Mercy Seen

Thanks for prayers for my mom, whose surgery went well.  She can't notice any improvement yet in her vision . . but she also did not LOSE vision in the procedure, and her doctor is hopeful that over the next few weeks of healing she will see more clearly.  This is a mercy for which we are all thankful.

I pried open one of my patients' eyelids today to look in the inner eyelid for signs of anemia (a handy place to check on a dark-skinned child) and was shocked to see his cornea completely scarred, occluded, cloudy, from an infection at the tender age of 4 months.  It was a reminder to me of fragility of the vision we often take for granted, and the common humanity we all share in the face of health problems. My mom has supported two friends of ours here, one a 4 year old girl born ON HER BIRTHDAY (!) to a nurse friend of ours who sustained an eye injury, and the other a teenage student friend of ours who developed glaucoma, because her own eye illnesses have made her empathetic to those of children with fewer resources and options.  In the end, though some care is more skilled (Hopkins) than others  (mine), we all depend upon God's healing mercy.  Grateful.

Lobbying

The issue of pneumococcal vaccine for Uganda has continued to occupy my thoughts and heart.  It is a matter of justice (equal protection from easily preventable deaths for all infants whether they are born in Boston or Bundibugyo), good scientific sense (putting the vaccine resources into places where the impact will be highest), mercy (responding to the shockingly high rates of death here).  Over the last few days a UNICEF contact gave me the phone number for the doctor in charge of Uganda's national vaccine program. We had a great conversation in which I learned that he had just submitted a formal request for the addition of the pneumococcal vaccine to GAVI.  GAVI is the Global Alliance for Vaccines and Immunizaitons, an international organization dedicated to facilitating the increased availability of vaccines in poor countries.  Perfect.  I simultaneously got a negative reply from the manufacturer about donating the vaccine directly, so that door is closed.  So the one organization that can possibly manage to scale up pneumococcal vaccines for all children in Uganda actually HAS A PROPOSAL sitting on a desk somewhere requesting just that.

I've written to GAVI, pointing out the extreme nature of the pneumococcal disease burden in Bundibugyo related to the highest prevalence of sickle cell disease in the world.  But my email is unlikely to make much of a difference.

Prayer, on the other hand, could.  Do we really believe that?  Is prayer just for individual spiritual issues . . . or is it for lobbying?  The heart of a king is movable through prayer .. . so the heart of an international scientific committee should also be fair game.  I don't want to take resources away from anyone else, but I do believe I can make a case for the fact that if there is one place in the world to offer the pneumococcal vaccine, it should be Bundibugyo.  After all, matters of justice, good sense, and mercy are all over the Bible.  Matters of child survival form themes of Bible stories from Moses floating the NIle to Herod slaughtering the innocents. Death from pneumococcal bacteria is part of the impact of the Fall on our world.  Fighting against that is legitimate Christian endeavor.  

So please pray that GAVI would fund and implement a program to bring this not-so-new vaccine to Uganda.  For those readers in more comfortable parts of the world, I'll just add that I saw a 6 month old today with a droopy, weak, sluggishly reflexive right leg, a sudden onset of paresis that could be polio (tests pending).  Vaccines here are not a school requirement or an inconvenience, they are the line between walking and being paralyzed, between living and dying.  Let us lobby on our knees.

Heavenly Advocacy

Last week, we studied a psalm and the topic of prayer in out hospital staff meeting.  And challenged the staff to pray for change, to take their problems to God, first. Well, the problem on their mind was electricity.  We had approached an organization to fund connecting the health center to the power lines, but been denied that money, so we had in our hearts that we'd somehow manage to do it ourselves.  Scott (with LOTS of help from Nathan!) has been managing a contract to connect the school and most of the mission houses.  He did our personal house connection himself, which was relatively straightforward. Working with a contractor for the rest of it has NOT been straightforward.  It has been a tedious, slow, frustrating, messy, and expensive process.  So taking on yet another project, the hospital, looms like a shadow.  But we need the electric power for oxygen, and for our blood and vaccine storage fridges.  So we believe in it and know it is something we want to do, but have not been able to manage it yet.  Last week, however, the staff prayed.

And two things happened.  A church related to one of our team mates decided to link an upcoming fundraiser to us, APPROACHED US, and agreed to fund electricity.  Then a few days later, the chairman of the electric board in Bundibugyo town APPROACHED Scott and told him he wanted to handle the initial phase of the connection himself, because he'd been convicted in his heart that this was an important public health issue.  Suddenly the two main obstacles, money and skilled personnel, were gone.

I have a fairly long list of things that I think are important projects, services, issues.  Much longer than we can actually accomplish on our own energy.  Much more expensive than our current resources allow.  But this week's uncanny convergence of events reminds me of the obvious.  The best way we can advocate for the redemption of Bundibugyo is to stimulate prayer.  Even though we've seen this over and over (like the time the mothers of malnourished kids prayed for a change in the UNICEF decision about providing milk) . . I need reminders like this hopeful electricity story.

So, on the long list, next up:  PNEUMOCOCCAL VACCINE.  The "prevnar" immunization against pneumonia is standard in the USA.  It is NOT standard in Africa, where much greater proportions of children are dying from this particular bacterial infection.  And it is a distant dream in Bundibugyo.  However, this is probably the most important place in the world for this particular vaccine to be given. Because this district has the HIGHEST prevalence of the sickle cell gene in the world (45%!  THAT's A LOT).  And the number one infectious killer of young kids with sickle cell is the pneumococcal bacteria.  In our pediatric ward, 11% of admissions are for sickle cell disease.  We're a small health center yet we average 12 new diagnoses a month (I doubt many big-city specialty hematologists see that many).  The vaccine has the potential to save many thousands of lives.  

I don't know how to make the manufacturer (Pfizer) donate it.  Or make UNEPI (the vaccine program) decide to include it as essential.  Or make the Ugandan Ministry of Health, or the United Nations, or any other powers that be choose to initiate a new vaccine program in a place as remote and tenuous as Bundibugyo.

But God does.  So as we advocate here on the ground, let us also advocate on our knees.  And draw others into doing the same.

VISION

Please pray for my mom, who is having a delicate and complicated eye-surgery tomorrow at Hopkins. She has the best care in the world. But she also has three major different problems in the same eye, a history of multiple other surgeries there, making it a very complex and risky situation. Her vision has deteriorated significantly in recent years (impacting things like driving and reading, pretty significant for a person living alone), and we hope this surgery will prevent a further progression towards blindness. Pray her post-op vision would actually be IMPROVED.

Jesus did a lot of vision-healing . . because vision is so central to life and survival and enjoyment of this world, so much a part of who we are in God's image. I know He would delight in answering our prayers for yet another! And though we are so far away (and thankful that my sister will drop everything in her life to accompany my mom) we know that our collective prayers please our Father who likes to give us what we ask for.

Football Season Begins . . .

Off to a Bundibugyo start . .

The tournament consists of four groups, each group has 2 to 5 teams that play each other, the top teams advance to quarter and then semi finals. Our group is the largest, so we were to have three different days on which we would play each of the other four teams (one day we play twice). The whole thing is to be done between today and Easter, only 3 weeks. There should have been four games today, starting early this morning. By ten nothing was happening. By noon it became clear that only one other school was coming, and they were not a school we were slated to play against today. It seems that though the plan was agreed upon at a meeting of head teachers, one of the schools had second thoughts about the fairness of some of the policies, and convinced others to boycott. Passive-aggressive, the preferred conflict style. Meanwhile our team and Kakuka's milled about in their uniforms, the sun beat down with more and more heat, the community pressed up to the fence to see what was happening, the hired police had nothing to do, the referees and district games personnel sat at their tables waiting, and nothing happened. Finally mid-afternoon they decided that the no-show teams should forfeit, the two teams on site (Kakuka and CSB) got automatic wins. We proposed a "friendly" match (outcome would not count in the tournament) just to give our team and Kakuka's experience, but Kakuka preferred to go home rested and injury-free.

And so, what ensued was probably the best football match ever played on the CSB pitch. Christ School starters vs. the second-string team helped by Nathan and Alex, two coaches (Bwampu and Ajeku also coach, but sat this one out). The progress these boys make year to year is so noticeable. Kevin got them started down a path of discipline and skill, but it seems the improvement now is exponential. The game was a 1 to 1 draw, because there really is little difference between our starters and our subs. Nathan scored the goal for the second team on a cross from Alex . . which in my opinion was like Ashley's goal in the staff/student girls' game Monday, a reminder to the kids that these coaches know what they are doing. There was good passing, ball control, strong shots, team work. Really fun to see.

Hopefully the girls will have a few games eventually. And hopefully the boys will play someone besides each other, multiple times, in the next few weeks.

Today was a reminder of the power of sports to bring the Kingdom forward. Hard work, accountability to team mates, following rules, taking risks, a taste of success, the approval of adults, the importance of physical and mental and spiritual strength all combined. Then the grace to be blessed by good uniforms, helpful teachers, a level pitch, things that are rarely found here. Coaches have the opportunity to instruct, to challenge, to encourage, to lead. This is an area of missions to Africa that should grow. So few African kids have the opportunity to play sports this way, supervised and taught. And yet so much of who we become in God's image can happen on a football pitch!

Lastly, since we are pondering missionary football coaches . . . a tribute goes out to Josh Trott, one of our first. Who is now engaged to be married to a young woman named Lydia. No doubt they will be bringing just such opportunities to needy kids in inner-city Philadelphia. Congratulations.

the way it is supposed to work

Since things rarely happen the way they are supposed to, it is important to take note when they do. To shout. To laugh.

M.U. went home today, cured. He was one of those rare kids who came in simply HUNGRY. He had a mother, and a father, and no chronic incurable diseases. Back in December he got sick with something, a typical diarrhea virus or malaria. He stopped breast feeding, because he just didn't feel well. He was over 1 and a half, so his mom did not push it when he didn't want to nurse. But he never bounced back the way a healthy kid should. He dwindled, until he was picked up by one of our outpatient programs. His weight for length was so low that Nathan referred him for admission rather than treat him as an outpatient. Like many, he got worse before he got better, dropping down in that first week. But then he turned the corner, got his appetite, began to drink the UNICEF milk. And he came back to life. Woke up. Smiled. Began to stand, and then walk. And then play. He is the kind of happy child you hate to send home because he's such a joy to see every day!

He and Kabasa both packed up and went home today, amazing examples of moving from death to life. And three other kids who all had TB: two in joints which I may have missed if I had not gone to our recent CMDA conference and learned more about the subtleties of TB diagnosis, and been emboldened to start sticking more needles into places I had feared to go. All five of those kids would have been dead within a few more months, and all five should live normal lives now. Another discharged 8 year old boy had presented with severe anemia, bloody diarrhea and vomiting, perhaps dengue fever, but went home much improved. His dad said he had no way to come back for follow-up because they lived hours away . . he had spent all his money to get here because he knew his kid was really sick and he'd heard this was a hospital where kids got help.

Many times, things don't work. Many things blow up in our faces (as our colleague experienced with a generator yesterday, which led to no injuries but a BIG MESS). Many times we are misunderstood, or we blow it relationally.

But some days we get to see kids cured, and then we forget the messy frustration and feel that the struggle was worth it. Scott led us in John 16 yesterday in Bible study, where Jesus uses the analogy of childbirth to demonstrate that pain is forgotten when joy emerges. He asked us: is there real joy without passing first through pain? A good question for life, in Bundibugyo and elsewhere. Maybe not. For this evening we are just happy for our little patients' cure.

celebrating richness

Invited three good friends over for dinner last night, to introduce them to the Johnsons. Two have kids in the age-range of Lilly, Patton, and Aidan. And as much as a bunch of little ones can connect in spite of a spread of age and language and experience, they did, rolling balls to each other across the floor and stacking blocks, giggling and chasing with Jack and Julia in the middle of it all. It was an evening of richness. We are rich to have three women of strength and beauty and character as our friends here, Melen, Olupa, and Assusi, all people who work very hard to serve others in spite of difficult circumstances in their lives. And rich to have new friends courageously coming into this place with an intention to stay, to love, to live.

It wasn't until they walked in that I realized it must be near Jonah's Birthday. His mom had to think about it a minute, and then we confirmed he had turned 2 on the 8th. Only two days late . . and thankfully Amy had baked a cake (!). Jonah was delighted by the attention, amused by the candles, and mostly interested only in the soccer balls. So another richness, the survival of this smiling child, with his father's name and face.

And a last amazing surprise gift of the day yesterday: A NEW TEAM MATE. Yes, a young woman who is a senior in college and had applied with WHM to work in Africa . . . at the last moment, as plans fell in place, the Sending Center people in charge realized her overlap with her potential team potentially left her alone much of the year, which did not seem wise. So over the weekend we got the message that she might be a possibility for Bundi, she came to interview in Philly on Monday and Tuesday, and yesterday we heard she's officially our newest team member: Chrissy Chipriano. We are praying that the richness she brings to us will be matched by the rich blessing of fast fund-raising which allows her to graduate in May and arrive in September. Welcome Chrissy.

quotes of the day

"Heal-or-Heaven".   Prayed this morning that God would either heal Ivan Tumwiine, or take him to Heaven.  Not something I normally pray, but this child has suffered for about four weeks, his little skeleton draped with sagging wounded flesh, his swollen feet the most substantial part left of him.  He's got sickle cell anemia and probably TB too, and he came in starving.  Whenever he gets some milk into his gut, he loses more ground from diarrhea.  When he refused to even sip from a spoon for a while he had an ng tube, but eventually the energy loss of fighting it seemed to outweigh its value.  His mom had another baby while he was admitted, so now she has to divide her time, and he's frequently left moaning on his bed.  Some kids can be pulled back from that, but metabolically Ivan's body has so altered in his months of slow death that I'm not sure he can turn around, and if he does the impact on his brain might be severe. I'd love to be proven wrong, and Kabasa who got two candies today (instead of the traditional one candy) for reaching his target weight is a living reminder of those children who take a long time but do eventually heal, and smile, and chase balls.  After praying the Heaven-or-Healing prayer early morning, I cautiously looked at Ivan's bed when I walked in the door, but there he was, alive, barely.  

"They left us without an answer".  Sat in briefly as John led a group of community leaders today in a discussion of improved agriculture techniques, after the dozen or so had toured our demonstration garden.  John's point and purpose was openness, cooperation, sharing of ideas and information.  The group was all for that.  Information, in this culture, is power.  Give away your food, but don't give out knowledge!  So our agriculture group's effort today was counter-cultural in the best way.  Interestingly, one of the men mentioned that last week in the build-up to the WFP anti-hunger campaign, someone came and met with their village (he thought it was a woman but seemed unsure).  She asked the parents why they think their kids are stunted.  People gave many ideas . . . but she never told them the answer.  I'm sure this woman left with a good sense of community discussion and mobilization and inclusion, and the reality is that stunting is a complicated endpoint reflective of many problems.  However her audience was left with the assumption that SHE knew why their kids were stunted, but she wasn't telling them!

"Christian brotherhood is not an ideal which we must realize; it is rather a reality created by God in Christ in which we may participate".  Last night we initiated our CSB staff Bible Study for 2010.  We had surveyed the teachers to see if there was interest, and what time would be most convenient for them.  Even when people express verbally or on a survey that they want a Bible Study, one never knows who will show up at 8 pm after a long day of work.  However, almost ALL of them did!  I think there were 25 of us, which is an unwieldy size, but they wanted to meet together rather than in smaller groups.  We are attempting Bonhoffer's book called Life Together, which is a study of Christian community.  All of the basics of a Christian life are there, but in the context of living in community (which we do) and in the context of Bonhoffer's opposition to political evil and personal suffering (which is a pretty African context, too).  Chapter 1 emphasizes grace:  our community may not match our mental ideal, which frustrates us and tempts us to demand that others change . . better to realize that we live in a real place of God's placement and choosing and look for ways to be thankful.  I was convicted of my own complaining heart, and long for the real love Bonhoffer describes which brings freedom to others as we long for Christ's best in them rather than OUR ideas for them.  Praying this study bonds us, missionaries and school staff, in a common goal.

"You number my wanderings . . "  Psalm 56 was our theme for early prayer meeting this morning.  It perfectly mirrors our vacillation between that desperate sense of being swallowed up by too much work, un-solvable problems, evil and corrupt people . . and then the flip side that God is our refuge, that He is FOR us.  I particularly appreciate the fact that God knows all 17 beds the Johnsons have slept in in 2010 as they wandered this way, and knows where the rest of our paths will pass this year.  He does not promise to avoid tears, but He does save them up in His bottle.  Sorrow and sojourn come, but He notices, and only allows what has purpose.  Clinging to that.

"At least you can stay for life".  This is my favorite.  Yesterday afternoon Scott was working with our new calf (he and Jack and Julia put up a fence!).  An acquaintance came zipping in on his motorcycle, having just heard the rumor which circulates every few months that we're pulling out of Bundibugyo.  He was relieved to find that we were still home.  Then he said to Scott .  . "Doctor, I know this is a hard place to live, but at  LEAST you can stay for . . . . (we're expecting something like one more year . . .) .. .LIFE."  Hmmm.  I guess compared to "at most you can stay for eternity", life is a short "at least".  

International Women's Day

Celebrated here in Uganda by:

First, my non-woman house worker took the holiday quite seriously, and did not show up, allowing the only woman involved in our house (me) to scramble with cleaning up an ant invasion and dishes and getting ready for the day.

Second, down to the ward, because sickness does not generally take a holiday.  Only to find that neither of the assigned nurses showed up.  One was mad because the other one skipped duty yesterday and left her alone.  Punishing me, and the patients, to make her point I suppose.  I was not amused, having left my own kid (Jack) home with a fever and strep throat, reading on the couch, certainly not as sick as many other kids but still . . . .  I called the more guilty missing-the-second-day person and she showed up two hours late.  Thankfully Heidi and Nathan pitched in, because the place was PACKED, no room even on the floor really.  Five tiny babies now in the 1.5 kg range (one of them has doubled his birthweight to get there).  It seemed appropriate to spend half of Women's Day doing what most women do:  enabling the survival of their children, priority number one.

Third, back to our house for an afternoon nutrition meeting.  Heidi, Nathan, John, Travis, Scott, Lammech, Pauline, Baguma Charles, and me, the mood lightened by one of my favorite International Women, Pat Abbott, who sent a care package.  We broke out some marginally nutritious pretzels for the occasion.  Again, a good way to celebrate women.  The 298 (one of the 300 fell behind a laying box and was crushed, the other was eaten after it was clearly lame and twitchy as per Pauline, which sounds a little scary to me) chickens have been scientifically divided into two groups to test the volume and duration of their egg-laying capacity on two feeds, commercial and locally mixed, in the hopes that a local mix would be more affordable and practical to encourage local farmers.  John and our extension agents are really networking well, drawing in schools and lead farmers to view our demonstration projects, exchanging ideas. All were happy to hear that an expensive stud male goat who is supposed to be contributing genetically to the dairy-goat leanings of the Bundibugyo goat population got over his long bout of the blues and seemed to finally catch on to what was expected of him with the female goats.  Seriously, we do have some fun meetings.  Lammech is ready to start the next round of training for HIV-positive families or caretakers of motherless children who qualify to get goats, and the next batch of 25 will go forth in April.  The main challenge for our two outpatient sites in education and nutritional supplement provision is the flooded rivers and muddy roads, making them hard to reach.  Again, dedicated people are reaching many women at the point nearest and dearest to their hearts, child survival.

Fourthly, without a pause, four of the team women changed into pants and t-shirts and raced down to CSB to join other staff (teachers and wives of teachers and a few other assorted relatives) in a Staff Women vs. CSB Girls' Team International Women's Day Football Match.  I'm sure my face is still red as I type:  intense sun this afternoon, the full field looked pretty dauntingly huge, and I haven't sprinted like that in a LONG time.  Lots of laughter, wild kicks, good dribbles, team work and fun.  Miss Ashley dazzled the onlookers by dribbling through four or more opponents routinely, and scoring a great goal.  Important, in my opinion, for establishing respect as the women's coach (no one can quite believe a GIRL can play like that . . . ).  We ended tied 1 to 1, which was perfect.  Considering I'm not only old enough to be the mother but in this fast-reproducing place the GRANDmother of most of the girls, I'm just glad to have held on.

Now, back home, Jack improving on antibiotics, Oreo getting stronger each day, Scott struggling with CSB computer issues and accounts, wishing there was someplace to go OUT for dinner instead of me thinking of yet another night's plan after I clean up from the day . . . 

Happy Women's Day.

 

Oreo

. . .is the proposed name for the calf that our faithful old dairy cow, DMC, gave birth to last night.

DMC is a no-nonsense Ugandan cow. Like many women, she bore her fifth pregnancy without a word of complaint and barely a hint of what was happening internally. It was only when her milk changed to a thick proteinaceous colostrum a few weeks ago that we were really sure she was pregnant . . . which was a posthumous surprise from Sir Loin whom we thought had failed to leave his genetic contribution behind him prior to his untimely demise. Yesterday Scott noted the passing of the mucus plug that portends labor, and when we watched DMC she laid down a few times and seemed restless. We decided to separate her from her 14-month-old daughter Truffle by closing the gate between the two halves of the pasture, in case Truffle bothered her, but he separation upset both of them so much we re-opened the gate. Other than that, nary a moo of distress escaped DMC's lips. We saw her at 10 pm, and when Scott made one final check about an hour later before we went to bed . . three pairs of eyes reflected in his flashlight: two big pairs at chest level and one tiny pair on the ground. We got more light and saw the fragile little black-and white calf. It rained most of the night and I worried about the baby being too cold . . but this morning, there she was, on spindly legs, following her mother. She's smaller than the last two calves DMC has had, and hasn't caught on to nursing yet. In keeping with our chocolate theme (Dairy Milk Chocolate is the mom, the name of a Cadbury bar purchasable here in Uganda, and her calves born here in Bundi were Ghiardelli (a dark-brown male whom we returned to Atwoki in Fort Portal) and Truffle (a cream and brown female)) Scott is calling this one Oreo, since she's mostly black with some white in the middle.

Besides being a fun farm real-life experience . . the calf means milk for our team, which sustains the life and growth of our kids. So we're very thankful and blessed with this new baby.