Pulled

Pulled in many directions, mostly good ones.

The conference, a constant flow of interesting and important talks, sincere people, fantastic ideas.  In almost every hour there is a challenge for a new direction we could pursue to improve health, something we should change in our practice, reminders of things we have dropped.  In every break, there is another person we can meet, inspiring heros who have forged further down this road than we have, or young faces whom we would love to encourage to stick with this crazy life.

The guest house, a creaking old dorm of rattling window panes, a mix of teens and toddlers, a dozen of us around the table most meals.  Building community with our new and old team mates, trying to pay a bit of attention to our kids, touching base with long-term friends around RVA/Kijabe.  This weekend our boys were on "mid-term" break.  We had thought of getting away as a family, but Luke was pretty content to stay on-grounds since about a quarter of the senior class was doing the same, and he has never been on-station and out-of-dorm, to zip around on his friends' motorcycles and hang out at their homes.  Plus we had another team birthday (celebrating 7 in a month, 3 Myhre, 2 Johnson, plus Bryan C and Anna L!).  

As it turned out, it was good that we stayed.  Caleb came down with a pretty serious pneumonia on Friday, either a complication of the influenza or a secondary bacterial infection . . by Saturday morning he looked concerning enough to consider hospital admission, but turned the corner shortly thereafter (it's pretty handy to live in a doctor community where a friend has a portable pulse oximeter handy).  We skipped our classes that day, Scott took the other kids into Nairobi for some fun, and Caleb and I had some down time for recovery.  I am SO THANKFUL his illness hit exactly on our visit weekend for fast recognition, diagnosis, and treatment.  

Messages from students back home in Bundi, concerns about team mates whom we have asked to do a lot, thinking ahead of what faces us on return and through 2010.  Travel arrangements for Luke, invited to interview at a small engineering school where he applied for college, sending our just-17 year-old alone from Kenya to Boston for a weekend at the end of the month.

Pulled:  medicine, a world of data and learning, kids, relationships we value, the impending launch of one son to American life in university, the whisper of ever-present risk as God heals another serious family illness, glimpses of the future with new team and even potential-team, responsibility for those we love back in Bundi, bigger perspective as we encounter people from dozens of countries doing hundreds of good things.  Releasing a grip on the future, and walking by faith for the day.

The Johnsons

The Johnson family has arrived, like a gust of fresh air.  Sincere, eager, kind, affirming, interested, humble, competent, friendly, they jumped out of a van impossibly stacked with more trunks and bags than you could imagine. Creative Lilly, fun Patton, and sweet baby Aidan, three precious fragments of delicate humanity deposited here.  After all the goodbyes, at last a hello, a looking forward.  After many struggles, more partners to put their shoulders into the Kingdom together.  Hooooooraaaaaay.

CMDA

When we were in college, people described the experience of URBANA, the triennial student missions conference in the US, as "trying to get a sip from a fire hydrant."  So much amazing and relevant experience and information flowing past, a torrential outpouring of resource, that left one encouraged, overwhelmed, stunned, challenged, changed.  Twenty-five years later, this week at CMDA feels similar.  Though it is a tiny event compared to URBANA, we see the same element of passion for the nations, the same atmosphere of worship and zeal, the same congregating of admirable saints, and the same wealth of relevant experience and information all around us.  Our days begin before dawn so we can by in the car on the way by 7.  The morning worship includes teaching from veteran missionary and pastor and professor Robertson McQuilken.  Then there are four different simultaneous options for lectures and workshops, a total of 28 to 30 per day.  We go from hour to hour engaging with statistics about HIV and breast-feeding from studies just being published, brought by one of the most global-thinking competent lecturers I've ever heard.  Then on to a panel of experienced missionaries presenting their thoughts and experience about spirituality and healing.  Next a cardiologist presenting cases, or a radiologist teaching us how to differentiate benign and malignant tumors of the liver.  Or an update on changes in immunization policy.  At breaks and meals we meet new and old friends.  Among all the 6 billion people in the world, these few hundred are probably the most like us, and the sense of connection and understanding comes as a relief.  We stand in awe of the programs others have managed to wrest out of chaos, we listen with great thankfulness to professors who have given up two weeks of their year to come and teach us.  Then another 45 minute drive back to Kijabe where Ashley and the kids have prepared a dinner, we sit around a long table for 11 as the sun sets and the Kijabe winds whip down the mountain, rattling the window panes.

Reality inserts itself in real-time, occasionally, messages from Bundi, emails, calls, which have to be quickly discussed and juggled during the fraction of time left in the day.  Or yesterday, as I walked out of a lecture and saw an sms from Caleb, temp 101, feeling sick, admitted to the school infirmary.  A bit ironic to be talking about sick kids while my own lies alone, so I find an earlier ride back and sit with him for an hour or so.  Sad to see him there, but at least thankful that this time I CAN SEE him.  Praying his bug is much quicker to leave than Luke's week-long bout.

Luke, 17 years of life

Luke celebrated another Kijabe-based-birthday yesterday: we've ended up here in Kenya as he turned 2 (to have Caleb), 5 (evacuated and waiting for Jack), probably another couple for previous CMDA conferences, and now 16 and 17 here at RVA. The 8th of February was also our first day of conference: an intense morning of Pediatric Advanced Life Support doing CPR on mannequins and interpreting EKG tracings, then back to the mission house where we're staying to cook dinner and cake for the Bday, with huge help from all, especially Ashley. Luke and Caleb came down the hill with two friends to join our WHM family group including the newly-arrived Johnsons, Heidi, Ashley, and Scott Will. We played bowl-full-of-nouns with a Luke theme (such as "Mile-High-Over-the Nile Bungee Jump" or "Number 18 Parkville Community Soccer League" or "the Mujangile"), prayed, ate, sang, and sent him back to study. Luke at 17 is a young man who inspires confidence and respect, towers at 6 ft 2 in at least, laughs with his friends, can be impatient and restless, devours books, solves problems, plays soccer with passion and skill, and is poised to launch into life. He will do so his own way, and it will be good.

Four Pillars

As we pulled through the first week of CSB and getting ready to go to Kenya for our CMDA conference, I noticed with thankfulness four pillars who support our team: the "singles", as they are collectively titled, when their group is distinguished from the families.  Single people face a unique set of challenges on the mission field, not the least of which is that they have no spouse or family to cushion their loneliness when leaving home in America, and no buffer of continuity as others come and go.  And as a group who are younger and generally on a 18 month to 2 year time-line, they can sometimes feel peripheral or temporary.  But on our team, they are a core of strength.  Our teachers, for instance, are so much more than that.  Anna and Ashley do teach, but they also function as most of  the other positive adult influence kids from our culture have in their lives:  aunts, Sunday school teachers, neighbors, family friends, coaches, camp counselors, baby-sitters, role models, you name it.  This week Anna was on loan to the Sudan team to make their retreat time possible by teaching and encouraging the Masso kids, while Ashley took it upon herself to not only pack up curriculum for teaching our kids while in Kenya but also to think of art supplies, balls, recipes, and general life.  They make up what is lacking in the lives of MKs who have busy, distracted, stressed, or otherwise struggling mothers!  I guess that's been obvious for years.  The long line of teachers who have made our life possible in Bundibugyo have done so by taking a VERY broad view of the word "teacher".  They are joined by nurse Heidi, who has lots going on in her own life and growth, but from my view of the Universe was placed in Bundi because God knew I would otherwise not have survived.  It is invaluable to have a colleague who gets me, and is a friend, as well as one who does a lot of the behind-the-scenes administration that keeps the medical care flowing.  And Nathan, who spans both of those roles as a teacher as well as the primary point person for the BBB outpatient nutrition program.  We offered rather late for him to come to the CMDA conference with us, since he's entering med school next year.  He decided to stay in Bundi.  As we packed up yesterday morning, and Scott was handing over this thing to do and that thing to check on, we were getting in the car feeling a bit guilty about leaving him there, and a scene from Sahara (great movie) came to my mind.  In the scene the young hero-character calls his boss with a grim report on the situation at hand.  The boss says "I can't ask you to go in there" and the young man, who is of course just about to do the dangerous and impossible, replies "that's just the thing sir, you know you don't have to."  Nathan's that kind of guy.

Today I'm thankful for all four of these brave souls, who put up with us, with a difficult culture and living situation, with lonely separation from family and friends.  We are grateful for families too, of course, the Clarks who are nearing the one-year mark and the Johnsons who landed in Africa last night.  But a team takes a good mix of people, and we really need our "singles", pillars in the temple.

Mobile Study

When we arrive at the conference, day 1 will be an intensive course called Pediatric Advanced Life Support (for me) and Advanced Cardiac Life Support (for Scott).  This is not our first time to take it, of course, but it has been many years (should I confess I've never even SEEN an AED, the automatic defibrillators that I hear are in malls and airports and schools and everywhere these days??).  In order to offer the certification efficiently we're supposed to have studied the manual and completed a pre-test and reviewed 12 case studies.  So we're studying in the car, our only "down" time to prepare.  As we drove out of Bundi I opened the text.  And realized, I love this stuff.  Equations where cardiac output is related to stroke volume and heart rate, where the world makes sense in numbers and diagrams.  Pages of drugs where one has to choose, where there are options.  Glossy tables, color coded ideas, science, data.  Sometimes I forget how much I love medicine that is technical and effective. As I'm reading, I get a call from the health center, the blood bank is empty, I make more phone calls and beg for type B for my little friend with the UVA T-shirt who has a hemoglobin of 3.  Which is not even an emergency here, just a moderate deviation from the average marginal life.  The contrast makes me shake my head, and try to remember as in a distant dream a world where I might have just written an order in a chart:  transfuse 150 ml PRBC . . .and within a few hours it would be done.  Where Mr. UVA would have been on a heart monitor, pulse-ox chirping, oxygen available,  in a clean room surrounded by functional up-to-date equipment and attended by an army of professionally trained staff.  Instead, I'm calling from one district to another and doling out shillings for transport and hoping a set of tubing will be obtainable when the blood finally arrives, and that he'll have stayed alive two days eating beans from a common bowl and hanging out on his mattress.  All to say that a foray into the world of PALS, with its protocols and order, feels a little like going home.

At the Border

The Uganda-Kenya border, a brown-water creeping creek traversed by a single-file creeping line of masive transport trucks, women with baskets of bananas, scruffy kids peddling water, belching buses.  We sit now in the border zone, pounding sunshine at 10 am.  A woman passes with a large red duffel on her head, enterprising young men try to talk us into samozas or chapatis.  Our border agent Salim haggles for Kenyan road permits and car insurance while Scott leads the flock of fellow-missionary-first-time-over-the-border friends through the immigration process, and Jack, Julia, and I watch the cars.  We have left Uganda behind for a while, but only after a merciful miracle.  SW's visa had expired, and in spite of attempts to update it our time in transit was too short to accomplish that.  So it was with trepidation we approached the Uganda exit-immigration counter.  We could have been asked for anything from the full fee to a huge penalty to refusal to let him go to who knows what, . . .arrest?  Scott prayed.  Just as they put their passports on the counter, a big red safari-bus of Africans in transit pulled up, and disgorged a hundred passengers who pushed into the line.  The weary clerk did not even look at SW's dates.  Stamp, stamp, next please.  Hallelujah.  Now for more lines and paperwork and permits and money and questions and stress on the Kenya side, the usual ambiguity about price and procedure that always keeps you a little off-balance, a little unsure.  The zone is crowded, active, the rip tide of two countries' loose citizens milling, crossing, looking for opportunity, passing the day.

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.