For the third day in a row in the late afternoon/early evening Scott got a distress call from the hospital. He had told Jonah a couple of weeks ago that he wanted to start assisting him occasionally in surgery, most particularly C sections . . . But wasn’t expecting so much practice so quickly! Yesterday’s involved a mother with twins, and one twin’s heart beat could not be found on the portable ultrasound, while the other’s was showing signs of impending distress. They contacted Jonah but he was a few miles away working at his home property, where he maintains some garden and animal husbandry projects. He promised to come but asked Scott to get started, confident that since this was the 5th operation in 6 or 7 days Scott was ready. Scott was not so sure, but clearly he sensed the tragedy of losing both babies, so agreed to begin. By the time Jonah made it the surgery was well under way, so he observed and advised from the sideline. Amazingly both babies were delivered alive, though only barely, but responded well to resuscitation and are looking great this morning. Twins are extremely common here, they are called “balongo”. After the newspaper article I wrote about yesterday, the opportunity to offer prompt emergency care and save potentially three lives (mother and two babies) made the weariness and inconvenience of a Saturday evening interruption more palatable.
Besides the obvious advantage of averting death . . These hours in surgery have been an unexpected way to deepen our partnership with Jonah, and reverse our roles. A decade ago he was the medical assistant learning from us as doctors. A few years ago he was the student we supported. Now he is in charge of the hospital and refreshing rusty surgical skills as he teaches and supports us. That’s the way it should be, and we’re thankful, but tired.
Reading the passage in Ephesians 5 about the armor of God with the staff yesterday, we talked about how a UPDF soldier is equipped for the battle against flesh and blood, and how our battle is not against flesh and blood but principalities and power and forces of evil . . . Which sounds very reasonable in Africa and a bit on the edge of creepy in America, but the fact is that distinction helps me avoid the dehumanizing pressure to see those who obstruct my plans as enemies.
Take the case of Paulo. This little boy showed up on the bench outside the old Peds ward in early July, referred to me. I thumbed through is well worn kitabo (exercise book) and saw that his persistent mother had taken him to various health centers, more than a dozen visits in his three short years of life. In most he complained of painful urination, and was prescribed antibiotics. He had some abdominal tenderness on exam but otherwise looked like a normal healthy preschooler. I started asking questions and formed a pretty good guess that his problem was posterior urethral valves, a congenital blockage of the urine stream, which eventually leads to increased pressure all the way back to the kidneys and destruction of kidney tissue. His urinalysis was a mess, and Scott did an ultrasound that confirmed the impact on his kidneys was already significant. He needed surgery, three years ago, but at least as soon as possible.
There are only two options for specialty care: the massive public referral hospital for all of Uganda called Mulago in Kampala, or finding a private/mission hospital with a surgeon. I had a phone number for one urologist at Mulago, and he instructed me to send him for his colleague to see. The only private option, International Hospital, has limited charity surgical beds and told me they were full. I know Mulago is a terribly difficult place, but if he did not get surgery his life would not be very long, and the time he had would be increasingly uncomfortable. So I sent them off with transport money, pocket money, and prayer, two parents and a little boy who had never been out of Bundibugyo before bravely navigating the big city.
So began their Kafka-esque weeks of futility, languishing in the decaying and over-crowded hospital. The place is desperate, and ill-equipped and under-staffed. Care is supposed to be free, except for the fact that nothing functions and there are no supplies, so patients are routinely sent out to private clinics and pharmacies to buy anything from a few pills of tylenol to gloves for the surgeon. Paulo’s father spent a precious few coins calling me on the phone in pressured Lubwisi, I could tell he was out of money but had no way to reach him. Then he sent his wife back to explain that the surgeon would not operate without a radiologic study of Paulo’s urinary system (a reasonable test) but they needed 80,000/= (about $50 or a typical month’s wages here) to have the test done privately. I was caught in my typical gamble, a little more money could make all we’ve spent so far pay off . . . So I complied. Then a few days later the desperate phone call again.
This time I’d had enough, it was three weeks since I had sent them and they seemed no closer to definitive help. The sword of the siimu came out—cell phones are called “siimu” after the sim card. I burned up the airtime trying to contact the patient and the doctors. About two hours and a half dozen phone calls later I had convinced the admitting doctor at the International Hospital to accept him in transfer from Mulago and arrange for surgery. This hospital was started by an Irish missionary doctor who finished his mission service, survived cancer, then returned to Uganda to found a hospital with higher quality medical care for paying patients. It truly fills a need (including emergency surgeries for two or our kids in the past few years!!). Recently they convinced some businesses to support a “Hope Ward”, free care for indigent pediatric patients. They have to be referred and accepted, but this is the third kid I’ve sent this year.
Now the real twists: the private urologist who agreed to do his surgery at International Hospital (paid for by this charity) turns out to be the head of the same group of physicians who had not managed to give him care at Mulago over the last three weeks. Injustice? Or just reality? And to make matters worse, the only way I had to contact the patient with the good news that he could move to International was through these doctors, who immediately began to make excuses that the surgery would be done at Mulago right away, as they realized how iffy the whole thing looked, transferring their patient from public to private.
It’s a long story, and not over yet. Paulo’s mother showed up again this morning with his radiologic results at last. Diagnosis: posterior urethral valves. Same thing we suggested three weeks ago. She was told that surgery could not be done until they managed to obtain a urinary catheter. So she spent two days and another chunk of money coming back to find me. I wrote a letter to transfer Paulo and gave her instructions and money and sent her back yet again.
Headlines in the national newspaper today decry the tragic state of medical care at Mulago: 60-70 deliveries a day, 15-20 needed C sections, average 5-6 infant deaths/day among those deliveries, women crying in pain on the floor of the overtaxed unit, 3 staff on the roster per shift to care for all those patients. Now who is the enemy? The doctor who drags his feet at Mulago but jumps at the chance to operate at International? Though I was angry about this injustice, today I have more perspective. Those doctors are working in a hospital built 40 years or more ago, when the country’s population was probably a quarter of what it is now. They are struggling to make do with little funding, inconsistent supplies, and a never-ending onslaught of referrals, the last resort of a crumbling medical system. Last night Scott helped Jonah on their 4th emergency C section here in Nyahuka this week—nothing like the Mulago rate, but frankly beyond what this little theatre can handle in terms of supplies. Who is the enemy? Not flesh and blood, not desperate patients, not tired staff. The evil is so much bigger than that, the sickness that came into our fallen world, the greed and injustice that diverts money from the needy, the disparity between what is available in America and Uganda, the apathy that allows patients like Paulo to go years without a simple but life-saving procedure.
So we are called to fight back, even if it is will a cell phone, we take satisfaction in the one little reversal of injustice that Paulo represents.
This is the phrase that ends all exams at Christ School. Luke is in the midst of “mock exams”, the trial run of 19 half-day exams (!!) he will take for real in October/November. So literally, he is in a time of testing.
And it pretty much sums up our life as well. Another week of testing. I led my weekly Bible Study discipleship time with health center staff this morning, a series we’ve been doing on the Lord’s Prayer. Today we looked at “Lead us not into temptation but deliver us from evil.” As an opener we discussed: do you see life as a journey, or a battle, and how? Hmm, I should have realized that in Uganda a journey and a battle are both full of danger and struggle! We looked at some great Scriptures that tell us we will suffer in this world, even if we follow God’s will perfectly, as Jesus did, right to the cross. This is not a prayer to take us out of the world but to bring us through testing, ultimately victorious. I found it very encouraging.
Our staff meetings occur on a porch right by the operating theatre, where 12 hours prior a literal battle had taken place as Scott and Jonah performed a C section together to save the life of a mother and baby. Nearby is the new pediatric ward, another battle ground of life vs. death, healing vs. destruction. I think it helps the staff to get a vision of the big picture reality, to see their continuing struggle in the context of God’s moving into the world, reversing the curse, redeeming the fall. Well, even if it doesn’t help them, it helps me. The soul-iron I’ve been needing comes from hours like this. Yesterday for team meeting I had prepared a study of “Birth, Babies, and Danger”, a look at this theme through the span of Scripture from Creation to New Heavens and Earth, which also inspired me to see our little efforts as participatory in the ongoing struggle against the same enemy which tried to wipe out the Israelite babies in Egypt or the Jewish babies around Bethlehem.
And as we continue to struggle, there are moments of grace. One of my Kwashiorkor patients played peek-a-boo with me this morning, smiling behind her hands, for the first time. Another baby who had languished with severe malaria and no available blood transfusion revived, pulled back from the brink to live for a while longer. Two days ago I was thrilled to see one of my AIDS patients laughing, walking, and a normal weight for the first time in his three sad years of life, after being on anti-retroviral drugs for the last few months. His grandmother is truly one of my heroes, a frail little lady who belongs at the end of the Hebrews 11 hall of fame.
And so the struggle continues, advocating, praying, thinking, touching, confronting . . . Looking onward to the end.
Life here is full of hello and goodbye, sometimes in dizzying succession. Above see the picture of the interns on their last night here, posing with our family in our yard at dusk. The evening before we had fun hosting an all-team sit-down chili and cornbread feast with candles and tables and cloths and specially designed place cards, a little touch of elegance and sense of family celebration. After dinner the kids and teachers presented a clever video goodbye, screenplay by our talented Bethany Ferguson as a take-off on Pirates of the Caribbean (if you’re having a hard time imagining this . . . Picture Luke as a long-haired Johnny Depp with eye shadow and ear ring and African accent . . . ). Then the interns presented their goodbye video, co-starring Myhre kids as well (this time with British accents) and our cow . . . (now you’re really curious, my hint is that the show was a take-off on a TV show called Creature Comforts). It was a fun evening of prayer and closure, and a ringing confirmation of how great this group has been for our ministries and for us personally. As our kids get older, the attention and investment of interns becomes even more significant in their lives. Before they even pulled out this morning we received two more very short term (less than 24 hours!) visitors, Canadian young guys who were touring the country and met us months ago, and came to see the work and be encouraged in their potential future as missionaries to Uganda. When they said at breakfast they’d have to leave today I saw Caleb’s face fall—it takes a toll on kids to have people coming through our home and family and life, but the balance is well worth it.
Thankfully the pain of goodbye to our interns has been balanced by the amazing woman at the top of this post: Pat is back! She’s been here for several weeks, but we just had to use this opportunity to post this great picture, snapped when she was painting “Paediatrics” on the front of the new ward just before the dedication. Pat has been one of the most stable features of our childrens’ lives, and we’re glad she had a refreshing Home Ministry Assignment (the new missionspeak for furlough) and has returned to serve. She’s coming over for dinner tonight, a touch of grace in a time of goodbyes and transitions.
We need prayer as leaders to bring meaningful reflection and closure for those who leave, to open our lives to those who come, to process the ripples of impact on changing dynamics of relationship and ministry as our group grows and shrinks (mostly grows!), to offer vision and direction as people move on from one year to the next. I’ve been reflecting on some of the Psalms of pilgrimage (in the 130’s and 40’s) and struck by the fact that pilgrimage is not just a state of being, it has a goal. I can certainly see the transience of life, but need prayer to see the goal that our pilgrimage approaches. Even if we never reach in this life, there is a difference between wandering and traveling. And since many of those to whom we say goodbye are pilgrims heading in the same direction, the hope of another hello encourages us onward.
The baby pictured near his mother’s face, at the top of the last entry, died this week, as did the little preemie with the oxygen mask. This is a hostile place to the vulnerable and weak. The first patient to receive oxygen, who had a severe congenital heart malformation had died a week ago. And this morning, as we gathered around to treat and pray, another little girl, Beatrice Biira, about 4 years old, also died. The place of healing has also become a place of death, inevitably so when we invite the sickest and weakest through our doors. Beatrice had survived meningitis two months ago, and seemed to be doing well at home, until she suddenly started convulsing and lost consciousness. She came this morning burning with fever, limp, twitching. Our overworked staff rallied to give her all the care at our disposal. I even called staff around her to pray specifically for her (besides my general opening prayer) as we treated her. But her mother saw it coming, began wailing hysterically even as she took that last sighing gasp that dying children make, and her heart stopped. She was not revivable. Her father began shaking with sobs and her aunt also writhed on the floor in loud grief. Beatrice’s face was finally peaceful as we wrapped her lifeless body in the shroud of a gold patterned kitengi, her ordeal over as her family’s began. It is always hard for me to see the cloth pulled tightly over a child’s face, I resist the suffocating look of it, the uncompromising reality that that face is no longer breathing.
Four deaths. Part of me wants to look away and focus instead on forty lives—as of yesterday our 27 bed ward held 40 patients, a record. People are coming, hoping. And we are being pushed to the limit and past the limit to care for them. We just started a book called Walking with the Poor by Bryant Meyers, excellent so far. He points out that our Western world view accepts words (philosophy, truth) and deeds (science, development), but skips over signs and wonders, the area of unseen spiritual powers. I asked the team to pray for me to not be too confident in the cause and effect world of medicine that I lose sight of the signs and wonders God performs as people are healed. My courage to pray specifically over Beatrice was a step of faith, I hesitated to feel I was putting God on the line, and what if He didn’t come through in this public way? Well, He didn’t, not the way I asked anyway. And I don’t feel it shakes my faith so much as worry that I’ve shaken theirs. No easy answers in this broken world.
But then a glimpse of God’s power, as a boy I care very much about at CSB, one of my orphan students, has struggled with some sort of arthritis. We have prayed for him and treated him. This week he had a very powerful dream about being healed, and came away from it convinced that God was pursuing him, and that he wanted to study Scripture in a more disciplined way. So I’m thankful for that, not wanting to explain it, accepting the good as well as the sadness that comes to us here.
Over the last week we have had responses from five individuals and two churches/groups to help with nutrition expenses! Only five months to go to cover the whole year at $1600 each month. Today I was reminded that God sees the needs here, and plans ahead, and it is our privilege to be a small part of His work on behalf of the orphans and widows and hungry people he cares about. We have been in the new ward for one week . . . But today there are 30 patients in our 27 beds, meaning 3 on the floor. Yes, even this huge new ward is filled to overflowing. If we had not moved, I think I’d be crying in despair. As it is, we were ready for the upsurge. Two weeks ago we thought we might have to quit providing nutrition at all, our program was out of money and our UNICEF grant proposal was denied. But people responded with generosity and just in time for probably the highest number of severely malnourished kids we’ve ever had to care for at one time.
Sixteen of those thirty inpatients are malnourished. Today on rounds I snapped a photo of each one, to remind myself and all of us that these are individuals, human beings for whom God created good plans. The first four are low-birth-weight babies, premature but also small for their gestation. The top two are twins, one of whom essentially died yesterday while I was on seeing another patient. The mother had started crying that he was dead, and sure enough I found him darkly purple, with no heart beat or respiratory effort. A few minutes of CPR, stimulation, antibiotics . . . And he was breathing and revived. The third one did the same thing today while waiting to be seen in nutrition . . Costa suddenly brought him into the room where I was seeing another patient saying “this baby has packed” and I saw that he also was dusky, not breathing, but this time the heart had not completely stopped. He was also able to be revived and is now on oxygen thanks to the new ward, the oxygen concentrator, and power from the generator. All four are gestating skin to skin for warmth, sipping expressed breast milk, and supplemental formula to encourage growth.
Next are the newest admissions, from today: a child age 2 1/2 who had poked along until a month ago then began to drastically lose weight. We routinely screen for HIV infection and found this one was positive, one of the last kids born before our universal screening of pregnant women began in 2004. Another is a four-year-old from Congo whose parents both died from cholera within a few days of each other, and a few months later presented to us with Kwashiorkor, swelling of the body from protein deficiency as she eats a very marginal diet in the care of her old grandmother.
Others have been on the ward for some time, struggling with sickle cell disease or malaria, diseases that push them over the edge in a place where food is bulky and not very highly caloric, or where families barely manage in good times but are thrown into disarray by these chronic illnesses. Two of the three with sickle cell were diagnosed in the last few days as a result of our screening of kids failing to thrive. Two have absent fathers who are fighting for Uganda in Southern Sudan, to protect the people of the north from the LRA. One of those has AIDS. The other has no real disease, but his mother basically tries to feed herself and her four children with no help from relatives, no land, doing odd jobs for coins to survive. After a week of milk in addition to breast feeding the baby is finally up to five pounds at one month of age . . .
Near the bottom the babies of three heroines, breast-feeding grandmothers, women whose daughters or daughter-in-laws have died. Left with the care of their grandchildren they have bravely attempted to re-lactate, in these three cases successfully, though the children have needed some additional nutrition. No retirement relaxation for them, they have their hands full with the hourly care of infants. The last one looks pretty good compared to the rest . . Because he went home today. Though his bed was only empty for moments before it filled again with another needy child.
THANKS to those of you who have gone out of your way to provide for these children. I hope you are encouraged by seeing their faces, to know that you are helping real people. It helps me to make it through the long day when I hear the words of Jesus “as you did it to the least of these” . . . . In a small way this ward is the house of God, because Jesus lives there in these faces.
I just posted the good news that 5 of 12 months were covered, and had another message from the person who is mobilizing her 32 friends to give $50 a piece for the sixth month. I don’t think I can email a person who posts a comment unless I know their address . . . So I’m requesting that anyone who wants to be part of the 12 months of nutrition support email me at drsmyhre@yahoo.com. Then we can be in touch directly about which month you’d like to sponsor, and how to send the donation. We’re half way there! Thanks.
4 Stitches our team mate needed to close a wound over his eye on Saturday when he bent over to fix a water pump in his storage room and was rudely stopped by a protruding wooden paddle used for stirring matoke. Perhaps the first team injury directly attributable to matoke?
13 Number of team mates who happened to drop in for other reasons during the Saturday afternoon suture session on our kitchen table, and watch with interest. No privacy here.
25 Number of kilometers on a spectacular hilly dirt road mountain bike loop that six women on our team rode together on Saturday morning.
24 Number of those kilometers that seemed to be straight uphill . . .
7 The number of women who began the ride that six finished—one slipped in loose sand and gravel and got pretty scraped up, though she’s fine now. We had to call our ambulance, Scott for a rescue. This was unrelated to the 4 stitches. We get lots of injuries here . . .
3 The number of stitches Jack will have removed tomorrow, amazingly not infected and still holding together in spite of serious wrestling and other wildness. He even managed to write left-handed all week, though a back-log of homework did nearly push him over the edge on Friday.
4 The number of HIV positive people who stood up to give public testimonies in church this morning, encouraging others to be tested, to access care, and calling on the community to stop discrimination against positive people. Unexpectedly, the first one asked an elder in the church to stand up and pray for Scott, me, and Pamela to have the strength to care for them! It was a meaningful moment for me, to be prayed for in this way. We have had lots of dramas about AIDS, but I have rarely seen this kind of public courage to be identified as infected.
4/11 The proportion of the university sponsorship quota for students graduating from A-level (Senior 6) in Bundibugyo that went to CSB students! The results were announced Friday.
49, and 62 The number of people (including team) who were at our house for dinner on Thursday night . . And the number of pizzas we turned out of our oven to feed them. We had a short visit from a US Naval Academy student group on a short term missions trip. Though they only had 16 people compared to the last team of 21 . . . It shows that midshipmen have a healthier appetite than Charismatic Episcopals?
? 6 Hours of desk time I feel like I need to even begin to catch up on life after this intense week (i.e. Clean up, plan, write emails)
0 Hours so far accessed for above (but we have had some good family time, good food, and good sleep!).
I save the best for last:
5/12 The proportion of months that people have already pledged to cover for nutrition costs!!! Amazing. Another blog commenter says she’s pulling 32 people together to each give $50 . . . If she manages that will be half the year. Still holding out for six (or seven) more!!
Well, the good news is that I did my first day of rounds on the new ward and it was so lovely. Instead of 20 patients crammed into a 10 bed ward the size of most people’s living rooms . . . They were dispersed over a 25 bed ward, each with their own bed, mattress, shelf, plenty of air, light, windows . . . Of course the fact that this motherless child has lost 2 kg since graduating at age 1 from the nutrition program and is back in desperate shape, this baby’s Kwashiorkor is related to AIDS and a severe case of malaria to boot, this mother’s family is telling me there is no one to help her, etc. does not change. The world is still a broken place, but now at least those who are suffering the most severe effects have a clean place to lay their heads. We even turned on the generator power to run an oxygen concentrator for a child who arrived gasping her last breaths . . . Blue and weak, she probably has a congenital heart defect, but the oxygen staved off death this hour at least. We could not have done that on the old ward. I’m grateful.
The sad news is that the nutrition program is completely out of funding. We lost WFP food last year, and we were denied our UNICEF grant proposal this month. Stephanie rushed to get in another grant, but in the meantime Karen got milk on credit this week and we are struggling to feed about five seriously malnourished inpatient children as well as three premature babies. I know that churches and Sunday school groups, student fellowships, etc. often look for a worthy cause. So I had the idea that if we got 12 groups to cover particular months (one takes August, another takes February) then we could manage another year while we try to work on the more sustainable aspects of the program (seeds, milking goats, an agriculture extension worker) that we’ve applied for grants to fund.
$1600 a month covers:
Boxed Milk - $400 (Kwashiorkor and severe malnutrition)
Formula - $400 (prematures and initial care for motherless)
Breastfeeding Stipends - $400 (motherless)
Peanut Butter Paste and Misc - $400 (mostly for HIV+kids)
It’s a lot of money, but this budget helps about 50 kids/month at the cost of 1$/kid/day.
If anyone who reads this has a group that wants to commit to a month, let me know!
