Hosting

Having a visiting family member from America is an important event in our lives, as a family and a mission. And with Grammy in residence we have become a popular group! On Friday we were treated to a feast at Ndyezika and Juliet's new house, which somehow ballooned to involve both a passel of uncles and cousins from Ndyezika's side, and an equal contingent of CSB teachers and friends of Juliet's. Grammy presented Bibles to the newlyweds, we told stories of our long history together, everyone who had attended a boarding school away from home gave Luke advice, and we ate piles of rice and matoke and cassava and potatoes, sombe and cabbage and gunts and meat, as the light ebbed out of the neat little house and candlelight illuminated our faces. Saturday we enjoyed various team-mates coming by as well as an impromptu lunch on the porch for seven of the young men whom we sponsor with school fees, because they had been released from their school term that day. In the evening Melen and her youngest three kids joined us for dinner with Ashely, Pat and her two "nieces", the daughters of her friend who died of AIDS almost exactly a year ago. Many friends lined up to greet Grammy at church, and tonight we'll be hosted by our neighbors in her honor. It is nice to take a pause in the press of life to just acknowledge the significance of relationship, to look back at the blessings of the many years. We are thankful that my mom's health and energy have held up so far, it is no small feat to thrive in Bundibugyo after two major surgeries in the last year. And though she is getting a heavy dose of grandchild attention and connection, her presence for two weeks perhaps makes the painful reality of the many years of separation more visible.

Gracious encounters

We received an official delegation this afternoon, Monday Julius and his bride Alice, accompanied by his three brothers. They came to thank us for our support of Julius during Ebola, for our contribution to their wedding, and mostly for choosing him to be a recipient of the Dr. Jonah Kule Memorial Leadership Fund scholarship for medical school. Scott reminded them that the money does not come from us, though we'd love to sponsor him ourselves, but from the many people who gave in response to Dr. Jonah's death as a way to continue his dream of providing medical care to the people of Bundibugyo. We had baked a celebratory cake, and after sharing tea and visitng, we prayed for them. Alice is beautiful, articulate, confident, a midwife working at a Church of Uganda Hospital on the other side of the Rwenzoris. Julius is one of the most pleasant, hardworking, and trustworthy young men we've encountered. What a privilege to be a small part of God's provision in their lives, to see them at this young stage and hope for the many years of faithful service their marriage and professions will afford Bundibugyo.

Juno and Jeneffer

Contrasting stories: the hollywood version was in a DVD we saw this
week, the story of teenage pregnancy, a cute saucy articulate 16 year
old who chooses to carry her surprise pregnancy to term and give the
baby up for adoption. Juno is a great character, and while the movie
has some raunchy moments it generally chooses life by acknowledging
the incredible value of an unborn baby, and sympathetically portraying
the longing of a childless woman who waits to adopt, and the paradox
of being a normal teenager who is required to also be a responsible
adult. The movie asks the question: can two people really love each
other for life? And answers with hope, in spite of all evidence to
the contrary. And the baby ends up well cared for and loved while the
teenagers are figuring all this out.

Now the Bundibugyo version. Jeneffer also showed up this week, 15,
quiet, on the margins, dutifully bringing her scrawny infant for
care. We weighed him in at 1.45 kg, not even three pounds, though
he's more than a month old. She agreed to stay admitted with him, but
on the second or third day it dawned on my that she was sleeping on a
bare hospital mattress with no sheets, and had none of the usual
clutter about her: no pans, no food, no relatives, no extra clothes.
The nursing staff got her story for me: she had been a primary school
student, living with an aunt after her parents divorced, and agreed to
sex with a secondary school boy who promised to marry her. When her
aunt saw she was pregnant she angrily ejected her to the care of the
boyfriends' parents, who were not so thrilled. He went to school
every day and she dropped out. Eventually she ran away to her
mother's home (about 10 km), but her mother had remarried and the step-
father was not interested in taking in the pregnant teenage daughter
of another man. So they told her to leave, and she went to her
father's house. Here the reception was not hostile, but her father
lives across the border in Congo and is busy with his new wife and
family. So among these four homes (aunt, boyfriend, mother, and
father) there is not one single adult who seems to have noticed that
this is a girl with a starving baby and no help, that she came for a
check-up and never returned. Meanwhile she sits on her bed on the
Paediatric ward, half-heartedly breast-feeding her pitiful skeletal
little boy and spooning milk formula into his mouth when the other
mothers take pity and allow her to use their pans to boil water. I
help her with some food and blankets, one of the nurses sometimes
brings her a meal. I don't think she expects the baby to live, and
I'm not sure I do either.

The contrast must carry some clue . . . in the America version the
girl is smart, goes to school, gets medical care, has friends and
family who support her. She makes some bad choices, and some good
ones, and life goes on. Her pain is another's blessing, which carries
seeds of redemption. In the Bundibugyo version, the girl's bad
choices define her and seem to defy her any chance of escape. The
proverbial African family which should provide a safety net for her
landing has instead been found to have holes, and she has fallen
through, dropped by her relatives, by the education system, even by
the medical system. No one is looking very blessed at the moment,
least of all her child. Juno is aggressive and active in pursuing
what she thinks is right, even at high cost. Jeneffer is passive and
fatalistic in waiting for help that trickles her way. I have often
read that poverty is the lack of choice, and this seems to hold in
this story. How can we give Jeneffer choice, which is probably more
important than giving her milk for her baby? And is it fair to try to
get her to take hold of a life that is so massively stacked against
her? Does she have real options, or only illusions of them? When I'm
dealing with a mother the age of my oldest child, it is a wake-up call
that something is very very wrong. Both girls would have done better
to wait for sex until the commitment of marriage in the context of
maturity. But they didn't, and I'm interested in the contrast in what
happens then. I suspect the girls' fathers are key in the contrast,
and the disconnect between fathers and daughters in this culture is
one I have not thought enough about.

Arrivals and Departures

After dreary and drenching days on end, today the sun broke through in time to firm up the grass airstrip just enough for a very important landing. My mom, Judy Aylestock, and Sarah Reber's parents and sister arrived, and midwife-intern Larissa Funk departed. It is a world- intersection moment when our families can set foot in Bundibugyo. Melen, my two neighbors, Ndyezika and Juliet, and church elder and friend Bamparana all formed the Ugandan welcoming delegation, and almost our entire team came as well, for a swirling crowd of hugs and tears, of joy and emotional overload. In the excitement of travel there was not much rest, so today we are allowing them to catch up before the grand tour of Bundibugyo starts tomorrow. It has been more than five years since my mom last reached this far (my parents' last trip stopped in Kampala) so the kids and the trees have both grown quite a bit . . as well as the house (we added a porch/room on the front). Praying for a meaningful visit for all.

HIV/AIDS Awareness

Data can drive programs, decisions, push money in the right direction,
move hearts and minds. So in that spirit, here is a fascinating web
site called Global Health Facts, which compiles data from the UN and
from individual country reports, and maps and ranks it for meaningful
thought: http://www.globalhealthfacts.org/topic.jsp?i=6. This
particular link takes you to children living with HIV/AIDS. I was a
bit surprised to realize that Uganda ranks fourth among the over 200
countries and territories of the world in absolute number of kids with
HIV. The adult prevalence is higher in southern Africa, but the sheer
number of infected kids centers here, right where we are. There are
lists and maps and numbers for maternal mortality, childhood
malnutrition, TB incidence, malaria (where Uganda ranks NUMBER ONE in
case rates, with 477 cases per 1000 population . . .meaning half of
the people in the country suffer a case of malaria every year, and
fourth in the world in the number of deaths from malaria). This kind
of data should of course drive health services. Why not send the
doctors and nurses and malaria medicines and hospital equipment and
public health research and educational outreach to the epicenters of
disease? Well, the maps for health workers are actually the INVERSE
of the maps for disease. Uganda ranks 129 of 135 countries with data
for physician coverage, with 0.08 doctors per 1000 population, and
only 39% of births attended by skilled personnel. I hope that medical
schools and mission agencies spend time reviewing data like
this . . . .

X-ray

This may help you understand some of the challenges of accessing care in Bundibugyo.  A year ago Jack injured his heels by running cross country, too far and too hard, in poorly-padded used tennis shoes.  He was a big strong 9 year old running with mid-adolescent kids. Though we did once go on line to look for age-related distance limits . . .he is the kind of kid that pushes, and is able to do too much.  Plus we did not take his occasional complaints of pain in his feet seriously enough.  By the time we realized it was a problem, he had done damage to his growth plates.  Thanks to our good friend who is an orthopedic surgeon we learned his diagnosis, calcaneal apophysitis (Sever's disease).  And his treatment:  rest, no running, pads in his shoes, stretching exercises.  For months we've been slowing him down (we even tried crutches briefly to keep him still), no football, no sports, no hikes, always banning bare feet or hard shoes.  For an athletic kid like Jack, the result has been frustration, and it probably has significantly impacted his ability to enter into school life and have friends, and been part of his general discouragement.

The good news is that this disease will go away as he reaches adulthood and stops growing . . . but that is still a long way off.  It has been hard for him to be patient with the slow process of healing.  Recently though we've seen the benefits of his rest and his heel pads, and he has not had nearly as much pain.  So he has been allowed a limited amount of activity .  And our doctor friend in the US suggested follow-up xrays.  Since Jack is very worried about all this, and looking for good news, we really wanted to comply and get films.

Sounds simple.  No xray film in Bundibugyo.  So a month ago, our only weekend out of Bundibugyo this quarter, I went to two hospitals in Fort Portal with Jack.  In one the xray machine was broken.  In the other there was a line of patients a mile long, and we had a car full of people waiting for us, so we had to give up.  So then Scott bought a box of xray film and took it back to Bundi.  The xray tech has been unavailable, and the machine only works when the generator is running which is a few hours a week.  Finding an overlap between the xray and Jack's school schedule has not been easy.  We thought we had one today.  But no fuel for the generator.  So we had to drive to Bundibugyo in the rain, buy 10 litres of diesel fuel, find the xray technician, give him the box of film, get the generator started, and take the pictures.  Just revving up the machine and arranging it all took over an hour.  When the films were finally developed they were a bit light . . . the tech apologized that the chemicals for developing were old.  

A simple xray of the heel is never simple.  The staff say that the fuel issues stems from the fighting between politicians, which is freezing all the bank accounts for the district, so the hospital has no money. We have resources and resolve, but you can imagine that for most people the barriers of film, fuel, and passive-aggressive foot-dragging, would be too high to surmount.

We are praying that Jack's heels are healing . . . that he will be increasingly able to move normally, good for body and soul.  But the dreary process of accessing care also reminds us to pray for justice, for relief, for the many who wait for help and healing that never comes.

On the difficulty of aid

Bundibugyo has received thousands of insecticide-treated mosquito nets from UNICEF, bundled in bales with labels from as far away as Japan, hefted on ships and trucks, stacked in warehouses and then heaved into pickup beds, unloaded at health centers.  What could be better than handing out protective nets to pregnant women and young children, preventing the most vulnerable from being infected with malaria parasites?  Malaria remains the number one killer in Bundibugyo, as in most of sub-Saharan Africa.

But getting the nets hung over the sleeping forms of the unborn and recently-born and about-to-give birth is more difficult than one might think.  A few months ago the hospital administrator was jailed, accused of stealing hundreds of the nets, to sell. Since then the nets do seem to be making their way to the health centers as intended.  But yesterday the staff launched into their litany of complaints about this program.  If even they can not hand out a free boost to their fellow citizens, no wonder we struggle.  Here are some of their observations:

• Women who are pregnant take the nets back to their parental home, not to their husband's home where they are living.  This points out the tenuous nature of marriage:  the net belongs to the woman but since she is a temporary member of her husband's household, she risks losing it.  Also she considers it his job to buy the net that protects his unborn baby, so why should he be let off that hook by UNICEF?  So the nets given to pregnant women are not slept under by pregnant women.
• Women return for maternity multiple times using new names or saying they lost their card, so they can acquire more free nets.  Perhaps not a tragedy if they were hanging those nets up over more of their children . . .but the story is they can easily sell them to merchants.  
• Many people never take the net out of its bag.  It becomes more of a talisman, a symbol of protection or wealth, that would be spoiled by actual use.
• As the program gathers momentum, the sense of entitlement grows, and when the "man with the key" was gone last Monday the nursing assistant feared being practically lynched by the angry crowd of pregnant women!
• The lure of a free gift brings many people to the clinic (generally good) but also many who don't belong there (not even really pregnant), which in a marginally equipped system means that the resources are diluted and those women with real medical concerns can be lost in the crowd.

I asked for one bale of the nets to be kept in the Paediatric Ward store, and I am now dispensing them at discharge to kids who are admitted with severe malaria.  My reasoning is that the parents have just narrowly escaped losing their child and will be motivated now to believe the risk is real and therefore use the net, the net will be going to a house which we know harbors malarious mosquitoes, and the child is particularly vulnerable to fatal consequences from re-infection.  Still, it would be ideal to follow these kids a week later and see how many are actually sleeping under the nets.  In a house made of mud bricks or wattle walls, how easy is it to hang a net?  In a house plagued by rats, how many get chewed through?  In a home where mattresses are shoved side by side on the floor to accommodate many kids, how easy is it to hang and use only one net?  

Yes, there are difficulties, even in giving away something as straightforward as a mosquito net.  But these issues are not insurmountable.  Attitudes can change.  The same parents who beg, borrow, and steal to manage school fees for their kids can learn the value of a mosquito net.  We all want the same thing:  a thriving, live child who grows up to his/her full potential, whose mother survives her subsequent pregnancies too and stays involved in his/her life.  A few ounces of filmy white netting can be the wall that shuts out death.  It's aid worth giving, even if it is difficult.

Countdown

Jack and Julia made a count-down calendar to Grammy's arrival on
Wednesday. Every day they tear off one more number from the back of
the door, and spend the rest of the day saying : "Guess what? ONLY
FOUR MORE DAYS . . . ." The excitement builds. And I'm thankful that
in spite of spending 14 of our 15 years as parents on the continent of
Africa, our children securely sense their connection to all of their
grandparents, aunts, uncles, and cousins. Our sense of family spans
the thousands of miles, but the countdown to a real hug is still sweet.

Dragon lumps and deeper unveiling

We will finish Voyage of the Dawn Treader tonight, in our second or third time through the CS Lewis Narnia series.  These books are always fresh with Lewis' grasp of reality, seen more clearly in the imaginary worlds.  In this book a boy named Eustace is inadvertently pulled into the adventure with his cousins, and Eustace is not a nice boy.  He's self-centered, complaining, wimpy, and often just plain mean.  He sneaks off from the others and ends up in a dragon's lair, where his greed turns him into an actual dragon.  When he emerges, he is big, lumpy, scaly, and frightening.  In fact at that point his physical form reflected the truth of what his heart was like all along.  This chapter coincided with our Sacred Sorrow chapters on Jeremiah, where Card points out that God's judgement on Jerusalem is to simply make visible what was already spiritually true, the city had lost her true glory.  And it coincided with my turn to share prayer meeting with Annelise, who suggested that we organize our prayer requests under the headings of "unveiling" and "inviting" (I found out later that her intent was more along the lines of beauty and Song of Solomon, but that's OK).

The Spirit used this coalescence of readings and thoughts to unveil the dragon lumps in my own heart.  Many missionaries point out that the challenges of living cross-culturally, or in poverty, or under constant stress, do much to make our sin more visible.  Eustace was always beastly, but he didn't really know it until he saw himself as a dragon.  And I've always been judgmental and impatient and self-concerned, but Bundibugyo makes it much easier to confront those issues on a daily basis.  Being pushed to the limit can be a good step towards pulling back the surface of nice-ness.  When Mackline died in my care, another kid named Christopher dwindled from what I think was basically a slow poisoning by his grandmother's herbal enemas, and I watched yet another child gasp his last agonal breaths this week, I was left with a sense of failure and sorrow and discouraging, scaly, desire to run away from it all.

But in Eustace's case, the unveiling down to the dragon layer is not the final unveiling.  Later he meets Aslan, the lion who pictures Jesus in the stories.  At Aslan's instruction he peels off the dragon scales, but every time he does so he finds another layer of hard, ugly dragon-flesh underneath.  Finally he allows Aslan to use his sharp claws and go deep, removing all the layers of dragon.  And underneath is the new Eustace.  The real Eustace.  A frightened, lonely boy who no longer wants to be isolated by his mean-ness, a bright child with a kernel of courage who wants to be loved.  

The unveiling of judgment (making visible what was spiritually true) allows the unveiling of healing (ripping off the hard crust of sin to reveal the true soul God made).  The untame lion may seem to wound, but he really frees.  There is a hymn which says:

When through fiery trials thy pathway may lie

My grace all-sufficient shall be thy supply

The flames shall not hurt thee I only design

Thy dross to consume and thy gold to refine.

And there the "inviting" comes in.  What we really need, is the Presence of God.  Card's book points out that it is rarely what we ask for, but always what we truly need.  All the burning and washing, peeling and pain, are simply means of removing the barriers between us and God.  

Whom shall I fear?

I read Psalm 27 this morning for staff Bible study at the Health Center.  About 20 people come weekly, and we alternate between spiritual and medical topics.  Scott had challenged us as a team to take the teaching from Sacred Sorrow and try and apply it in our lives as cross-cultural missionaries.  My first study for Ugandans was on Job, and today we looked at David.  Background Bible literacy is low (not surprising for a place where the Bible does not yet fully exist in the language), so I had to tell a few stories to show that even though David was a King he suffered:  he was haunted by enemies, often on the run in hostile wilderness places, plagued by his own lusts and sins, grieved the loss of a baby to illness and a grown son to armed insurrection, betrayed, and at the end of his life ill and infirm.  But in all of this he held onto God, tenaciously, honestly, in lament as well as in praise, often alternating between the two in a single breath.

Psalm 27 is one of the places where David's bold faith and naked pleas come together.  He talks a lot in this Psalm about fear.  So I asked the staff to go around the circle listing fears, and here is a sample of what I heard:  evil spirits, sickness, death, famine/hunger, war, inability to provide for children, poverty never getting better, being cursed by jealous people, AIDS, malaria.  All of these fears seem quite reasonable here, because all are things that most of our staff have experienced.  It struck me that I was sitting between a man whose child I had watched die this year, and a woman who is ostracized because she is from another tribe.  But then I asked them to look at the Psalm, and consider what David's worst fear was.  Surprisingly it was something that none of us mentioned:  the fear that God would abandon him.

Is it my presumption that allows me to overlook this fear?  Does God ever hide His face?  If our personal sins cause God to withdraw, then how do we explain the most poignant expression of God-abandonment in history, Jesus' cry from the cross "My God, my God, why hast thou forsaken me?"  God turns away from our sins.  But does He also obscure HIs presence, veil His face, to build our faith?  To show us our true appetite is actually FOR His presence, not for His gifts?  He seemed to lead David often into places of wilderness, where the gaping chasm between what we hope for and what we experience looms painfully.  In the wilderness David learned true worship.

The psalm ends with this:  wait on the LORD.  Not on answers, solutions, relief.  Wait on the unveiling of the presence of God Himself.