Monday afternoon news

On Luke: no news really. He had the MRI, thankfully, but they were unable to wait for the films to be developed and read. He is supposed to see the orthopedic surgeon tomorrow, not clear if this will come off since he came back without the data. So maybe tomorrow it will all come together. I hope so. He is still in pain daily, so it would be good to start making progress on diagnosis and treatment. We feel restless, expecting at any moment to make plans to go .. .

On Basiime Godfrey: Just heard that the doctor is very kindly arranging to get him from his University to the hospital in Kampala (Mengo) tomorrow, which is no small feat, it is about an hour's drive. We assume this means he's on the surgical schedule. We are now trying to figure out if we need to mobilize someone to go care for him post-op, since in Uganda much of the nursing care is performed by family members (he says no, but we are not sure). Please pray for him as a boy out of his element, newly enrolled in college, missing classes, going to an unfamiliar hospital alone. Thank God for Dr. Bonner who is going to such trouble to save Godfrey's vision.

On life in general: Holding on. Good moments today, a rooster and a sack of potatoes and onions and tomatoes and bananas and sugar cane and great thanks from Baluku's family as he heads off to school; greetings from Ammon and his family as he does the same. Trying to focus on immediate issues but pulled again in too many directions, and waiting for sufficient grace.

On rice seeds and bounty

Today the sermon came from 2 Corinthians 9, sowing bountifully, and again I found that the sermon on "giving" which I could have tuned out as yet another attempt by desperate church leaders to raise money, was instead spirit-directed to reassure and comfort me. The pastor used rice as the example (no wheat here), the tiny seed which is mysteriously transformed and multiplied. The more you sow, the more you reap, the posture of cheerful expectant hope, willing giving. Then the promise of v. 8: God is the one who multiplies and makes sufficient, just as He did with the five loaves and 2 fishes. It is all grace.

I found myself profoundly tired sitting on that church bench, and let my mind wander a moment to analyze why, reviewing the last three days. The Kwejuna Project Distribution/team meeting/visitors arriving day on Thursday, followed by the marathon Christ School Parents' Day on Friday, mingled with an unplanned visit by a remarkably talented and personable young man filming footage for a possible documentary project about Ebola whose questions dredged up hard memories and a few tears. Saturday is usually a bit of a catch-up organize cook and pay attention to kids day . . . but this week as I tallied I could think of no less than 28 visitors, 27 of whom were people that I know fairly well and share significant relationship with and truly want to attend to when they drop in to greet or talk or present their problems. The first came by 7:30 and the last left at about 10 pm. In the middle of all that dealing by phone with Godfrey's diagnosis and talking to Luke. Oh, and feeding my family and playing a game or two with kids. No wonder I feel tired.

The promise stands: sufficiency for all things, abundance for every good work. Giving extravagantly, receiving bountifully. May God multiply our small scatterings of seed to bring a richness of glory.

The blind and the lame

Let me cling to the categories of people whom Jesus said would usher in the Kingdom.

Basiime Godfrey, the orphan student of ours whom God opened doors to get into Uganda Christian University, had an eye exam today. A visiting American ophthalmologist had graciously contacted us by email and we took the opportunity to set up a check-up for Godfrey, who had a history of some chronic eye complaints. When Scott filled out Godfrey's pre-admission University forms, he did a physical exam and noted that Godfrey's vision was significantly impaired in one of his eyes . . . Today he finally got to see this ophthamologist and we got the news that Basiime Godfrey suffers from severe glaucoma. He is nearly blind in one eye already, and will be completely blind in both in less than five years if nothing is done. I just want to cry. First, that this boy who has struggled to get where he is now has this crushing prognosis. Second, that like Jack's heels, we did not take his occasional mention of eye pain or redness as signs of serious disease. He was boarding at Christ School when this started, we did not see him often, and his issues were one of the dozens that get put before us daily. He did not perceive it to be a major problem, and neither did we. Now much irreversible damage has been done. The doctor's schedule for surgery next week is full, but we are praying he'll be able to squeeze Godfrey in. Then later he'll need surgery on the other eye, plus daily medication. He's far from home and just starting school and worried about missing classes. After we talked to the doctor on the phone we talked to Godfrey again, and he was planning to refuse the surgery under the mistaken impression that his eye would be removed. We assured him it would remain, and that surgery was his best chance in delaying blindness.

We had just gotten off the phone with Luke when we called Godfrey's doctor. Luke is still having pain, and his MRI is scheduled for Monday at 2:30. Ashley told us an encouraging testimony of her own knee injuries in soccer, she had been diagnosed provisionally as a meniscal tear but the MRI cleared her inexplicably, and she improved without surgery. We would love to see a similar outcome for Luke! He's hanging in there pretty well, considering. He moves about campus but can not do much.

I did not expect to find the blind and the lame among the kids on my heart, nor to be so helplessly far away as they face their diagnosis and treatment. I suppose that puts me in a category in the beginning of the same passage in Luke 4: in need of healing for the brokenhearted.

Parents' Day

As a biological mother of three CSB students and a sponsoring mother of five more, not to mention wife of the Chairman of the Board of Governors . . . I try to attend Christ School's annual Parents' Day. So I went to work at the hospital early, tried to make my staff meeting and teaching time efficient, saw all of the inpatients, and then headed over to the school. The event would be similar to an open- house, back-to-school night in the States, combined with the annual choir concert, drama production, and graduation ceremonies. In other words, a long day to fit in the primary official parent/staff/student/ administration contact for the year.

Upon arrival the parents sign in at the gate and then are assigned a group tour guide who escorts them through the grounds, inspecting dormitories, admiring the agriculture projects, and being entertained and amazed by demonstrations in various classrooms. As soon as I arrived Julia spotted me, so I did a personal tour, beginning with her "knitting and crocheting" club group who had spread their handiwork on tables in a classroom and eagerly told interested parents about their creative process. From there Jack found me and pulled me into Caleb's classroom where one of the boys we sponsor, Kadima, was spokesperson for the agriculture club, and had set up a model of a three-pit system for composting. In the labs we saw a frog and a rabbit dissection in process, and students were on hand to discuss insect parts and preserved biological specimens. The cooking club had set up a small kitchen and discussed their recipes as they cooked. Then Caleb took me to his math club demo, where they used a surveying method to measure the height of a tree. All of these stations are an opportunity for the students to show the parents skills they are learning, and for the parents to appreciate the opportunities the school affords. Occasionally there is also a take-home message; in the frog lab the opened intestines were crawling with a mass of roundworms, and the teacher in charge was using this as a public health opportunity to remind parents of the importance of deworming children.

By noon most people were gathering in the student's assembly area, an open-air hall which is used for chapel. Yesterday it was decorated with balloons and flowers and crowded with several hundred parents in their best clothes. Then came the program, which went for a good five hours. Songs, speeches, poetry, traditional dance, and a long play, all interspersed with speeches from various representatives. Most of this was good even if a bit long, with striking harmonies and amazing rhythm. In Ugandan "demand" culture, it is typical for parents to present their requests and administration to answer. I realized this year that most of the major points parents make every year (we need an infirmary, there should be a school canteen for buying small essentials, the dorm space is too crowded, the library is not well used) had ALL been answered at last, with the completion of building projects and more recently even the work that Annelise has invested in the library. David gave a good speech introducing himself as the new headmaster but emphasizing from Psalm 126 that the school is Christ's, not David's or Kevin's, and that we are here to work together. He told the parents that he valued transparency and wanted to address problems openly and together, and asked for their cooperation and prayers. Scott was the final speaker, and used a passage from Philippians 2 talked about Christ-like humility.

Which was appropriate, because the only really distressing part of the day was the student council representative's speech. This boy is the soon-to-graduate son of a recently-investigated-for-fraud political leader, and he was shockingly disrespectful of the teaching staff, the administration, and even the parents. I will not repeat his allegations, but I was most appalled when he basically threatened violence, and many others were shaking their heads. Most sadly for me, one of my students was the translator (the speech was in English so he was translating for the vast majority of the parents who can not understand English). I was not the only person who cares deeply about the school and the kids there who was nearly in tears by the end. However since then I've tried to realize that the students have not learned how to express dissent and opinion in a respectful way, how to be heard while still saying what is on their hearts. They got a taste of the power of free speech and blew it. They need smaller steps of learning to protest.

This is a battle ground, and so often our hearts want to withdraw, or give up, particularly if we are under attack. Pray for supernatural love to propel us towards the unruly and the proud, the immature and the ungrateful. Jesus moves towards me in love in spite of my indifference and selfishness. Praying for the parental love to do the same.

Counting Kwejuna

204-- HIV positive women who flocked to the Community Center for the  all-day process of talking to us, being weighed and counseled, tested and encouraged, and going home with food. 70-cups of beans each woman carried away, in a sack. Food to boost the family. 3- litres of cooking oil, to add calories . 500--grams of salt, adding the flavor. 3--dollars given to each for transporting the above home. Some come from 20 miles away, some from a stone's throw. Some are thriving on their treatment, some are so weak they could not begin to carry their sack of goods ten feet. So we provide a token gift to enable them to get their help home without losing it. 26--children coming with their mothers, who were over a year old and weaned, and had not previously been tested. 24-children out of the above 26 who were HIV-negative, a cause for celebration. This is not a random sample so we can't draw too many conclusions, since the sickest or deceased will not show up. However any time our transmission rate seems to be on the order of less than 10% we are pleased, rather than the expected 30% with no intervention. 17--number of babies too young to be tested by the rapid antibody test who are waiting for the sophisticated polymerase chain reaction viral detection test, whose samples have to be carried to Fort Portal for analysis. These will then be encouraged to wean earlier than normal, and be absorbed into the Matiti project to receive milk-giving goats. 41--number of women who elected to receive a family planning injection, enabling those who have delivered babies to now rest and regain some of their own health and strength, to perhaps live longer to care for the child they already have. 13 and 5--number of kilograms a mother and baby pair gained this year in the program. Luci came weighing 35 kg (this is an adult woman!) in February, but was up to 48 today. Her son Byamukama doubled, from 4.5 to 9 kg.

5 and 15--number of missionaries and Ugandans, respectively, who labored all day to pull this off, including nurses and lab techs, pastors and manual laborers. Kwejuna project affords us the opportunity to pull together for a common cause, to be blessed by the diverse gifts of the people God has placed here. Intangible--the real reason people come, Heidi commented after watching all day, is not to get so many beans or that extra bag of salt. It is to spend a day where being HIV-positive is normal, where you are only one of two hundred women in the same boat, where a polite and caring group of people have assembled just to care about you, where you can tell someone about your anxieties and be understood, where you can hear words of hope and life that are matched by deeds of love and sacrifice, and perhaps catch a glimpse of God.

Babies with babies

Here are some "snaps" of my patients cradling the dolls that Karen's mom sent. Kansiime is the little girl I wrote about a few days ago, who sits in wide-eyed silence, waiting. Jackline, in the next bed, has far to go, just admitted with the yellowish skin and scant hair and puffiness of Kwashiorkor .. but at least she can hold her doll while her mom nurses the newborn baby that pushed her off the edge. Her neighbor is Bakaswala, who giggles as she plays with her doll, and is more hungry and less chronically damaged than the others. Alisemera Jane is named after our member of parliament, and I hope she's elected some day, able to represent the hungry and struggling. Lastly Muhindo Richard, who made the most amazing recovery I've ever seen .. . his mother had run away with a soldier and his father's whereabouts are unknown, so he was passed through relatives until he landed with his very competent grandmother. As soon as she had the resource of milk, she poured it in, his edema melted away, his smile emerged, and he was ready for discharge in a week and a half. No shame in loving a doll here if you are a 5 year old boy.

It is a privilege to be the conduit for international protein (milk from the UN) or American baby dolls, and to gently re-awaken body and heart in these kids.

This interview in today's Guardian newspaper with Uganda's minister for primary health care again reemphasizes the long-standing difficulty of recruiting doctors to rural areas.

More fuel for our strategy of sending "sons of the soil" to medical school who are then willing to come back and serve as doctors for the long haul in their home place.

If you missed the post about our newest student, Baluku Morris,  see our post from yesterday below...

A torn heart

This morning I was moving around pediatric ward seeing patients when I got the message that Luke's knee injury was potentially as bad as we feared, and that the orthopedic surgeon had recommended an MRI in Nairobi to help make the decision about surgery. And after that I found it hard to concentrate on the kids in front of me, thinking of my own child. Again the paradox occurred, where both extremes are true, even extremely true: deep compassion compels me to stay, and a numb despair pushes me to escape. There is a sense in which being a mother who has entrusted her son to the care of other doctors heightens my sense of responsibility for the patients in my care. I can easily put myself into the parents' shoes (not that many wear them . . ) and I want to do my best, just as I hope the doctors in Kijabe are doing their best for Luke. On the other hand, I struggle to wonder why I am here helping other peoples' kids when my own is not well. So much of me wants to pick up and run. When Luke's news came, I was actually standing by the bed of 2-year-old Nyakato: she came yesterday barely breathing, a slowing heart rate, cold, in shock, unresponsive. Her father had red eyes from crying all the way to the hospital; her mother sat in the corner and prayed into her hands Hannah-like. Nyakato was the only surviving twin, and her mother's heart was breaking. Heidi, Olupa, the head nurse Mwenge, and I all went to work. Whether the fluids, the medicine, the prayers, or all of the above, she revived, and today she was sitting up eating a lollipop I gave her. A very satisfying snatch back from the shadows of death, except that as I stood there the price paid by Luke to have us here and him there, well, it seemed steep. Praying for the wisdom of Solomon, and feeling the tearing of my heart.

An unexpected opportunity

On August 26th in a post titled "In Praise of Fathers", we mentioned our involvement with a young man who recently came to us for sponsorship in medical school. Without any recruitment effort on our part, this Bundibugyo-born student, Baluku Morris, gained admission to the newest medical school in Uganda, the Kampala International University Medical School. He just showed up at our house with his admission letter and a letter of reference from the LC5, the highest ranking politician in Bundibugyo. At the time, we hesitated. Our lack of knowledge of this young man and the lack of money in the bank made this seem like an unwise decision. We pledged that we would give him 25% of his first year's requirement. He and his father went home, discussed their options, and returned. They didn't have any savings that could begin to pay the balance of the tuition so they appealed to us about whether we would consider sponsorship in nursing or laboratory medicine schools (institutions they knew where we had previously sponsored students). Their humility and persistence in this process caused us to reconsider our first decision not to fully sponsor him. Then, we began to receive inquiries and offers from generous blog readers interested in assisting Baluku.

Baluku expresses a fervent desire not only to study medicine but also to serve the people of Bundibugyo. His father who we have since learned is a "cousin-brother" to Jonah (seems everyone is related to each other in Bundibugyo if you go back far enough), says that Baluku "has the heart of Dr. Jonah." We believe the academic credentials and intellectual aptitude are "required, but not sufficient" to be a doctor. This heart of compassion for people is what we always seek as we recruit doctors for Bundibugyo. Hearing Baluku voice a desire to serve has given us confidence to move ahead with him.

So, by faith, we have made a commitment to Baluku Morris to sponsor him for five years of study at the Kampala International University Medical School. It will cost an estimated $3500/year. Classes begin October 3rd, 2008.

(We have previously raised the full amount to sponsor Monday Julius at the Mbarrara University Medical School for five years through the Dr. Jonah Kule Memorial Leadership Fund, but don't have any additional funds beyond the need of Monday Julius).

If you would like to contribute towards sending Baluku Morris to medical school, you may send a gift to World Harvest Mission (see the sidebar links for how to contribute by snail mail or by electronic transfer) designating your gift for the Dr. Jonah Kule Memorial Leadership Fund. And then begin praying for him...it is a long hard road full of barriers - frustration, distraction, difficulty, and even despair. He'll need an army of prayer warriors backing him up.

on paradox and cannibals

Kisembo preached for communion this morning from John 6.  As he re-told the story, the language Jesus used in talking about his body and blood implied that the Jews were bhalogo, cannibals, a shocking insult that would have riled them to violent reprisal.  It is good to take the Scripture into African culture and see some things that do not make sense in America, such as the taboo of cannibalism, the raw boldness of Jesus' speech.

So what was Jesus saying?  Clearly, murder and the eating of a fellow human being are perhaps the ultimate acts of destruction, the furthest from godliness.  Yet just as clearly, partaking of the body and blood of Jesus through the Lord's Supper is the ultimate act of communion with God.  I'm reading GK Chesterton's Orthodoxy, and he makes the point that non-Christian culture tends to find a moderate medium between two extremes.  In this case, that could be either asserting that human bodies are no different than animal life so that the act of eating human flesh would be the same as eating a cow or a goat; or glossing over the language of John 6 as purely symbolic metaphor.  Maybe.  But Christianity is rooted firmly in paradox, that two apparently contradictory things are both true.  The heart of our faith is Jesus, very God and very man, not a compromise between them, but the furthest extreme of both.  

So we enter into worship through the service of the Lord's supper. In this case, "bread" is not really part of the culture, so the leaders buy little packages of cookies in the market, alphabet-shaped crackers.  And "wine" is also nowhere to be found, so we sip flat syrupy soda.  Through experience they've learned not to pour it out until the moment of the drinking, after ants one time infested the table during the sermon.  But munching my S-shaped cracker and sipping my modicum of soda seemed appropriate to the truth:  common daily humble items transformed by the power of love into life-giving substance.  A paradox, Christian cannibals, looking for mercy.