Here, our team, including Craig and Dick from the Mariner's Church (Pierce home church in Annapolis) and our intern Doug . . Tim it seems was pushing the timer button and didn't make it. Sorry Tim!
The reason I am surviving here without Scott: cheery kids and a hard-working team. This is the pizza production on my Bday. And it proves that Tim (blue shirt) is actually here.
Me, with two fire-cracker candles standing in for the 47.
Ashley made the amazingly rich dense chocolate cakes, and the Pierces made ice cream. Pretty yummy.
But the real excitement in church today was an earthquake. It sounded
like an explosion, the whole church shook, everyone jumped up from
their benches and looked around, then a few seconds later there was
another less intense rumble and shaking. Many of the congregation ran
outside. I made my kids go. It is the prudent thing in an earthquake
to NOT be in the only building for miles around that is large enough
to kill people if it falls. I know Paul did an excellent
construction job, but I'd rather observe the strength of the walls
from the outside . . . However nothing fell down and everyone hugged
and laughed to cover their fear, including me. Then we came back
inside and sang two vigorous praise songs. The danger energized the
service, and the preacher later used it to illustrate the nearness of
Jesus' coming and the importance of standing for Him.
In the kitubbi, two anxious parents and one very dehydrated baby. No,
they had not gone through proper channels of being referred from the
hospital. But I had seen them there during an admission less than
three weeks ago, so when the baby became seriously ill again they went
straight to the place they hoped to get help. And while part of me
wants to create protective rules for my Saturday survival, thanks to
the music in my head I was able to see them with empathy. If my baby
looked like that you better believe I'd do whatever it took to get
attention. The dad's dress indicated a different world religion, but
that is no barrier when a child's life is at stake, and I'm glad for
that, that justice and mercy offered in a humble way cross barriers of
faith and culture.
On Friday, at the "launch and lunch" celebrating the end of our week-
long Village Health Team training on nutrition in HIV/AIDS, I walked
in late just as John was graciously covering for me, and found myself
immediately invited to speak. The first thing that came to mind was
Isaiah 58, so I read a few of my favorite verses, and found that
though I was preaching to the VHT's the Spirit was speaking to ME. If
you extend your soul, pour yourself out, on behalf of the needy and
hungry . . . then God will be your guard, He will come to your aid.
As volunteers these health workers will pay a price to help others.
But their reward is from God, and He promises to refill what they pour
out.
Today I cling to that promise, too. And to the clarity: what is
required? Just this: to do justice, to love mercy, to walk humbly
with God. This was a life verse we reflected on at my Dad's death, a
summary of the way he lived. And it provides a guide for me and for
our team. Let us pursue justice vigorously, let us live out acts of
mercy, and let us do both, not in a way that promotes ourselves or
America or World Harvest . . .but in a humble day to day walk with God.
For tonight, resting in the rescue God provided Kevin and JD, and
rejoicing that he has a new valve and a new hope for life and
relationship and work and meaning.
(Press release): Nairobi, June 16th 2009: Africa observes the Day of the African Child, in memory of, thousands of black school children who were maimed and killed in 1976 Soweto uprising, as they took to the streets to protest the inferior quality of their education and to demand their right to be taught in their own language.
Today is a UN-sponsored day to draw attention to the plight of the African Child, which is all too often a life of marginal nutrition, sub-standard education, fragmented family (in spite of our stereotypes few kids here grow up with both parents), and too-early shouldering of adult roles and responsibilities. I suppose I celebrated it in my own way today, struggling for the real lives of a few real African children. All in a day's work: a newborn baby with spina bifida who could be helped by referral to a neurosurgical mission hospital on the other side of Uganda; a newborn whose mother died in the process when her uterus ruptured who could be helped by milk until the family sorts out a surrogate breast-feeder; a convulsing baby whose anxious and misguided parents had been treating him for days at home with herbal enemas which were ineffective for his real problem of meningitis, but who could be helped by IV antibiotics; a five-year-old inexplicably malnourished little girl who tested positive for AIDS and could be helped by the correct medicines and counseling; a child with newly diagnosed sickle cell disease who could be helped by prophylactic antibiotics and vitamins; an infant with severe gastroenteritis who could be helped by large and fast infusions of IV fluids; and the list goes on through a crowded ward and a line of consults.
Too many days I have the sense that all the effort is for little gain. But today a small supply of anti-retroviral drugs arrived (not much, but enough for the next week) and another consignment of anti-malarials, which is huge news. Both evidence that prayers are at work, that good is gaining margin over the chaos of want. And lastly I want to share one very satisfying victory. Two weeks ago a child was admitted with severe malnutrition, and given his terrible respiratory status and his coughing skinny mother, we thought the pair probably both had TB. But the mother's sputum tests from another hospital were negative. The clinical picture was so convincing, though, that I set out to get her re-tested. I have never worked so hard for one simple lab test. It would be too tedious to describe every turn in this story, but here are a few: no frosted microscope slides, which the TB program requires because the slides have to be marked with the patients' name and saved for review, phone calls, none at another lab but the idea of using tape to mark the slide, the lab refusing and demonstrating the slide would then not fit in the right slot in their storage box, more phone calls including the District Health Officer informing him that our entire public health effort to find and treat TB was failing for lack of lab supplies, who then suggested we send someone to beg them from another health unit, paying for the fuel for the motorcycle to do so, to no avail since they did not have them either, noticing a truck from Kampala with "TB and Leprosy Programs" painted on the side and shamelessly interrupting to beg aforesaid frosted slides which they happened to have stashed in the back seat (?prayers), then finding out that a certain acetone fixative was lacking for the stain, more money for more motorcycle fuel to track the fixative at another hospital, then having the mother turned away from the lab for lack of gloves, providing gloves . . . meanwhile the interns looked at this kid and couldn't believe he was still alive. By Friday this was still going on and I decided to just start treating the child for TB anyway. He actually improved over the weekend. And today his mother FINALLY (AFTER TWO WEEKS OF RUN AROUND) got her sputum sample: triple plus positive for TB. So instead of a dying child and a more slowly dying mother, or a child who was treated empirically for TB only to be orphaned when his mother died of the disease or re-infected when he went off therapy . .. now we have hope of two people being cured and living normal lives.
And the real story here is the same story as Kevin's . . . it is God who is looking out for individual lives. Most times the degree of difficulty involved and the sheer volume of other demands would have meant that this child and his mother slipped through the cracks. Many mothers might have also wearied of the rigamarole and gone home by now. But in this one small case, God kept prompting one more step, one more try, until the diagnosis and treatment were complete. Because He cares about the African Child, not just as a politically correct concept, but as an actual flesh and blood and tubercle bacillus-infested individual who will one day take deep breaths and perhaps graduate from high school or build a house or write a story. Or just carry water for his mother.
Meanwhile Julia, Jack, and I are attempting to hold down the fort at
home. No small thing. Just before he left, Scott, with Nathan's
brave help, moved our very mean and dangerous bull away from the
paddock by our house to the yard at the old Tabb house. For safety.
But our cow DMC just stood at the fence and cried her little heart out
all evening. And I could so relate to her! Her husband is out of
sight, and her calf might as well be at boarding school since they are
separated by a fence (to prevent nursing so we get the milk). A few
hours later, the gate was left ajar and the calf Truffle entered her
mother DMC's paddock. So there were Jack, Julia, and I all with
sticks running around in circles trying to get them apart and drive
the calf back into her proper quarters, an exhausting and futile
exercise until cowgirl Julia got some dairy meal (like oats) and lured
her. Thankfully I had turned off the stove at the last minute so
dinner was saved, but if this first night is any omen for us and the
cows, the next two weeks could be a doozy. Now DMC is moaning and
alone again. She has the separation woes, and so do I.
The Barts posted Psalm 139 on their blog with the news that Kevin's
surgery for replacement of his aortic valve is scheduled for today at
1 pm (Duke time, 9 pm here in Bundibugyo). Join us in praying that
the same God who knows our spiritual hearts, our hopes and longings
and sins and weaknesses, will also know Kevin's physical heart and
guide the team of surgeons and staff to give him many more years of
life on this earth. His recovery to this point has been nothing short
of miraculous. Looking forward to more of the same today.
Over the years we've trained traditional birth attendants, community
health workers, nutrition outreach volunteers, peer educators . . .
all people whose role and qualification comes from being respected
members of the community rather than from degrees earned in school.
In a place with limited manpower, this cadre of informal, unpaid
workers forms the backbone of primary health care. Fifteen years ago
no one but our WHM predecessors (Dan Herron, Lori Borchert) seemed to
be attempting much of this in Bundibugyo. We found our way to the
Uganda Community-Based Health Care Association and bought their
manuals, incorporating spiritual as well as physical lessons on
health. Over time, though, our role has become less direct. Team
mates such as Pamela and Stephanie and Pat worked more recently with
these volunteers, and bigger programs such as UNICEF and the Belgian
government put lots of money and effort into scaling up this kind of
training and organization for the whole district.But today John Clark launched a new wave of community health outreach. Thanks to contacts we made in the last year with a program called NuLife, we were able to send two of our great agriculture/ nutrition extension workers to be trained to teach village health workers about infant and young child feeding, particularly in the context of HIV/AIDS. This organization, funded by USAID and working in close partnership with the Uganda Ministry of Health, has developed a nice set of teaching aids to bring basic health and nutrition messages to the village level, and to teach dedicated village health team members to screen their population for malnutrition. Instead of waiting in the hospital for the kids to come to us, these village health team (VHT) members will actively search out those failing to thrive. This dovetails nicely with our other health-center and hospital based programs for moderate and severe malnutrition. And this prepares our district to receive the commercially prepared high- calorie food supplement which NuLife hopes to begin manufacturing. That is still a ways down the road, and as a medicinal food it will only be given to the most severely malnourished and those with AIDS, so again there is complementarity with our BBB local-production for moderately malnourished kids.
Over the last few months a good amount of aggressive advocacy was required to get our staff included in the trainings, and to try and hold together the various partners involved. But now I am enjoying the teamwork, dropping in to see our trainers drawing out the 20 VHT's in a participatory way, noting that a good number of those chosen for the training are HIV-positive people themselves taking an active role in their own care, thanking John who saw to all the details of transporting and feeding and informing and facilitating the people involved in this event. The training will go on all week and end with a community launching ceremony. We pray it puts information, inspiration, vision into the hands of the people.
Bundibugyo in the news again. Not much good news comes out of here.
We have been spending time in the story of the lost sons, the "prodigal" son and his sulky brother, the forgiving father and the feast, from Luke 15. The parable serves as a mirror as we see too much of ourselves in the sons, but also as a beautiful goal of becoming like the father.
Kevin Bartkovich, our long-time team mate and friend, is in the
hospital in Durham NC in critical condition.He had gone out for a jog with Joe yesterday and collapsed within a hundred yards of the house. Thanks to Joe's calls for help neighbors called 911 and started CPR. JD ran out to find him with no pulse or breathing, and continued the CPR herself until the ambulance arrived. He was in ventricular fibrillation, the kind of arrhythmia that causes sudden death. It turns out that he has a previously undiagnosed congenital anomaly of his aortic valve, which occurs with some frequency (at least 1 out of a hundred people) but does not usually cause any symptoms until mid-way through life, and then the first sign can be this kind of sudden collapse during exercise. The paramedics had to shock his heart three times; the third time in the ambulance finally got it beating again. Kevin was without vital signs for at least 5 to 8 minutes. In the Duke ER he did try to fight the tube in his throat for breathing, and opened his eyes, so those are hopeful signs. He is heavily sedated, medically paralyzed, on life support, and cooled down to a near freezing temperature, all to try and minimize the damage to his brain from the long period of no oxygen. Preliminary tests indicate he did not have a "heart attack" (myocardial infarction) or a stroke; the collapse was due to the electrically ineffective rhythm his heart went into.
Yesterday was the Bartkoviches' 15th anniversary. I can only barely imagine JD's experience of finding Kevin lifeless on the street and doing the first CPR she's ever had to perform, on her own husband. By the time she got her 4 year old twins cared for and got to the hospital, she had no idea if Kevin was alive or dead, since she had last seen him put into the ambulance after the first two attempts at defibrillation were unsuccessful. Her family, and many friends, have rallied around her now. His prognosis is far from clear, he is certainly not out of the woods, but we hope and pray that he will recover without major impact on his brain. He will eventually need a replacement of the abnormal heart valve.
Where is God's mercy? We can not see it as clearly as we would like; we say by faith that it must be there. Here are two glimpses.
One, since this event stems from a life-long silent heart defect, it could have happened any time during the Barts' ten years in Africa. Kevin's final weekend he hiked over the mountain pass with teachers from CSB, a strenuous endeavor hours from any road or phone, not to mention hospital. He coached soccer and jogged around the school track. If v-fib occurred here, he would not have survived. Even if he had gone down most places in America, he might not have been revived in time. This happened five minutes from one of the premier medical centers in the world. This is a small vision of the way God sends His angels to keep us from stumbling, even when we don't know it.
And glimpse number two, this occurred in the midst of Christ School crisis. Yesterday the students were becoming very restless and threatening violent strikes, the immediate issue being the school's new policy of having a "spot exam" (pop quiz) period at the end of every day. The bigger issues are complex, related to being teenagers, poor, reckless, with little to lose, no skills for non-violent conflict, distrustful, many with histories of abuse and abandonment. We got the news about Kevin while students and staff were in the midst of meetings over their complaints. The meetings turned into prayer meetings for Kevin. This was a needed reality check and change in focus, at least for the day.
Please pray for the Bartkovich family, for bigger views of God's glory and merciful care as they walk through the valley of the shadow of death. And pray for the school that they devoted a decade of their lives to found, for us to see God's glory and mercy there, too.
But a mercy of God is that with a kid at RVA, we take a mid-term
breath-catching pause. From Friday to Sunday this week we are a
family first and only, putting aside worries about patients and
robbers and polio and funding and the future. Our job, for the
weekend, is to be with our kids. And they're a pretty fun group to be
with. This is what they like to do: play ping pong and tennis and
soccer, swim and read novels, watch Mythbusters and World Cup Football
qualifiers, eat Thai, Indian, and Italian food, catch a movie in the
theatre, laugh at Calvin and Hobbes jokes, jump on the trampoline, and
read some more. And talk, about schools and travel and people and
chaos and God. It's a welcome break from the day to day reality of
Bundibugyo. We are usually on the move, heading to a conference, a
meeting, or at least a game park when we're on a school break. This
weekend we're just in Kampala, impersonating a normal American
expatriate family going to restaurants and relaxing. It's been great.
And we're back at the ARA (the American Recreation Association), a
place where we have history, where some of the same staff watched
these same teenagers when they were toddlers learning to walk and
later to swim. This is the very room where we landed to recover from
rebel attack in 1997 without a single change of clothes to our name,
where the managers let us rustle through the lost and found. Year by
year as Bundibugyo became home, the ARA also reminded us that we're
still Americans, too, who like a hamburger and a room with a fan. It
has been a safe place to escape into order, a place of respite.
Sometimes all the more frustrating for the illusion of American-ness
without the reality, sometimes a disconcerting dose of parallel
universes of rich and poor . . . but mostly a great escape.
So we're thankful for the weekend off, storing up the memories and the
resilience to hit the ground running again on Monday.
Today I saw 6-year-old Anita, who has been my patient since birth. She was one of the first children started on ARV's (antiretroviral drugs) in our clinic, and responded wonderfully. Her CD4 counts are excellent, her mother caring and faithful. She does not miss appointments or forget to take medicines. She is exactly who USAID, EGPAF, Uganda MOH, JCRC, Baylor, etc. etc. labor to save, and infant who would likely have died by now but instead turned into a growing normal-looking girl. And up until today, she represented the way things are supposed to work.
But today, there was not ONE SINGLE antiretroviral pill in our clinic, or in any other clinic in the district. We've watched the supply dwindle. We've made reports, follow-up phone calls. We've switched regimens to economize and use every possible pill. We've been told to ration, to not start any new patients on drugs, to be patient ourselves, to hang on because the supplies are coming. But they never did. The margin has long been tenuous, but the shocking truth is that today dozens of clients left the hospital without medicine. By next week half of the hundreds of people on ARV's in Bundibugyo will be off therapy.
And even more shocking: a phone call to Kampala confirmed that this is a nation-wide stock-out of drugs. What happens in the world if one of the countries with the highest number of AIDS patients, one of the places were the epidemic began and gathered momentum, suddenly takes thousands and thousands of patients off meds? In the short term, some people who were barely surviving, early on therapy, will die. In the long run, it sounds like the perfect scenario for a drug-resistance nightmare.
I sat outside our clinic in the hot sunshine after my phone calls, crying. Crying for Anita, for injustice, for the inefficiency and poverty and poor management that led us to this point, crying for my own frustration of impotence to do anything about it (these drugs are tightly controlled and not available to just run out to the store and buy). So at least I will give voice to the Anitas of Uganda.
