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Thursday, April 29, 2010

Football Fever

The first term of school in Uganda ends with national football (soccer for Americans) tournaments for both boys' and girls' secondary school teams. Each of Uganda's burgeoning number of districts (recently topping 100) can send one school. For the boys the event is sponsored by Coca Cola, and I have to say this is a fine example of an industry putting something back into East Africa. They do tournaments in Kenya, Rwanda, and Tanzania too, and promote the development of coaches, the identification of talent. They even sponsored an under-18 team to go to South Africa in a World Cup warm-up event. Coca Cola pays for the food for 80 teams of 20 boys and 2 coaches each, over a ten day period, plus t-shirts, banners, prizes, and a major media event for the opening and closing games. Because football is THE SPORT in Africa, the secondary school tournament is one of the major sporting or social events of the year for the country. And because football affords opportunity for health, success, competition, awareness of other tribes and areas of Uganda, team-work, pride, goal-setting, etc., the tournament contributes to the development of young people. And because our boys get to see a new place, interact with new people, spend large quantities of time with their coaches, struggle, and process, the tournament fosters discipleship and growth. As you can tell, I'm a fan.
This year we had planned to try and see the boys play as we returned from taking Luke and Caleb to fly back to Kenya. We were preparing to leave Kampala and checking on the first day or two of fixtures with Nathan when we got the surprising news: CSB had been randomly drawn to meet the host school, the powerful St. Henry's Kitovu, in the opening match. This is the only match that all the invited guests watch from the grandstand, that has a marching band, that every team lines the fields to see, that draws reporters and football officials and coke executives and you name it. This game is huge.
We pulled onto the St. Henry campus, which was nicer than almost any school in Uganda, expansive, huge fields, many, many dorms, chapels, classes, halls, green grass, space. This is a school that's probably five or six times older than ours, several times larger, and a hundred times richer. It was shocking. Hundreds and hundreds of boys from all over Uganda milled about in identical coca-cola shirts, a sea of red, a striking picture of what could have been a military camp (same age group) but was instead a sports camp (praise God for that). We greeted our boys who were nervous but smart in their CSB warm-ups. After music, acrobats, speeches, parades, the match was opened like a Premier League game, with much hooplah. There were our boys lined up on the field with several thousand people watching.
For the first 15 minutes or so we were great. Hope glimmered. We could have won. Nathan is a great coach, and Alex has prepared them well, they are smart and fast and able. I can't really explain the mental aspects of football, but they are huge. Perhaps the booming drum of the home team. Perhaps the murmurs in the crowd that we would lose 20 to nothing (I kid you not another team did lose 19 to 1 in another match). Perhaps the pressure of being in the spotlight. Perhaps playing a team that could do things like intentionally draw us offsides (our in-district competition was not at this level). Perhaps the decades of being colonized and marginalized and losing confidence, the sense of being from a remote and undeveloped place, of being unable to compete. Perhaps the larger pitch and general exhaustion. We lost 4 nil. We played hard, though, and the score does not reflect very well the eveness of the game.
Afterwards we shook everyone's hands, and left praying the boys would not lose heart. Nathan told us the same thing happened today in the second game, losing 3 to 1 in spite of initially coming on strong. Time for Kevin's "I believe in you" speech! It would be great if they won at least one of their next two matches.
Meanwhile we came back to Bundi, more on that some day, but tomorrow the girls' team leaves for their tournament. They are NOT sponsored by Coca Cola. Their tournament is pay-as-you-go, and Ashley and her supporters are our source here. The girls had no in-district games to prepare them, but they have practiced hard. Their tournament is in Gulu, which is a two-day drive from here. The pomp and glory will be lacking I suspect . . but they will probably have more fun. Instead of 80 teams they will be lucky to have 40.
Praying for our girls to travel safely, enjoy their adventure, play their best, and experience a taste of victory (one game won would be great!). Praying for Ashley in a position of responsibility, and Julia too, in cultural immersion. Stay tuned next week for the scores!

Monday, April 26, 2010

safety in isolation

Yesterday I completed mission impossible, penetrating the US Embassy in Kampala, for the controversial and delicate assignment of . . . adding pages to my passport.  You might think I was trying to extract trade secrets or subvert national security for all the barriers one must pass to get a dozen small pieces of blank paper attached to a passport.  

Background:  When you go in and out of Uganda to take kids to boarding school in Kenya several times a year, the pages go fast, since Kenya now has a lovely colorful full-page stick-in visa, and border agents everywhere delight in stamping and signing.  We rarely spend more than a day or two in Kampala, and always have an arm's length list of things to do.  So a couple of trips ago Scott thought he'd swing by the embassy for this relatively simple procedure, during the hours they have set aside for "Americans only" service (there are other times of the day when the poor Ugandans who want to travel to the US have to queue up, and I can only imagine how brutally difficult that is).  But nothing doing, he found they had changed their system so that no American can just enter through security for open hours.  One must apply on-line ahead of time for a designated slot, fill out all the correct computerized forms, and then be issued a computer-generated ticket.  I suppose so they can do a background security check on us, in case we're dangerous spies posing as missionaries.  So before his last trip to Kampala, alone, he did all that, and even though he was thinking several days in advance (which is a lot for us) he had a hard time getting an appointment.  But at last he did.  He approached the fortress, submitted his passport, emptied his pockets, went through security in the concrete surrounding walls, was escorted through locked doors to the waiting area, then sat in the bullet-proof cubicle behind glass to turn in my passport and request pages.  But no go.  Even though he did this for our kids some months back, he could not do it for me, his wife.  I had to be personally present to authorize the blank page addition.  I was 8 hours travel away in Bundibugyo manning the home front.  So he left, having wasted two precious hours of Kampala work time for nothing.

Back to yesterday:  I clutched the precious e-ticket, went through the same tough security, sat in the same chair.  With, I might note, ONE other person.  In the hour and a half I was there, only two of us got seen and taken care of. Meanwhile I had left a distraught American woman standing outside the fortress entrance speaking desperately into her cell phone, catching phrases about how she had tried to get an appointment but there were none available, could she just be seen today???  As I sat for an hour waiting for my passport to be expanded with new blank pages, I thought about all this.  

The new American embassy was built to withstand terrorist attack after the Nairobi and Dar Salaam embassies were bombed some years back.  This was not an idle fear; real terrorists did real and terrible damage.  We were in Kampala on that day, staying at the ARA no less, and it was frightening to come close to that potential, since our embassy was slated for destruction too but the plot here failed.  America reacted with a show of concrete and bullet-proof glass and procedure and protocol, with rules and guns and power.  The new embassy is much, much safer.  Most of the people who died were Africans, and everyone I encountered yesterday was too.  I'm sure there are Americans in there somewhere but even deeper and safer behind the protective perimeter. I'm glad the diplomats and the Ugandans who work for them have such a spacious and secure environment in which to work.

But I also have to wonder if the obsession with safety has gone too far.  Even as an American I felt alienated by the whole procedure yesterday. Our culture is one of no-risk, of insurance and law suits and seat belts and safety.  Which results in many people living long and healthy lives.  Wonderful.  But taken to extremes, also results in us being unable to truly encounter the majority of the people of the world, where life is unsafe.  All that protection leads to some serious isolation.

When we told the church elders we would be working as Field Directors from the Nairobi area for a couple of years, one of the first responses we got was this:  you stayed with us in the war, and you stayed with us in ebola.  All the medical care and projects and funds did not speak as loudly as our physical presence during the two most dangerous and frightening periods of recent Bundibugyo history.  We certainly have taken many isolating precautions in our life here (we drive a car, for starters).  But it was good to be reminded that sharing in common risk is a powerful communication of love.  That is the message of the incarnation.  

An option for missionaries; not for embassies I realize.  But I wished yesterday that America could present a less formidable face to the world.  I guess that's part of our job.

Sunday, April 25, 2010

A day in your courts

Thanks to generous grandparents . . we were able to spend our two-day family get-away goodbye in a place that perhaps mirrors the beauty of the house of God more than most. When we settled in on Wednesday afternoon, I pulled out my Bible and my Psalm for the day was Ps 84. As I read it, on the porch of an immaculate tent overlooking pristine wilderness, flocks of greater striped sparrows swooped through the brush and in and out of the eaves of the roof, a perfect picture of this psalm. That caught my attention . . surely the courts of the Lord would be characterized by good food, cold drinks, space, family, trilling birds, glimpses of wild animals, symmetry and order and tasteful, restful loveliness. And the fortunate sparrows enjoy this all day, every day, while we long for it on our journeys. It's not wrong to feel a sense of release and peace when wilderness and luxury intersect. It is the home for which our souls were programmed in eternity past, the Garden and the City of God.
The middle of the psalm though acknowledges where we are now: hearts set on pilgrimage. Passing through the valley of weeping until those tears become springs of blessing and life. Moving towards our goal, God, His presence, through a world that contains tastes and promises but not ever quite the real thing.
Our 48 hours in the Semliki Valley were ones of blessing. The reserve was practically ours alone. We had long hours of conversation in the pool and beside it, on the porches, around the table. Spectacular lightening rolled in while we were on a game drive, blowing cool wind. The stuffy hot months melted into rain that night, a change in the atmosphere, a reminder of God's mercies, refreshment. The thousand days of separations and struggles were forgotten in the one day of quiet and fellowship.
And we left, hearts re-set for the pilgrimage ahead.

Tuesday, April 20, 2010

Orphans and Vulnerable Children

"OVC's" is aid-speak for kids whose existence is so marginal as to be threatened. And we have a lot of them here in Bundibugyo. In fact the sheer volume often threatens a shut-down of compassion, as one more sickly, rash-ridden, hungry, or goopy-nosed kid comes across our paths, as needs are presented by grandparents left in charge of orphans or mothers left alone to cope. Then as they grow physically, their mental and spiritual needs flood the churches and schools. Every Ugandan values highly the precious resource of an education, though the options are limited and the costs beyond the capacity of many families. Jesus was able to feed the crowds while touching the individuals . . and calls us to do the same. OUR VISION at Christ School - to build an academically excellent senior secondary boarding school that produces servant leaders, for the good of Bundibugyo and God's glory. 340 teens live and learn on campus. These kids receive the best education in the region, in a context of Christian discipleship and community service. They also receive three meals a day, and beds in a cement-floor dorm (a step up from most homes), and electric power for lights to study by, and a library full of books, and access to a computer lab. We keep tuition lower than any other boarding school (in the country!), subsidized by donors to WHM, so that the poor may participate and indeed own and change this district.
However, for some orphans and vulnerable children, even our low tuition is an impossible barrier to overcome. So every year we look for 60 sponsors willing to cover the full cost of a child's education: 10 per class in 6 grade levels, Senior 1 to 6. These kids are selected based on a combination of need and academic promise. They are the harbingers of Jesus' value-inverting Kingdom, the least of these who will be raised to reign. And sponsoring a child is a way to connect with an individual face and name out of the crowds. In 2010 we know that 18 of the 60 are sponsored . . .but that leaves 42 whom we have admitted on faith and need to connect with resources. We offer two levels of sponsorship: $400/year covers the subsidized costs that others pay in Bundibugyo; $600/year ($50/month) covers the actual cost of education.
Click here for the CSB page on the World Harvest web site; click here to sponsor a specific orphan student (touching the individual); or here to contribute to the subsidy for the general tuition of the other 280 kids (feeding the crowds).
Our investment in the lives of the kids in the post below is probably the most important thing we've done in 17 years . . . it is a privilege we invite others to share.

Goodbyes Begin

These boys have been part of our life, our extended family, for a decade or more. John (far right) and Luke used to fight over trucks in the sand under the mango tree when they could barely walk. They all learned their math facts from flash-cards in our kitubbi, and their catechism. They listened to Bible stories on flannelgraphs, and read our books and magazines. They have spent countless hours playing football in our yard, eaten countless meals here, gone on hikes and trips with us. Now they range from just-starting secondary school to mid-University level. (Two are not pictured because they are in schools outside Bundibugyo now). Tonight they gathered to say goodbye to Luke, and to some degree Caleb as well. Luke will not come back to Bundibugyo when he graduates in July, so this was his last night at home. Their commitment to us is not all gain for them, it comes at a cost, since others are jealous of their position and ridicule them. Like adolescent boys anywhere they have gone through their share of restlessness, searching for identity, testing us and our relationship. An occasional suspension from school, or frustrating requests for more than we can give, challenge us. Then letters come from their hearts, full of thanks, and all is well. Ours is a very human and imperfect relationship, made more murky by the ambiguity of parental ties in this place, and by the chasms of culture and economy. However, when all is said and done, we love this crew, and the daily monitoring of their development counts among the greatest losses we anticipate. A true friend is a rare gift and Luke has found that (in some more than others, but it's there). On Friday we will pass through Fort Portal and say goodbye to three of his former classmates, who are also good friends. None of these boys will be on facebook in the near future, or have phones with international calling capacity. None will be traveling the seven thousand miles to visit Luke. None have ever even heard of Yale, though they're glad for his chance to go to University. Their worlds are diverging, painfully, though we will all do our best to hold them in some kind of parallel, to bridge the gap whenever we can, leaving high school and home is a pretty drastic step when home is Africa.
The goodbyes begin.

Monday, April 19, 2010

Unbelieving, I believe

Read one of my favorite passages in Mark today . . the father who brings his convulsing son to the disciples who fail to heal him, and then Jesus gets pulled in.  I love the father's heart cry:  Lord, I believe, help my unbelief.  This paradox of vacillating certainty, accentuated by parental love.  My own son is not falling into fires or dramatically beset by indwelling demons.  But I long for his healing and safety and happiness all the same. 

Luke has opted for Yale.  It has been a good, long, restless month of processing.  Praying, reading, researching, corresponding, trying out arguments, deciding and not-deciding.  There were other great choices, closer to grandparents.  So it took him a long time to sort out that this was where he really WANTED to go, and to courageously step through a door God graciously opened with fantastic financial aid.  It's a whole new world out there, where the best schools in the country can also be the least expensive for low-income missionaries.  Luke is an amazing person and it is a frightening privilege and responsibility to be his parent.  

The decision brought a moment of relief, it's done.  But then reality set quickly in.  We're out of limbo-land, where we can pretend that life goes on like this indefinitely, where we ignore the fact that tomorrow is the last day our family of six will live together in the only home we've ever had.  Suddenly we have a real college to deal with, with paperwork and schedules and dates and decisions.  Suddenly we are here, at the end of all things we've known.

That's where I cry with the father of the epileptic:  Lord I believe (look what you've done, bringing this 8-month-old baby to Uganda in 1993 and now he's survived 17 years and grown to  6' 2" and read a thousand books and is encouraging US that God is the constant in all the moves ahead).  Lord help my unbelief (this child of Africa thrown into the icy competition of the Ivy League, this home that has been our base shifting).  The father's faith is gritty, honest, unpolished, real, and desperate.  I like that.  But it's not the real story:  the real story is Jesus who does not let the boy suffer from the failures of others, who breaks in, who asks questions, and who at last authoritatively brings life, who is willing to pay the cost of prayer and fasting to pull this boy out of the fire and water.  Let me rest on that Jesus.

Sunday, April 18, 2010

Lame Ducks

Well, in the midst of chaos and grief, a little humor goes a long way.  A package from the Johnsons arrived at last: they had mailed it to our team more than 4 months ago as a way to begin to bond with us, little imagining that they would beat the package here by a wide margin.  Among the many fun gifts was a set of little rubber duckies for the Pair-o-docs/ ducks.  See above.  And now that we're in a leadership transition . . . that makes us not only a pair-o-ducks but lame ones at that.  

Saturday, April 17, 2010

Pilgrims and Strangers

For 16 1/2 years, we've lived the paradox of being pilgrims from our families and country of origin and strangers in Uganda's Semliki valley . . . and yet not pilgrims, because we've stayed put in the same house and job and community all that time, and not strangers as we've delved into language and culture and connection and life.  About ten years in we noticed a definite shift, the community beginning to accept us as part of the normal background of life.  We did not have a plan B.  

But part of the missionary rhythm of life is supposed to include the "home ministry assignment" (a.k.a., furlough), the periodic return to one's supporting churches to report and encourage and ignite vision, the refreshment of reconnecting with family and the familiar.  In WHM that is approximately 1 year in 5.  This has basis in the Biblical principle of sabbatical, 1 year in 7, an acknowledgement of the creation pattern of work and rest, a challenge to the life of faith, a counter-cultural turn from relentless forward progress.  We took ours in 2000, a memorable year in Baltimore when we completed MPH degrees at Hopkins and had live-in rotating grandparent help and bonding.  And since then we've had a hard time seeing beyond the wisdom and goodness of remaining rooted, with shorter trips as family crises or the needs for meetings arose, always pushing the sabbatical/HMA time a bit further back.  Now with Travis and Amy Johnson on the team, as we've thought about how to manage HMA again in 2010, we've seen God leading us in good but painful paths.  Back to pilgrimage.

First, Scott has been asked to take the job of Africa Field Director with WHM.  This is an honor for him, and us, as we are fully committed to WHM and Africa, and love the various teams, the people and the work.  It allows us to step aside for new leadership to arise on the team level, and yet to remain intimately connected with the tiny part of the Kingdom that we've been privileged to witness.  It is, however, a job that requires him to travel and communicate in ways that are not compatible with living in Bundibugyo full time.  And secondly, our mission leadership and family have been supportive of the idea of a short America-based HMA (mid-July to Dec) and a longer near-Nairobi-based time.  We have a commitment from Kijabe Hospital for both of us to work half-time there, so Scott can be a Field Director and I can be a mom, having 3 of our 4 kids at home (it's right next to RVA) . . while still practicing medicine in Africa which is our passion.  And in a place where we can learn and grow, for the good of Bundi and places like it some day, as well as our own good.

All that came together last week when Scott was interviewed for the Field Director job, and accepted.  In my heart it came together when we were in the process of thinking about our year and my mom called ME and suggested pretty much this very plan, before we could have told her anything, even though it involved sacrifice and loss for her.  It was a goose-bump, Holy-Spirit-leading, moment.

And I have to remind myself of all that, because right now, the whole plan feels very, very sad.  WHM asked us to wait until Thursday to begin talking about the job and changes.  So we booked out our days on Thursday and Friday to spend going from person to person, group to group, to explain face to face how our job is changing.  Scott walked our friends through the news of the new job, and its implications.  I mostly sat next to him and cried.  Though WHM is a very small organization, it is a good thing for our friends here to find out that they now have an advocate in a "higher" place, that we remain with the big picture ongoing work.  However, it is NOT a good thing to introduce a thousand kilometers of separation, to break our daily community life, particularly for the kids who have become part of our extended family.  I grieve that for myself, and for them.  I grieve the pain we are causing the brave souls who have taken us into their hearts, who have risked friendship, who hoped we would not be one more in a long string of departing people, who could easily feel dehumanized  as expendable objects of ministry.  They are not.  This change ahead in July is already an excruciating weight on my heart.

My dad died four years ago today.  He left well, thankful for what was behind, not afraid of what lay ahead, and trusting the process into God's hands, well aware that he could not delay it, let alone stop it.  As a pilgrim he did not cling to home.  I find it hard to strike the right balance of fully entering into this world as if it was home . . . and remembering that it isn't.  Entering relationships as if they will last forever . . . and bravely enduring the "for a little while you will see me no longer."  Being a pilgrim and a stranger, but journeying towards home.

Friday, April 16, 2010


I'm not exactly flying through the Bible these days, but am trying to regularly read chunks from the historical books, wisdom literature, psalms, and Gospels.  So in the first category I've made it up to Numbers, first two chapters. Which, at face value, is a bit of a dry list.  Simeon's male descendants over the age of 20 were 59,300.  And the leader of Manasseh is Gamaliel son of Pedahzur, who camps with his 32,200 men on the west next to Elixhama son of Ammihud.  

However, if you think about it, numbering implies value.  Here were former slaves, so expendable that all male babies could be thrown into the Nile river.  Suddenly they are free.  There are rules.  Organization must be put in place to rally a mob that had been oppressed and bullied for generations into a people movement capable of withstanding the desert and conquering territory.  By numbering, Moses was assigning place and importance to every individual.  

This is an issue of justice and public health that remains today.  The children of Bundibugyo are not numbered.  We do not know how many are born, and how many die, and where, and why.  When we ask a mother on the ward about her other children and find out she's buried 10 of 13 now, that is staggering news.  Or it should be. Instead it is hidden suffering.  In the last week five children have died on our ward, in our care.  Baluku Thomas, the child with ants crawling on him day before yesterday, I found this morning as a body wrapped in a kitengi cloth, having breathed his last at 3 am, his grandmother waiting for help to transport him back home for burial.  He and another child I never even saw both died of hunger, severe kwashiorkor, languishing in another hospital for a week then being transferred here to die.  Ahebwa and Kisembo Nassan both died of fear and ignorance, having their gums sliced for supposed false teeth.  Katusiime Annet was the one month old infant of the Barts' former house worker and our neighbor, who received everything we could give for a three day battle with severe pneumonia, and lost.  

The movie The Interpreter ends with the main character reading aloud lists of the names of people who had died.  Africans, whose deaths are more easily hidden than those of many continents.  (It's fiction, but truth, and a fantastic movie by the way).  So today I name our losses of the week.  

And look towards the day when the Babwisi and Bakonjo are numbered, when a birth is registered, and a death certified, when the abundance and loss impact policy and catch attention.

Wednesday, April 14, 2010

It was the ants

I think it was the ants that really got to me.  I knew today was going to be long and hard.  Wednesdays almost always are.  Our team begins with early prayer, rotating focus on different members, and today we prayed for Anna, Luke, Caleb, and Nathan.  With Luke and Nathan it is an unsettling time of decisions and transitions, and both are such great godly young men . . . so that no doubt began the day with more emotion than usual.  Then I was the first person in the ward, trying to get a jump on the day.  As I breezed through the doors and headed to the store room to put on my white coat and get my clipboard, I greeted patients and glanced about.  My heart jumped when I saw the toddler lying on a mat on the floor directly beside the store door.  I have seen dead bodies that looked more alive than that.  His color was a corpse-like cross of pallor and sickly yellow,  and he was motionless, still.  I bent down to feel for a pulse and as I moved back his blanket, the stench of putrid peeling skin wafted out.  And then I saw the ants, tiny ones as colorless as the child, crawling around his eyes, over his shoulder.  A shudder-inducing emergency-inspiring disaster, a child in an advanced state of malnutrition and decay,lying there with a caretaker who seemed lost and listless herself.  But he was alive.

And so the struggle began.  Soon other staff arrived, and I had great help. Though his heart was beating and he would moan when moved, caring for Baluku was like running a code.  Assign jobs.  Pay attention to the time.  Think globally of what could make the difference between life and death in the next few hours.  Get labs, take a focused minimal history.  Mom died two months ago when he was two, grandmother is the caretaker, first noticed a swollen abdomen a few weeks ago . . . then was admitted to another hospital for over a week where he became worse and worse until they transferred his care to us at the last moment.  His edematous body with fragile peeling skin made IV access nearly impossible, so within five minutes I gloved up to insert an intra-osseous line, a brutal needle that pops through the cortex of a leg bone in order to give a child fluids through the vascular network of bone marrow.  Travis walked in at that moment and got his first chance to use this simple, useful technology on a real human being.  Meanwhile there were two other critically ill patients on the ward, another 30-or-so admitted, and another dozen-or-two waiting for outpatient evaluation.  Crazy.  So once the intra-osseous line was in and the initial fluids pushed, we left Heidi, bless her heart, to warm water and clean him, to monitor the spooning of milk, to push the syringes of transfused blood slowly into his leg.  She spent hours hands-on with this child.  And by afternoon, with blood and antibiotics and fluids and bandages, with a cozy blanket (one of the last of Annelise's friends' gifts), the possibility of survival  was there.  Not likely, but possible.

Somewhere in the middle of this, I went into the store room again for something, and ran into Nathan who was scrambling for something else, and had a quick cry.  I think it was the ants crawling on Baluku that seemed so overwhelmingly sad.  Nathan is one of those dependable, honorable Scott-like guys that sometimes gives the sympathetic word that breaks down the resolve.  I've seen so many malnourished kids, so many tragic stories, so many deaths and near-deaths.  I don't want to ever reach the point of not being emotionally punched in the gut by a child like Baluku.  Nor do I want to reach the point of running away, tempting as that was today (a new diagnosis of AIDS in another child, another baby whose parents took him for horrific teeth-cutting now in shock on oxygen and fluids and blood and looking very likely to be this lame mom's 10th (of 13) child to die, another baby with half her nose eaten away by some bacteria leaving a crusty gaping hole through which she breathes, burns and wounds and pus and malaria).   So a quick cry that acknowledges this is NOT RIGHT, and then a deep breath and hands on the next medicine or syringe or whatever was needed, and on to the next patient.

The ants can not have Baluku, yet.

Monday, April 12, 2010

Kusiima Jenepha

A baby landed at our house at dusk one evening, a newborn wrapped in kitengi cloth, at that point nameless.  She had been born on the path as her mother tried to make it to the hospital in time.  Once there, however, the midwives or parents noted that all was not well.  She was born with imperforate anus, a margin of a few millimeters of cell migration and differentiation in the early weeks of her embryonic existence, a tiny failure to complete the course with huge consequences for survival.  And so she entered life outside the womb with not only a chaotic outdoor delivery, aspirating fluid and gasping for breath, but also the only outlet for her intestines being a small fistula track into her vagina.  

But at least there was an outlet, and with that, hope.  Oxygen and antibiotics for her wet rumbling lungs.  A missionary surgeon in Kampala advised on how to irrigate the meconium out of her small openings.  She tentatively began to feed.  Ultrasound did not find any related anomalies in other organs, though with the coarse lung sounds and no xray we could not rule out an associated tracheo-esophageal fistula.  Meanwhile I was emailing and calling about the country, trying to find a surgeon and hospital with the expertise to handle such a child.  I try to spread my begging for favors around, and regret that I called International Hospital's Hope Ward (charity ward) last.  They agreed to help her.  Her prognosis was poor, certain death if we did nothing, and likely death if we transferred her, and at the very best a life of surgeries and medical challenges that even a family with ten times the resources would be hard pressed to endure.

The parents were committed from the first hour to do whatever it took.  So on the 5th day of her life, I filled out paperwork and gave them transport money to get to the best hospital in Uganda.  I asked then if they had given her a name.  Yes, they said.  "Kusiima Jenepha".  My heart contracted.  Kusiima and Jenepha are both common names.  The first means "thanks".  And the second has been a world-wide favorite, beginning in the 60's when my parents chose it without ever having seen the movie Love Story.  But the combination made me squirm.  I wished I had done more, earlier, faster, more efficiently.  I did not want to be saddled with the credit for this life that was unlikely to last long.

Kusiima Jenepha died the next morning, a few hours after making it to the hospital where she was to have surgery.  The ten hours of transport on the bus were too much, even though we pumped her up with fluids and antibiotics, she arrived in critical condition.  They gave her superb resuscitation care, but she did not recover.  The hospital administrator called to tell me.  I did not expect to see the family again, but the father came back to my house at dusk a week after the first evening.  I knew we had failed him, but he came to thank us for our help.

I do not like to dwell on the patients that die.  We discuss them in our weekly staff meetings, and I tend to explain why we could not have done better, why death was inevitable.  In the last week or so I've lost two children with AIDS and TB, both of whom arrived at late stages and no prior care, malnourished and hypoxic and vomiting and way past the point of return.  And another normal baby whose parents took him to have his baby teeth cut out of his gums to cure diarrhea, a diabolical (literally) practice perpetuated by fear and misinformation that claims too many children.  All of these kids spent at least 48 hours in our care, all seemed to have a chance of recovery, but none did.  I was in the room for only one of these recent deaths, the distressing moment of declaring the struggle over, telling the mother as she wilts wailing to the floor, trying to reach relatives on the phone.

Kusiima Jenepha, however, reminds me that this is not about success or failure.  About striving, sure.  About going the extra mile.  About caring.  About giving every opportunity.  About sacrifice (time, heart, money, worry).  About team work.  About life that is short at 6 days or 6 years or 60.  Perhaps even about love, though that seems too strong and noble a word for my part, it applies to the parents.  Even those who come too late, have come because they love.  I'm thankful for their forgiveness when we fail them.


Decisions loom this week.  We celebrate God's abundance in giving Luke (our 17-yr-old senior in HS) six amazing choices for college, excellent schools with financial aid beyond what we dared hope.  This is a kid who has only spent 2nd grade in America, and now he's heading off to college there.  And Nathan, in his second year of working very hard here as a nutrition manager, football coach, and biology teacher, has options at several top medical schools.  And Sarah, who just completed over two years of teaching and working with nutrition programs, must also choose between excellent public health graduate programs.  Please pray for all three of them.  The God who whispers and asks questions gives them freedom in choosing their next steps along His paths.  With that freedom comes a certain weight of responsibility, mixed with the joy and relief that the bizarre turn they have taken (be it 2 years or 17) through Bundibugyo has not closed the door to higher education.  All want to serve God with their degrees, most likely in difficult places.  All their options are good ones.  Pray for clarity as they ponder them, and peace as they reach conclusions.  And for us, the parents, the team leaders, the one-step-back advisors, to support and respect and cheer.  It feels like a significant week as these loved ones strike out on their paths.  Luke's will impact our next few years, too, and we also could use prayers for clarity and peace.

Sunday, April 11, 2010

District Champs

Christ School - Bundibugyo triumphed in the District Football Final game yesterday, 1-0, against Simbya St. Mary's Senior Seconday School. It was not an easy game. Our boys came out strong, passing, dominating. But by half we were only up by one, and in the second half our best striker was injured and out, and we played hesitant and uncoordinated football. Not our best, but good enough. Interestingly this week Luke (who has been practicing with the team, a whole new ball-game since he's 6-2, and not the slow little kid anymore) was pushing one of his friends to be more aggressive in play, and the boy told him "but then either I will be shamed or the boy I'm attacking will be shamed". I think we felt that in the finals, a holding back lest anyone look too bad in front of the biggest crowd of the year, against our nearest rivals. Hoping that they will loosen up at the national tournament (VERY far from home, the last week of April) and have more fun.
On to Masaka! Praying it will be a time of bonding and discipleship as the team travels and stays together, an eye-opening interaction with kids from all over Uganda, a confidence boosting memorable treat, and a chance to represent both Christ and Bundibugyo in good ways.

On demand (again)

Twice on Friday, we encountered the disgruntled and demanding.  This is the season of "Child Health Days", a spread-out-from the hospital into the community push that is designed to top up all the immunizations and public health prophylaxis that keeps us from preventible death.  World-wide, neonatal tetanus causes 7% of deaths in the first month of life, making it one of the top killers of newborns.  But I have not seen a case in over five years, which is certainly the result of immunizing young girls and pregnant women.  Measles epidemics are deadly in the malnourished and displaced, but our last one here was over a decade ago, thanks to immunizations.  Great stuff.  So it was discouraging to hear the staff return from their first school-based outreach to complain that the teachers at the school refused to assist them at all.  Why?  Because said teachers were DEMANDING a cut of the action, a greasing of the palm, a little something in payment.  The assumption of everyone is:  the government wants us to do these outreaches, so money must be allocated, so I deserve to get some of it, and if I don't, it's because someone else is "eating" it, and I'll never see a shilling unless I make a demand.  As it turns out, there are no funds for teachers to participate.  And once people were convinced of that, their attitude changed.  Second example:  later I heard that the football team were complaining that their usual perk of an extra egg and chapati a day (after all they train for a couple of hours every evening on rather minimal calories) had been dropped.  I'm sure they also assumed that someone was "eating" the money designated for their goodies, and if they did not push for it, they would never get it.

This culture is fueled by demand.  From the time a child is born, it is his duty to cry in order to be fed, to ask and grab for what he needs.  It is the patients' responsibility to ask every six hours for their injections on the ward.  It is the employees' responsibility to file endless paperwork and make endless trips to personnel in order to be paid.  It is the wife who must throw a tantrum to get a dress. It is the inlaws who must haggle goats from the bridegroom.  It is the right of any relative to ask for whatever is needed from those who have more.  The up side of this is that people are in touch with their desires, and that parents/teachers/supervisors feel relaxed and free whenever someone is NOT in their face, they aren't necessarily mind-racing ahead to the next good thing that COULD be done, but more content to wait until it becomes imperative to do it.

The down sides are also there, however.  The malnourished lethargic kid who does not cry for food can easily be neglected.  The zealous missionary who takes seriously every request (and then also thinks ahead to self-imposed potential duties) becomes exhausted.  The average person can't assume that anyone in a position of responsibility will spontaneously do their job, so there is this constant push and pull of disgruntled demanding and passive-aggressive threats.  

And our culture most surely impacts our view of God.  The demand culture, I think, leads to honest and constant prayer for every need, which is Biblical.  But it also can paint God as some cosmic disinterested being from whom we must demand attention.  Do we have to push for everything we need?  Not in my experience.  Rather, we are bowled over by the extravagance of His grace.  Is that just our culture, where plan-ahead duty-driven self-push is the norm, or at least the ideal?  Or is there a deep truth to mercy?

Saturday, April 10, 2010

A little fire kindles

This past week in our Life Together study, we focused on the tongue, that little fire that kindles great forests (James 3).  WHM employs in our training a famous homework called "the tongue assignment" :  for one week do not gossip, complain, put anyone down, defend yourself, etc.  The impossibility of it drives us to grace; and an analysis of WHY we want to speak so often on our own behalf reveals our real values.  Bonhoeffer writes about holding one's tongue, meekness, and listening as the foundation for true ministry.  This is a risky study, and a risky assignment:  as a leader, of course, we have to be the first ones to repent.  So in the group I found myself telling stories about what the Spirit had revealed during the week: as visitors came, I saw how I lay out our ministry or tell stories of the past in a way that makes me look good and puts down people who have been difficult.  I don't listen when I assume I know what someone else (usually Scott) is going to say.  I was critical of one of my students until later I realized that his complaints were legitimate, I had forgotten a promise I made.  I use my tongue to be the opposite of meek:  to defend and promote and justify myself.  Not lovely.  

It is also a risky topic cross-culturally.  We wondered, would anyone relate to this, or is it too abstract?  But God is answering prayer, and on the move.  One of the participants fell under strong conviction about harsh words he had showered on his subordinate, and asked for help in seeking forgiveness and reconciliation.  Angels blew trumpets, I'm sure.  It's not easy to repent anywhere, and moreso in a hierarchical society for an elder to repent in front of a younger man.  Then even more amazingly, he decided to share the story with the whole group, putting himself in a very bad light.  Two others expressed their struggles as well.  Past seminars (Kevin's Sonship and Donovan's Teaching Redemptively) were mentioned, demonstrating that the Word is still slowly percolating, that fruit will still sprout from those days.  

It was a holy evening.  We continue to pray for real all-things-new wholeness in our hearts and our colleagues', the emerging character of leaders that will transform Bundibugyo.  This was a glimpse of the answer.

Thursday, April 08, 2010

Great Start

The campaign to end chronic hunger in Bundibugyo took one more step forward today, as we were called to a meeting in the District Health Office to evaluate a 30-page proposal by WFP.  Interestingly, Stephanie Jilcott who worked on our team to set up the BBB program after she finished her PhD in nutrition, was visiting, and it was her data that documented the shocking 45% stunting rate in this district that got this ball rolling.  She and Scott Ickes combined their missionary service and academic research in a unique way that drew attention to the pervasiveness of undernutrition in Bundi.  Today she, Travis, Olupah and I joined a half dozen others from the district to discuss plans for radio spots, dramas, community mobilization, and general education and focus on the crucial issue of child feeding.  The conversation ranged from the possibility of establishing a radio station (any takers?) to the nuances of language choice and the motivations behind cocoa production.  We're big advocates of emphasizing the connection between school performance (highly valued by parents) and early nutrition (harder to see and value).  Rather than policing how much land a family devotes to vegetable production, teach them the importance of a varied and calorie-adequate protein-rich diet and then let them make good choices.  

A month or so ago, before the big launching party, some reporters visited our hospital.  They are just now filing their reports, so if anyone wants to read a story from the national paper on Easter, here it is:
 In case you're wondering, I'm Myra and Nathan is Eldad.  

And the catchy song that says that REAL parents feed their children:   Uwe mubyaye weniniye, olisiya abaana bawee!

It's jingling in my mind even as I type.  This is our five loaves, the breaking and giving of our small resources in a way that can multiply and feed thousands.

Wednesday, April 07, 2010

one wedding and a funeral

In the last three days we've spent two afternoons at different neighbors' houses, Monday at a funeral and Wednesday at a wedding.  Both were times to experience and participate in the solidarity of community.  The funeral was by far the larger and more significant event, attracting hundreds of people.  We sat on dried cocoa leaves under the shade of the cocoa trees, as the grave-digging was completed a short stone's toss from the front door.  As soon as the clan leaders spied Scott they announced he would be giving a speech, and so he was called forward into the bright sun of the courtyard to talk about community, mourning, relationship, and the preparation of our hearts for the inevitability of death.  Burials represent probably the largest community events in this culture, and by their very nature times to ponder immortality and the Gospel.  It was hard for me to watch Richard, only a few years older than Luke, hunching his shoulders and wiping his eyes as his father's body was lowered into the freshly dug hole.  The next morning I went back to take some tea to his mother.  It is traditional for close family to spend four days sleeping outside the deceased's home, on the ground together, a long watching and supporting.  Solidarity.

Yesterday's event was more intimate.  We had been informed that we should come, but I had forgotten completely until I walked in from a very long morning at the hospital at almost 2 and found Scott waiting to go.  Our direct nearest neighbor Tabaka, brother of the late Mukiddi, was receiving bride-price for his daughter from a family in Congo where she had "married".  In traditional culture a couple often "elopes", pays a fine of a chicken to show they are officially together, and it can take a year or two or more for the formal family negotiation legitimizing the marriage.  I think this couple had two kids already.  The Babwisi have incorporated some Baganda culture into their marriages in the last decade as this place has become less isolated.  The whole event is rather dramatic, with appointed spokes-persons for each side, the two family groupings seated facing each other, and much bandying back and forth.  The groom's group has to present the goats they have brought; the bride's family makes a great show of inspection and rejects some on the basis of their size being too small or their fertility being unproven, then the groom's family will make them "grow" by adding on an envelope of money.  Besides the goats there were a list of concrete demands such as "7 litres of paraffin" and the men on the bride's side had to open the bottle and smell the liquid to be sure they weren't being cheated with plain water.  The 15 kg of sugar when counted out turned out to be 14 and a half, but the bride's group agreed to forgive. 

Lots of laughter, but also the underlying cultural appropriateness of the DEMAND.  A woman is something to be haggled over, and the exchange of a daughter for goats and crates of beer and soda is considered a fair deal.  And the last chance to press for more, so take it.  ( Our weddings in our culture could also be seen as mercenary, with the expectation that all guests bring gifts . . . ).

So, a couple of observations.  The wedding had very little to do with the bride and groom.  They were peripheral to the whole affair.  The event yesterday was an bonding of two families.  It was a negotiation of alliance, and exchange of goods that sealed a relationship.  The last order of business was formal recognition of the "mukwenda", the go-between, who is related to both sides and will serve to relay messages and confirm rumors and smooth conflicts between the two groups in the future.  The burial was also about family and clan rather than a dead individual.  In the speeches and the customs, the lineage, the property, the descendants, are the key points of interest.

Second, it was a privilege to be drawn into both.  Particularly at the wedding, we were called to come as part of the bride's family.  In fact Scott has had the opportunity to care for both of her parents at times over the last 16 years when they would have died otherwise.  Tabaka, who is now in his 70's and the elder of the whole affair, and recipient of the don't-try-this-at-home surgical procedure Nathan blogged about a week or so ago, made a formal statement early in the ceremony.  He came into the courtyard and introduced Scott as his son to all present, so that we were not attending as guests but seated with the family.  One of our "adopted sons", boys we sponsored through school, was the MC of the affair.  Two other young men who have been very connected with our mission sat near us.  The "maid of honor" I had also sponsored in school, and another "bridesmaid" young woman is one of my patients.  

Sitting under a tarp laid with banana leaves for coolness, in the bright afternoon heat, straining to follow dialogue in a foreign language, claimed by a rascally clan of sometimes-devious always-generous people who have forgiven our other-ness and drawn us in, thankful for moments of inclusion in a life that is often disjointed, but always interesting.

Monday, April 05, 2010

Rolling Stones

I suppose it was the smashing, tumbling drama of the small boulder that Pastor Kisembo rolled in the Easter Sunday service yesterday that has stayed with me.  The resurrection itself has little witness, the flesh forming back over the 39 lashes, the life fluttering behind eyelids.  By the time anyone saw Jesus he was up and about in the garden, and mistaken for a gardener.  But somewhere between the stirring of breath, the swinging of pierced feet down from the slab to walk out of the tomb, and the meeting with Mary in the garden, there was a cataclysmic force that rolled the massive sealed stone door, open.  A blinding light, frightening rough soldiers into a dead faint.  

Because the women who were approaching the garden at dawn worried about how to get inside the tomb to embalm the body with their spices, we know it was no small rock.  And because they wanted to get IN, I think I've always thought of the "stone rolled away" in terms of our access to Jesus.  But primarily the stone was removed to give HIM access to US.  He was the first one who crossed that threshold, coming OUT.  

And I find that encouraging today.  God is willing, and able, to blast away anything that might stand between Him and His will.  Bethany posted on Easter using a phrase from a Mundri saint:  God will not be defeated.  Nothing will stand in His way, tons of stone, or hearts of stone, He will always break through to get out into the world, out among us, to find us, to speak and touch and heal and change.  To make all things new.

Sunday, April 04, 2010

Easter Sunday: resurrection and reality

Easter Sunday faded into cloudy light as our team gathered at the Johnsons to sing hymns and be led in a meditation on John 20 by Travis, looking at the ways Jesus comes to the many characters in the story, from Mary to Thomas. Then we all dispersed to our homes for family breakfasts, ours an unusually leisurely waffle production (we have a cast-iron one-by-one pan that cooks over the gas flame, allowing for extended coffee and conversation). The church service began in a pouring rain but ended in steamy sunshine, almost four hours, including about four different singing groups, and the two main choirs must have done 8 to 10 songs each. Kisembo brought an actual large rock to illustrate the sermon, which he dramatically rolled down the steps of the front dais, with a crash! Many people brought produce as their offering, and a business-man visitor in a suit bid up the post-service auction to the highest prices ever, much to the delight of all concerned. In the afternoon our whole team, and a few friends, came to our house where we had spread a long table in the shade and we grilled meat and feasted. People stayed around to chat as the day became cooler, kicking a ball, making phone calls home, playing ping pong, eating cake, and finally resting under the stars by candle light. It was a lovely day.
But reality broke in, too. We got phone messages as we were preparing for the team dinner, that one of our neighbors had died. Milton was the father of a boy we sponsor in school, a boy who has played with our kids and been our friend for most of his life (he's about 21, and we've known him since he was 5). Richard finished CSB this past year, and we sent him last month to be trained as an electrician in a trade school in Fort Portal. By evening he had received the news and come home, and Scott, Luke, and I left our party and walked up the road to his house. From the sparkling table-under-the-trees spread with food and surrounded by laughter, we went to Richard's where I crouched on a dirt floor strewn with banana leaves next to a dead body while Luke and Scott sat with the men outside. No glorifying death here: wailing tears, a man basically our age who worked as a laborer and lived in extreme poverty and struggled with alcohol and died in his home gasping for breath after three days of a pneumonia for which no one sought medical help.
Since my Dad also died on Easter night, it was a bit surreal for me. I gave Richard a big hug. His dad could not provide much (which is I believe a huge factor in the numbing attraction of drink for men here) but he was the anchor of that household, and now he is gone.
Songs and friendship and feast are part of reality . . but only made substantial and sweet by the dust-to-dust contrast of a soon-to-decay body in a soon-to-crumble mud house. Resurrection, come.

Saturday, April 03, 2010


Yesterday's focus on prayer and memory was good, but absolutely exhausting. More than the long hours, I think there is a draining energy of pushing back against evil in prayer.  Some encouragement came from scattering the invites and finding between 15 and 20 people showing up in the afternoon after a morning's church service, missionaries outnumbered by Ugandans, a diverse cross-section of men and women, young and old, church leaders and teachers, indigenous to Bundibugyo and working here from other parts of the country.  Praying for things like gardens and protection from thieves and justice in government and strength in marriages and even the much-hoped-for pneumococcal vaccine provision.  Praying for miracles. Later in the evening we missionaries met again, about half the team, to meditate on the Cross and then enter into a half-night of prayer.  Since our work is usually very hands-on and public, it is good to acknowledge that yesterday's work is the real deal, the hidden and effective push behind that which is seen.  Our focus for the night was from Heb 12, the paradoxical mixture of suffering and joy that characterized Jesus' approach to the cross, the fatherly scourging that draws us into the unshakable Kingdom.  We prayed for endurance to run the race, we prayed for our WHM teams in Sudan and Nairobi as well as our own, for unity and love, for seismic shifts in endemic corruption, for clear signs of new life.

But today, I feel the cost in weariness, and a rebound of discouragement.  

Which should not be surprising.  The cross was a fully costly experience for Jesus.  He gave up every vestige of wanting to be loved by others, was disfigured, misunderstood, silent, accused, revolting.  There was absolutely nothing in His walk to death that was calculated for popularity, that pushed His own agenda.  The Son of Man did not come to be loved, but to love . . the cross was a full emptying of any right or desire to demand love, an in its place a full sacrifice of unreturned love towards others.  

That was Jesus.  That is not me.  And that's why Saturday feels long, and tiring.  How to thrive in a life of giving love rather than seeking it?  I think a big answer is the continuous way Jesus prayed, which is strikingly portrayed in the movie the Passion.  Psalms drop from his lips and flow from his heart.  Patrick from our mission wrote a post about this a few days ago, the continuous prayer that taps into the power of God.  Power to love. Because I can't, none of us can. May the morning's celebration of resurrection begin there, a fresh-from-the-garden encounter with the One who has the power to love, and to share that with us.

Friday, April 02, 2010

Good Friday

Our church here in Uganda always spends Good Friday morning meditating on the seven "words", phrases really, that the Gospels record Jesus speaking from the cross.  It is a smaller service, more somber, the faithful come, but the crowds do not.  And I always find something new in the way that people from a culture closer to Jesus' read and understand his words.  Today, for instance, when Jesus speaks to John about his mother, the preacher drew a picture of how a boy might bring a friend from school to his home, to eat, and then later if that friend came alone (without the real son of the home) he'd be welcomed by the parents based on the friendship with the son.  So Jesus was showing us that those he calls friends are now part of his family, and welcome, even in his absence.  Or the phrase "I thirst" . . . was very analogous to the first words anyone would say coming in from a morning's work in the garden.  We're on the equator.  We sweat.  Everyone leads lives that involve physical exertion.  So to hear Jesus say the same thing makes sense to them, it is a word of his humanity, of his connection.  He is not over-spiritualized into someone inaccessible or opaque, rather he is portrayed as he was, a flesh-and-blood man in agony, pouring sweat, and feeling real thirst.  Seeing Jesus through the eyes of others makes him more real, to us.

On the night he was betrayed . . .

Jesus ate, with his friends. He knew he was walking into the end, and yet he took the time to celebrate, to feast, to honor tradition, to build community over a meal. To drink the four cups of wine, to consume of the sacrificial lamb, to break the crisp unleavened bread.
In the stress of conflict and impending arrest and torture, Jesus did not consider such an evening of fellowship optional or expendable. And he knew what physical, concrete creatures we are, how we need to be anchored in the rhythms of community and remembrance. How we need the drops of deep red wine, the tang of bitter herbs, the texture of shared bread, to understand reality. And how we need each other, how meals bind. These friends would soon desert him, but in the act of this meal he affirmed his love and set the tone for bringing them back together on the other side.
And so this year once again we relive the Passover, a doubled vision backward of the Exodus and the Crucifixion, and a peek of vision forward to the Supper of the Lamb. Holy and deep with analogy and meaning, but also immediate and accessible in the familiarity of a dinner with friends.