Shaking it up at church

Our church service this morning was, shall we say, LONG. I think it
comes of a cultural need for participation. Multiple choirs, multiple
songs per choir . . but also in the prayer requests, there are just a
LOT of people sick or with problems they want to share and pray
about. As community grows and deepens, it takes time. Musunguzi
preached powerfully as usual, from Acts, challenging each member to
share the Gospel themselves. As he said, Dan Herron and Alan Lee came
here in 1986 and sat in Alinga's kitubbi and told us about Jesus. Are
they here now? No, but they don't need to be, because they taught all
of us. It was a great illustration of the way Paul and Barnabas
planted churches in Acts 14, and a sweet look back on our
predecessors. Later he also said, you only heard the gospel because
those men came far from their homes out of love for us, and that is
why missionaries are still here among us, they love our people. A
soothing moment for my frazzled missionary heart . . .

But the real excitement in church today was an earthquake. It sounded
like an explosion, the whole church shook, everyone jumped up from
their benches and looked around, then a few seconds later there was
another less intense rumble and shaking. Many of the congregation ran
outside. I made my kids go. It is the prudent thing in an earthquake
to NOT be in the only building for miles around that is large enough
to kill people if it falls. I know Paul did an excellent
construction job, but I'd rather observe the strength of the walls
from the outside . . . However nothing fell down and everyone hugged
and laughed to cover their fear, including me. Then we came back
inside and sang two vigorous praise songs. The danger energized the
service, and the preacher later used it to illustrate the nearness of
Jesus' coming and the importance of standing for Him.

On feasting and fighting

With Scott gone, leading team Bible study fell to me, and as always the process of spending the week in John 2 made it way more meaningful to me than to anyone else I'm sure.  It is a fascinating picture of the announcement of Jesus' ministry:  first, he rescues a wedding party by lavishly transforming water meant for ceremonial cleansing into fantastic wine.  Then he whips the chaos out of the temple courts so that the Gentiles can regain their access to worship.  Hard to imagine an mission or NGO with a similar ministry-launch, a combination of alcohol and fury, feasting and fighting, joy and judgement.  But if Jesus is to invite us into the final wedding feast of the Lamb (Rev 19) there are battles to be fought, because we live in a world gone awry, surrounded by enemies.  And the deeper symbolism only becomes apparent later, when the passover cup of wine turns into a true consuming of God's wrath, when Jesus' blood flows for the final cleansing and making of all things new.  In that moment we see wine and joy and pain and sorrow and wrath and judgment all come together in one action, LOVE.  In Skip Ryan's book on the Gospel of John I found this poem, which beautifully combines the images:

The Agony (George Herbert, 17th century poet)

He who knows not love,

Let him take and taste that juice

Which on the cross a nail against a beam did loose.

Then let him say, if he did ever taste the like,

Love is that liqueur, sweet and so divine,

Which my God tastes as blood, and I as wine.

Do, Love, Walk

My desk is awash with papers and books that need attention, my kids
are working on homework projects and want advice, many flagged emails
and things to think about, without even coming to the food shopping
and planning and cleaning and normal home organizing that has to
happen on a Saturday, the only day in the week I usually spend focused
on life survival. So when I finally sat down to work and there was an
immediate knock on the door as Julia called "mom, someone's in the
kitubbi" my heart sank. Part of the stress of being home alone is the
no-sharing of dealing with anything. But as I walked to the door, the
ipod (on blast volume I might add) was playing a Stephen Curtis
Chapman oldie: Do justice, love mercy, walk humbly with your God. A
well-timed attitude check from a musical Micah 6:8.

In the kitubbi, two anxious parents and one very dehydrated baby. No,
they had not gone through proper channels of being referred from the
hospital. But I had seen them there during an admission less than
three weeks ago, so when the baby became seriously ill again they went
straight to the place they hoped to get help. And while part of me
wants to create protective rules for my Saturday survival, thanks to
the music in my head I was able to see them with empathy. If my baby
looked like that you better believe I'd do whatever it took to get
attention. The dad's dress indicated a different world religion, but
that is no barrier when a child's life is at stake, and I'm glad for
that, that justice and mercy offered in a humble way cross barriers of
faith and culture.

On Friday, at the "launch and lunch" celebrating the end of our week-
long Village Health Team training on nutrition in HIV/AIDS, I walked
in late just as John was graciously covering for me, and found myself
immediately invited to speak. The first thing that came to mind was
Isaiah 58, so I read a few of my favorite verses, and found that
though I was preaching to the VHT's the Spirit was speaking to ME. If
you extend your soul, pour yourself out, on behalf of the needy and
hungry . . . then God will be your guard, He will come to your aid.
As volunteers these health workers will pay a price to help others.
But their reward is from God, and He promises to refill what they pour
out.

Today I cling to that promise, too. And to the clarity: what is
required? Just this: to do justice, to love mercy, to walk humbly
with God. This was a life verse we reflected on at my Dad's death, a
summary of the way he lived. And it provides a guide for me and for
our team. Let us pursue justice vigorously, let us live out acts of
mercy, and let us do both, not in a way that promotes ourselves or
America or World Harvest . . .but in a humble day to day walk with God.

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.