In the midst of sadness, we still have some ka-celebrations. Ka is the Lubwisi prefix for small, and though my heart is heavy on many fronts I will allow it to sing out on a few others. Today Masika went home. Many people have prayed for her. She was admitted on the first day of October and discharged on the last day of October, and in that month she slowly but steadily transformed from a skeletal, barely alive, 6.4 kg little pitiful being, with open sores and peeling skin, to an alert, smooth-skinned brown little girl who could stand and hold a doll and even, today, smile. Mid-month I took her a Raggedy Andy from my kids’ stash, and it rarely left her side. The first week her mother seemed to barely touch her, as if she were withdrawing from this child who would almost certainly die. So her mother’s broad smile and tender holding of Masika today was almost as much worth celebrating as Masika’s improvement.
Then there is Mumbere, one of my favorite HIV positive children, who has grown 7 cm longer since the last time I measured him. His tiny little grandmother who brings him for care on her back complains of neck pain—no wonder, he’s growing on his ARV’s. A ka-celebration. And there is another dear patient of ours, Annelise! I heard her voice briefly tonight before my phone ran out of airtime . . .she sounded weak but herself, somehow a relief after major surgery on her neck, to know that she is still she, her own self and own voice. Another celebration, that her troublesome thyroid was removed by careful surgeons in just the right timing, and she’s recovering in America.
And then there is the help that God sent my way. I somehow thought I’d take it a bit easier from mid-October to mid-November, sort of focus on my family, on good meals and early bedtimes and scheduled study habits as Luke progressed through exams. Instead it has been an intense period of both team distress and severe malaria/anemia/overcrowded wards/staff shortage/lack of medicines at the hospital. . . All the things that make work stressful. The main nurse assigned to Paediatrics for the day shifts during the month of November has managed to be present for 2 of 20 shifts. God knew, and without any effort on my part sent me Mary Irungu, Rachel Locker, and Scott Will. Mary is a very sweet and quietly competent nursing graduate, who worked briefly for Kwejuna project which led to a friendship over the last few years. She finished school but is not yet posted in government service, and about two weeks ago just showed up to volunteer on the ward. Rachel and Scott are two American physician assistants from Baltimore, who contacted us and asked to come and help. They’ve been tremendously active, evaluating patients, dispensing medicines, organizing the work for the 30-40 inpatients on the paeds ward as well as antenatal and HIV clinics, not to mention filling in and teaching at nutrition outreaches. Rachel leaves tomorrow to continue a residency program at Hopkins, while Scott will stay until mid-December.
This morning at prayer meeting we read John 20 and Scott Ickes led us in a meditation. When Mary saw the empty tomb she cried, thinking Jesus’ body was stolen. The empty tomb was the best news ever, but she couldn’t grasp it! She saw reality, but did not interpret it correctly. I wonder how often we do the same thing. We see Chase’s developmental problems and the Grays’ anguish, Annelise’s surgery and changing team plans, hungry children and overwhelming work. We feel the story is not working out the way we thought it would, and it seems like the wrong side has emptied the tomb. Then Jesus can come and say our name, and just His voice and presence changes the meaning of all the events around us. That’s what I sense in Masika’s smile, or Mumbere’s bulk, in Annelise’s voice, in Mary, Rachel and Scott’s hard work. They are the ka-celebrations that remind me of Jesus, of The Celebration, of the empty tomb, the old order of death being reversed. So pray we’d hear His voice in our day to day encounters, that we’d wake up to realize that the empty tomb is not a disaster but rather good news.
The plump little girl carrying her cross-culturally adopted white doll baby was born to an HIV+ mom. HIV-exposed, but thriving. The veritable PMTCT poster child.
Yesterday, 185 HIV+ women and their babies came to the WHM Community Center for their quarterly food ration (courtesy of a couple at New York’s Redeemer Presbyterian Church): about 40 pounds of beans, a gallon of cooking oil, and a pound of salt. Some come as far as 25 miles journey for about $20 worth of food. What a privilege to serve “the least of these” with food (both physical and spiritual). Pamela Brown-Peterside has taken this food distribution on as her own: raising the funds, procuring foodstuffs, organizing down to the last detail including porridge snacks for the women who arrive hungry and wait patiently through the day-long process. Our two visting physician assistants, Scott Will and Rachel Locker, spent the morning praying with small groups of the women, hearing their problems, bearing their burdens and bringing these issues before the Father in prayer. The whole day was an incredible team effort (thanks Amy, Kim, Pat, Amina, Jennifer...) with ever increasing number of HIV+ women. Sadly, though, Pamela departs in December after two years serving HIV+ moms and their babies. She will be missed, but thanks to her efforts, we expect these distributions to go on...
All week I’ve been drawn to John 6, Jesus the Bread of Life. I came across this chapter in my regular Bible reading, but kept coming back as I watched kids admitted for malnutrition growing stronger, meditating on how Jesus brings life, to them and to me. This morning we had communion at church, which prompted me to read the chapter again. This time I was struck by the context: the people wanted bread, they wanted the gift, the health, the results, and Jesus said you need ME. I am so much like that. I want a successful ministry or healthy kids, I want peaceful relationships and a good life. Jesus promises in this chapter that He is bringing all that and more, but only through Himself. He’ll set all things right, but not necessarily on our schedule.
The promise and the challenge of that hit deeply right now. Every six months (well, at least annually!) we have a team health day, a time to do routine health maintenance. Some is the typical doctor check-up stuff: blood pressures and weights, reminders about calcium or cancer prevention. Much of it relates to living in the tropics: checking on malaria prophylaxis, updating immunizations, dispensing medicines to intermittently clear the body of other potentially dangerous parasites like schistosomiasis or filaria. It is also a time to pray with people about their emotional, physical, and spiritual health. With a team our size that can take the better part of two days, so we were thankful to put our visiting Physician Assistants Rachel Locker and Scott Will to work. And happily most of what we found was good. For people who live under a fair amount of cross-cultural and plain old survival stress, we have remarkably low blood pressures! Kids who had been a bit on the skinny side were catching up to better percentiles, testaments to the hard work and careful planning of their mothers.
But I went into this period knowing that I was worried about Chase Gray, and actually planned the health days as a way to gracefully call attention to those concerns. Chase is the Gray’s 8 month old, their third son, cute as a button, bright smiles and rosy cheeks, fair hair and kissable pudge. Over the last month it had dawned on me that he looks like a perfect 4 month old, but he’s not 4 months old anymore. Even for me as a doctor looking for problems, I had strong defense mechanisms to assure myself that Chase was OK, just on the slower end of the normal development curve. After all the Grays had been through with Grant, where a quick trip to the US for delivery turned into a four year odyssey of surgeries and therapies for his arms, it was hard to believe that Chase was not OK. Then Julia drew his name for Christmas and decided to crochet him a hat, so I measured his head for her and compared it to my charts. That got me really worried, though even then I thought I might have made a mistake. The night before his check-up I stayed up very late reading up on developmental milestones. By the time I finished I was pretty convinced that his small head and significant lag in development were indicators of potentially serious problems. The next morning I shared my concerns with the Grays, recommending that they go back to America within the month for more extensive evaluations in case there is a definable diagnosis, but more importantly to start on early intervention therapies that could make a real difference in his development.
Well, team kids are family. We’ve all been crying. First it is hard to look at sweet little Chase and project that he might have significant challenges with sitting, eating, walking, talking, learning. It is too early to tell but it could be a long road with a lot of struggle, and that is just plain painful to know. Then it is hard to look at Rick and Wendy our friends, and tell them that even though they thought they’d been through the worst and made it, they had survived Grants umpteen surgeries and managed to move back to Uganda, now they have another child with possibly serious medical problems that will send them back to the States and back to the endless routine of appointments and tests and therapies again. Then it is hard for our team and for our community in Bundibugyo to open up again to the uncertainty, to wonder what the impact will be on ministry and life. God can redeem even this I know, but right now it is hard to see any good in the brokeness of the world as it slams into the Grays again.
Then it is hard to step back and look at the bigger picture. MOST of the families who have served here have left before they planned due to serious physical, emotional, or educational problems with their children. Starting way back with Alan and Sally Lee’s son Ben . . . And now potentially up to Chase. Facing that possibility again takes a toll on all of us. I have some survivor guilt: why are our kids thriving? Yes, there is part of me who is like the people in John 6, all this Jesus and missionary stuff is nice but let’s get to the real point, I want assured daily bread, I want to know my family is going to be OK. But over the last couple of days what I think I’m hearing two things. First, I’m seeing more clearly is that this same Jesus gives himself to all of us, in the ways that we need. Some of our team mates will eat of His life by facing the challenge of children with disabilities, or even death. Others will find Him in the long haul of slogging it out here in Uganda. Secondly, I’m so aware that it is only by God’s mercy and plan that we are still here, so we need to seize the day and plunge into His life and work. Whenever a family has to face a new challenge, our hearts break together, but then I am left with a sense of perspective, that the momentary afflictions we Myhres have really aren’t so significant after all, that it is a privilege to be here. We’ve been given so much! So it helps me to press on, not only for ourselves but for the Lees, the Carrs, the Herrons, the Bensons, the Learys, the Fillyaws, the Tabbs, maybe even the Grays, we don’t know.
Then Jesus said: throw your lot in with the One God has sent. That kind of a commitment gets you in on God’s works. . . I am the bread of Life. I came down from heaven not to follow my own whim but to accomplish the will of the One who sent me. This, in a nutshell, is that will: that everything handed over to me by the Father be completed—not a single detail missed—and at the wrap-up time I have I have everything and everyone put together, upright and whole. . . I am the bread of Life. The Bread that I present to the world so that it can eat and live is myself, this flesh-and-blood self.
Dear Praying Friends,
This has been a heavy week in many ways.
But for now please pray for three things that are on our hearts:
- Surgery for Annelise. On Tuesday Annelise Pierce, who is on a short HMA in the US right now, will have her thyroid gland removed. This is a complicated surgery necessitated by the fact that she was born with an abnormal gland, and while it has given her intermittent issues over the years the doctors at Bethesda Naval Hospital determined that it would be safer for her to be without it, especially living in Africa where we can not follow and treat changes in her hormone levels as closely. The way that God orchestrated her appointment on Friday, bringing her into contact with the best possible specialist through a “chance” meeting in the hall with a friend, and clearing his schedule so that the usual two month wait was reduced to a few days . . . Gave us all assurance of His hand in this care. Please pray for Annelise’s safety, courage, recovery, for the preservation of all the other essentials in her neck (!!) for talking and swallowing. This will delay their return to Uganda for another month, so pray for faith and hope all around, and for God to give them good rest and family time in the interim.
- Evaluation for Chase Gray. In just over two weeks the Gray family will also be taking an unexpected trip to the US. We have been becoming more and more concerned about Chase’s development. He is 8 months old, but unable to roll, sit, grasp toys, babble, or eat solids. For the last month we’ve been hoping he was just a little behind the normal curve, but on Friday we sat down with the Grays and expressed our conviction that this is a more serious problem. It is hard to believe because he’s so cute, smiling, interactive watching faces, and chubby . . . . But his head size and length are significantly below even the lowest normal measurements for his age. We would like him to get a more extensive evaluation to see if there is a definable cause of his problem, and we encouraged a trip sooner rather than later because developmental delays can be improved significantly by early intervention with physical and occupational therapy. The possibility of life-long challenges with learning and movement is very real, which is devastating for any parent to face, and even more so for the Grays who have just been through years of surgical procedures with Grant. Our hearts grieve with them; this is truly where the rubber of faith meets the road, and so many families who have tried to work here have been attacked through problems with their children. Please pray for them to be visited by HOPE, to sense the presence of Jesus with them in their discouragement and confusion.
- Kwejuna Food Distribution. Lastly please pray for tomorrow’s food distribution to Kwejuna Project mothers; we anticipate it may be the biggest ever, with over 150 families expected. Pamela is the primary missionary coordinating these days, and this will be the last one before she finishes her term, though her supporters have offered to fund the distributions for another year (!!). We see the day as an opportunity to show the love of Jesus to the poor and sick very literally (Matthew 25), and it also gives us an opportunity to follow-up on mothers and babies who do not otherwise come in for care. There are interviews, weight checks, blood tests, counseling, devotions, fellowship, laughter, tears . . . It is always a very demanding but worthwhile endeavor. Pray for us as a team as we serve these families.
Thanks so much. I’ll close with Lamentations 3 from the Message, which spoke to me in the grief I feel especially for the Grays in the past few days. Please pray through this for them and for Annelise in particular, that they would enter the silence of God’s presence and wait for hope to appear.
With love and gratefulness,
Jennifer for the team
LAMENTATIONS 3
I’ll never forget the trouble, the utter lostness,
The taste of ashes, the poison I’ve swallowed.
I remember it all—oh, how well I remember--
The feeling of hitting the bottom.
But there’s one other thing I remember,
And remembering, I keep a grip on hope:
God’s loyal love couldn’t have run out,
His merciful love couldn’t have dried up.
They’re created new every morning,
How great your faithfulness!
I’m sticking with GOD (I say it over and over).
He’s all I’ve got left.
God proves to be good to the man who passionately waits,
To the woman who diligently seeks.
It’s a good thing to quietly hope,
Quietly hope for help from GOD.
It’s a good thing when you’re young
To stick it out through the hard times.
When life is heavy and hard to take,
Go off by yourself. Enter the silence.
Bow in prayer. Don’t ask questions:
Wait for hope to appear.
Don’t run from trouble. Take it full-face.
The “worst” is never the worst.
Why? Because the Master won’t ever
Walk out and fail to return.
If he works severely, he also works tenderly.
His stockpiles of loyal love are immense.
He takes no pleasure in making life hard,
In throwing roadblocks in the way . . .
Yesterday a friend was at our house and mentioned to Scott that Dr. Crispus Kyonga, the Minister of Defense for the country of Uganda, was visiting Bundibugyo. Dr. Kyonga was formerly the Minister of Health, and we intersected as students at the Johns Hopkins School of Hygiene and Public Health seven years ago. We were Ugandans-at-heart living in Baltimore, so when Dr. Kyonga was in town we invited him to our home. Our funny memory of the event was that even though we were aware of his status as a cabinet member . . . Our kids just saw a familiar African form, and ran to sit on his lap! Anyway when Scott heard he’d be in Bundibugyo for an event of some sort he mentioned that he’d like to greet him. An hour later we got a phone call that the Minister would like to see us and our kids and would stop by. We rushed to put on decent clothes and clean up the front room and wait. And wait. We thought he had changed his mind when at 7:30, in the dark, a motorcade entered our yard, five vehicles including about twenty UPDF armed guards churning our grass into mud. Our member of Parliament, the Honorable Jane, and her husband, and Dr. Kyonga came in to say hello while the army took positions outside. They asked questions about the hospital and the school and talked about their families, drank tea, and at his suggestion (!) we took this photo. Never a dull moment . . . . .
This is Luke’s Senior Four Class, reluctantly gathered for a photo after their CRE Old Testament Exam this afternoon, standing on the porch of the administration block and trying to stay out of the incessant rain. The O level exams continue until mid November, but more sporadically; this was the last compulsory subject which meant the last time this group of kids will all be together. You can probably pick Luke out in the back row . . . His closest friend is the boy on the front left, Kataramu Taddeo, who has been a God Send, literally, a studious orphan on scholarship from Fort Portal, determined to behave well and learn as much as he can. Two rows behind him are Luke’s other good friends, Richard (neighbor whom we sponsor) and Nuuru. Two of the girls were in my cell group for most of the last four years (Dota the daughter of our Bible Translator Hannington Bahemuka is the thin tallish girl in the center).
These kids are the future of Bundibugyo, the cream of the crop in many ways, at least of those too poor to leave the district. Look at them and pray that they will be the generation that eschews corruption, that chooses hard work over dubious short cuts, that chooses faithfulness over promiscuity, that avoids AIDS and alcoholism and witchcraft, that enjoys a wholesome life with a solid family, dependable job, service to the community, that takes risks for what is right, that creates beauty and peace in this land.
This is Kabugho, whose big searching eyes have reached my heart this week. I should see some reproach in them because I had pretty much given up on her, but instead I see the calm non-judgmental interest of a six month old. I first met Kabugho a few months ago when I heard that the staff wanted to use baby formula for someone whose mother was admitted on the female ward. We promote breast feeding, so I was wary of the request, and feeling protective of our supplies for nutrition I marched over to check out this story of a mother too sick to breast feed . . . And found this woman dying. Literally, she died while I stood there. It was pretty upsetting, she was a young mother, with TB and AIDS, and I had come to insist that she breastfeed her child only to watch her gasp her last breath. Her own mother had struggled alone to care for her, and kind relatives of other patients held the hungry baby while the staff wrapped up the body. I quickly supplied two cans of formula and told them to return when they finished burying, to get set up with a dairy goat from the Matiti project, and to start following the baby for treatment. Since then she had been seen a few times by various staff but sort of fell through the cracks until Costa, advocating for her, calmly said to me last week that he did not know what to do with this patient. I looked up to see the frail grandmother and the tiny baby, less than 8 pounds at age six months, deathly ill, gasping, bloodless eyes and peeling skin. I rushed them to the lab where her hemoglobin was 3.2 mg/dl, a value not compatible with many more hours of life. Her grandmother insisted that she had nothing with her, had come alone, and could not stay. I stood there with the staff trying to convince her to be admitted at first. But I looked at the baby and the grandmother and thought of the pain and loss she had already experienced, and how much worse it is culturally to die in the hospital than at home, and how marginal her chances were . . . And told her that if she really wanted to go she could. Thankfully she changed her mind and stayed. I did not expect her to live 24 hours. Now a week later she’s looking at me with those big eyes. Blood tranfusions, malaria medicine, antibiotics, skin creams, milk, TB therapy, some funds slipped into the grandmother’s hands for her own food . . . And the little life that was slipping away has returned. She’s going home soon, and though I don’t know how long she’ll live, I’m grateful for the lesson to not give up, to value the love the grandmother had for this child, to gaze into her patient little eyes and try.
The ART clinic today was full of stories, including a happy mother who showed me her baby’s negative test results, several fat little newborns whose status is still unknown, others waiting for medicine refills. But my other favorite patient of the day is a little boy who may be 5 or may be 7, they’ve told me both ages at different times. His mother died, and his uncle who is in charge rarely manages to come to clinic with him, so he is basically being cared for by his 12 year old brother. The two of them shyly stand in my exam room, silent, in tattered shirts, the younger barefoot and the older in mud-splattered school shoes and uniform. I offer them both candy which brings big smiles. No matter what I ask they nod and agree and rarely speak. It is nearly impossible to know how well his medicines are given at home. But today I got the results of his CD4 count back: in less than a year his absolute CD4 count has doubled and the percentage nearly tripled. So the two little boys must be doing something right. I pat them on the head and refill the prescription, praying he’ll keep improving.
Grammy ended up with titanium rods in her back and the anticipation of a more difficult recovery, so we would appreciate prayers for her! Jack set up a count-down widget on the computer screen desk top, so we know she has exactly 55 days to be well enough to land in Uganda.
Luke survived what may have been one of his toughest days. Can you describe the reaction when copper sulfate is heated, including the color of the compounds and the chemical formulas? Or could you write an essay on the healing of Jairus’ daughter in the Gospel of Luke and its relevance to Christians today, worth 25 points? The struggle continues . . . .Biology tomorrow.
Feeling thankful for small, and not so small, things tonight. A few hours of sunshine after days of rain. The smooth brown convexity of home made bread. Sending two malnourished patients home because they were so much better (even though their beds were filled within the hour by two new desperate kids). The arrival of 11 propane tanks for the team—about half the the team households had ceased to be able to cook, or refrigerate, which puts some stress on health and happiness. Introducing Jack and Julia to basic algebra in their homework, and having their frustration turn to interest. Our faithful old dog Angie wagging her tail and eating after a morning of chills and lethargy . . .
To end the day, a quote from another poem, called EVENING:
But on a hill among musizi trees
Sweet nuns sing the litanies
Of that virgin whose Son we know.
Priests like lamp posts in a graveyard
Stoop over the breviary.
There’s a piping of crickets in the bush
And a bellowing of frogs--
All sing the ancient elegy
For the sun has died in the west. (Lubega)
First, my mom just went into the operating theatre for back surgery, and here we are thousands of miles away. That is very hard. My sister is faithfully caring for her as well as friends from church. We are praying that this procedure will relieve the severe pain she has been experiencing, and enable her to come to Uganda for Christmas!
Second, Luke continues to slog on through exams, today was Physics. He thought it was pretty hard, though the topics had been generally addressed many questions contained specifics (describe an experiment that demonstrates the reversibility property of light) that he had not previously seen . . . He’s generally having a good attitude but restless, and the sheer volume of exams and material weighs on him. And therefore on all of us. Tomorrow Chemistry (Theory paper 2, essay) and Christian Religious Education (Gospel of Luke).
Thirdly, Scott went to Kampala for much needed medicine, groceries, and a meeting about the new EGPAF grant. So we are missing him here, in the incessant rain and dragging sicknesses that are passing through the team, and particularly with exam stress upon us.
Lastly, Masika looked slightly better today, don’t give up praying for her. I hope to post some pictures soon.
Rose died on Wednesday evening, the 15 month old baby of JD and Kevin’s houseworker, and our near neighbor, Jowasi. I had found them admitted already on Wednesday morning on the Paeds ward, mother and baby sleeping on a mattress on the over-crowded (!) floor, one of almost 40 kids needing attention. And I failed Rose, failed not notice how sick she was becoming throughout that chaotic day. After seeing all the patients, running home to feed Luke lunch between two exams, and meanwhile greet a delegation from Catholic Relief Services touring the country, then running back to see the HIV positive kids in the clinic, I checked on her. No malaria parasites on her smear, a hemoglobin that was anemic but not a critical value. He mom said she was breast feeding; I declined to order them a Quinine drip given the lab results and decided to keep her overnight on oral medications with an anticipated discharge the next day. It was mid-afternoon, and I left, much more concerned about two other children who seemed objectively much sicker, than about her. So when I heard from friends early the next morning that she had died, I was shocked. Evidently about 6 pm that evening she had begun to deteriorate, probably more anemic than I realized, and she died in the hospital. I went to their home to find the women shuffling quietly single file, weeping, to the nearby compound of Jowasi’s clan, where they would bury that day.
There is no glossing over death in this place. I suppose I usually move on with the assurance that we did all we could, or the convenience that the family whisks away the dead body during the night so I only find the empty place. This time I could not do either. After finishing at the hospital on Thursday I accompanied JD back to the place of the burial. We sat outside in the drizzling rain, clustered with other women around the mud and wattle house where Rose’s body lay. A few sang hymns and beat a drum until the freshly dug grave was complete. Neglected children tried to amuse themselves, or huddled under the dried banana leaf shelter of the kitchen shack. Oblivious duck families waddled about as rain collected into puddles. Even as Bundibugyo homes go, this was a pretty bleak scene, unswept dirt and leaning shelters, scraggly livestock and runny-nosed toddlers. Then we listened as a local elder and a family member took turns recounting the events of her short life and death. In this place, and in this clan in particular, accusations will arise. Who bewitched them? Whose jealousy was aroused by Jowasi’s job with the mission, by his two wives, his 8 plump children? Whose fault that there was a quarrel in the marriage, and the sickness began while Rose and her mother were staying away from home, sulking back at the in-laws?
When the short coffin, covered in bright purple cloth, was lowered into the hole Rose’s mother threw herself into the loose dirt at the brink of the hole, crying out “they have taken my child” until she was carried away by other women, the grave dirt on her face and clothes, while men shoveled the clods of soil with the thump of finality onto the hollow box. Her father sat forlorn, some distance back. We walked away, heavy-hearted, to team meeting and James 2, Abraham and Isaac. I struggle with that passage. God clearly judges against the nations that sacrifice their children to Molech, that burn their babies, something He hates, the prophet Jeremiah rants on and on against the idea of gaining advantage by sacrificing a child. Yet in this story Abraham ties Isaac and puts him on the altar, then raises the knife, and this is pointed to as true faith in James. Testing, the purification by fire of a precious metal. After 14 years I’m still crying out for that kind of faith. If it were my child in that box, not Rose, would I believe God’s goodness? And even if (I sincerely hope) I never face that test, can I keep on with the more subtle daily sacrifices that living here entails for my kids?
The rain drizzles on, and I pray that my faith will lean on Jesus, the ram in the thicket, the child whom our Father in Heaven watched die, in our place and my kids’ place. And Rose’s place, so that she could rise from that mud-splattered purple coffin and run into the arms of her Lord.
