Over the last week we have had responses from five individuals and two churches/groups to help with nutrition expenses! Only five months to go to cover the whole year at $1600 each month. Today I was reminded that God sees the needs here, and plans ahead, and it is our privilege to be a small part of His work on behalf of the orphans and widows and hungry people he cares about. We have been in the new ward for one week . . . But today there are 30 patients in our 27 beds, meaning 3 on the floor. Yes, even this huge new ward is filled to overflowing. If we had not moved, I think I’d be crying in despair. As it is, we were ready for the upsurge. Two weeks ago we thought we might have to quit providing nutrition at all, our program was out of money and our UNICEF grant proposal was denied. But people responded with generosity and just in time for probably the highest number of severely malnourished kids we’ve ever had to care for at one time.
Sixteen of those thirty inpatients are malnourished. Today on rounds I snapped a photo of each one, to remind myself and all of us that these are individuals, human beings for whom God created good plans. The first four are low-birth-weight babies, premature but also small for their gestation. The top two are twins, one of whom essentially died yesterday while I was on seeing another patient. The mother had started crying that he was dead, and sure enough I found him darkly purple, with no heart beat or respiratory effort. A few minutes of CPR, stimulation, antibiotics . . . And he was breathing and revived. The third one did the same thing today while waiting to be seen in nutrition . . Costa suddenly brought him into the room where I was seeing another patient saying “this baby has packed” and I saw that he also was dusky, not breathing, but this time the heart had not completely stopped. He was also able to be revived and is now on oxygen thanks to the new ward, the oxygen concentrator, and power from the generator. All four are gestating skin to skin for warmth, sipping expressed breast milk, and supplemental formula to encourage growth.
Next are the newest admissions, from today: a child age 2 1/2 who had poked along until a month ago then began to drastically lose weight. We routinely screen for HIV infection and found this one was positive, one of the last kids born before our universal screening of pregnant women began in 2004. Another is a four-year-old from Congo whose parents both died from cholera within a few days of each other, and a few months later presented to us with Kwashiorkor, swelling of the body from protein deficiency as she eats a very marginal diet in the care of her old grandmother.
Others have been on the ward for some time, struggling with sickle cell disease or malaria, diseases that push them over the edge in a place where food is bulky and not very highly caloric, or where families barely manage in good times but are thrown into disarray by these chronic illnesses. Two of the three with sickle cell were diagnosed in the last few days as a result of our screening of kids failing to thrive. Two have absent fathers who are fighting for Uganda in Southern Sudan, to protect the people of the north from the LRA. One of those has AIDS. The other has no real disease, but his mother basically tries to feed herself and her four children with no help from relatives, no land, doing odd jobs for coins to survive. After a week of milk in addition to breast feeding the baby is finally up to five pounds at one month of age . . .
Near the bottom the babies of three heroines, breast-feeding grandmothers, women whose daughters or daughter-in-laws have died. Left with the care of their grandchildren they have bravely attempted to re-lactate, in these three cases successfully, though the children have needed some additional nutrition. No retirement relaxation for them, they have their hands full with the hourly care of infants. The last one looks pretty good compared to the rest . . Because he went home today. Though his bed was only empty for moments before it filled again with another needy child.
THANKS to those of you who have gone out of your way to provide for these children. I hope you are encouraged by seeing their faces, to know that you are helping real people. It helps me to make it through the long day when I hear the words of Jesus “as you did it to the least of these” . . . . In a small way this ward is the house of God, because Jesus lives there in these faces.
I just posted the good news that 5 of 12 months were covered, and had another message from the person who is mobilizing her 32 friends to give $50 a piece for the sixth month. I don’t think I can email a person who posts a comment unless I know their address . . . So I’m requesting that anyone who wants to be part of the 12 months of nutrition support email me at drsmyhre@yahoo.com. Then we can be in touch directly about which month you’d like to sponsor, and how to send the donation. We’re half way there! Thanks.
4 Stitches our team mate needed to close a wound over his eye on Saturday when he bent over to fix a water pump in his storage room and was rudely stopped by a protruding wooden paddle used for stirring matoke. Perhaps the first team injury directly attributable to matoke?
13 Number of team mates who happened to drop in for other reasons during the Saturday afternoon suture session on our kitchen table, and watch with interest. No privacy here.
25 Number of kilometers on a spectacular hilly dirt road mountain bike loop that six women on our team rode together on Saturday morning.
24 Number of those kilometers that seemed to be straight uphill . . .
7 The number of women who began the ride that six finished—one slipped in loose sand and gravel and got pretty scraped up, though she’s fine now. We had to call our ambulance, Scott for a rescue. This was unrelated to the 4 stitches. We get lots of injuries here . . .
3 The number of stitches Jack will have removed tomorrow, amazingly not infected and still holding together in spite of serious wrestling and other wildness. He even managed to write left-handed all week, though a back-log of homework did nearly push him over the edge on Friday.
4 The number of HIV positive people who stood up to give public testimonies in church this morning, encouraging others to be tested, to access care, and calling on the community to stop discrimination against positive people. Unexpectedly, the first one asked an elder in the church to stand up and pray for Scott, me, and Pamela to have the strength to care for them! It was a meaningful moment for me, to be prayed for in this way. We have had lots of dramas about AIDS, but I have rarely seen this kind of public courage to be identified as infected.
4/11 The proportion of the university sponsorship quota for students graduating from A-level (Senior 6) in Bundibugyo that went to CSB students! The results were announced Friday.
49, and 62 The number of people (including team) who were at our house for dinner on Thursday night . . And the number of pizzas we turned out of our oven to feed them. We had a short visit from a US Naval Academy student group on a short term missions trip. Though they only had 16 people compared to the last team of 21 . . . It shows that midshipmen have a healthier appetite than Charismatic Episcopals?
? 6 Hours of desk time I feel like I need to even begin to catch up on life after this intense week (i.e. Clean up, plan, write emails)
0 Hours so far accessed for above (but we have had some good family time, good food, and good sleep!).
I save the best for last:
5/12 The proportion of months that people have already pledged to cover for nutrition costs!!! Amazing. Another blog commenter says she’s pulling 32 people together to each give $50 . . . If she manages that will be half the year. Still holding out for six (or seven) more!!
Well, the good news is that I did my first day of rounds on the new ward and it was so lovely. Instead of 20 patients crammed into a 10 bed ward the size of most people’s living rooms . . . They were dispersed over a 25 bed ward, each with their own bed, mattress, shelf, plenty of air, light, windows . . . Of course the fact that this motherless child has lost 2 kg since graduating at age 1 from the nutrition program and is back in desperate shape, this baby’s Kwashiorkor is related to AIDS and a severe case of malaria to boot, this mother’s family is telling me there is no one to help her, etc. does not change. The world is still a broken place, but now at least those who are suffering the most severe effects have a clean place to lay their heads. We even turned on the generator power to run an oxygen concentrator for a child who arrived gasping her last breaths . . . Blue and weak, she probably has a congenital heart defect, but the oxygen staved off death this hour at least. We could not have done that on the old ward. I’m grateful.
The sad news is that the nutrition program is completely out of funding. We lost WFP food last year, and we were denied our UNICEF grant proposal this month. Stephanie rushed to get in another grant, but in the meantime Karen got milk on credit this week and we are struggling to feed about five seriously malnourished inpatient children as well as three premature babies. I know that churches and Sunday school groups, student fellowships, etc. often look for a worthy cause. So I had the idea that if we got 12 groups to cover particular months (one takes August, another takes February) then we could manage another year while we try to work on the more sustainable aspects of the program (seeds, milking goats, an agriculture extension worker) that we’ve applied for grants to fund.
$1600 a month covers:
Boxed Milk - $400 (Kwashiorkor and severe malnutrition)
Formula - $400 (prematures and initial care for motherless)
Breastfeeding Stipends - $400 (motherless)
Peanut Butter Paste and Misc - $400 (mostly for HIV+kids)
It’s a lot of money, but this budget helps about 50 kids/month at the cost of 1$/kid/day.
If anyone who reads this has a group that wants to commit to a month, let me know!
This morning it was back to normal life, patients who had accumulated in plenty during the celebratory pause, team issues, kids, homework, cooking etc. (Did I mention that Jack played with a pocket knife during some of the Ambassadorial hooplah and gashed his hand, which we wrapped up with the scarf I was wearing over my shoulders until we could put in three stitches about half an hour after the guests departed?). When I arrived at the hospital I met the mother of one of our premature babies gallantly trooping her small baby and bag of possessions from the old ward to the new as Maternity officially shifted. Pediatrics is flowing onto the floor and out the doors of the old ward, but that will be more complicated to move, so we are going bit by bit. By the the time I finished seeing patients at 1 pm there was a mother in labor, so I told the staff to inform us when the first baby was born in the new delivery room. Sure enough, within the next two hours, that mom “produced” as they say here. So while the interns hung out with the kids Scott and I zipped back down on the motorcycle in the late afternoon to present a blanket that friends of Annelise had sown for patients, a hugely luxurious and clean and colorful soft covering.
What a fun time: the mother was delighted, proudly aware of her status as first to deliver in the new place. It turned out that she was a Kwejuna Project mom, someone who was identified as HIV positive through our PMTCT program and she and her baby received the life-saving doses of Nevirapine to prevent transmission of the virus. Even more fun: when we greeted her, she displayed her strapping male infant and told us with excitement that his name was, of course: Scott (pronounced Scotty). So Dr. Scott and baby Scott had their picture taken together with the new blanket and the beaming mother. Who knows, after all the attention yesterday, there may be a run on the name Scott (which is not, shall we say, popular in Uganda, in fact virtually non-existent). We thank God for yet another unnecessarily fun affirmation of the new ward.
Today’s dedication and hand-over of the new Maternity/Paediatric ward was a day of celebration from start to finish. Every prayer was answered, from the clear dawn which grew into the first sunny day we’ve had in two weeks, allowing the airplane to safely come and go and allowing hundreds of people to comfortably watch the festivities. Every major district leader personally attended, including the LC5 (governor) with his entire executive counsel, the Resident District Commissioner, the Chief Administrative Officer, both Members of Parliament, the Director of District Health Services, the UPDF Battalion Commander, and dozens of other local officials. No one quarreled, the major political combatants laid aside their differences for the day. Our American Ambassador spoke with grace, highlighting the powerful impact of individuals who give and serve, and the partnership between citizens and government. The primary school choir sang welcomes, and two excellent dance and drama groups performed skits encouraging women to use the new maternity services. There were traditional flutes and belled ankles, gyrating hips in grass skirts, painted faces and booming drums to give the African sense of celebration, combined with lovely tent shades and flowers and dignified protocols to give the sense of decorum. We unveiled two plaques, one giving credit to our major donors (Mr. Cheung of Daeyang Shipping in South Korea, James Kern, my family and Scott’s family, and our friends the Hanleys). The other commemorated the Hon. Ambassador Stephen Browning as guest of Honour. The Ambassador cut a ribbon and toured the new buildings, Scott dramatically handed the keys to Jonah. Several hundred people ate a feast. We even managed to get the Ambassador and the Honorable Jane, our women’s member of parliament, to tour Christ School, greeting staff and students. There was just the right amount of time for all the hosting we had planned, and the Ambassador even commented that in all his years (?30 or more) of service this was the warmest welcome he had ever received.
But the best part of the day was to bask in the pause, the stepping back to give glory to God, enjoying acceptance from the community, the appreciation and sense of team work all around. Many thanked us and the mission for “sticking with them through thick and thin” as they recalled the hard and dangerous years of the ADF insurgency. The member of parliament called us citizens of Bundibugyo as well as America. The RDC compared Scott to the Good Samaritan, who saw a need and did not walk by but stopped to help women and children who were dying. I know we should do everything we do just because it is the right thing . . . But it is a blessing to spend a day hearing that the people we serve do appreciate our presence. Scott delighted people by dancing with the dancers. Our whole team turned out to support us, and the Ambassador even spent some special time with the interns as a gesture of encouraging young American volunteers.
This day was truly one of the milestone days of our time in Bundibugyo. I wish that all of you our family and supporters and friends from the US could have also heard the thanks that people poured out for you! It was a true answer to prayer that everything went so well. I think we would like to sleep for a few days . . . But life will go on tomorrow. For tonight we can rest and rejoice.
This evening we dedicated the new ward in prayer. The official hooplah all starts tomorrow; pomp and circumstance, food and drink, crowds and music. But first we gathered to pray, which in my heart it the real dedication. A good portion of our team, all the elders from our church, and a representation of hospital staff all came together, about 35 people, and an encouraging intersection of our ministries. We stood in the labor and delivery room and read from 1 Kings 8 where Solomon dedicates the temple. No building can contain the Lord of Heaven and Earth . . . But like Solomon we could pray for Him to hear the pleas of the people when they cry out to Him in this place. God with us, not in a temple or a hospital, but in the presence of the hungry, the sick, the naked, the prisoner (Matthew 25). If these are the people through whom we now encounter Jesus . . Then this ward is a bit like the Temple, the representative dwelling of God. We prayed for the mothers who will labor, the babies who will take their first breaths, the midwives who will make tough decisions, the nurses who will lose sleep and struggle over IV’s, the clinical and medical officers who will diagnose and prescribe, the children who will be fed and helped. We prayed that healing and hope would abound within these new walls.
The sermon this morning came from Luke 17:20-21 . . . .where Jesus tries to counter political expectations of the coming Kingdom by emphasizing that the Kingdom of God is not visible, and will be accompanied by conflict and suffering as much as by victory. Amen to that, we clearly see that we are not part of a conquering force, and the last two weeks have had their share of conflict and suffering to be sure. On the other hand when John’s disciples ask if Jesus is the Coming One, he answers with concrete and visible Kingdom effects: the blind receive sight, the lame walk, the poor have the Gospel preached to them. And that aspect is also clear here in Bundibugyo over the last ten days.
It was not until this morning that I reflected on why we might be iron-deficient in our souls: this has been an amazing stretch of Kingdom progress! Consider that in the space of ten days the book of ACTS was dedicated, the student/parent meetings at CSB were completed and school resumed, the Butogho water line was completed, and tomorrow the Paediatric/Maternity Ward is slated for dedication and handover! That is four major milestones of the Kingdom in the four major areas of our ministries here, all very public and visible. And as expected most involved significant opposition, struggle, last-minute crisis, and conflict. For instance Michael spent days this week dispelling rumors and reconciling with communities over water line issues that threatened to derail the project in the 11th hour. But by God’s faithfulness, TEN THOUSAND people now have clean and safe water for the first time, in the lowest most distant populations centers where we used to get most of our cholera outbreaks.
Tomorrow’s dedication will also serve the poor and sick, more visible but less important really in the public health sense than the water line. But even that has been threatened with last-minute conflict as various politicians yesterday squabbled over the order of honor and put Scott in the middle of their jockeying for position. The last thing we want to do is make enemies. We have a truce of sorts and everyone is supposed to come, but you can keep praying the day will be one of joy and celebration and glory to God, not an opportunity to settle political scores.
Bukama Bwawe Bwise: Thy Kingdom Come.
Kabajungu Margaret (whom I erroneously have been calling Kabugho Margaret) heads back to Kampala for her second round of chemotherapy tomorrow. She came smiling shyly to our kitubbi today, and Scott showed her father how the tumor had shrunk from filling most of her lower abdomen to a manageable 4 x 9 cm. I’m daring to hope that she can be cured, that a few hundred dollars could mean the difference between life and death for her. I heard a Lubwisi proverb today that the stone that is not on your road should not bother you . . . . But this little girl became a stone in my path, something God called me to act upon in faith, and through me perhaps a handful of blog readers who are praying for her. She has far to go, but there is hope.
