countdown to take-off

In about 8 hours we should be driving out of Bundibugyo, on the way to Kenya.  Every two years the Christian Medical and Dental Association puts on a 2-week conference for missionary doctors, so we can stay current with our continuing education hours and keep our medical licenses up to date. Of course it is also a wonderful opportunity to be encouraged, to not be ALONE.  Due to the timing of my Dad's death we missed 2006, and the post-election violence in Kenya led to cancellation in 2008, so it has been six years since we last attended.  This time we will be taking along nurse Heidi and PA Scott Will, and meeting our new doctor-colleague-team mate and family Travis and Amy Johnson, who will land in Nairobi tomorrow and wait for us.  And Ashley, to teach Jack and Julia while we're in class.  We're quite an entourage of 7 adults and 5 kids . . made even more complicated by the news today of ongoing insurmountable car difficulties for the Zoolander (the former Bart-mobile shared by the singles) which means that our truck will be the sole ground transport for all.  All of us but Scott Will are sharing a very simple guest house at the Moffat Bible College adjacent to Kijabe and RVA.  Though it is about 40 minutes' drive from the conference site, no kids/families are allowed at the conference facility to maximize space for missionary and national doctors.  So we'll be in a sort of commune, cozy, probably not overly-comfortable, but likely to be memorable.

Meanwhile, that means with travel to and from, we'll be away from Bundi for almost three weeks. Which feels like a LONG time, and less-than-ideal timing.  Scott has been severely pulled and pushed by the inevitably bumpy transition into the new school year.  And so leaving for a few weeks puts a huge strain on the last day here, friends still desperate for school fees for their orphaned siblings, our beloved dog with maggots from sand-flies, biting ants swarming outside our bedroom window, deciphering complicated spread sheets and making adequate money available for programs, persisting at the bank long enough to will one's way through the passive-aggressive managers, sitting down with visitors, the typical afternoon crisis of a fever in a neighbor's kid, the usual.

However, there were some reminders during the count-down-to-departure today that God smiles.  My first patient was sporting a very clean, spiff, University of Virginia (our school) T shirt.  And nothing else, of course. He was a 4 year old sickle cell patient whose smile and energy belied his hemoglobin of 2.2.  Of course we see all kinds of American-slogan shirts all over the place in the thriving used clothes trade, but I'd never seen a UVA shirt that wasn't ours before.  Fun.  The next bed held a child from Congo with severe malaria, no history of immunizations, looking bewildered by the whole hospital experience.  I shamelessly give every patient a little wrapped candy as I begin my exam, which distracts them, and as a gesture of good will counteracts the rumors used to scare children that white people are spirits who have come to eat them.  This kid looked at the candy so hesitantly, and held it so carefully, I was pretty sure he'd never seen such a thing before. Throughout the day I was struck by the competence of Olupa and Asussi, the nurses I love to work with.  I would put my confidence in them over most anyone I know (doctors included) to care for critically ill Ugandan children.  Then Nathan walked in to join us, and the next patient was one whom he had identified at an outpatient nutrition program months ago.  The child had been severely ill, basically starving, and would have died unless his path crossed with Nathan's and BBB.  He completely recovered and was back for a minor gastrointestinal illness.  Then my favorite little guy at the moment, Obeni, with TB, reached his weight goal today, another small gift for me as I hate to walk away from these kids.  Later Nathan told us about Day #1 at our newest outpatient site in Butogho where he spent the afternoon, an area that our extension workers identified as having prevalent nutritional problems.  Baguma Charles trained the clinic staff and volunteers in January, and today they screened kids for enrollment.  Everyone was so excited to see the program begin that they flocked to the health center, calling their neighbors to join, drawing pasers-by off the street.  Nathan estimated that at least 200 kids showed up, mostly NOT malnourished.  But among them they picked out 17 who were severely malnourished enough to qualify.  

Only 19 more minutes in today.  And the countdown of hours until we load the truck and pull out ticks on.  Time to finalize packing, to rest these kids in the Healer's hands, to accept what has been left undone, and go.  So we can come back, more ready to care.

welcoming home

Nathan arrived safe and sound, a welcome sight around 4:30 last evening, amazingly awake, strong hugs.  As our friends return from Christmas there is a sigh of relief, the realization of their absence and the hole they left, the-world-is-more-right feeling of being back together.  Now Clarks, Ashley, and Nathan are all home.  A dry-season perk is that the insect population is marginally less overwhelming, and since the inside of the house remains solidly in the 90's until well after sunset, we've been eating by candlelight on the little brick-and-bougainvillea patio outside.  So in the midst of a hectic week (the two babies I thought would die survived but a third I hoped would turn around didn't . . . Jack in tears after his first beginning-of-term exams when he realized he had made mistakes on almost every math problem. . . Scott mediating a dispute over which staff member needs the newest computer left to the school . . . letter written to explain why we are supporting the church leaders' decision and not over-riding their authority in a recent church dispute . . . accounting and prayer and stretching out the last of our food . . ) it was a taste of heaven to eat together, the candles flickering in a rare breeze, insects chirring, hearing stories of med school interviews and family times.

Monday, heat, bustle, beginnings

Monday, the start of a new work week, of a new month today, and of a new school year in Uganda. And of a team retreat for our Sudan team, and so the beginnings of dreams and plans and listening to God. The first day for CSB to be up and running without a missionary head teacher. And so a few impressions from today, mid-way through . . .

Heat: the dry season has at last arrived, after a month and a half delay. The oppressive cloud cover broke in a massive storm, and since then mid-day temps soar, dust rises, rain is infrequent. It is drier, but not exactly dry, maybe a drop in humidity from 99% to 85% (I'm making this up) and a rise in temperature from 85 to 99 (well, not quite that high perhaps, but in the mid-day on the road it must be close). Kind of a Bundibugyo balance to keep the misery index constant. And child after child on the ward had temps well over that, 102 seemed to be the average today. HEAT, from the sun and from the body fighting infection, purifying. Purifying me, too, sweating it out, and pursuing contentment in all circumstances. Thanking God for two top nurses, Olupah and Asusi, pleasures to work with even in the heat, and a welcome sight on the Monday when all the rest of the medical WHM team happens to be out of town.

Bustle: The community alarm clock is a person whapping a metal wheel rim well before 6 in the pre-dawn darkness, because the primary school two doors down has decided to institute a boarding section. Meanwhile the hundreds and hundreds of non-boarding school students all began to flock on the roads today, assorting themselves into color-matched pods of one school's uniforms or another. Bodas carrying parents, trunks, people missing work to pay school fees, prayers, anxieties, scramble, the massive effort one can only appreciate in a country where 50% of the population is under age 15 and where education is seen as the ticket to success in life, and for the clan.

Beginnings: I watch my students' trunks being checked as they enter the CSB gates, greet teachers who are sweating through that onerous task, pop my head into the school nurse who is tasked with performing pregnancy tests on all comers, sit in the line of fee-paying parents. The bursars listen patiently to everyone's stories, dutifully marking down what payments are made, issuing receipts, gently chiding those who did not pay all their fees from last year, checking off lists, explaining the categories of payments. The staff and returning students mingle with hopeful parents, all greeting, recognizing old friends, a pleasant sort of chaos on the school porch. Staff with new duties look serious and determined to fulfill them. New signs are on the office doors. Deus smiling, quietly going about his supervision. I wonder how much grief underlies the day as people re-start life here without the Pierces; I know they are missed, and I suspect they are grieving somewhere on their travels, knowing school has begun. The sad reality of ways that part, of following a call they've heard to move onward, of being left here behind. We alternate between hopeful reassurance that life goes on and students and staff will manage, and weary wondering if all the loose ends they held together will unravel too far.

It is almost 8 hours since I left home this morning. I've seen two babies that will not likely live through the night, jaundiced and feverish and fragile newborns. Another whose mother bled to death less than six hours ago, leaving the family to cope with an orphaned newborn, which thanks to surrogate breast-feeding support should be possible. A 10-year-old in a coma, with signs of increased intracranial pressure, spinal tap looks very clear but waiting for results, prognosis also poor. Blood dripping into a child with sickle cell anemia, a hope-it's-not-too-late transfusion. A preemie who made it up to 925 grams today. Two new diagnoses of TB and one who is on his second week of therapy and finally starting to improve. There are knocks at the door, notices about meetings, complaints about water flow, flat tires and honking horns, and my own family who will expect a dinner sometime soon, good news from Luke that he's back in classes and out of quarantine as of Friday . . . And so another Monday passes.

Advice for New Missionaries

This morning's sermon from Acts 21 compared the advice given to Paul as he came to the Jerusalem church to that the Babwisi would like to give new missionaries.  In the Bible, there is tension between the ancient culture of Judaism from which the first believers are emerging, and the question of how much of that culture should be part of non-Jewish Christian practice, and which pagan rituals are acceptable or unacceptable for Christians.  It is fascinating to consider these cross-cultural issues which arose from the very beginning, and to see that most of the direct written-in-Scripture commands of the new Kingdom are heart-level principles about love and humility and service and obedience and holiness . . with the specific application to various cultures left to councils and consensus of leaders.  In Acts they decide (1) it is good for Paul to participate in a traditional Jewish vow ceremony so people can see he respects the old laws and ways, so the Gospel does not negate all pre-existing traditions, (2) the believers from other cultures should not be required to become Jews, so the Gospel does not create a monocultural standard, and (3) there are a few things that the leaders deem worth taking a stand against in the prevailing Greco-Roman culture like sacrifices to idols and sexual promiscuity, so the Gospel does impact certain aspects of every culture it enters.  So much of the New Testament deals with the practical outworking of these issues, with where to draw the lines, and who gets to draw them.  Respect for the old ways (even recognizing God's presence in them), embracing diversity, and taking a stand against evil:  finding the balance between these three values threw the early church into turmoil, and continues to haunt missionaries today.  

So the preacher's advice to new missionaries was this:  

1.  Know our culture.

2.  Bear with us because we are poor and not so much educated.

3.  Learn our language, either Lubwisi or Lukonjo.

4.  Know our beliefs, because sometimes we believe in these small gods.

5.  Know what type of food we eat.

And his example was, that if you come to a home and find the kanumba (small shrine to ancestral spirits) out back, do not kick it down.  Instead, sit and talk to the owner, and be patient, until he decides on his own to dismantle it.  Excellent advice.  It is always a danger to think we see the evil in another culture, and find too many things that fit the third category above.  Instead we should look for more ways to honor the culture, to enter, to redeem, to strengthen its uniqueness. until the believers themselves sort out which aspects of their past were oppressive and wrong and should be left behind.  God is merciful, both to us missionaries who have over-westernized too much of the world  by painting in clear black and white strokes,  and to indigenous Christians who cling to their views in tones of grey.  

And lastly, it was a fascinating morning, because almost any other sermon I've heard on these Acts/Galatians type passages have interpreted them in light of a defense of salvation by grace (you don't have to be circumsized, or it's 20th century American religious equivalent of morality, to be saved) rather than as a defense of preserving old cultural ways (it's OK to keep circumsizing, to shave heads and pay vows, that Christianity is compatible with most aspects of cultural tradition).

confirmation

The little girl who was a rape victim picked her assailant out of a group, which must have been a horrible experience for her.  The police made her do so separately from her mom.  And the first group they paraded did not include the accused.  But she's a tough little six year old, and she told them he was not there, then pointed him out in the second group.  The mom also made an ID separately.  And I spent another afternoon filling out police reports in triplicate and driving them with Heidi all back up to the station to be sure the file was complete.  So, it seems we have the right man arrested. As ambivalent as I was, the mom's relief and triumph in the apprehension made me glad we kept persisting in the quest for justice.  Now we just have to keep advocating for his conviction, for his removal from the community where he has done such evil.  As well as the second case, the one from this weekend, involving a different man and a 12 year old girl.  I can not think of many stories where the line between good and evil appears so clearly drawn as between a violent sexual assault by a possibly HIV positive man and a primary-school age pre-pubertal little girl held down and harmed.  However, even now, I sense weariness more than victory, sadness more than relief.  And the sickening realization that these two cases are only the visible tip of a murky multitude.  And the punched-out feeling that both men are now aware of our involvement in their prosecution (shirtless, pushed up against the bars of the holding cell with a dozen other men, watching as we interact with the police), and I have a 13 year old daughter, and why should the angels protect her in a way that these other two little ones were not?  Tough, tough questions, the evidence that we are slamming right up against the powers of evil, and that even small successes come with scars.

confessions of a medical mom

Luke is spending his fifth day of fever and confinement in the school infirmary . . . I've tried to be confidential, but someone wrote they heard about it on facebook, so I guess it's public knowledge.  His school has been hit with a massive epidemic of flu.  Yes, the dreaded disease.  Extremely contagious, and nasty to live through, but as the wave crashes through it seems to be a relatively mild strain, in that there are no serious complications or deaths.  When H1N1 began to spread, the anticipated mortality rate was 1 to 2 %.  Sounds low, until you have nearly a hundred kids sick in a boarding school.  If one or two die, at our school or others, it would send shock waves for sure, but so far in the schools that have been hit here in Africa, the kids have recovered well.  We think we're probably seeing a similar epidemic of fevers and respiratory viral symptoms here in Bundi, just treated one of Luke's friends whose symptoms are similar.  So I confess I've been challenged to have faith, felt sad that my own child is suffering far from home, second-guessed alternative diagnoses lest we miss something serious and treatable in those 103 degree fevers, and prayed.  And wondered over the irony of caring for other peoples' kids instead of my own, as I've seen patients all week.  And chalked up another God's-plan-not-mine-episode, living through a week of transition and challenge and crisis while my heart is occupied with a distant case of flu.

evening encouragement

Yesterday was a long pummeling bounce from one crisis to the next. Everything seemed broken, from a team vehicle to the entire water system to the propane fridge at the health center used to store blood. And these are not mere annoyances. Passive-aggressive staff behavior and nation-wide bureaucracy and corruption will cost lives, the lives of innocent kids. The first case of potential cholera in many years was admitted to the isolation ward, which had no water. Hundreds of students are about to arrive on campus and need to eat, and the kitchen is not yet functional. At one point as I watched Scott figuring out which valves to turn at the town's water tanks .. . I felt more alone than we have been in many many years. We're not alone, I know. God has called us to this moment, and He's asking us to hold on.

In that context, the evening was very encouraging. We had invited the CSB staff to share pizza with our team (well, what's left of it, our pared-down family of four with Heidi, Anna, Scott Will for two more days, and Ashley just arrived). Last year we were never able to manage this kind of gathering. And with all the change of the last few months, without the PIerces, and with the uncertainty of starting a new year, it was with some trepidation that we invited them. But God was gracious. His primary symbol of presence-on-earth is a meal, communion and community go hand in hand. Last night, we experienced that incarnational reality. About 20 staff joined us, outside, as we created pizzas and encouraged them to try the unfamiliar (I also had massive pots of rice, meat, sombe and beans so that no one would leave hungry . . . and though people ate the familiar, they left most of it in favor of adventure). Soon there was loud laughter in the dimming evening, candles, joking. Jack and Julia and I kept walking around with fresh pizzas, and staff members would joke and insist they were full and then be cajoled into a bit more. Scott Will brought a wealth of toppings, and when we got to the dessert pizza (condensed milk, jam, and chocolate!), people were amazed and delighted. Two young guys actually had to lay down on the grass they were so stuffed. Later we sat in the front room and played a game, and then ended the evening with recounting some blessings of 2009, worship, singing together and praying for the year, that we would all reflect God's glory in a dark place. It was a moment of tasting goodness, in the food and in our team's super-helpful hospitality and in the staff's joy and fellowship. Many more problems will come, starting today no doubt, but we are encouraged as we plunge into the year.

Some scenes of the week

Miss Ashlely Welcoming Party: her football players, Julia and Charity! Getting initial hugs from Ashley by the MAF plane. She's just left the snowiest winter in Virginia to land in blazing equatorial mid-day heat. Finding a bit of shade on the airstrip while the MAF pilot does a routine check. Jack entertains with card games during a cooking lesson: Miss Anna took Jack and Julia to a neighbors' house where their friend Naomi taught them to pick, clean, pound, and cook sombe and ground nut sauce. The sombe, leaves from a cassava plant, ready to cook. Some processing required: cassava leaves contain cyanide, and have to be pounded in the wooden mortar/pestle apparatus before cooking. Flavor added with pili pili (peppers). The Send Me Band, Bundibugyo's first Christian Recording artists, perform last Sunday afternoon at the Community Center. Scott Will and friends groovin' to the tunes in the back row of the standing-room-only crowd.

police work

Our police tend to sit in their office and wait for crime to come to them.  But a couple of good things have happened this week.  Note, this is not a kid-friendly post, even though it's about kids . . . so don't read it if you don't want to hear.

First, the rapist from the weekend was truly transferred yesterday to Bundibugyo, and will be appearing in court tomorrow.  So far, that case, very public, has not been dropped.  And that encouraged Heidi and I to follow up on our case from last summer, the little six year old girl Heidi called Miss Polkadots who was grabbed in her garden and held down and raped while her siblings ran home crying.  Though we had pushed and pushed for the police to find and arrest the perpetrator most of June and July, he ran away, or so we were told.  Now that six months had gone by we figured his guard might be down.  And we have a couple of new officers posted here, so it was worth a try.  Sure enough, they raided this morning, and brought the man in.  I went to the station myself, and have to say that the satisfaction was hollow, I was prepared to hate this man with righteous wrath, and instead I felt sorry for him.  The man is ill, younger than I thought, pitiful, sitting shirtless and handcuffed on the floor, looking terrified.  I talked to him a little, seems he just had an abscess drained on his back and his wife just delivered a baby girl.  He has the right name, right village, right history of being in the UPDF, and the police are convinced (in a sort of circular reasoning way) that he is the guilty party because they arrested him.  I just felt sobered by the responsibility of having his blood to account for if we're wrong.  Still out of loyalty to Miss Polkadots and little girls everywhere, I agreed to drive him with an armed guard to Bundibugyo town.  They located his file, but not the key for the handcuffs.  He'll be examined at the hospital, and then taken to court too.  The half-dozen other shirtless young men behind bars begged me for money.  I tried to talk to them about using this time in their lives to pray because God if forgiving.  I don't think they were convinced.  I thought of Jesus talking to his cross-mates.  Bundibugyo jail is a pretty barren place.

Meanwhile, some Baptist missionaries we met a couple of months ago are back doing a seminar in our Community Center for teachers and church leaders, sensitizing them to Ugandan law and childrens' rights.  Great topic, great timing.  And today's national paper carried two gruesome stories of ritual murder to obtain body parts for witchcraft.  We think that both rape cases were related to the devil-inspired-hope that an HIV-positive man can be cured by sex with a virgin.  Evil abounds, but there are people standing up, journalists and lawyers, policemen and doctors, saying "no further".  Let us pray.

pared down

Team composition ebbs and flows, like the tide.  Or in this agricultural context, there are rainy seasons of abundant growth and dry seasons of retraction, pruning, burning.  Right now we're kind of cut back to the stump.  This week we also say goodbye to Scott Will, who was here for four months in transition to his "real" appointment to the Sudan team.  He's an amazing missionary, combining genuine enthusiasm for people of all sorts with sincere service and savvy skills.  Another gaping hole will be left in our team, and in the lives of the dozens of young men and kids who hang out at his house, the friends he has made, the staff he assists at the hospital.  And most of all, in OUR lives, as another person moves on.  Barb Ryan did a Birthday skit/game for Scott that involved a stack of hats . . . he needs ones with various former-team labels to whip on and off, because the more people who move through, the more hats he gets left with.  Yesterday,  once again water was not flowing in Nyahuka, and Scott noticed a gushing pipe that had been cut behind the community center where dozens of people were rapidly filling jerry cans, which led to the discovery that some unscrupulous residents had TURNED OFF the valves to the huge tanks that serve the town in order to build the pressure in the line to feed their personal cut-pipe-water-source.  Then he whips off Michael's hat to put on various others, friends of old missionaries, coming in the week before school to ask us to contact their old friends for help with school fees.  Then the church planter hat because our presbytery is in a conflict and both sides want his ear.  And of course the CSB-board-chairman-only-missionary-left hat, dispensing the last piles of Pierce stuff they left in the house to give away, taking Deus to the bank to sort out the new account and signatures, dealing with the electricians, getting the field mowed, answering queries, turning in accounting to the US office.  His REAL hats, medical and team leading, had to take a rest yesterday, but will be pulled back out not doubt today.  

It was Scott who led the team bible study on John 15 this week.  Pruning never feels very pleasant to the plant, I'm sure, and never seems to make sense.  But that's the state we're in right now, as a team, as a family, as a mission--we've had entire branches removed, some to graft elsewhere.  Please pray for an abundance of life to flow in the little bit of us left, and bear fruit.  Please pray we'd stay attached to the vine, and not despair of our limits, rather be faithful conduits. Please pray that all this pruning would make room for new, healthy growth!