Mothering

From our national newspaper today:   "UGANDA is ranked 122nd out of 158 countries in the State of the World's Mothers report, released by Save the Children yesterday. . . . .The best place on Earth to be a mother is Sweden, followed by Norway. Of the 10 worst countries for mothers, nine are in Africa. They include Sudan, Sierra Leone, DR Congo, Eritrea and Angola. . . "In short, providing mothers with access to education, economic opportunities and maternal and child health care gives mothers and their children the best chance to survive and thrive," the report says. "

And from me:  thanks for praying for Anita, who came with her mother again yesterday, and got a 3-week supply of medicines from the limited stock that arrived.  Her mom said her appetite has been poor.  Hard to say yet if this is a sign that the gap in supply has sent her viral counts spiraling.  

The report on mothers ranks countries based on life expectancy for women (53 years in Uganda, so I'm getting closer to the end . . ), average years of formal education for girls (10 in Uganda, which is pretty good for the region), access to family planning services and supervised safe deliveries, income potential relative to men's, political representation.  

It does not, however, measure the soul-piercing reality of watching your child go off of ARV medicines, of waiting in interminable lines for care, of having your baby bitten by a rat, of bringing children into this world whom you are powerless to feed and clothe and protect and nurture.  As a mother I can only imagine what lies in the hearts of the many women I interact with every day, but that imaginary glimpse pushes me on.

Inscrutably good

My wise friend Karen Masso had this example of the difference in
Jonah's and Kevin's experiences with death: once the crowd threatened
Jesus at the cliff, and he walked through unharmed. The second time
the crowd gained deadly momentum, they pushed him to the cross. Kevin
has walked through this experience of death like Jesus parting the
crowd and leaving the cliff. Today he's out of the ICU again post-op,
eating and walking again, and once again showing the most amazing
recovery speed. God has been given glory for the miracle of his
resurrection, the timing, the people, the third-try shock, the
protocols at Duke, the surgery, everything. When the surgeons saw his
valve, they confirmed that he had very severe stenosis. In most
scenarios he would not have survived, but now they are thinking about
which day to discharge him home. Jonah, on the other hand, followed
the path of the cross. I can not explain why God worked so
differently for those two men who had dedicated so much of their lives
to the Kingdom in Bundibugyo, who had wives and young children in the
balance, and who had been our friends. But Karen's analogy of Jesus'
life shows that God's ways can not always be predicted or boxed in or
explained, that the same crisis may have different outcomes that both
turn out to be based on love.

For tonight, resting in the rescue God provided Kevin and JD, and
rejoicing that he has a new valve and a new hope for life and
relationship and work and meaning.

Day of the African Child

(Press release):  Nairobi, June 16^th 2009: Africa observes the Day of the African Child, in memory of, thousands of black school children who were maimed and killed in 1976 Soweto uprising, as they took to the streets to protest the inferior quality of their education and to demand their right to be taught in their own language.

Today is a UN-sponsored day to draw attention to the plight of the African Child, which is all too often a life of marginal nutrition, sub-standard education, fragmented family (in spite of our stereotypes few kids here grow up with both parents), and too-early shouldering of adult roles and responsibilities.  I suppose I celebrated it in my own way today, struggling for the real lives of a few real African children.  All in a day's work:  a newborn baby with spina bifida who could be helped by referral to a neurosurgical mission hospital on the other side of Uganda; a newborn whose mother died in the process when her uterus ruptured who could be helped by milk until the family sorts out a surrogate breast-feeder; a convulsing baby whose anxious and misguided parents had been treating him for days at home with herbal enemas which were ineffective for his real problem of meningitis,  but who could be helped by IV antibiotics; a five-year-old inexplicably malnourished little girl who tested positive for AIDS and could be helped by the correct medicines and counseling; a child with newly diagnosed sickle cell disease who could be helped by prophylactic antibiotics and vitamins; an infant with severe gastroenteritis who could be helped by large and fast infusions of IV fluids; and the list goes on through a crowded ward and a line of consults.  

Too many days I have the sense that all the effort is for little gain.  But today a small supply of anti-retroviral drugs arrived (not much, but enough for the next week) and another consignment of anti-malarials, which is huge news.  Both evidence that prayers are at work, that good is gaining margin over the chaos of want.  And lastly I want to share one very satisfying victory.  Two weeks ago a child was admitted with severe malnutrition, and given his terrible respiratory status and his coughing skinny mother, we thought the pair probably both had TB.  But the mother's sputum tests from another hospital were negative.  The clinical picture was so convincing, though, that I set out to get her re-tested.  I have never worked so hard for one simple lab test.  It would be too tedious to describe every turn in this story, but here are a few:  no frosted microscope slides, which the TB program requires because the slides have to be marked with the patients' name and saved for review, phone calls, none at another lab but the idea of using tape to mark the slide, the lab refusing and demonstrating the slide would then not fit in the right slot in their storage box, more phone calls including the District Health Officer informing him that our entire public health effort to find and treat TB was failing for lack of lab supplies, who then suggested we send someone to beg them from another health unit, paying for the fuel for the motorcycle to do so, to no avail since they did not have them either, noticing a truck from Kampala with "TB and Leprosy Programs" painted on the side and shamelessly interrupting to beg aforesaid frosted slides which they happened to have stashed in the back seat (?prayers), then finding out that a certain acetone fixative was lacking for the stain, more money for more motorcycle fuel to track the fixative at another hospital, then having the mother turned away from the lab for lack of gloves, providing gloves . . . meanwhile the interns looked at this kid and couldn't believe he was still alive.  By Friday this was still going on and I decided to just start treating the child for TB anyway.  He actually improved over the weekend.  And today his mother FINALLY (AFTER TWO WEEKS OF RUN AROUND) got her sputum sample:  triple plus positive for TB.  So instead of a dying child and a more slowly dying mother, or a child who was treated empirically for TB only to be orphaned when his mother died of the disease or re-infected when he went off therapy  . .. now we have hope of two people being cured and living normal lives.  

And the real story here is the same story as Kevin's . . . it is God who is looking out for individual lives.  Most times the degree of difficulty involved and the sheer volume of other demands would have meant that this child and his mother slipped through the cracks.  Many mothers might have also wearied of the rigamarole and gone home by now.   But in this one small case, God kept prompting one more step, one more try, until the diagnosis and treatment were complete.  Because He cares about the African Child, not just as a politically correct concept, but as an actual flesh and blood and tubercle bacillus-infested individual who will one day take deep breaths and perhaps graduate from high school or build a house or write a story.  Or just carry water for his mother.

 

Daring to care

A friend sent this link in response to the posts a while back about the importance of investing in sports for girls, which makes for good "Day of the African Child" viewing:

http://www.youtube.com/watch?v=-Vq2mfF8puE

Separation Woes

Scott and Caleb drove to Kampala today, and tomorrow morning they will
board a BA flight to America. Scott was encouraged months ago to make
this trip by members of his high school class who REALLY wanted to see
him at their 30th reunion, but the decision was finally made to go in
response to his dad's recent bike accident and illness. They will go
to California to see the Myhres and thank the Half Moon Bay Methodists
for their support at a service on the 21rst, as well as preach three
services in the Wyoming Presbyterian Church (a Cincinnati suburb where
he grew up) on the 28th. Sadly for us, to keep the trip to two weeks
Scott will miss a Sunday at our main supporting church Grace OPC in
Vienna, VA, instead attending a mid-week Bible study to thank our
friends there. Caleb will also go to the annual Aylestock family
reunion, and there will be lots of good food and grandparent time and
hugs and stories. They will be in four states on two coasts in two
weeks, so it will be a pretty packed time.

Meanwhile Julia, Jack, and I are attempting to hold down the fort at
home. No small thing. Just before he left, Scott, with Nathan's
brave help, moved our very mean and dangerous bull away from the
paddock by our house to the yard at the old Tabb house. For safety.
But our cow DMC just stood at the fence and cried her little heart out
all evening. And I could so relate to her! Her husband is out of
sight, and her calf might as well be at boarding school since they are
separated by a fence (to prevent nursing so we get the milk). A few
hours later, the gate was left ajar and the calf Truffle entered her
mother DMC's paddock. So there were Jack, Julia, and I all with
sticks running around in circles trying to get them apart and drive
the calf back into her proper quarters, an exhausting and futile
exercise until cowgirl Julia got some dairy meal (like oats) and lured
her. Thankfully I had turned off the stove at the last minute so
dinner was saved, but if this first night is any omen for us and the
cows, the next two weeks could be a doozy. Now DMC is moaning and
alone again. She has the separation woes, and so do I.

You Know My Heart

The Barts posted Psalm 139 on their blog with the news that Kevin's surgery for replacement of his aortic valve is scheduled for today at 1 pm (Duke time, 9 pm here in Bundibugyo). Join us in praying that the same God who knows our spiritual hearts, our hopes and longings and sins and weaknesses, will also know Kevin's physical heart and guide the team of surgeons and staff to give him many more years of life on this earth. His recovery to this point has been nothing short of miraculous. Looking forward to more of the same today.

back to the community

Over the years we've trained traditional birth attendants, community health workers, nutrition outreach volunteers, peer educators . . . all people whose role and qualification comes from being respected members of the community rather than from degrees earned in school. In a place with limited manpower, this cadre of informal, unpaid workers forms the backbone of primary health care. Fifteen years ago no one but our WHM predecessors (Dan Herron, Lori Borchert) seemed to be attempting much of this in Bundibugyo. We found our way to the Uganda Community-Based Health Care Association and bought their manuals, incorporating spiritual as well as physical lessons on health. Over time, though, our role has become less direct. Team mates such as Pamela and Stephanie and Pat worked more recently with these volunteers, and bigger programs such as UNICEF and the Belgian government put lots of money and effort into scaling up this kind of training and organization for the whole district.

But today John Clark launched a new wave of community health outreach. Thanks to contacts we made in the last year with a program called NuLife, we were able to send two of our great agriculture/ nutrition extension workers to be trained to teach village health workers about infant and young child feeding, particularly in the context of HIV/AIDS. This organization, funded by USAID and working in close partnership with the Uganda Ministry of Health, has developed a nice set of teaching aids to bring basic health and nutrition messages to the village level, and to teach dedicated village health team members to screen their population for malnutrition. Instead of waiting in the hospital for the kids to come to us, these village health team (VHT) members will actively search out those failing to thrive. This dovetails nicely with our other health-center and hospital based programs for moderate and severe malnutrition. And this prepares our district to receive the commercially prepared high- calorie food supplement which NuLife hopes to begin manufacturing. That is still a ways down the road, and as a medicinal food it will only be given to the most severely malnourished and those with AIDS, so again there is complementarity with our BBB local-production for moderately malnourished kids.

Over the last few months a good amount of aggressive advocacy was required to get our staff included in the trainings, and to try and hold together the various partners involved. But now I am enjoying the teamwork, dropping in to see our trainers drawing out the 20 VHT's in a participatory way, noting that a good number of those chosen for the training are HIV-positive people themselves taking an active role in their own care, thanking John who saw to all the details of transporting and feeding and informing and facilitating the people involved in this event. The training will go on all week and end with a community launching ceremony. We pray it puts information, inspiration, vision into the hands of the people.

Rwenzori snowcap melting...

Bundibugyo in the news again. Not much good news comes out of here.

It seems that the AFP news service recently visited our little corner of the world. An article entitled "Lifestyle melts away with Uganda peak snow cap" popped up on our Google news page, complete with interviews of local Bakonjo folks who are witnessing the warming effects. The article mentions that the Rwenzori glacier has shrunk from 217 hectares to only 19 hectares in the last century.

At that rate, they estimate it will be gone by 2023.

Sad.

Motivated by Love

We have been spending time in the story of the lost sons, the "prodigal" son and his sulky brother, the forgiving father and the feast, from Luke 15. The parable serves as a mirror as we see too much of ourselves in the sons, but also as a beautiful goal of becoming like the father.

First, the younger son, who broke all the rules by breaking away from his family, forcing an early reading of the will, cashing in the ancestral property and spending it all on his new friends and life. Perhaps because Scott is about to go visit our families, I have found this part of the story suddenly uncomfortable. How much are we as missionaries like this son? We have left our families, traveled to a far country, and spent our lives prodigally, in the sense of giving beyond our means of time and energy and money and life. And there are certainly days when the pediatric ward (running at 200% capacity lately) feels a short step away from the pig-sty, when the thought of returning to cobble together some sort of safer life sounds very appealing. How much pain have we caused our parents and siblings over the years by our absence? How much of the nobility of the "missionary call" is a holy veneer for independence, for setting ourselves apart and defining ourselves by who we are not? This is the younger son's approach.

Then, the older brother. He wants justice, he wants rules, he wants to be right. As Tim Keller points out, it is his very "goodness" that threatens to separate him from the reality of relationship, that makes him unwilling to come to the feast. Easy to see myself here, judging the world in such a way that I feel more noble, more helpful, more spiritual, or more persecuted, than the average person. So much so that life becomes a slaving drudgery of good works.

Both brothers are actually quite similar, using the father's property for their personal gain, insecure in their positions, jockeying, seeking identity by NOT being the other.

In contrast, the father. Who does not worry about looking foolish as he runs to welcome the younger son. Who does not tally up the losses as he throws in his robe, his ring, his fatted calf. Who does not allow the older son to sulk but seeks him out, and reaffirms that all he has is this son's. This character shines out of the story as the one person who is motivated by love. Not by freedom, not by maintaining his personal rights. And not by victory, by winning the argument or being proved correct. His only desire is to see both sons come in to the feast. Yes, the sons' behaviour has consequences for their life going forward from the dramatic point of reconciliation. But they will face those consequences together, in relationship.

So what would it look like for my life, for our lives as a family, as a team, to be purely motivated by love?

I suppose it would look like a pretty big party, a slaughtered calf and a lot of music and dancing. Something to dream and pray towards.

Rising Up

In church today, the sermon text was from Acts 14, where Paul is stoned and dragged and left for dead.  But the disciples gather around him, "and he rose up"  (v 20).  We feel that we have had a distant glimpse of a similar miracle with Kevin.  JD's mom told us today that he's up out of bed,  Walking.  Talking.  Eating.  He remembers the past well, recognizes everyone, is very coherent, and even the initial glitch of short-term memory/retention is improving dramatically and speedily.  This is such a rapid return of life that we are all amazed, grateful.  From life support in the ICU  to walking down the hall and talking to his wife and kids, in 2 1/2 days.  I told Mrs. Johnston that if I ever experience sudden death, I hope JD is near by!  The first two responders were a man with a cell phone who called 911, and a man who pulled over and jumped out of his truck having just completed a life-saving certificate.  He and JD clearly did an excellent job to keep blood flowing and oxygen entering in all those long minutes of pulselessness.  The wife as a warrior, fighting for her husband's life, is an image I have of the event.  On their anniversary, no less.  

I realized with this good news, too, how we've all been in a collective suspended state of uncertainty, waiting for news, and if that is emotionally draining seven thousand miles away then it must have been nearly unbearable up close.  Please continue to pray for the Barts as the week unfolds, as the work now of isolating the trigger of the arrhythmia, and correcting it possibly surgically, will be necessary.  

Meanwhile that collective relief is also palpable at school, as Kevin's former students and staff contact us frequently for updates, and as the anxious stirring of unrest and violence seems to be diffused for now. We may not be gathering around physically, but the Ugandan disciples have gathered spiritually.  As the young man leading the church service said today, there is not a single family in the congregation whose life has not been impacted in some way by Christ School and the Barts.  Many are giving God glory for this miraculous rising up.