The Vav

Scott here.  In the middle of my ultrasound clinic yesterday Jennifer stopped in to say goodbye as she headed for Kampala  with Heidi to visit the UNICEF office, trying to persuade them to continue to supply us with the therapeutic food we need for our malnutrition patients.  Of course, I expected life to notch up to "hectic" level.  We survive because we are a unit, juggling the myriad responsibilities of patient care, team coordination, and the seemingly endless list of general life maintenance tasks required to live in Africa (...last time I tried to flush the toilet there was no water which led to a two hour comedy of errors including eradication of a colony of biting ants just so I could touch the outside water valve connecting us to Michael's gravity water line).   

An hour and a half after she left, just as I finished my last ultrasound case, Jennifer called.  "The car just stopped and steam poured out from under the hood," she said.  She drove the Bartkoviches old car (~11 years old) so we could  equip it with new tires and put the machine into the hands of our young teachers.  We discussed lots of possible scenarios, including various explanations and solutions to the overheating and various car swaps.  She accepted the challenge of refilling the radiator while I got on the road to come and assist.   A half hour into my journey towards her, I found the road blocked by two trucks (one broken down and one which got stuck in the mud trying to pass) so I turned back to use an alternate path.  In the meantime, Jennifer called to say she got the car started again and we agreed that she could proceed.  I headed home, but halfway home, she called to say "We're halfway up the mountain and the thing died again."  So I turned around and headed back towards her.  Thirty-five kilometers of bone-jarring, bolt-loosening, washboard, cobblestone road to hurry over and ponder...why.

We're currently in a 10 week study of Michael Card's A Sacred Sorrow, a book subtitled Reaching out to God in the Lost Language of Lament.  His thesis:  Lament (weeping, protesting, complaining) to God is the path to worship of God. Eugene Peterson in the Foreward says, "...learning the language of lament is not only necessary to restore Christian dignity to suffering and repentence and death, it is necessary to provide a Christian witness to a world that has no language for and is therefore oblivious to the glories of wilderness and cross."  

After nearly 15 years in Bundibugyo, we continue to seek to understand the mystery of pain and suffering.  Immersed in the ocean of it nearly from dawn to dusk.  Yesterday alone:

I told the wife of our house-worker that their 15 week baby-in-utero was dead....

I found a three year old child who's shoulder (proximal humerus bone) was gone, eaten by infection...

I received three requests for financial assistance, for the mere basics of roofing sheets, chairs in the home, and secondary school fees....

We've studied and prayed, trying to comprehend the purpose of pain, to see it through the lens of the Scriptures, to develop a "theology of suffering".  The general response here is to explain through blame.  Usually a curse, a relationship out of kilter, ancestral spirits creating havoc.  

A Sacred Sorrow is not an apologetic for the existence of evil in the world, but rather a biblical examination of the real world response of several of the giants of the historical Judeo-Christian faith (Job David, Jeremiah,Jesus).  It seeks not to answer or justify, but merely to lend a hand to those who grieve.   

David's struggles in the wilderness led to a whole host of Psalms of Lament (Psalms 5, 13, 22, 28, 31, 38, 51, 55, 59, 69,109).  They all begin with his complaints, his struggles, his desperation.  But there is in each one a sudden transition, a switch in focus from Self to Elsewhere.  The sixth letter of the Hebrew alphabet, the vav (also spelled waw) marks the "crossing of the line" from whining to worship.  It always seems sudden and to me inexplicable.  This is what I want to understand....how does that happen?

Yesterday while I jostled and bumped towards a dead car, I wondered...  "What is the point of this?  This is a colossal waste of my time."  My head and throat ached from an annoying viral URI which had developed in the morning.  I was diverted from my work and kids to hours of struggle and frustration.  Compared to Job, of course, I could not complain, nevertheless I did.  

I did finally reach Jennifer in the mid-afternoon on the mountainside, gave her our reliable LandRover so she could proceed to Kampala.  I creeped back toward the mission in the crippled Nissan.  I broke down another half dozen times and arrived home at dusk, dirty, thirsty, yet thankful.  Thankful because it could have been worse?  I suppose partly.  Somewhere along the road, though, in the midst of my grumblings, I realized that I did have a need, a hunger.   I remembered David's imprecations which melted with "disturbing clarity" into worship.  My annoyance also morphed somewhere into something else.  In some way, I realized that I had no where else to go.  The path of pain seems to lead either to despair or worship.  I choose worship.

(N.B.  "A Sacred Sorrow" has an accompanying "Experience Guide", a booklet which leads through 10 weeks of readings in Job, the Psalms, Jeremiah, and the gospels. Both get five star ratings from Bundibugyo).

Pots, deep and numerous

About a week ago the passage about the widow who collected her neighbor’s pots and found them filled with oil sank into my mind and heart, with the realization that we only see as much grace as we risk needing.  

Like faith, risking the need for grace is a concept that sounds noble but feels a bit like death.  And as so often happens, when the Spirit supplies such a direct message, the need to grasp onto that truth follows close behind.

So though it is only Tuesday, the depth and volume of my week’s empty clay pots feels cavernous.  

It could have something to do with the fact that our 23 bed ward is crammed with 37 patients, a half-dozen of whom should be in an ICU with their sky-high malaria parasite counts or purulent brain fluids.  It could also be related to the fact that yesterday we confirmed that over 30 kilos of sugar and a similar amount of beans have slowly leaked out of our nutrition store in the last two months, a cup here and a bag there spilling into a life-threatening hemorrhage of dishonesty.  Or the fact that a few hours after the painful meeting in which we asked for the staff to return their store key . . . We got a disturbing email from UNICEF that not only canceled their visit which we had prepared for that day, but also implied that the one disbursement of amazing therapeutic milk powder they had bestowed in April would not be repeated because we were not following their rules closely enough.  Since the stock had dwindled and we had been led to believe for the last six weeks that the next shipment was imminent, this was quite a blow.  In between these two gaping potholes, the entire S2 class from our school (actually the ONLY class in which I have no biologic or sponsored children, so it could have been a worse shock) was dismissed temporarily after another meal disaster was met by student wildness and rock-throwing.  In the process of processing that yet more issues surfaced of envy, abusive behaviour, layers of disrespect and misunderstanding.  Sigh.  The empty jars lined up rather quickly.

And underlying all these dry vessels, the reality that some major family changes are imminent.  Last week Luke was offered a spot at Rift Valley Academy, a missionary boarding school in Kenya, for 11th grade beginning in August. Though I’ve had our kids on waiting lists for years for vague future spots . . . The chances of one opening in high school are usually slim.  So not until now have I had to face the risk and loss of that separation.

As these pots collected, though, the oil began to flow. First and foremost, we stand in awe of Luke’s readiness to give RVA a try.  He’s made the decision to go, with our blessing, in a mature and sensible manner, one that shows he is more ready than we are for this milestone.  Then the dismissal of the unruly students proceeded smoothly and has already made a difference in the school’s atmosphere.  We continue to pray for real conflict and reconciliation skills to grow out of a grasp of the Gospel at CSB.  Then the nursing staff worked incredibly hard to shoulder the burden of overwhelming disease, and two of our best nurses showed up (surprise!) on break from their further schooling to pitch in and help.  And lastly, after a day of emails and phone calls and indecision, UNICEF agreed to meet with Heidi and me on Thursday morning to work out an agreement that will allow continued cooperation.  

So that flowing oil actually opens another gaping pot, I have only driven to Kampala without Scott a couple of times, and do not feel confident about the challenges of the next few days, or about leaving my kids or the hospital ward.  The collaboration which brings resources to desperate kids means I need to risk needing that grace, but I’d appreciate prayers for the trip and for immersion in oily grace.

A tribute to his dad on Father's Day... from Luke

The doctor and his wife in Bundi live
With their four sweet little kids

Feeding and healing the hungry and poor
Ultrasounds, accounting, surgery and more

He's a mobile banker
Free money for those who have a hanker

A pizza chef of great acclaim
Never are two ever the same

Grilling tender quality steaks
Then delicious tacos he makes

On safari (a different mode)
"A willager on this road?"

He protects his family at Campsite 2
With a slingshot and a cooking pan too

He even has a small farm
One goat, two cows, he shows his charm

But they stamp and butt
They chase to cut

But he milks them still
So that we drink our fill

Sewing and super-gluing our lacerations
Trying to prevent macerations

And when the dangerous Ebola he did see
He stayed and and helped and did not flee

On muddy roads treacherous
In Clifford he comes to fetch us

Global digerati a techno master
He has a Mac that's always faster

An avid photographer Nikon d200
Some people ask, "how is he funded?"

He has a strange need for fire
Burning and exploding till the situation's dire

First his face, the kitchen burnt
The trash pit; you'd think he learnt?

My dad is the very best
Trial by fire
He has passed the test.

A Day of Celebration: striving for Peace and Purity

Bundikyora Church became an official congregation today as three elders took vows to strive for the peace and purity of the church.  I like that phrase, the balancing of righteousness with graceful love.  After decades of patient work by the mission and by Ugandan evangelists,  of teaching and training, of living and working and waiting, there are now three fully-formed Presbyterian churches in Bundibugyo.  Today’s milestone was especially poignant, as this was the location of Rick Gray’s and Greg and Beth Farrand’s effort to live in tents half-time in order to be more fully invested in the lives of the people of this village.  Their experiment ended when the ADF attacked in 1997 just a few days before the elders were to be interviewed.  Now 11 years later their dream became a reality.  Scott read from 1 Chronicles 29 as he spoke, and the parallels are interesting.  King David wanted to build the temple, and though he put in much effort and planning, God did not allow him to see the accomplishment of his vision, but rather delayed until his son Solomon reigned.  Rick, Greg, and Beth are no longer present as missionaries here, and their work passed into the hands of their “sons” in the faith long ago.  This group continued to struggle and meet when the village lived in an IDP camp; we remember visiting when a paltry dozen or so people gathered in a half-built school room.  So It was a privilege to see, at last, the glory of this day, where a couple hundred people crammed the shelter constructed beside the mud and wattle tin-roofed church.  Streamers of toilet paper, bright balloons, three choirs, enthusiastic drumming, and hours of ceremony marked the milestone.  As Scott reminded them, the temple was built by the offerings of the tribes of Israel, because they gave from loyal hearts.  And this church also rests not only on the vows of the new leaders, but on the faithfulness of the congregation.

We biked to this village, almost 10 km, with Michael and Karen this morning, leaving our kids in Luke’s care (Scotticus thankfully pitched in too), probably the first time we’ve done a “couples” outing leaving the kids behind.  The quiet plantations of cocoa trees punctuated by bustling villages, the rutted tracks, river crossings, tricky puddles, and breathtakingly steep hills . . . It was a beautiful but strenuous ride, fun to be out, to be pedaling, to be alive.  But besides the adventure aspect of biking to church in a dress through the mud, two things about the day really  stood out.  First, after the three new elders were “sworn in”, their first act was to wash the feet of their three wives.  Each knelt on the ground before his wife and held her foot, pouring over water and sort of baptizing her in the name of the Father, the Son, and the Holy Spirit.  It was a powerful image of servant leadership, a shocking stance to take in a culture where women are basically owned by men.  

Second, after the ceremony, we sat in a big circle to eat, scooping sticky rice from huge platters and topping it with salty steaming chicken.  And I realized afresh the depth and length of relationship that binds us here.  In our circle:  Bhiwa and Topi, Josephu and Rose, Charles and Mary, Kisembo (his wife Jessica just had a baby and could not come), Joyce, Pat, Michael and Karen.  These are the people whom we have worked with for so long, and it was a celebration not only of the newly-organized church, but of the culmination of the partnerships we share.  Our striving together for peace and purity has not always been easy:  we have walked with some of these people through the deaths of their children, through alcoholism and abuse, through infidelity.  But we’ve also walked with them through forgiveness, recommitment, and faithful perseverance, never letting go of purity even as we all seek peace.  Amen.

Cross-cultural Fun

In case anyone out there is  wondering, if you find yourself with a half-dozen young African doctors-in-training coming over for dinner, the hand-down (literally) best entertainment is Speed Uno.  I think Lydia Herron introduced us to this version of the game, which includes lots of switching of hands, changing of the order of turns, and enough random off-balance special-case scenarios to keep everyone on their toes.  And the ever-popular rule that whenever a 5 is played, all players slap their hands into a pile in the center, with the last person on top having to draw five cards.  Through obscure machinations an OB-GYN doctor who teaches at Mbarara University ( the second major medical school in the country, after Makerere) arranged for six young med students who are just completing their studies and awaiting placements in internships to spend a month or two in Bundibugyo!  We invited them to come for dinner, to talk about their lives, their goals, what it means to serve in a remote place.  They were personable and confident young men, comfortable with each other, friendly, from several corners of Uganda.  After eating we introduced them to Speed Uno, and that broke any residual barriers of reticence as they laughed and teased each other and tried to win.  We gave them “The Purpose Driven Life” to structure their 40 days in Bundibugyo around seeking God.  Don’t know what will come of any of this . . . We certainly need doctors, so if any sense a calling to return we’d be thrilled.  But in the meantime we had a rare evening of riotous cross-cultural card-playing fun.

Part and Parcel, Ear to Ear

I found myself yesterday afternoon in a long and tedious meeting which Scott was supposed to attend by virtue of his appointment to a community-based committee that manages the health center.  But he was being overwhelmed by 25 ultrasound referrals at the hospital (either the overzealous referring of unsure visiting doctors-in-training here for the month, or the passive-aggressive action of the usual ultrasound staff refusing to screen out the routine cases and only pass on questionable ones to Scott, in protest against action to stop them from illegal surcharges, or divine opportunities for him to serve and teach . .. he was never quite sure).  While I struggled with the restless sense that the hours were slipping through my hands leaving much left undone, I found I could not easily slip away.  For one thing, these are the people among whom I have spent most of the last decade and a half, and I care about the issues they are raising.  For another, the elected official chairing the meeting made me sit right beside him and gave a speech about how we are “part and parcel” of the community and the work.  Sigh.  So I listened and even challenged or supported various points.  Instead of “shoulder to shoulder” the idiom for cooperation I heard was “ear to ear”.  Sort of an interesting picture of us here, ear to ear with our colleagues, a meeting of the minds and a cooperative physical pushing against disease and poverty. The day only got more ear to ear as it drew to a close.  A couple of newly-weds came to greet us, and as we chatted I reflected on the privilege of moving from a relationship of parent/sponsor to one of colleague/friend.  Am I getting old?  I guess so.  Perhaps the wisdom of age or the whisper of the spirit, I decided to offer the wife prenatal vitamins, sensing she might need them soon if not immediately.  I called her aside and learned that her last period was two weeks before the wedding . . . So we did an impromptu ultrasound with our portable machine, and once again had the fun privilege of introducing new parents to the waving limbs and fluttering heart of their tiny fetus.  But this time it was not American team mates, but Babwisi friends, with whom we could share the same joy, and hug, and pull them into staying for dinner with our family.  And the due date:  Christmas Day.  Fun. By the time we cleared up from dinner and the long day and got the kids down to Friday night clubs at school (they attend games club where Jack teaches his friends great short English boggle and scrabble words, crafts club where Julia nestles in with the girls and learns to crochet and knit, and math club where Caleb reluctantly rises to the challenge of interesting problems) . . . We were exhausted, and ready to relax, settling down on the couch with Luke after about 14 straight hours on the go.  But as soon as we hit the couch there was knocking on the door, a bit ominous in the dark.  Particularly when the dark face at the door is covered with blood.  Our neighbor Buligi and his wife stood there with a knot of relatives, and we immediately sat Buligi down.  His face had been mangled from a motorcycle accident.  Scott ended up taking him down to the health center to do a little plastic surgery by flashlight with the cheerful and competent help of the theatre nurse, who was one of our original “Mother and Child Survival Project” community volunteers more than a decade ago.  Buligi’s is the second case this week of stitches in the operating theatre after a motorcycle accident:  the other was our lab technician.  Both are responsible adult men with one wife, married in the church, with jobs, families (which makes them far from average).  They are not reckless teens out for joy rides.  One was taking blood samples to the central lab, the other coming from taking soap to his boy at a boarding school.  But the crowded road, the meandering goats and pedestrians, the deep rusts and jagged loose rocks, the sharp turns and bushy roadsides . . . Make for danger.  So Scott ended the day ear to ear with our worried neighbors and our hospital staff, part and parcel of the night’s work.

Bullying

There is an interesting comment on the post about DDT, from someone who identifies himself as a coffee buyer and concludes that the concept of an entire district losing its “organic certification” is patently false. The middle-man cocoa buyers are bullying the farmers with this threat. I find that quite believable: perhaps it is this way all over the world, but the bullying culture seems well developed in Africa. On the surface the society seems relatively peaceful to the outsider, the strong clan identification and respect for elders. But underneath, there is violence and fear. Older kids bully younger ones, a huge problem at our boarding school in past years (though one we’re fighting), as new students find themselves surrounded and threatened and relieved of their stashes of sugar meant to sweeten their morning porridge, or of their pocket-change meant to buy pens or soap. Teachers bully students. A friend told Luke last night that his teacher told him that unless he stopped playing soccer in the afternoon break time, the hour and a half of exercise and recreation that breaks up the long school day, he was going to fail that teacher’s class. Men bully their wives, and parents their children, using beatings or withholding food to assert their power. Staff bully patients, berating them at times for disturbing their peace. Families bully their relatives when they accuse each other of witchcraft and extract expensive fines and rituals for peace. Harsh words, raised hands or sticks, coercive threats, turn the interaction into one of power and abuse. So the idea of cocoa buyers pressuring farmers with the threat of boycott seems quite real. And with most bullying, one must query what the bully seeks to gain. A lower price for the product, and a higher profit margin? A political point scored against a government policy? Or just a sense of control? And perhaps that points to the reason the culture of bullying thrives in a place like this. When the vagaries of international trade and exploitation of resources have depleted a continent, when the ravages of disease and drought lurk around the corner of every month, when daily survival is a struggle and the outcome by no means certain, people want a small sphere in which they feel some sense of security. They want some way to manipulate the world in their favor. So from the hungry teen all the way up to the shady businessman, the stronger pushes the weaker, and feels stronger still. Sounds like something out of Ecclesiastes, another lament. And a warning to my own heart. Lament lays the injustice before the throne of God, rather than bullying the bullies into submission.

Wrong Birds

Last night at midnight we were awakened by shouting men, a revving motorcycle, clapping, barking. We tried to ignore the noise but it escalated, and we began to wonder if thugs were bothering the Mukiddis. We went out to the porch and saw flashlights shining through our hedge, and heard a large rock rustle through the trees and thud into the grass. Star was going wild on her leash. Scott yelled at the group of men to go home to bed. They answered “Doctor, we are chasing a wrong bird. We don't like it.” Luke has lately noticed a Verreaux Eagle Owl sometimes roosting in our tree. It seems this bird is associated with evil spirits, and all our neighbors had gathered to scare it off, a collective action of noise and desperation. Evil abounds, but people have been deceived into fighting useless battles.

Tonight we will chase evil in a different way, though some clapping and gathering will be involved. We have planned an extended prayer time for our team, beginning with lament, naming and mourning the evils and then turning to God in worship, praying for the Kingdom to come. We will use Psalm 22, the words Jesus echoed on the cross. The cry that begins in despair ends in faith, and we hope to make that journey tonight, honest protest, engagement with God’s presence, and hope for the future. The psalm ends like this:

The poor shall eat and be satisfied;
Those who seek him shall praise the LORD.
May your hearts live forever!
All the ends of the earth shall remember
And turn to the LORD;
And all the families of the nations
Shall worship before him.

Posterity will serve him;
Future generations will be told about the Lord,
And proclaim his deliverance to a people yet unborn,
Saying that he has done it.

On the politics of health

Scott was called by the top elected official in the district to join with the district health leadership and all other NGO’s in evaluating progress in the fight against AIDS.  He carefully compiled the numbers, extrapolating population data and comparing statistics from the health centers to show that our HIV prevalence among pregnant women remains low (3% or slightly less), but the Kwejuna Project has had a significant impact on the care those women receive.  Since its inception four years ago, the percentage of women in Bundibugyo who receive any prenatal care has risen from 49% to 72% (we were actually up to 80% pre-ebola, so have some lost ground to recover this year).  That’s 72% of 13 thousand pregnancies . . . A lot of women.  The percentage of women coming for prenatal care who were tested for HIV went from 0% to 98% in the first two years and now hovers in the mid-80’s (slippage in interest and supply shortages).  The number of male partners tested has increased from 8 (yes, 8 men in the whole district) to over 2,000 . . . Still less than half of new fathers, but a steep incline that indicates major shifts in practice.  Pre-Kwejuna men were never even seen within a mile of a prenatal clinic!  But perhaps the statistic that most significantly indicates a strengthening of health capacity in our district:  health-unit based deliveries have tripled in number and risen in percentage of all deliveries from 19% to 33%.  Most women still deliver in their mud-walled homes alone or attended by their mother-in-law, but more are accepting the oversight of trained midwives in a half-dozen equipped birthing centers.  In a place with high maternal and neonatal mortality, this trend has the potential to save hundreds of lives every year.

At the same time, major world AIDS programs had convened meetings today in New York, a far cry from the Bundibugyo conference.  I heard on BBC tonight that while progress is being made, less than a third of people who need to be on anti-retroviral drugs world-wide have access to treatment.  New infections still outpace capacity for care.  Countries like Uganda can not meet demands, though they spend almost 10% of their budget on health (relatively more than the US) the actual outlay per person is very very low.  Nation-wide the doctor:patient ratio is two hundred times thinner than in the west; in Bundibugyo it is two thousand times more desperate.  And so we struggle on, seeing some hopeful mile markers passing,  but painfully aware of the distance still to run.

Scott’s meeting started two hours late (surprise) which was not just the lethargy of Africa-time.  Instead, a peaceful protest had disrupted the town.  Demonstrators spoke and marched against the new government policy to spray houses with DDT as a way to combat malaria.  Here the politics of health becomes very murky.  Will small amounts of residual DDT lead to environmental catastrophe, as in Silent Spring?  How does a country weigh environmental cost against the deaths of thousands and thousands of children from malaria?  Is sounds very politically incorrect to support DDT . . . But most of those voices come from places like America, where we no longer fear malaria, because we wiped out the anopheles mosquito.  Is it fair to forbid Uganda to do the same?  While I would like serious data to wrestle with these questions, the protestors had more practical concerns. Over the last decade Bundibugyo’s economy has been driven by cocoa.  It is now a major cash crop.  And the biggest cocoa buyers have made it clear that if any DDT is sprayed anywhere in this district, ALL farmers will lose their “organic” certification.  As Luke pointed out, being “organic” is one of the only things that Bundibugyo really has going for it, one of the few up sides of isolation and poverty.  The price per kilo of cocoa would be almost cut in half if the organic label is removed.  That means almost half of most family income would disappear. So will the health benefits of decreasing malaria transmission be lost in the doubling of poverty?  A very reasonable question.

Health is a political concept.  Today’s protestors were arrested as anti-government, since there is no real distinction between policy and person.  Disagreement is equated with disloyalty.  The wisdom of Solomon is needed for these impossible choices, for parents who are trying to survive by choosing between the income that allows them to pay school fees for their older children, and the marlarious soup that drives the younger ones into disease and all too often death.  A cruel irony that choosing against spraying may mean that the very child whose education the cocoa-money would have funded may instead be the next one in a coffin.  

A Tuesday Lament

Kwikilija Jakobo, age 6, died this morning, killed by inefficiency, apathy, corruption, poverty . . . I walked into the paediatric ward at 8:30 and his distraught mother pushed her way into the front, waving papers from Bundibugyo. In a reversal of referral patterns the staff at the district hospital had referred him to our smaller health center with the scrawled note “severe anemia ? Cause . . History of having got treatment in Bundibugyo Hospital, there no blood and for possible management by medical officer.” I took that to mean that the hospital was out of blood, no surprise, since our lab staff had failed to obtain the weekly supply from Fort Portal and the hospital administrator had twice this week sent for blood from the regional blood bank there but been told it was “finished”. In a classic waste of time and money, the patient’s condition probably deteriorated further because of being sent to Nyahuka, when a phone call would have confirmed that there was no blood at our health center either (or even a short conversation with any other staff would have revealed that patients with the same problem had been transferred earlier that day in the opposite direction).

First I called the regional blood bank’s officer . . Only to be told that the earliest we could get blood would be tomorrow. Upon further questioning he claimed that the entire western region’s blood supply was nil, because they had run out of bags. BAGS????? Whose fault is this? Is it the blood bank staff who fail to notice that they are using their last carton of heparinized sterile bags to store donated blood? Is it a corrupt or careless staff member who pockets the money for new supplies, or just forgets to process the order? (Evidence of both in other items this week, a disbursement of medicines listed as being worth more than twice as much as their real value, and hospital staff “borrowing” medicine from our health center to supply AIDS patients at the main hospital because their requisition forms were “lost” so that they ran out of medicines). Is it an entire country living on the margin with no reserve, so that one week the stock of an essential item can simply be gone? Is it poor communication, is it the barrier of deplorably maintained roads, the lack of fuel to transport personnel and supplies? Is it an over-zealous AIDS testing policy which, as in western countries, takes the risk of viral transmission in transfused blood from 1 in a thousand down to 1 in a hundred thousand, never mind the fact that the risk of a child dying from anemia increases from 1 in 100 to 1 in 10???? We live in the epicenter of sickle cell anemia in the world; we live in a valley where malaria is so endemic that almost 90% of children have some level of parasites in their blood; we live in a district where iron deficiency is universal, where diets are poor and intestinal worms remove tiny increments of precious heme on a daily basis.

So Kwikilija, like so many children before him, dwindled, until his heart could no longer metabolize enough oxygen to keep the watery blood circulating in his body, even as we scrambled to try and save his life, too little too late, the wailing relatives throwing themselves on the ground in grief. Raw lament from his mother; anger and frustration from me. I struggle with how to enter the fray with Jesus-style table-turning zeal, but without my own prideful self-righteousness hurting those who are already victims of injustice themselves. How to allow the waste to wring my heart, without hurting others.