Living the 11th hour in a troubled world: 11/11/2020, Pandemic day 236 in Uganda, bracing for cheer

 The 11th hour is upon us. 

This story is about this woman, and death, and faith. Keep reading.

Today's remembrance holiday commemorates the end of WW1 102 years ago. Poppies blooming between crosses, larks singing where guns once pounded, capture the hope that time and beauty heal the wounds of war. By pausing today, we acknowledge that war has taken a toll, that death and evil invade and distress, but also that sacrifice and love prevent their triumph. That's why we honour our veterans. 

In the USA today, we have our government casting doubt upon the legitimacy of our democratic process, even though ten lawsuits so far have been concluded with no evidence of fraud. The secretary of state implied that the incumbent president who lost the popular vote by 4-5 million votes and the electoral college by 279 to 214, with 45 votes still to be finalised in Arizona, Georgia, and NC, will continue into a second term. There were 139,855 new coronavirus cases yesterday in America and 1448 deaths, both exponentially increasing. Here in Uganda we have a steep rise as well, and our first confirmed COVID death from our own Bundibugyo hospital. As dire as all that sounds, I suspect 1918 was worse as the flu pandemic raged amidst the brutalities of WW1. Still, good emerged, but only after a lot of sorrow.

Today, my Bible reading included one of my all time favourite verses, one that pretty much sums up the history of now. 

In this world you will have trouble; but be of good cheer, I have overcome the world.

Two truths that do not blend easily together, a troubled world, and a cheerful confidence. Sorrow and hope. A world that keeps throwing punches, and a God who says it will all be OK.

It's been one of those weeks. Monday, as I was finishing staff Bible study looking at the covenant God made with Abraham (side note, but who would choose circumcision for a 99 year old man who was unable to make his wife pregnant? God stacks the odds against the outcome we pray for sometimes to make it so dramatic) . . . Dr. Isaiah came to find Scott. His sister-in-law was bleeding, after a difficult C-section, and there was no blood in the hospital. They began arranging to send her to Fort Portal for blood, but before they could load her into the ambulance, she died. Meanwhile Scott was pulled in to see another woman in labor because she came with an ultrasound diagnosing twins, which was quite believable since she was very large. He re-scanned, did not see twins, baby was OK, but labor was stalled, so planned to take her for a C-section too. Only there was: NO sterile instrument set (insert 3 hour delay), NO sterile gowns or drapes (do without). Once she was in theatre her Blood Pressure was 221/150--sky high-- not the ideal time to have gotten the first set of vitals. She was hyper-reflexic, heading into ecclampsia, so this was suddenly life and death. NO medications for the ecclampsia, or the hypertension. Anesthetist UNABLE to get the spinal so he just dosed her with ketamine until she was moaning less. I think you get the picture--an extremely non-ideal situation. If we wait for the ambulance to get her to Fort Portal, or to get back with blood, she's going to be dead. So Scott went ahead, a really really hard case due to all the missing things and her obesity. At the end, she just started bleeding even more (not surprising in ecclampsia, which messes with clotting), so he re-opened and tightened up and re-sutured. By now her BP was 70/40, pulse 120's.  The baby was great so after a quick resuscitation I had handed the little girl off the maternity nurses and stayed to keep praying, taking BP's, prompting more IV fluids, more oxygen, calling the returning ambulance whose driver pretended to be almost to Bundi but had actually not even started to return yet. Post-op we got her BP up a bit with the fluids, had her on oxygen, propped up her legs, waited and waited. Finally the blood arrived and it was nearly dark by the time we had it running in. She was opening eyes and moving, and we were relieved. As we went to bed, we got an encouraging report from the on-call doctor. And a half-hour later, she died. Two maternal deaths in one day. I'm not sure we had even had two this year prior to this, except for a woman with advanced AIDS. Babies and children die almost every day, but not mothers. We were all devastated. As I looked back over the weekend, I realised at least one child had died each day due to lack of blood supply. Extremely discouraging, particularly when our regional blood bank is projecting statistics to the country of functioning perfectly.  In the last couple of weeks, I've had to declare several children dead as they breathed their last in front of me, and pretty much every time I come to rounds I find someone missing. 

In this world you will have trouble.

Ten days ago, when we were in the capital to pick up Michaela, we witnessed a horrible accident. As we drove down a main city street, a matatu coming towards us hit a motorcycle taxi. Two women on the back of the boda fell off, one into the path of the matatu. We watched her body bounce on the pavement and then the matatu run over her, wheels crushing her abdomen and chest as it jolted on. The matatu driver sped away as we pulled off the road and ran to the body. We cleared her airway and held her neck in traction, she was still breathing but unconscious, with blood pouring out. A crowd quickly gathered and grabbed her from us and loaded her onto the back of a small truck, to rush to a hospital. I know she died. This is a country without 911, without accountability for wanton vehicular homicide, without emergency options.

In this world you will have trouble.

I think the accumulation of death this November is just too much. Too much blood, too much trauma, too much impotence to change. We're in a disaster-level rainy season, and there were more floods on Friday. We got a two-night weekend respite for Scott's birthday, but spent hours stuck in a line of mired trucks on the muddy road, and nearly didn't make it. We came back to a tormentuous crop of intensely itchy bug bites. Our team is grappling with the rising coronavirus, and we are wading through murk in trying to create liveable protocols with almost no testing or data. Today was supposed to be our final court appearance, when the judge would announce his decision about the attempt to grab back land we as a mission bought 20 years ago for Christ School gardens. The son of the couple who sold the land is a policeman with power, and decided to try and invalidate the sale 14 years after the fact. It has been in the courts for six years. This morning when we arrived in town, the judge said he needed more time to consider the case. Not a good sign. Our friend, neighbour, and former worker was walking home Saturday night after dark and got mixed up in a fight of some sort on the road, which a soldier decided to break up with bone-breaking force. Literally, he clubbed our very slight, fragile, hundred-pound, 50-something friend so hard he ended up with a broken arm. So that was another day, getting xrays and Scott putting on a cast. The main young doctor who has been working with us quit last week too. So every day is longer, and the days we devote to our other jobs as Area Directors and Team Leaders leave the hospital even less covered.

In this world we have serious trouble. Flood-level trouble from injustice, misinformation, greed, corruption, broken systems, crazy weather, just plain evil.

But, Jesus said on the night before he was killed, "be of good cheer, I have overcome the world." It didn't look like a bloody surgery on an important part of Abraham's body was going to give him an heir. It didn't look like a bloody execution on the cross was going to defeat evil once and for all. It doesn't look good right now that we lost two bleeding post-CS mothers this week, or multiple kids with malaria and anemia and seizures and infections. It doesn't look hopeful that an off-duty soldier can whale on a pedestrian with bone-breaking force, or that a judge can take more than six years to decide that after the proceeds of a land sale were used by a dad to put his son through college, that son can't claim to invalidate the sale. It doesn't look like we're on the evil-defeating side when our patients die, or when we are just kneeling on the asphalt holding a bloody anonymous woman. 

The 11th hour is decidedly where we live. There are poppies and larks at times, but those grow and sing amongst the graves. Jesus has conquered all evil, all broken systems, all bleeding and disaster, but we're still living in the last hours before we see that reality on earth as it is in Heaven. "Be of good cheer" is less a breezy greeting and more a bracing command that goes against the grain, that determines to look deeper than all we can see.