Ebola Hero admitted to Medical School

On December 16, 2007 we lauded several heroes of the Ebola response in
our blog, one of which was the Clinical Officer who spearheaded the
response at the very epicenter of the epidemic, Julius Monday. He
fearlessly put himself in harm's way for the good of his patients all
the while managing not to contract the dreaded disease himself. In
the midst of The Plague he chose not to run but to care for the sick
and the dying, both before and after he knew the lethal identity of
the viral agent. His clinical acumen, compassion, and endurance
caught our attention and after the epidemic was over we publically
promised (at the District Ebola-Free Celebration) that if he could
garner an admission letter to one of either of the top two medical
schools in the country (Makerere or Mbarrara) that we would privately
sponsor him through the newly established Jonah Kule Memorial
Leadership Fund.

Well, by God's grace that day arrived today. Julius called me from
Mbarrara with his Medical School Admission letter in hand- jubilant
and thankful. "Thanks, thanks, thanks Doctor Scott for your prayers!"

It is a long road he faces. Five years to complete the degree and
then another year of internship. Six years is a long time. It's
still a struggle to face the travel on this road without Jonah, but
Julius is one of the sprouts that we see coming to life from the death
of Jonah's grain of wheat. I look forward to seeing the heavenly
accounting: the lives saved, the suffering snuffed, the compassion
extended by Julius Monday in the memory of our colleague and friend.

Please pray for Julius Monday.

Paradox Tuesday

The two smiling, thriving girls whose malnutrition had been cured went home today.  Both had been transformed from stick-figures to plumpness, from lethargy to life.

But two others died.  Including Mackline, the pitiful orphan who came too far too late.  Her first sips of milk and ORS threw off her precarious balance, and the life drained out of her.  The other death was of an infant with AIDS--though he had tested negative a few months ago, and his mother weaned him, he must have become infected in the last month, and he dwindled to death in the short course of a week, in spite of IV antibiotics, fluids, and milk.

While the two celebrants packed their belongings to return home from their weeks of hospitalization, Mackline's aunt wept lonely tears as the staff helped her bundle her things for her trek.  And that is the way the battlefront looks.  Victories and defeats mingling together, from bed to bed.  Birungi Suizen came to greet us all today: a whopping 10.8 kg (he used to weigh 5!), he is actually getting close to being a within-normal weight for his age.  But as we passed him around, digging up candy from pockets and teasing him, smiling, remembering the miracle of his life, another patient returned, the withered premature infant of a 15-year-old mother, 1.45 kg.  Will he look like Birungi Suizen one day?  Seems doubtful.

The two deaths made me review our records:  58 admissions for nutrition in the last two months.  6 deaths.  About 10%.  Of those six, four died within the first day, all children who came from distant reaches of the district, too late.  The other two were born to mothers with AIDS.  So do we need more case-finding outreach?  Better initial stabilization?  Is 10% the devil's toll, the inevitable margin of loss?  Much of me rebels against that defeatism, but I admit to feeling that way at the moment.  There is great value in professionalism (doing the best we can with our resources, first do no harm, and all that), but we as doctors, and as westerners, can also live with the delusion of being able to save everyone.

So, as always, walking the paradox.  Rejoicing with those who rejoice, weeping with those who weep, examining my own heart to know if I have been negligent, fearful of what I might find, weary of the war.

In celebration of provision

Scott unloaded the UNICEF boxes over the weekend, so these stacks
greeted me when I opened my medicine store today. I quickly unloaded
the new scale and length board and set to work measuring everyone on
the ward. After rounds I got all the boxes onto shelves, since they
can't be stored in contact with the floor. The disbursement we were
sent almost perfectly fills the store room--I remember when Scott
built it that I was thinking it was way too big to be of use, but God knew that
we would need the space. Just like He knew we'd need the food for the
continuing arrivals of the desperate. Today's newest patient:
Mackline, not yet a year old, whose mother died in a village on the
other side of the mountains (2 hours' DRIVE from here) and who then
ended up in the care of a great aunt in Ntandi (more than ONE HOUR
drive away). She is more than three standard deviations below normal
weight, and a good portion of that is the edema fluid that has
accumulated in her protein-deficient tissues.

Some of the packets spent only a matter of minutes in the store before
going right back out to feed the hungry. Week before last (Faces of
Hunger and Healing, July 16) I posted pictures of children who were
cured, and at the bottom of the list an anxious girl clinging to her
mom, and a hungry little girl holding her red cup. Those two should
be discharged within a week, the first now smiles and laughs and
greets me, the second is up from just over six kilos to NINE today!

From the hospital I biked straight up to Karen's for our semi-monthly
nutrition team meeting. As Karen prepares for Sudan, she is getting
all the accounting in ship shape to hand over to Sarah while we wait
for more team help. Sarah majored in economics, and with Luke going
to boarding school and Acacia to Sudan, half of her teaching time is
being freed up. We were all relieved when she volunteered to step
into Karen's role tracking and distributing the $65 thousand a year
that flows through BundiNutrition into four major areas: direct
purchase of food for the malnourished, dairy goats for milk for babies
whose mothers have died or who are HIV-infected, the chicken coop for
eggs and demonstration garden for fodder, and the salaries of the
three extension workers who manage the nitty gritty of all this.
These funds come from you, our friends, people who organize their
friends to buy goats or who decide to invest in the Kingdom by
providing food for the least of these. Every month about 150 kids get
some kind of help: nutritious eggs and beans or gnut/soy paste, goat's
milk, in addition to the UNICEF food. Some are HIV-infected, others
are orphans, some have mothers who are unable to manage, all are in
need of a boost to cling to life. That's 150 families who directly
experience the provision of God, and many more who are related to
those and see what is happening.

And amazingly, if all pledged funds come in, we should have exactly
what we need. Just like the store being exactly the right size. This
week one of our donors wrote that God moved her to give a bit above
her pledge, and a few months early . . . Over and over we see evidence
that it is God who cares for these children, and God who provides, who
anticipates the next Mackline and makes sure that there is milk. We
merely watch on the sidelines and give you commentary so that you can
also rejoice.

Re-Creating

The root of the word recreation is to become re-created, to have that
breath of life re-breathed into the soul. For me, that is facilitated
by the isolation and beauty of nature. It did not take much
convincing to get the four single WHM women to join a 24-hour camp-out
in the rainforest this weekend. We piled our gear in Pat's car Friday
afternoon and headed for the Ituri Rainforest, set up in a clearing in
the woods, grilled vegetables and marinated chicken, told stories
around a blazing campfire (and learned Larissa is a bit of a
pyromaniac), and scurried for the shelter of an old Myhre family tent
(which we had to resurrect with pirated poles) when lightening and
wind threatened a storm. In spite of the rest of the district's
drenching we slept peacefully dry! Saturday morning we hiked through
the boggy forest. As usual most of the animal life was jumping
through the canopy: five different species of monkeys on our hike,
plus a few squirrels and rare birds. Closer to the ground we saw only
prints in the mud: sitatunga, bush pig, forest elephant, buffalo,
baboon. The hike took us by two hot springs, sulfurous steaming
moonscapes where boiling water bubbles through the crust of the
earth. Our guide told us that the local people used to sacrifice
children there to thank the gods of the springs for the salt they
collected. A stark reminder of the grip that fear and evil have held
on this place that we love, Bundibugyo.

By mid-day Saturday we were back to real life, including a brisk trek
through the Nyahuka river to reach the family home of a nurse friend
whose father had died. The burial was over but we found the family
still sitting exhausted on dried banana leaves scattered on the mud
floor of their house. . . . I went because I remembered how much I
appreciated the many, many friends who supported my family when my
father died. The situation was a bit similar, with Rose being the
oldest, the medical daughter, who helped take care, but in her case a
stroke had debilitated her father for many years. Like us there was a
mixture of relief that her father's suffering had ended, with the
sadness of missing him.

Last but not least, the highlight of the weekend for the Myhre
kids . . . every Sunday afternoon we play a little game of family
soccer for about an hour or so in the yard. This year we've had the
tremendous advantage of Miss Ashley's skill and Miss Sarah's efforts,
so that when we play adults vs. kids it is a pretty even match. Scott
treated us all to team jerseys his last trip to Kampala, so the final
photo shows us post-game, a bit muddy and sweaty but definitely re-
created!

Accounting Heroes

Do you know who blew the story that King Leopold of Belgium had turned Congo into a personal kingdom run by slavery?  An accountant.  A clerk at the shipping docks added up what went out to Congo, and what came in to Belgium, and concluded that the balance was not in Congo’s favor.  This led to the awareness by the rest of the world that rubber was being obtained by drastic measures (including cutting off the hands of those who did not tap enough trees).  

So accountants can be heroes, particularly in the world of aid, of missions, of development.  This post is a small tribute to some of those heroes.  Jerry and Dwight in our Sending Center.  Scott, David, and Karen, who manage tens of thousands of dollars each, carefully planning, tracking, submitting receipts, being responsible for Kwejuna project, CSB, and BundiNutrition.  Michael, at least we hope soon, handling money for development in Mundri, Sudan.  And Scott again, because all the miscellaneous and sundry needs of team and widows and projects and orphans pass through his hands.  All of these people do lots of other things too, but their non-glamorous desk time may be the most important.

Where are the brave accountants, the careful people who are patient enough to sit at a computer or use a calculator, to save the world?

On weeping, waiting, and hope

Read the following list of woes and guess where in earth it is referring to:  loss of land to foreigners, scarcity of drinking water and firewood, forced labor, bad government, famine, widespread rape, slavery, proliferation of orphans and widows, breakdown of community life. Sounds a bit like Africa, particularly the immediate areas around us in Eastern Congo, Sudan, Rwanda . . . But it is actually straight out of Lamentations chapter 5, a description of the fall of Jerusalem.  In the face of that destruction Jeremiah weeps and waits, for hope.

It’s been a weeping and waiting kind of week here, actually a weeping and waiting kind of life. And usually I think I’m waiting for solutions, for answers, for change.  But Lamentations says we are waiting for hope.  Waiting for a glimmer of God’s presence.  Because that is what we really need, even though I think we need much “more” which is actually much less.  Like food for the hungry and justice for the poor and rest for the missionaries . . .

Pray that in the spurts of relief and answers we would not be satisfied with less than God Himself.  Pray that hope would come.  Here are some glimpses of it this week:

• Right now Scott has a truck full of UNICEF supplies, heading back from Bundibugyo.  It was touch and go.  He went to their office in Kampala which seemed to trigger the release of the goods, but they were sent via a UNICEF driver to Bundibugyo and mistakenly off-loaded at a district store.  By the time we traced them we worried that we would never see them again . . .but all is well.  A major answer to prayer.  The most severely malnourished inpatients will be drinking this milk powder for months to come.
• Thanks to vision from Michael, persistence from David, and footwork from Kasereka, CSB was able to obtain three UNICEF water tanks that were donated to the district for school use.  These are worth many thousands of dollars, freeing other CSB funds for the many other needs of the school.  Amazing.
• A friend from UVA days is funding the salaries of the three nutrition extension workers for three years.  Wow.  This allows our ongoing donations to go for food, and allows the sustainable parts of the program (chickens producing eggs, goats producing milk and more goats, gardens producing food) to be built and secured.  We are so grateful.
  

Many days, like Jeremiah, I feel that this calling is too much, that we are “caught between a difficult God and the service of His impossible people” (loosely quoting from the Card book).  Then we get generous friends and amazing supplies from unexpected places, and it is a brief parting of the clouds to keep us moving forward.  Weeping we wait, and hope does arrive.

Cooking class and Dr. Seuss socks

It’s only Tuesday . . . But Monday was a week in itself.  I walked in the ward, early, alone (well, no staff, but not really alone).  As I read through the nurse reports I realized that baby Precious had died during the night.  I heard people referring to her as “Precious” so I’m glad her name defined her in her very short life.  I was then almost finished with weighing all the patients when a father rushed up at the end of the line to put his 3-ish year old daughter on the scale.  He was sweating, having carried her from a village quite a few miles of steep paths away.   As soon as he unwrapped her still form for weighing, Larissa and I whisked her into the treatment room.  In his hurry and distress he had not realized that she died somewhere along the way.  She had no heartbeat, not even a flutter of breath, fixed glassy eyes, cold skin.  Women wail in a very scripted way, and their mourning I have come to expect and predict.  But this young dad had rushed so earnestly that he arrived a good 20 minutes ahead of the rest of the clan, so when I told him his daughter was dead he was stunned and alone, and his spontaneous tears really got to my heart.  By this morning three more kids had died, all with a final pathway of anemia.  We are still struggling to keep up with the blood supply (which is why I welcomed the recent blood drive at Christ School!).  I find myself sometimes hesitating, not wanting to care too deeply about yet another frail fragment of humanity that is so easily lost.

And that’s why today’s nutrition clinic was particularly encouraging.  When I finished inpatient rounds I went around the corner of the ward to the porch where we distribute outpatient food to help Pat, who is filling in for Heidi while still doing most of what she usually does.  Pat was there, but all eyes were on the cooking demonstration being led by a young man we just hired to help with BundiNutrition.  Charles Baguma just completed a degree in social work at Makerere, which makes him part of an elite cadre of University-graduate Babwisi.  But there he was with his pans and spoons and the riveted attention of 20-some grandmothers and caretakers.  Thanks to his interning with Scotticus, he was ready to teach them.  He showed them how to mix the gnut/soy paste with cooked matoke to form a nutritious mash.  Then he made everyone go wash their hands and took spoonfuls around the crowd, for each kid.  What fun to see little Mariam munching away on the protein!  And my morning was complete when one of the two great-grandmothers who are breastfeeding their orphaned great-grandsons returned.  Baluku was barely over 2 kilograms a few weeks ago, and is now close to 4.  But what really made me smile was the fact that he was wearing the most glaring purple and green striped pom-pommed socks which came up to his thighs, an accessory straight out of a Dr. Seuss book, and NOTHING ELSE.

This lions are quarreling

“And we are just here in the grass.”  That was how my neighbor described the atmosphere in Bundibugyo District.  The civil servants, those nurses, teachers, accountants and administrators, who depend upon government-issued salaries, are on edge.  They do not want to take sides in the major political strife that is occurring, because they are not quite sure which side will emerge victorious.  And this is not about which side is right, at least not for them.  It is about survival.  Corruption is assumed to be rampant, truth is assumed to be elusive, success in life is assumed to be tied to patronage, so the path of wisdom is to lay low in the grass until the lions achieve some truce.

I’ve been reflecting on the role of the outsider, people like us, in this place.  More and more I see that a major aspect is that we ARE outsiders. Yes, we try to learn the language, to achieve acceptance, to work within, to build relationships.  But our other-ness carries a measure of safety and a measure of power for change.  My life does not depend upon which of the lions dominates the other.  My income does not depend upon staying in the good graces of the governing political party.  My relationships don’t carry any weight of bribes asked or owed.  

That independence sets us apart. It means the school can fire teachers who abuse female students, even if that teacher would happen to be related to a man of power.  It means that our nutrition programs hand out food to children who are marginalized and malnourished, not to those who are relatives of the health workers. It means that we can speak against injustice without fearing a curse.  For some, it means we can be trusted.  For others, it means we can be dangerous, because we are harder to manipulate.

Last week I was filled with indignation, I won’t say holy indignation, because I now my anger does not carry the fully righteous mix of truth and compassion that it should.  But I was confronted with two-year-old child who had become progressively lame, with a gibbus back, probably due to spinal TB, a treatable condition.  I had arranged for transport from our own donors (equivalent to about a month’s salary here) to get her to a decent hospital for neurosurgical evaluation.  I asked her mother to call her father to come in and contribute some token amount, for a meal along the way, so that he would also own the decision to seek care.  He was a relatively well-off man with three wives and a fish-trading business.  He refused to give his wife and child a single shilling, telling me that he had nothing.  As confidently as I could in Lubwisi I cautioned him that God sees his heart and actions and cares about the life of even this child.  And I advised the mother to seek support from her brothers if her husband refused to help.  She requested discharge and a few days later came back with her brother and her own savings to embark upon the journey towards healing her child.  But interestingly, even though she was going with her brother, her husband was there to see her off.  I think he had begun to doubt his refusal to help.

It is anti-cultural to put the power of money and motion into the hands of a woman when her husband is not in agreement.  Was this wrong?  I hope not.  I hope it was an example of the way the Gospel frees.  I hope it was a small stand to show the mother of this child that she was a valuable person who could act to help her child.  Certainly Jesus was not intimidated by the religious establishment of his day, which made him a dangerous person too.  But I am very , very aware that I am not Jesus, and all of my struggles for justice are tainted by pride, by a judgmental heart, by incomplete understanding of the real story.  I can only pray that while the lions quarrel, we can give a hand up to some of those cowering in the grass.

Prayer Requests for the Team

“Arise, cry out in the night, at the beginning of the watches;
Pour out your heart like water before the face of the Lord.
Lift your hands toward Him for the life of your young children
Who faint from hunger at the head of every street.”   Lam 2:19

Jeremiah wrote these words watching the suffering of Jerusalem at the hands of invaders.  Scott has been leading our team in a study of lament, which challenges us to cling to God.  As we also bear witness to the harrowing effects of sin and sorrow, we invite you to cry out in prayer, to pour your heart before the Lord.

1. For the life of children.  Would you pray specifically for Christ School, as we near the end of the second term?  We all knew it would be a rough summer with the transition in leadership, and we praise God that the riots which erupted this time last year were avoided, that in spite of a major theft, struggles with the food service, shortfalls in funding, and student suspensions for misconduct . . .the Pierces have weathered their inaugural term with grace, vision, and even a spark of humor.  Please pray specifically for the staff and missionaries to have wisdom to teach and model godly sexuality.  When you take over 300 pubertal human beings emerging from a culture where sex is viewed as a commodity for transaction and an essential component of normal body function . . . Well, we realize that the spiritual beauty of the creation of humans as male and female, and the spiritual safety of the placement of sexual relationship within the commitment of marriage, is lacking in these students’ minds and actions.  This has become starkly apparent this week as we cared for a girl who nearly bled to death, possibly from a botched abortion.  Pray for their lives.
2. Who faint from hunger.  The pediatric ward has been running at 150% of capacity for most of the summer.  Rising food prices, unreliable weather patterns, dissolving family safety nets, increasing awareness of the hope of help . . All have brought many more desperate children to our attention that we have the resources to care for.  Praise God that the team of former missionary Scotticus, summer interns, and Ugandan university students conducted an illuminating evaluation of the BundiNutrition programs which confirms the wisdom of expanding the use of locally produced peanut/soy paste that Stephanie pioneered.  We distributed another batch of Matiti project goats (organized by Karen), and another round of supplementary food to HIV-positive women and children (still funded by Pamela’s advocacy, in absentia).  PLEASE PRAY that UNICEF would confirm their commitment to provide milk-based therapeutic food by signing their agreement and sending our next shipment THIS WEEK.  Pray for Heidi, my right hand help and friend on the front lines, who has to spend two months’ “internship” in Kampala for her nursing license, and for me to persevere, to see the fainting revive and live.
3. At the head of every street.  Bundibugyo is more of a maze of paths than a grid of streets.  And the political system reflects that obscurity, with funds and accountability being hidden behind twists and turns.  Yet your prayers are beginning to shake things up.  In the last two weeks, a crisis has boiled over, pitting one seemingly “good guy”  against some entrenched local corrupt politicians. Three fairly influential and notoriously dishonest civil servants were “interdicted” (fired) this week.  Would you please KEEP PRAYING FOR JUSTICE to prevail?  For the Lord to hear the cries of the hungry and remove from power those who embezzle their aid?  For a true turning to the Lord in the hearts of the people, so that they rely on God and not on stealing for their security?  Your prayers have the power to bring about real change in Bundibugyo.
4. Pour out your heart.  The season of sorrowful goodbyes cycles around again, as Katie, Jesse, and Nick finish their internship and depart tomorrow with their leader Kim.  The Massos have tentatively scheduled their long-anticipated (but I admit serious denial in my own heart) departure for Sudan in the beginning of October.  And very close to home, Luke will enter Rift Valley Academy’s 11th grade class the first of September, our oldest off to boarding school.  The waves of grief are building once again.  Pray for hope, for the daily assurance that God leads and loves even in loss.  We had hoped for another couple (the Clarks) and two more single guys (Jason and Nathan) to be here by now, picking up some of the threads that will be left dangling as our team fabric is torn with these departures as well as the others over this year.  Pray for their support to come in God’s timing, and for us to recognize mercy in the apparent delay.
   

Thank you for being our watchers, those who cry out in the darkness and strain to see the dawn.  We know that your prayers are moving in the lives of students, hungry families, politicians and team members.  

Precious, not pictured

I was asked to name a baby today.  Her weary mom seemed out of ideas on her 9th child.  Or perhaps she did not want to bind herself too closely to this tiny and deformed little girl.   I had been called by the midwives to examine the baby, and found a full term but very small baby with a cleft lip and palate, missing skin on the back of her scalp, a small extra sixth finger on each hand, and a huge omphalocele, which means that her bowels protruded in a sac of membrane extruding with her freshly cut umbilical cord.  This is a classic combination for the highly lethal Trisomy 13.  In a rural African health center, what can we do for her?  Cover the gaping abdomen, keep her warm, and offer milk.  Not much more than that.  Though I debated taking the same aggressive referral risks that saved the little girl Kabajungu in the picture below, I decided not to send this baby anywhere.  Her prognosis with full Western medical care is a 50% mortality rate within the first month of life.  So who am I really helping if I push the family to take a long and uncomfortable journey to an unfamiliar place, to struggle in a dysfunctional medical system, and probably return empty-handed?  Still, it is hard to make the decision to pursue comfort and palliation and not surgical correction.  I feel the heaviness, the gravity of such a decision, and the draining tiredness of having to make it.  I’d rather not.

When I was filling out her admission forms and asked the mother for a name, and she told me to choose one, I thought for only a few seconds. Precious.  My Lubwisi falters on matters of the heart, so I called a nurse to help me explain that the name symbolizes that this little girl, even with all her problems, is precious in the eyes of God, whether she lives a few hours, days, months, or decades.  The testimony of friends from Chicago whose son Micah died of lethal congenital anomalies the day he was born came to my mind:  from the perspective of eternity, a life of 7 hours and a life of 70 years are the same, both immeasurably short, and both infinitely precious, worth the attention and love and sacrifice of God.

And while part of me would like to take a photo of Precious for scientific purposes, I decided that on this post she should not be pictured.  Because her earthly body at this moment is a very distorted picture of the eternal reality of who she is, of what she will look like when she is made whole.  The privilege of watching bodies become whole is one of the greatest ones I have experienced here, but this time I will have to wait for Heaven.