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Sunday, June 18, 2017

20 Years ago today, we ran from war

June 18, 1997, was one of the most terrifying days in our lives.  We had been in Uganda 4 years, and were just hitting a stride with medical care, community health, a new training program for young nursing students.  Luke was 4, Caleb was 2, Julia was 8 months, and Jack was a yet-to-be-known-about few weeks in utero.  The other families had left for the summer, but we were settled in with newly arrived interns, two single team mates, and one young couple.  Rebel invasions were not on our radar.

Now 20 years later, the Allied Democratic Forces (ADF) still terrorize eastern Congo.  They raided a prison last week and freed 900 prisoners, many no doubt merely poor and unfortunate victims of injustice but some potentially dangerous.  They are a bit limited in scope these days, but certainly not gone.  Two decades ago, however, in the aftermath of the Rwandan genocide, the flight and pursuit of the Interhamwe,  ascension of Kabila, the ADF were on the rise and our home in remote Bundibugyo became a war zone.  Many suffered much more than we did, including our best Ugandan friend Dr. Jonah who lost his father in that time.  In honor of the principle that telling the story and grieving the losses and clinging to faith are essential steps in healing, I will copy below a chapter from our lives that both sent us into a grey zone of uncertainty and sorrow, and paradoxically bonded us to a place we continued to call home for many more years.  The way of the cross sometimes involves a very messy path.


(circa 1997, and in honor of Father's Day today)

(The incursion had begun a couple of days earlier, but we had been reassured by the presence of Ugandan military and the hope that the battles would stay distant from our home.  We were wrong) . . .


Weds June 18, 1997, 6 a.m.
Gunfire, loud, continuous, close. 

We roll out of bed to the floor in the clothes we had slept in, and crawl into the bathroom, the least-exposed part of the house.  It is the hour of dawn when one can just barely distinguish objects from shadow.  A clinical compartment of my mind finds the extreme physiologic effects of adrenaline shocking:  I would never have guessed that my mouth could feel so parched, my knees so wobbly, my stomach so dropped.  This is the end, I think.  We are about to be killed.

We pray.  In whispers.

Scott crawls to the front of the house, peeks out, as the arcs and flares of tracer bullets cross the yard.  No one is talking, yelling, crying, there is only the explosion of gunfire and the vacuum of fear.

We are in the thick of the battle now, no longer observers.

Somehow in the next half hour, we get the whole team to our house again, ducking, gasping.  Jonah and family are nowhere to be found (we had given them shelter when the battles began two days earlier), they must have already long run.  We get the kids out of their beds, put on their shoes with shaking hands, tying laces, keeping them quiet.  We grab our diaper bag back-pack and the satellite phone.  And then we run.  Staying holed up in the house is no longer an option in our minds.  These are Al-Quaeda trained rebels, who would be expected to search out and kill Americans.  These are desperate men who would hope to steal medicine or money from people like us.  This is not the edge of battle anymore, it is an attack, moving right into our yard.  One by one we slip out the back, climb over the fence, and run at a stoop into the shadows of the paths that twist away from town and into the bush.  I have 8-month-old Julia in a locally made front-pack type carrier, and the diaper bag with a few diapers, baby cereal, blanket, a change of clothes for the kids, on my back, and Luke holds my hand, running on his own 4-year-old legs.  I had stuck in their favorite duplo car and motorcycle, with little grey-haired duplo people they called Grammy and Grampy.  I thought we might be able to keep them quiet in a dangerous spot with that.  Scott carries 2-year-old Caleb, but just before climbing over the flimsy reed fence turns back to the house to get our dog, Angie, who was cowering on the front porch.

I run for a ways, then look back for Scott.  I can’t see him on the path.  I pull Luke into a clump of bushes and we hide, waiting.  The gunfire is still intense, surrounding us.  Luke and Julia are miraculously silent, sensing the danger. 

I pass the most excruciating moments of my life.  It feels like years.  Scott is not coming.  The others are ahead of me.  What if he or Caleb have been shot?  What if he is lying in the yard, wounded, or dead?  Should I run back?  Or should I stay with Julia and Luke, trying to keep them safe?  If I die, they would surely die.  How can a mother choose between children, husband?

Agony. 

Then he is there, with Caleb, with Angie our dog on a leash, and Rick bringing up the rear.  We move on in our crouching run, catching up with Greg and Beth, Heather, Rob and Jeremy.  Eleven of us, passing silent houses, no sign of the inhabitants. 

As we move further from Nyahuka, the gunfire becomes more muted.  We slow to a walk.  It seems ludicrous to think that the vines and elephant grass will protect us from stray bullets, but we feel safer in the closeness of the path.  Rob, it turns out, is a cross-country runner.  He offers to carry Luke, and he and Scott switch off between the two boys through the day. God’s provision for parents of three very small children, we could not have trekked the probably 20 kilometers of rough terrain we cover that day carrying all three of them ourselves.    We do not have the tents or provisions we had gathered two days earlier, we don’t have much.  But we do have the briefcase-sized satellite phone.

As the morning wears on, our path joins other paths, until we find ourselves walking down a dirt road in a proverbial tide of would-be refugees.  Exactly what you would see on CNN, tired bewildered people, focused on escape, hoisting basins of food and clothes and trussed chickens, yanking at reluctant goats, kicking up dust, sober.  We blend into the flow of forbearing Africans as much as a family with three small blond people can.  The sun is fully up now. I wonder how long we can manage on our small bottles of water. 

Advice and rumor spread.  Go to Congo, the UPDF will help you there.  Don’t go to Congo, the ADF are headed there.  Go to Bundibugyo town, the UPDF are back in control.  Don’t go to Bundibugyo town, the ADF are still fighting there. 

To our south, the almost 17 thousand foot peaks of the Rwenzoris, glacial, impassable.  To our east, the range stretches down to a potentially crossable 9 thousand feet, but this is the very territory where the ADF rebels had hidden, from which they had launched the attack.  To our west, a river, and then the Congo with its vast impenetrable rain forest.  Since the ADF came from years of hiding in Congo, this does not seem to be a good direction for us, and even without the ADF the Congolese could be nearly as dangerous.  Millions of people were later calculated to have died in this territory in the late 90’s.  So we veer away from the massive westward stream eventually, and head on obscure footpaths back northeast towards town, our only option.  Perhaps if we avoid the road, and stay as hidden in the bush as we can, we can slip past any ADF and reach the center of Bundibugyo town, which we think is probably back in Ugandan military hands.

We choose paths as best we can, having never walked this way before, stopping at a stream where Heather washes her feet, bleeding and blistered from all the miles. Luke on Rob’s back, Caleb on Scott’s, Julia nursing as we go.  Through dense bush, past deserted homes.  We are grimy, hot, filthy.  Our jeans tear where we fall.  Once an armed lone man in fatigues walks by us, silently.  I think now he was probably an ADF; we were each trying to escape each other.  We follow steep slick paths crossing ravines, then climbing.  Dense forest, palm trees, the occasional mud-walled compound, disconcertingly silent. 

By mid day we are exhausted, thirsty, tired. We stop in a church compound where some people are cooking.  I am offered use of a pan and their fire to cook up some porridge for our hungry kids, and someone shares their bananas with us.  For months we had struggled with illness and poor weight gain for Julia and especially Caleb, neither had any margin for hunger, and I don’t know if or when we can get them any other food.  For once the playing field is, briefly, level.  We have no car, no food, no money, no rescue, no plan.  We sit outside on the ground with others, stirring a pan over a fire, uncertain, with no protective barrier between us and the daily realities of survival for everyone around us.  We are far from any battle now, though people are cautious and edgy, they are not running.  We could hear and see helicopters, which seemed to be landing in Bundibugyo Town, our destination.  We take this as a good sign, surely only the UPDF has helicopters, not the ADF, so the town must be safe.  Scott sets up the satellite phone, with only a few minutes of battery power left.


He calls the embassy again, and tells them we are fleeing on foot, but if the town proves safe we would like to go there, and perhaps be put on one of those helicopters.  Then the battery dies, and we are on our own.

We can not stay on the exposed hilltop church compound indefinitely.  Rick and Greg volunteer to scout the final kilometer into town, while we wait, nervously, for their return.  If the town is not in government hands, we don’t want to walk into the middle of an ongoing battle carrying our kids.  The helicopter continues to appear and disappear, and since we are fairly certain these rebels have no vehicles or aircraft, we take that as a good sign.  It is nevertheless tense waiting for the two men to come back.

They return with a green light; we trudge onward, the final kilometer of steep ascent on little used paths, avoiding the main road.  Now we see dead bodies, mostly uniformed ones, presumably ADF.  As we clear the top of the ridge we pass the line of UPDF (Ugandan soldiers) with their tripod-mounted guns, lying in wait, aiming in the direction we’ve come from, protecting the perimeter of the town. The UPDF are indeed back in control.  They seem unsurprised to see our little parade of Americans emerging from the bush to seek safety behind their lines.  They are, however, unaware of the attack on Nyahuka, until we arrive, so our reports result in a flurry of action to deploy military in that direction.  We stop in the first place we come to, the Picfare “hotel”, hoping for something to drink and news.  From there we walk through town on the main road past the hospital to Dr. Moll’s house, the only other resident foreigners in the district.  Right in the middle of town a body lays in the middle of the road, the chaos of a situation such that a human body lying in a heaped angle, in the road, would not attract any action or concern.  I try to divert the kids’ attention, and we also simply pass it by.

Dr. Moll and his wife tell us their story.  They had been on the road near town Monday morning during the first attack.  They were captured by rebels and made to lie down, tied, on the floor of a mud house, searched and groped but otherwise not harmed.  When the UPDF responded to the ADF attack, they used the distraction and confusion of the ensuing battle to roll out the door, across the road, and down the hill, until the battle ended and the UPDF resumed control.  Now they are trying, like us, to get to a safer place. 

After a day of running through the bush, sitting down at the Moll’s neat German compound is an incongruous paradise.  Very soon the message comes that we should all report to the central town “square”, the large open assembly area used for public gatherings next to the administrative offices.  Our embassy has contacted the UPDF high command, and we are ordered to get onto the next helicopter evacuating wounded soldiers.  As we walk back through town and join the crowd of the curious, we learn that two high ranking church of Uganda officials have been trapped here on a visit, and four random young European hikers who had chosen the wrong weekend to cross the mountains (tourists were very rare in Bundibugyo).  The Ugandan government wants all of us OUT.  Nothing is worse for tourism, upon which many livelihoods depend, than the death of foreigners in a border skirmish. 

So we wait, bracing against the deafening roar and rushing wind of the landing helicopter.  The wounded are loaded first, on stretchers, then the unfortunate tourists, the stately church officials, and lastly our team.  Rick tells us as we wait that he will not get on, that God has put him in Bundibugyo for such a time as this, that he has no kids or wife to care for and he wants to stay.  We respect that, even though it is a hard decision for all of us to hear at the time, splitting our little fellowship of survival, casting doubt.  There is little time to react, we are being motioned forward, ducking, shouting above the noise, climbing into the darkness of the helicopter’s interior.  The kids are crying, finally, the frightening noise of the helicopter, the chaos and unfamiliarity, the stressful day catching up with them.  Scott brings up the rear, and there is some pause. 

Angie, the dog.  Of course we still have her with us, on a leash.  The UPDF draw the line.  Bajungu they will take, even their small children, but NOT their dog.  So Scott runs back and hands the leash to Rick, who is gracious even though this is not a burden he would choose.  Dr. Moll has, it turns out, intentionally taken the hospital truck to get “one more thing” and missed the flight too, though his wife is on board.  Like Rick he is glad to get us off, but not quite ready himself.  He will come out out a few days later.

Within seconds we lift off, the danger and noise of battle receding rapidly below us, swallowed in the dense green of the jungle, the deep crevices of the mountain.  From the sky the district looks calm, innocent.  And what is usually a many-hour harrowing jolting nauseating car ride becomes an effortless fifteen minute flight.  We cross over the lowest part of the ridge, hovering above banana trees and crater lakes, then eastward to the town of Fort Portal.  The helicopter touches down on a football pitch proximal to the hospital, we jump out into a normal day of sunshine and care-less people, incongruously unaffected.

Now what?  There we are, ten of us now, with no real plan.  Scott manages to get us rides in the back of a small pick-up.  We head for the Mountains of the Moon hotel, in those days about the only place in town to get a bed and dinner (it is now unrecognizably renovated into a luxury resort, but in those days it was basic cement and velor, unchanged since it was built in the 30’s I’m guessing, low quality and endearingly familiar).  On the way our truck stops for fuel, and a woman parliamentarian spots us as she fills her tank at the station.  She comes over to our pick-up to talk to Scott about the situation in Bundibugyo, and after one look at him gives him her free-with-a-full-tank T shirt.  Here, you need this more than I do, she says.  That epitomizes our situation.  We have nothing, we are filthy, we smell of fear and dirt and escape, and we are dependent upon the charity of others.

The Mountains of the Moon staff brings buckets of hot water, with the sweet charcoal smell of the open fire where it was heated.  We pour them into the nonfunctional bath tub and take off our filthy clothes and bathe.  The day behind us feels like a hundred years have passed.  Without clean clothes, or cribs, we just wrap up in the frayed sheets and all lay down on the bed together, exhausted.  And sleep.
(circa 1998, after the above events . . )

Tuesday, June 13, 2017

Reshaping the world, in minuscule quanta


This is baby A, all 1.1 kg of her, who disguised the fact that part of her intestinal tract was missing by being a typically fragile little preemie with jaundice and an infection and spitting up feeds.  Last Monday, though, I was pretty sure this was more than just being tiny, and thankfully the Kijabe paeds team and surgeons agreed to take her in spite of her critical condition.  A few days later, Scott and I went to Kijabe to cover for a couple days and a night.  She looked much better already, alone instead of in an incubator of 3, getting total parenteral nutrition instead of plain sugar-water IV fluids, and waiting for surgery.  I think you can see the relief on her mom's face, too.  And when I went back to Naivasha yesterday, the moms of the other dozen or so preems were thrilled to see her picture and hear her report.  It's a communal effort, and a communal joy that God would provide unaffordable and inaccessible specialized care for one, demonstrating love and awareness of all.

Or consider the story of baby C.  Her pregnant mom went to work Thursday in Naivasha town, but didn't turn up on Friday.  Neighbors thought they heard a baby cry sometime Friday morning, but no one answered when they knocked, so they though she had left the room where she lived alone.  No one saw her or heard from her for over 48 hours, so when a friend from work came to check up on her Sunday they community decided to break in her room by removing a roof tile (New Testament style).  They found the mom on the floor unconscious, and the baby also on the floor still connected to her placenta.  Miraculously, they were both alive, and were rushed to our hospital which in spite of a nursing strike still keeps admitting those who have nowhere else to go.  Like kids with AIDS or meningitis, adults with TB, babies who need oxygen, pregnant women in labor, post-partum moms with bleeding or hypertension.

Such small people, such limited stories.  And in the face of so much uncertainty and frustration and injustice, strikes and closures, is it enough? 

Which is why these words on-line jumped out at me this week: 

Only the forgiven can forgive, only the healed can heal, only those who stand daily in need of mercy can offer mercy to others.  At first it sounds simplistic and even individualistic, but it is precisely such transformed people who can finally effect profound and long-lasting social change.  It has something to do with what we call quantum theology.  The cosmos is mirrored in the microcosm.  If we let the mystery happen in one small and true place, it moves from there!  It is contagious, it is shareable, it reshapes the world.  (Rohr, Hope against Darkness, 2001)

 Getting one tiny baby's bowels reconnected; warming up a starving newborn and mom stranded dying in their home, unnoticed.  These are almost invisible quanta of justice in a world that is fractured.  And they are enough, because by grace they are contagious, spreading out like ripples in the space-time pond of reality, from the cross out to the renewal of all things.  



 Being back at Kijabe was a paradox of sweet memories and head-spinning change.  This hall connects the old hospital to the new; Acacia and Jack helped lay out the river-of-life design for the floor tiles back in the day.  Now there is space, cleanliness, light, comfort.  And monitoring, good staffing, intense care.

Colleagues, smart dedicated people, multiple consultants here on a Saturday morning reviewing patients and carefully signing out the sickest ones to each other.  Trainees, of all levels.  Labs.  Function.  A lot of good happens here. 
Scott did an emergency surgery on a critically unstable woman bleeding from an ectopic pregnancy and kept watch over a busy labor and delivery; I managed the 30 or so babies on the newborn service then covered everything from a dog-bite to a new leukemia to a lung-damaged baby on a ventilator and an epidural hematoma/skull fracture in an 8-year-old hit by a motorcycle while trying to cross the road to her school bus (sounds terrible but she was awake and smiling).  It was exhausting to cross cultures back into that world again, and fun, and we're so glad we could.
The newborn unit has happy walls and a Bible verse.  I showed the resident my old habit of making a list of the critical patients on the white board and going over it with the nurses.  It felt good to be back.

For a day. But coming back to Naivasha, I have to say, felt like home.  Yes, we have a LONG way to go to reach Kijabe-level care.  But at Naivasha we provide a reasonable fraction of that care with a minimal fraction of the resources.  Now we're into our second week without our regular nursing staff (they are on strike), and with reduced patient admissions, and without assurance that the doctors won't resume their strike.  It's hard. But . . the new interns have given us a little breath of fresh air, as we teach on rounds, give lectures, answer questions.  There is good to be done, and God has so far allowed us the health and stamina to keep doing it.

Scott took this page out of our own training--teaching suturing skills on raw meat.  These interns significantly improved on their C-sections after an afternoon of training.



The quantum of care at Naivasha feels even smaller after being at Kijabe.  But in this world held together by the invisible forces of grace, it just may reshape everything.  



Thursday, June 08, 2017

Strike week 25/51 . . .

As per the UW chief resident who has been working here at Naivasha in medical education for a year, that's the tally.  I should have been keeping track, but I'm sure as we move into our 9th month it's actually more than half the time.  This week it is the nurses, who came back quickly in December after their short strike when the government formed an agreement with them . . that was never signed.  Word on the street is that the doctor's agreement wasn't signed either, so they may join on Monday.  The inability to anticipate patient load or collegial help day to day gets very tiring; I am sure the inability to even access care gets MUCH MORE TIRING for the patients who must face a choice between suffering, and potentially dying at home, or calling in every favor to raise the downpayment for a private admission.  For many there isn't really a choice.  I think the sheer duration of incessant and repetitive strikes makes it clear that this is not an efficient means of progress or change.  Punishing the poor to force the hands of the powerful doesn't seem to work very well.  And in a society where political affiliation is almost purely tribal, such actions don't impact voting much.  The government can run the health sector into the ground and still be re-elected.

Meanwhile here in Naivasha, we keep plugging on at about (maybe slightly below) half-normal numbers using "contract" (non-union) nurses.  You can run for 100 days without doctors, but not even one without nurses.  We're taking emergency admissions, and continuing to care for our long-term nowhere-else-to-go patients.  We have our clinical officer interns, and our medical officer interns who just started their year after the mess of the long doctors' strike, for now (no telling what will be true come Monday).

And in spite of how we sometimes want to throw up our hands or cry, there really are remarkable things happening.


Baby E's mom came in severely dehydrated because her mom had an abscess and wasn't able to feed her well.  By severe, I mean a sodium of 192 and a creatinine upwards of 900 (that's over 10 for mg/dl).  No ICU, just weeks of fluids, antibiotics, care for the mom and baby both, using what we learned at Kijabe.  Yesterday they went home.  A miracle.
And in the NBU we have just discharged a whole preemie class of a half-dozen who grew from 1 kg to nearly 2, and the tiny ones keep coming.  Over a dozen right now who are mostly in the 880 gm-1.2 kg range, a few getting up to 1.6 or 1.7.  It is hopeful to see the team calculating fluids, knowing what antibiotics to give, watching for jaundice, paying attention to gestational age.  They have come a long way, and I am pretty sad that the CO interns must change rotations next week and the doctors might strike again.

Yes, we had one positive cholera case on the male ward, but so far our Paeds samples have been negative (though we lost two kids in the last two weeks shortly after admission, before even being reviewed by one of us, so those might have been real cases).  Meanwhile the classic cholera cots in the hall remind me of Bundi and make me happy to see them not in use.

Having the patient census at about half, but the CO and doctor team fully present, allows for more teaching.  I prepared a lecture for this morning for all the hospital trainees, giving some evidence-base about respiratory infections and teaching them to use the Kenya protocols for treatment.  We do bedside teaching every day, and enjoy it.


After the first C-sections with interns took more than triple the normal time, Scott bought $3 worth of meat and did a surgery clinic with his new interns.  They seemed pretty happy with the stitching practice.  This kind of investment in teaching is a big reason we came to Naivasha.



And lastly, just for fun, since the American president's name is in the news even here in Kenya for good or for ill . . . I finally met my first baby T.  Yes, that's right.  We had a lot of Obamas (Kenya was particularly proud) but so far only one T.  


Please pray for the many who are left without care during yet another upheaval in this health system, and pray for justice to roll down like the rains we so desperately need.



Saturday, June 03, 2017

Bloody socks, and other metrics of a week on the edge

Last night, our evening walk was abruptly interrupted by a distress call to help a visiting resident and the interns with a 40-year-old woman on her 11th pregnancy whose uterus ruptured.  Hours later as Scott wearily walked back in the door for a 9:30 pm dinner, and I was starting the laundry (thankful for a washing machine these days) to deal with the usual sweat-soaked scrubs, he sighed "the blood soaked through my socks".  That's what a surgery with 3 liters of blood loss, with a patient who's blood pressure never topped 60 until the end of the case, when you go through 80 sterile sponges, looks like. The baby was dead before the mom made it into the operating theatre, but thankfully the mom (particularly good news for her ten other kids) lived, and today is alert and recovering.  There are not many places in Kenya where that would be true.  Kenya's maternal mortality ratio is 500/100,000 (5/1000); which means given our volume of deliveries (600/month) we would expect 3 deaths/month, or 24 since we started in October.  Instead there have been 2.  That's a good metric, but the bloody socks demonstrate the reality of what it takes to get there.




Neonatal mortality is a bit more difficult for us.  Given the national ratio of 23/1000, we would expect about 14 deaths/ month just from our own labor and delivery but we also get the sickest babies born anywhere in a radius of probably 50 miles around. This year so far we're averaging about 16 deaths/month, with an average of about 150 admissions/month.  That NICU mortality rate hovering just over 10% is good on a national average, but still means we've lost over a hundred patients in the time OB lost 2. It gets pretty hard.  Still, our department is probably the most pro-active in the hospital.  We just started doing exchange transfusions for severe jaundice, the levels that cause brain damage.  Only a few places in the country will attempt this.  This week we had two babies with shockingly horrible levels due to a mismatch between their (paternal inherited) blood groups and their mothers.  Both were successfully drained of their entire blood volume twice over and replaced with donor blood in increments of a tablespoon or two at a time.  Both are doing well today.  On the prevention side, my colleague has a grant to teach "Helping Babies Breathe", the essential first-minute-of-life resuscitation skills every nurse-midwife needs.  This week she presented a quick taste of this at our hospital-wide CME, and began the first of a series of 9 weekly one-day trainings to up-skill select nurse-trainers around our catchment area.



That's how we walk in a world where your socks get bloody--first by attempting to push care boundaries to save individual lives day after day, and secondly by supporting the slow shift of education and attitude and habit and expectation that makes a long-term impact.  And thirdly, by bearing witness to the realities of injustice and brokeness, the stories that don't have such triumphal endings, but are equally important to God.

Little B came into our paeds ward at the beginning of the week, 9 months old, wasted thin limbs, an enlarged liver, a terrible cough, fevers, and a convulsion.  Her cerebral spinal fluid looked clear, but her chest x-ray showed pneumonia, and we suspected TB even before her universal admission HIV testing came back positive.  It turned out that her quiet mom was on treatment for AIDS, and as a baby B's first test after 6 weeks was negative.  But when it came time for her next test at 6 months, the family had traveled to the far western border to bury her 10-year-old brother who had been killed in a bicycle accident.  The dutiful mother had B tested there.  Positive.  Per the current international standards, she should have been started on highly-active anti-retroviral treatment (AIDS drugs) right away.  The mortality in the first year of life for infected babies, untreated, is on the order of 50%.  But the hospital there said, no, go home and get started in Naivasha.  When B's mom returned home with her many weeks later after the terrible ordeal of one child's death, she had no official record of the positive test, so the small health center in a flower-farm settlement insisted on repeating it.  These tests have about a month turn-around time, sadly.  So that meant B was 9 months old and dying and had never been treated by the time she showed up at our hospital.  We started strong antibiotics, and extra nutrition, and tested for TB, then decided to treat even though the test was negative.  But by Friday evening she was dead.  Too little too late, as is so often the case for children with AIDS.  A terrible virus, and a terrible failure of the health care system to find little B and treat her in time.

Which brings me to the end of this post.  This week in a devotion talking about the Franciscans, the author stated "Francis wanted us to live a life on the edge of the inside--not at the center or the top, but not outside throwing rocks either.  This unique position offers structural freedom and hopefully spiritual freedom too."  This phrase resonated, and I hope that's where we are, fully engaged in living and speaking truth, but on the edge willing to take risks.  We're not in a position of power at Naivasha hospital, we're plunging in but our influence is small and slow and hopefully more helpful than harmful but always a mixed bag.

Bearing witness on the edge of the inside, and working in concretely specific as well as globally foundational ways for change, sounds a lot like Micah 6:8, the verse on our prayer card and on my Dad's funeral program.  So here's a couple of examples from the news this week that I found convicting and inspiring.  First, as the NBA finals roll on, a press conference with LeBron James after a hateful person sprayed racist graffiti on his house:

"No matter how much money you have, no matter how famous you are, no matter how many people admire you, you know being black in America is tough," James said. "And we got a long way to go, for us as a society and for us as African-Americans, until we feel equal in America."

And lastly an interview with the author of Just Mercy, Bryan Stevenson, about growing up in America and the current controversies over Confederate monuments.  He makes good points about truth leading to reconciliation (though I would argue that true repentance is healthier than shame).  This book is on my list to read in the next few months.  Here's a quote from the interview:

"For me, it's important to redefine what it is we are dealing with when we deal with poverty, and that definition begins with recognizing that the opposite of poverty isn't wealth. The opposite of poverty is justice. If we actually had been just to those communities that we removed from the land, if we had been just to the formally enslaved, if we'd been just to immigrants who came and gave great wealth, we would actually be in a very different place when it comes to dealing with structural poverty."




Friday, June 02, 2017

Fair? I do not think that word means what you think it means . . .

Last night, our President announced that the USA would join Syria (at war) and Nicaragua (who wants stricter plans) in refusing to comply with the Paris agreement on reducing destructive pollution.  Every other country in the world (195?) plans to try and save it, but our leader said the deal was not fair to America and made other nations laugh at us, so we would go ahead and do only what we think is best for us.  America first.

Every country has a right, and a duty, to protect its own citizens and interests.  But let's be realistic.  WE DON'T WANT FAIR.  We have contributed more to the degradation of the earth than any other country in history (though China by sheer volume of population will eventually catch up and surpass us).  Fair would mean that we bear the brunt of change, that we live with the consequences, that we pay for our prosperity.  Instead, the poor of the majority world will pay the highest price.  We see it already.  Fair would mean that we use earth's resources in proportion to our population, or land mass, not at our current excessive rates.  Fair would mean that we pursue renewable energy jobs for places like West Virginia, rather than pretending that a return to coal can employ enough people.  Fair would mean that we plan with a timeline of centuries, that we consider the Americans of 2050 and 3000, not just the ones making money today.

So at least we should be honest, and admit that "make America great" in this administration's view can come at the expense of the rest of the world, and the earth, and our future generations.  Which begs the question of whether "great" means what we think it means, either.

I don't know the best way to employ my friends and relatives in my home state, to provide enough energy for the world, and to best turn over to my kids and (hopefully some day) their kids a world that God gave us to care for.  But I'm pretty sure that the ocean tides, the polar ice, the clouds, the trees, the oxygen, don't respect national boundaries, and this is one issue that won't be helped by running away from the dialogue.  

Monday, May 29, 2017

In Memorial

As a mom of a soldier, I have developed a Memorial Day phobia.  This is the American holiday devoted to those who die in military service to the USA.  And, I am ever more aware, there are many.  I cringe and must force myself to read their news.  In the last 20 years, the average/year has dropped from about 2000 to about 1500.  About a third are from hostile action (what you think of in military deaths), a third from accidents (training and deploying are DANGEROUS), and the other third is split between physical and mental illness, meaning sickness or self-harm.  Except for 1983, vanishingly few are due to terrorism (terrorists target unarmed civilians, after all).  This document gives all the official stats from the Revolutionary War to now, when wars have such double-speak vague names it's hard to tell just what they refer to.  Those are stats.  But to understand them, you have to also know the stories.  Each of those deaths represents a person of courage and promise, a family of sacrifice and pride, a system that worked or failed. Unlike other risk statistics, most of the USA military dead are white males.  


But the most recent death I've read about is not, and it's one of the saddest.  2nd Lt Richard Collins III, days away from his college graduation, on a track much like Caleb's, an officer, jump qualified, and athlete, a leader.  He was standing at a campus bus stop late at night. A drunk, belligerent student who was a member of a white-supremacist online group approached him and told him to move.  He didn't, so the assailant stabbed him.  Fatally.  For nothing other than standing at a bus stop, and standing up to a bully.  For being black? Seems so. Would he have been safer in Iraq than in Maryland?

This follows only a couple of days after two other men, one an army veteran, were stabbed on a bus in Oregon because they stood up to a man harassing women.  Women wearing muslim dress.  None of these three were technically killed in action this week as active duty US Military, but all three represent the meaning of Memorial Day, putting your body in harm's way to stop evil.

Our values of justice under the law without bias for all, of freedom to speak, assemble, worship, choose, of work and community and innovation, of opportunity . . . all of these hinge upon people of principle who stand up to bullies, who draw a line for evil and say, no further.  Sometimes on a national scale, sometimes very personal.  Sometimes the line between right and wrong is clear--I had 7 uncles in WW2, all of whom came home alive, hiding the scars of their traumas, all resilient good men who lived long lives with their families.  Most times it is not, as I think my cousins who fought in Viet Nam would attest, with their more difficult re-entries.  But in a world where hate accesses knives and bombs, it remains essential to have a counter-force answerable to the public, controlled by clear directives, and willing to pay the highest price so the rest of us don't have to.

Here in Kenya, it's just another Monday.  But if you're in America and celebrating a long weekend, picnic weather, family and friends, remember why you can.