A day in your courts

Thanks to generous grandparents . . we were able to spend our two-day family get-away goodbye in a place that perhaps mirrors the beauty of the house of God more than most. When we settled in on Wednesday afternoon, I pulled out my Bible and my Psalm for the day was Ps 84. As I read it, on the porch of an immaculate tent overlooking pristine wilderness, flocks of greater striped sparrows swooped through the brush and in and out of the eaves of the roof, a perfect picture of this psalm. That caught my attention . . surely the courts of the Lord would be characterized by good food, cold drinks, space, family, trilling birds, glimpses of wild animals, symmetry and order and tasteful, restful loveliness. And the fortunate sparrows enjoy this all day, every day, while we long for it on our journeys. It's not wrong to feel a sense of release and peace when wilderness and luxury intersect. It is the home for which our souls were programmed in eternity past, the Garden and the City of God.

The middle of the psalm though acknowledges where we are now: hearts set on pilgrimage. Passing through the valley of weeping until those tears become springs of blessing and life. Moving towards our goal, God, His presence, through a world that contains tastes and promises but not ever quite the real thing.

Our 48 hours in the Semliki Valley were ones of blessing. The reserve was practically ours alone. We had long hours of conversation in the pool and beside it, on the porches, around the table. Spectacular lightening rolled in while we were on a game drive, blowing cool wind. The stuffy hot months melted into rain that night, a change in the atmosphere, a reminder of God's mercies, refreshment. The thousand days of separations and struggles were forgotten in the one day of quiet and fellowship.

And we left, hearts re-set for the pilgrimage ahead.

Orphans and Vulnerable Children

"OVC's" is aid-speak for kids whose existence is so marginal as to be threatened. And we have a lot of them here in Bundibugyo. In fact the sheer volume often threatens a shut-down of compassion, as one more sickly, rash-ridden, hungry, or goopy-nosed kid comes across our paths, as needs are presented by grandparents left in charge of orphans or mothers left alone to cope. Then as they grow physically, their mental and spiritual needs flood the churches and schools. Every Ugandan values highly the precious resource of an education, though the options are limited and the costs beyond the capacity of many families. Jesus was able to feed the crowds while touching the individuals . . and calls us to do the same. OUR VISION at Christ School - to build an academically excellent senior secondary boarding school that produces servant leaders, for the good of Bundibugyo and God's glory. 340 teens live and learn on campus. These kids receive the best education in the region, in a context of Christian discipleship and community service. They also receive three meals a day, and beds in a cement-floor dorm (a step up from most homes), and electric power for lights to study by, and a library full of books, and access to a computer lab. We keep tuition lower than any other boarding school (in the country!), subsidized by donors to WHM, so that the poor may participate and indeed own and change this district.

However, for some orphans and vulnerable children, even our low tuition is an impossible barrier to overcome. So every year we look for 60 sponsors willing to cover the full cost of a child's education: 10 per class in 6 grade levels, Senior 1 to 6. These kids are selected based on a combination of need and academic promise. They are the harbingers of Jesus' value-inverting Kingdom, the least of these who will be raised to reign. And sponsoring a child is a way to connect with an individual face and name out of the crowds. In 2010 we know that 18 of the 60 are sponsored . . .but that leaves 42 whom we have admitted on faith and need to connect with resources. We offer two levels of sponsorship: $400/year covers the subsidized costs that others pay in Bundibugyo; $600/year ($50/month) covers the actual cost of education.

Click here for the CSB page on the World Harvest web site; click here to sponsor a specific orphan student (touching the individual); or here to contribute to the subsidy for the general tuition of the other 280 kids (feeding the crowds).

Our investment in the lives of the kids in the post below is probably the most important thing we've done in 17 years . . . it is a privilege we invite others to share.

Goodbyes Begin

These boys have been part of our life, our extended family, for a decade or more. John (far right) and Luke used to fight over trucks in the sand under the mango tree when they could barely walk. They all learned their math facts from flash-cards in our kitubbi, and their catechism. They listened to Bible stories on flannelgraphs, and read our books and magazines. They have spent countless hours playing football in our yard, eaten countless meals here, gone on hikes and trips with us. Now they range from just-starting secondary school to mid-University level. (Two are not pictured because they are in schools outside Bundibugyo now). Tonight they gathered to say goodbye to Luke, and to some degree Caleb as well. Luke will not come back to Bundibugyo when he graduates in July, so this was his last night at home. Their commitment to us is not all gain for them, it comes at a cost, since others are jealous of their position and ridicule them. Like adolescent boys anywhere they have gone through their share of restlessness, searching for identity, testing us and our relationship. An occasional suspension from school, or frustrating requests for more than we can give, challenge us. Then letters come from their hearts, full of thanks, and all is well. Ours is a very human and imperfect relationship, made more murky by the ambiguity of parental ties in this place, and by the chasms of culture and economy. However, when all is said and done, we love this crew, and the daily monitoring of their development counts among the greatest losses we anticipate. A true friend is a rare gift and Luke has found that (in some more than others, but it's there). On Friday we will pass through Fort Portal and say goodbye to three of his former classmates, who are also good friends. None of these boys will be on facebook in the near future, or have phones with international calling capacity. None will be traveling the seven thousand miles to visit Luke. None have ever even heard of Yale, though they're glad for his chance to go to University. Their worlds are diverging, painfully, though we will all do our best to hold them in some kind of parallel, to bridge the gap whenever we can, leaving high school and home is a pretty drastic step when home is Africa.

The goodbyes begin.

Unbelieving, I believe

Read one of my favorite passages in Mark today . . the father who brings his convulsing son to the disciples who fail to heal him, and then Jesus gets pulled in.  I love the father's heart cry:  Lord, I believe, help my unbelief.  This paradox of vacillating certainty, accentuated by parental love.  My own son is not falling into fires or dramatically beset by indwelling demons.  But I long for his healing and safety and happiness all the same. 

Luke has opted for Yale.  It has been a good, long, restless month of processing.  Praying, reading, researching, corresponding, trying out arguments, deciding and not-deciding.  There were other great choices, closer to grandparents.  So it took him a long time to sort out that this was where he really WANTED to go, and to courageously step through a door God graciously opened with fantastic financial aid.  It's a whole new world out there, where the best schools in the country can also be the least expensive for low-income missionaries.  Luke is an amazing person and it is a frightening privilege and responsibility to be his parent.  

The decision brought a moment of relief, it's done.  But then reality set quickly in.  We're out of limbo-land, where we can pretend that life goes on like this indefinitely, where we ignore the fact that tomorrow is the last day our family of six will live together in the only home we've ever had.  Suddenly we have a real college to deal with, with paperwork and schedules and dates and decisions.  Suddenly we are here, at the end of all things we've known.

That's where I cry with the father of the epileptic:  Lord I believe (look what you've done, bringing this 8-month-old baby to Uganda in 1993 and now he's survived 17 years and grown to  6' 2" and read a thousand books and is encouraging US that God is the constant in all the moves ahead).  Lord help my unbelief (this child of Africa thrown into the icy competition of the Ivy League, this home that has been our base shifting).  The father's faith is gritty, honest, unpolished, real, and desperate.  I like that.  But it's not the real story:  the real story is Jesus who does not let the boy suffer from the failures of others, who breaks in, who asks questions, and who at last authoritatively brings life, who is willing to pay the cost of prayer and fasting to pull this boy out of the fire and water.  Let me rest on that Jesus.

Lame Ducks

Well, in the midst of chaos and grief, a little humor goes a long way.  A package from the Johnsons arrived at last: they had mailed it to our team more than 4 months ago as a way to begin to bond with us, little imagining that they would beat the package here by a wide margin.  Among the many fun gifts was a set of little rubber duckies for the Pair-o-docs/ ducks.  See above.  And now that we're in a leadership transition . . . that makes us not only a pair-o-ducks but lame ones at that.  

Pilgrims and Strangers

For 16 1/2 years, we've lived the paradox of being pilgrims from our families and country of origin and strangers in Uganda's Semliki valley . . . and yet not pilgrims, because we've stayed put in the same house and job and community all that time, and not strangers as we've delved into language and culture and connection and life.  About ten years in we noticed a definite shift, the community beginning to accept us as part of the normal background of life.  We did not have a plan B.  

But part of the missionary rhythm of life is supposed to include the "home ministry assignment" (a.k.a., furlough), the periodic return to one's supporting churches to report and encourage and ignite vision, the refreshment of reconnecting with family and the familiar.  In WHM that is approximately 1 year in 5.  This has basis in the Biblical principle of sabbatical, 1 year in 7, an acknowledgement of the creation pattern of work and rest, a challenge to the life of faith, a counter-cultural turn from relentless forward progress.  We took ours in 2000, a memorable year in Baltimore when we completed MPH degrees at Hopkins and had live-in rotating grandparent help and bonding.  And since then we've had a hard time seeing beyond the wisdom and goodness of remaining rooted, with shorter trips as family crises or the needs for meetings arose, always pushing the sabbatical/HMA time a bit further back.  Now with Travis and Amy Johnson on the team, as we've thought about how to manage HMA again in 2010, we've seen God leading us in good but painful paths.  Back to pilgrimage.

First, Scott has been asked to take the job of Africa Field Director with WHM.  This is an honor for him, and us, as we are fully committed to WHM and Africa, and love the various teams, the people and the work.  It allows us to step aside for new leadership to arise on the team level, and yet to remain intimately connected with the tiny part of the Kingdom that we've been privileged to witness.  It is, however, a job that requires him to travel and communicate in ways that are not compatible with living in Bundibugyo full time.  And secondly, our mission leadership and family have been supportive of the idea of a short America-based HMA (mid-July to Dec) and a longer near-Nairobi-based time.  We have a commitment from Kijabe Hospital for both of us to work half-time there, so Scott can be a Field Director and I can be a mom, having 3 of our 4 kids at home (it's right next to RVA) . . while still practicing medicine in Africa which is our passion.  And in a place where we can learn and grow, for the good of Bundi and places like it some day, as well as our own good.

All that came together last week when Scott was interviewed for the Field Director job, and accepted.  In my heart it came together when we were in the process of thinking about our year and my mom called ME and suggested pretty much this very plan, before we could have told her anything, even though it involved sacrifice and loss for her.  It was a goose-bump, Holy-Spirit-leading, moment.

And I have to remind myself of all that, because right now, the whole plan feels very, very sad.  WHM asked us to wait until Thursday to begin talking about the job and changes.  So we booked out our days on Thursday and Friday to spend going from person to person, group to group, to explain face to face how our job is changing.  Scott walked our friends through the news of the new job, and its implications.  I mostly sat next to him and cried.  Though WHM is a very small organization, it is a good thing for our friends here to find out that they now have an advocate in a "higher" place, that we remain with the big picture ongoing work.  However, it is NOT a good thing to introduce a thousand kilometers of separation, to break our daily community life, particularly for the kids who have become part of our extended family.  I grieve that for myself, and for them.  I grieve the pain we are causing the brave souls who have taken us into their hearts, who have risked friendship, who hoped we would not be one more in a long string of departing people, who could easily feel dehumanized  as expendable objects of ministry.  They are not.  This change ahead in July is already an excruciating weight on my heart.

My dad died four years ago today.  He left well, thankful for what was behind, not afraid of what lay ahead, and trusting the process into God's hands, well aware that he could not delay it, let alone stop it.  As a pilgrim he did not cling to home.  I find it hard to strike the right balance of fully entering into this world as if it was home . . . and remembering that it isn't.  Entering relationships as if they will last forever . . . and bravely enduring the "for a little while you will see me no longer."  Being a pilgrim and a stranger, but journeying towards home.

Numbers

I'm not exactly flying through the Bible these days, but am trying to regularly read chunks from the historical books, wisdom literature, psalms, and Gospels.  So in the first category I've made it up to Numbers, first two chapters. Which, at face value, is a bit of a dry list.  Simeon's male descendants over the age of 20 were 59,300.  And the leader of Manasseh is Gamaliel son of Pedahzur, who camps with his 32,200 men on the west next to Elixhama son of Ammihud.  

However, if you think about it, numbering implies value.  Here were former slaves, so expendable that all male babies could be thrown into the Nile river.  Suddenly they are free.  There are rules.  Organization must be put in place to rally a mob that had been oppressed and bullied for generations into a people movement capable of withstanding the desert and conquering territory.  By numbering, Moses was assigning place and importance to every individual.  

This is an issue of justice and public health that remains today.  The children of Bundibugyo are not numbered.  We do not know how many are born, and how many die, and where, and why.  When we ask a mother on the ward about her other children and find out she's buried 10 of 13 now, that is staggering news.  Or it should be. Instead it is hidden suffering.  In the last week five children have died on our ward, in our care.  Baluku Thomas, the child with ants crawling on him day before yesterday, I found this morning as a body wrapped in a kitengi cloth, having breathed his last at 3 am, his grandmother waiting for help to transport him back home for burial.  He and another child I never even saw both died of hunger, severe kwashiorkor, languishing in another hospital for a week then being transferred here to die.  Ahebwa and Kisembo Nassan both died of fear and ignorance, having their gums sliced for supposed false teeth.  Katusiime Annet was the one month old infant of the Barts' former house worker and our neighbor, who received everything we could give for a three day battle with severe pneumonia, and lost.  

The movie The Interpreter ends with the main character reading aloud lists of the names of people who had died.  Africans, whose deaths are more easily hidden than those of many continents.  (It's fiction, but truth, and a fantastic movie by the way).  So today I name our losses of the week.  

And look towards the day when the Babwisi and Bakonjo are numbered, when a birth is registered, and a death certified, when the abundance and loss impact policy and catch attention.

It was the ants

I think it was the ants that really got to me.  I knew today was going to be long and hard.  Wednesdays almost always are.  Our team begins with early prayer, rotating focus on different members, and today we prayed for Anna, Luke, Caleb, and Nathan.  With Luke and Nathan it is an unsettling time of decisions and transitions, and both are such great godly young men . . . so that no doubt began the day with more emotion than usual.  Then I was the first person in the ward, trying to get a jump on the day.  As I breezed through the doors and headed to the store room to put on my white coat and get my clipboard, I greeted patients and glanced about.  My heart jumped when I saw the toddler lying on a mat on the floor directly beside the store door.  I have seen dead bodies that looked more alive than that.  His color was a corpse-like cross of pallor and sickly yellow,  and he was motionless, still.  I bent down to feel for a pulse and as I moved back his blanket, the stench of putrid peeling skin wafted out.  And then I saw the ants, tiny ones as colorless as the child, crawling around his eyes, over his shoulder.  A shudder-inducing emergency-inspiring disaster, a child in an advanced state of malnutrition and decay,lying there with a caretaker who seemed lost and listless herself.  But he was alive.

And so the struggle began.  Soon other staff arrived, and I had great help. Though his heart was beating and he would moan when moved, caring for Baluku was like running a code.  Assign jobs.  Pay attention to the time.  Think globally of what could make the difference between life and death in the next few hours.  Get labs, take a focused minimal history.  Mom died two months ago when he was two, grandmother is the caretaker, first noticed a swollen abdomen a few weeks ago . . . then was admitted to another hospital for over a week where he became worse and worse until they transferred his care to us at the last moment.  His edematous body with fragile peeling skin made IV access nearly impossible, so within five minutes I gloved up to insert an intra-osseous line, a brutal needle that pops through the cortex of a leg bone in order to give a child fluids through the vascular network of bone marrow.  Travis walked in at that moment and got his first chance to use this simple, useful technology on a real human being.  Meanwhile there were two other critically ill patients on the ward, another 30-or-so admitted, and another dozen-or-two waiting for outpatient evaluation.  Crazy.  So once the intra-osseous line was in and the initial fluids pushed, we left Heidi, bless her heart, to warm water and clean him, to monitor the spooning of milk, to push the syringes of transfused blood slowly into his leg.  She spent hours hands-on with this child.  And by afternoon, with blood and antibiotics and fluids and bandages, with a cozy blanket (one of the last of Annelise's friends' gifts), the possibility of survival  was there.  Not likely, but possible.

Somewhere in the middle of this, I went into the store room again for something, and ran into Nathan who was scrambling for something else, and had a quick cry.  I think it was the ants crawling on Baluku that seemed so overwhelmingly sad.  Nathan is one of those dependable, honorable Scott-like guys that sometimes gives the sympathetic word that breaks down the resolve.  I've seen so many malnourished kids, so many tragic stories, so many deaths and near-deaths.  I don't want to ever reach the point of not being emotionally punched in the gut by a child like Baluku.  Nor do I want to reach the point of running away, tempting as that was today (a new diagnosis of AIDS in another child, another baby whose parents took him for horrific teeth-cutting now in shock on oxygen and fluids and blood and looking very likely to be this lame mom's 10th (of 13) child to die, another baby with half her nose eaten away by some bacteria leaving a crusty gaping hole through which she breathes, burns and wounds and pus and malaria).   So a quick cry that acknowledges this is NOT RIGHT, and then a deep breath and hands on the next medicine or syringe or whatever was needed, and on to the next patient.

The ants can not have Baluku, yet.

Kusiima Jenepha

A baby landed at our house at dusk one evening, a newborn wrapped in kitengi cloth, at that point nameless.  She had been born on the path as her mother tried to make it to the hospital in time.  Once there, however, the midwives or parents noted that all was not well.  She was born with imperforate anus, a margin of a few millimeters of cell migration and differentiation in the early weeks of her embryonic existence, a tiny failure to complete the course with huge consequences for survival.  And so she entered life outside the womb with not only a chaotic outdoor delivery, aspirating fluid and gasping for breath, but also the only outlet for her intestines being a small fistula track into her vagina.  

But at least there was an outlet, and with that, hope.  Oxygen and antibiotics for her wet rumbling lungs.  A missionary surgeon in Kampala advised on how to irrigate the meconium out of her small openings.  She tentatively began to feed.  Ultrasound did not find any related anomalies in other organs, though with the coarse lung sounds and no xray we could not rule out an associated tracheo-esophageal fistula.  Meanwhile I was emailing and calling about the country, trying to find a surgeon and hospital with the expertise to handle such a child.  I try to spread my begging for favors around, and regret that I called International Hospital's Hope Ward (charity ward) last.  They agreed to help her.  Her prognosis was poor, certain death if we did nothing, and likely death if we transferred her, and at the very best a life of surgeries and medical challenges that even a family with ten times the resources would be hard pressed to endure.

The parents were committed from the first hour to do whatever it took.  So on the 5th day of her life, I filled out paperwork and gave them transport money to get to the best hospital in Uganda.  I asked then if they had given her a name.  Yes, they said.  "Kusiima Jenepha".  My heart contracted.  Kusiima and Jenepha are both common names.  The first means "thanks".  And the second has been a world-wide favorite, beginning in the 60's when my parents chose it without ever having seen the movie Love Story.  But the combination made me squirm.  I wished I had done more, earlier, faster, more efficiently.  I did not want to be saddled with the credit for this life that was unlikely to last long.

Kusiima Jenepha died the next morning, a few hours after making it to the hospital where she was to have surgery.  The ten hours of transport on the bus were too much, even though we pumped her up with fluids and antibiotics, she arrived in critical condition.  They gave her superb resuscitation care, but she did not recover.  The hospital administrator called to tell me.  I did not expect to see the family again, but the father came back to my house at dusk a week after the first evening.  I knew we had failed him, but he came to thank us for our help.

I do not like to dwell on the patients that die.  We discuss them in our weekly staff meetings, and I tend to explain why we could not have done better, why death was inevitable.  In the last week or so I've lost two children with AIDS and TB, both of whom arrived at late stages and no prior care, malnourished and hypoxic and vomiting and way past the point of return.  And another normal baby whose parents took him to have his baby teeth cut out of his gums to cure diarrhea, a diabolical (literally) practice perpetuated by fear and misinformation that claims too many children.  All of these kids spent at least 48 hours in our care, all seemed to have a chance of recovery, but none did.  I was in the room for only one of these recent deaths, the distressing moment of declaring the struggle over, telling the mother as she wilts wailing to the floor, trying to reach relatives on the phone.

Kusiima Jenepha, however, reminds me that this is not about success or failure.  About striving, sure.  About going the extra mile.  About caring.  About giving every opportunity.  About sacrifice (time, heart, money, worry).  About team work.  About life that is short at 6 days or 6 years or 60.  Perhaps even about love, though that seems too strong and noble a word for my part, it applies to the parents.  Even those who come too late, have come because they love.  I'm thankful for their forgiveness when we fail them.

D-Week

Decisions loom this week.  We celebrate God's abundance in giving Luke (our 17-yr-old senior in HS) six amazing choices for college, excellent schools with financial aid beyond what we dared hope.  This is a kid who has only spent 2nd grade in America, and now he's heading off to college there.  And Nathan, in his second year of working very hard here as a nutrition manager, football coach, and biology teacher, has options at several top medical schools.  And Sarah, who just completed over two years of teaching and working with nutrition programs, must also choose between excellent public health graduate programs.  Please pray for all three of them.  The God who whispers and asks questions gives them freedom in choosing their next steps along His paths.  With that freedom comes a certain weight of responsibility, mixed with the joy and relief that the bizarre turn they have taken (be it 2 years or 17) through Bundibugyo has not closed the door to higher education.  All want to serve God with their degrees, most likely in difficult places.  All their options are good ones.  Pray for clarity as they ponder them, and peace as they reach conclusions.  And for us, the parents, the team leaders, the one-step-back advisors, to support and respect and cheer.  It feels like a significant week as these loved ones strike out on their paths.  Luke's will impact our next few years, too, and we also could use prayers for clarity and peace.