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Monday, January 15, 2007

Signs and Redemption

Ten year ago, in 1997, Heather Pike ran out of her house in the predawn chaos of gunfire and joined our family, Rick Gray, and Greg and Beth Farrand (along with two newly-arrived summer premed student interns) as we ran for our lives. That flight into the unknown came very near to the planned end of Heather’s term. We made our way to Kampala and later to the US together. The bonds forged by shared work and shared danger lasted through the decade as Heather worked in the US, and we continued in Bundibugyo. She was able to return for a visit once, and say a more satisfying goodbye. I remember clearly that as she visited our home we sat in the kitubbi under one of the most spectacular rainbows ever seen, and marveled together at this sign of God’s good intentions, of hope, of redemption of evil.

On Saturday Heather was married to Paul Agnello. We sang “Come thou Fount of Every Blessing” in the ceremony, then the guests and wedding party proceeded to the reception, where another rainbow sparkled as an Ebeneezer of where Heather had come by God’s grace. Yes, a rainbow, in balmy un-January weather. And even more amazing, after all those years and disparate directions, all of the team who ran together came back to celebrate the day (including Jack who was an embryo back then . . .). And not only those ten, but twice that many as subsequent teachers and team members also came. It was quite a reunion, a real party of shared memories and good food and carefree dancing. One of the ways God redeems our struggle is to bring us into true community, the kind of community that only arises from suffering, from passing through the deep waters to the place of whirling under the rainbow of God’s redeeming smile. What fun to be there with Heather.

Tuesday, January 09, 2007

On the Road (Almost)

In a few hours we need to be prepared to pull out of here, to begin our trek to the US.  8 hours on the road trip, then two 9-10 ish hour flights, all back to back to arrive 3 pm EST Thursday, (which is actually 8 hours longer than it looks . . ).  Meanwhile these are full days, with Scott working very hard to tie up all project loose ends (including tedious reports which require him to sift through obscure hospital records) and me trying to settle patients and students and friends and visitors and team.  By God’s grace we have had a great visit with one of the WHM Board members Dr. Randy Bond and his son Ian.  Both yesterday and today he accompanied me to chaotic rounds at the hospital where one patient died as we were there and a second may not survive meningitis . . Then hours of hiking up to an isolated village to weigh and measure children with Stephanie Jillcott and Scott Ickes as part of a 900 kid nutrition survey, then back to another larger settlement (former IDP camp) where Stephanie had arranged a drama troupe to dance and act out a lively soap-opera like drama that did an excellent job of nutrition education.  Today Karen brought together the 40 -some motherless infants whom we help support with milk, then there was seeing more patients, and Dr. Randy taught a half-day seminar for the health center staff.  In short, not the kind of schedule that is conducive to thoughtful packing or house-cleaning.  The Bible has a lot to say about being pilgrims and strangers on the earth.  As much as I like to be on the move, I struggle with the disorienting effects of packing and goodbyes.  Please take a moment if you can to pray for us to be gracious and full of faith, to leave lovingly and enter the US ready to minister to our families and to you all.  Pray that in all the chaos we would be in touch with the Spirit.

On Saturday we will have the great joy of witnessing the marriage of Heather Pike, who taught our kids here ten years ago.  Many reunions await us with my mom, Scott’s parents, my sister and niece, other friends in the next week.  So in that way traveling is a little like death—some pain and stress here in order to leave, but loved ones and good times promised on the other side.  Next post from America!

Sunday, January 07, 2007

Bringing in the New Year at Nyahuka Health Center

Today we spent largely at the end-of-2006-beginning-of-2007 first annual Nyahuka Health Center Staff Party. This event was Jonah’s idea, and since it fell on this particular day we asked our visiting board member Dr. Randy Bond and his son Ian to accompany us. Like most parties, it started hours later than scheduled (we were savvy enough to call ahead, but na├»ve enough to believe it when we were told “come now, the party is in full swing” . . . Only to find we were the only guests who had arrived!). Like most parties, it involved formalities of seating arrangements, agenda, prayers, speeches, acknowledgements. We were seated right up front at lace-covered table with artificial flowers, facing the staff who sat on benches, and we were assigned a speech each. Even Dr. Randy, who did not appear on the agenda, did not escape, as Jonah insisted he address us.

But unlike most parties this one turned out to be an unexpected gift of encouragement. First, at Jonah’s request we allowed them to use the new nearly-finished pediatric ward for the event, a pristine, freshly painted, spacious building with probably the nicest tile floor west of the Rwenzoris. The setting leant an air of celebration and accomplishment. Second, Jonah’s presence was a source of universal thankfulness and rejoicing. He began his introductions by calling the whole staff his “partners”, and he gave glory to God. Third, almost every person who spoke (about a half-dozen staff representing various departments) thanked us as a mission for the support we give to the health center, for medicines, for sponsoring students, for bringing Jonah, for the new building, for caring about them. One person in particular made me feel that the hours spent daily in the drudge of wading through patients and needs, the battles in prayer for justice, the long slow progress of being part of their lives, meant something to the staff.

So when it came to my turn to speak, I got emotional. Because sitting there I had a little view of my life, and how these people who had come together to wear their nicest Christmas clothes and listen to blaring pop music and munch charred meat and cabbage, these people have become my friends. Dr. Bond our visitor, I thought, has saved so many more lives, he’s an academic pediatrician at one of America’s top institutions, and has a position he uses for great good. When I’m around that I wonder what other directions our life could have taken. But today I felt content that in this obscure corner of the globe, among these people whom nobody outside of a thirty-mile radius even knows exist, we’ve simply come and lived and served and persevered by God’s grace. Nothing so great, just years of struggle, and the improbable but real sense that we have been in the struggle together. For at least today I felt the depth of the privilege of having lived these years here. The glow of that fellowship will evaporate in the press of patients tomorrow I’m sure, but I’m thankful for the mercy of God in giving us a glimpse of it today.

Vanilla or Chocolate

The streets of Nyahuka currently display massive harvests of vanilla and chocolate (in the raw, preprocessed form). Besides the beautiful contrasting color we are enjoying some of the most aromatic clouds of invisible bliss ever to be liberated in our district. Thousands of dark, oily vanilla pods bask in the sun on tarps from UNHCR, releasing their sweet pleasant fragrance to all who pass. Normally, one would usually hold their nose passing through Nyahuka: raw sewage, decaying garbage, animal feces, etc. But it's all been swallowed by the power of beauty. That gives us hope somehow.

Saturday, January 06, 2007

It's a Wonderful Life, Pat Abbott!!

Our longest-standing colleague in Bundibugyo now is Pat Abbott. She is due for a six-month Home Ministry Assignment (new mission-speak for furlough, or leave), and will travel with us next week. So Friday we planned a short tribute after team meeting, to thank her for her work and pray her on her way. All Christmas season we had been wanting to get in our annual viewing of “It’s a Wonderful Life”, but could not find the movie. So we had the great idea of filming a version for Pat. The great thing about being a team leader is one can have a great idea, and then dump it on someone else to sweat out the nitty gritty details, in this case Scott Ickes, who put in many hours of filming and editing! Julia starred as Pat, discouraged missionary ready to turn in her passport to our personnel director, played by Scott I. Jack co-starred as Clarence, the only “angel” in the missionary kid association who did not yet have his wings, earned by convincing a missionary to stay on the field. So Jack/Clarence takes Julia/Pat to see life as it would be in Bundibugyo if she had never come. There were scenes of hungry children (gamely acted by our neighbors, sucking in their stomachs and looking pitiful). There were scenes of irritable missionaries shutting their doors to requests (gamely played by irritable missionaries). There was a particularly great scene involving our neighbor playing a person that Pat has helped over the last year, in the scenario that there was not one around to help him. Another scene showed Luke and Acacia play Scott and me struggling with surly hearts through HIV clinic. In short Bundibugyo was depicted as a place just as bleak and desperate as the Pottersville of the original movie, a place where Pat’s merciful heart had not had its impact. The shocked Pat begs to go back, and the relieved angel prays, and suddenly the accountants at the sending center find her support account overflowing . . . And the movie ended with the whole team singing special Pat words to auld lang syne.

This skit was particularly apt because that very day we received a threatening letter accusing two of our missionaries of ruining the life of a student . . . Basically this kid was sponsored all the way through school, largely through the generosity of a young woman who worked here for a year many years ago now. As she tried to decide whether to fulfill his request for university sponsorship she asked for help from Pat, and some gave the opinion that the boy’s requests and plans were not reasonable. We thought she sent had sent the young man the money directly anyway, and since we had not heard from him in months, we assumed he was in school. Suddenly we received this complaint of “human rights abuses” and threats that if he commits suicide it will be our fault. . . . Not a typical interaction, but still very frustrating since he and his family have been closely tied to the mission and church over many years.

So a night to laugh together, to tell Pat that we would not be the same team without her, to remind her of the many many many people whose lives have been changed by her mercy, such a night was much needed.

On discernment

I meet with the health center staff every Friday morning, alternating Bible study with continuing medical education.  This week I began some basics of neonatal resuscitation in anticipation of a short seminar we will have on Tuesday, led by a visiting WHM board member who is a physician, Dr. Randy Bond.  As we talked about traditional practices, we tried to put them in three categories:  those customs that are beneficial, those that are neutral, and those that are harmful.  Since about 70% of babies are born at home, it is important for midwives and medical personnel to be in touch with home-based practices.

In the beneficial category for Bundibugyo we definitely have breast feeding—most babies are handed directly over to the mother for skin to skin contact, initiate breast feeding in the first few hours, and keep it up for two years!  Bundibugyo could teach the rest of the world a thing or two about this.  There is no shame to an exposed breast, no setting in which feeding is inappropriate.  And with encouragement a good number of grand-mothers (ladies my age!) have actually managed to re-lactate when caring for a grandchild after the death of the mother.  This we celebrate.

In the neutral category we have the disposal of the placenta.  The placenta is taken by relatives and hung from a tree.  It should not be buried or disposed of.  If it dries slowly on the tree the child will thrive.  If wild dogs come and eat it the baby is given a special name and it’s survival is in question.  On the scale of all that happens in life here . . . Hanging the placenta from a tree seems fairly benign, not hurting anyone.  So we leave that alone.

In the harmful category, treatment of the umbilical cord.  It has been common in times recently past to put animal dung or mud on the baby’s umbilical cord stump.  This, as you might imagine, is basically rubbing dirt into an open wound, not a good idea.  Thankfully the health workers have mostly convinced the public that this is not in their best interests.  The eradication of the application of harmful herbs to the eyes is almost gone, too.  One of the practices that angers me the most is the crude cutting out of baby teeth as a cure for diarrhea—this tradition we researched and found it only extends back about 30 to 40 years, having been introduced in the time of Idi Amin by his military, many of whom came from northern Ugandan tribes.  This we fight against.

It strikes me that the heart behind most of these practices is good:  parents want their children to survive, and are willing to be inconvenienced or pay fees or carry a placenta home, in order to ensure that that happens.  I try to remember that when I see those who come to the hospital as a last resort after trying something in the third category.  My judgmental heart wants to condemn them, but then I’ll see a mother crying and realize that she was pressured into the action by others, or she really believed she was doing the right thing.  And I wonder how an outside observer would categorize some of the things I do?  Pray for us as missionaries, to discern harm and fight against evil, while still having compassion on the people who do harmful things.

Wednesday, January 03, 2007


Kyomanywa is dwindling, ebbing away before our eyes. For the first six months of his life he seemed to be thriving in spite of being born to an HIV positive mother. His mother’s infection was diagnosed through the Kwejuna project’s antenatal care. As she began coming to clinic we encouraged her to practice exclusive breast feeding (no other foods or milk), and then wean at six months of age when his antibody test was negative and he seemed to be healthy (the national policy). Each month of breast feeding carries some small risk of transmission. His mother followed our advice and took the hard step of denying him her breast, very counter-cultural in a less-than-two-year-old. And then his weight started to drop. We boosted up his nutrition thinking this was a side effect of weaning. But every month she would come back worried about his health, persistent in her instinct that something was wrong. So I repeated the test for HIV—it was positive. He must have been infected just before he weaned. We must have waited a week or more too long? With his constant fevers and weight loss he soon qualified to start anti-retroviral drugs. At least, I thought, we can turn him around now that we know what is wrong. But he keeps slipping. It has been a month and now he’s worse than ever, with a terrible whole-body rash, itching, dark patches with raised borders. Today he sat scratching, his mom able to distract him into smiles a few times, but mostly he cried.

And I want to weep too. I stopped two medicines that might be giving him an allergic reaction. We have almost no options for altering his treatment course, so are persisting with two drugs instead of three for HIV. I’m checking some pitifully inadequate labs and a chest xray—could we have missed a co-infection with TB? Kyomanywa dwindles and waits for us to figure it out, his spunky mother who loves him and keeps telling me that we don’t have it right yet, and me his doctor who feels like there should be someone else to turn to and ask for the right answer. There are plenty of happy stories in my ARV clinic, kids who turn out to not be infected, kids who are so much improved on medicines that their mothers are frantically chasing them down. But Kyomanywa isn’t one of them, and as I am leaving for a month I can only pray he doesn’t dwindle all the way out of this world.

Monday, January 01, 2007

Welcoming 2007

We have welcomed 2007 in style, Ugandan style. Last night the team gathered at the Pierce home with a handful of Christ School teachers, a few young friends like Ndyezika, and the ever-lively Bihwa family, a party unto themselves. There was food and a campfire and singing and drumming and dancing. Ndyezika and I almost fell on the ground laughing as Scott Ickes and Josh Dickenson followed Bihwa’s energetic Muleddu dancing with a dance of their own around the fire that they made up to commemorate Bundibugyo life with moves symbolizing hoeing, carrying water, greeting friends in the market, and riding a picky-picky. At midnight we hooped and hollered and beat drums and then dispersed to beds, to rest up for an even bigger party today.

Ten years ago, we spent New Year’s Day 1997 with Jonah and his family. He and his wife Melen had just moved onto property that we had leant him money to buy, a small mud house with a tin roof nestled up against a steep hillside farm that was just beginning to be profitable. We had worked together for several years by then and become friends. That New Year’s Day stands out in our memories: we spent the entire day out at his homestead, just sitting and talking and cooking together, unhurried fellowship. It stands out because about six months later the ADF rebels invaded. Jonah and Melen fled from that home, we scattered. It was later burnt by the rebels, and Jonah lost much. Bullet holes are still visible in the repaired walls. As he said today, during those dark days of 1997 we could not have known that ten years later we’d be back, at peace, still working together, still great friends. The decade has added four more children between us, seen Jonah through medical school, internship, and the rocky return to Bundibugyo, seen us through further MPH studies, team expansion, many ministries and projects. So it was with a great sense of thankfulness and joy that we decided to commemorate the Ebeneezer of the decade completed by celebrating the day together again.

Jonah asked us to come up in the morning and spend the day, and that we did. We dragged Scott Ickes along at the last minute (the kids’ pulled him in when he came up to ask a question). We sat on mats in the shade teaching kids to play UNO. We toured around the farm, seeing stands of matoke and cassava, cocoa and groundnuts and beans, scattering chickens, huffing up to the boundary mango tree to look back down on the valley. Jonah the doctor is at heart Jonah the farmer, with plans for more livestock and different patches of crops. Julia got smiles from the Jonah daughters (he has five now!) playing jump rope and tossing a ball. But the highlights of the day were two.

First, the goat. The whole idea was for Jonah to slaughter a goat for us, a way of saying thanks, of acknowledging us as part of his life. He chose a young kid from the very line that he has maintained since he was in primary school. Scotticus and our kids were fascinated by the whole process, and Scott (Myhre) used the dissection to teach lots of anatomy as the animal was skinned and then opened and cut up. The goat was all-day entertainment. Scotticus even helped chop some of it up into cook-able pieces. We ate the first part fried as a “lunch snack” and the rest stewed for the main meal. From bloody carcass to steaming dinner our kids thought it was fascinating and tasty. I marvel at the way God uses sacrifice and the meal of fellowship to symbolize His coming to us. Seeing it happen today made that very real.

The second highlight was taking Jonah and his older three girls to Ngite Falls in the late morning, after we had been hanging out together for a couple of hours. Though this home is less than a kilometer away from the Falls. . . He had never climbed up there! I got one of the girls to get in the water with me and let the spray hit her head, which is an intimidating experience for anyone, especially marginal swimmers. Jonah marveled at the spectacular beauty, and thanked us for being the ones that bring new experiences and adventure into his kids’ lives.

So today was another gift. The losses of the last decade have been significant. Jonah’s father was killed by rebels in the late 90’s; mine died this past year of ALS. There were many points of uncertainty, and as Sam says in the Lord of the Rings, many opportunities to turn back, only we didn’t, which is the bulk of what makes the story. Living out our relationship with each other through the changes, experiencing God’s mercy together over the long haul. We laughed a little about our plans to do this again in 2017 . . .