Wednesdays . . .

Always start well, with team prayer meeting, and the opportunity to play our little keyboard piano and sing, which I love.  The last two weeks in particular, those team mates leading prayer have taken admirable risk to confess sin and ask for prayer in deep and real ways.  2 Cor 4 keeps coming up, faith, looking clearly for that which can not be seen.  

Yogurt, granola, coffee, tea, making sandwiches for lunches, checking email, thinking through the day, greeting workers and making sure they are set, gathering a few supplies to restock at the hospital, getting on bikes to head off to school and work . . .. 

Wednesdays are usually pretty full, with rounds on the over-crowded ward and then mid-day in the HIV clinic.  Today was no exception.  Sometimes the nurse coming off of night shift tells us whom she thinks is the most critically ill, so Heidi and I begin there, then proceed slowly, bed by bed.  Checking labs, counting out pills, examining, touching, talking, thinking, searching for clues, trying not to miss any important danger signs, patient after patient.  Sometimes the sheer effort of listening in another language fatigues.  I try to think about teaching staff as we go on rounds together, too, though the extra energy for that can be hard to find.  And with two interns (one pre-med and the other in med school) who are bright and questioning, I come to the end of what I know pretty quickly!  I remember why parents like to justify action with "because I said so . . ".  Sigh.  Mid-rounds I excuse myself briefly to call the District Police Chief and complain that the rapist still has not been arrested, a moment of advocacy in the midst of science.  With all the beds full a dozen or more patients are on mats on the floor, so I have to kneel or squat to examine them.  One of the last kids looks pretty comatose, but responds to pressure on his hand, opens his eyes, but does not talk.  I see him trying to focus on me, on his mom.  So I pull out a sweet, and ask if he'd like it, and he raises his eyebrows . . and I'm reminded of Kevin coming out of his coma, and smile.  This kid has severe malaria, but he'll be OK.  

Then over to the clinic for AIDS patients, which is usually bustling.  I see patients in a little side room, calling out  "onje?" (is there another?) through the curtain as I finish with each one.  As I'm tracking down a lab result, I notice one of the interns looks bored having finished weighing all the patients, and pull him in to see patients with me, more time here to discuss the complicated issues surrounding HIV-care in a resource-limited setting, something close to my heart.  We tell a mother that her baby's HIV test was negative, a joy I get to repeat twice today.  I notice that Barak Obama, who was named after our American president after being born in our truck on the way to the hospital, is also negative.  Fun.  I review the 5-years-of-growth-chart data on Mumbere, who has the ID number 4 (out of a thousand or so), one of our first HIV patients.  This is where he came starving and malnourished, this is where he got TB, this is where his mom died, this is where he began anti-retrovirals, this is where his grandmother took over his care.  Later I notice a baby whose mother coughs, a lot, and I send her for TB testing, no use to just treat the baby when his greatest risk is probably his mom's untreated infection.  In and out of the exam room, connecting some patients with peer counselors, making sure that CD4 counts are being collected, that medicines are being dispensed.  

Back to the ward, malnourished twins have arrived, a rather complicated (and in duplicate) ending to a five-hour morning  . . then notice that three of our best nurses are struggling to get an IV in a very anemic child, who is going into shock.  While they keep trying, I walk the medical student (who has EMT experience) through an intra-osseous line.  He gets it in, but we are not getting good flow, and by that time the nurses get an intra-venous line.  

Brief stop at CSB to discuss some team issues, then back home for an hour, firing off a few emails and counting out funds to send 30 blood samples for CD4 testing (has to be done in Fort Portal), with the bonus of returning with blood for transfusions from the blood bank.  Back to CSB for chapel, very optional, but an opportunity to greet a few staff and students, touch base with Jack and Julia, pray while the chaplain preaches, for heart transformation and spiritual growth and cultural change and peace at the school.  

Then cooking dinner, Jack and Julia stay for football (soccer) pick-up games with kids at school, and I'm alone for the first time since 6 a.m.  Liz from the WHM office has sent me a fantastic sermon series, so instead of the radio, I put one on as I cook, knowing I need my frazzled focus to be re-directed to Jesus.  The story is of Mary Magdalene, of looking beyond the voices in our lives which tell us who we are, to the unseen reality of what God says is true.  Again, looking clearly for that which can not be seen.  I've seen a lot of grief and anxiety and conflict and instability over the course of the day, and I realize how strongly I want to blame my stress on the situation, want to have the problems fixed my way, instead of waiting on God.

Wednesday nights are family night.  Right now that's just three of us,  but we set out our best plates and glasses and light our candles and eat our spaghetti with freshly made sauce.  I'm so thankful for this protected evening, setting ministry and other relationships aside, to listen to my kids tell about their friends, about what a teacher said or how a soccer play went.  Their lives are not always easy.  Today Jack was blatantly fouled from behind while dribbling the soccer ball, then had lots of kids jeer at him as he rode his bike alone up the road, and came home to chores and the news that he has an unexpected chemistry test at 8 in the morning.  That's a lot for an 11 year old to take.  So we talk, and call Luke, and listen to music, wash dishes, read out loud, until Wednesday fades into sleep.

All Things New

Watched Slum Dog Millionaire (again) this weekend, and this time noticed an unusual scene.  At the very end, when Jamal kisses Latika's scar, suddenly there is a rewind-like camera shot of the scene in which she receives the knife cut to her face.  We go backwards from the struggle to a moment of expectation and happiness, when the two lovers look at each other unwounded, with joy.  

A striking visual of Revelation 21.  Tears wiped, death becomes life, the act of love reverses the ravages of hate.  

Perhaps in the context of the struggle for healing and justice for my rape patient, this image is particularly poignant, since Latika was also sexually abused.  Not just a covering over of evil, but an actual un-doing.  All things new.

Pictures from Birthday

Heidi, my hero, taught me to upload pictures to my blog (yes, all that you've seen up to this point was Scott). So here is my lovely prayer-breakfast table, which began the day on the Masso's porch: Here, our team, including Craig and Dick from the Mariner's Church (Pierce home church in Annapolis) and our intern Doug . . Tim it seems was pushing the timer button and didn't make it. Sorry Tim! The reason I am surviving here without Scott: cheery kids and a hard-working team. This is the pizza production on my Bday. And it proves that Tim (blue shirt) is actually here. Me, with two fire-cracker candles standing in for the 47. Ashley made the amazingly rich dense chocolate cakes, and the Pierces made ice cream. Pretty yummy.

Seek Justice

The case of the little 6-year-old girl who was raped continues to gnaw at our hearts, with no resolution or arrest to date.  So when I asked Heidi what topic we should address in CME today (our weekly staff meeting), she suggested we discuss sexual abuse.  At first I was taken aback, about how to approach this . . .but I realized it was a good opportunity to allow airing of viewpoints and to integrate spiritual and medical perspectives.  

So I asked for the Spirit's guidance and began to look through my Bible to prepare, since this week should have been a primarily spiritual topic.  And I came to the story of Dinah, in Genesis 34.  Defilement of a young girl, capitulation by her father and murderous revenge by her brothers, intrigue and suspense.  It's a gripping tale but I worried it did not provide many clear answers.  Still we read it, and then discussed some questions.  Was Dinah guilty? NO, at least everyone agrees on this, which is reinforced by a very specific law in Deut 22:25-27.  Does God allow violent nonconsensual sex as a means to marriage?  NO, we all agreed here too, even though some cultures in Uganda consider this a normal means of courtship.  Was Dinah's father Jacob right to accept dowry payments to legalize the marriage after his daughter was raped?  The first two respondents said, YES.  A female clinical officer argued that now that the girl had been defiled, this was her only option for marriage, so it was better for the father to settle financially and leave her with the man.  An older male took the perspective that Jacob did:  peace in the community was more important than one particular girl's violation, and a monetary settlement that preserved community relationship was acceptable.  At this point I began to regret choosing this Bible story.  Maybe it is my own cultural bias, but Jacob's passivity mirrored too closely what was happening in real life to my patient.  

But then two more men spoke up, disagreeing.  If the father takes the dowry, then rape is accepted, and we can not allow that, they said. Once the first spoke up, almost everyone else agreed with them, that from a moral and legal and practical standpoint, rape of a young girl (or any woman) could not be condoned.  This led to good discussion about WHO is responsible to protect our children:  parents, the community, the government, the police, God.  And after some medical teaching defining sexual abuse and discussion the physical and psychosocial consequences, we came back to the case at hand.  As medical workers, what else could we do?  We had treated the girl, filled out the proper police reports, appealed for action.  Yet the assailant was seen going about his business yesterday.  It is one week since the incident, and he remains free.  And here the community of medical workers gave me hope.  They came up with a plan to write letters to various people in police and government, and even an appeal if no action is taken by next week.  We ended with Rev 21, where all tears will be wiped away, all things made new, even the mind and body of a raped 6 year old.  For the first time it made perfect satisfying sense to continue to verse 8 (I'm usually temped to stop at 6 or 7 on the God-high and not look too hard at hell in v. 8).  It is no mercy for the assailant to continue on his way without consequences; if he is not led to repent now, he faces a grim eternity.

So this afternoon I'm dispatching my missives, hoping for the proper tone of outrage and respect that will stimulate some action.  Meanwhile our sweet patient complains of pain when she walks, and restless sleep, and vague stomach aches, and waits for justice to roll down.  

Discipline of Thanks

Today is my Birthday . . . and I am devoting this post to a few things to be thankful for, in honor of the June 25th  meditation in my devotional book. Because today was a doozy, with enough crazy vortex-of-crisis type events to make me wonder . . . including the last straw, a psychotic woman who started attacking me when I went out to see what she needed in my kitubbi (no harm done, and when she lunged for Heidi who was holding all the pizza toppings at the time I managed to deflect her).  Thankfulness opens the heart to communion with God, which I sorely need, so here goes.

+Jack and Julia, who are doing a great job of taking care of me without Scott, Luke, and Caleb here . . . pitching into chores with dog, cows, water, bikes, dishes, etc., solicitous of my Birthday happiness.  They are an amazing pair and a joy to be with.  

+Goats, which were sent home today with a variety of needy people. Picture a petite little mom with AIDS tugging at the rope of a massive white horned beast, her baby on her back, setting off for home!  Earlier I had the privilege of listening to the pre-distribution speeches, as our visitors Craig and Dick shared from the story of the abundant filling of oil for the widow, surely a closely related picture to the replenishing supply of milk these animals will provide.  As they talked I watched one of the mothers:  I had mourned with her when, in the pre-ARV pre-UNICEF era, we watched her son Dickson waste away and die.  She had no surviving children at that time, a real tragedy here.  But now she has a healthy 6 month old who tested HIV negative, and will stay that way by drinking the goat's milk provided today.  Having sat with her at Dickson's grave made it all the more sweet to see her receive life, and hope, in the form of the goat today.

+Team.  The young single crowd surprised me this morning when I slipped away to the Masso's empty house for prayer, preceding me with fresh home made muffins, and several scripture passages (including my Dad's favorite Psalm 121) written out, my favorite hymn, and flowers.  I felt very loved.  All day long people popped in and out to check on me, and then tonight put together a great cake-and-ice cream post-pizza celebration.  I'm humbled and heartened by the kind words on my cards, and the acts of service.

+Kevin home from the hospital, two weeks from death to beginning the rest of life, God's mercy.

+Cell phones, which allowed me to talk to my husband, my mother, friends in Sudan, Uganda, America.

+The USA football (soccer) team . . Ok bear with me but it was really fun to watch them beat Spain, to hang out with my son and some of the guys and enjoy a game where heart and determination beat the odds.  Hopeful for our life in general.

+Dancing:  we ended the evening with an all-out dance party, candles and a whooping bass, on the porch under the bougainvillea and a damply humid dark sky.  

Discipline of Thanks

Today is my Birthday . . . and I am devoting this post to a few things to be thankful for, in honor of the June 25th  meditation in my devotional book. Because today was a doozy, with enough crazy vortex-of-crisis type events to make me wonder . . . including the last straw, a psychotic woman who started attacking me when I went out to see what she needed in my kitubbi (no harm done, and when she lunged for Heidi who was holding all the pizza toppings at the time I managed to deflect her).  Thankfulness opens the heart to communion with God, which I sorely need, so here goes.

+Jack and Julia, who are doing a great job of taking care of me without Scott, Luke, and Caleb here . . . pitching into chores with dog, cows, water, bikes, dishes, etc., solicitous of my Birthday happiness.  They are an amazing pair and a joy to be with.  

+Goats, which were sent home today with a variety of needy people. Picture a petite little mom with AIDS tugging at the rope of a massive white horned beast, her baby on her back, setting off for home!  Earlier I had the privilege of listening to the pre-distribution speeches, as our visitors Craig and Dick shared from the story of the abundant filling of oil for the widow, surely a closely related picture to the replenishing supply of milk these animals will provide.  As they talked I watched one of the mothers:  I had mourned with her when, in the pre-ARV pre-UNICEF era, we watched her son Dickson waste away and die.  She had no surviving children at that time, a real tragedy here.  But now she has a healthy 6 month old who tested HIV negative, and will stay that way by drinking the goat's milk provided today.  Having sat with her at Dickson's grave made it all the more sweet to see her receive life, and hope, in the form of the goat today.

+Team.  The young single crowd surprised me this morning when I slipped away to the Masso's empty house for prayer, preceding me with fresh home made muffins, and several scripture passages (including my Dad's favorite Psalm 121) written out, my favorite hymn, and flowers.  I felt very loved.  All day long people popped in and out to check on me, and then tonight put together a great cake-and-ice cream post-pizza celebration.  I'm humbled and heartened by the kind words on my cards, and the acts of service.

+Kevin home from the hospital, two weeks from death to beginning the rest of life, God's mercy.

+Cell phones, which allowed me to talk to my husband, my mother, friends in Sudan, Uganda, America.

+The USA football (soccer) team . . Ok bear with me but it was really fun to watch them beat Spain, to hang out with my son and some of the guys and enjoy a game where heart and determination beat the odds.  Hopeful for our life in general.

+Dancing:  we ended the evening with an all-out dance party, candles and a whooping bass, on the porch under the bougainvillea and a damply humid dark sky.  

Goat-Huggers

Some college kids and grad students do tree-hugging environmentally-active politically-correct summer projects.  We in Bundibugyo have our summer interns hug goats.  Last night, in the moonless darkness about 8 or 9 pm, a large truck loaded with 49 goats arrived on the mission compound.  Lammech had gone to purchase these high-grade dairy goats from a project in central Uganda, using the funds raised by the Christmas-tree-ornament-project.  Forty-nine goats had to be wrangled to the edge of the huge flat-bed truck, which was about shoulder level for us on the ground, then enfolded in the arms of a waiting Tim, Doug, Nathan, Jack, Sarah, or a few strapping young men whose darkness melted into the dark night, then physically carried a few dozen yards through uneven paths to reach the Masso goat pens.  Some goats were sort of cute.  Some were massive males, like the size of small cows, for breeding with local goats.  These had pretty impressive curving horns and sharp hooves!  Doug, ever up for humor, kept us all laughing as he called out to John (tallying) and Lammech (wrangling) on the truck:  bring me a big one, bring it on, bring it on, I'm gonna wrestle this one . . . Pauline waited to sort them into the proper pens.  She had arranged for loads of fodder to be available, and water.  I merely held flash lights and helped people find their way around, and laughed and encouraged.  But I will treasure the images of Tim and Doug, arms outstretched, determined smiles, grabbing these big wiggling furry creatures to their chests and carrying them all the way into their pens.  It reminds me of Sunday School pictures of the Good Shepherd bringing home the 100th lamb.  And it is probably a far cry from anyone's image of an aspiring doctor, but nevertheless very Jesus-like.

Must-read

JD has posted the full story of the events of Kevin's mostly-dead collapse, and recovery.  It is a must-read.  Link to it here:  http://kwegesiya.blogspot.com/2009/06/instant-replay.html.

I think this is the first day they can really believe he is going to be OK, to go home, following the first night with the new internal defibrillator which allowed JD to sleep with some peace that if the deadly v-fib rhythm recurred, he would be automatically shocked back out of it.  This is a testimony of pain and fear and facing the ultimate loss, and of miraculous healing and community and love and provision.  Resurrection is God's favorite and essential modus operandi, so this points to Him as a real-life story of present-day power.

Divided Heart

With half my immediate family and all of my extended family out of this country . . I go through the day bouncing between thinking of tragedies like the little girl in red polka dots, and then about my loved ones far away, calculating time zones in Virginia, California, North Carolina . . .  Kevin had an automatic defibrillator surgically implanted yesterday, which sounds rather intimidating, praying it went well.  I heard that my mom had a fiasco with a dead car battery and then a claustrophobic 2 hour MRI of her back. Luke sounds great in Kenya, using his pottery class to design nose cones for the rockets he's making in AP Chem.  Scott and Caleb have had a great weekend with the Myhres of California, were warmly received by the Half Moon Bay Methodists, and yesterday soaked up renewing sunshine in a strenuous ridge-top hike and an afternoon of boogie-boarding in the surf.  And back to my loved ones here, today is Miss Ashley's birthday, and her devoted fans have been working hard on a lovely card.  By evening the shipment of 50-some goats should arrive by truck, to be given to HIV-affected families and orphaned babies.  It is the technological experience of simultaneity (not a word I'm sure) that can be jarring, interrupting our breakfast here to say goodnight to Caleb on a cell phone!

The world goes not well

First, if you are reading this as a kid less than 16, skip this post.

We know the world goes not well, but usually it is a background irritant to the illusion of success.  Today, however, the "not well" is like a punch in the gut.  On my ward, a 6 year old girl, who was raped.  A very normal looking sweet thin little girl in a red polka dot dress,  watching us all, accompanied by her pregnant mother and harried father.  Seems she and her two siblings were in the family's gardens alone (not so shocking, mom was tired, told them to go play after lunch) when an old man, a former UPDF soldier, grabbed her, told the other kids not to scream or he would find them and shoot them . . . and then proceeded to hold the little 6 year old girl down and rape her.  The siblings ran home crying, having recognized the man as an uncle of their neighbors, and the family brought the little girl bleeding profusely to the hospital.  This happened over the weekend, but even today the evidence of the trauma is quite clear on exam.  

How do I as a pediatrician react to this?  Shock and horror and outrage and anger.  Then some action, paltry probably.  Most importantly to let the little girl tell me her story, again, figuring that another adult taking it seriously and letter her vent is a good thing.  She spilled it out rapidly, concretely, matter-of-fact, not emotional.  Then to tell her in very clear terms this is not her fault, she did nothing wrong, she did not deserve this, she has nothing to hide or be ashamed of.  And to promise that we and her parents will make every effort to protect her.  Then to get her started on HIV-post-exposure prophylaxis (which thanks to our trip to EGPAF two weeks ago, I actually HAD in the medicine store, thank God).  The soldier connection is worrisome, and there is a belief that sex with a virgin can cure AIDS, so it could have been part of the motivation for the attack.  And treatment for syphilis.  And calling the child welfare officer attached to the town council.  And filling out the blank police report form.  And then, at last, marching to the police station myself with Heidi and the nurse and the father, to discuss the plan to apprehend the perpetrator.  It is actually unimaginable to me that no one has taken any action yet.  Fear?  Reluctance to get involved?  Hope for a cash settlement?  Apathy?  Or just lack of transport?  In this country the police sort of wait in their office for the family to do the real work of finding the criminal.  I put down a good chunk of money to try and spur on some action.

Last week our worker Saulo's family went into a frenzy of panic when their little girl, Nightie (?age 4ish) was missing from her nap.  They searched and found her a few minutes from home, left lying by the river, with a story that a man speaking Luganda had entered the house and picked her up while she slept, then threatened her not to scream . . not clear why he set her down, but he did, and she was unharmed.  There is a lot of press right now about child sacrifice, about unscrupulous and greedy people taking children to witch doctors for sacrifice to ensure success in business.  It is always attributed to "outsiders", someone from another tribe.  There is also an idea that only an un-scarred child will be used, so a circumcised boy, or a girl with pierced ears is safer.  This is driving earlier and earlier circumcision, the culture is abandoning the historical traditions of near-adolescent group-enculturation and ceremonial circumcision, in favor of protecting their toddlers.  And the day after this scare, Nightie and her sisters had their ears pierced.

When children are used by adults as sacrifices for their success, healing, or need for power . . . we know that the world goes not well.  We have a visiting pastor, Craig, from the Mariner's Church in Annapolis which supports the Pierces.  He read us the Lazarus story last night and spoke on the verse "Jesus wept".  This, he said, is God's continual posture towards the broken world.  He weeps.  Even knowing that resurrection is imminent, knowing that the Kingdom comes, does not erase the pain of wounded love for His children.  He is not indifferent, and He is actively reclaiming the territory of grief, with tears that become springs in the desert, that transform suffering into blessing.  Hard to see that today, but we hold onto the truth and pray for the Kingdom.