Reunions

In a life that contains way too many goodbyes, the reunions stand out, sweet and strong.  I can see now Julia hugging Acacia when she left, and when she returned yesterday.  Karen and kids touched down about noon on the airstrip, enveloped immediately into the community that has missed them.  Naomi and Quinn almost popped in the moments of anticipation, and the friends have been inseparable since.  Karen told us all the story of their first two weeks, with photos.  I think my favorite part was the way the airplane pilot making a landing mid-stay just "happened" to bring them a load of fresh vegetables, right when they had reached a low point of feeling desperate about the lack of food choices.  I remember only vaguely now the way Uganda was in the early 90's, the sense of burden in collecting and cooking enough calories to sustain a family, but this challenge looms large for Karen.  The diocese of Mundri has welcomed them warmly, and we rejoice to hear their opportunities and dreams.  Last night, we had the fun privilege of hosting ALL the team kids for dinner, and movies and cake.  A taste of the final feast of the Lamb, the reunion of all reunions.  

Ebola in the News

Just in time for the one-year anniversary of Ebola, the open-access Public Library of Science journal on-line has published research that arose from our outbreak.  Here are two clips from news reports today:

From Science News:

A species of Ebola virus that emerged in Uganda in November 2007 is unlike any other, scientists report in the November PLoS Pathogens. A team of U.S. and Ugandan researchers collected and analyzed blood samples from people infected in and around the town of Bundibugyo and found that last year's outbreak of hemorrhagic fever there resulted from a previously unknown Ebola species, tentatively called Bundibugyo ebolavirus. The virus infected roughly 100 people, of whom 37 died, says virologist Jonathan Towner of the Centers for Disease Control and Prevention in Atlanta.

From AFP:  

The newly-discovered species came to light after VHF erupted in the townships of Bundibugyo and Kikyo in November 2007, says the study, authored by US and Ugandan doctors.

The US Centers for Disease Control and Prevention (CDC) tested 29 blood samples, which were negative to high-sensitivity tests tailored to the three known strains of Ebola virus. But the samples tested positive in an older, broad-spectrum antibody assay. Intrigued, investigators pulled apart the pathogen's genetic code to see what they had snared.  Using ultra-fast sequencing technology, they decoded the virus' genome in a matter of days, finding a variation of 32 percent compared with the three existing strains.  Of the 149 suspected cases of Bundibugyo ebolavirus, 37 were fatal, translating into a mortality rate of 36 percent.

The wide genetic divergence between the strains has major implications, the authors say.  It will require the invention of new diagnostic tools to detect outbreaks and could complicate the quest for vaccines and treatments.

So as the hot winds of drier season blow us into December, and my kids begin playing Christmas carols, I find my heart and thoughts harking back to the events of last November.  It was a year ago next week that we went to Kikyo and saw patients ourselves, and days later that the outbreak was confirmed to be Ebola.  Christmas and death have become inextricably intertwined.

Kwejuna Day

Yesterday the quarterly distribution of supplemental food (20 kg ofbeans, 3 liters of oil, a kilo of salt) drew a record 230 HIV-infected women to the WHM Community Center. Most had a baby or relative in tow, so imagine the chaos of about 500 people milling through our various stations, reuniting with friends, comparing experiences and admiring each other's babies. Each is interviewed first by a health worker or peer educator, to document her status and be sure she is enrolled in ongoing care and treatment. Each is weighed and measured, to collect data on nutritional status. We scrutinize the outcome measures for the babies, and have a temporary lab set up for either sending blood spot samples for viral testing or immediate antibody screening. Each woman is offered family planning on the spot, too.

Most  importantly, all have the opportunity to enter a side room in small groups for prayer. Skip and Barb poured out their hearts to woman after woman, hearing their worries, lending a compassionate ear, laying on hands and praying. Theses women carry heavy burdens of rejection by their families, abuse in their marriages, anxiety about who will care for their children when they die, weakness as they deal with their own declining health. Being heard, and being interceded for before God . . . these are gifts that the Ryans and Pastor Kisembo offered.

Finally there was a message to all: a sack of beans and a cup of oil given to the dying, God's miraculous provision to the widow that aided Elijah reflected in the present reality, a gift that can multiply into grace for many. Each woman was then called forward to receive the food, and a generous "transport" allowance (cash) to get it all home.

A LONG day, person after person, so much brokeness. Yet these are always celebratory days too, giving good-news test results to most, seeing growth and survival. And witnessing the partnership of a former team mate who advocates, a generous supporting couple who finances, nearly our entire team at work, a dozen health workers who give their all. We are grateful.

By any road

The over-night trip to Semliki Safari Lodge was, as in past years, exactly what we needed. Peace and privacy, sun and a small pool, the raucous sounds of monkeys in the trees outside our spacious tent in the night, morning birds and coffee on the porch, long talks,excellent food presented in civility. And this year the treat of going with Skip and Barb Ryan. Who would have believed that thesepeople who seemed a short step down from deity when we were in college 25 years ago would now be spending a retreat sharing focused attention, love, concern, and prayer . . . would now be our friends?Amazing.

The trip home, as it often does, threatened to thoroughly erase the restoration of the almost two days away. All was well until the very top of the mountain switchbacks, when our right rear tire blew out.  Scott got the truck to the side of the precarious road and jacked up in a few short minutes, he's had so much practice. Then we found outthat not one, but BOTH of our spare tires were flat. These were tires that had been repaired, one in Kampala at the premier tire centre, but inexplicably over the journey on the roof rack had lost their air.

Even for us this was a new situation: six tires, only three usable, so stuck. It was not long before the first truck stopped and let Scott add on to the mountain of matoke and clutching passengers, with the two spares, to the nearest village (about a half-hour away). Meanwhile the Ryans and I sat on the tailgate reading books in the dusk of the deserted mountain road, until Pat and Nathan came along, also returning to Bundibugyo from an EGPAF meeting in Kampala. To make a very long (HOURS) story shorter, Barb and I ended up getting a ride home with Pat, in the dark but at least in time to get my kids from the Pierces and to bed. Nathan and Skip waited for Scott to bring a spare back by motorcycle in the dark, discover that our new jack was not functional, wait for another good samaritan to lend a second jack, change the tire, have it go flat again, get a the second spare on, have the car fail to start, finally get it started, have the second spare begin to leak air, and at last have the angelic driver of the good samaritan truck wedge a pebble between the tire's tube stem and wheel rim that maintained enough air to carry them home at about 10 pm.

This morning I read this quote" The Lord is glorified in a people whose heart is set at any cost, by any road, upon the goal which is God himself. A man who is thus minded says, 'By any road!' Amen, but our road has quite a few bumps, jolts, mires, and treachery. And flat tires, dust and delays. Praying we can stay on track.

rest and small things

Rest: I am profoundly in need of it. Scott too. For the last several years we've taken a night away in November, ostensibly for Scott's birthday, to the luxury tented safari camp inexplicably located only two or so hours from our home. It grew out of a friendship with the managers, and has become a lifeline which we could not otherwise afford but desperately need. So readers-who-are-pray-ers can ask that the next 36 hours be a time of focus inward, a freedom from the every-ten-minute demand and crisis of normal life, a refreshment of beauty, quiet, sleep, and soul-connection. And pray that we make it through this day to reach our rest! Today I found 43 inpatients on the 25 bed ward, in other words an insane and exhausting crush of sickness and sadness. Plus two phone calls in the midst of rounds, one from Mulago and one from Mbale, were I have sent patients, whose needs still reach me. Near the end I came to little Mbabazi Kristine, whose mother has remained cheerful throughout more than a month of struggle over her dwindling life. Not so today, today her tears began to flow, and she asked to go home. Heidi had the good idea of introducing her to her across-the aisle neighbor who once looked the same and had the same diagnoses, but is now a solid chunk of a boy. I don't know if she was convinced to persevere, but I begged her to stay. Slogging through all this and trying to think clearly and compassionately in two languages pretty much wears me out, some days more than others, and this was one of them. Add to that concern for team mates and their hearts, treading fine lines that I fail to navigate well that require listening and supporting without fixing and answering, absorbing the angst of four kids entering exam periods, embracing my limited-ness and living in the hands of an all- powerful God . . . well, I'm ready for a break. and hoping that no sudden illness or disaster keeps us from it.

Small things: we had an extended prayer time last night, for the coming Day of the Lord in Bundibugyo, a time of repentance and vision for God's purposes . . . based on the book of Zechariah. In preparation I have been reading and re-reading the book, full of fantastic visions and poetic truths. It was not until prayer time, though, that the phrase jumped out of chapter 4: "For who has despised the day of small things?" This comes right after "Not by might nor by power, but by My Spirit, says the LORD of hosts." Rather incongruous, God of the angel armies in His power commending us to notice the small things. So today I offer a brief testimony to a few small things, mostly because in my tiredness I need to remember the fragility of redemption's visible presence in the muck of now. The best: Fransini smiled. Again. This baby was essentially dead last week, a tiny bit of orphan with a dedicated grandmother who was gasping with pneumonia so distressedly that we resurrected a long- disused generator to get power to the old oxygen concentrator . . . and now he's smiling. And we're matchmaking him to his six-month-old wisp of a female counterpart, Malyamu, who dipped down into the realms of death last week too, but has now revived. Both just reached 4 kg milestones (a 25% improvement on their descent to the 3ish range), and both smiled at us, little human eyes looking for interaction in spite of their hungry suffering. 

One more anecdote...this afternoon, I dropped in on a nutrition seminar completely organized and executed by our three extension workers, a small group in the grand scheme of addressing world hunger . . .but 26 community members, men and women, young and old, had gathered to discuss team work and community development, chicken eggs and sustainability.  And best of all, we merely encouraged and observed, it was Lemech’s vision.  

Fransini and Malyamu, the prayers of a team mate, the pink clouds at dawn this morning, my kids who selflessly encourage us to go for this jaunt of a vacation without them, a bite of bread an sip of wine that partake of the reality of Jesus, these small things I do not despise.

About Blogging

During tonight's phone conversation with Luke he said, " You need to update your blog, it's pitiful" (meaning he's missing home and he wants news and photos). Caleb's reply from a poster he saw on-line (using his usual filing-cabinet brain to retrieve an appropriate quip):

Blogging . . never have so many with so little to say

said so much to so few.

Ah, out of the mouth of babes.

Too much of a good thing?

When we moved here in the 1993, Uganda's population was HALF what it is today.  We are living in a country whose growth rate is among the handful of the highest in the WORLD, exploding before our eyes.  The good side of this is that Ugandans value children, value family.  The bad side is, that like any good thing, children (or more accurately multitudes of children) should not become the goal of life.  Only with a goal of God Himself in the center of life can we avoid country-wide indifference to the plight of children and killing of the almost-born (America) . . . or country-wide pursuit of fertility at the expense of the already-born (Uganda).  Every culture has its blind spots, certainly. In the US we accept limits on some good things (consumption of red meat or ice cream, for instance) but not others (pursuit of sexual gratification).  This week I sat at the bedside of a smiling but starving baby, whom we were trying to rescue with milk.  Her mother's lethargy and reduced lactation became more explicable when she confided that her surgical wound from delivery (C-section) remained unhealed after 4 months.  Yet the baby's father, a man in his 60's, was resistant to the idea of family planning.  I tried to reason with him that having a child every year, and all of them dying, did not help him as much as a child every 3-4 years who lives . . . don't know if he bought my logic.  Decisions about sexuality and reproduction are rather personal, but the implications and effects ripple out, sometimes into a tsunami which engulfs innocent children and suffering women and desperate men.

Grammy's Appendix

We were SHOCKED to learn this morning that my mom was in the hospital, having just had her appendix removed! She was experiencing some abdominal discomfort for a little more than a day, went to get it checked out, and a CT scan and few hours' wait later she found herself being wheeled into the operating room. Thanks to my sister we found out by the time she was recovering, and were able to talk to her on the phone. As I went on rounds seeing my Bundibugyo patients an hour later, I felt the familiar frustration of being pulled into the needs of these patients and absent for the needs of my own family. But there are a few things I am very thankful for: first, the good medical care my mother received. Second, that she bravely went through the whole procedure on her own but did not feel lonely, that she can experience the peace and presence of God. Third, that our amazing church friends are faithfully and willingly picking up the role that we are unable to fill. And lastly, that we now have cellular phones, so that instead of finding out a week later that my Mom was ill, I merely had to talk my way through the hospital switchboard operator and two nursing stations to track her down right in her hospital room! Last week I called my hospitalized aunt as well. It is no substitute for being there in their hearts, but it helps ME to be able to hear their voices, standing amidst cocoa trees on the equator and chatting with them in their high-tech hospital beds in Virginia!

Happy Birthday to My Man

Today we pause to celebrate Scott's life. He is a man that can lead a Bible study or a worship song, perform a surgery, fix an engine, plant a garden, compose a photo, milk a cow, balance an account, score a goal, paint a picture, tell a joke, cook a dinner, debug a computer, or build a house. A recent good-read was The Time Traveler's Wife, a book I liked because the woman in the title got glimpses of her husband as an older man, and she liked what she saw. I met Scott 28 years and 1 month ago . . . and though I thought he was good-looking and athletic and smart then, I had no vision of the depth which would mature in his character and skills. So today, a tribute to true love, and to my man.

A Tale of Two Babies

We hosted the EGPAF (Elizabeth Glaser Pediatric AIDS Foundation) team for a 24 hour Bundibugyo tour: a distinguished emeritus Duke Pediatrician, a sharp young Ugandan doctor whose practical compassion always refreshes me, a former Ministry of Health doctor who actually understands the protocols and systems and can relate to our staff, and a woman who, as Scott says, is "in charge of Africa" (not an enviable task) meaning she runs the prevention of mother-to-child transmission programs for the foundation. Plus two amiable drivers. All enjoyed pizza courtesy of our team last night, and then spent today touring our programs. Interestingly there were two approximately 1-year-olds admitted to teh Paeds ward who exactly illustrate the spectrum of the problem.

First, Mbabazi Christine, who will turn one later this month, and barely clocks ten pounds, febrile, fussy, wide-eyed. Her mother is a soft-spoken second of three wives, and has already watched her first child die. When she went for antenatal care this time she claims she tested negative for AIDS, but lost her records. She probably feared the stigma, and chose to hide from care. She did not take the medicine which can reduce the risk of transmission. She did not get treatment for Christine, either, until her condition became severe. Now we have been trying to rescue her for a month with UNICEF milk, and two weeks with anti-TB therapy, but we have yet to see improvement. These doctors confirmed our suspicion that she will not respond nutritionally or respiratory-wise until we begin to treat the HIV virus. Very complicated given our limited resources.

Contrast this story with Baby Scott. Yes, remember the first baby to be born in the new Maternity Ward? His mother is a large and pleasant woman, unafraid of her identity. She accepted her results, took her Nevirapine pill, and made sure her baby got his treatment. She comes to clinic. She practiced exclusive breast feeding up to six months of age, then weaned with the help of a dairy goat provided by the Matiti Project (which she also named Scott!!). Baby Scott's viral tests have been negative twice. He has escaped infection, and though he was admitted now with a little diarrhea and goopy nose (like most of Nyahuka these days) he should be fine.

This is what Kwejuna Project is all about, to give mothers the hope and the means to protect their babies from the virus that has devastatingly entered their own lives. It does not always work . . . but we are grateful for the opportunity to channel the resources of this large American charity, of our many supporters, to help real women and real babies survive.