More confirmation, small mercies

During Jonah’s acceptance speech he said his first priority was to get a nurse-anesthetist posted to Nyahuka so that he could start doing emergency C-sections.  Not two hours passed before he received a phone call:  the sister of one of the nursing students we chose in 1997 for sponsorship called to say she had just finished further studies in anesthesia.  She had come back to the district to work but later was chosen for this anesthesia course, and we had not seen her in over a year, so she certainly wasn’t on our minds.  Yet at the very hour she was needed her sister called Jonah to help arrange transport for her as she was coming from school this weekend to return to work in Nyahuka!  Jonah was so amazed by God’s providence and timing he zipped up on his motorcycle, glowing, to share the news.  As I was making rounds I found a rather functional wheelchair stashed in the hall.  It turns out that one of the senior nurses, a man whom I had struggled to work with, took it upon himself to obtain this piece of equipment from who knows what depths of storage at Bundibugyo hospital, so that Kabasunguzi Grace could be taken out in the sun and move a bit after months of being bed-ridden.  Small mercies, the process of redemption continues, prayer pushing back evil.  Three separate people have pledged considerable chunks of money for the needs of the hospital; and another friend’s brother’s client’s contacts in a pharmaceutical company may be supplying vitamins.  O me of little faith, when such a Force is on the move.

This Time a Happy Ending

Jonah is the new In-Charge Doctor for Nyahuka Health Center IV. Like Jacob he worked seven long years for this moment, through many setbacks and struggles. Today the entire staff gathered for a rather formal time of speeches acknowledging the changing of the guard. The outgoing in-charge, a senior medical assistant, graciously confirmed his gladness to hand over to a doctor, asked the staff to forgive anything he had done wrong, and affirmed his readiness to work in partnership with Jonah. His speech and attitude were amazingly positive. Scott spoke about Jonah’s history in the District and the joy of welcoming him home to address the injustice of inadequate health care for Bundibugyo, the picture of redemption in this process of the world being set right. Jonah emphasized that only the power of prayer had brought him through. He was also remarkably humble, giving God the glory, and telling the staff that his goal was to serve his people. In his moment of receiving power, he wisely pointed to God as the only source of all he had received. Many of you reading this blog are the ones who prayed. Be thankful with us today! The chairman of the management committee told a proverb: water that is not in your house cannot quench your thirst, meaning that past doctors did not want to stay in Bundibugyo but all hope that Jonah as a son of this place will be in the house and available. Interestingly, the district leadership did not attend. Though the doctor had called Scott and promised to come, today he sent a message that he lacked transportation. This is a very weak excuse, and evidence once again of the poor reception Jonah has received from those in control now. He is a threat to the system and we have not seen the last of the battle. Ward Shope, our visiting Director of Human Resources from WHM-Philadelphia, attended part of the ceremony, which was meaningful to us as the culmination of something we have also worked for for seven years. God is gracious, to bring all of that together at the right hour! Ward is counseling with each missionary as part of his ongoing care for teams in the field. We are trying to give him a flavorful sample of Bundibugyo life and ministry which will enable him to manage personnel more effectively. He attended Christ School chapel yesterday which gave him a picture of how most of the team pulls together to disciple students, and saw the staff gather to send Joy off in prayer as she returns for medical care for her back next week. In other news: the dog’s brain turned out to be positive for rabies. Most of the folks showed up for their final vaccine in the five dose series this week, but the girl I was most concerned about was absent, so we sent people to find her. We are hopeful that God will take our meager resources (vaccines procured late, no immune globulin) and like the five loaves multiply the effect to protect these people. And through searching medical literature on the internet I’m still trying to find help for Kabasunguzi Grace. She’s slightly better but I’m praying this weekend about whether to gamble on a course of steroids (prednisone) next week. Every victory is really just the beginning of the next stage of the fight. . . . So stay with us, and with Jonah.

Showdown Take Two: Today is the Day

Jonah arrived yesterday about noon—nothing is easy, he had tried to come the day before but was turned back at the last section of the road by people who advised him the road was insecure for travel at night.  Then yesterday morning he hitched a ride with the Chedesters bringing our Human Resources Director to visit from America . . And again the road was blocked by a truck stuck in the mud so that they had to walk a short distance from one vehicle blocked on one side of the mountains to another vehicle past the problem on the other side!  But he came directly to the health center and was pleased to be greeted enthusiastically by the staff.  Later the district director called Scott and the whole hand-over of authority is set for today.  Stay tuned.  

But then, there is always the unexpected

We watched the 1957 movie “Bridge on the River Kwai” this week, a fascinating WWII conflict of Japanese, British, and American culture as prisoners of war struggle to survive in the jungle. Many parallels to the spiritual war, to our determination to build something helpful and lasting, to the physical challenges of life on the edge of death. Many times during the movie, one of the soldiers will make a plan and then concede: “But then, there is always the unexpected.” Sometimes the unexpected is a gift. Yesterday in the midst of many things one of the kids told me there was a woman waiting in the kitubbi, our grass thatched circular porch. A number of other patients and people with problems had been by that day, and I was working on something else for a team member, so I relayed a message back out that she’d have to wait, assuming it was yet one more patient. Then our cow got out of her pasture and was kicking feistily in the yard, an Irish aid worker and his girlfriend arrived for a meeting I was late to, I was trying to settle Julia who had an unexpected fever . . . And nearly forgot her until I was walking out to the meeting and saw her still sitting patiently waiting. I recognized her as the mother of Dixon, one of our little AIDS patients who had died earlier this year. His picture was in one of our prayer letters, a frail all-eyes baby whom we pulled back from the brink of death for a while. He spent long weeks in the hospital and we got to know his mother. When Dixon died, we visited her home in a crowded muddy camp left over from the ADF days, and saw his grave. He was her fourth child, and the fourth to die, and she had been chased from her husband’s family to live with her relatives. A month or two after his death she asked me for a small loan to start a business of buying rice in Congo and selling it in Uganda, to support herself, a major problem for an HIV positive woman with no husband or children. So I leant her about $25, enough to buy rice in bulk and start growing a little business. I told her that when she was making enough profit to keep the business going, she should bring half of the loan back to help someone else. The other half I’d consider a gift. Now I’ve tried that scheme with many people who have more education, strength, resource, math skill, than this woman. And I was content to just let that little bit of money go for her survival. Months passed, I really forgot all about it, I greeted her at the hospital when she came for her regular care, but never mentioned the business. Even when I saw her in the kitubbi I assumed she would be asking for some help for a sickness. But yesterday she said quietly that she’d brought me “a little food from her business” and then pulled out of her bag a crumpled wad of notes and coins that added up to the loan. The unexpected, a gift to build my faith in redemption. The unexpected usually feels like the unwanted I’m afraid. Jonah is due back in the district on Tuesday, the 31rst, for the promised hand-over of Nyahuka Health Center into his charge on Wednesday the 1rst. Yesterday we heard confirmation of a rumor that one of the only two doctors left in the district (another two have left this year) had taken a job in Kampala with an NGO. So will Jonah really be posted to Nyahuka if only one doctor is left at the district hospital? The patient volume is nearly identical so one could see it as a fair division of labor, but I’m afraid that the general perception is that no doctor would be posted out peripherally without at least three doctors centrally. Another unexpected wrinkle. Our season of welcoming new team members (two families and four singles in the last few months) has also been unexpectedly disrupted by the impending early departure of one of our single young women, a teacher at Christ School. She has bravely endured unexpected, unexplained back pain since June and together we made the difficult decision that it was time for better medical care. Since last January she has grown attached to the community of the team and the school; she leaves without knowing if or when she will be well enough for return. A heaviness for all our hearts. Time to be reminded, the unexpected is an illusion based on our position trapped in time, the basis for living by faith. If we could see then we would know that nothing surprises God, that He answers our prayers the way we would choose if we could see all that He knows. For Him, there is no unexpected.

Pediatric – Maternity Building: Construction Update (HELP!)

Our vision: Basic, essential, appropriate medical care for mothers and children living in the vicinity of World Harvest Mission – Bundibuygo. Three years ago, we decided that a prerequisite to achieving this vision (in addition to the arrival of Dr. Jonah!), is a more spacious (clean!!) building—and the Combined Pediatric-Maternity Building concept was born. Our template: a neurosurgical ward of the CURE Hospital in Mbale, Uganda where we send many of our hydrocephalic patients. We visited this facility about two years ago, got the blueprints, and began to modify for our context (expanded to ~3000 sq. ft.) Two generous donors combined to give ~$63,000….our estimate to complete the building (including furniture and solar electricity). Our Problem: Call it poor planning, if you like….mostly it is a lack of experience building on this scale. Additionally, we decided to splurge on a beautiful industrial-strength porcelain tile floor which pushed the costs far beyond our original estimates. What the locals are saying (according to one of the elders)…“This is the nicest building in the district. We’re sure glad Dr. Scott is building it...if our local contractors built it, all that money would have been ‘eaten’…" Bottom line….we’ve shot our wad of $63,000 and have the following phases yet unfinished: 1. Windows: screened with glass louvers (estim $1400) 2. Doors: interior/exterior (estim $830) 3. Final painting: (estim $900) 4. Verandah: (estim $1500) 5. Plumbing (sinks/elevated water tank/water lines/etc): (estim $2300) 6. Basic furnishings: beds (~35), desks, chairs, cupboards, shelves, trolleys (estim $ 4000) 7. Solar Photovoltaic Electric system (estim ~$8,000) TOTAL NEED: $18,930 If you are interested, let us know by e-mail (drsmyhre@yahoo.com) We would like to keep the momentum of construction moving ahead.

Return of the prodigal dog

At 5:20 this morning we were awakened by pounding at the door. In Africa, the land of rebels and thieves, one does not answer the door in the dark lightly. We crept quietly out of the bedroom with flashlights off. No one spoke, but the pounding repeated. Then Scott realized what it was: Star returned, and she was banging the screen door. He opened the door and she quivered in, cowering with shame and happiness. All alone. Whether she heard the car, the calls of her name, the kids out searching, or she just tired of running with the wild pack, of hunger and maybe abuse . . . She came home. We welcomed her with food and water, but her older “sister” Angie snarled and tried to get at the food in typical prodigal sibling fashion. There is much happiness in the Myhre house today, and perhaps understanding of the forgiveness and joy of the welcoming Father. (the pix: Angie, the elder, in the foreground..and Star, the prodigal dog, in the background)

Missing pet, some small things are important

Star is missing.  We have two yellow lab pet dogs, Star and Angie, who represent home and continuity to our kids.  We were gone over the weekend for a much-needed family break, but while we were gone there was some confusion about the care of our dogs.  Star was not tied up overnight and ran away.  She did this once before.  Since we arrived home this afternoon and found out, our kids have been searching high and low.  Luke came back caked in mud from an hour and a half of biking for miles around; Jack went on a motorcycle search with Scott; Caleb accompanied neighbor boys who are friends walking as far as he could.  They did find a couple of disparate witnesses in far flung directions who claimed to have seen her.  They are very sad.  A couple of months ago some kids threw a brick at Star and she was briefly paralyzed.  We are worried that someone could beat or kill her while she’s on the run.  Pray for her return, for our kids’ sake.

Reality Check

Yesterday I decided to discharge one of my scrawniest little patients, Jerrad.  He is the age of the toddlers on our team but half their weight (reality check number 1).  His mother had been staying in the hospital with him to get treatment, food, and milk.  She was very pregnant, so we thought at first that explained his problems (children who don’t breastfeed a full two years usually don’t thrive in this low protein culture, so when he weaned at less than a year old from his pregnant mom, he did not grow). But even with food his improvement was minimal, and he continued to have nightly fevers and a terrible cough.  So we presumptively diagnosed TB and saw a margin of improvement after he began treatment.  Then his mom delivered her next baby, a girl, and went home leaving him irritable and lonely with a grandmother.  I took pity on his bereaved wailing and decided he would be better off with his mother, so should go.

Reality check number 2:  he is my neighbor.  When I started asking about where he lived, hoping it was close enough for frequent follow-up, I found out he is the grandson of one of the elderly men whose land borders ours.  His father died this year, which now makes the whole picture make more sense.  This child with his pale hair and fragile stick-like legs, his bleeding lips and desperate whine, lives within a stone’s throw of our milk-producing cow.  Wow.  I felt that like a punch in the gut, that I did not even know about him until he was admitted to my hospital ward.  

So today we bought him his own pitcher, and I took him a liter of milk.  I was passed from one guide to the other (“here, take her to Friday’s, she’s the doctor’s wife”) skirting around the edges of our back pasture, through a cocoa grove, then houses, back to a larger path, then through crowded compounds littered with scraps of discarded plastic containers and strung with ragged clothes.  We found the house:  chalked on the side of the mud wall was “WFP World Food Program”, no doubt copied from a discarded oil tin or flour bag from our food distributions.  Jerrad clung to his mother when he saw me, probably fearing I was there to whisk him back to the hospital.  We sat for a while in the windowless house, on low stools.  They tried to get Jerrad to drink the milk I brought, but since it had been in my fridge all day it was unpleasantly cold to him and he pushed it away.

So reality checks continued:  here is a lady with a newborn infant, a dead husband, and a critically ill toddler, also responsible for several other kids, living in mud surrounded by bare dirt and weeds, smiling very graciously at my visit and thanking me for the milk.  Here is my neighbor, the one that Jesus told parables about when self-righteous people like me wanted to justify themselves.  Here is one of the most pitiful looking children in Bundibugyo and he’s growing up (or not growing) right out my back door.

Wounded but still shooting . . .

Well, the showdown did not end in our favor for this round. The depth and strength of the opposition to Jonah’s presence continues to amaze us. Here is what happened. Jonah arrived late last night. Scott had contacted the relevant people to arrange a hand-over this morning. But early in the morning we got wind of the fact that they were not going to cooperate. Jonah decided that he should go up to Bundibugyo to meet the Director himself, and found him consulting with the current in-charge of the unit. Not wanting to interrupt he then went to the hospital and saw patients until 2 pm, and came back to find the Director alone. They had cordial greetings, and then he told Jonah that he was very busy that day and could not come to Nyahuka, nor could he come the next day, or the next, in fact his schedule was completely booked until November 1. People who have been oppressed tend to become very adept at passive-aggressive resistance. According to my parenting book it is the absolute worst way to handle conflict, but in Africa it is common. There are people who do not want Jonah at Nyahuka. Since he has a letter of appointment, they are now going to delay his arrival as long as possible. This is a district which is desperate for doctors. But Jonah was told to go back home and wait two more weeks. We suspect that those who have been accessing the accounts for the health center have to clean up the books and want time to do that. Meanwhile we heard that one of the other scant few district doctors (posted at Bundibugyo Hospital) is leaving, one has already escaped to Kampala, and the one left behind is threatening to quit. The mismanagement of funds, the disregard for these professionals, threatens to leave us with no doctors at all. So Jonah will return to Kampala tomorrow. He knows what he’s in for, and it is clear that the only thing drawing him back to Bundibugyo is his commitment to our friendship. He is suffering, his family is suffering, and though he believes in the call of God the roadblocks are so tangible that I know he would throw up his hands in disgust and walk away except for the memory of our relationship. I think team works that way for all of us here. The glorious pronouncements of the Kingdom pale in the fire of opposition, but the commitment to the real flesh and blood friends whom we work along-side-of pulls us through. So both sides have retreated to recoup and reload, Jonah to moonlight two more weeks in Kampala, make a little money, see his family. The District office to doctor their records and spend funds and who knows what else. By high noon on Nov 1 we should be back for round two, or is it round two hundred.

Monday Numbers

Here are some numbers from today: 117 = the number of HIV positive families (mothers, husbands, children) who received more food than they could carry today. 100 = the number of pounds of food that constitutes “more than they could carry”. Today was to be our last Kwejuna Project distribution, but it turned out that our supplies will allow one more monthly party. As usual Pamela had the logistics running smoothly, we welcomed Stephanie into the weighing role, Carole was able to find over a dozen of the 70 or so randomly selected mothers for our follow-up data, Scott was directing and Pat and I filled in here and there registering mothers, Luke joined the young men who help divide and carry the heavy sacks of food, in short a community effort. 5 = the number of children one of my inpatient mothers has produced in less than three years. This lady has two-year-old twins at home, and came heavily pregnant from the furthest corner of the district to visit a relative in Nyahuka a few days ago, when lo and behold she went into labor and delivered triplet girls. We are all having trouble keeping them straight in spite of color coded hats (which keep changing heads) so the Dad finally devised a system of strings tied around the wrists. All are between 1 and 2 kilograms (2 to 4 pounds). 9:30 = pm is the time Jonah arrived from Kampala tonight, and am is the time he plans to officially begin his new job as the in-charge medical officer of Nyahuka Health Center. Scott arranged for the hand-over with the District Health Office for tomorrow morning. Knowing how much passive-aggressive opposition has occurred we wonder what will happen. More on that tomorrow. 7 = the number of people on our team of 34 who are either losing too much weight (adults) or not gaining normally (children and pregnant woman). We had a “health day” on Saturday, a day-long open house of check-ups, blood pressures, immunization advice, prayer. Soberingly, a significant portion of our newest members are not exactly thriving here. We need prayer and calories. The issue is complex: partly a matter of adjusting to new foods and tastes and habits, partly the bulky nature of local foods (filling without being very nutritious), partly the reality that food planning and preparation consumes hours rather than minutes of the day’s schedule, partly the increased body demand accompanying frequent minor illnesses and moving everywhere on foot and bike. The American perspective would be: so this is a problem? But the reality is that we have to keep tabs on a person’s ability to survive here, and if we see kids dwindling we can’t ignore the problem. Life requires such effort here. Sigh. 2 = the number of team boys who turned 4 this week, celebrated by a joint birthday party complete with two cakes (a monkey and a tiger). 18 = the number of girls in the S4 class at Christ School beginning O-Level exams today, out of 43 in the class. Last year we had exactly two girls, both were in my cell group, and both were from outside of Bundibugyo. So 18 is a very encouraging trend. These exams involve about a dozen 3-hour (each) papers in eight or nine subjects spread out over almost a month. Which is to say, they are an intense experience, and all of a student’s future educational opportunities are determined by the scores. Pray. 14 = the number of kilograms Kabasunguzi Grace weighs, at age 11. That’s the average for a 3-year-old girl. She is gaunt, movement is painful, yet she cheerfully thanks me every day for coming to see her. I am praying for a miracle and doing my best to give her rational and adequate care. That’s a numerical wrap-up of Monday, sparing you any real math from my teaching 5th grade at RMS of course. JAM