2 years and 10 years, milestones and memories

Today is 2 years since my Dad left this earth for Heaven, and 10 years since my nephew Noah left his mother’s womb for this earth.  Two birthdays, both celebrations if looked at from the right perspective . . . But both involved significant pain in the transition, significant change and the perception of loss, significant tears.  I’m thinking about my Dad a lot.  My neighbor John M is only two years older than my Dad would have been, and his immobility (from a hip fracture), his wasting body (cancer), his resilient spirit as bodily functions become problematic and public, his loyalty to us . . . Even his jaunty English cap . . . Remind me of my Dad.  I don’t know how long he has now, Scott had to put in a permanent catheter in his abdomen to relieve the pain of blocked urination, which was another similarity to my Dad’s last days.  As with my Dad, we are part-family and part-doctors, holding his hand and greeting but also taking his blood pressure and managing his medicines.  It is hard enough to walk this path with family, let alone cross-culturally with neighbors . . . Pray for us to do it well.

Caring for the Queen

I treated Queen Elizabeth today.  Yes, that was the name of the tiny febrile baby, born in the midst of the hype surrounding CHOGM and the royal visits to Uganda!  Queenie has become a rather popular name around here, and I have a second baby on the ward with just that name (no Elizabeth).  Also saw two babies named after local celebrities today:  Scott, the first baby born on the new maternity ward last July, to an HIV positive mother, his test results still pending but he looks great.  Parenthetically, she received a goat at the goat distribution which she also named Scott.  Scott the goat is providing milk for Scott the baby, who has weaned to try to save him from infection.  Later I dropped in on Baby Jonah, who smiled at me at 5 weeks, which I am sure is a sign of his precocity.  Being named after doctors is much better than one of my other patients, a now-4-year-old former premature baby boy born to an older HIV positive mother.  He was burdened at birth with not only HIV and prematurity, but the name Robert Mugabe.  I was sure his name fit his poor prognosis in life, and had no faith at all that he would make it.  But he’s fine, HIV negative and growing taller, and no one seems to mind that he’s named after an infamous dictator.  Perhaps that is because  names are so unimportant, countless times the parent has a blank stare when asked their child’s name, or their spouse’s name.  One of the services I offer I call “name consolidation”.  Many, many kids have major discrepancies between the names one parent or another or a grandparent use, one name on the immunization record and another name in the chart.  I resolutely insist that the mother choose the two names she wants to stick with and then I cross all the other ones out and rewrite her favorites on all official documents.  Even though no one but me really cares.

The poor never get sick

The angel of Death has racked up a lot of frequent flier miles for visiting Bundibugyo over the years.  

Last week Issac (no real names here), a 38-year old living immediately adjacent to our mission, died of chronic alcoholism.  He led a sad life of scraping by - mostly through stealing stuff from the mission - and squandering what he managed to scrape up.  The saddest part of his tale is what he leaves behind--four healthy kids with no legacy, no nothing.  These kids have been handed over to Charles, his brother, a former house worker to a WHM missionary family who have returned to the USA.  Charles  is unemployed (like 90% of those in Bundibugyo) and scraping by with intermittent manual labor and a subsistence garden.  

Charles showed up at our door on Saturday morning and reported that he now has eighteen mouths to feed two meals a day...and nothing in his pocket with which to buy food in the Saturday market.  I would skeptically brush aside such comments from many, but Charles tends toward the truth in a culture where words are a tool of manipulation and truth is, let us say, not a core value.

Consider for a moment what such a situation must be like. No money in your wallet, no money in the bank, no food in the pantry, no check in the mail, no security whatsoever. And a huge group of people expecting you to provide their next meal.  I'm afraid that the sense of desperation that I would feel in such a situation would reveal a heart of darkness rather than of faith.

So, I asked him to bring a day's worth of elephant grass for our cow and then gave enough cash to buy a day's worth of food for his burgeoning flock...and found him back at my door on Monday morning, hopeful for more work.   Not exactly what I had in mind.   So, after several minutes of agonizing I decided to give him a couple of days more worth of work clearing weeds and brush in our pasture.  Rarely, have I seen more work accomplished per hour.  It looks like he'll finish this job in a couple of days, hoping because of his strenuous efforts that he will have earned the privilege of gaining even more employment in the future.  

While Charles was down in the pasture and I contemplated this situation a week down the road, another former mission house worker, Mark, planted himself on our porch with his tale of woe.  He's not been around he said, because he's not been feeling well.  "So," I said, "you've been in bed at home?"   

"No. Scott, you know we have a proverb in Lubswisi - The poor never get sick."

"I don't think so," I said, "confidently. If anything, the poor are more likely to get sick.  Poor nutrition.  Poor sanitation.  Unclean water.  The poor get sick all the time."

"The proverb means", he said, "that the poor have no time to lay in bed, to recover, to play the role of a sick person.  We must bear our burden of sickness and continue our struggle to feed and clothe and educate our children."

I nodded in agreement.

How long, O, Lord, how long? -Psalm 6:3

Dancing on Monday

Today Birungi Suizen weighed 8.3 kg.  His target for minimum survivable weight for his length was 8kg (though it still leaves him WAY below the minimum size for age).  And he has gone in just a week from standing, to walking, to DANCING.  Yes, dancing.  Pat saw how much he liked listening to our cell phone rings, and managed to find him a gaudy pink plastic toy cell phone that plays obnoxious electronic riffs over and over.  He loved it, held it to his ear smiling and swaying, then stood at the end of the bed holding onto the rail, dancing.  He is the closest thing to the insubstantial nature of prayer taking form.  I’m sure we’ll never know how many people over this world have followed his resurrection journey, how many prayers lay behind those grams accumulating.  He is supposed to stay over target for a week to be ready to go home, something the other little baby boy with TB (Rick Tom, what a great name!) did today, all smiles as we sent him on the way.  My heart still cringes with the possibility that Suizen could fall apart again . . . But for today I rejoice in the dance.  

A Bundibugyo Weekend: Community and Fatigue

This was a community-oriented weekend, the kind that gives the shalom-sense of rootedness, connection . . . Alternating almost as quickly with the sense that it’s time for a break. When we get to the three-month mark of staying in the district without a Kampala break . . . both of those things happen in varying proportions. I’m more content to be here, more aware that this is home, more appreciative of the little ways that we are included or accepted across improbably deep cultural chasms. And I’m more tired, more ready to take offense or long for relief, to count the hours until a break. Colleagues. Fridays I set aside time for staff meeting at the health center. We do medical topics interspersed with Bible studies, discuss problems on the wards, report on any seminars people have attended, and generally exhort continued effort. This week I taught on meningitis after we lost a six-month-old boy to pneumococcal meningitis (one of the vaccines not deemed essential enough to provide to African children yet). Ugandans are almost universally eager to learn, and I appreciate their enthusiasm. The seriousness of the topic was balanced by their delight in the new jargon “nuchal rigidity” (means stiff neck in medicalese . . . ). Everyone always comes late and I generally start the sessions secretly planning to make the punishing announcement that I’m not putting the time into preparing and attending if they don’t come on time . . . But by the end there are almost 20 staff, and the atmosphere of camaraderie and prayer and commitment makes me willing to do it all again, and I leave cheered, steeled to face the ICU-like atmosphere of my now packed-to-capacity ward. I can tell the midwives are growing to lean on Scott, too. In Jonah’s absence they are calling him regularly (whether it is 3 am or Saturday afternoons) to evaluate difficult labors and take women to Bundibugyo for C-sections. He’s done two with Dr. Sessanga this week, a major step in their partnership as the two general doctors in this district, and one step towards Scott feeling confident enough to do surgery alone. Workers. Friday evening we invited one of our two house-workers and family over for dinner, which we had not done in probably a year. I was convicted by my tendency to value my workers for the way they make my life manageable (washing clothes by hand, doing the first installment of the day’s dishes, sweeping, mowing . . . catching up enough that when I get home from the hospital I can focus on cooking more than cleaning). I resist the time and effort needed to take interest in them for who they are. This man was ill last week, as he frequently is, and we wanted to address some heart issues with him in the presence of his wife. Scott really came through with a loving but clear talk about alcoholism, and a good plan to support abstaining. I think they felt loved by our intervention, time will tell (...he came to church today, for the first time in months!). Neighbors. Our closest neighbor is 76, has for a time survived cancer and a broken hip and severe hypertension, has been completely bed-ridden now for well over a year. This week we thought the end was imminent. Rain caught me when I went to visit, and I spent a good chunk of an afternoon with him, his two wives, his 78-year-old brother, a nephew and two other older ladies, all clustered around his mattress on the floor in the dim room as the rain thundered down. As the day wore on he revived, recognized me, held my hand. We all chatted about the things that most interest my neighbors (marriages and children). It was a rare time of sensing inclusion in the midst of sorrow. By Saturday he was back to his usual self, which is not great, but a relief. Friends. Both Julia and Acacia went to the market with me Saturday morning to find matching white shoes (amazingly, we did, cheaply made heeled sandals) for their wedding garb. They are to be flower girls in Ndyezika and Juliet’s wedding next weekend, so attended a rehearsal later in the day, another taste of inclusion. In between the market and the rehearsal we went to a birthday party Pat had planned for the two daughters of her friend Melija who died of AIDS last year. Kyomugisha turned 7, and Lydia 5. A handful of other kids and the missionary girls all blended in laughter over relay races and lunch. The delight on Kym’s face made the day particularly memorable. Lydia adores Julia, and Julia does a beautiful job of being friendly in the mixture. Pat was called forward to participate in leading a song a church today which she did with good humor, and then got called on to pray too. Her efforts to reach out do not go unnoticed, she is a much loved part of this community. A full weekend of being fully present. But tonight, after two Sunday evening patient consults, I’m counting the days left (11) until we get a break.

Casting seeds in tears

Pat led us in prayer this morning, from Psalm 126: Those who sow in tears shall reap in joy . . . using a song sent by Heather:

Those who walk in fields to sow
Casting their seed in tears,
Will one day tread those same long rows
Amazed by what’s appeared.

Seeds, falling, watered by tears. This gives the tears meaning, and even hope, that what we mourn will be transformed, that the mourning itself is part of the transformation.

Six weeks ago I stood on the Paediatric ward to welcome our visitors from the USA, but I could hardly talk to them, because Birungi Suizen lay wasted, bleeding, starving, pitiful. Tears flowed. Today I was truly amazed by what has appeared: he took steps on his own, just a few, but real steps. He eats eagerly now, laughs, cries with passion, jives a bit to a cellphone ringtone, resists the grabs of his baby brother. His transformation has been one of the least likely ones I’ve ever witnessed. I’m glad to have tread that row long enough to see the joy.

Sometimes the tears are not so selfless, just tears of weariness and frustration. Having four preteen/teens can be a storm of hormones, a cacophony of conflicts as they collide in a small house. And their heart issues become more complicated. When Jack and Julia appeared in their new uniforms, they were met at their classroom building by a large group of students on the steps who laughed at them. And while some kids can shrug that off as just the pettiness of the group, the tendency of a small isolated culture to protect themselves from difference . . . It is very hard on Jack who is already much younger than anyone else, who can’t interact on the sports field like my other three kids because of his running-induced heel injury, who is the youngest and more sensitive to acceptance and approval, whose solid frame has become even more strikingly large with his lack of exercise and more likely to draw out malicious teasing. So when he says “I like living here and I don’t care if people laugh at me on the road, but I just want to go to a school where I can be part of the group too . . .” well, that is hard to take. Praying for faith that those tears (his and mine) will bear something of valuable beauty in his life some day.

Monday Milestones

A few milestones of the day, which is only half over . . . .

• Jack and Julia headed to school in their spiff new CSB uniforms this morning. This year the white shirts, for the first time, have a colored logo on the pockets, with the school motto: The fear of the Lord is the beginning of wisdom. Julia had been on a special overnight camping trip with Acacia and Michael, so Jack was very glad to have her back for school today. Karen commented that the two of them are functional twins, which has become even more true this year at CSB . . . . Seeing them in their secondary school uniforms, it is quite clear that they are growing up.
• Luke is growing up even higher. I noticed yesterday that he could reach a really high shelf . . So this morning I had him stand back to back with Scott, and yes, it is official, Luke is now the tallest by a half inch. That means he must be a solid 6-1 since Scott is slightly over 6 feet. His life-long goal to be taller than his father has been accomplished. A real family milestone.
• Birungi Suizen is also growing. He will never be 6 feet tall, maybe not even ever 3 feet tall . . . But he’s alive. Today he was standing with support, holding onto the side of his bed, and broke out into a huge smile when we saw each other. He’s up to 7.5 kg (from 5 kg). The nurses all are so attached to him, in the way that only happens when you’ve poured your life into someone you thought would die, they carry him around the ward and tease him. Annelise came to visit and brought him two match-box cars, which later the delighted mothers of all the nutrition patients were racing across the white tile floor! This child was a skeleton loosely covered by sores and scabs, listless and nearly dead. Now he is laughing, scooting, and today standing. A great Monday milestone.
• The CSB football (soccer) team will be practicing today, and practicing hard, because they are headed to Arua for nationals in two weeks, having won the district finals 1-0. After the semi-final match result was reversed, CSB faced Good Hope in the finals on Saturday. It was a close game, with lots of angst and energy translating into the ball popping wildly down the field. Usually CSB starts out with a disciplined passing game and kind of unravels as the time goes on, but this time they started out scattered and become progressively more organized throughout the match. The only goal was scored as a penalty kick: a Good Hope player had a hand ball in the box around the goal, which meant that CSB could take a direct penalty shot. They called their own goal keeper, Suula, forward, so it was a keeper-to-keeper showdown, and Suula scored. He also had many, many great saves, so he was a star that day. The only trouble came when the Good Hope choir streamed across the field mid-second-half to rumble with the CSB choir, but the forceful ref calmed them all down. So another milestone, district champions, without Kevin for the first time, a great boost to the confidence of Alex, Kasereka and Ejeku who coach the boys.
• My last milestone is not at all triumphant, but I want to hold out hope. Maate, the 15 year old 20-kg boy (pictured above), has been in the hospital for over a month now. We thought he had TB, but he is not improving on treatment. Today’s milestone: I got through to the Hope Ward doctor at International Hospital. This is the best hospital in the country, and thanks to the missionary founder and his visionary Ugandan daughter and generous corporate sponsorship, there is one ward dedicated to patients like Maate, who can not possibly afford the care. Maate’s father has not been seen in weeks, his mother is terrified of the trip, and he’s so weak I don’t know what he understands. But I’m praying that they will organize themselves today and find a courageous relative to accompany them, that the referral letter and transport money will be enough to connect him back with life. It would be wonderful to celebrate the milestone of Maate being cured!

Beads over blood

Give me beads over blood any day.

This morning, blood.  My sickest little patient, a comatose 1 year old, lay jaundiced and limp.  After two days of antimalarials and powerful antibiotics, his feverish convulsions had quieted, but he remained weak, obtunded, jaundiced.  As we made our way around the ward, the attentive dad pointed out the bloody stool that this baby had just passed. I suspected this was a pre-terminal sign, and labored over his exam, to find anything we had missed.  I pulled down his eyelids:  now frighteningly pale, the combination of malaria and chronic anemia and now gastrointestinal bleeding conspiring to drain his life.  Our most competent nurse quickly took a blood sample to the lab to get blood as we prepared IV fluids, but within ten minutes he was dead.  This boy’s mother is mentally retarded, she sat expressionless on the bed, perhaps unable to comprehend the loss.  But his father, the one who had carried him in, who had sat by the bedside, who had managed his care, understood.  He began to sob.  I rarely see a man cry here.  The usual post-mortem scene is of wailing screaming women, writhing on the ground, while grim men gather the body and stride off towards burial.  But this mother did not react, and this father had those shoulder-shaking heaves as his tears began to flow.  Mine too.  This boy needed an ICU, instead he had us, and we were not enough to hold on to him in this world.  

This afternoon, a bead, the far opposite end of the spectrum.  Two grandmothers appeared in the kitubbi just as I was heading off.  Sigh.  What now?  I read the referral:  the child they were holding had been send to the operating theatre in Bundibugyo . . . For a foreign body in the nose.  I could have given them transport money, probably what they were hoping for.  Instead I went inside for a flash light and my handy little ear-wax remover, part of the essential pediatrician package, a sturdy pen-like instrument with a small wire loop at the end.  A few seconds later I had determined which nostril held the object, and reached past it with the loop and pulled it out. A bright orange plastic bead, just like the dozens that were braided into this toddler’s hair.  The old women jumped to their feet and began a spontaneous song and dance, they were so happy.  Me too.  This is my kind of problem:  concrete, limited, solvable, with clear evidence and end points.  I laughed with them.  They must have been very worried, and must have been so attached to this little girl, their rejoicing was refreshing.

I have to admit that I prefer beads over blood.  Something I have the tools to handle, something where I can see the problem and make a difference, in a very short time.  No patience required, and little faith.  No broken hearts, no tears, and quick glory.  Why can’t more of my life be like that, instead of convulsions and tears and blood and feces?  Why can’t my problems be as shiny, compact and tangible as a bright orange bead?

A bit of redemption

Redemption comes piecemeal in our lives, in spurts, with obscure outlines, but tangible nonetheless. Today, redemption looked perky and smelly, in the bleating stubbornness of 51 little goats, yanked by their ropes to follow beaming HIV positive mothers, or bereaved but resilient aunts and grandmothers, home, portable protein. Scores of people across the globe had given up their usual Christmas treats to purchase dairy goats for poor women in Uganda instead, to purchase the hope of feeding one’s child with the daily milk, the means of avoiding infecting one’s precious baby. Amazing. Karen’s vision, supporters’ sacrifices, Lemmech’s footwork, Pat’s advocacy, Stephanie’s organization, Pauline’s competence, Acacia, Jack, and Julia’s goat-wrangling enthusiasm . . . All pieces of that redemption.

More redemption arrived in shoeboxes and duct tape: the long-awaited orthopedic inserts, in triplicate, packages mailed in early Feb, mid-March, and late March, caught in the web of the Ugandan postal system, and spit out in rapid succession to reach us all on the same day. Jack is gliding along in cushioned protection, more hope of healing. We are grateful to our orthopedic surgeon friend, who never gave up and kept mailing. Luke’s face shows good signs of healing, too.

And more redemption, buried in the nuances of a four-hour staff meeting at Nyahuka, camouflaged by inefficiency, wordiness, complaint, and story-telling. In the end there was some positive organizational process, some airing of grievances, some exhortation towards work and responsibility and courage and community. We struggled mid-meeting through the cautionary tale of the UNICEF bicycle disaster (how good intentions can have devastating effects): they donated two bicycles for immunization outreaches, the district person in charge gave the bikes to two male nurses saying that a woman would not use the bikes for work, ignoring the fact that the person who has actually DONE almost ALL the immunizations over the last decade is a female. She responded by a passive-aggressive work slow-down, and now post-bicycles children are not getting immunized. An unhealthy but perhaps unavoidable response to the injustice she so keenly felt. After much begging she seemed to agree to resume her duties today. Happiest for me, a new nurse whose friendship Heidi and I are growing to enjoy, volunteered and was approved by the group to move into a position of partnership and responsibility in the nutrition programs. Mostly good news in this meeting, just my American efficiency which bristles at the long time it takes to reach those decisions.

And lastly, the redemption of a rain-free day, a respite from the drenching, a hot breeze and blazing sun, pizza at a relaxed pace without the threat of impending storms, enjoying team.

You know it's going to be a tough day when . . . .

• when half the team misses 6:30 a.m. prayer meeting, because they just went back to bed after unloading the much delayed (brake failure, road blocked by mud, etc) truck of goats which pulled up to the Masso house at 3 am today!!
• when the teammates who DO show up report the theft of a significant chunk of money from their house in the last day
  
• when Luke wakes up, and yesterday’s bruised nose now clearly moves where it shouldn’t, i.e. It is actually broken
• when Scott comes walking back from taking the kids to school without the truck he left in (driving them because of Jack’s feet, and the terrible rain . . . ), he had slipped off the slick muddy road into a ditch, stuck on a journey of half a mile . . .
• when perky Caleb stays home sick with aches and a mild fever
• when a two-week-old baby manages to collect a half a liter of pus under his scalp, just from a simple infected wound (though the good news is that the baby looks much better after incision and drainage), reminding us of this swamp of infection we live in
• when we struggle through our first post-Stephanie HIV clinic day
  

Praying for glimpses of redemption in all this tomorrow.