Why I keep going

Today I remembered why I keep going.

There are three little boys at the hospital who need more than the paltry medical care we can offer to have a hope of survival.  The oldest is Matte, who at 15 weighs less than the average 5 year old, every bone prominently protruding from his shrinking flesh.  We think it is TB, from his chest xray, so we have started therapy.  He smiles and says “thank you” in English when I hand him a jar of peanut butter and tell him to eat a spoonful every few hours.  The second is Ngonzi Christopher, 8 years old, beads of sweat in an intricate pattern on his straining face as he spasms in the classic rigor of tetanus.  When the spasm passes he can answer my questions in Lubwisi, his breathlessness being the chief complaint, tetanus a disease that suffocates a person with their own uncooperative muscles.  We are sedating him and supporting him, but after a series of phone calls I have determined there is no tetanus immune globulin in the country, and no ICU that will take him.  So only quiet, fluids, prayer and hope remain.  The third is Birungi Suizen, age 4 1/2.  I posted his picture last week, when his pitiful condition made me weep.  Today I wept when his sweet spirit surfaced.  He’s been admitted now for a few weeks, against all odds still alive.  Like a chameleon, he peeled off his sickly scabby skin and a new layer is emerging from within.  For the first time he’s sitting, and I found him eagerly sipping the milk his mother fed him from a spoon.  Every day I give him a piece of candy which he grabs, my assurance of his mental alertness.  Today I held out my closed fists, and instead of one piece I had enclosed two. He chose the right hand, and I turned over my fist to reveal the two pieces of candy on my palm.  Two!  He looked at them, and at me.  Then he slowly took one in one hand, and took the other and handed it to his mother.  I wanted to cry again.  This tiny suffering person was ready to share his first bounty, not to horde but to give.  He is barely alive, his years of malnutrition and neglect have to have impaired his intelligence, but he understands love.  

That’s what keeps me going.

Keeping eyes open

As I rode down the road this morning, I could see the barren peak of the Rwenzoris in it’s post-storm clarity, a shadowy horizon against the blue of the day.  We’ve just had a spate of visitors and I find myself challenged to see this world from their fresh perspective.  So I kept my eyes out for sights that have become normal to me, but which I really should appreciate:

• Six people riding one motorcycle.  Yes, six.  Most SUV’s in the US don’t even drive around with six people.  They were expertly arranged with a medium kid in front, a smaller kid between the next two adults, and a woman at the rear with a toddler tied onto her back hanging over the rear wheel.  The perfect family transportation.
• Our muscular builder walking down the road holding hands with another man, a sign of friendship, not anything weird.
• A bright blue fluttering kingfisher alighting on our grass-thatched kitubbi as I left.
• My shrivelly old lady neighbor smoking a home made cigar as she swept her dirt courtyard.
• A couple of dozen women in a shuffling circle dance with wreaths of leaves on their heads celebrating the boys in their family about to be circumcised (we had heard the drums all night, but as Luke cheerfully pointed out better drums than guns . . . )
• A cow with 3 foot long horns that shouldered me off the road
• Coke bottles lined up full of thick orange palm oil for sale
• No one looking hurried, no matter how late they were for school, no one too busy to stop and comment or greet or stare . . . .except me of course, zipping by, almost too fast to notice the rest of the world.

Going Post-It

I remember when “going postal” was a euphemism for raging insanity, because of a postal service worker who shot his fellow employees.  When Scott travels, I find my center untethered, my sanity slipping, my patience fraying at an alarming rate.  A couple of years ago when I was coping alone I resorted to post-it notes, everywhere, to remember all the details of my usual responsibilities plus his, because our life is definitely a two-person job. Then I heard a silly song (Philadelphia Chickens CD) making fun of typical “I’m so important” busy-ness, and felt convicted.  I think I’m going post-it again.  Today I forgot to send my kids’ lunch to school, appreciate the irony of being called at the nutrition clinic by my son to tell me I forgot my own children’s nutrition.  I biked home to pull something together, then was leaving them and pulled out a list of things I was trying to remember from the hospital . . . And Annelise reminded me of my post-it note phase.  When I’m the single parent and single doctor and single team leader, life comes at me from all directions, and I find that I start to slip.  So the best prayer is to probably simply remember my sense of humor, sort out the truly important, and cheerfully let the rest slide.  But not lunch.

Baby Jonah Muhindo, 8 March 2008

Last night we got a phone call that Melen was in labor. I had asked to be with her when she delivered, and when I talked to Jonah’s sister they were still at home, waiting but soon heading to the hospital. We planned to meet in 2 hours . . But this being baby six I went 45 minutes later to pick them up. Only to find they were already at the health center (she stays right next door). I burst into the delivery room to find that she had just delivered a healthy baby boy! She never even made it to the delivery table, but had him on the bed the midwives use to sleep in when they are on call. I thought this might be a real moment of grief, but instead I think the joy of this baby outweighed the reality that he is already fatherless. Labor and delivery are a women’s world anyway, so his absence was not strange yet. It was fun for me to be the one to clean and weigh the baby, and hold him to warm him while Melen cleaned up. Two of my favorite nurses, Agnes and Rose, were in the room, as well as Jonah’s two sisters Sophia and Janet. I’ve been through a lot of life with all these women, especially in the last couple of months. It was a rare sweet moment, the bright white clean delivery room, the laughter of the women, the relief of Melen, the burbly grunts of a newborn, the bustle of care, taking time to pray together. An hour later Melen was ready to go, so we headed out to the truck in the darkness, to drive the hundred yards up the road to her rooms. We sat by lantern-light while he eagerly began to nurse. Melen smiled. I’m sure that in spite of the ultrasound she didn’t REALLY believe this child was a boy until she saw it with her own eyes. Having a son is crucial in this culture, even more so for a widow. A quiet sign that God was caring for her, after five girls, a boy to carry on Jonah’s name. We pray he will be courageous and true as his father.

Goodbye to Scott Will

Our hearts are flowing with thankfulness for Scott Will’s six months here, he was literally a God-send, yet also over-flowing with the inevitable sadness of goodbye. We hosted a candle-light and kitengi dinner out under the bougainvillea last night in his honor, then a bit of humor, some good stories of how he stood with us in the Ebola days, and lastly prayer. I will include below the last few lines of a poem we wrote, because if we don’t laugh we’ll just cry. Think Dr. Suess’ Green Eggs and Ham to get the cadence, and imagine the dialogue to be between us and the WHM Sending Center convincing them to send Scott Will back:

Say! I think Scott Will will do!
He can go from here to there
With World Harvest anywhere.
He can manage snakes in the house,
He can dispose of bugs or a mouse.
We’ll send him up the steepest rocks
We’ll trust him with a deadly pox
We’ll hope he doesn’t spill his blood
When slogging through the deepest mud.
We’ll not worry over heat or rain.
We know Scott Will won’t go insane.
He can take charge of dairy goats
Even in a place remote.
Scott will will do, yes he will do
Scott Will will do it all, it’s true.
Yes we see Scott Will will do.

Lancet Cover

Here is the quote on the cover of this week’s Lancet (the premier British medical journal):

Africa carries 25% of the world’s disease burden
yet has only 3% of the world’s health workers
and 1% of the world’s economic resources
to meet that challenge.

That about says it all.

Introducing . . . .

Today was a cultural milestone for our family: we attended our first “introduction”, sort of an official engagement party, a melding of the western idea of rings and engagement and dressing up and cake with the African tradition of the man’s family coming to the prospective bride’s family with their bride price of goats and gifts. So some aspects were very familiar to us: pink and white ribbons, festive balloons, the bride feeding the groom cake, speeches, rings. Other parts reminded us that we are not in Kansas, so to speak, such as when the gifts we brought (goats) began munching on the building (banana leaf shelter). We loaded up four vehicles just after noon, which we had decorated with flowers, balloons, and toilet paper, to bring Ndyezika’s delegation of about 50 people to Juliet’s uncle’s home. They had set up tarps on poles to provide shade in the grass out front. The groom’s family and supporters sat on one side facing the bride’s family of another almost 50 people on the other side. There were welcomes, prayers, a “break-lunch” (like breakfast, but about five hours later?), and then the games began. Juliet’s brother very dramatically asked why we had all come to their home, because they had been planning another function and wondered what this major interruption was. Then Ndyezika’s spokesman went WAY around the bush several times with much laughter until he finally named the woman they were seeking. To this the bride’s family responded that her father had a hundred children, so they were not sure where to find her. She might be in Masindi, but they would need petrol for the motorcycle to go look for her. The groom’s mukwenda (negotiator, go-between, spokesman) produced and envelope of money, and a bride-relative was send on a pretend motorcycle with sound effects around the yard looking. He sadly came back and reported she was not found. This charade went on for several rounds, i.e. Here is the aunt and she can call Juliet but she needs air time for the phone . . . Finally a half dozen OTHER girls were brought out, and the mukwenda had to pay their transport to get them out of the way. On the last round another half-dozen young women came out of the house veiled, literally they had sparkling nylon scarves completely covering their head and face. They bowed down and the hid, and the groom’s people stalked around discussing which one was Juliet. They finally chose, and they were correct! At that point Juliet then sat by Ndyezika, on our side.

Then the negotiations started, and it all became a lot less fun. I found it hard to restrain myself, because I know a number of people on the bride’s side, and their histories (defilement of young girls, multiple wives, serial marriages, wife-beating, alcoholism), and the fact that NOT ONE of them has been officially married in a church or paid anything CLOSE to what they were demanding from Ndyezika. We were mercifully seated to the side and told to keep quiet, so we did. Both sides made dramatic exits en masse at different points. The booty we brought included 10 goats, a cow, 50 kg of sugar, 8 crates and 2 jerry cans (40L) of beverages, a mattress, lantern, hoe, boxes of soap, a suit and a dress, a jerry can of paraffin, I can’t even remember what else! It was quite a pile of gifts. The first goat was judged to be too young (requiring extra money). The cow was rejected on the grounds of being male (requiring extra money). And the huge stack of money was rejected on the basis of being half of the absurd amount asked for (though still probably 5 to 10 times what most people pay). It took a couple of hours to resolve all this, but in the end they accepted all the gifts and animals but declared that Ndyezika has a debt for more money, but the ceremony could go on. Everyone seemed happy with this, though it still made me sad to see men of this caliber putting more burden on the young couple, all for greed. At that point we were hours into the day, it was almost evening, and our restless kids and we were all tired.

But then the day was redeemed. Ndyezika and Juliet gave each other rings, inexpensive metal wedding bands, which they will shift to the proper finger when they are actually married but for now serve as symbols of their commitment. Ndyezika spoke first, without any qualms, a beautiful speech that brought tears to my eyes, about how he had prayed for a godly wife and how God had answered his prayers, how he had waited and worked for Juliet to be his wife for a long, long time, how he would be faithful all the way to death. It was the only part of the day that really gave any glimpse of the holiness and reality of marriage. It was very moving. Then Juliet also spoke, about the power of God and of prayer, about how amazing it was that they had reached this moment, about how this ring showed that she was waiting for Ndyezika and for the day she would marry him. She turned then and looked right at the haggling family members who had been difficult for the last several hours and said basically: “God is so powerful and has so clearly brought this about, that if anyone thinks they can disturb our marriage, I laugh in their face.” It was about the boldest statement I could imagine. She was poised and stunningly beautiful and the two of them are so happy, it made all the other unpleasantness worthwhile.

It was only at the very end, the 6 or 7 hour mark, that the “Introductions” (which is what the day is named) were made. Ndyezika’s uncles decided to blend us into their family, which was sweet. So when “fathers” were called, they stood up with Scott. Then “mothers” included Ndyezika’s mother and me. “Brothers” included our boys, and “sisters” included Julia. We also had to do many groupings of photos with all of the above as the sun set.

Ndyezika and Juliet are one of the only couples I’ve ever known here to make a commitment to wait on living together until marriage, to go through all the proper family channels. They are taking a courageous road less traveled, and they will no doubt meet opposition. Her father has already mysteriously delayed the wedding for another month. So they can still use your prayers, to pull off the church ceremony and meet all the family demands. Pray that many other young people would have the desire to follow this path, would see the joy and beauty of their relationship and dare to aspire to something like it!

World AIDS Day, 3 months and 5 days late

Thursday Bundibugyo celebrated World AIDS Day (Dec 1), better late than never. The festivities were held at Nyahuka Health Center, so though it would have been the first day in weeks without a major event (other than the usual team meeting) planned, the breath we hoped to catch was swallowed up in the all-day affair. Most of it was fairly predictable, the speeches, the songs. Scott was asked to speak as the NGO representative, and emphasized this year’s theme of Leadership by honoring our health center staff who show leadership in working hard to care for HIV positive people, and then calling on members of the community to show leadership in their families by seeking counseling and testing, by coming for treatment, by speaking out against stigmatization, by boldly modeling and teaching faithfulness in marriage to their children. The primary school who sang avoided the usual “we welcome you our visitors” cheery chant, and instead sang a lament in a minor key, decrying abuse. It was quite haunting. And for the first time, a group calling themselves “Bubandi People Living with AIDS” performed. About two dozen of our AIDS patients formed the group! The public nature of this event and their willingness to identify themselves as people living with AIDS was a huge step towards openness. Their leader was the mother of our little patient Dixon who died a couple of years ago, a woman with no remaining living children, who continues to struggle on.

. . . And back to the Battle

After Birthdays, Visitors, Prayers and Parties . . .(see below) we are now back to the Battle of Bundibugyo, the day to day pushing back against the chaotic fallen realm of the prince of this earth, the daily determination to cling to our God and to His sure but subtly advancing Kingdom. The verse that has stuck with me this week is the one that Jesus whispered as He died, from Psalm 31:5: “Into Your hand I commit my spirit . . “ If Jesus could take that verse from a Psalm of trust and deliverance and apply it to his final moment of suffering on the cross, then surely I can commit all to God in the daily struggle that is life here. It is a little over 24 hours since we waved our last visitors off on the plane. But in that time the onslaught is back full scale. The Paeds ward is packed. Three new 1 kg (2 pound) preemies, more and more desperately malnourished children with tragic tales of mentally ill or dead mother, of absent fathers. A little boy with AIDS whom we have been struggling to reclaim from near death for a month (and who had made real progress I thought), Byamukama James, died last night. We resumed immunizations and full lab services this week since Ebola was officially declared over, but in both cases only after overcoming significant barriers (no record book, interruptions in the cold chain, absent staff, etc.). Meanwhile on the school front, a third teacher moved on to a better paying job. Two had left to join a government school less than a mile away for more money and less work, and this one left to join Coca Cola! There is a significant personal issue that is causing much angst amongst some of our Ugandan colleagues in the nutrition program. And two mysterious deaths are now under investigation for yet another potential viral infection.

Yesterday morning our team gathered to pray. And last night I looked over the list of 12 urgent things we prayed about, and realized that God had moved in significant ways on 9 of the 12 requests! Yes, we are in a battle, but we are not alone. Pray for us to remember that, and join us in praying for His Kingdom to Come.

Jack turns 10!

Jack turned 10 on Monday, which means that our whole family is in double digits now (until Scott turns 100, but that’s a ways off). This is a great stage in our family’s life, and one we are very thankful for. After his early morning at school we hiked and swam at Ngite with the Bolthouses, where Jack likes to jump from the highest rocks into the pools of the river. The whole team came for pizza, prayers for Jack, a “10” cake with firecracker candles, and we ended with a dance party on the side porch lit by candles and powered by Toby Mac. Jumping, eating, and dancing . . . Plus a little book reading and drawing and hugging or wrestling, and you pretty much have Jack’s ideal day. At 10 he is smart, wild, affectionate, mischievous, loyal, funny, provocative, short-fused, coordinated, and much-loved. And when he dances you know this is a boy who has grown up in Africa.