Rounds on the paediatric ward and the nutrition clinic on Tuesday, from top to bottom:
Tumusimwe—this little boy has a wheezy tuberculous cough and skinny little limbs, trying to recover from the TB which killed his father and left his teenage mother a widow.
Bacecura—this little boy has Kwashiorkor, and as he’s begun to drink milk over the last week his massive swelling has subsided, leaving the malnourished shell, the first step. He’s lost about three pounds already, which is a lot for someone who only weighs about 20. Pray for him to gain strength.
Chance—one of my favorites, his parents are dead, his aunt breast feeds him though she’s pretty desperate herself. He’s holding on to life but only tenatively.
Ngonzi—another favorite, with his AIDS and TB and his sweet, careful but lame mother. He’s waiting for ARV medications, to rescue his immune system from a CD4 count of 60. He’s over a year old but only weighs 5 kilos (11 pounds!).
Evarette—both parents died leaving her with this grandmother. She’s feisty and just beginning to head towards recovery.
Maskia—another orphan cared for by her grandmother, improving.
Ahebwa—sweet and tiny, this baby’s young mother is afraid to tell the family that her husband died of AIDS because she knows she’s positive too, and does not want to be thrown out. Problem is that there are four other oblivious wives and collected children all living still, in Congo.
Robert T—nestled skin to skin, we call this “kangaroo care” for low birth weight infants. He is his mother’s 13th child, and the 12th was also malnourished getting help from us. Sigh.
All of those are getting nutrition help, but there is one more picture of a mystery case. This boy Mubiiru Morisi is 7. He fell ill almost 2 years ago when he was admitted to the hospital for two weeks with fevers and sleepiness and weakness. Since then he’s had dwindling strength, poor weight gain and growth, and swollen legs, and I’m not sure what is wrong with him.
Then there are three of my dearest little outpatients who came back for follow-up today, all of whom have been prayed back to life as people read their stories on the blog:
Kabugho—the baby whose mother died of TB and AIDS right in front of me, and who was nearly dead herself a few weeks ago, still with those penetrating big eyes, not giving up on life!
Masika—after one week at home her weight is up again, and she looks great!
Makuni—still gaining weight too at home, back for a check-up.
Last but not least a few pictures of the missionary crew today:
Stephanie—the woman who pulls it all together for BundiNutrition!! It is a lot of work to arrange food, transport, staff, teaching, patient evaluation, records, fund-raising. She’s amazing.
Julia and Miss Ashley, volunteering their time on their day off of school, made the work go quickly.
Pat was investigating MUAC’s , mid arm circumference.
And my life continues to be improved by the presence of Scott Will, PA from Baltimore.
The Stanbic Bank branch in Bundibugyo was robbed Saturday night, to the tune of 1.3 billion shillings (half a million dollars). This is cocoa season, so buyers are coming into the district, which means money is flowing as the lorries of cocoa roll out over the muddy road. The story is that two women approached the two police guards posted by the bank and offered them drinks which were drugged. While they slept the perpetrators (or thugs, as they are referred to in the newspaper) used crow bars, acetylene torches, and the conveniently located keys to the vault to get in and out with the money. This is a town where hundreds of people live within a stone’s throw of the bank, and the process could not have been silent. This is a district with ONE ROAD and a place where NO ONE drives at night, yet when the police set up road blocks they failed to find the guilty cars (there were two). We are sad for the bank manager who is a friendly and competent lady, and for the disruption this will likely bring to our ministries and projects as the bank recovers. Meanwhile today Jonah is involved in meetings to investigate a mystery gastrointestinal epidemic striking people in Kasitu/Kikyo (not too near us). The difficulties of disease investigation and the success of a brazen bank robbery both are reminiscent of what it must have been like to live in the western US 150 years ago . . . .
The overnight get-away to Semliki Safari Lodge was . . . .words can not express. The place is an oasis of beauty, both the wildness of nature and the order of a luxurious manicured lodge. We were guests of the managers, along with a photographer and his wife who were shooting reams of photos for publicity, and a travel agent checking the park out. Amazingly the photographer’s other job is a full time doctor at the Infectious Disease Institute in Kampala, dealing with AIDS, and his wife started the very successful Beads for Life project which creatively enables the poorest of the poor to start their own businesses. They were a delightful surprise and I hope friends we can keep up with. We always enjoy the manager couple as well, so it was a nice mix of much-needed down time for us as a couple, and of good company, fine wine, gourmet food, peace and quiet.
But as we drove back through the slick mud, leaving the cheerful ambiance of the SSL behind, I felt like we were emerging from story-book Africa back into real Africa. The cavorting kob were replaced by crowds of kids, rusted bicycles, overloaded pick-ups, soldiers and guns. And as soon as we walked into the door we began to get some hard news. None as hard as this past week’s news about Chase, but still not what we hoped for.
First, my mom can’t visit for Christmas as planned. Her back surgery was too extensive and her recovery will not be complete by that time. This was a big blow to all of us. It is still sinking in how much of the next couple of months of life were revolving around that expectation. We are all grateful she was able to have the surgery, it was much needed, but the loss of the anticipated trip is hard.
Then Ndyezika walked in with his exam results. The good news is that he passed more things than last year, and does not have to repeat any classes. The bad news is that he has to re-take 2 of the 5 exams, either later this month or in February. He’s a relentlessly optimistic guy, but even he was pretty sad, commenting that he had hoped just this once God would bring him all the way through, but in his life it never seems to happen that way. It was hard for me to accept as well. More uncertainty, more waiting, another potential failure looms ahead. The same day we got a letter from his fiancée's family expressing their willingness to enter negotiations, and detailing a long list of expenses that will be associated with her bride price. Now we have to choose our “mukwenda”, the go-between who will negotiate for us. It is good news that they are willing but we know it will be weeks or months of financially draining expectations to meet. And we will have to walk carefully between our role as his guardians who are wealthier than he could ever be . . .and raising the bar so high for a church wedding that everyone else continues eloping.
Those are the two big disappointments, but it’s also continuously raining, a very demanding patient showed up early this morning, the power is shutting off the internet, I got news that my sister’s car was stolen (along with all their credit cards, house keys), and the week ahead looks like a long vale of tears as we say goodbye to Scotticus, Amy, and the Grays. The tomb is definitely empty, and it feels like the body was stolen . . . We need prayer as a team in the midst of November clouds to hear the voice of Jesus, putting it all into perspective, that though things are not unfolding according to our hopes and expectations our God is still in control.
“You will find rest for your souls” . . . In a week (a month, a year . . . ) that has held much burden, we are grateful to have the gift of rest. Friday morning Scott and I will head out for Semliki Safari Lodge, a luxury tented camp of the wealthy colonial genre improbably located in the savannah around Lake Albert within the boundaries of Bundibugyo District. It is about two hours’ drive from our home. The managers have volunteered in some public health initiatives in their area which allowed us to connect, and they graciously invited us to come for a night. This will be the third (or fourth?) year we’ve been able to take this little break, and we really look forward to it, being away from patients and responsibility, soaking in the beauty of Africa with all the harsh reality smoothed out. Even God rested on the Sabbath, how much more we need to do so. Last night I finally got a shower and pajamas and just about had dinner ready when Jonah came to consult on a newborn baby. I knew he really wished (though he wouldn’t say it) that I’d come back to the hospital, but I was so tired and felt that I needed to care for my family (and truthfully myself too) instead, so I told him what should be done. I felt a bit guilty for not going myself, and somehow I just knew that this morning I’d find that the baby had died. It had. Probably my presence would not have made a difference, but most people don’t have to face death as a consequence of resting . . . So that experience both leaves me more ready and eager for a real break, and aware of the cost of resting too. The kids are staying home here with Scott Ickes, who finishes his one-year term next week, so it’s a farewell party of sorts. We don’t leave them often, or lightly, though now that Jonah is around that is not quite so scary, but sometimes I realize there is no 911, no ER, and anything can happen. But anything can happen every day, and usually does, whether we’re here or not.
Though the time is not long, only about 36 hours, God can meet us in that space. We’re praying for true rest, which is more than just a break from work, the kind of rest that lays down all burdens but the yoke of Jesus, that hears only His voice calling our names, the kind we can enter into together and emerge from strengthened for the next stretch.
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.
