must-read

This is Kevin Bartkovich's testimony as presented at Exeter where he now works. Powerful. I didn't think I'd cry over the story again, but I did. Read it: http://kwegesiya.blogspot.com/2010/02/meditation.html.

Marching to End Chronic Hunger

After a very brief check on the Johnsons this morning and hurried rounds, we went up to Bundibugyo town with Nathan and Emily to attend the launch of World Food Program's new campaign against chronic child hunger. Another interesting out-of-the-missionary-box day: first, the entire event had its conception really in the scientific surveys performed by our team, which showed that levels of chronic malnutrition reflected in stunting were more severe in Bundibugyo (and parenthetically Karamoja where our OPC-friends work) than any other area of Uganda. About 45% of kids slow down their linear growth in response to constant infection and inadequate food. Their striking shortness is just a marker for how hard their little brains are struggling to grow and develop, against the odds. So it is no wonder when later they fail to achieve adequate standards in school. Chronic undernutrition is a COMPLICATED sort of multi-factorial issue, a final common pathway of social injustice, poor choices, family disintegration, inescapable infectious diseases, poor roads, watery starchy protein-poor foods, unstable marriages, poverty, generational cycles, gaps in educational opportunities for the girls who will become mothers, individual greed and sin. So there is no one easy answer, and attacking the problem means asking an entire culture to consider child-nurturing practices and ponder where we have gone wrong, and how important a change would be, and what it might look like. Which is just the sort of place that missionaries should be, advocating for the voiceless children, contributing scientifically to the debate, and reminding us all that the issues stretch from microbes to heart-attitudes, and praying for God to send organizations with expertise and resources to do so much more than we could ever do on our own.

So back to today. Scotticus and Stephanie's research led to some papers, and that led to some contacts and short-term work in Kampala, and attention for Bundibugyo. Right at the time when WFP was changing its policy to address underlying causes of malnutrition and not just distribute food. Visits ensued, articulate and eager WFP staffers came and talked to us, and we expounded on all we've seen over the years. WFP hired a very creative and professional media-campaign guru named Richard who then mobilized many others. The government Ministries took note. There were trainings, meetings, ideas, proposals. And songs were written. Richard contracted two local talents to collaborate on a catchy-beat tune in Lubwisi that extolls parents to care about their children's nutrition. The major messages they chose to focus on were about balanced, varied diets, the impact of malnutrition on brain growth and school performance, the responsibility of men to care for their families (another original song: What is a Man? Who is a real man? Someone who drinks when his family is hungry? NO!) All of this came to a head today, when the launching celebration took place.

We arrived just in time to march with a brass band through Bundibugyo Town. ALL around Bundibugyo town, actually. Picture a sure drum and mostly-in-tune brass tubas and trumpets, banners, dignitaries, local people in campaign T shirts, us, and a thousand kids, winding through the market and up and down streets, waving banners and drawing attention. I looked down a lot to keep my footing on the uneven stones and mud. But it was great fun. The ladies I was marching beside laughed a lot. About half-way through I turned around to Scott and said "If only they would play 'When the Saints Go Marching In'" . . . and sure enough, a few minutes later, the tune changed and that was the next song! Sadly and foolishly I had changed at the last minute into my cheap Christmas heeled shoes, which I thought were more appropriate with my dress-up outfit, but as it turns out are not ideal marching shoes so now my feet are throbbing with blisters. I'm sure there's a lesson on vanity there, or a good parable about taking on some pain for the children of Bundibugyo!

Other highlights of the day: meeting two very interesting young men, PhD's from America and Italy now working with WFP, and having a long talk over lunch about the causes of hunger, and life in Bundibugyo. Seeing a creative mime/dance troupe from Kampala perform. Watching our own local musicians dance and perform their new song. Trying to concentrate on the political speeches when they switched into Lubwisi and weigh just what was being said. Having Scott called on twice to pray. Hoping that the several-thousand-onlooker crowd would take some of the message home.

Praying that Bundibugyo will be redeemed, that an awakened awareness of the impact of hunger on children will lead to real change.

Pediatric Advanced Life Support, and Reporters: Just another day . . .

I am mentally exhausted this evening, but as I think back on the day, I realize it contains just the mix of raw life-and-death and bizarre circumstance that I appreciate about being a missionary.  The day dawned grey after all-night rain, so my new friend Dr. Emily and I grabbed umbrellas and made our way through the muddy streets towards Nyahuka.  I rarely walk:  my bike is my usual mode of motion, but that was not so fair to Emily.  And I enjoyed the slower pace, the greetings along the way, stopping in at CSB, hugs to Justine who has completely transformed the library (Annelise's vision realized at last), hearty palm-shifting hand-shakes with staff, enquiries about my family.  At last we reached the hospital.  In spite of earlier quiet, Asusi warned me the ward was filling up.  But with her and Balyejukia, and Nathan and Emily, we began to work our way through.  Nice to have another pediatrician to discuss cases with, a fresh young American academic perspective.  Asusi and Balyejukia also know what they are doing, a strong team, and I tried to keep affirming the excellent decisions they had made in my absence.  Dr. Emily has begun to research the diagnosis of TB in children, a subject dear to my heart, and we had a couple of perfect examples of the challenge of sorting out a malnourished child's root problem.  We were just deciding to put a 4.9 kg (10 pound) 3 year old twin with Sickle Cell anemia back on TB therapy (she had defaulted a year ago), when a family carried in their limp and unconscious infant.  Balyejukia quietly called me over, with the words "this is a hopeless case".

Well, as it turned out, he was right.  Let me begin by saying that 6-week old Tumwine did die at about noon today, probably because he had begun convulsing during the night and the flooded river made it impossible for his family to reach the hospital until mid morning.  But rather than feeling helpless and discouraged, I was left with a sense of marvel that our little primitive ward and team functioned so professionally.  Because I had just re-certified in PALS (Pediatric Advanced Life Support), it all seemed so familiar.  Bounding peripheral pulses with mottled skin and a 7 to 8 second capillary refill:  distributive shock, most likely septic.  Gasping respirations, cool, unconscious, critical.  We jumped into ICU mode, and my team was amazing.  I didn't even get to try one of my new spiff intraosseous needles because Balyejukia was so quick with the IV access.  Thanks to several lectures on septic shock I didn't hesitate to push hard on fluids.  We had ambu-bags from Heidi's nurse friends, and Emily assisted the child's breathing throughout the almost two hours of hard work.  Fluids, dextrose, antibiotics, oxygen, epinephrine, an ng tube, labs, and prayer.  Airway, breathing, circulation.  Whenever his heart rate dropped, and sometimes stopped, Emily and I would do CPR for a minute or less and he'd come back.  Asusi was ready with every medicine, and corrected one of my dosing orders, which I thanked her for (which is a nurse-doctor scene straight from the PALS text).  OK I did have to dig up money for fuel and oil to get the hospital generator started to hum the oxygen concentrator to life, but it DID hum to life.  Sadly, though the baby's circulation improved, he never woke up, and over the course of the second hour his pupils stopped responding to light, until they were fixed and dilated, a sign of irreversible brain damage.  At that point we had done cpr numerous times, and it was taking longer to get his heart back each time.  I decided to do a lumbar puncture, more to have a head start on anyone else who became ill in the family than to hope to save this baby.  The cerebrospinal fluid was grossly bloody.  A hemorrhagic infection, or trauma?  Either way not a problem we could cure.  I am thankful God provided Emily that day, as we had to make the hard decision eventually to let him go.  The next time his heart stopped, we continued oxygen and waited a minute.  Nothing.  His grandmother, resigned, accepted our condolences.  We removed the tubes and wrapped his little body.

And then walked out into a ward that was filled with reporters and cameras.  Yes, Nyahuka Health Center, in the news.  Tomorrow World Food Program is sponsoring the launch of a new educational push to draw attention and action towards the problem of chronic undernutrition in Bundibugyo.  I believe that this is a direct result of Stephanie Jilcott and Scott Ickes' advocacy and research.  Several teams of people from Kampala, UNICEF and WFP, have come out to investigate, to talk to us, to ponder the fact that 45% of kids in Bundibugyo are stunted in their growth because they suffer hunger.  Almost half.  The impact is devastating, but quiet, felt in poor school performance, in lethargy, in sorrow.  Ahead of tomorrow's major launching party to-do, WFP brought reporters.  And so we suddenly found ourselves answering questions for the New Vision, the Monitor, the Independent, while Uganda TV cameras rolled.  A bit flustering.  I tried to remember the important stuff, emphasize social issues, team work, multi-factorial causation necessitating creative holistic approaches, education for girls, etc . . . but who knows what I actually said and how it will come out.  Bewildered parents who agreed to talk had their photos snapped a dozen times or more, with their skinny scabby kids.  

Last patient of the day, patiently waiting until the ward quieted down mid-afternoon, an HIV-infected mom on anti-retroviral therapy,  with a not-yet-infected baby, deciding to wean.  Thanks to the conference I had good data for her on this issue, and a more scientific and reasonable assessment of her risks, which are GREATER for weaning (death of the child from infection and diarrhea and malnutrition) than for continuing to breast feed (death from AIDS).  She still wanted to wean, so we affirmed her choice.  And prayed for her, and talked about her life, too.

So, a crazy day, but not so unusual.  Families in crisis, looking for help.  Opportunities to pray, to offer advice, to teach, to advocate, to emphasize, to protect.  Individual tiny important lives, in the balance.  An entire society, also in the balance, pondering big cultural questions of family unity and responsibility and the impact of adult decisions on child survival.  Jesus reached people through their concern for their kids, children who convulsed, who had fevers, who died, whose parents came to him in their time of sorrow.  I'm glad to be a small part of a good team of Ugandans and missionaries doing the same.

God's Welcome

7 pm, a light misting rain and a setting sun, the team gathered at the up-til-now Masso home waiting to welcome the Johnsons.  Jack and Julia and Ashley and Anna have posted welcome signs and decorated the porch, Loren has a full-team dinner cooked and keeping warm in the oven, Nathan has pushed the electricians and the house-crew to be finished and ready for this moment.  We look up, and there is a brilliant full-sky arching rainbow, fully visible from start to finish, spanning their entrance.  Then we hear Scott's horn, and he drives leading the way up the hill, followed by the Johnsons in their car, through the rainbow and into their new home.  Scott jumps out with the new black lab puppy he and Travis picked out yesterday evening.  As Amy notes, could their life not have been full and complicated enough with 23 bags, 3 kids including a not-quite-4-month old, a new job, a new home, a new country?  But the puppy makes a house a home, and Lilli is clinging to this little guy for dear life.  The whole group spills out, slowly, gathering shoes and emerging from seat belts, watching the last color of the rainbow fade in the evening light, welcomed by neighbors, and entering their new home.  Patton is immediately mesmerized by a toy rocket left by Gaby, and delighted with the "Cars" sheets on his bed.  There is much chatter and laughter, going from room to room, the sense of a year-long journey of faith finally ending there.  

Not ending, of course, only beginning.  Just as Noah's landing from the ark was not so much the end of their survival of the flood disaster, as it was the beginning of a new life in a new land, a holy freedom to walk out into the world and live for God, under His promise to restrain the consequences of sin, to give us all space and grace to plunge in.

half-home

Three of us are back at home: I drove Heidi's car (she actually flew to the USA for the funeral of her grandmother) with Jack, Julia, Ashley, and visiting Dr. Emily Pearce (med-peds resident from Indiana University, we met by blog and email thanks to Bart connections at Blacknall when she was an undergrad at Duke), ten trunks, and some groceries, back to Bundi yesterday.  Today Scott will lead the Johnson family in our truck and the former-Pierce now-Johnson-mobile with the rest of the loot, medicine, food, 3 kids, and . . . a puppy. As Scott said last night on the phone after failing to get my passport extra-pages (US rules), and failing to get an extension on one of the aspects of our work permits at immigration (Uganda rules), and sitting in Kampala city traffic for HOURS, does it really have to be this complicated?  Prayers for peaceful hearts in massive transition much appreciated all around.  Good to be back in our own home, in spite of the fact that dust, roaches, and lizard droppings abound.  Life is just a lot of work.  

Goodbye again

Woke up this morning realizing that for the first time in two weeks, we're back in a different country than Luke and Caleb. And missing them even more, because of that. During the conference we stayed at the Moffat guest house: one of the truly great deals left in Africa I suppose, we ended up spending about $4 per person per day on lodging and another $4 per person per day on food. Pretty basic, but that allowed us to bring the whole family for less than a single doctor would pay at the conference center.

And more importantly, to taste from the fringes a bit of Kijabe/RVA mission life.

We toured Kijabe hospital on Friday: busier than when we worked here during an evacuation so many years ago, but not completely different. 260 beds, 112,000 outpatients/yr, 2000 babies delivered/yr, 9000 surgical operations/yr. Forging ahead to build African leadership: where there were once only missionaries and 3 Kenyan interns, now there are about 8 Kenyan fully-qualified "consultant" physicians and probably 2 dozen doctors-in-training. The missionaries still serve a vital role, but one that is slowly shifting into the background, as it should, year by year, bit by bit. There are ventilators in an ICU and preemies in incubators, and pounding construction as new theatres are built, and hundreds upon hundreds of personnel bustling about. It's pretty impressive. Peaked into the two-bed delivery room where I had Caleb in 1995 on the left-side bed, and Jack in 1998 in the right.

Jack and Julia attended a day of classes at RVA. I think the thing that struck them most was that they blended in, that it was not immediately obvious to everyone because of their skin color that they were different. And that the classroom atmosphere was less intimidating than a Ugandan secondary school, the work more easily understood and accomplished. Kind adults invited Jack to a class party one evening for 7th grade, and he bravely walked right into the fun, no hesitation. Reassuring to parents who wonder about our kids' adjustments.

We really stayed an extra day, though, to see the social event of the year, known as "Banquet". Because of the conservative mission roots of the place no dancing is allowed, so the equivalent of the Junior/Senior prom is an elaborate dinner theatre. Juniors and their parents and sponsors work for months to prepare a creative set, this year with the theme of ancient Greece (last year Luke's class created Willy Wonka's Chocolate Factory). Between acts, a gourmet meal is served. Caleb was a tunic-clad waiter, joining many other 10th graders to serve their older classmates for the evening so they could sit at beautifully decorated tables in their formal-wear enjoying the show. The whole thing is very hush-hush in the weeks leading up to the BIG NIGHT, the theme is a CAREFULLY GUARDED SECRET, so that the Seniors are surprised when they walk into the hall. The evening begins with the guys at their dorm getting dressed, taking photos, arranging flowers, corsages. Parents were allowed to hang around with cameras and pin on boutonnieres. Luke and one of his best friends decided to carry on a tradition of wearing two garishly tacky 70's loud suits that had passed on from generation to generation, surfacing every couple of years or so to much laughter. I admit that we were a bit shocked when we saw our son . . . worried that the elegantly dressed young lady he was escorting would burst into tears or at least second-guess her choice of a date. But he was having such a blast with his buddies and all assured us the girl has a great sense of humor . . . After many dorm photos the boys then go in small groups to the girls' dorms where they are allowed in one by one to pick up their dinner partner for the night, whom they escort arm-in-arm up a lantern-lit path to the hall. Watching, I'd say it's a healthy introduction to genteel manners for a bunch of kids who have grown up in some pretty primitive circumstances, and a memorable milestone for their final year together.

The evening lasts well past midnight (2 am??) so the boys were both pretty tired by Saturday. We made a family Bday (early) lunch for Caleb, and it was probably the most extended and relaxed time we had with them the whole two weeks, just hearing about the night and hanging out and eating without any other guests. On this Wednesday Luke leaves for his quick weekend-interview trip. Which leaves Caleb on his real Bday (next Sunday, 28th) the only Myhre in Kenya, the first time one of our kids will spend a Bday with NEITHER parent present. The rain soaks Kampala, dreary, the very atmosphere dripping with goodbye. I suppose though that goodbyes will be part of the essential fabric of our life from now on, with kids at boarding school and soon college, with ministries and travel.

overload and emptying

It is not just our truck that is sagging with good things:  our lives are full, too.  I've learned that I"m high-extrovert AND high-introvert.  Which means that the flood of interesting people, relationship, fact, and input from the conference and travel is great.  But that the lack of any sort of down time is wearing.  Good stuff, but so much of it at once!  

Here is a paragraph from Bethany's meditation on Lent (connect to the entire poetic and wise post from the side bar):

All I am trying to say is that you hear quiet things more clearly when some of the loudness is removed. This lenten season allows us to step away from some of life's noisiness to create space for the quiet thunder of our Creator. In that way, the giving up actually creates space to receive something you didn't even know you were missing.

Amen.  I know I'm thirsty, but riding the crazy rapids of the last couple of weeks, I haven't stopped to realize how. Or for what.  So praying for a little Lenten quiet, a season of hunger and thirst, a pre-feasting focus on that which we truly desire.

exodus

We exited Kenya yesterday, and I was catching up on my Bible reading in the car. I'm in Exodus.  As usual, life and story move in parallel.  We approached the border with trepidation, piled high with about 16 trunks/bike boxes/bags/coolers . . topped off with a double baby jogger.  Most all spiff, new containers, labeled from the US with airline stickers. Nothing illegal, it is perfectly OK to bring your stuff to Africa.  Only this wasn't mostly OUR stuff, and we didn't have a list, and to a Kenyan or Ugandan customs agent it could have looked like loot we had accumulated in Kenya to sell in Uganda.  Our axels nearly sagged with the weight.  In spite of the fact that God miraculously made a way through for out expired-visa-coworker on the way into Kenya (remember the angel-directed bus that swept into immigration flustering and hurrying the process??), here we were again, worried.  It didn't help when our border agent began suggesting tedious day-long bureaucratic processes that would have put all the paper-work in order.  

So we prayed and pressed on, but not with amazing faith.  Still, God helped us.  No one asked so much as one question.  We were waved on.

When I read about the Isrealites on their desert-crossing journey, it is easy to wonder why they doubt.  God provides rescue, they rejoice, but a few days later they are ready to give up and doubt again.  At each challenge along the way they are quick to assume abandonment.  

Yesterday, I realized, we're the same.  One deliverance is great, but no guarantee of the next, and we so quickly worry about the next steps.  The way ahead looks so unsure.  God tells Moses that the people are not ready for battle, so He graciously leads them on a detour where He can strengthen their faith with smaller trials of water from the rock and manna from the dust.  What looks to them like an unnecessary and directionless waste of time actually serves to build community, build faith, prepare them for the conquering of the land.  I need that perspective for the weeks and months ahead, deliverance in desperation to steel my heart.

sneaky grief . . .

 . . . stalked unexpectedly in a lecture on pediatric pain control during procedures yesterday, which reminded me of a horrific night in Bundibugyo hospital about ten years ago with Caleb having surgery under somewhat minimal anesthesia, trading off his cries for the risk of him not breathing.  Which in the context of this weekend's bout with pneumonia and the previous evening's return to school and separation, suddenly just overwhelmed my heart, so that I was hardly tuning in for the rest of the morning and as soon as Scott presented a sympathetic face at lunch the dam burst in embarrassing snotty tears.  Grief is that way, hiding in the shadows, ready to pounce when least expected.  

Later a sweet moment, a gift of memory that balanced that context.  We braved the rough dirt-road trek up the ridge in the evening to visit the home of the Kenyan lady who helped us back in 1997-8 when we had evacuated from war and were working here until Jack was born.  Over the years we've kept up with visits or short-term work together.  How many people can walk into a Kikuyu log home in Kenya and find several pictures of their kids displayed on the wall?  I love that.  We prayed for her elderly prayer-warrior mom and her brother with cancer, and thanked God that she now has a full-time job.  She was one of the first people in this world that Jack saw . . and here he was playing with her mangy puppy and drinking ginger-spiced tea.

Job said, the Lord gives and the Lord takes away, but in either case, blessed be His name.  Even in the small details of our lives, grieving over our struggles and losses but rejoicing in the gift of a kind friend.

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.