Wounds on the Doctor

This has not been a good season for my body.  My bike accident left me with deep bruises and my knees are still not fully scabbed over, tender.  Last week I cut my finger deeply while cutting fabric to repair a skirt . . .stitches seemed like too much bother but that turned out to be a bad decision as the wound reopens and bleeds.  (Yes, I’m clumbsy and easily distracted!)   I’ve had so many bandaids plastered around that I’ve developed an allergic reaction to the plasters.  Most troublesome has been a chronic ear infection, a perforated ear drum that still carries a scab and does not move normally.  My hearing is decreased, I sound to myself like I’m in a well, popping and crackling when I swallow.  Whenever I get too discouraged Scott looks in with an otoscope and tells me it is improving . . . Be patient.  Being A PATIENT is a bitter medicine in itself.  I need to grow in humility and patience, but I’d like the short cut.  That seems to be what Satan offers in Luke 4 when he meets Jesus in the wilderness:  here are good things, bread, rule, fame, God’s protection . . .  but why not take the non-suffering path to get there?  Yes, that sounds tempting.  Jesus however resists.  He sees clearly that the path to redemption involves the cross.  

No cross for me, just the constant reminder to everyone to repeat what they say and talk more loudly, the reluctance to sing when my own voice reverberates in my head, the awkwardness of cooking and typing and washing dishes while protecting a lacerated finger, the short searing pain of pulling off bandages on my legs.  

But a glimpse of redemption along the path.  When my ear was at its worst, we got a random email connection from a lady who supports work in the DRC.  She sent photos and a description of a boy who was at their orphanage.  He had had a severe infection as a young child, and now was ten but never spoke and was socially withdrawn.  Since I was also feeling socially isolated by my lack of hearing, I wondered if the boy’s muteness could be related to deafness, possibly his infection years ago had been meningitis, and now he could not hear.  This week she wrote back and confirmed that the boy was seen by a doctor and was indeed deaf, and they have already raised money to send him to learn sign language so he can communicate.  I’m sure they would have figured this out eventually . .. But God let it happen this way to encourage me to trust His bitter medicine of patience in sickness, faith in redemption.  Why shouldn’t a doctor have wounds, since a Saviour does?

Your navel cord was not cut, nor were you washed . . . .(Ez 16:4)

In the midst of the chaos of clinic on Wednesday, one of our church leaders who comes to minister hope to AIDS patients at the hospital pulled me aside and asked as a favor that I look at the sick baby of  . . . Well, our English language is poor in the specificity of relationship words, but this young woman was related to his wife’s family, a sister to his wife’s parent of some sort.   I agreed, in most cases friends of friends turn out to be not very sick consults who just want the extra authoritative touch of the doctor, so I let her wait in the line of patients waiting for me.  About noon I realized this quiet young woman was constantly being superseded by more aggressive moms who were used to the clinic, so I stopped the line and let her in.  Bundled in a deceptively white cloth on the outside was a baby with a putrid odor on the inside. One eye was completely swollen shut, boils covered her whole scalp, and a festering open wound oozed on her neck.  She weighed less than 5 pounds though tomorrow will be her 1 month birthday.  The mother, K.R., rubbed her sore breast and said quietly that she did not have enough milk to feed the baby.  I admitted them emergently, to treat the mother’s infected breast and the baby’s infected body with our best antibiotics.  Today I pieced together her story, which is perhaps sadly representative of all too many young women in Bundibugyo.

K.R. Grew up in Izahurra, a village ridge outside Bundibugyo town.  She attended primary school until P4 but at age 13 her father died, and she dropped out.  Three years later her mother also died, so she was left at age 16 in the care of an older brother.  She got a job in Bundibugyo town serving food at a “hotel”, which is a one-room cramped cement shop that caters hot meals to men working in town.  Soon she developed a sexual relationship with a man who frequented the hotel and worked as a truck driver.  He gave her small amounts of money for the things she needed, they met in town,  but she never “married” him, meaning she never went to stay at his home and her brother never received any bride price.  When she became pregnant and told him, he wanted nothing else to do with her, and stopped giving her any money.  Around this time her brother moved the family further from town.  So last month she ended up delivering her firstborn baby, a little girl, alone.  When her labor came on everyone else was gone to the garden, so she stayed in the mud house by herself until the baby dropped out onto the floor.  She couldn’t even cut the umbilical cord.  

Not a promising start in life for this baby, Masika.  Masika is a shrively reddish-yellow, irritated, cooler than she should feel, loose skin on bones, opening one eye anxiously.  She is not a cute baby, and I have to remind myself to touch her and smile.   K.R made three prenatal visits (but lab tests were unavailable on all three occasions) and has brought her baby for help two times since birth.  She is a caring mother.  Twice in the last two days I’ve watched her hunched over her baby as silent tears slip down her face.  So today it was with a heavy heart that I had to tell her that we had tested her blood, and she is HIV positive.  Her reaction:  Does that mean my baby will die?  She seemed to have little concern for herself, but a heartbreaking hope that her baby can survive.  Perhaps those years of exchanging sex for survival eroded too completely her sense of value in who she is, but she hasn’t given up on this child.

This baby and her mother remind me of Ezekiel 16, where God uses the image of the pitiful unwashed baby as a symbol of His helpless people whom He then protects, grows, loves, clothes and adorns.  It’s a shocking chapter to find in a book like the Bible.  I would love to see both the 1 month old and the 19 year old girls, mother and child,  wearing silk and eating pastries (v. 13), famed for their beauty.  And someday I believe I will.  In the meantime we offer prayers for healing of body and soul, we offer food for putting flesh back on the bones, we offer the good news that Jesus seeks out the skinny and scabby and smelly, and we humbly acknowledge that we are all the same.

  

On Blood and Cell Phones

This morning dawned hesitantly, but by 9 am the sun was blazing into the muck of the rainy-season and promising a good day.  The health center truck came up to our house to get the district vaccine supply (which we’ve been storing in our fridge) while I want down to see patients.  Nurses were organizing supplies and personnel for the first “Child Health Day” outreach, and annual exercise designed to take vitamin A, deworming medication, and immunizations out to the community.  Over the next week teams will go out to 6 or 8 more distant schools and gather children for treatment and health education.  It’s a great idea, if somewhat chaotic.  We are sending our two health interns as well, to record and weigh and dispense and encourage.  But just as all this was getting organized Scott began to hear gunfire, distant but close enough to be concerning.  In the old days this would have led us to forbid anyone to move out of their homes, we would have canceled the outreach, we would have been thrown into a dither of uncertainty.  But in the new era of cell phones, we simply called the District Internal Security Officer, who called the nearest UPDF detach and found out they were conducting a training exercise.  Everyone apologized for not informing us ahead of time . . . And then health care and the day went on as normal.  Amazing.

An hour later I found that one of my sickle cell patients looked significantly worse.  Her labs confirmed a drop in her hemoglobin to 3.8.  All week we have been lacking blood of her type (O+).  But thanks to my cell phone I had called and begged blood from the Fort Portal Blood Bank yesterday, and when this tiny child needed it I could also call Bundibugyo Hospital and confirm the blood had arrived last night and could be sent to us today.  I remember the “old days” when we would have had to simply wait it out and hope for help.  

Later still, Scott was called by the US Embassy, who may be able to send a representative to our Pediatric Ward Dedication.  Later still, our immobile neighbor Mukiddi (who has a phone!) called Scott for emergency help.

Cell phones, important tools for defense and health!  I know that most people in America are plagued by too many phone calls, but I am still able to be thankful for the days of effort, travel, and missed opportunity which are saved by the simplicity of a phone.

You know you're a missionary when . . . .

• Your day involves making massive recipes of granola to store for the week’s breakfasts, to combine with daily home-made yogurt from milk from the cow that lives in the back yard.
• Your day also involves brushing up on how to use logarithms to multiply peculiar numbers with no calculator, only archaic tables (do they do this in American high schools?)
• Two dead baby rats drop out of the shade vine over the side porch, and you’re so glad they are dead it makes the presence of their stubbornly alive and difficult to eradicate mother less noxious.
• Not one but two sets of twins of HIV positive mothers show up in the space of an hour with pleas for help because they feel they cannot sustain their babies with breast milk . . . And you cry out because there is no good choice between the risks of infection and the risks of malnutrition.
• Your worker laughs when he shows you a fist-sized tarantula he killed in the yard.
• You have to detour while biking the kids to school to avoid a small wooden building being dragged down the middle of the road with ropes and logs, by pure manual labor.
• Very articulate delegates from the European Union make a stop on their tour to discuss the last decade of experience we’ve had with issues of war, displacement, and resettlement (as if we were some experts, when our main contribution has been to just stick with the situation).
• You rejoice to see the sun emerge from the grey sky, so that clothes can get dry and electricity can be produced by solar panels after days of cloud and rain.
  

And lastly,

• You see a weathered  old woman, with gappy yellow teeth and crinkled skin, thin limbs wrapped in a traditional cloth, carrying her two-year-old orphaned nephew whom she’s been breast feeding since his mother died, and it strikes you that this woman is truly beautiful in the eyes of God.  She’ll be a finalist in the Miss Universe contest in Heaven, when all our illusions of good are turned upside down and inside out and we see what is really real.
  

(All of this really happened in the last day or so).

Homecoming

Kabugho Margaret is coming home to die.  After two weeks at Mulago, the nation’s referral hospital, her tumor has not been found to be treatable in this country.  I do second-guess my decision to even send her there, but as a doctor and a parent I find it necessary to have at least tried, to know that every avenue was exhausted.  Someone posted a comment asking about contributing to costs for referral care:  we would be grateful.  Click on the “how to contribute” sidebar for sending money to our support account, then send me an email (drsmyhre@yahoo.com) and we will withdraw that amount of money and keep it in a certain envelope we have in our safe.  When children need funds for transportation to other hospitals in the country I then pull from that money. Sometimes it is as little as a few dollars to get a chest xray, as in the little girl I sent today to Bundibugyo hospital, she is wasted and breathing quickly and an orphan, so I suspect TB.  Compared to America it is never very much money—for a few hundred dollars baby Witness went to Mbale to have her spina bifida repaired this month, I spoke with the nurse and she should be ready to come home soon.  About two months ago we were able to send a twin with a cleft lip for plastic surgery.  So our role sometimes is to problem solve how to connect our needy patients with other charities, and we use some of our support money to help that process.  Thanks for asking.

I need to remember that Kabugho’s return to Bundibugyo is not her true homecoming.  Thoughts of home, what makes a place home, how is Heaven our home, fill my heart.  One of our interns spent a good chunk of her childhood here, so seeing her re-connect with people and place does my heart good as I hope my own children will always feel at home in Uganda.  Luke found out this week that he qualified, along with three other CSB students, for a regional math contest in Mbarrara in about two weeks.  I can see that this rare moment of approval, belonging, representing the school, is good for him.  In God’s graciousness, the day of the first round of the contest, the whole thing was so disorganized and late that Caleb gave up and Luke’s best friend here Kataramu took Caleb’s spot.  Kataramu also qualified, so they get to go together.  It is hard to explain how significant that is . . . But I am grateful for the friendship and the way it all worked together as a little encouragement that Bundibugyo is, on some level, Luke’s home. . . . Even though we are painfully aware of all the ways this is not home.

Praying for a not-too-painful homecoming for Margaret, both to Bundibugyo and to Heaven.

Fiercely Good, images of God

There is a CS Lewis quote in a Grief Observed that says something along the lines of : anyone who does not understand how a good God can allow pain has not been to the dentist lately.

For the past week plus I’ve been treating a little boy who burned his arm when he fell into boiling porridge on an open fire, an all-too-common problem where cooking is done outside on the ground.  The partial-thickness burns extended over his elbow and down to his wrist.  At first I encouraged the parents and staff to be doing “physical therapy”, moving his arm about.  But after a few days I realized that I always found him with it bent at 90 degrees, and no one was forcing him to move it.  If he continued in this immobility he would heal with contractures that prevented him from feeding himself, writing, lifting, riding a bike, hoeing a garden, hugging his own child, so many things.  So each day I began to straighten and flex his arm.  The wound bled, he screamed, in fact he began to cry as soon as I walked onto the ward most days and did not stop the entire time I was present.  I did try to mitigate the misery with pain medications and candy.  Pink new skin began to grow, the crusty exudate of blood and scab fell off, and today he barely whimpered, more eager for his payment of candy than worried about the brief moment of pain.

This boy has been a clear picture to me of life: God is stretching my arm even though it makes me bleed, because he wants to heal me, and give me the ability to live in fullness and joy.  I see Him coming and scream and resist, because I don’t realize the extent of my danger, or see ahead to the goodness of His intended outcome.  Faith occurs in the moment of bleeding, before the hindsight of new skin growing.  

The second image of the week comes from the movie Blood Diamond, which I saw for the first time last night.  This is an intensely powerful movie.  Violent and disturbing, so I hesitate to recommend it, but redemption is the main measure of a story for me and this movie exceeded expectations.  The image of God comes late in the movie as a Sierra Leonean man faces his young son who has been abducted into a rebel army, brainwashed, and turned into a child soldier.  The son is pointing a gun at the father and saying hateful words, trembling, about to kill him.  But the father looks at him and says “I know you have done some terrible things, but this is not who you are:  you are a boy who loves soccer and school, you are a good boy, you are my son and I love you and I will always be your father.”  There was the Gospel, our Father in heaven looking at us in our rebellion and hate and self-importance, yet looking through those things to say He loves us anyway and has come to rescue us out of that life and bring us back into communion with Himself.  Watch it.

God the strong father, confronting our evil and pulling us out, even at the cost of blood spilled.  His own.

Introducing . . . .and still looking for . . .

Four new people committed to joining our team in 2008:  a married couple with a new baby whose passion is long-term missions, living and loving among the poor.  And a nurse with several years of experience and a rather cross-cultural childhood.  We are thankful that God continues to put the people of Bundibugyo on specific American hearts and draw them here to join in the work of the Kingdom.  And we know from personal experience that their coming means that God has work to do in their own hearts as well as they come to the end of their resources here and are thrown into the walk of faith.

Now we are waiting for two young men.  Yes, we still need two more people.  With all the boys on our team and given the balance and mix and culture, we would like to see two males join in 2008 as well.  At least one should be willing to teach.  If you fit the category or know someone who does, contact Dan Macha at dan@whm.org.  Maybe two brothers?  Friends recently graduated from university looking for a stretching adventurous year or two?  Someone in between university and grad school who needs public health experience?  Someone who likes to coach sports?  Get dirty?  A teacher who needs a break after five years of teaching the same grade level?  We don’t know who you are, but we are still praying for you.

On humility, or lack thereof

I had a humbling day.

This morning I rode my bike as usual to the hospital, after doing speech therapy with Jack at school.  As I was riding through the most congested part of Nyahuka, the point where a culvert runs under the road so there are drop-offs on both sides, right in front of the “taxi park” where swarms of restless young men hang out on motorcycles and make inappropriate comments . . . I saw that a small pick-up truck was stopped in the middle of the road, facing in my direction so that if it started on we would meet.  I pedaled on and I must confess the pride in my heart.  Yes, my thoughts were something like this: “I see you there and I am not budging off this road so share the space and get out of the way”.  You may be thinking there goes one missionary doctor that needs to be humbled.  And you would be right.  And evidently God would have agreed with you.

Because a second or two later I realized that two men were walking up to the stopped truck, directly intersecting my trajectory forward.  Because of the culvert there is no option of leaving the road, so I began to brake and try and get their attention, still thinking confidently that everyone needed to get out of my way. I lifted my right hand (back brake) to ring my less-than-effective bell.  However I kept squeezing my left hand brake.  Anyone who bikes can imagine what happened next.  My front wheel stopped but I didn’t, and I flipped head over heels right there smack in the middle of everything.  I landed on my back (my pack probably pulled me down that way) with my skirt up to my bleeding knees and my bike slightly twisted but sort of on top of me.  Because of my bike’s position and my stunned shock I could not really move more than to pull my skirt down as far as possible.

The vulnerability of that situation would have been humbling enough.  But here is what happened next:  all those obnoxious young men treated me with respect and care.  No one laughed.  People said “sorry sorry” and ran to lift my bike and help me up.  As I dusted myself off I only met with stares of concern not derision.  I had judged those guys in my heart and was doubly humbled, first by my fall which so appropriately followed the proverbial pride, and then by the kind response I got from people I expected to enjoy my distress.

So if you are praying for me to be more humble you can let up a bit now . . . Sigh.

The Week Starts

The week started with an infant dying of anemia as we were trying to connect a blood transfusion, a tragedy, a wailing flailing inconsolable mother and a resigned tearful grandmother wrapping up the body, while our new crop of interns hovered outside waiting for their tour of the hospital.  Welcome to Bundibugyo.  A teenage girl who drank “poison” in a suicide gesture after someone stole the thirty dollars her father had given her to pay her school fees.  A fifteen year old mother with a two pound baby who was AWOL this morning, either she decided that she could manage on her own with the formula we had provided or she gave up.  A shrinking baby slipping away from life who turns out to have sickle cell disease.  No news on our cancer patient Kabugho Margaret.  Scott off to Kampala, 16 hours in the car, two days away from home and kids, all because the new bank WHM works with has failed to manage to transfer money to Bundibugyo, so he has to go to the capital and deal in cash to keep the water project, school, hospital construction, Kwejuna project, etc. all moving along.

Then as always, signs of hope, postings that remind us the Kingdom is coming.  Motherless infants came today for their monthly assistance . . . What a satisfying joy to see formerly skeletal babies plumping up on the breastmilk of their aunts or grandmothers, smiling and playful.  A patient whose teenage sister used to bring him for TB therapy came back, she still cares for him though she’s now married with a child of her own.    New skin growing into a severe burn, the puffiness of kwashiorkor dissolving in the tide of nutritious milk.  Anti-retroviral medications (ARV’s) for patients with AIDS finally arrived in a two-week-delayed shipment from Kampala.  Perhaps most amazing of all:  two of our staff decided to get “ringed”, meaning have their marriage officially recognized in a church service, on Sunday as they were baptizing their newborn baby Judith (named after my mom because I told hem she was born on my mom’s birthday!).  Church weddings are very very rare as everyone would prefer to keep their options open and not feel so committed, so it is fun to see our lab man sporting his new wedding band.  We sponsored both of them in nursing and lab programs over the last few years, and they are back now at work in Nyahuka.  No doubt their marriage will be attacked, but for this moment we can be thankful for their step of faith.
 
Someone threw a mostly dead snake onto the end of our driveway this morning, which I discovered in the dim light after Scott departed.  Maybe it was random chance, maybe it was maliciously meant to intimidate me.  But I choose to interpret it as a positive sign, like the bronze snake in the wilderness.  I’m thankful to the unknown protector who struck the snake.  I’m thankful too that like our other “near misses” it was left to remind me of God’s care.  I lifted it on a stick and threw it into the ditch by the road.  The serpent is crushed.

Track Team

Yesterday the newly formed CSB Cross Country Team held an intramural racing event, in honor of “new” used uniforms donated to the organizer Scotticus, and in honor of intern Larissa Funk’s final day with the team. What a treat for us missionary parents to see two of our kids, Caleb and Jack, as well as Joe Bartkovich, proudly wearing the bright red running shorts and shirts. Scotticus has welcomed them into the team and in spite of being among the slowest and youngest they have enthusiastically responded to his passion for the sport. They ran the 400 m (Jack and Joe) and 800 m (Caleb), smiling away, even giving that final-stretch kick towards the finish line. And each participated as one leg of a relay race too. As kids without any access to sports and extra-curriculars, and as constant outsiders, it is hard to overestimate the value of this simple gesture of being “on the team”. This is where they were knocked down by the lightening five days earlier, so a sense of God’s goodness and redemption too, as the boys ran and the threatening rain clouds of Friday blew off towards the mountains instead.