Festive Disease

Yesterday the Community Center buzzed with crowds of HIV-affected women, babies, and assorted relatives, 240 families in all. It was our quarterly Kwejuna Project distribution, a day that always involves so much planning and work and chaos and money. It is a day that I always anticipate being a burden of tragic stories and needy people. But it is a day that consistently surprises me with the atmosphere of a party. Women greet each other, and pass babies. Kids run around with their cups of porridge. WHM workers shoulder bags of beans and cartons of oil, health center staff and community volunteers listen intently to sort out details in interviews. People are weighed and measured, tested and recorded. Family Planning injections are offered. It is an effort that calls upon the resources of nearly our entire team, and then some. A couple from New York sponsors the 5 tons of beans and rivers of cooking oil and hills of salt that are given out to supplement the calories of these families as they fight their disease. This quarter we invited a Church of Uganda pastor from up the road, and a few of his colleagues, to man the prayer room, where they laid hands on any woman who wanted prayer. Reverend Kiiza then spoke to the group about Jesus' words to the winds and the waves: Peace, Be Still. Good words reminding us that God has power over natural forces, even those of disease, and that we can rest in the storm. It was the first time we had partnered with a different local church, and it went well. One of my students, no doubt sent by God, offered to help me out and the two of us spent a solid six hours screening the HIV status of every child, making sure they were enrolled for appropriate care. EGPAF visitors came by, and our district HIV focal person. As exhausting as it is, I'm thankful to be a small part of this picture of the Kingdom, bringing resources to the neediest in a spirit of prayer and love, partnering both locally and nationally, empowering many others to participate, a snapshot of what our mission should look like. Confronting disease, festively.

A Flash of Good News

Just got a call from our Ministries Director Paul Leary, with amazingly good news of God's provision.  A private donor, whose interest in WHM in Africa grew out of a brief meeting in an airport parking lot in Rome facilitated by our colleagues . . . which became the foundation of the pediatric and maternity ward two years ago, another water line, and some buildings at Christ school . . . now decided to fund a huge grant proposal which will enable several significant Christ School projects to move forward, and enable the Sudan team to begin building.  In this time of financial uncertainty we are awed and grateful for a business man who is willing to part with many thousands of dollars over the next three years.  This proposal had been in the works for months (thanks to much work by Scott, the Pierces, Michael, and Paul), but it seems it landed in a spam section of the donor's email . . and was only retrieved in the last week.  Hard to remember that in early January we and the Pierces sat and prayed together over a bleak forecast for the year, wondering if God was giving us a message of radical changes to our mission.  There was simply no money, and the Pierces were weary with the prospect of facing the year.  Now six weeks later, we've seen our friends come through with sacrificial gifts, seen churches decide to partner, seen the mission shoulder lingering debt from past years, and now seen this donor give extravagantly.  God uses this to encourage us, to tell us to carry on.  We are almost as excited for the Massos as for us.  They moved to Sudan by faith, and have spent months subsisting very simply, waiting for funds.  Now the timing is perfect, as they have two young interning men with construction expertise who can pitch in to get the offices and housing off the ground.  Literally.  We thank God for moving hearts.

Happy and Bright

Would you name your child "Happy Bright" if you knew he was going to have AIDS?

Happy Bright came to clinic today, with his perky elf-pointy ears, sporting his Chinese-store-bought suit, and smiling expectantly. He's been in our program for most of his life, which at this point is about two months shy of four years. And though his stunted height looks more two-year-oldish, he's reasonably plump, and true to his name . . . happy and bright.

A Bundibugyo paradox, that an HIV-infected child and his mom can dress up for their day in clinic, because it probably represents one of the high points of the month (free cups of hot porridge while waiting, the festive sense of community in the crowd of fellow sufferers, the quick flash of candy from my pocket, the doling out of life-sustaining meds). And that they can be the happiest and brightest spot in my day, too.

Team Leader Epiphany

This particular epiphany came to me during church on Sunday, and related more to my wandering anxious thoughts being addressed by the Spirit in the atmosphere of worship and community than to the text or the sermon . .

God, and only God, can work all things together as in Romans 8 so that the earth is healed, the Kingdom comes, and individual good is maximized. I, on the other hand, often find myself thinking I have to hold in tension what might be good for a team mate and good for the team. In God's economy, those two goals are one. And for that I'm thankful. Because as a team leader, there are times when an individual seems to be struggling, to be unhealthy or depressed, to be homesick or floundering, to want to go back "home" . . . and one wonders if we do them a disservice to allow them to continue to serve here simply because their efforts as so much needed and valued. On the other hand, there are also times when someone wants to stay here, wants to push on through in spite of high levels of stress . . . and one wonders if we do them a disservice to allow them to stay because we need them. And for most of us, those two states can occur multiple times over the course of a year, or a day! As I sat thinking through this in church, how to encourage someone who dreads much about their life here and makes comments about wishing to leave, or how to wisely advise someone who might need a break they don't really want to take . . it was a great comfort to grasp, once again, that God always works so that an individual's needs are best met by the team's and the Kingdom's needs being best met, too. Whether that means extending a term or shortening it, He knows what He is doing.

So our job is to listen, to support, to watch, to trust.

And this morning my Sunday epiphany was confirmed, as we were led in prayer. A young team mate who decided to stay in Bundibugyo an extra year (and then felt the brunt of the loss involved) led us in looking at Mark 14, and the contrast between Judas who followed Jesus in order to gain something (and therefore felt it a burden) and Mary, who followed Jesus because of love (and therefore could pour out her precious oil to anoint Him). Given that it is one of my favorite stories and we also sang one of my favorite hymns . . . but I also came away from the prayer time awed that God is indeed weaving good for my team mate and good for all of us out of her difficult decision, that He speaks to her words of love as she pours out her life in a way that many might question. So I breathe a bit more deeply and entrust her into His plans, and feel encouraged to trust the rest of our team to stay there as well.

The News from Bundi

No unifying theme comes to mind, so I will ramble in the style of a news report.

Family Reunited.  Well, most of us.  Luke is still in Kenya of course.  His class at RVA put on their major event of the year, the Junior-Senior Banquet, which involved months of planning and days of set construction and rehearsal, sort of a prom/stage show/dinner/creative festival all rolled into one.  The theme this year was Charlie and the Chocolate Factory aka Roald Dahl, and they transformed an auditorium into the magical world of Oompah Loompahs.  Hope we can post some pictures soon to celebrate the ingenuity and perseverance required.  Luke's assessment: the evening was too short (7 pm to 1 am).  Which means everyone was having a great time.  Meanwhile I'm so glad to be home, with Scott, for a while.  Thanks for prayers.

Bundi is still Bundi.  Hadn't been home more than ten hours before one of my most desperate little patients, Peter John, was at the door early Sunday morning dying of dehydration.  The battle for that family still rages.  Small victories:  he was rescued with fluids, and I caught his sister smiling today.  And good news that our supply of anti-retrovirals, the life-extending anti-AIDS drugs, is supposed to arrive today.  We've been scraping by pill by pill for two months, and the situation was looking bleak.  Almost a quarter of my ward right now is HIV-affected.  Sadly a young woman whom I sponsored in primary school in our first years here, who is the sister of a good friend, died of AIDS on Saturday.  I biked out to her ancestral home yesterday evening to pay condolences to her mother and siblings.  She had several failed "marriages" in her short life (she was only 22 when she died), none of which produced children.  This morning a 15 year old's 790 gram 24 week premature baby died at the hospital.  My heart goes out to all these teenage girls, looking for worth and love and value and ending up fatally infected or grieving.

Investing in Leaders.  This is one of our themes this year . . .and before returning, I had a chance to visit nurse Asusi Mildred and her family.  She has completed her degree and is mid-way through her internship, and Heidi and STephanie and I had one of those rare evenings with her when we all are just people who live and work and relate together, when we can laugh and talk about politics and eat and pray, and not feel the barriers of nationality and status so blatantly.  It was a six-hour investment to get to her place and back (and nearly cost us our lives a couple of times when insane drivers passing on the wrong side swerved into our lane), but well worth it.  

Goats and more leaders.  Since I was driving back without all the family, we were able to arrange for a young couple John and Allison from the goat project in Masaka to come out to Bundi and consult with Lammech on the Matiti project, while setting up a computer-based tracking system for the goats.  We have now put so many in the community it requires a data-base to know which breeds are where, and how the genetics blend with each generation of breeding.  As they all spent the evening with us on Sunday I was again thankful for Lammech, who has a flair for community-organizing and teaching, and a heart for the people of Bundibugyo, and skills that bring life to others.  Another leader.

A big week.  We are already into the week, and there is much water to still flow under the bridge.  Today's main task was to clarify with the Nyahuka Town Council that the dedicated water line to the health center is NOT available for other users to tap into.  This should help assure water supply for little details like washing hands after dealing with cholera patients . . or mixing ORS to save a life.  Yesterday and today, goat training.  Today and tomorrow, nutrition education re-training in Busaru and Busunga.  Tomorrow through Friday, a site visit from EGPAF.  Thursday, the quarterly Kwejuna Project Food Distribution, with a couple of hundred patients and tons of beans, a measure of survival in the lean season of February.  Meanwhile the kids go to class and sports, the sun beats down, the patients show up, and life goes on.  We can use prayer this week (as always!!).

That's the news from Tuesday morning.

Has anything good come?

Remember when skeptical people questioned Jesus' validity because he was from Nazareth? We heard a similar comment yesterday, after Stephanie presented her paper on the BBB program. She detailed the effort to design, implement, and refine the production of high-calorie soy-peanut paste for the treatment of malnourished kids, and did a beautiful job. As she sat down, the elderly British doctor who was chairing the session said "This must be historic, I believe it is the first time I have ever heard of research coming out of Bundibugyo!" I was so proud of Stephanie and Scotticus and our team at that moment, showing that quality medical care are innovation can occur even in our remote setting. Scotticus presented more data as a poster session, showing that though we give enough for each child to consume 680 kcal/ day, by careful dietary recall (thanks to Baguma Charles) they are actually only taking in 150 kcal of this product per day. This is why science and measurement is so important: rather than focusing on giving MORE food, we need to focus on getting the mothers to GIVE the food they are receiving! I like working in an area where the answers are still not clear, where we have to think and try.

60% of childhood death in Uganda is attributable to malnutrition, either as a direct cause or as a contributing factor in other diseases. Surely Jesus, who fed the lost crowds and took children on his lap, who called Himself the bread of life, would want His people to be bringing light and Kingdom here.

Fighting Hunger

I am sitting among 273 delegates from 19 countries at the first Uganda Action for Nutrition Congress, in Kampala. The first speaker, professor Tola Atinmo from the Federation of African Nutrition Societies noted that the US President Obama just signed a 787 BILLION dollar bail-out for the US economy . . . and asked when he could obtain a mere 10 billion dollars to bail-out the malnourished in Africa. More than 50% of Africans live on less than one dollar a day. We have heard from the USAID and WFP country directors, both articulate and compassionate men, from a UN representative and from local leaders. The guest of honor who opened the two-day meeting was the First Lady of Uganda, Janet Museveni . . . which combined with an increased terrorism alert for Uganda this week led to pretty severe security screening as we entered. The atmosphere is professional and yet passionate, a room full of African intelligentsia sprinkled with Americans and Europeans, representing governments and schools, aid agencies and hospitals, policy-makers and implementers. All are focused on the fact that Africa as a continent can not move away from being marginalized until our children are well fed. . . yet this is the only area of the world where the percentage and number of people living in extreme poverty is increasing. With 126 million undernourished children, with half of the continent's population stunted (a measure of chronic hunger), the challenges seem overwhelming.

But hope lies in the people, the champions of this cause. Most impressive so far, Dr. Stanlake Samkange. His points: our programs must be evidence-based because malnutrition has a multitude of causes and there is no single solution, success requires political will which can grow when governments realize that the cost of INaction is higher than the cost of action, and programs must build institutional capacity at all levels, especially locally.

So here I sit with Heidi our nurse, Baguma Charles our nutrition extension worker, and Scott and Stephanie our former team mates who have returned to academic public health in the US. And I pause to breath in the beauty of this diverse role in life we have as missionaries. We work hands-on at the grass roots level, we channel charitable gifts from the US as well as UN-provided food, we coordinate and partner with the government's ministry of health and with community organizations, and we invite the investigation and innovation of the researchers. Few people have the privilege of that combination, daily contact with the hungry, some responsibility for policy and planning, and the stimulating opportunity for advancement of knowledge. Praying that this congress gives us solid science for doing good, and creative ideas for helping others.

Standing in the need . .

. . of prayer. Scott will land in less than an hour, to face the multitude of issues that have awaited his attention (patients, requests, finances, mechanical problems, you name it, you can't leave here for six days and not have a certain number things pile up). Not to mention three kids who are NOT happy for their mother to leave AGAIN. Pray for him.

And for me, too. This morning has been an emotional slap, a reminder of what we face. Peter John's sister Grace came to clinic, the teenage girl caring for her orphaned brother who we bet on to pull him through some months back. He's so much better . . . but she asked to be HIV tested. And she's infected too. She's a bit old to have been carrying the virus since birth, so I started asking more questions, and finally it dawned on me what had happened. My gentle translator almost refused to ask, but now we're glad we did, Grace needed to unburden and had a good cry and I had one later. Grace and her brother had the same mother, but different fathers. So as Grace was caring for her dying mother in the end stages of AIDS, her mother's husband began to sexually abuse her. Now he's dead too, leaving her with an unwanted virus, no parents, and a sick sibling. Please pray for her to grasp hope, somehow. That on top of ward rounds and saying goodbye to my kids, rushing to make the plane . . . and to top it off, the bush baby Komba stopped chirping last night, I barely got him to take any milk today, and now I'm sure he's dying. Just a tiny little non-human life and nothing compared to the sorrow of those all around me, but still a way to grieve the pain of feeding and caring for a frail speck of breath that is then extinguished.

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.