Congo: Responsibility to Protect

Alex Perry writes in TIME, about the current conflict in the DRC, the ever-shifting alliances, the impotence of the UN to stop the bloodshed:

It's also about what MONUC is. In addition to 3,000 extra troops, Doss persuaded the U.N. Security Council to expand MONUC's mandate to allow it to target the commercial drivers of the war: the trade in Congo's minerals, like gold, and the world's largest reserves of coltan, which is needed to make components for cell phones. He continues to argue for an even more muscular approach to enforcing peace. "When we make these statements, when we claim the responsibility to protect, we have to be careful that we have the means to match our mandate," he says. "You don't go to war with blue helmets and white tanks."

Talk of war is a long way from traditional peacekeeping. But it is a direct consequence of the open-ended nature of R2P, and it raises troubling questions. Where does the responsibility to protect end? Does it mean fighting a national army? Does it mean supplanting a national government? Does it mean accepting the large losses that would inevitably accompany intervention in Somalia--the site of the world's worst humanitarian crisis--or in totalitarian states like Burma? Doss insists there are limits to what he proposes. "We assist the national process. We do not replace it," he says. "We're not an army of occupation." But introducing a foreign combat force into Congo would cast doubt on whether such declarations are sincere.

Definitely thought-provoking.  Some of my patients come from across the border, severely malnourished, or having been subjected to dangerous traditional treatments.  Where does our responsibility to them begin, and end?

By Partnership, By Prayer

Partnership:  one of our themes for 2009, and tonight we expressed our team's desire to partner with the Christ School staff by inviting them to join us for dinner and games.  Scott impressed the men greatly with his grilled chicken, and everyone ate their fill of hot foods and local sauces, cold sodas and fresh bread.  We designed some ice breakers (find someone with more than ten siblings, someone who was born more than 100 km from the place his/her parents were born, someone who watched a football match this week) which set everyone at ease, and then played "bowl full of nouns", a great group party game that has everyone acting and laughing, slapping knees and protesting points.   Joanna Stewart would have been proud.  It was an evening of camaraderie, a respite in their week of intense preparation work, and indrawing of collective breath before the 350 students arrive on Monday.   As with our team, a foundation of trust upon which to build the year's work.  The Pierces have worked hard to set a tone of ownership and responsibility, integrity and planning.  And perhaps the best part of the evening for me, to see my kids participating, at ease with their teachers in a way that is hard to achieve in the school year.  

Prayer:  our other theme, and we will re-join the CSB staff Sunday night for a prayer walk around the school.  This will be a time to physically move from dorm to dorm, class to class, asking for God's protection and power to change lives.  We know that oppressive sexual relationships and abuse, witchcraft, bullying, fear and shame, alcohol dependance, manipulation and cheating, all plague CSB and other schools in Bundibugyo.  I treated a 500 gm (1 pound) 25 week (5 to 6 months) preemie born to a 14 year old primary school student this week . . not from Christ School, but a stark reminder of the tragic turns many students' lives can take, and the fatal results.  So prayer is needed; please join us (5 pm = 9 am East Coast time Sunday, perfect for Sunday Schools and early services!) in asking God to actively invade this school in 2009.

Covenant of Faith

Wednesdays, early morning prayer meetings, gathering in the darkness to sing and pray. We rotate responsibility for leading, so that every couple of months each team member receives the gift of an hour and a half of group prayer focused on their own heart and life.

Today was my turn, and as I happen to be in Nehemiah I took the prayer from chapter 9 as my theme. Appropriately, this prayer is offered post-retreat, after the people have enjoyed in chapter 8 a festival of rich foods and communal worship such as we just did. The priests lead in praising God for who He is, thanking Him for the amazing things He's done (and we had quite a list for January 09 already, evidence of God's work in many details of life from Ivan's PLE's to Arthur's birth to thousands of dollars of CSB support to even more generous giving to our own support account), and then a long confession of sin all cushioned with the reality of God's lavish mercy and unending patience. It is not until verse 32 that the requests begin to appear, the plea for God's deliverance. Likewise we then moved into praying this morning for my ministry in 2009 along the lines of our themes and emphases from our retreat, asking God to deepen our prayer life, to strengthen partnerships among team mates but also with groups like UNICEF and UNC, and to bring fruit from the investment in emerging leaders.

After the prayer, the people of Israel in Nehemiah 10 renew their covenant with God. At first glance the details seem legalistic: no inter-marriage of their children with the pagan tribes, keeping the Sabbath free from work, paying tithes, observing the year of jubilee. Dry rules? No. At a second look it hit me that this is a covenant of faith. Where does the rubber meet the road when we are on this journey? When we have to trust God with the things that are dear to us: children, survival, finances, success. The people of Israel could work seven days a week, cut corners, cement alliances with marriages, pursue wealth. OR they could trust God and make unpopular and costly choices. They opt for the latter, and I prayed this morning that we would do the same. That we would trust God with boarding schools and friendships, with test scores and sports, with health and thriving, with enough money to go on.

It is a covenant of faith, to dwell in this land only by the mercy of God.

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.