatment for Christine, either, until her condition became severe. Now we have been trying to rescue her for a month with UNICEF milk, and two weeks with anti-TB therapy, but we have yet to see improvement. These doctors confirmed our suspicion that she will not respond nutritionally or respiratory-wise until we begin to treat the HIV virus. Very complicated given our limited resources.

Contrast this story with Baby Scott. Yes, remember the first baby to be born in the new Maternity Ward? His mother is a large and pleasant woman, unafraid of her identity. She accepted her results, took her Nevirapine pill, and made sure her baby got his treatment. She comes to clinic. She practiced exclusive breast feeding up to six months of age, then weaned with the help of a dairy goat provided by the Matiti Project (which she also named Scott!!). Baby Scott's viral tests have been negative twice. He has escaped infection, and though he was admitted now with a little diarrhea and goopy nose (like most of Nyahuka these days) he should be fine.

This is what Kwejuna Project is all about, to give mothers the hope and the means to protect their babies from the virus that has devastatingly entered their own lives. It does not always work . . . but we are grateful for the opportunity to channel the resources of this large American charity, of our many supporters, to help real women and real babies survive.

News on Tuesday

From the Associated Press:  KIBATI, Congo (AP) — A cholera outbreak in a sprawling refugee camp has spread to eastern Congo's provincial capital of Goma, increasing fears of an epidemic amid a tense standoff between troops and rebels.  We studied the cholera epidemic in this very area a decade ago, when we were at Hopkins for our MPH degrees.  Massive congestion and crowding as people flee from war, drinking from contaminated surface water, hard volcanic soil that makes it difficult to dig latrines, and surrounding political instability cutting off aid:  all of that adds up to unbridles spread of cholera.  We've seen cholera before, it is gruesome.  This is bad news.

From BBC Radio, we heard Nkunda himself interviewed this morning, confident, aggressive, projecting his rebellion to sweep the country and anticipating the aid of political allies.  The reporter later commented on the well-equipped and disciplined troops, estimating their numbers in the thousands.  Then a government spokesperson said he would next see Nkunda in jail.  The chances of peace sound very remote.  We are not affected, yet, but listening with concern.

But both of these issues, cholera and rebellion, represent a society gone wrong, and not far away.  I am reminded of the response of the early Christians:  come Lord Jesus, come.  And struck that as we turn to corner towards Advent, the anticipation of the coming of the Messiah, it is just such evidence of the world gone amok that makes us strain our eyes . . . .

Jack of All Trades

We cut out a great quote, a while back, about all the diverse things a human being should be able to do, from deliver a baby to sail a ship. Missionary life affords many opportunities for diversifying one's skill set: making marshmallows from scratch, for instance, or milking a cow. Or installing a solar hot water system. Scott and Nathan spent the entire day Saturday (?10 hours) assembling and installing a solar- heated water tank for our teachers' home. Threading pipes, dealing with coolants and gradients, digging pipelines, busting through shower walls. I'm sure it would have been easier for Michael, but now we're on our own. Scott, I know, often feels the pressure of "the buck stops here." If there is a plumbing issue or a computer crisis, a serious illness or a immobilized bike, it tends to find its way to him. And he's good at figuring things out. So there is satisfaction when hot water flows, and frustration when he can't make it work, and a need for prayer to maintain equanimity whatever the case.

Girls and Boys

For many years I believed that it was easier to be a missionary kid boy than a girl in Africa. Our yard was always populated by boys, who did not have to mind babies or carry water at home and were therefore more free to come and play. Boys are over-represented in schools, and more likely to speak English. Boys can build friendship on playing football and digging in the sand-pile, running and tussling. Julia always held her own with all this, but I anticipated life being more difficult for her.

However, I was wrong in many ways. We attended chapel at Christ School yesterday, which we do intermittently, an optional early morning Sunday service with greatly energetic praise and worship (OK, we are Ryan groupies and went to hear Skip preach again!). I noticed that there were a fairly equal number of boys and girls, about 50 of each. But those 50 girls are half the female student body, while the 50 boys are only about a quarter of the males. At one point they read a Psalm responsively. The girls' verses sounded as if they had practiced: in cadence, loud, assured. The boys' verses sounded mumbly and limp. The girls sit in a tight cluster. They boys sit scattered. Julia immediately went to a bench with friends and sat with them. Jack and Caleb stuck with us.

It has been one of the shocks of this year, that our daughter is much happier at school than any of our boys have been. Miss Ashley and football are a huge part of that. Julia's personality is another, she is friendly and open and generally cheerful, confident. But I think there is something deeper that we are glimpsing.

In a strongly patrilineal society, boys represent clan, ancestry, land, power. They are in subtle competition. Outsiders are dangerous. But girls are expendable and temporary members of families, they are traded off for marriages and have fewer rights. A girl is less threatening. So, subconsciously, our daughter finds more acceptance than our sons as a teenager (almost) in a rather closed community. She will face her own challenges; we live by faith when we hear the comments that men make about her as they do about any girl. But for now we are thankful for the unexpected gift of companionship she has found.

Soul Space

In today's early morning Bible study, Barbara shared her life story, with pictures.  It was a beautiful image of what missions should be:  a foreign woman entering into this rural African culture, but connecting on common themes of caring for siblings, growing up too soon, loss, the pain of bearing a disabled child . .  . and looking, finally, to God.  There were two university-educated teachers present, from CSB, women with dreams and ambitions that might be more similar to ours.  There were a couple of younger women, in their late teens and twenties, who are navigating the changing society.  There were a half-dozen mothers, who may not have much formal education at all, whose world revolves around hoeing in their garden and feeding their babies.  We all sat in a circle and listened, drawn into community by the common elements of Barbara's story, and by the interesting and humble group process of translation.  When she described, like Job, the responses that she received to the extreme physical and mental disabilities of their third child, the women nodded.  Evil spirits?  Lack of faith?  Unconfessed sin?  All of these are real, and all bring fear and blame and despair to a grieving mother.  She led us through Scriptures that grapple with the problem of evil in a very personal way, and show that many of the painful experiences of our lives result from living in a fallen world. I saw this morning the way that someone with a graduate degree, from a wealthy professional neighborhood in a distant country, could breach the gap:  through suffering.  Barbara ended with these words, of hope, promising more next week:

When God hurts you He creates a space in your soul, then He fills it with Himself.

Friday, finally

It has been a bit of a long week. This afternoon I am thankful to be
home, after a very long day at the hospital and rain of Biblical
proportions turning the road into a river. I stopped on the way back
to check up on our student Ivan .. . reality check, the entire
compound where he lives was under water. No wonder the ward is
crammed with babies with diarrhea, I shudder to think of what is
swirling in the muddy pools that cover most of the ground. Dr. Louis
reported for his first official day of duty, three months into his six
month contract. For a district which should be desperate for doctors,
our administration has made it incredibly difficult and tedious for
this man to move into the doctor's house . . . he actually brought his
three other doctor friends to team pizza last night, along with our
nutrition extensionist . . . perhaps we are using food to lure these
bright young men to stay, but if it works it's worth it. A mission
worker who has AIDS made a suicide attempt last night, taking a bottle
of anti-retroviral pills. The pressure of ostracism and anxiety weigh
heavily on infected people, particularly single women I'm afraid.
Meanwhile Scott led about 25 medical staff this morning in a review of
our prevention-of-mother-to-child transmission efforts, a good time to
ask ourselves why our health center's performance has slipped (a few
years ago we managed to test more than 99% of pregnant women, now it's
about 75%). He introduced the new T-shirts he designed, with the
Kwejuna Project logo (THANKS FRAN ALLEN, it is still serving us!) on
the front and a Crested Crane on the back with the message: One Life,
One Wife. That got a lot of reaction, joy from the women, and teasing
of polygamous staff, and some disgruntled sighs from the men. Will be
interesting to see who wears it!

So those are the external events of the day: rain and diarrhea and
sick babies and spinal taps, teaching and laughing and exhorting and
visiting, listening and messaging and planning and cooking.

Internally, the teaching from Skip continues to sink into our hearts:
honesty, humility, helplessness. Learning to live our real story,
unhidden, not a version which we wished were true. Learning our
limits as human beings in the hands of an unlimited God. A great
phrase: resigning as general manager of the universe. I am
personally processing how to be a competent doctor who strives for
accurate and effective diagnosis and treatment .. . while accepting
failure. How to be an agent of change in a fallen world . . .while
accepting the impossibility of changing much. How to be a responsible
team leader . . . who does not try to control my team mates' lives.
How to alleve the suffering of children, even my own . . . while
accepting that some suffering is an integral part of our cross-walk
path with Jesus. Which brings me back to Chesterton and the paradox:
not a compromise, but a grasping of two good extremes, a living out of
incarnational truths: competence and failure, work and rest,
responsibility and freedom, power and sacrifice, weakness and strength.

For Masso Fans

I had my first phone call from Mundri, Sudan, this morning. Michael
and Karen arrived with their umpteen hundred kilos of gear on a
chartered AIM-air flight. They unloaded the plane and carted the
goods from the airstrip into town (easier now that there is an actual
BRIDGE instead of the wild hand-over-hand boat passage we experienced
on our visit . . .). They assembled the kids' bikes and all was
going well except for one small detail. The man with the key was
gone. They rented a small house to accommodate them while they build
their own place on land the church has donated. But the house was
locked up and no one quite knew how to locate the key. When I talked
to them they were preparing to sleep in a tent for the night, and had
stored all their gear in a tukul (local hut). So begins the newest
WHM Africa team, a few hours into their official move to Sudan, and
already homeless! But they sounded great, being Africa-veterans they
were not to worried, and it was amazing to realize that in spite of
the remoteness of both of our locations we can talk to each other.

God's Humor?

Does God have a sense of humor? Tonight the Ryans had a lovely dinner
with us, after a very long day, we were able to finally relax and eat
a great meal and hear a bit more of their story. We still have the
sense of unreality, that these people who are so important could be
sitting in OUR house in Bundibugyo. Anyway after dinner, tea,
conversation, fellowship, with the theme turning to us, to avoiding
burn-out, to setting boundaries, to the kind of things that
spiritually sensitive and directive people in our lives need to say.
Scott talked a bit about the long day the day before, and the
frustration of coming home late to find yet one more person with an
ear-ache waiting in the yard for care and his irritation with the
person. I talked about saying no, how hard it is, how this very day I
told a Christ School girl who walked into the ward to see me that
she'd have to come back tomorrow because I was overwhelmed with other
patients, only to come home late and find a message that she was worse
and in a lot of pain. But in both cases we did sense a limit, a human
inability to rescue, a need to say sorry but we can't manage
today . . . We talked about our kids and our team and the things going
on in life in general, until about 10:30, all of us were tired, they
graciously bowed out, and we prepared to quickly clean up and get some
rest.

Ha. Not five minutes after our whole conversation on setting limits,
a neighbor from up the road appeared in the darkness as our dog went
wild with barking. There in our driveway was a scene from the Rwandan
genocide, a young man swooning from blood loss, his scalp tied with a
rag soaked in blood which dripped down his soaked shirt. His cousin-
brother had attacked him with a panga, the local machete-like tools
that killed most of the victims in 1994. Scott put him into our truck
and is still at the hospital now as I write, presumably suturing the
wounds to stop the bleeding.

Not sure what God is saying in this evening's juxtaposition of great
counsel and bloody reality. Perhaps that we should listen to wisdom
but that we can't expect to confine life to the limits of our boxes?
Or that serious rest requires serious regular removals from the range
of panga-wielding feuds? Or to keep a sense of humor in the craziness
of it all? Easier said than done, I'm afraid, especially for Scott who
is actually mucking it out in the darkness tonight.

A life remembered

The Reverend Ammon Sereboya died last night, at the age of 83, friend of the mission and father of one of our nurse-midwives. His life was remarkable in many ways, and we were privileged to carry his body in the casket from town to his parental home for burial, and speak at the ceremony. He was born in 1925 in what is now the DRC, but his parents shifted a few miles eastward when he was a boy, into British- controlled Ugandan territory where he attended colonial-inspired schools. He was a primary school teacher and an Anglican pastor, and he taught at about a dozen different schools over the years. But Scott recognized him for two outstanding life features.

First, he was instrumental in the beginning of the Bible translation project. He served as chair of the Lubwisi/Lwamba Orthography Committee, and throughout the last two decades continued to work on the committee to oversee and check and promote the translation and literacy work. Sitting at his burial with hundreds of people today, I was struck by how his effort and vision contribute to a preservation and validation of their culture. And how the Gospel intersects with that, saying that each people group is valuable and unique and every language worth studying and encoding. What will the impact be on generations of children who learn to read in their mother tongue, who hear the truth in understandable words?

Second, he was married for 56 years, to one woman. Monogamy is not the norm here, particularly not for a man of his stature. Yet he persevered in his call as a man and as a pastor to the principal of "one life, one wife". Scott took some risks to stand up and publicly exclaim this in a crowd of men and women who may not agree. But he expressed admiration for the Reverend and compared him to the Ugandan national bird, the crested crane which mates for life, and people seemed to listen and enjoy the idea. I was at his wife's burial about a year ago. We have great respect for the elders who survived decades of disease and war and hardship, and brought a family and a community into being.

And so we joined our friend Alice, his daughter, and many many others today, lowering the body of a man whose soul, we were reminded by the main speaker, now walks face to face with God.

Africa rejoices . . .

I'm sure our supporters are mixed in their enthusiasm for the outcome of the presidential race in America. But there is no mistaking the enthusiasm here. Ugandans are smiling broadly. Today we had kids chanting "Obama Obama" as we drove by on the road. We actually tuned into the satellite radio early this morning (pre-midnight in the US) and heard projections but tight races . . . then after prayer meeting we turned the radio back on in time to catch Obama's speech, listening as a team, with our kids, here in Africa, his nostalgic rhetoric seeming substantial and historic in the growing morning light. At the very least the sheer fact that a man whose father was Kenyan could become president of the United States gives the average person here in Uganda a sense of pride, of possibility, of redemption, of interest in the potential for America to turn towards Africa in real ways.

In Memory of Daniel

Daniel died today.  He was four years old, and down to skull and ribs and 6.2 kg of feverish flesh.  For three weeks we had tried everything we had to revive him, but we failed.  He suffered, a lot.  Dying of malnutrition is not comfortable.  He drank the proffered milk, right up to the last day, so I think he felt hunger even though almost everything that went in was vomited back out.  More than everything that went in came out, he heaved his life out, so that he slipped downward, losing ground daily in an inexorable march towards not-being.  Ironically I suppose, I had requested the whole family to be present today, father and brother and sisters and mother, to consider transferring him to a referral hospital in Kampala. But when I arrived this morning to a ward of chaos (39 patients instead of the normalish 23-25 . . ), Daniel's father informed us that he was much worse.  He was the first patient Heidi and I evaluated, and we found the family packing up all their scraps of cloth and pans and pills into a sack to go home, though Daniel was arousable at that point, and able to swallow a few spoons of milk.  We discussed referral, but his father pointed out that he would never reach, he would die en route, which was true.  I thought they just wanted to go home to die.  It was agonizing to agree that we had failed him, that there was nothing else to offer.  An hour later they were still sitting on the bed though, as ambivalent as I was, not sure if they should begin their homeward trek or wait until he died.  Then he began to convulse, and have a fever, and we all agreed that we should try a small amount of IV fluid and Quinine.  At least the diazepam for the seizures would perhaps make him more comfortable.  Hospice care should not be a part of nutrition therapy.  Anyway he died at 12:47 pm, still hot with fever, but no longer struggling, vacant-eyed and stiff.  Heidi and Olupa wrapped his body in cloths while the family bustled to collect everything else and his mother began the traditional song-like cry of grief, and escalating wail of sorrow.  Finally Heidi and I slipped into the store room and shut the door and had a good cry ourselves.  When you see a child daily for weeks, when you ask your kids to pray for him by name every night, when you have to be present and helpless through the final agony, well, it is brutal.  

Though this is Daniel's story, not ours, we are listening, looking for meaning in the way our lives intersected briefly.  Is this a clue, to where God wants to tell the story of redemption?  Daniel's suffering?  Our powerlessness, our failure to save him?  No answers today, just a tiny bundle of cloth and a spasm of lament.  Any angels escorting him to the place of no tears did so unseen, as we emerged from the ward to a sky grey with spitting rain.  Faith, not substance, all that we have this afternoon.

Not exactly a restful day . . .

But a good one. Our three new arrivals, the visiting Ryans and the
just-arrived Nathan, joined us for our Sunday morning feast. Over the
years our family has slipped into a sabbath rhythm that works for our
sanity and survival, at least it mostly works. We start with making
tortillas together on Saturday nights at sundown as we listen to Car
Talk on NPR by satellite radio . . . games or something fun, solid
sleep, no morning alarm clocks, a long breakfast with worship music
playing, church from 10:30 ish to 1:30 ish, reading or hanging out
together outside on the one day a week when we don't have onslaughts
of visitors in the yard, a family soccer game in the late afternoon,
a simple soup dinner that brings the day to a close as we get ready
for another week of life. Great. Today's rhythm began well enough
with the steaming coffee and cinnamon rolls, telling stories and
getting to know each other, and continued into lively and joyous
worship at church and the amazing experience of hearing powerful
preaching in our own mother-tongue right here in Bundimulinga as Skip
talked about the pursuing love of God in the story of the Lost Son
(Luke 15). People were very engaged with this story of the father who
humiliates himself to run to His son.

When you push, you get a reaction. After church things went downhill,
fast. Rest fled. The door to our house would not open. We've had a
recalcitrant bolt lock, but today we jiggled and coaxed and no deal.
The good news is that our house is NOT EASY to break into. The bad
news is that it took a generator, an angle grinder, cutting through
metal bars with showers of sparks to get a space a kid could be eased
through, to get us in after church. An hour of sweat and frustration
for Scott, and a mess. Now it was nearly 3, kids were hungry. Before
we could clean up the break-in mess, a family brought a deathly ill
newborn to the kitubbi. Sixteen-year-old mother whose prolonged labor
produced a gasping convulsing child, carelessly absent school-boy
father, concerned grandparents, prognosis almost certainly severe
brain damage if not death soon. A few minutes later two men from
another NGO pulled up in their spiffy vehicle to ask us for data on
one of the water lines (on a Sunday?). I was supposed to be making
bread for communion and soup for dinner for the team, clean up the
house for everyone to come to worship, practice about 16 songs for our
first Sunday evening without Michael's talents to lead us (no pressure
that our visiting pastor Skip wrote a BOOK on worship and is used to
the kind of amazing gifts one finds in a 6,000 member church), and
make my kids feel loved by keeping our commitment to our family soccer
game, all before 5:30 . . . Can I just say that my sense of humor was
not carrying me through with grace? That I was feeling the rest slip
right through my fingers as the old and new weeks melded without a seam?

By evening, though, the candles were lit and the songs began to
ascend, and, amazingly, the sermon that would normally be written for
the benefit of thousands was again offered to the dozen of us. Psalm
139, encouraging us to discern the way God is at work in our lives to
tell His story of redemption. Skip challenged us to look for the
truth about ourselves, to look for that truth in unexpected places, in
parts of our story we'd rather skip over, and offer those hard and sad
things to God for redemption. While we're with you for a month, he
said, try to take note of the times you feel stressed, angry, or
fearful . . . .

Well, how 'bout most of the afternoon?

Praying that we and our team listen to that voice of the Spirit
challenging us to offer that which is painful, praying we would not
run from the truth, but wait for redemption.