Of Health, Public and Private

Public health considers the well-being of the community. As we work to improve antenatal care, we hope that the impact is community-wide, with more mothers and babies surviving and thriving. Measuring the impact requires scientifically sound sampling and careful follow-up. So we have Carol delving into an ambitious project, a case-control study of sorts, choosing systematically (every other name) nearly a hundred HIV+ women who delivered babies 1 and 1/2 years ago, and then randomly choosing two controls for each one who are matched by age, parity (how many pregnancies) and village. After she collected these names from the clinic registries, the tricky part begins: finding almost 300 women with only names and villages to identify them over a year after they have delivered their babies. We want to know how many of the mothers and babies survive and are collecting some data on their nutrition and overall health. For the HIV positive mothers, we are able at a year and a half to find out if the virus was transmitted to their babies. While we do this every time we have a food distribution and every time we see people in clinic . . . That only tells us about the health of the small percentage who choose to remain in contact, which may skew our assessment, because we’re seeing the ones who live near, or like medical care, or are organized enough to get help, and therefore more likely to have good outcomes. For weeks now Carol and her trusty research assistant Ndyezika have been combing the community with their list of names. Take into account that there are no addresses, almost no roads, no phone numbers, no computers, no files. Then consider that names in this culture are rather unimportant and fluid, and a nervous mom at antenatal care may say the first thing that comes into her head when asked for her name. I have frequently asked husbands and fathers the names of their wife or child and seen them struggle unsuccessfully to come up with the name! Many times the name on a child’s immunization record bears little resemblance to what he’s called at home. Then consider the fact that marriages are very impermanent. If a woman registers while living in one village, nearly two years later she may have moved on, back to her parents or on to another husband. So after weeks of struggle they had found less than 20 people. We like the approach of going to the patient .. . But thought we’d try to lure the patients to us one more way. For four days a list of 60 names was announced on the radio. On Friday morning 13 of those women showed up. Not bad, not great. Still slogging on. Private health considers the well-being of the individual patient. One of the mothers who came on Friday was among the HIV positive group (obviously for reasons of confidentiality, the study is being billed as a general antenatal follow-up with no mention of connection to HIV status). Her 18 month old son was a strapping and healthy looking boy. She had dropped out of any follow-up and was still breast-feeding the toddler. We tested him, and he was not infected! What joy to share this news with her. But then we advised her to wean the child right away. His nutrition was good, and the small risk remained of transmitting the virus through breast milk. She tucked her breast back in her dress, and we gave him sweet biscuits to distract his crying. Maybe one little life saved? It’s possible. Both public and private health are important. Jesus fed 5000, taught principles of community cooperation. But he also raised one widow’s dead son, or healed one bleeding woman in a crowd. So we continue on, trying to change policies and reach thousands with teaching and testing, while also touching the one toddler who can be saved from infection.

Prayer Update E-mail for Team 16 Nov 06

Dear Praying Friends,
It is the time of year to thank God for His blessings, and though I sigh over the mud, for our neighbors and friends this rainy season’s abundant dampness would surely number among the greatest of blessings.  This week we looked at 1 Kings 18 and 19.  Just as Elijah called down fire and then rain, God has come to us in great power and goodness here.  Some of the many things we are thankful for :

• You, your prayers and encouragement, your pouring out of your own blessings.  We’ve received two major pledges in the last month for the health center, and this week found out that one phase of our nutrition program expansion will be funded by a SALT grant written by one former intern (Stephanie) and submitted/promoted by another former intern (Jenn Butz).  These aren’t small amounts and we feel like the Israelites, awed at God’s power.
• Jonah striding around Nyahuka Health Center, confident and competent and testifying to God’s answers to prayer.
• Some of the health issues we asked prayer for looking up, with team kids gaining health and strength.
• A team that has expanded gracefully, drawing in newcomers and opening arms of love.
• Joy Muhlbaier was able to travel safely back to the US with Ward Shope and is beginning to get physical therapy for her chronic back pain.  Also the Gray family left today to travel back to the US next week for the anticipated January arrival of boy number three.
• WHM’s new vision and mission statements and new web site, plus the expanding interest in new fields in East Africa
• Against all odds Kabasunguzi Grace still alive and smiling in spite of being blind and bedridden.
• Drawing to the end of another CSB school year and exam period.
  

But in 1 Kings 19, as soon as Elijah experienced God’s mighty power and deliverance, he ran away discouraged.  Spiritual attack intensifies in times of moving forward, and we feel wearied by this event-ful year.  So God moved Elijah out to the wilderness for food and rest, but more importantly for an encounter with Himself.  Would you pray for us this Thanksgiving that we would long for the God of the Blessings rather than just the blessings of God?  That we would find rest and strength in the whispering voice of His presence?  That the Christmas season would be one of focusing on Jesus more than on the great gifts He brings us?

After God meets Elijah, He sends him on to announce and set in motion major world-changing events.  Most of that involves choosing new people to do His work.  Pray that we would likewise be readied for God’s work in 2007.  Specifically:

1. CSB is in desperate need of funding for meeting end-of-year payrolls; and we expect to need new teachers in several key positions come January.  Please pray for God’s provision of money and people!
2. It is also time to start thinking of new teachers for RMS for August 07.  If you know any elementary/middle school teachers who would be up for such an adventure, start praying for them.
3. Our last Kwejuna Project Food distribution occurs Monday the 20th, pray for God to bless the women and children who come, and for more funding to open up for their nutrition next year.
4. Carol Logan is working tirelessly to track down many mothers and babies around the district for follow-up, a nearly impossible task.  She has only a couple of weeks left; pray for miraculous finding of the right moms!
   

Thanking God for you as always,
Love,
Jennifer for the team

Feature Presentation: Brutal Beauty, or Scott&Jennifer's Bday Adventure, or Motorcycle Blogs

Saturday evening our team surprised us with a little video whipped up in honor of Scott’s Birthday, entitled “Feature Presentation”. The inspiration came from Michael, Josh, and Scotticus, with the non-Myhre kids and Annelise providing more ideas (no theme was rejected, as Michael said) and most of the acting. The story involved Scott and Jennifer heading off for the Birthday Trip to the Semliki Safari Lodge. Joe played Scott and kept saying “the security risk is very low” in reference to Scott’s reassuring assessment at last team meeting. Acacia played me with a wild wig of hair, and all the smaller children were an assortment of leopards, panthers, princesses, and kids coming to the rescue from Michael, a fire-breathing dragon who captured us en route. In the special feature cast interviews, they explained this symbolism had to do with Scott’s intimate and sometimes disastrous relationship with fire. It was hysterical, and we felt very loved by the effort involved and the community event of everyone coming to the screening the night before we left. Well, we did not encounter any fire-breathing dragons on the real trip, but it turned out the drama did foreshadow the real thing. This is November, which means rain, which means mud. Twice in the last week to ten days the road has been closed due to huge trucks stuck in the mud on hairpin mountain turns blocking other vehicles from passing. Being good, stubborn, can-do, frontier missionaries, we said to everyone “We desperately need a break and we ARE going to get to the lodge, come hell or high water.” Well, it turned out that we encountered quite a bit of both. To avoid the truck-clogged mountain pass road, we decided to adventure forth on Scott’s motorcycle and take a little-used route that runs through the Semliki River Valley north to Rebesingo, then cut back down towards the lodge. We had tried this route twice before, coming from the other direction, and it had always seemed a bit vague and tentatively even passable. But coming from the southwest, and using a motorcycle, we were sure it would be a good idea. So Sunday mid morning we headed off, packing tools and spare tubes and a change of clothes into a heavy back-pack, wearing gum boots and raincoats and zooming away. Much of the trip was lovely. The road skirts the mountain range’s northern roots, and winds through a cattle-strewn grassland. About a third of the way into the less-traveled part, we began to follow behind another small motorcycle which gave us confidence. When the road was cut through by a river at one point we stopped to eye the steep banks and the herd of cattle lower than our feet drinking the river water . . . When our guardian angel boda drivers waved to us to show us a more gradual path down and the best place to ford the river. We felt optimistic and well cared for. But the road kept getting smaller and smaller until it was barely a path, and we came upon the boda pair again. We could not find a shared language in which to communicate more than the fact that they were heading in the same direction, and they advised us to skirt the swamp they were enmired within. So for about half an hour we tried to find an alternate route while they struggled through the quagmire, but eventually we came to the conclusion that there was no way around, and that we’d have to follow. If they could do it couldn’t we? Well, their machine was half the weight (or less) of ours. We both managed to get through, but barely. I knew we were in trouble when the mud sucked the boots right off my feet, and it took all my counterweight and strength to pull them out with my hands. By that time I had given up on boots and we were both up over our knees in mud, a gooey, slippery, bottomless, quick-sand like mud that threatened to swallow the motorcycle. It stretched out as far as we could walk in every direction. If Scott were any less strong we might be there still. A few inches at a time we pushed and shoved and pulled and gasped, until we made it through the worst hundred yards or so. We were exhausted and coated with mud, but we pressed on. Then it started to rain, and the track we were following became as slippery as snow. We wiped out twice, bruises but no serious injuries. Our short-cut turned a 2 1/2 hour trip into a 5 1/2 hour survival odyssey. If you have never sat on a motorcyle for over 5 hours (and not more than 30 seconds of that time on any smooth or firm road surface) . . . Then don’t. Many times the road petered out into a confusing crossing pattern of cattle paths, or disappeared beneath ponds of water. Many times we were so sore and tired we weren’t sure we would make it. The brutality of the trip made the beauty of the lodge even more dramatic. There were only two other guests whom we barely saw, so we had a wonderful evening to reconnect as a couple, read, talk, eat, sleep, and sleep some more. Our tent had a wooden floor with oriental rug, firm poster bed, warm shower, and a view of multiple species of monkeys and birds cavorting in the trees. We heard the breathy, throaty call of lions in the early morning, then went back to sleep, secure in our house-like tent. This afternoon we came back by the road-more-traveled . . No picnic amidst the muddy tracks and stony jolts, but nothing like the challenge of the day before. Was it worth it? Definitely. We will read some verses (like Psalm 69) about rescue from the miry pit with new feeling now. Will we do it again? No, or at least not until we forget the pain of this trip! We are thankful to our great team for caring for out kids while we got away, thankful to the unlikely angels who offered us the stay and the others who guided us on the path. Thankful that there are evenings of respite in this life of struggle. And mostly thankful that we were in it together.

Of Weariness and War, heading for the broom tree

Sometimes the spiritual nature of the war for this world is unmasked, sometimes by the war in my own heart.  Weariness, plodding, irritability, rain.  Yesterday in thinking about the last couple of weeks it’s no surprise that like Elijah I want to run to the wilderness and feel sorry for myself.  Remember the dramatic show-down with the prophets of Baal, fire and rain and blood and speed?    Nothing quite that showy has happened in Nyahuka, but we have had a pretty intense stretch.  First, the whole Jonah show-down, his decision to return, his testimony, his presence.  I stopped teaching Jack and Julia math as soon as our new teacher came two weeks ago. . . And the pediatric ward immediately seemed to become twice as busy, as if the patients just doubled to take up the time that was freed.  Then it was touch-and-go with one of our dear team mates dealing with physical pain and imminent departure and intense emotions.  Meanwhile a visit from our Human Resources Director, encouraging but also the reality of having a day to day observer of our less than ideal family dynamics as he graciously put up with us in our home, and the reality that his visit puts everyone in the slightly edgy mode of thinking about their futures.  Then we’re trying to help Luke process his plan for CSB next year, what classes to take and whether to sit for the national Ugandan exams.  And did I mention that we heard a little spate of gunfire that was not worrisome in itself (no reports of a real attack, no one seems worried around us) it brought up memories of old insecurity and the current situation that we have a BIG team here, most of whom have not had to live through rebel rumors and reality before.  To make the picture complete, several team members have been sick, including one child who was frighteningly ill Thursday evening with pneumonia, now improving.

If you read the next chapter (1 Kings 19), you’ll see that all of those realities take their toll, even though in every case God has been faithful:  Jonah is posted and finally got his salary for the first time this year, patients are surviving, our team mate made it safely to the US, our Human Resources director had a great visit, we’re safely protected by a formidable UPDF presence, the crisis evening of sickness passed and all are back on the road to health.  But like Elijah, I’m wiped out.  

So like Elijah, Scott and I are escaping to the wilderness.  Some angels in disguise from the nearest Safari Lodge, a lovely tented camp for rich tourists, offered us a free night, and we have prevailed upon two of our single team mates to stay with the kids while we go tomorrow for Scott’s birthday.  Like Elijah we’re hoping for good food, lots of sleep, and time to hear the still small voice of God’s real presence.  

Small things new

“Christians have been invited to live beyond triumphalism and despair, spending ourselves for a cause we firmly believe will win in the end.  In a vision lovely enough to break a person’s heart, John shows us (in Rev 21) that heaven comes to us and renews this world.”  (C. Plantinga)

A little glimpse of heart-breaking loveliness in, of all places, the AIDS clinic.  I didn’t recognize my patient—my handwriting was all over his chart, but I just couldn’t place the kid in my mind.  Then I realized he’d gained more than five pounds (more than a 20% increase for his small body!) in the last month or so since he started antiretrovirals, the specific medicine that treats the HIV virus.  This toddler was sitting on his mom’s lap playing peek-a-boo with a pair of tattered shorts worn, of all places, over his head. He wasn’t actually sitting, he was squirming, laughing, and engaging my eye whenever I looked up from the papers.  Between the rounded cheeks and the perky playfulness I did not recognize the struggling lethargic child of two months ago.  A small thing, but being made new, a taste of redemption in a game of peek-a-boo.  Remember Mumbere, the only picture his grandmother has of his dead mother?  Another little picture as he snuggled into her side, clearly attached and at home, no longer the pitiful crying baby that his dying mother could not cope with, now he feels somehow safe and at home.  The AIDS clinic this week:  I am never too much tempted towards triumphalism in that epicenter of suffering, but neither was I crushed by despair.  We are spent, literally, day by day, but thankful for small things picturing newness, reminding us all to hope.

the tribe

Here's latest visual of the Team ... at the airstrip, sending off Ward and Joy...

Follow-Up: Pediatric-Maternity Building Needs

Should we be surprised by God's generous provisions? Though He provides ... again and again... our small faith often wavers in light of our current needs. After having listed the LARGE remaining financial need for finishing our Pediatric-Maternity Ward Project (see Oct 24 posting)...we have now received $24,000 to help us finish that project (considerably in excess of our anticipated needs). O, me of little faith.

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.