Reading nature

Early morning, pre-dawn dimness, the flutter of fruit bats with their
paper-thin wings and ominous swoops, returning to roost in the royal
palms, darting under the eaves and through the trees. I stand in the
yard and look up as one of the bats erupts in shrieking. An eagle
hawk grabs an oblong bundle of bat, holding it in his talons as he
flies low and powerful between the trees, confident, conquering.
Since ebola, it is hard not to see bats as evil, harbingers of
infection and rustlers in the dark. In our prayer times this week
we've been focusing on the fact that the unseen reality trumps the
visible problems . . . So as I stood watching this improbable scene, I
thought of angels, swooping down with precision timing and selection
to protect us from a particular crisis. Outnumbered but still
individually strong, pulling one problem out of our way, but not
eliminating the swarm of evil. Yet.

Later, the hospital is abuzz with the events of the night. Scott is
told by the staff that a rather prominent business man, a trader on
cocoa, who lived nearby, died. How? He was relieving himself outside
in the night when he was attacked by a snake and bitten SEVEN TIMES.
In painful places. People told us with assurance that the snake even
followed the man onto the hospital ward. I suppose it is reasonable
to assume it could have been gathered up in his sheets or clothes as
it tried to escape while his collapsed form was being transferred to
care? But the idea of a snake that stayed around long enough to
strike that many times, had enough venom to kill a grown man within
the hour, and appeared even on the hospital ward, is rather grim. A
tangible enemy, to be sure, unlike the subtle viruses, mutated genes,
or creeping fungi that attack most of my patients. I came home
forgetting the small victories (a preemie reaching 2 kg thanks to his
mother's skin-to-skin incubating care, and going home; a stick-figure
little sickle cell patient now smiling, naked except for her stuffed
giraffe tied to her back, having climbed from the ditch of
malnutrition to resume her march along the road to health) . . . in
the tragic arrival of a primary-school age child who presented with a
massive brain tumor growing out of her nose, her blind eyes swollen
shut, beginning to have trouble breathing, her disease having
progressed months untreated and now nothing more to do than palliate.

I am reminded, as I am many days, of the apt watch-phrase: "How goes
the world?" "The world goes not well, but the Kingdom comes." We
could use a few swoops of the hawk.

Deadly Beliefs

One of the great gifts of having a team nurse is that Heidi has allowed (?insisted) that I not do inpatient rounds EVERY day . . which has freed up Tuesday mornings this month for one of my first loves, community health and medical anthropology, the exploration of beliefs and their impact on health.  There are many strong and healthy and God-reflecting aspects to local culture.  There are many other neutral practices.  But there are a few deadly ideas, beliefs which result in much suffering and needless mortality.  I applaud the former, ignore the middle, and vehemently protest the latter.   I frequently see children in the terminal stages of dehydration and infection who have come to the hospital in a last desperate attempt to save their lives, after their well-meaning parents have subjected them to some barbaric practices.  Though I plead and lecture on the ward, it is a losing battle.  So this month I invited five recent CSB grads (3 of my male students and 2 girls whom I came to know well as their cell group leader) to conduct qualitative research on the topic of "bhiino", or "false teeth".  

These kids conducted 50 interviews with a cross-section of community members, and today we gathered to discuss their results.  The basic idea is that severe diarrhea in infants is caused by the presence of  evil abnormal teeth hidden in the gums, and these offending teeth must be cut out by specialists in the community, extracted by knife-point from the toothless gums of the babies.  This cultural practice filtered into Bundibugyo in the 1970s on the heels of Idi Amin's soldiers, who carried the idea from their home regions to the North.  By now it is so pervasive and popular that EVERY woman and most of the men interviewed reported having taken at least one child for this procedure, and EVERY informant believed beyond the shadow of a doubt that such teeth exist and must be manually extracted to save the life of the child.  

Sadly, the reality is that the mutilated babies refuse to drink, becoming more dehydrated, and the wounds from the non-sterile crude knives often become infected.  We say on our team (in memory of Michael Masso and Kevin Bartkovich) that we are life-long learners.  And though I've been speaking out against this practice for 15 years, I learned new things today.  First, that mothers blame themselves when their baby gets this problem, for not wearing herbal protective charms around their waists consistently throughout their pregnancies.  This struck my heart, because I know that parents allow and in fact pay high prices for this procedure because they truly want what is life-saving for  their child . . and now I realize the underpinning of guilt that makes the whole scenario even more desperate.  Secondly, I learned that the what I consider to be the second most deadly belief, the forcible administration of enemas to babies, is not a completely separate entity but is often combined with the tooth extraction.  So the baby who was already sick, whose mouth has just been sliced up, is further compromised by the dehydrating and painful procedure of having herbal solutions blown into  his or her bottom through a pumpkin stem.

This week's task:  for the young people to design an intervention to combat these deadly beliefs.  The encouraging thing is that our communities WANT their children to survive and are going to great lengths to ensure that they do . . it is just the tragic misunderstanding of reality that turns their heroic efforts of love into the fatal incisions of destruction.  I read to the group from Matthew 2, Revelation 12, Jeremiah 31, all referring back to Genesis 35:  the battle is real, and the battlefield is all too often the vulnerable bodies of babies.  Rachel weeps when her children are assaulted. Let us comfort her with truth.

Back to School

The mile of dirt road which stretches in front of our house hosts no less than five primary schools (3 large government schools and two major newly-opened private ones) and three secondary schools.  I would estimate that these 8 institutions enroll over two thousand pupils, not to mention that dozens of others use the path to head further afield.  So when the school year officially began this week, let's say it was quite noticeable!  Clusters of boys and girls, from tiny tots to burly teens, in solid color trousers and white shirts, maroon shifts and checkered blouses, a palette of colors, shapes, and sizes, all flowing up and down the corridor.  This is the first new school year since my neighbor died, and his successor son decided to observe a cultural practice involving sending the wives of his father back to their pre-marriage relatives (in spite of the fact that these women have lived there for 20 to 40 years . . .).  So I ended up taking the two teenage parent-less girls to sign into "Parental Care Primary" school.  It was also the first year of a stricter and more organized CSB entry process, so I went there to sign in my usual boys.  It was somewhat festive, rubbing shoulders with other parents, many of whom I know, respectfully waiting my turn, paying fees, saying goodbye.  Students greeted each other, harried staff members searched through trunks to enforce the proper clothing and shoes and books being brought.  And so the 2009 year begins here, hopeful.  

Give A Goat

A comment on the blog asked if we require goat recipients to return the first female offspring to the program. The answer is YES, we do. Only 8 were returned in 2008, but our extension officer anticipates at least a dozen more coming soon (female kids that he's seen in his home visits). The vision is that this program eventally become self-propagating, so that needs for immediate individual assistance can be quickly met as mothers die or as HIV-infected mothers wean their babies. But we also have a growing vision for the broader problem of chronic widespread under-nutrition in toddlers and preschoolers. Bundibugyo's stunting rate is 43%--that means almost half of kids are shorter than the lowest cut-off for normal in a healthy population. This happens because small bodies faced with repeated cycles of infection and access to minimal calories and protein compensate by slowing their linear growth to preserve survival (even our own child experienced this in his second and third years of life here, though he's recently miraculously sprouting lengthily). Our dream: the male dairy breed goats that we import will be used by every village, crossing with the hardy local goats, to eventually produce flocks of little milk-makers, adding high-quality protein to the marginal diets of most children. The Joy Children's Center in Masaka has provided most of our goat stock and we continue to work together towards this end, thanks to Karen's years of establishing the program, Lemmech's daily forays into the bush to follow-up on goats, Sarah's careful records and accounting, Pat and Heidi's patient screening of potential recipients, our Nairobi team's creative assistance with hand made ornaments, our Sending Center's coordination of gifts, and the 117 extravagantly gracious people like the commenter on the blog who actually purchase these goats for poor families. It's an amazing partnership (remember our themes!), made even more powerful by the prayers which accompany the giving.

A Vision of Hope

The 2009 school year begins tomorrow . . . and so tonight our WHM team joined the CSB staff for a prayer walk, bathing every corner of the campus in praises and supplications. David shared a few words about the faith of Caleb in the Bible, who was not intimidated by the giants in the land of Canaan because he sensed God's power to be more real. Annelise kept us moving from dorm to dorm, classroom to classroom, in small groups and then all together in a circle of prayer. We prepared the way for the students by asking God to do great things: to protect from disease, to give a passion for learning, to provide adequate food, to inspire teachers, to draw forth worship, to change lives. It was a beautiful tangible picture of our partnership, and a way for us to collectively acknowledge that like Caleb we know that the God we serve is the One who can bring true change to CSB.

And our vision of hope was boosted by the weekend's news of the O Level exam results. Christ School emerged as the leader in Bundibugyo once again, with 5 students in Division One and NO FAILURES. To put that in perspective, we had 5 of the 8 division one scorers in the district, but only 51 of the 435 students. That means a Bundibugyo student at CSB was 8 times more likely to score in the top tier than average. And in our district more than 10% of students fail, but none of ours did. We still have a long way to go to meet the highest national standards, but this was hopeful news.

And so we meet the new year. The giants in the land are real (alcoholism, abuse, cheating, mediocrity, rebellion). But the grape- cluster vision of what God can do makes it worth the risk to move forward.

Provision

Let us take a moment to be thankful, and to acknowledge the power of provision as a firm confirmation that we must persevere here. While the entire world scales back expectations, and struggles to navigate the thin ice over bankruptcy. . . God has moved many hearts to provide for the Kingdom advance in Bundibugyo. A paradox, for sure. We were tentative in our goat hopes this year, and would have been thrilled to fund 50 . . . but 117 were purchased through the Christmas Ornament Matiti Give-a-Goat fundraiser!! Lemmech will begin training new owners in February for the first allotment to go out in March. Amazing gifts have come in for Christ School, dramatic and generous answers to prayer, churches and individuals sacrificially putting money (that is no longer flowing so easily in America) into Ugandan education and discipleship. And a heartfelt salute to our own supporters, whose end-of-the-year outpouring of mercy carries us into 2009 with great hope. We've already been able to share the bounty with a boosted power supply for the lab fridge for blood banking, and with the nutrition office to computerize the goat database. Next on our list will be the non-glamorous but very-necessary addition of a new latrine for hospital staff housing. Dr. Jonah's children began their new year of school and our medical students continue in their studies thanks to your gifts. We are humbled and grateful to witness so many giving, not out of excess but in spite of your own financial losses, out of love.

And, equally amazingly . . .the Chief Administrative Officer has announced that an entire year's worth of government funds for health in the district have been "recovered" from the various departments which had "borrowed" them for other business. This is a huge answer to our anti-corruption prayers. Pray for this man, Elias, who faces not only opposition but no doubt also temptation to allow shadiness to continue. It takes much effort and courage to draw the line.

So both through donors and through the Ugandan government, God is pouring out His provisions in response to your prayers. Keep it up!

Disparity

A Ugandan woman in Gulu delivered premature sextuplets this week, after 4 months of hospitalized bed rest. And every one of them died. There was a newspaper story about her grief. She left the hospital with nothing to show for her love and effort.

Meanwhile the California octuplets make world headlines, having had 46 doctors and nurses attend their delivery, receiving state-of-the art intensive care, and all are so far alive.

The babies in both cases were similar sizes, 800 to 1000 grams. But California and Gulu are worlds apart. Regardless of who used what fertility drugs (the Ugandan woman denies, and the American might deny too) . . . the ethics of selective termination have overshadowed the more glaring ethical question of justice, of a world where one woman buries six and the other goes home with eight.

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.