Provision

Let us take a moment to be thankful, and to acknowledge the power of provision as a firm confirmation that we must persevere here. While the entire world scales back expectations, and struggles to navigate the thin ice over bankruptcy. . . God has moved many hearts to provide for the Kingdom advance in Bundibugyo. A paradox, for sure. We were tentative in our goat hopes this year, and would have been thrilled to fund 50 . . . but 117 were purchased through the Christmas Ornament Matiti Give-a-Goat fundraiser!! Lemmech will begin training new owners in February for the first allotment to go out in March. Amazing gifts have come in for Christ School, dramatic and generous answers to prayer, churches and individuals sacrificially putting money (that is no longer flowing so easily in America) into Ugandan education and discipleship. And a heartfelt salute to our own supporters, whose end-of-the-year outpouring of mercy carries us into 2009 with great hope. We've already been able to share the bounty with a boosted power supply for the lab fridge for blood banking, and with the nutrition office to computerize the goat database. Next on our list will be the non-glamorous but very-necessary addition of a new latrine for hospital staff housing. Dr. Jonah's children began their new year of school and our medical students continue in their studies thanks to your gifts. We are humbled and grateful to witness so many giving, not out of excess but in spite of your own financial losses, out of love.

And, equally amazingly . . .the Chief Administrative Officer has announced that an entire year's worth of government funds for health in the district have been "recovered" from the various departments which had "borrowed" them for other business. This is a huge answer to our anti-corruption prayers. Pray for this man, Elias, who faces not only opposition but no doubt also temptation to allow shadiness to continue. It takes much effort and courage to draw the line.

So both through donors and through the Ugandan government, God is pouring out His provisions in response to your prayers. Keep it up!

Disparity

A Ugandan woman in Gulu delivered premature sextuplets this week, after 4 months of hospitalized bed rest. And every one of them died. There was a newspaper story about her grief. She left the hospital with nothing to show for her love and effort.

Meanwhile the California octuplets make world headlines, having had 46 doctors and nurses attend their delivery, receiving state-of-the art intensive care, and all are so far alive.

The babies in both cases were similar sizes, 800 to 1000 grams. But California and Gulu are worlds apart. Regardless of who used what fertility drugs (the Ugandan woman denies, and the American might deny too) . . . the ethics of selective termination have overshadowed the more glaring ethical question of justice, of a world where one woman buries six and the other goes home with eight.

Congo: Responsibility to Protect

Alex Perry writes in TIME, about the current conflict in the DRC, the ever-shifting alliances, the impotence of the UN to stop the bloodshed:

It's also about what MONUC is. In addition to 3,000 extra troops, Doss persuaded the U.N. Security Council to expand MONUC's mandate to allow it to target the commercial drivers of the war: the trade in Congo's minerals, like gold, and the world's largest reserves of coltan, which is needed to make components for cell phones. He continues to argue for an even more muscular approach to enforcing peace. "When we make these statements, when we claim the responsibility to protect, we have to be careful that we have the means to match our mandate," he says. "You don't go to war with blue helmets and white tanks."

Talk of war is a long way from traditional peacekeeping. But it is a direct consequence of the open-ended nature of R2P, and it raises troubling questions. Where does the responsibility to protect end? Does it mean fighting a national army? Does it mean supplanting a national government? Does it mean accepting the large losses that would inevitably accompany intervention in Somalia--the site of the world's worst humanitarian crisis--or in totalitarian states like Burma? Doss insists there are limits to what he proposes. "We assist the national process. We do not replace it," he says. "We're not an army of occupation." But introducing a foreign combat force into Congo would cast doubt on whether such declarations are sincere.

Definitely thought-provoking.  Some of my patients come from across the border, severely malnourished, or having been subjected to dangerous traditional treatments.  Where does our responsibility to them begin, and end?

By Partnership, By Prayer

Partnership:  one of our themes for 2009, and tonight we expressed our team's desire to partner with the Christ School staff by inviting them to join us for dinner and games.  Scott impressed the men greatly with his grilled chicken, and everyone ate their fill of hot foods and local sauces, cold sodas and fresh bread.  We designed some ice breakers (find someone with more than ten siblings, someone who was born more than 100 km from the place his/her parents were born, someone who watched a football match this week) which set everyone at ease, and then played "bowl full of nouns", a great group party game that has everyone acting and laughing, slapping knees and protesting points.   Joanna Stewart would have been proud.  It was an evening of camaraderie, a respite in their week of intense preparation work, and indrawing of collective breath before the 350 students arrive on Monday.   As with our team, a foundation of trust upon which to build the year's work.  The Pierces have worked hard to set a tone of ownership and responsibility, integrity and planning.  And perhaps the best part of the evening for me, to see my kids participating, at ease with their teachers in a way that is hard to achieve in the school year.  

Prayer:  our other theme, and we will re-join the CSB staff Sunday night for a prayer walk around the school.  This will be a time to physically move from dorm to dorm, class to class, asking for God's protection and power to change lives.  We know that oppressive sexual relationships and abuse, witchcraft, bullying, fear and shame, alcohol dependance, manipulation and cheating, all plague CSB and other schools in Bundibugyo.  I treated a 500 gm (1 pound) 25 week (5 to 6 months) preemie born to a 14 year old primary school student this week . . not from Christ School, but a stark reminder of the tragic turns many students' lives can take, and the fatal results.  So prayer is needed; please join us (5 pm = 9 am East Coast time Sunday, perfect for Sunday Schools and early services!) in asking God to actively invade this school in 2009.

Covenant of Faith

Wednesdays, early morning prayer meetings, gathering in the darkness to sing and pray. We rotate responsibility for leading, so that every couple of months each team member receives the gift of an hour and a half of group prayer focused on their own heart and life.

Today was my turn, and as I happen to be in Nehemiah I took the prayer from chapter 9 as my theme. Appropriately, this prayer is offered post-retreat, after the people have enjoyed in chapter 8 a festival of rich foods and communal worship such as we just did. The priests lead in praising God for who He is, thanking Him for the amazing things He's done (and we had quite a list for January 09 already, evidence of God's work in many details of life from Ivan's PLE's to Arthur's birth to thousands of dollars of CSB support to even more generous giving to our own support account), and then a long confession of sin all cushioned with the reality of God's lavish mercy and unending patience. It is not until verse 32 that the requests begin to appear, the plea for God's deliverance. Likewise we then moved into praying this morning for my ministry in 2009 along the lines of our themes and emphases from our retreat, asking God to deepen our prayer life, to strengthen partnerships among team mates but also with groups like UNICEF and UNC, and to bring fruit from the investment in emerging leaders.

After the prayer, the people of Israel in Nehemiah 10 renew their covenant with God. At first glance the details seem legalistic: no inter-marriage of their children with the pagan tribes, keeping the Sabbath free from work, paying tithes, observing the year of jubilee. Dry rules? No. At a second look it hit me that this is a covenant of faith. Where does the rubber meet the road when we are on this journey? When we have to trust God with the things that are dear to us: children, survival, finances, success. The people of Israel could work seven days a week, cut corners, cement alliances with marriages, pursue wealth. OR they could trust God and make unpopular and costly choices. They opt for the latter, and I prayed this morning that we would do the same. That we would trust God with boarding schools and friendships, with test scores and sports, with health and thriving, with enough money to go on.

It is a covenant of faith, to dwell in this land only by the mercy of God.

And it was very good

Genesis 1 contains this refrain, which clamors to still echo in our hearts in spite of brokeness. God created this patch of earth upon which we live, and His work was good. Last night we conversed among ourselves as missionaries about having eyes to see the imprint of God's abundance and goodness as we view the world here, and today I sat with five young people talking about culture and belief and what they saw in their own traditions that was good, that they wanted to preserve. So this post is dedicated to testifying to the deep and original goodness of Bundibugyo.

From outside, looking in: jagged mountain views in the clear morning, fertile soil, community spirit, genuine joy in relationship, assuming that visitors are a blessing and that work should be shared, the privilege of being called into the work of responsibly managing the earth's resources, the precious value of children, the generations of skill in keeping goats (yes, a phone conversation with an agricultural missionary yesterday reminded me of his informed opinion that the people of Bundibugyo are very good at this!).

From inside, looking out: circumcision ( a healthy and community- binding cultural practice), respect for elders, the investment of elders in advising younger people, bride-price (the way this values women).

Let us look around us this week with Genesis 1 eyes, to see the goodness.

On Night Screams and Psychologic Conundrums

We finished dinner last night in the lovely glow of candlelight, abundance, fellowship and thankfulness, Bethany with us for her last night in Bundibugyo (for a while) and the Pierce family having just returned from a CSB leadership team weekend retreat. We sat around the table still lingering over fresh chocolate chip cookies (team care packages! Yeah!!) and fresh milk, hearing about the way the CSB teachers are gelling into a great team for the beginning of a new year. Suddenly we heard commotion, cries, screams from not far away. Scott and I went outside with flashlights to see if our neighbors were OK, as the noise grew into a wail. "Someone has died", Scott commented, but as we walked in the absolute darkness out our driveway to investigate, the disorderly sounds of riot approached us. It was one of our neighbor-friends, carrying a 13 year old limp and apparently lifeless boy, supporting his hysterical grieving mother and trailing no less than 20 relatives and onlookers from babies to grandmothers, all shouting and mourning and working themselves into a frenzy. I reached for a pulse and determined the boy was alive, spread him on the floor of the kitubbi and opened his airway for breathing while Scott scolded the mob into order with the assurance that he was not dead, yet. When they were able to calm down slightly they said he had been well all day, eaten and played, but suddenly a fever "caught" him and he collapsed, and convulsed. Clearly his mother, whom we know well, was completely convinced that he was dead when they came running to us, and her anguish was real and raw. He felt cool, maybe clammy, not febrile, no increased pulse rate, no findings on exam except being unresponsive to voice or touch. They denied any trauma or ingestions of poisons . . . sometimes the initial rigor of malaria can be accompanied by a seizure before the temperature climbs, so we injected him with a strong anti-malarial and Scott drove the entire entourage down the the hospital for admission on an IV. He did not react to multiple needle sticks . . . but a couple of hours later his father reported he was awake and sitting and acting normal. It turns out he had been in town watching a video against his parents' permission, and when he came home he was "punished". No signs of abuse, and no story from him even this morning.

So what happened? A drama to get out of trouble? I don't think it is that straightforward. Interestingly there were two pre-adolescent boys admitted last night with similar stories. A learned response to stress? It seems similar to the way women cope, the collapse, the breakdown, the outpouring of community emotion, the wave of concern that carries the group to the hospital, then the mysterious complete resolution. I think that it is 99% subconscious, an ingrained cultural pattern. Except for the heartbreaking moments for his mother, and the inconvenience to us, the possible waste of a dose of medicine . . it was a way to diffuse the family tension over his behaviour, and all's well that ends well. The nurses and I gave him Aunt-like advice on not repeating this episode, and he went home.

We all long for the assurance that we are loved, that we belong. Perhaps if we told each other in the daylight, the night screams would not be necessary.

Starbucks, Bundibugyo

Two former team mates (three cheers for Amy and Stephanie) sent
amazing coffee this week. Yes, we live in the land of cocoa and
coffee trees, but NOT the land of chocolate factories or processing
plants, so a bag of really nice roasted Starbucks is still a treat.
This coincided with the first batch of fresh milk from our cow.
Combination of fine coffee, fresh hot frothed whole milk, and the over-
the-year-and-miles friendship of Bethany sitting in our kitchen
Saturday morning . . a taste of Heaven. Even here.

all in a day's work

Sending home a little 7 year old sickle cell disease patient who presented extremely ill, unstable, septic a few days ago, but now is walking out on his own, the wonders of IV antibiotics. I've been caring for Aligonila since he was born, struggled many times in his early years to get him knick-of-time lifesaving transfusions, and sat with his mother's tears when her other child with sickle cell was brought in dead from his grandparents where he had been staying. This family is the same one supporting little Lydia whose burns are healing. . . soft-spoken and genuinely concerned father who numbs his burdens with alcohol . . . this is a taste of small town family medicine, the continuity over time and the spread of relationship over a complex web of consanguinity.

Staff meeting topic of the day: teeth, their normal pattern of erruption, the basics of preventive hygiene and care. It is a topic I want to focus on for a while, because of the insidious and destructive belief that "bhino", a bad or false tooth, in an infant's gum is the source of diarrheal disease and removal by razor blade incision can cure. In fact, the removal often leads to death as the baby stops drinking or the wound becomes infected. Rousing discussion from the staff in which it became clear to me: these people are not REALLY convinced themselves that the "bhino" hoax is wrong. There is lingering doubt in their minds. They would prefer to get the gums cut and then inject the baby with penicillin. Cover all the bases, witchcraft and science. If the staff are ambivalent, no wonder the villagers take their babies to ritual specialists for this dangerous procedure! I try to affirm the underlying good of this culture's value on children, of their desire to do what it takes to cure . . while suggesting that culture constantly changes and there are choices involved in what we embrace and reject. The intersection of medicine and anthropology always interests me, the connection between behaviour and health, between belief and action.

Last inpatient of the morning: a premature baby who in six weeks has held onto life and climbed from just over 1 kg (2.2 pounds) to a whopping 2.08 kg today (4 1/2 pounds). I realize her teenage mother's entire experience of parenthood has been in that hospital bed, she is gigglingly happy for the victory but intimidated to leave our care and be discharged. Last outpatient: a 2 year old with the tiniest head I've ever seen, almost no substance above the eyebrow line, blind and deaf and spastic, but with a matching suit of clothes and healthy skin, evidence of a mother's careful sacrifice month after month. I'm humbled by her perseverance, though unable to offer much more than seizure control and vitamins. Last kitubbi-at-home patient of the day: a two month old with a heart rate almost too fast to count, 260-300 beats a minute, whom we've treated for a few days in the hospital for infection or dehydration. But this baby looks and acts well, it is just a rollicking heart that can't hold out like that forever. So we bring him home where I have a fridge, fill a bag with ice water, and while Heidi monitors his heart with a stethoscope I basically smother him with a freezing damp face pack. He holds his breath and the newborn diving reflex kicks in, breaking the gallop down to a reasonable trot of 150 beats/minute. I don't want parents to trust tooth-extracting witch doctors, but I do want this mother to let me apparently suffocate her baby . . .

Scott comes back from Bundibugyo town with packages galore for the team, Nathan's mom and my mom, Stephanie Jilcott and friends of the Massos and Pierces and Heidi, a delayed Christmas. And he brings Ivan's PLE scores, division 1, which puts him in the top 5% in the nation this past year. We are thrilled for him.

On to pizza preparation and team meeting as a surprise rain soaks the ground, cleaning and catching up with correspondence. All in a day's work.

red rover, red rover...

Scott here.

Wednesdays are crazy days at Nyahuka Health Center. I spend the morning conducting an ultrasound clinic adjacent to the HIV Care and Treatment Clinic. I see a variety of obstetric, gynecologic and pediatric cases. But, mostly I am there hoping to catch HIV+ women in for routine HIV care so I can quickly scan to confirm their dates, do some continuing education about their pregnancy/HIV issues, and try to build bonds of trust with the medical establishment. Today, one of our HIV+ moms was in the "walking around stage" (active labor), but the midwife on duty (Judith) was concerned about the baby's position. Indeed, her scan showed the baby was breech and still very high in the uterus. Judith was not comfortable delivering her at Nyahuka and asked if I could take her to the hospital so that emergency surgery might be available if necessary.

"Fine, no problem. How, many centimeters dilated is she?" "Ten centimeters, doctor (fully dilated--7th baby)". "Judith, she's going to deliver in my truck on that bumpy road!!" (No response. Awkward silence.) "OK, Judith. I'll take her. Get her stuff and her people ready."

Ten minutes later, the patient and her belongings appear at my red LandRover with their pots, pans, mattress, etc.. And Judith. "Doctor, I am going to come with you just to make sure she's OK."

So, we proceed, bumping, jolting, groaning over the twelve kilometers of undulating road which appears more like a rutted, rocky riverbed than a road. One hundred meters from the hospital the passengers in the back bang on the glass. "Slow down." "Is she ready to deliver?" "Yes." "Then shouldn't we speed up?"

We pull into the hospital parking lot and I hop out. The baby's hips are out. Judith applying traction gently, expertly. In typical fashion the crowd gathers, gawking, staring without one bit of respect for the fact that this woman is totally exposed in the back of my truck. I move the truck trying to position it to protect the patient. No time to move the mom. A few minutes and the baby is out.

"Webale Kwejuna" (thank you for surviving). "Webale kusabe" (thank you for praying).

One more thing.... it was a boy. Baby Obama.

We turn around and go back to Nyahuka Health Center, the baby receives his medicine to prevent HIV transmission from his mom... and the mom walks home.

(Note: cell phone photos...apologies to the shy).