And it was very good

Genesis 1 contains this refrain, which clamors to still echo in our hearts in spite of brokeness. God created this patch of earth upon which we live, and His work was good. Last night we conversed among ourselves as missionaries about having eyes to see the imprint of God's abundance and goodness as we view the world here, and today I sat with five young people talking about culture and belief and what they saw in their own traditions that was good, that they wanted to preserve. So this post is dedicated to testifying to the deep and original goodness of Bundibugyo.

From outside, looking in: jagged mountain views in the clear morning, fertile soil, community spirit, genuine joy in relationship, assuming that visitors are a blessing and that work should be shared, the privilege of being called into the work of responsibly managing the earth's resources, the precious value of children, the generations of skill in keeping goats (yes, a phone conversation with an agricultural missionary yesterday reminded me of his informed opinion that the people of Bundibugyo are very good at this!).

From inside, looking out: circumcision ( a healthy and community- binding cultural practice), respect for elders, the investment of elders in advising younger people, bride-price (the way this values women).

Let us look around us this week with Genesis 1 eyes, to see the goodness.

On Night Screams and Psychologic Conundrums

We finished dinner last night in the lovely glow of candlelight, abundance, fellowship and thankfulness, Bethany with us for her last night in Bundibugyo (for a while) and the Pierce family having just returned from a CSB leadership team weekend retreat. We sat around the table still lingering over fresh chocolate chip cookies (team care packages! Yeah!!) and fresh milk, hearing about the way the CSB teachers are gelling into a great team for the beginning of a new year. Suddenly we heard commotion, cries, screams from not far away. Scott and I went outside with flashlights to see if our neighbors were OK, as the noise grew into a wail. "Someone has died", Scott commented, but as we walked in the absolute darkness out our driveway to investigate, the disorderly sounds of riot approached us. It was one of our neighbor-friends, carrying a 13 year old limp and apparently lifeless boy, supporting his hysterical grieving mother and trailing no less than 20 relatives and onlookers from babies to grandmothers, all shouting and mourning and working themselves into a frenzy. I reached for a pulse and determined the boy was alive, spread him on the floor of the kitubbi and opened his airway for breathing while Scott scolded the mob into order with the assurance that he was not dead, yet. When they were able to calm down slightly they said he had been well all day, eaten and played, but suddenly a fever "caught" him and he collapsed, and convulsed. Clearly his mother, whom we know well, was completely convinced that he was dead when they came running to us, and her anguish was real and raw. He felt cool, maybe clammy, not febrile, no increased pulse rate, no findings on exam except being unresponsive to voice or touch. They denied any trauma or ingestions of poisons . . . sometimes the initial rigor of malaria can be accompanied by a seizure before the temperature climbs, so we injected him with a strong anti-malarial and Scott drove the entire entourage down the the hospital for admission on an IV. He did not react to multiple needle sticks . . . but a couple of hours later his father reported he was awake and sitting and acting normal. It turns out he had been in town watching a video against his parents' permission, and when he came home he was "punished". No signs of abuse, and no story from him even this morning.

So what happened? A drama to get out of trouble? I don't think it is that straightforward. Interestingly there were two pre-adolescent boys admitted last night with similar stories. A learned response to stress? It seems similar to the way women cope, the collapse, the breakdown, the outpouring of community emotion, the wave of concern that carries the group to the hospital, then the mysterious complete resolution. I think that it is 99% subconscious, an ingrained cultural pattern. Except for the heartbreaking moments for his mother, and the inconvenience to us, the possible waste of a dose of medicine . . it was a way to diffuse the family tension over his behaviour, and all's well that ends well. The nurses and I gave him Aunt-like advice on not repeating this episode, and he went home.

We all long for the assurance that we are loved, that we belong. Perhaps if we told each other in the daylight, the night screams would not be necessary.

Starbucks, Bundibugyo

Two former team mates (three cheers for Amy and Stephanie) sent
amazing coffee this week. Yes, we live in the land of cocoa and
coffee trees, but NOT the land of chocolate factories or processing
plants, so a bag of really nice roasted Starbucks is still a treat.
This coincided with the first batch of fresh milk from our cow.
Combination of fine coffee, fresh hot frothed whole milk, and the over-
the-year-and-miles friendship of Bethany sitting in our kitchen
Saturday morning . . a taste of Heaven. Even here.

all in a day's work

Sending home a little 7 year old sickle cell disease patient who presented extremely ill, unstable, septic a few days ago, but now is walking out on his own, the wonders of IV antibiotics. I've been caring for Aligonila since he was born, struggled many times in his early years to get him knick-of-time lifesaving transfusions, and sat with his mother's tears when her other child with sickle cell was brought in dead from his grandparents where he had been staying. This family is the same one supporting little Lydia whose burns are healing. . . soft-spoken and genuinely concerned father who numbs his burdens with alcohol . . . this is a taste of small town family medicine, the continuity over time and the spread of relationship over a complex web of consanguinity.

Staff meeting topic of the day: teeth, their normal pattern of erruption, the basics of preventive hygiene and care. It is a topic I want to focus on for a while, because of the insidious and destructive belief that "bhino", a bad or false tooth, in an infant's gum is the source of diarrheal disease and removal by razor blade incision can cure. In fact, the removal often leads to death as the baby stops drinking or the wound becomes infected. Rousing discussion from the staff in which it became clear to me: these people are not REALLY convinced themselves that the "bhino" hoax is wrong. There is lingering doubt in their minds. They would prefer to get the gums cut and then inject the baby with penicillin. Cover all the bases, witchcraft and science. If the staff are ambivalent, no wonder the villagers take their babies to ritual specialists for this dangerous procedure! I try to affirm the underlying good of this culture's value on children, of their desire to do what it takes to cure . . while suggesting that culture constantly changes and there are choices involved in what we embrace and reject. The intersection of medicine and anthropology always interests me, the connection between behaviour and health, between belief and action.

Last inpatient of the morning: a premature baby who in six weeks has held onto life and climbed from just over 1 kg (2.2 pounds) to a whopping 2.08 kg today (4 1/2 pounds). I realize her teenage mother's entire experience of parenthood has been in that hospital bed, she is gigglingly happy for the victory but intimidated to leave our care and be discharged. Last outpatient: a 2 year old with the tiniest head I've ever seen, almost no substance above the eyebrow line, blind and deaf and spastic, but with a matching suit of clothes and healthy skin, evidence of a mother's careful sacrifice month after month. I'm humbled by her perseverance, though unable to offer much more than seizure control and vitamins. Last kitubbi-at-home patient of the day: a two month old with a heart rate almost too fast to count, 260-300 beats a minute, whom we've treated for a few days in the hospital for infection or dehydration. But this baby looks and acts well, it is just a rollicking heart that can't hold out like that forever. So we bring him home where I have a fridge, fill a bag with ice water, and while Heidi monitors his heart with a stethoscope I basically smother him with a freezing damp face pack. He holds his breath and the newborn diving reflex kicks in, breaking the gallop down to a reasonable trot of 150 beats/minute. I don't want parents to trust tooth-extracting witch doctors, but I do want this mother to let me apparently suffocate her baby . . .

Scott comes back from Bundibugyo town with packages galore for the team, Nathan's mom and my mom, Stephanie Jilcott and friends of the Massos and Pierces and Heidi, a delayed Christmas. And he brings Ivan's PLE scores, division 1, which puts him in the top 5% in the nation this past year. We are thrilled for him.

On to pizza preparation and team meeting as a surprise rain soaks the ground, cleaning and catching up with correspondence. All in a day's work.

red rover, red rover...

Scott here.

Wednesdays are crazy days at Nyahuka Health Center. I spend the morning conducting an ultrasound clinic adjacent to the HIV Care and Treatment Clinic. I see a variety of obstetric, gynecologic and pediatric cases. But, mostly I am there hoping to catch HIV+ women in for routine HIV care so I can quickly scan to confirm their dates, do some continuing education about their pregnancy/HIV issues, and try to build bonds of trust with the medical establishment. Today, one of our HIV+ moms was in the "walking around stage" (active labor), but the midwife on duty (Judith) was concerned about the baby's position. Indeed, her scan showed the baby was breech and still very high in the uterus. Judith was not comfortable delivering her at Nyahuka and asked if I could take her to the hospital so that emergency surgery might be available if necessary.

"Fine, no problem. How, many centimeters dilated is she?" "Ten centimeters, doctor (fully dilated--7th baby)". "Judith, she's going to deliver in my truck on that bumpy road!!" (No response. Awkward silence.) "OK, Judith. I'll take her. Get her stuff and her people ready."

Ten minutes later, the patient and her belongings appear at my red LandRover with their pots, pans, mattress, etc.. And Judith. "Doctor, I am going to come with you just to make sure she's OK."

So, we proceed, bumping, jolting, groaning over the twelve kilometers of undulating road which appears more like a rutted, rocky riverbed than a road. One hundred meters from the hospital the passengers in the back bang on the glass. "Slow down." "Is she ready to deliver?" "Yes." "Then shouldn't we speed up?"

We pull into the hospital parking lot and I hop out. The baby's hips are out. Judith applying traction gently, expertly. In typical fashion the crowd gathers, gawking, staring without one bit of respect for the fact that this woman is totally exposed in the back of my truck. I move the truck trying to position it to protect the patient. No time to move the mom. A few minutes and the baby is out.

"Webale Kwejuna" (thank you for surviving). "Webale kusabe" (thank you for praying).

One more thing.... it was a boy. Baby Obama.

We turn around and go back to Nyahuka Health Center, the baby receives his medicine to prevent HIV transmission from his mom... and the mom walks home.

(Note: cell phone photos...apologies to the shy).

On Leadership

We returned from our retreat just in time to gather round CNN by satellite and watch the inauguration. I sat between Caleb and Ivan, both born in Africa, watching this man with an African father ascend to the powerful position of president. He's a third-culture-kid, as ours are. And more striking to me (because Obama's connection to his father seems slim and his pigment almost unnoticeable to our Africa- trained eyes), the first lady emerges from a family that truly did have generations in which slavery and oppression were the dominant reality. We marveled at the music and prayed along with Pastor Rick Warren in our hearts for the wisdom and balance and courage only God can give. We gasped along with hundreds of millions of others as the supreme court justice fumbled the short 35 word oath. We concentrated on the meaning behind the speech from the perspective of our neighbors, listening, hoping that American impact will improve their lives in some way. We laughed aloud with pleasure in the rolling cadences of the benediction.

But mostly we saw a leader. I do not know Obama's heart, and can not predict the balance of good and evil he will usher into the next four years. But the world watched America yesterday, hummed our Star- Spangled Banner (Pat was made to sing it solo at the workshop she's attending today, and I can tell you that has NEVER happened to us in Uganda before!!), and considered that we may represent a nation that embraces justice and sacrifice and honor and ideal and not just wealth and power. I believe it was a taste of the way my parents' siblings strode into the 1940's and the leadership that decade wrested from them. It was fun to join from across the world the excitement of the day and see the boost Obama's leadership gives our African friends. They gather from his smile, his poise, his rhetoric, his stride, that he is ready to lead.

Journeying with Jesus

This was the theme on which Donovan spoke to us, or rather didn't speak much but led us into times of silence and reflection.  He prepared four evening meditations and four morning times of processing and journaling and listening to God.  These turned out to be the perfect framework for the work of the rest of the day, personal depth out of which to enter into trust and dream and plan and refine goals with the group.  We did some interesting exercises together to understand our unique gifts and affirm them, as well as consider our challenges and sins and pray for them.  The heart of the team time involved trying to narrow our focus to the main thing God was asking of our team in 2009, and here again Donovan's theme proved useful.  We built on previous retreats in which we had developed vision (destination) and mission (the road to get there) . . . by describing our current focus as method (the vehicle in which we will traverse this winding and muddy road this year).  

"By prayer and partnership, investing in emerging Ugandan leadership as we work together to  show the compassion of Jesus to the poorest".

This sense that God is calling us in all our work to invest in emerging leaders is not new, and has been a large part of the CSB purpose and our many sponsorships through schools of nursing, theology, education, medicine, etc.  But it was helpful as a team to consider our work strategically from this perspective, to pare down some draining but less productive activities, and to challenge each other to consider new ways to invest in people.  And to remember that we do not do this in order to make leaders powerful or wealthy, but in order to multiply the hands that serve the world.  Once we had committed to this method we were able to look at data from our diverse areas of ministry and discuss and apportion our 2009 plans.  

Meanwhile Bethany, former teacher of our kids and recent seminary counseling grad, worked with the team kids as a group and met with them individually.  And she was unexpectedly boosted by the availability of teacher Laura from Fort Portal, so we were well cared for.  The pruning loss of 2008 has hit the kids' hearts too, and we are thankful Bethany was able to join us in ministry to them.  All of this occurred in the spectacular setting of a nearby safari tented camp . . the word "tent" being rather a weak association for the tastefully laid out bedrooms on private platforms where porches overlook trees of monkeys or kob coming to a water hole.  One evening the whole team went on a game drive in two open jeeps, the cool breeze as the sun set, the scuttling wart hogs and the gruffly suspicious buffalo, and even an elusive family of forest elephants disappearing into the swampy reeds of the river's ravine.  The sheer relief of having meals served with candlelight and flare, of hearing nothing but birds . . it was very restful.

We are thankful for the many prayers which brought us through this time.  I struggled with a mild fever and bothersome respiratory infection and Scott was truly seriously ill with high fevers and shaking chills causing him to miss some of the sessions, so we are very aware that the peace and beauty and productivity came at a cost.  Looking back I see that all we asked for, we received:  the testimonies of our hearts confirm that God did show up, the amazing announcement on the last morning of a hugely generous gift from two of our supporters to CSB that had been delayed by our mis-management of communication came as a redemptive "Lord will fight your battle" moment, the synergy of our meeting times gave us a greater sense of unity, the kids had a great time, even down to the final detail that the one meal hungry Naomi spoke of longing for (lasagna, not very common in rural Bundibugyo) appeared as our final menu . . all of this once again encourages us to keep our eyes on the LORD and wait and see the things He will do this year.

It's a wild journey.

A calf, and milk!!

Our dairy cow, DMC (for Dairy Milk Chocolate, the local Kenyan brand) delivered a calf on Sunday while we were away on our retreat. More about big blessings later, but as we returned home last night and head out to the work we've taken a break from this morning, here is a quick picture of the newest member of the Myhre family farm. The baby is a spindly-legged nappy-furred big-eyed girl, white and brown patched. DMC looks none the worse for wear, relieved of her burden and placidly eating away as milk begins to flow again. The kids are still deciding on a chocolate-related name . . . l

The milk from this cow is probably responsible for several inches worth of healing normal growth in our adolescent spurting children, and for significant contributions to the staying power of our whole team, not to mention various neighbors. We are grateful.

In the Semiliki Wilderness, Seeking Blessing

In a few hours we will trek north within our district to a lovely
tented camp within the first gazetted game reserve in Uganda,
Semliki. We have received MANY notes of encouragement and prayer
which demonstrate that you are joining with us in turning our eyes to
the LORD. Please pray for Him to show up in unmistakable and
unexpected ways. Pray that we would have a unified sense of His
leading. Pray that we would honor and love each other well with our
words. Pray that the kids would be renewed and boosted by Bethany's
ministry to them, and that all of us would be blessed by Donovan's
care for us as we plan. We will be off-line until next Wednesday.
For the world's good and God's glory . . .

On advocacy, abuse, enemies and justice

When I was in residency I pursued child advocacy as an essential aspect of pediatric care.  Sometimes a child's doctor might be the only adult who sees the neediness of his or her life, and the only voice to call for help.  Today Heidi and I were able to see that in action right here in Nyahuka.  We had called our local "child protection officer" about the little girl Lydia who was admitted last month with a severely burned hand while in the custody of her paternal grandparents.  The protection officer delegated the case to an energetic and articulate young woman whose role as "assistant community development officer" on our new Nyahuka Town Council seemed to infer the authority we needed.  So we found ourselves on benches in the treatment room shoulder to shoulder with Lydia's teenage mother and her cousin-brothers on one side, and Lydia's paternal grandfather and aunts on the other.  The grandfather gave his story of the injury (it was an accident and Lydia's fault because she was impatiently hungry and stuck her hand in boiling water to pull out a cooking banana), and then her young mother gave the story she had heard from this nearly-3-year old child (she was teased and goaded into trying to put her hand in the boiling water, but refused, so un-named persons at the home forced her hand in).  Medically the evidence fits the latter.  The officer then gave the grandfather the option of returning the girl to her mother's care and paying a monthly assistance, or of going to court.  There was much wrangling negotiation which took the better part of an hour, mostly based on everyone's assumption that the primary need in the family was for the grandfather to successfully pay the school fees for the absent young father so he could return with income to care for the two kids he has fathered with this young woman (I was the lone advocate for stopping his schooling and allowing him to face the consequences of his choices as a severe mercy).  In the end the grandfather wrote out a statement that he would pay a certain amount through the Town Council office monthly, and that Lydia's mother would take her and her sister home to her relatives.  This is only one small story of abuse and justice.  And I'm sure I've incurred some new enemies by speaking out.  But I have real hope that attitudes and expectations are changing, and responsibility is being required.  Let us pray.