Parenting teens

Parenting teens . . . in most cultures involves conflict, part of the movement from dependence to independence, from a relationship of authority to one of mutuality. I'm working with five young people ranging in age from 19 to 23, and observing their reception in the community as well as hearing some of their issues from home life (yes, thanks to Heidi and my new Tuesday community health schedule I actually have time to listen to them sometimes!) has given me pause for thought. Some issues in this culture and in this period of history conspire to make the inevitable growing pains more severe: this generation will be more educated than any previous one, and more westernized, so that an older teen could be tempted to despise parents' habits. In the case of harmful practices like polygamy or wife beating, this is a good and necessary cultural shift. Yet respect for elders is a pillar of African culture. A twenty-year-old must show subservience to a 40-year-old parent or teacher. My students must do their community health teaching with assurance, yet be perceived to be humble. At the same time fathers can feel impotent when unable to provide ever-increasing school fees, or when unable to guide from experience as a child moves into never-before-dreamed-of paths like University. In a place where authority has been based on force, physical prowess, and the wisdom ascribed to age . . . we are shifting into an era where sheer muscle does not translate into survival edge, and where knowledge of the world favors the young. Yet we expect these emerging leaders to behave with humility and respect even when their elders intentionally snub them to show who is boss (cruel remarks or harsh demands perhaps the only way they know how to maintain supremacy) . . . and we expect the parents to manage with grace the balance of discipline and freedom that a teen needs to thrive and launch, even though most have practiced a pretty hands-off style since the child could walk. I don't see many people doing it well. And my heart is with both the teens and the parents, struggling to find their way in a rapidly changing world, to know they are loved and valued, to test relationship and feel its security.

Dwarf Galago: species identification?

We have decided to call our bush baby Komba, in honor of a character in a book . . . actually the book I wrote the kids for Christmas features a bush baby, which makes this one dropping out of a tree and into our lives a bit interesting. Komba weighed in at 45 grams, that's 1 1/2 ounces. He is 6 cm crown to rump (a little over 2 inches). In other words, he's tiny. His chirpy little voice calls us from his box nest in the bougainvillea outside our kitchen door, and we give drops of warm milk and pieces of soft papaya. He has human- shaped hands, a wrinkled snout, over-sized ears, scraggly dark fur, and a curling tail. His personality is, so far, persnickety.

His order is primate, suborder strepsirrhini, family galagidae, genus galago. I do not know if his species is G. demidoff or G. thomasi, or some other species I can not find information on. So if the biologist (?Jesse is that you) who commented that zoonoses were rare in this family wants to hazard a guess from the pictures and data, we'd love to know.

It must be Monday

Early morning darkness, I am awakened from a dream in which I'm teaching someone to suture a wound which happens to be on my own foot. I'm sure there's meaning there, the wounded healer.

This must be Monday, the beginning of the week scramble for school uniforms (are they shrinking that fast, or are the kids growing that fast?), doling out yoghurt and granola, pasteurizing the morning's abundant fresh milk, making tea for my workers, checking the internet, looking for a misplaced school book, making lunches. A patient's mother arrives at 7:30 to tell me that her son (Paulo, thanks for praying for him!) finally got his surgery on Friday, to close his abdominal wall and allow him to urinate normally. She is followed by one of my students reporting back from his interview trip to the intensive Christian discipleship and boarding school work program . . no results yet, so we sit down to make a strategy and budget for beginning school locally in case he is not admitted there. Meanwhile my three kids lug their 20 pound back packs (!) onto their backs and get their bikes and helmets and head off to school, I finish my coffee and show my workers where to plant some papaya seeds. A little milk and fruit for the bush baby, and I'm off too, to the hospital.

On the ward Heidi helps me get started, then she has to head out to a smaller health unit where we are re-training nutrition outreach workers to begin another cycle of the Byokulia Bisemeya ya Bantu (BBB, good food for people) program. As soon as she leaves I discover that three one-month-olds with similar diagnoses (pneumonia) but dissimilar sizes (2, 3, and 4 kg) have had their charts mixed up, and it since mothers often don't read and don't seem to concerned about what their kids' name is (seriously I'm holding the papers and reading the names and they are all looking at each other unsure), it takes some doing to sort it all out. As soon as we get that settled (and no harm done, all were on the same antibiotics) . . . an unconscious child is rushed in, a huge looking 4ish year old, completely zonked. Mother and aunt had left him with other kids, no one seems to know what happened, later dad thinks he was hallucinating during the night . . . he's cool to the touch and floppy and sonorous, with junky lungs. Most likely thing around here is a convulsion that coincided with a major temperature spike from the release of malaria parasites, but he doesn't feel hot. I ask the mother if she sells alcohol. No. Could he have gotten into a stash, or taken any other drugs? No. But of course they weren't exactly watching. We bundle him into the treatment room, send labs, push dextrose, and put up drips for malaria. While I'm doing the lumbar puncture and the clear spinal fluid is dripping out of a needle in his back, dad remembers now that he found empty bags of alcohol at home . . this is strong stuff, vodka sold in plastic baggies. That explains a lot, but we can't afford NOT to treat malaria and pneumonia given his exam, until our labs come back. As I round, and look into each little face, I am reminded of how much children have to fend for themselves, how often they are left to their own devices. Tempting to gather them all in to my idea of safety, but I also see that they cling to their mothers (even to less- than-reliable ones). There are worse things than being ill, and being taken away from your mother must be one of them.

Roadblocks on the way home, with police. I hear someone calling on his cell phone to get help from his dad, it seems the police are confiscating all motorcycles without license tags (called number plates here). Which is most of them. The road is eerily quiet. I like it. Maybe they will find our stolen nutrition cycle. In the short ride home I'm called by the midwives who need help getting HIV test kits for antenatal clinic, and another staff who asks me to contact the water line fundi to turn the water back on for the health unit, and I get a message that our appointed doctor will not be around 4 or 5 days again this week. I try to be patient but mentally tally about 6 total clinical working days in Nyahuka in the six months of the contract . . . though many more I am sure at Bundibugyo hospital, or doing administrative tasks.

At home the blazing sun makes the laundry on the line smell like it has just been ironed, it is almost too hot to touch. The team is gathering for an afternoon nutrition meeting: we are hosting Stephanie Jilcott and Scott Ickes this week, as they follow-up on research they had begun while here. Soon our Ugandan extension workers (Pauline, Lammech, Baguma Charles) join us to discuss progress or lack thereof, what percentage of chickens are laying eggs and why, how we will improve home visit follow-up of malnourished kids.

Just as the meeting is beginning Ivan arrives to say that the CSB gatekeeper has told him the gate is closing on admissions . . . he must be accompanied by a parent to get in. I had intended to do this in the early morning, but Ivan was mis-informed by an administrator that the process BEGAN at 2 pm. Not wanting to be difficult I did not appeal based on my hospital and meeting schedule . . but now it turns out that the process ENDS at 2pm, and it is 2 pm. So I leave the meeting in progress and go through the newly organized and efficient admission process. Teachers at the gate inspect his trunk, criticizing him for having 3 casual-wear blue shirts (2 are required, so we thought 2 was minimum, but it seems they are treating it as a maximum). They make him remove one set. I recognize the entire process is meant to instill humility, to show off the bat who is boss, so I keep quiet. We sign in, confirm fees were paid, sign agreements to abide by the rules, get a meal card and dorm assignment. I like his dorm teacher, who was Jack's cell group leader last year, and I like the process of helping him carry his trunk down and seeing his bed. A half dozen other boys are in the dorm, and the boy in the next bed seems to know Ivan already. The shutters are closed and the room is dark and crowded, but livable. I shake Ivan's hand goodbye. Last year I got in the car and cried after leaving him in the miserable little unfinished brick primary school dorm. This year Ivan looks like he could cry, but he doesn't, and I think he's just nervous. We're both glad for him to be in Christ School. Back to the meeting, then back down to the gate to enroll my S5 student. It is my 5th time through the process so the teachers are beginning to expect me back . . . but this time it is less pleasant because the S5 deadline kind of crept up on us and my boy does not have all his requirements (only 1 graph book not three, only 1 belt not 2, etc.). So the teachers are harsh and I have to beg for grace. In the end though he is settled in a good dorm, a new one, with a staff member who was once a missionary-sponsored-kid in Ndyezika's class. A nice connection.

Back home in time to get my own kids snacks before they head down to sports practice . . knocks at the door, . . my neighbor with a headache and a covered appeal for moral support on her side of a family issue, the little brother of a good friend who is looking for help with school fees, a man who wants me to examine his wife because she's losing weight, a church leader who is caring for orphans and wants me to help one with shoes. Now, a debriefing respite between me and my computer which has done me good . . though I don't expect anyone but my mother and husband to read this far. Then I will go on to preparing dinner, chili, which requires tomato sauce made from actual tomatoes, beans, vegetable, corn bread made without a mix, that sort of thing which is tasty but time consuming.

The day will end with the peace of dusk, candlelight, community, food and shared life. It must be Monday.

Kamenemene

This is the local name for the dwarf bush-baby, who is still alive on syringes of milk. We made him a nest in our bougainvillea, and are hoping his mother returns to reclaim him. He (or she, I have no idea) is about as ugly as any creature, sort of a cross between Yoda of Star Wars and the Bernstein Bears . . . but watching him lap milk is so satisfying . . . an extreme example, but the frailty and bizarreness of this creature draw out mothering. Meanwhile he chirps and burrows into the rags and licks his lips when we put milk into his mouth. Touching is still off-limits because of my zoonosis paranoia. .

Taking the Offensive

Mid afternoon, waves of rain showers, interspersed with pulsating heat.  Pat and I on our bicycles, loose stones and red dirt of the road, hurtling down hill and panting up hill, calls of "mujungu" from children in tattered clothes.  My favorite:  a 4-ish year old boy in a neck to wrist to ankle one piece long underwear outfit, covering everything but his hands and feet and . . . the only personal area of his body clearly visible in a rent.  We reach the appointed place for a community meeting, a local primary school which consists of four tin roof shelters with dirt floors and no walls.  A half dozen men and about 20 women flow into one of the school "rooms", with another dozen or so children.  These are village women, wrapped in kitengis, women who have rarely sat on a school bench.  Four of the five young CSB graduates with whom I've been working this month are there, with visual aids and good ideas.  I notice one of the primary school teachers who drifts over from her class is a young woman I sponsored for a year at Christ School--she failed, but was ever so grateful for the chance, burns having left her disfigured and bereavement having left her in the care of a grandmother who subsists on selling alcohol.  I was pleasantly surprised to see her thriving (though a bit worried about her level of teaching ability).  My students unroll two posters they have commissioned to begin the discussion of the harmful practice of cutting "false teeth", bhino, out of the gums of babies with diarrhea.  One depicts a together-looking woman giving ORS to her baby out of a cup.  The other pictures the same mother holding her baby in front of another woman with a knife, who has evidently just cut out the teeth, as blood spurts and drips from the baby's mouth.  And just as the discussion begins, the dark wall of cloud that had been blowing towards us arrives.  Driving, hail-force rain, heavy drops amplified by the tin.  Everyone huddles centrally, away from the soaking of the open sides.  The leader shouts to be heard, and women strain to answer his questions audibly.  

We have taken the offensive here, drawn the line.  Many practices can be applauded, many others ignored, but this dual business of slicing gums and then cleaning out any swallowed blood by forceful and dehydrating enemas, this is killing our children and has to be confronted.  And so we do.  I say little, until the very end, merely watching the students engage and implore.  There is skepticism and active chatter, as the women consider the possibility that they are being duped by witch doctors out to make money (going rate in this village turns out to be 2,000/= or a dollar a tooth, and on average they are told that 4 to 6 teeth must be removed . . . which amounts to a week's worth of family living expenses, no small consideration).  Our offensive does not go unnoticed.  We have an Enemy who will send pounding deafening rain in order to drown out our teaching, in order to continue to devour the young.

We end with hearing the village's concerns, many of which center on disappointing experiences accessing health care.  Pat and I leave them with two ideas for addressing their concerns: PRAY, because God hears the prayers of the poor, the prayers of mothers for their children.  And then get politically active.  The people embezzling the money, the people paralyzing the delivery of health services, are the ones they elected.  Ask questions.  Demand answers.  Take responsibility.  Easier said than done, but if today merely raises questions in a few minds, we will have been successful.  If one mother hesitates to allow a procedure that can end in needless death, we are satisfied.  If one person goes home and pours out prayers for workers with integrity to be appointed, and workers who steal and abuse their position to be removed, then we know that God is on the move.

We ride back home, steep hills again, feet slipping off the muddy pedals post-rain.  An unlikely picture of a military offensive, two pale not-so-young-any-more women in skirts and rain coats, huffing on bikes, while four kids in T-shirts make their way on foot.  But we moved out into Enemy territory today.  Whether we conquered any small part of it remains to be seen.

Dwarf Galago

If my technical assistant (read, mechanically competent child) can manage we'll post a picture, but a quick note for old team mates and nature lovers.  We saw a first-ever new animal at team meeting tonight.  A dwarf galago (bush-baby), Galagoides thomasi I think, a distinct race that occurs in NE Congo.  First a slim squirrel-sized primate dropped down from the mango tree, stirred Star into a tizzy, jumped, ran up a couple of other trees and hopped back down, making its way erratically across the yard.  We got a good view of its pointy ears and over-sized eyes and long furry frayed looking tail.  Then the kids noticed a tiny baby version on the ground, it looked like a small wing-less bat with a long curling tail.  It did not move well.  Julia put on gloves to move it back into the tree and Annelise had the presence of mind to warn her against touching near the teeth . . . as Luke pointed out on the phone, there may have been a reason we saw these two tonight, perhaps they are sick.  And the primate to human transmission of viruses in Bundibugyo and environs lately has not been happy news.  Always something interesting in our yard!

ships in the night

This month we are practicing baton-relay parenting to a greater degree
than we ever have, and it is not ideal. However the alternatives are
for BOTH of us to miss events important to at least one kid, or for
the entire family to spend more travel money, or for 3 of 4 kids to
miss more school. So we have tried to compromise (great line from
tonight's movie, To Kill A Mockingbird, where the dad explains that
compromise does not mean bending the rules but rather a mutually
agreed upon path that minimizes the losses). I took Caleb to spend
the weekend with Luke for his 16th Birthday. Now I'm home with the
three younger kids; Scott had meetings in Fort today and moved on to
do some errands in Kampala before flying to Kenya himself for the
required work weekend that parents of Juniors are expected to
contribute to preparations for RVA's version of the prom, the Junior/
Senior Banquet. He comes back to attack the all-day task of medicine
purchasing and family shopping on Tuesday, then Wednesday we literally
switch places so I can attend the first UGAN (something like action on
nutrition network) conference where two former short term missionaries
are presenting papers related to research done through our nutrition
programs. It is a long stretch. Being the only parent right now, the
only on-the-ground team leader, the only doctor, the only adult in the
house . . . all take their toll. I much prefer partnering with my
best friend. Prayers appreciated, that I would live in the freedom
and peace of God's power and not rush around in a frantic panic!

Slumdog Diamonds

Thanks to our field directors I saw what must rate as one of the best
movies ever: Slumdog Millionaire. They had rented the DVD, then it
turned out that Caleb accompanied Andrew to a youth group meeting the
Sunday evening before our departure from Nairobi, and the Carrs were
going out to dinner with a departing team mate . . . leaving me home
alone with a video, which is a pretty rare event in my life. I keep
thinking about the film, and why it was so gripping. Pulsating music,
clever dialogue, creative cinematography, on-the-edge-of-your-seat
plot . . .but there is more. I think that there are occasional books
and movies that open our eyes to the reality lived by billions of
humans, painful to watch, wrenching, but important. Through the movie
we are forced to imagine encountering the depths of the world's
brokenness, first hand, defenseless. Like the children who live
within a stone's throw of my house, and in villages and city slums all
over the world, facing daily raw violence and sorrowful loss. But
more than an unblinking stare into all that is wrong sets this movie
apart: there is also the movement towards redemption: love persists
in the muck, goodness pushes back evil. Like Blood Diamond we see the
relentlessly pursuing love that mirrors God's, even when the object of
that love is damaged and rejecting like we are. Highly recommended,
though be prepared that it is not for the timid. Evil can not be
ignored in this movie, but a diamond of hope emerges from the mud.

The Scotts

Pictured above, Dr. Scott with Baby Scott, the first child born in our new Pediatric-Maternity ward a year and a half ago. He was born to an HIV-positive mom who took her prophylactic medication, weaned him to goat's milk provided by the Matiti project at age 6 months (she also named the goat Scott, by the way), and ended up with a healthy uninfected boy. He came to greet us in the clinic today sporting a spiffy suit, so we had to snap a photo.

More encouragement today: first patient in line, Kambale, growing and thriving, the little boy whose mother struggled to find her way home from Northern Uganda and deposit all her children with her own mother a week before dying of AIDS. Her act of bravery and kindness saved Kambale's life, at least for now, as his competent illiterate little old grandmother faithfully maintains his medicines. Next, one of my patients missed clinic and his mom just asked for a medication refill . . . because he started school. This was a child whose life hung in the balance for months as a baby. Now he's healthy and big enough to go to kindergarten. Later an unfamiliar-looking 13 year old girl was shown into my exam room, with records from Kampala where she had been on ARV's through a Baylor/Mulago initiative. It took me a while to realize she was one of our first diagnoses of HIV, many years ago. She also is healthy and strong and attending school, but has moved back to the "village" with her mother.

Who would have imagined that our AIDS patients would provide the clearest view of God's redeeming mercy, of hope?

Space for Advocacy

The sword of the cell phone came into play today, advocating for the orphaned and sick, trying to connect kids to resources, knowing I can not solve the problems. Kweyaya Paulo, a 4 year old who was born with a nearly blocked urinary system and rescued later by a blunt procedure creating a hole from his bladder through his abdominal wall. He leaks urine, continuously, in a land without pampers. He is always damp and smelly. After well over a year of trying to get him the public surgical care which is in theory available at the national referral hospital (8 admissions all ending without any substantial help, but who is counting?) I admitted defeat, and thanks to the gracious services of a hospital administrator at IHK we connected today with the only OTHER urologist in Uganda and have arranged surgical correction of his defect through Mengo hospital (Church of Uganda). It will cost about $350. Which is the per capita health expenditure for several whole villages, so this is not a sensible use of funds from the public health perspective. But even Jesus took note of certain specific suffering individuals, and this boy's mother has never given up. Pray for his surgery next week.

And for little Fathila Katusabe, another 4 year old with a dedicated mother, whose seizures and developmental delay stem from an early infection with meningitis. She needs to see an orthopedic surgeon for release of tight tendons which cause her to limp. After 3 failed attempts referring her regionally, I connected today with an Italian Orthopedic Surgeon who agreed to evaluate her next week, also in Kampala. Fathila's mother's mother died during the Ebola epidemic. I know this lady has suffered a lot, yet she remains hopeful, and thankful. Pray that the lame would walk.

Lastly, I spent time today advocating for an orphan student who would like to continue his studies. He's a good boy, with potential, and almost no supervision or resources, medium good grades but not the top of the class, not popular with the staff. I feel like he needs to get away from the influences of Bundibugyo for a couple of years, get out of the rut in which he's been pegged, and am sending him to interview for a place in the Cornerstone Leadership Academy, a Christian intensive discipleship and A level program that is academically very successful. He'll be competing with kids from all over the country for only 25 spots, so the chances are slim. Still, we have seen God going ahead and fighting the battles left and right this year, so why not hope? Pray for M.J.

Nouwen defines discipline as creating the space in which God can act. This resonates with the picture of 2 Chronicles 20: the armies held back behind the choir, stopping to first fast and pray, then arriving on the scene to find the victory already accomplished. I would like my life to look like that this year, a few phone calls and then getting out of the way, trusting these children into God's hands.