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Wednesday, January 30, 2008

Ebola wrapping up . . .

Yesterday we were enrolled in the CDC study of health care workers in Bundibugyo, giving blood samples and filling out questionnaires about our exposure.  It was a privilege to be able to assist these capable and dedicated people as they endeavor to sort through the messy data and glean patterns of truth.  After admitting on the survey that we don’t always wear gloves or wash our hands we felt a bit sheepish, but science can not be useful if we pretend to be better than we are.  Post-ebola I’m more aware, occasionally as I’m touching a patient it still strikes me that such an act of mercy and grace could have led to death a couple of months ago.  Sobering.  

All along the 37 deaths in the official toll excluded Dr. Jonah, because he died in Kampala and not in Bundibugyo.  This seemed absurd to us.  Though it was understandable at the beginning to separate the cases geographically when it seemed possible that Ebola was going to spread all over the country, it is a useless distinction now.   Jonah clearly became infected in Bundibugyo and it was a coincidence of his personal business travel that he happened to fall ill while in Kampala, and he’s the only case like that.  The CDC agreed, and so part of our task yesterday was to posthumously fill out a survey form for Jonah, answering all the questions to the best of our collective memory about what day he became ill and what his symptoms were and who he contacted.  A bit therapeutic, really, to recount that to interested ears and see it turned into fact by the marks on the form.  I still have to remind myself that he’s not coming back, and my heart resists thinking too deeply about him yet.  Melen returned to Bundibugyo with us and has re-opened her nursery school.  Amazing that she is functioning so well.  I don’t think I would be nearly as brave.

Meanwhile life is full of the usual richness and sadness that constitutes the atmosphere of Bundibugyo.  A baby died of meningitis last night, still waiting on lab confirmation but the fluid from the lumbar puncture was very cloudy.  Two six year old kids on the ward with severe malnutrition, peeling skin and puffy eyes and the listless faces of the hungry.  But there are joys too, a few improving kids, others starting on TB or ARV medicines which offer hope, the indomitable good spirits of Scott Will persevering at work, a new Ugandan nurse showing up for work today.  And on the team two milestones:  Stephanie returned just in time to celebrate her birthday with us, we made home made ice cream and set out candles on our patio for a Toby Mac dance party in the dark, sheer fun.  And Heidi joined us, landing directly into the wildness of life here.  It has been interesting to watch peoples’ faces as they encounter yet one more foreigner (there have been many related to ebola) and they glaze over as I say her name . . . Then come alive when I add “and she’s staying for two years”.  It will fly by too fast, but right now two years sounds pretty good to all of us who are goodbye weary.

Thursday, January 24, 2008

Many, Many, Thanks

First, please check out some new pictures (see Flicker sets on the side bar).  Our budding artistic photographer did a fantastic job of capturing some of the restorative beauty of our trip.  

Second, many people have asked about the Africa Response Fund.  Preliminary numbers are very, very encouraging.  The Sending Center is meeting with the Board next week to set up the final systems of accountability, so I will post real figures then.  But it looks very promising for being able to fully fund Dr. Jonah’s children’s education, provide a house for his wife, and even sponsor further medical education for others, even after the expenses of evacuation are cleared.  More details soon, but if anyone reads this who still intends to donate it is good to go ahead so we know exactly what we have to work with.

And last but not least, the goat response was amazing.  I posted the little goat ornament picture just before Ebola broke the news.  I thought the whole project would get lost in the crisis.  Not so.  Many of you saw it as a way to do something concrete that could help the people of Bundibugyo as you sympathized with their struggle.  And one of our dear friends Ruth Ann must have talked half her church into participating.  Checks are still clearing but we are sure we have at least 50 goats, and possibly our full goal of 70.  It will take another month or two to get them bought, immunized, and arrange transport, but sometime in the Spring Karen will be able to distribute them to HIV positive families, and to children whose mother has died.  THANK YOU.  I saw a baby yesterday whose mother was hospitalized and close to death a few months back.  Providentially, even though this was before the fundraiser, one of the families from previous distributions had brought back the offspring of their dairy goat just when this baby came to our attention.  They got the goat.  The child did not starve, but looks fine.  Her mother survived.  The two of them are a beautiful picture of life winning out over disease and death.

Re-Entry for Adolescents

Kids take time to readjust, too.  Luke is sitting out on the porch in animated conversation with four friends right now, good.  But yesterday just as the group of boys who hang out here arrived, my kids went down to help their teachers move furniture, clean, and paint at school.  And just as my kids returned, the bulk of their friends were leaving . . . But promised to come back and play football (soccer).  The previous two days Luke and Caleb had been having a blast, Luke in particular more relaxed than he’s been in a year perhaps, no school, no exams pending, just playing ball and laughing.  It helps that he’s almost 6 feet tall and can do 17 pull ups, in other words he’s getting bigger and stronger and can make his presence felt on our tiny field.  So he looked forward to the third day in a row of play . . . But no one came.  He hung out with the ball, waiting for a couple of hours.  Sigh.  I heard this morning that they were probably all playing at Christ School yesterday evening.  It makes sense that almost all the boys we sponsor go out for football—we love it, and they’ve been playing with a real ball at our house since they were small, an advantage many boys don’t have.  But yet again I have to watch Luke disappointed.  He’s not a CSB student anymore.  We missed most of this break due to Ebola and travel.  Just when he’s reconnecting and enjoying his friends they are moving back into the school orbit where he is not included.  It never gets easy to be a third culture kid.  No one on our team is more integrated into this place than Luke; but even he is always different, other, not quite accepted, not quite belonging.  I think as we move through adolescence that divide will continue to challenge us.

But just when I long for my kids to be more “normal” for this culture, more comfortable in it . . . I see reasons to be glad they are not.  My neighbor N. and her mother banged on our door after midnight, she was gasping for breath and complaining of diffuse pains in her eyes, ears, chest . . . So painful for me to see her devastated by her trauma.  She finally calmed down with pain killers and valium.  How to be a missionary and facilitate our own kids having friends and being part of the culture, when the culture is not safe for kids?  I sent my children for a while to the same school where this girl was abused.  So in many ways I’m content for them to maintain a little distance, to move in a protected orbit.  And that’s the way it is, expending energy to help them have relationships, to welcome friends, to provide constructive activity, but never quite fully entering into the bleak and powerless experience that is a Bundibugyo childhood, and so paying the price of dislocation.

Wednesday, January 23, 2008

Ebola's enduring effects

Life is back to a semblance of normal, but not quite normal.  A neighbor shook my hand this morning, spontaneously, the fear of touching now dissipating but I found myself surprised by the gesture.  The hospital is open, but many services that involve blood (testing pregnant women for HIV, or immunizing babies) have not yet resumed.  Trade and traffic are flowing, but there is still a tentativeness about the future.

As I sat in the HIV clinic seeing patients today, I reflected on the parallels between HIV and Ebola.  HIV attacks the disease-fighting cells of the body, so that a person succumbs to other illnesses.  Few AIDS patients are technically killed by the HIV virus alone, almost all die from things like TB or fungi or common bacterial infections that can no longer be resisted.  On a macro level, Ebola acts in a similar way.  Ebola attacked the disease-fighting personnel and programs of this society.  Only 37 people died of Ebola during the epidemic, but many more, untold numbers, have died because of the lack of medical services.  I think we will never really know the true impact.  Our pediatric ward is still half the usual census, and the ones that come are extremely sick, having waited to the last possible moment to risk coming to the hospital.  How many wait a few hours beyond the last possible moment, and die at home?  How many malaria deaths alone occurred over the last month because Ebola had attached itself to the health care system, essentially shutting it down?  How many kids will get diseases because the immunization coverage has been suspended for two months?  Today every kid I examined had last been seen in mid November.  Some had run out of ARV’s but did not get them refilled.  A very cute baby had a negative HIV result from the 22 of November (Ebola was declared on the 29th) but no one had interpreted the test for the mother, so she spent two extra months breast feeding the child and putting her at risk of infection, potentially a matter of life and death.  Another patient yesterday came to find me, after she had missed an entire month of TB therapy.  How much will resistance increase due to this sudden interruption?  

And now that it is time to pull the system back into function, we are left to do so without a few of our key allies.  In the HIV clinic I could see Dr. Jonah’s signature on the charts, a reminder that he was central in the fight and he will not be easily replaced, not in this generation anyway.  It is a weary-ing prospect, not only to work to bring back services but to do that work without our leader.  Like a body trying to recover from pneumonia without its immune cells, we are a district trying to recover from disaster without our most important doctor.  The attention of the world moves on, as it should, but the reality of recovery here remains, requiring patience and a long view.

Tuesday, January 22, 2008

A tale of lost childhood

My neighbor N. is a sweet girl.  Not too bright, but pleasant, strong, faithful.  She’s a few years older than our kids but has grown up hanging out here frequently when her little brother and sister came to play.  She’s in 6th grade, but about 18 now, though she looks much younger.  Over the last few months (Oct, Nov) she would come and sit in my kitubbi and complain of multiple vague illnesses, head aches, stomach aches.  Her demeanor changed.  I suspected she was perhaps becoming involved with a boy and afraid to tell anyone, maybe using illness as a way to ask for help, or maybe feeling the first trimester blahhs.   I asked her frequently about it.  Was anyone bothering her?  Was a teacher at school asking her for sexual favors (all too common)?  Had she missed any periods?  She always denied.  But then the next week she’d have another vague somatic complaint.  I sent her urine for a pregnancy test once, it was negative.  Later I was so convinced that I was missing something I had Scott ultrasound her, no baby.  But I never really connected with her. Her English is very limited.  My Lubwisi breaks down when we get to matters of the heart, or to sexual abuse or rape.  So I hoped she was just upset about her ill father, or just coping with changes in her body or life.  When I heard that she was hospitalized while we were gone in January though I wondered.  So yesterday evening I went to see her, and she launched again into vague stories of an ear ache and head ache.  I asked to see her medical book from the hospital.  There it was:  conversion reaction, psychiatric disturbance, prescriptions for valium and antidepressants . . . And they noted she had had an illegal abortion.  What????!!!!  I asked her mother if she knew what was written.  At first she said no, but when I asked more questions I realized she knew, and her father knew, they just didn’t know what to do about it.  

So this time I took N. aside again and tried to go further in Lubwisi.  Finally she started answering.  Yes, she had been pregnant and a person with a clinic in Nyahuka gave her an abortion.  The father:  her sixth grade English teacher, who happens to be the brother of another neighbor, a young man who is distantly related to her family but has caused them lots of grief.  She told me that this teacher had been abusing three other girls in her class too.  I was heartsick.  Here is a girl who has sat through many of our groups about AIDS, about abstinence, about saying no.  Here is a girl with a father and a family.  Here is a girl whom we see almost daily.  But she was not protected.  Who is safe?

The police are involved, but I’m not sure they’re effective.  Since N. is 18 the law may not help her as much, though from her depression now I think we can say with certainty that she was not in love with this man and being pregnant with his child was not her desire, no matter how old she is.  Her half-brother in Kampala has been informed, and I hope to find out from him what the next step is.  If nothing is resolved by the time school starts I would love to just storm into the school and demand this teacher be dismissed (and jailed).  But he’s no where to be found now, and I suspect he’ll have the sense to resurface somewhere far away to prey upon other unsuspecting young girls.

I keep wondering what else I should have done.  I didn’t talk to her mother when she came to me last Fall, even though I suspected this problem, I took N.’s word and did not push hard enough, one of those misguided American concepts of confidentiality.  And I keep thinking about this teacher, this man.  I believe in grace, but when I think of him I’d just like to extract some justice.  From him, from the school administration, from the man’s devious brother who may have facilitated the whole thing, from this world where a cute little girl is turned into a depressed and vacant teenage victim.

Monday, January 21, 2008

Return to Reality

As Scott often says, one can love and hate this place with equal intensity, and alternate many times per day.  So as we drove in last night, it was mostly love: spotting a troupe baboons awkwardly clambering down a tree, seeing the vast Ituri forest cut by the silver snake of the Semliki and a mist of distant rain, slowing for a bridge two hours from home and having a young man call through the open truck windows “Ehh, hi Jack-a!” (he was a Christ School student from the cross country team) and watching Jack’s face melt into a huge smile of the one known and welcomed, hearing neighbors cheer as we drove into our house, watching the kids reunite with our remaining dog Star, enjoying the fellowship of Pat and Scott who prepared a feast, realizing how much more at home we feel on the equator.  All this is real, but reality has another sharper edge, and it doesn’t take long to experience the other emotions . . . We were still unpacking the car when the toilet flooded the entire bathroom and a lake of water was seeping into the rest of the house by the time Julia thankfully went back inside and noticed the problem, Scott fired up the kerosene fridge to get it ready for our two months’ worth of meat and fresh food so that when I opened the door back up to start unpacking the cooler I found that the roaches who had set up home there in our absence were dying from the falling temperature (no matter how long I live here, I still find roaches thoroughly disgusting), then went to unpack the groceries and found that the jolting ride had caused an entire jar of honey to distribute itself over a huge box of dry goods.  Life is messy, and the moments of shalom (a dozen friends here now playing football with my kids) alternate with the moments of despair (home for twelve hours and already being approached for jobs, loans, help in various ways).  So it goes.

Friday, January 18, 2008

Back in Uganda and No Ebola

After a memorable trip by train, air, boat and bus from our conference via Salzburg, Prague, and Amersterdam . . We are back in the familiar brightness of Kampala with its booming music and dusty air, mucky streets and piles of traffic.  It is good to be home, almost.  The kids were jumping up and down with excitement as we waited for our bags in the airport, breathing in the softer wetter air of Uganda.  We’ve been reconnecting with team, listening to their stories and telling ours, looking at calendars and planning the grand return.  Because the best news of all is this:  NO MORE CASES of Ebola.  Both isolation units are shut down.  The mattresses were burned.  The international staff has thinned to almost no one.  Life is returning to normal, which means it is time to get the team back home.  Pat and Scott Will have been bravely holding down the fort alone long enough.  Over the next few days most of us will be returning.

Which means these few days in Kampala are full of the usual (for Scott mostly), shopping for boxes and boxes of medicine and piles of food, soap powder and paper and school shoes and tins of paint.  I’m not sure I’ve really re-entered yet, I’m still in the blur of good food and good care from others, the placid flow of travel and transience, not really yet facing the reality of return.

Perhaps when we are home we can post some pictures from our resourceful, creative, generous WHM colleagues who led us into castles and over bridges, to taste and gaze and touch and hear the amazing culture and history of Prague (Mark and Joanna with Sasha the cutest ever two year old, primarily, but also Phil and Shanna, Chris and Laura, and non-WHM old friends Carolyn and Ted with various and assorted kids) and Amsterdam (Miriam and Bob).  We are extremely grateful, it is as if God wrote on our foreheads BE NICE TO THESE PEOPLE...THEY NEED YOUR HELP.  Because we’ve certainly received way more than our fair share of love from all of them.

So here we are in the limbo of Kampala, far from the pristine timeliness of Austria, far from the magical artsiness of Prague, far from the ordered bustle of Amsterdam.  But not yet into the demanding chaos of Bundibugyo.  A time to draw a deep breath and wait on what God will do as we return to a place that certainly feels as difficult and far from Heaven as any on earth.  I’ll close with lines from W. B. Yeats, found here in the home of the Irish doctor where we are staying for this pause.  In this poem a Bishop calls upon a poor woman to focus on Heaven, but she replies that the foul earth has been the dwelling place of that most fair . . . .

    But Love has pitched his mansion in
    The place of excrement;
    For nothing can be sole or whole
    That has not been rent.

Monday, January 07, 2008

On glory and grief

We are in Austria, at the foot of snow-laden mist-shrouded mountains, nestled in a castle whose dark past of witch-burning and Nazi-occupation has been transformed into a Christian retreat center with clean beds and fire-places. But best of all we are enveloped in the love of our World Harvest Mission family, the people who have been praying without ceasing and supporting us through the crisis of the last month. Pastor Scotty Smith from Nashville is leading us in daily teaching from the book of Revelation, the encouragement to Christians who are suffering to show that God is still in control and bringing all things to newness of life. Very timely. And we are also studying a book about team dynamics to build our leadership wisdom. And praying together, weeping, hearing stories and offering solace from shared struggles. The kids are fascinated by the twisting stair cases and secret turrets, the icy sledding hill and fun input from the Spain team. All in all just what we needed at this point, strong Austrian order and peace, strong WHM friendship and prayer, and family togetherness. We are so grateful to be here.