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Monday, June 29, 2009

All Things New

Watched Slum Dog Millionaire (again) this weekend, and this time noticed an unusual scene.  At the very end, when Jamal kisses Latika's scar, suddenly there is a rewind-like camera shot of the scene in which she receives the knife cut to her face.  We go backwards from the struggle to a moment of expectation and happiness, when the two lovers look at each other unwounded, with joy.  

A striking visual of Revelation 21.  Tears wiped, death becomes life, the act of love reverses the ravages of hate.  

Perhaps in the context of the struggle for healing and justice for my rape patient, this image is particularly poignant, since Latika was also sexually abused.  Not just a covering over of evil, but an actual un-doing.  All things new.

Sunday, June 28, 2009

Pictures from Birthday

Heidi, my hero, taught me to upload pictures to my blog (yes, all that you've seen up to this point was Scott). So here is my lovely prayer-breakfast table, which began the day on the Masso's porch: Here, our team, including Craig and Dick from the Mariner's Church (Pierce home church in Annapolis) and our intern Doug . . Tim it seems was pushing the timer button and didn't make it. Sorry Tim! The reason I am surviving here without Scott: cheery kids and a hard-working team. This is the pizza production on my Bday. And it proves that Tim (blue shirt) is actually here. Me, with two fire-cracker candles standing in for the 47. Ashley made the amazingly rich dense chocolate cakes, and the Pierces made ice cream. Pretty yummy.

Friday, June 26, 2009

Seek Justice

The case of the little 6-year-old girl who was raped continues to gnaw at our hearts, with no resolution or arrest to date.  So when I asked Heidi what topic we should address in CME today (our weekly staff meeting), she suggested we discuss sexual abuse.  At first I was taken aback, about how to approach this . . .but I realized it was a good opportunity to allow airing of viewpoints and to integrate spiritual and medical perspectives.  

So I asked for the Spirit's guidance and began to look through my Bible to prepare, since this week should have been a primarily spiritual topic.  And I came to the story of Dinah, in Genesis 34.  Defilement of a young girl, capitulation by her father and murderous revenge by her brothers, intrigue and suspense.  It's a gripping tale but I worried it did not provide many clear answers.  Still we read it, and then discussed some questions.  Was Dinah guilty? NO, at least everyone agrees on this, which is reinforced by a very specific law in Deut 22:25-27.  Does God allow violent nonconsensual sex as a means to marriage?  NO, we all agreed here too, even though some cultures in Uganda consider this a normal means of courtship.  Was Dinah's father Jacob right to accept dowry payments to legalize the marriage after his daughter was raped?  The first two respondents said, YES.  A female clinical officer argued that now that the girl had been defiled, this was her only option for marriage, so it was better for the father to settle financially and leave her with the man.  An older male took the perspective that Jacob did:  peace in the community was more important than one particular girl's violation, and a monetary settlement that preserved community relationship was acceptable.  At this point I began to regret choosing this Bible story.  Maybe it is my own cultural bias, but Jacob's passivity mirrored too closely what was happening in real life to my patient.  

But then two more men spoke up, disagreeing.  If the father takes the dowry, then rape is accepted, and we can not allow that, they said. Once the first spoke up, almost everyone else agreed with them, that from a moral and legal and practical standpoint, rape of a young girl (or any woman) could not be condoned.  This led to good discussion about WHO is responsible to protect our children:  parents, the community, the government, the police, God.  And after some medical teaching defining sexual abuse and discussion the physical and psychosocial consequences, we came back to the case at hand.  As medical workers, what else could we do?  We had treated the girl, filled out the proper police reports, appealed for action.  Yet the assailant was seen going about his business yesterday.  It is one week since the incident, and he remains free.  And here the community of medical workers gave me hope.  They came up with a plan to write letters to various people in police and government, and even an appeal if no action is taken by next week.  We ended with Rev 21, where all tears will be wiped away, all things made new, even the mind and body of a raped 6 year old.  For the first time it made perfect satisfying sense to continue to verse 8 (I'm usually temped to stop at 6 or 7 on the God-high and not look too hard at hell in v. 8).  It is no mercy for the assailant to continue on his way without consequences; if he is not led to repent now, he faces a grim eternity.

So this afternoon I'm dispatching my missives, hoping for the proper tone of outrage and respect that will stimulate some action.  Meanwhile our sweet patient complains of pain when she walks, and restless sleep, and vague stomach aches, and waits for justice to roll down.  

Thursday, June 25, 2009

Discipline of Thanks

Today is my Birthday . . . and I am devoting this post to a few things to be thankful for, in honor of the June 25th  meditation in my devotional book. Because today was a doozy, with enough crazy vortex-of-crisis type events to make me wonder . . . including the last straw, a psychotic woman who started attacking me when I went out to see what she needed in my kitubbi (no harm done, and when she lunged for Heidi who was holding all the pizza toppings at the time I managed to deflect her).  Thankfulness opens the heart to communion with God, which I sorely need, so here goes.
+Jack and Julia, who are doing a great job of taking care of me without Scott, Luke, and Caleb here . . . pitching into chores with dog, cows, water, bikes, dishes, etc., solicitous of my Birthday happiness.  They are an amazing pair and a joy to be with.  
+Goats, which were sent home today with a variety of needy people. Picture a petite little mom with AIDS tugging at the rope of a massive white horned beast, her baby on her back, setting off for home!  Earlier I had the privilege of listening to the pre-distribution speeches, as our visitors Craig and Dick shared from the story of the abundant filling of oil for the widow, surely a closely related picture to the replenishing supply of milk these animals will provide.  As they talked I watched one of the mothers:  I had mourned with her when, in the pre-ARV pre-UNICEF era, we watched her son Dickson waste away and die.  She had no surviving children at that time, a real tragedy here.  But now she has a healthy 6 month old who tested HIV negative, and will stay that way by drinking the goat's milk provided today.  Having sat with her at Dickson's grave made it all the more sweet to see her receive life, and hope, in the form of the goat today.
+Team.  The young single crowd surprised me this morning when I slipped away to the Masso's empty house for prayer, preceding me with fresh home made muffins, and several scripture passages (including my Dad's favorite Psalm 121) written out, my favorite hymn, and flowers.  I felt very loved.  All day long people popped in and out to check on me, and then tonight put together a great cake-and-ice cream post-pizza celebration.  I'm humbled and heartened by the kind words on my cards, and the acts of service.
+Kevin home from the hospital, two weeks from death to beginning the rest of life, God's mercy.
+Cell phones, which allowed me to talk to my husband, my mother, friends in Sudan, Uganda, America.
+The USA football (soccer) team . . Ok bear with me but it was really fun to watch them beat Spain, to hang out with my son and some of the guys and enjoy a game where heart and determination beat the odds.  Hopeful for our life in general.
+Dancing:  we ended the evening with an all-out dance party, candles and a whooping bass, on the porch under the bougainvillea and a damply humid dark sky.  

Discipline of Thanks

Today is my Birthday . . . and I am devoting this post to a few things to be thankful for, in honor of the June 25th  meditation in my devotional book. Because today was a doozy, with enough crazy vortex-of-crisis type events to make me wonder . . . including the last straw, a psychotic woman who started attacking me when I went out to see what she needed in my kitubbi (no harm done, and when she lunged for Heidi who was holding all the pizza toppings at the time I managed to deflect her).  Thankfulness opens the heart to communion with God, which I sorely need, so here goes.
+Jack and Julia, who are doing a great job of taking care of me without Scott, Luke, and Caleb here . . . pitching into chores with dog, cows, water, bikes, dishes, etc., solicitous of my Birthday happiness.  They are an amazing pair and a joy to be with.  
+Goats, which were sent home today with a variety of needy people. Picture a petite little mom with AIDS tugging at the rope of a massive white horned beast, her baby on her back, setting off for home!  Earlier I had the privilege of listening to the pre-distribution speeches, as our visitors Craig and Dick shared from the story of the abundant filling of oil for the widow, surely a closely related picture to the replenishing supply of milk these animals will provide.  As they talked I watched one of the mothers:  I had mourned with her when, in the pre-ARV pre-UNICEF era, we watched her son Dickson waste away and die.  She had no surviving children at that time, a real tragedy here.  But now she has a healthy 6 month old who tested HIV negative, and will stay that way by drinking the goat's milk provided today.  Having sat with her at Dickson's grave made it all the more sweet to see her receive life, and hope, in the form of the goat today.
+Team.  The young single crowd surprised me this morning when I slipped away to the Masso's empty house for prayer, preceding me with fresh home made muffins, and several scripture passages (including my Dad's favorite Psalm 121) written out, my favorite hymn, and flowers.  I felt very loved.  All day long people popped in and out to check on me, and then tonight put together a great cake-and-ice cream post-pizza celebration.  I'm humbled and heartened by the kind words on my cards, and the acts of service.
+Kevin home from the hospital, two weeks from death to beginning the rest of life, God's mercy.
+Cell phones, which allowed me to talk to my husband, my mother, friends in Sudan, Uganda, America.
+The USA football (soccer) team . . Ok bear with me but it was really fun to watch them beat Spain, to hang out with my son and some of the guys and enjoy a game where heart and determination beat the odds.  Hopeful for our life in general.
+Dancing:  we ended the evening with an all-out dance party, candles and a whooping bass, on the porch under the bougainvillea and a damply humid dark sky.  

Wednesday, June 24, 2009


Some college kids and grad students do tree-hugging environmentally-active politically-correct summer projects.  We in Bundibugyo have our summer interns hug goats.  Last night, in the moonless darkness about 8 or 9 pm, a large truck loaded with 49 goats arrived on the mission compound.  Lammech had gone to purchase these high-grade dairy goats from a project in central Uganda, using the funds raised by the Christmas-tree-ornament-project.  Forty-nine goats had to be wrangled to the edge of the huge flat-bed truck, which was about shoulder level for us on the ground, then enfolded in the arms of a waiting Tim, Doug, Nathan, Jack, Sarah, or a few strapping young men whose darkness melted into the dark night, then physically carried a few dozen yards through uneven paths to reach the Masso goat pens.  Some goats were sort of cute.  Some were massive males, like the size of small cows, for breeding with local goats.  These had pretty impressive curving horns and sharp hooves!  Doug, ever up for humor, kept us all laughing as he called out to John (tallying) and Lammech (wrangling) on the truck:  bring me a big one, bring it on, bring it on, I'm gonna wrestle this one . . . Pauline waited to sort them into the proper pens.  She had arranged for loads of fodder to be available, and water.  I merely held flash lights and helped people find their way around, and laughed and encouraged.  But I will treasure the images of Tim and Doug, arms outstretched, determined smiles, grabbing these big wiggling furry creatures to their chests and carrying them all the way into their pens.  It reminds me of Sunday School pictures of the Good Shepherd bringing home the 100th lamb.  And it is probably a far cry from anyone's image of an aspiring doctor, but nevertheless very Jesus-like.


JD has posted the full story of the events of Kevin's mostly-dead collapse, and recovery.  It is a must-read.  Link to it here:

I think this is the first day they can really believe he is going to be OK, to go home, following the first night with the new internal defibrillator which allowed JD to sleep with some peace that if the deadly v-fib rhythm recurred, he would be automatically shocked back out of it.  This is a testimony of pain and fear and facing the ultimate loss, and of miraculous healing and community and love and provision.  Resurrection is God's favorite and essential modus operandi, so this points to Him as a real-life story of present-day power.

Monday, June 22, 2009

Divided Heart

With half my immediate family and all of my extended family out of this country . . I go through the day bouncing between thinking of tragedies like the little girl in red polka dots, and then about my loved ones far away, calculating time zones in Virginia, California, North Carolina . . .  Kevin had an automatic defibrillator surgically implanted yesterday, which sounds rather intimidating, praying it went well.  I heard that my mom had a fiasco with a dead car battery and then a claustrophobic 2 hour MRI of her back. Luke sounds great in Kenya, using his pottery class to design nose cones for the rockets he's making in AP Chem.  Scott and Caleb have had a great weekend with the Myhres of California, were warmly received by the Half Moon Bay Methodists, and yesterday soaked up renewing sunshine in a strenuous ridge-top hike and an afternoon of boogie-boarding in the surf.  And back to my loved ones here, today is Miss Ashley's birthday, and her devoted fans have been working hard on a lovely card.  By evening the shipment of 50-some goats should arrive by truck, to be given to HIV-affected families and orphaned babies.  It is the technological experience of simultaneity (not a word I'm sure) that can be jarring, interrupting our breakfast here to say goodnight to Caleb on a cell phone!

The world goes not well

First, if you are reading this as a kid less than 16, skip this post.

We know the world goes not well, but usually it is a background irritant to the illusion of success.  Today, however, the "not well" is like a punch in the gut.  On my ward, a 6 year old girl, who was raped.  A very normal looking sweet thin little girl in a red polka dot dress,  watching us all, accompanied by her pregnant mother and harried father.  Seems she and her two siblings were in the family's gardens alone (not so shocking, mom was tired, told them to go play after lunch) when an old man, a former UPDF soldier, grabbed her, told the other kids not to scream or he would find them and shoot them . . . and then proceeded to hold the little 6 year old girl down and rape her.  The siblings ran home crying, having recognized the man as an uncle of their neighbors, and the family brought the little girl bleeding profusely to the hospital.  This happened over the weekend, but even today the evidence of the trauma is quite clear on exam.  

How do I as a pediatrician react to this?  Shock and horror and outrage and anger.  Then some action, paltry probably.  Most importantly to let the little girl tell me her story, again, figuring that another adult taking it seriously and letter her vent is a good thing.  She spilled it out rapidly, concretely, matter-of-fact, not emotional.  Then to tell her in very clear terms this is not her fault, she did nothing wrong, she did not deserve this, she has nothing to hide or be ashamed of.  And to promise that we and her parents will make every effort to protect her.  Then to get her started on HIV-post-exposure prophylaxis (which thanks to our trip to EGPAF two weeks ago, I actually HAD in the medicine store, thank God).  The soldier connection is worrisome, and there is a belief that sex with a virgin can cure AIDS, so it could have been part of the motivation for the attack.  And treatment for syphilis.  And calling the child welfare officer attached to the town council.  And filling out the blank police report form.  And then, at last, marching to the police station myself with Heidi and the nurse and the father, to discuss the plan to apprehend the perpetrator.  It is actually unimaginable to me that no one has taken any action yet.  Fear?  Reluctance to get involved?  Hope for a cash settlement?  Apathy?  Or just lack of transport?  In this country the police sort of wait in their office for the family to do the real work of finding the criminal.  I put down a good chunk of money to try and spur on some action.

Last week our worker Saulo's family went into a frenzy of panic when their little girl, Nightie (?age 4ish) was missing from her nap.  They searched and found her a few minutes from home, left lying by the river, with a story that a man speaking Luganda had entered the house and picked her up while she slept, then threatened her not to scream . . not clear why he set her down, but he did, and she was unharmed.  There is a lot of press right now about child sacrifice, about unscrupulous and greedy people taking children to witch doctors for sacrifice to ensure success in business.  It is always attributed to "outsiders", someone from another tribe.  There is also an idea that only an un-scarred child will be used, so a circumcised boy, or a girl with pierced ears is safer.  This is driving earlier and earlier circumcision, the culture is abandoning the historical traditions of near-adolescent group-enculturation and ceremonial circumcision, in favor of protecting their toddlers.  And the day after this scare, Nightie and her sisters had their ears pierced.

When children are used by adults as sacrifices for their success, healing, or need for power . . . we know that the world goes not well.  We have a visiting pastor, Craig, from the Mariner's Church in Annapolis which supports the Pierces.  He read us the Lazarus story last night and spoke on the verse "Jesus wept".  This, he said, is God's continual posture towards the broken world.  He weeps.  Even knowing that resurrection is imminent, knowing that the Kingdom comes, does not erase the pain of wounded love for His children.  He is not indifferent, and He is actively reclaiming the territory of grief, with tears that become springs in the desert, that transform suffering into blessing.  Hard to see that today, but we hold onto the truth and pray for the Kingdom.

Sunday, June 21, 2009

Shaking it up at church

Our church service this morning was, shall we say, LONG. I think it
comes of a cultural need for participation. Multiple choirs, multiple
songs per choir . . but also in the prayer requests, there are just a
LOT of people sick or with problems they want to share and pray
about. As community grows and deepens, it takes time. Musunguzi
preached powerfully as usual, from Acts, challenging each member to
share the Gospel themselves. As he said, Dan Herron and Alan Lee came
here in 1986 and sat in Alinga's kitubbi and told us about Jesus. Are
they here now? No, but they don't need to be, because they taught all
of us. It was a great illustration of the way Paul and Barnabas
planted churches in Acts 14, and a sweet look back on our
predecessors. Later he also said, you only heard the gospel because
those men came far from their homes out of love for us, and that is
why missionaries are still here among us, they love our people. A
soothing moment for my frazzled missionary heart . . .

But the real excitement in church today was an earthquake. It sounded
like an explosion, the whole church shook, everyone jumped up from
their benches and looked around, then a few seconds later there was
another less intense rumble and shaking. Many of the congregation ran
outside. I made my kids go. It is the prudent thing in an earthquake
to NOT be in the only building for miles around that is large enough
to kill people if it falls. I know Paul did an excellent
construction job, but I'd rather observe the strength of the walls
from the outside . . . However nothing fell down and everyone hugged
and laughed to cover their fear, including me. Then we came back
inside and sang two vigorous praise songs. The danger energized the
service, and the preacher later used it to illustrate the nearness of
Jesus' coming and the importance of standing for Him.

Saturday, June 20, 2009

On feasting and fighting

With Scott gone, leading team Bible study fell to me, and as always the process of spending the week in John 2 made it way more meaningful to me than to anyone else I'm sure.  It is a fascinating picture of the announcement of Jesus' ministry:  first, he rescues a wedding party by lavishly transforming water meant for ceremonial cleansing into fantastic wine.  Then he whips the chaos out of the temple courts so that the Gentiles can regain their access to worship.  Hard to imagine an mission or NGO with a similar ministry-launch, a combination of alcohol and fury, feasting and fighting, joy and judgement.  But if Jesus is to invite us into the final wedding feast of the Lamb (Rev 19) there are battles to be fought, because we live in a world gone awry, surrounded by enemies.  And the deeper symbolism only becomes apparent later, when the passover cup of wine turns into a true consuming of God's wrath, when Jesus' blood flows for the final cleansing and making of all things new.  In that moment we see wine and joy and pain and sorrow and wrath and judgment all come together in one action, LOVE.  In Skip Ryan's book on the Gospel of John I found this poem, which beautifully combines the images:

The Agony (George Herbert, 17th century poet)

He who knows not love,
Let him take and taste that juice
Which on the cross a nail against a beam did loose.

Then let him say, if he did ever taste the like,
Love is that liqueur, sweet and so divine,
Which my God tastes as blood, and I as wine.

Do, Love, Walk

My desk is awash with papers and books that need attention, my kids
are working on homework projects and want advice, many flagged emails
and things to think about, without even coming to the food shopping
and planning and cleaning and normal home organizing that has to
happen on a Saturday, the only day in the week I usually spend focused
on life survival. So when I finally sat down to work and there was an
immediate knock on the door as Julia called "mom, someone's in the
kitubbi" my heart sank. Part of the stress of being home alone is the
no-sharing of dealing with anything. But as I walked to the door, the
ipod (on blast volume I might add) was playing a Stephen Curtis
Chapman oldie: Do justice, love mercy, walk humbly with your God. A
well-timed attitude check from a musical Micah 6:8.

In the kitubbi, two anxious parents and one very dehydrated baby. No,
they had not gone through proper channels of being referred from the
hospital. But I had seen them there during an admission less than
three weeks ago, so when the baby became seriously ill again they went
straight to the place they hoped to get help. And while part of me
wants to create protective rules for my Saturday survival, thanks to
the music in my head I was able to see them with empathy. If my baby
looked like that you better believe I'd do whatever it took to get
attention. The dad's dress indicated a different world religion, but
that is no barrier when a child's life is at stake, and I'm glad for
that, that justice and mercy offered in a humble way cross barriers of
faith and culture.

On Friday, at the "launch and lunch" celebrating the end of our week-
long Village Health Team training on nutrition in HIV/AIDS, I walked
in late just as John was graciously covering for me, and found myself
immediately invited to speak. The first thing that came to mind was
Isaiah 58, so I read a few of my favorite verses, and found that
though I was preaching to the VHT's the Spirit was speaking to ME. If
you extend your soul, pour yourself out, on behalf of the needy and
hungry . . . then God will be your guard, He will come to your aid.
As volunteers these health workers will pay a price to help others.
But their reward is from God, and He promises to refill what they pour

Today I cling to that promise, too. And to the clarity: what is
required? Just this: to do justice, to love mercy, to walk humbly
with God. This was a life verse we reflected on at my Dad's death, a
summary of the way he lived. And it provides a guide for me and for
our team. Let us pursue justice vigorously, let us live out acts of
mercy, and let us do both, not in a way that promotes ourselves or
America or World Harvest . . .but in a humble day to day walk with God.

Wednesday, June 17, 2009


From our national newspaper today:   "UGANDA is ranked 122nd out of 158 countries in the State of the World's Mothers report, released by Save the Children yesterday. . . . .The best place on Earth to be a mother is Sweden, followed by Norway. Of the 10 worst countries for mothers, nine are in Africa. They include Sudan, Sierra Leone, DR Congo, Eritrea and Angola. . . "In short, providing mothers with access to education, economic opportunities and maternal and child health care gives mothers and their children the best chance to survive and thrive," the report says. "

And from me:  thanks for praying for Anita, who came with her mother again yesterday, and got a 3-week supply of medicines from the limited stock that arrived.  Her mom said her appetite has been poor.  Hard to say yet if this is a sign that the gap in supply has sent her viral counts spiraling.  

The report on mothers ranks countries based on life expectancy for women (53 years in Uganda, so I'm getting closer to the end . . ), average years of formal education for girls (10 in Uganda, which is pretty good for the region), access to family planning services and supervised safe deliveries, income potential relative to men's, political representation.  

It does not, however, measure the soul-piercing reality of watching your child go off of ARV medicines, of waiting in interminable lines for care, of having your baby bitten by a rat, of bringing children into this world whom you are powerless to feed and clothe and protect and nurture.  As a mother I can only imagine what lies in the hearts of the many women I interact with every day, but that imaginary glimpse pushes me on.

Inscrutably good

My wise friend Karen Masso had this example of the difference in
Jonah's and Kevin's experiences with death: once the crowd threatened
Jesus at the cliff, and he walked through unharmed. The second time
the crowd gained deadly momentum, they pushed him to the cross. Kevin
has walked through this experience of death like Jesus parting the
crowd and leaving the cliff. Today he's out of the ICU again post-op,
eating and walking again, and once again showing the most amazing
recovery speed. God has been given glory for the miracle of his
resurrection, the timing, the people, the third-try shock, the
protocols at Duke, the surgery, everything. When the surgeons saw his
valve, they confirmed that he had very severe stenosis. In most
scenarios he would not have survived, but now they are thinking about
which day to discharge him home. Jonah, on the other hand, followed
the path of the cross. I can not explain why God worked so
differently for those two men who had dedicated so much of their lives
to the Kingdom in Bundibugyo, who had wives and young children in the
balance, and who had been our friends. But Karen's analogy of Jesus'
life shows that God's ways can not always be predicted or boxed in or
explained, that the same crisis may have different outcomes that both
turn out to be based on love.

For tonight, resting in the rescue God provided Kevin and JD, and
rejoicing that he has a new valve and a new hope for life and
relationship and work and meaning.

Tuesday, June 16, 2009

Day of the African Child

(Press release):  Nairobi, June 16th 2009: Africa observes the Day of the African Child, in memory of, thousands of black school children who were maimed and killed in 1976 Soweto uprising, as they took to the streets to protest the inferior quality of their education and to demand their right to be taught in their own language.

Today is a UN-sponsored day to draw attention to the plight of the African Child, which is all too often a life of marginal nutrition, sub-standard education, fragmented family (in spite of our stereotypes few kids here grow up with both parents), and too-early shouldering of adult roles and responsibilities.  I suppose I celebrated it in my own way today, struggling for the real lives of a few real African children.  All in a day's work:  a newborn baby with spina bifida who could be helped by referral to a neurosurgical mission hospital on the other side of Uganda; a newborn whose mother died in the process when her uterus ruptured who could be helped by milk until the family sorts out a surrogate breast-feeder; a convulsing baby whose anxious and misguided parents had been treating him for days at home with herbal enemas which were ineffective for his real problem of meningitis,  but who could be helped by IV antibiotics; a five-year-old inexplicably malnourished little girl who tested positive for AIDS and could be helped by the correct medicines and counseling; a child with newly diagnosed sickle cell disease who could be helped by prophylactic antibiotics and vitamins; an infant with severe gastroenteritis who could be helped by large and fast infusions of IV fluids; and the list goes on through a crowded ward and a line of consults.  

Too many days I have the sense that all the effort is for little gain.  But today a small supply of anti-retroviral drugs arrived (not much, but enough for the next week) and another consignment of anti-malarials, which is huge news.  Both evidence that prayers are at work, that good is gaining margin over the chaos of want.  And lastly I want to share one very satisfying victory.  Two weeks ago a child was admitted with severe malnutrition, and given his terrible respiratory status and his coughing skinny mother, we thought the pair probably both had TB.  But the mother's sputum tests from another hospital were negative.  The clinical picture was so convincing, though, that I set out to get her re-tested.  I have never worked so hard for one simple lab test.  It would be too tedious to describe every turn in this story, but here are a few:  no frosted microscope slides, which the TB program requires because the slides have to be marked with the patients' name and saved for review, phone calls, none at another lab but the idea of using tape to mark the slide, the lab refusing and demonstrating the slide would then not fit in the right slot in their storage box, more phone calls including the District Health Officer informing him that our entire public health effort to find and treat TB was failing for lack of lab supplies, who then suggested we send someone to beg them from another health unit, paying for the fuel for the motorcycle to do so, to no avail since they did not have them either, noticing a truck from Kampala with "TB and Leprosy Programs" painted on the side and shamelessly interrupting to beg aforesaid frosted slides which they happened to have stashed in the back seat (?prayers), then finding out that a certain acetone fixative was lacking for the stain, more money for more motorcycle fuel to track the fixative at another hospital, then having the mother turned away from the lab for lack of gloves, providing gloves . . . meanwhile the interns looked at this kid and couldn't believe he was still alive.  By Friday this was still going on and I decided to just start treating the child for TB anyway.  He actually improved over the weekend.  And today his mother FINALLY (AFTER TWO WEEKS OF RUN AROUND) got her sputum sample:  triple plus positive for TB.  So instead of a dying child and a more slowly dying mother, or a child who was treated empirically for TB only to be orphaned when his mother died of the disease or re-infected when he went off therapy  . .. now we have hope of two people being cured and living normal lives.  

And the real story here is the same story as Kevin's . . . it is God who is looking out for individual lives.  Most times the degree of difficulty involved and the sheer volume of other demands would have meant that this child and his mother slipped through the cracks.  Many mothers might have also wearied of the rigamarole and gone home by now.   But in this one small case, God kept prompting one more step, one more try, until the diagnosis and treatment were complete.  Because He cares about the African Child, not just as a politically correct concept, but as an actual flesh and blood and tubercle bacillus-infested individual who will one day take deep breaths and perhaps graduate from high school or build a house or write a story.  Or just carry water for his mother.


Daring to care

A friend sent this link in response to the posts a while back about the importance of investing in sports for girls, which makes for good "Day of the African Child" viewing:

Separation Woes

Scott and Caleb drove to Kampala today, and tomorrow morning they will
board a BA flight to America. Scott was encouraged months ago to make
this trip by members of his high school class who REALLY wanted to see
him at their 30th reunion, but the decision was finally made to go in
response to his dad's recent bike accident and illness. They will go
to California to see the Myhres and thank the Half Moon Bay Methodists
for their support at a service on the 21rst, as well as preach three
services in the Wyoming Presbyterian Church (a Cincinnati suburb where
he grew up) on the 28th. Sadly for us, to keep the trip to two weeks
Scott will miss a Sunday at our main supporting church Grace OPC in
Vienna, VA, instead attending a mid-week Bible study to thank our
friends there. Caleb will also go to the annual Aylestock family
reunion, and there will be lots of good food and grandparent time and
hugs and stories. They will be in four states on two coasts in two
weeks, so it will be a pretty packed time.

Meanwhile Julia, Jack, and I are attempting to hold down the fort at
home. No small thing. Just before he left, Scott, with Nathan's
brave help, moved our very mean and dangerous bull away from the
paddock by our house to the yard at the old Tabb house. For safety.
But our cow DMC just stood at the fence and cried her little heart out
all evening. And I could so relate to her! Her husband is out of
sight, and her calf might as well be at boarding school since they are
separated by a fence (to prevent nursing so we get the milk). A few
hours later, the gate was left ajar and the calf Truffle entered her
mother DMC's paddock. So there were Jack, Julia, and I all with
sticks running around in circles trying to get them apart and drive
the calf back into her proper quarters, an exhausting and futile
exercise until cowgirl Julia got some dairy meal (like oats) and lured
her. Thankfully I had turned off the stove at the last minute so
dinner was saved, but if this first night is any omen for us and the
cows, the next two weeks could be a doozy. Now DMC is moaning and
alone again. She has the separation woes, and so do I.

Monday, June 15, 2009

You Know My Heart

The Barts posted Psalm 139 on their blog with the news that Kevin's surgery for replacement of his aortic valve is scheduled for today at 1 pm (Duke time, 9 pm here in Bundibugyo). Join us in praying that the same God who knows our spiritual hearts, our hopes and longings and sins and weaknesses, will also know Kevin's physical heart and guide the team of surgeons and staff to give him many more years of life on this earth. His recovery to this point has been nothing short of miraculous. Looking forward to more of the same today.

back to the community

Over the years we've trained traditional birth attendants, community health workers, nutrition outreach volunteers, peer educators . . . all people whose role and qualification comes from being respected members of the community rather than from degrees earned in school. In a place with limited manpower, this cadre of informal, unpaid workers forms the backbone of primary health care. Fifteen years ago no one but our WHM predecessors (Dan Herron, Lori Borchert) seemed to be attempting much of this in Bundibugyo. We found our way to the Uganda Community-Based Health Care Association and bought their manuals, incorporating spiritual as well as physical lessons on health. Over time, though, our role has become less direct. Team mates such as Pamela and Stephanie and Pat worked more recently with these volunteers, and bigger programs such as UNICEF and the Belgian government put lots of money and effort into scaling up this kind of training and organization for the whole district.

But today John Clark launched a new wave of community health outreach. Thanks to contacts we made in the last year with a program called NuLife, we were able to send two of our great agriculture/ nutrition extension workers to be trained to teach village health workers about infant and young child feeding, particularly in the context of HIV/AIDS. This organization, funded by USAID and working in close partnership with the Uganda Ministry of Health, has developed a nice set of teaching aids to bring basic health and nutrition messages to the village level, and to teach dedicated village health team members to screen their population for malnutrition. Instead of waiting in the hospital for the kids to come to us, these village health team (VHT) members will actively search out those failing to thrive. This dovetails nicely with our other health-center and hospital based programs for moderate and severe malnutrition. And this prepares our district to receive the commercially prepared high- calorie food supplement which NuLife hopes to begin manufacturing. That is still a ways down the road, and as a medicinal food it will only be given to the most severely malnourished and those with AIDS, so again there is complementarity with our BBB local-production for moderately malnourished kids.

Over the last few months a good amount of aggressive advocacy was required to get our staff included in the trainings, and to try and hold together the various partners involved. But now I am enjoying the teamwork, dropping in to see our trainers drawing out the 20 VHT's in a participatory way, noting that a good number of those chosen for the training are HIV-positive people themselves taking an active role in their own care, thanking John who saw to all the details of transporting and feeding and informing and facilitating the people involved in this event. The training will go on all week and end with a community launching ceremony. We pray it puts information, inspiration, vision into the hands of the people.

Rwenzori snowcap melting...

Bundibugyo in the news again. Not much good news comes out of here.
It seems that the AFP news service recently visited our little corner of the world. An article entitled "Lifestyle melts away with Uganda peak snow cap" popped up on our Google news page, complete with interviews of local Bakonjo folks who are witnessing the warming effects. The article mentions that the Rwenzori glacier has shrunk from 217 hectares to only 19 hectares in the last century.
At that rate, they estimate it will be gone by 2023.

Sunday, June 14, 2009

Motivated by Love

We have been spending time in the story of the lost sons, the "prodigal" son and his sulky brother, the forgiving father and the feast, from Luke 15. The parable serves as a mirror as we see too much of ourselves in the sons, but also as a beautiful goal of becoming like the father.
First, the younger son, who broke all the rules by breaking away from his family, forcing an early reading of the will, cashing in the ancestral property and spending it all on his new friends and life. Perhaps because Scott is about to go visit our families, I have found this part of the story suddenly uncomfortable. How much are we as missionaries like this son? We have left our families, traveled to a far country, and spent our lives prodigally, in the sense of giving beyond our means of time and energy and money and life. And there are certainly days when the pediatric ward (running at 200% capacity lately) feels a short step away from the pig-sty, when the thought of returning to cobble together some sort of safer life sounds very appealing. How much pain have we caused our parents and siblings over the years by our absence? How much of the nobility of the "missionary call" is a holy veneer for independence, for setting ourselves apart and defining ourselves by who we are not? This is the younger son's approach.
Then, the older brother. He wants justice, he wants rules, he wants to be right. As Tim Keller points out, it is his very "goodness" that threatens to separate him from the reality of relationship, that makes him unwilling to come to the feast. Easy to see myself here, judging the world in such a way that I feel more noble, more helpful, more spiritual, or more persecuted, than the average person. So much so that life becomes a slaving drudgery of good works.
Both brothers are actually quite similar, using the father's property for their personal gain, insecure in their positions, jockeying, seeking identity by NOT being the other.
In contrast, the father. Who does not worry about looking foolish as he runs to welcome the younger son. Who does not tally up the losses as he throws in his robe, his ring, his fatted calf. Who does not allow the older son to sulk but seeks him out, and reaffirms that all he has is this son's. This character shines out of the story as the one person who is motivated by love. Not by freedom, not by maintaining his personal rights. And not by victory, by winning the argument or being proved correct. His only desire is to see both sons come in to the feast. Yes, the sons' behaviour has consequences for their life going forward from the dramatic point of reconciliation. But they will face those consequences together, in relationship.
So what would it look like for my life, for our lives as a family, as a team, to be purely motivated by love?
I suppose it would look like a pretty big party, a slaughtered calf and a lot of music and dancing. Something to dream and pray towards.

Rising Up

In church today, the sermon text was from Acts 14, where Paul is stoned and dragged and left for dead.  But the disciples gather around him, "and he rose up"  (v 20).  We feel that we have had a distant glimpse of a similar miracle with Kevin.  JD's mom told us today that he's up out of bed,  Walking.  Talking.  Eating.  He remembers the past well, recognizes everyone, is very coherent, and even the initial glitch of short-term memory/retention is improving dramatically and speedily.  This is such a rapid return of life that we are all amazed, grateful.  From life support in the ICU  to walking down the hall and talking to his wife and kids, in 2 1/2 days.  I told Mrs. Johnston that if I ever experience sudden death, I hope JD is near by!  The first two responders were a man with a cell phone who called 911, and a man who pulled over and jumped out of his truck having just completed a life-saving certificate.  He and JD clearly did an excellent job to keep blood flowing and oxygen entering in all those long minutes of pulselessness.  The wife as a warrior, fighting for her husband's life, is an image I have of the event.  On their anniversary, no less.  

I realized with this good news, too, how we've all been in a collective suspended state of uncertainty, waiting for news, and if that is emotionally draining seven thousand miles away then it must have been nearly unbearable up close.  Please continue to pray for the Barts as the week unfolds, as the work now of isolating the trigger of the arrhythmia, and correcting it possibly surgically, will be necessary.  

Meanwhile that collective relief is also palpable at school, as Kevin's former students and staff contact us frequently for updates, and as the anxious stirring of unrest and violence seems to be diffused for now. We may not be gathering around physically, but the Ugandan disciples have gathered spiritually.  As the young man leading the church service said today, there is not a single family in the congregation whose life has not been impacted in some way by Christ School and the Barts.  Many are giving God glory for this miraculous rising up.

Friday, June 12, 2009


Just got an email from Scotticus, who says Kevin woke up, is breathing
on his own, and even talked to JD a bit. He will rest now for the
night. This is so miraculous, such good news, my fingers tremble even
typing. Of course there is far to go and much to know, but even this
degree of recovery was faster and further than was anticipated. So

Continuing to pray

Thanks to all who labor in prayer for the Barts.  Tonight the only staff member left at CSB who has been serving since the very beginning spent time reminiscing with us, which was helpful for both his family and ours.  He glowed with hope that if God orchestrated this near-death event to occur with such miraculous timing and location for rescue, surely He can bring Kevin through the coma.  We have lived through too much inexplicable suffering in Uganda to make any prediction that we know God's intentions, except to testify by faith that His actions are motivated, always and in every situation, by love.  It is mid-day Friday in America, and over Friday evening and night the slow process of warming Kevin's temperature back to normal and then withdrawing the paralyzing and sedating drugs will occur.  Perhaps by Saturday, but perhaps later, there will be subtle signs that will give the doctors and JD some clues about the extent of injury Kevin's brain incurred in the long period of his cardiac arrest.  This period of unknowing is very difficult, like the disciples huddled in the upper room, dreading and assuming the worst from Friday to Sunday.  Let us pray that we, like they, will experience the amazing resurrecting power of the living Christ.  

Here is the link to the Bart's blog for updates:

Thursday, June 11, 2009


Kevin Bartkovich, our long-time team mate and friend, is in the hospital in Durham NC in critical condition.

He had gone out for a jog with Joe yesterday and collapsed within a hundred yards of the house. Thanks to Joe's calls for help neighbors called 911 and started CPR. JD ran out to find him with no pulse or breathing, and continued the CPR herself until the ambulance arrived. He was in ventricular fibrillation, the kind of arrhythmia that causes sudden death. It turns out that he has a previously undiagnosed congenital anomaly of his aortic valve, which occurs with some frequency (at least 1 out of a hundred people) but does not usually cause any symptoms until mid-way through life, and then the first sign can be this kind of sudden collapse during exercise. The paramedics had to shock his heart three times; the third time in the ambulance finally got it beating again. Kevin was without vital signs for at least 5 to 8 minutes. In the Duke ER he did try to fight the tube in his throat for breathing, and opened his eyes, so those are hopeful signs. He is heavily sedated, medically paralyzed, on life support, and cooled down to a near freezing temperature, all to try and minimize the damage to his brain from the long period of no oxygen. Preliminary tests indicate he did not have a "heart attack" (myocardial infarction) or a stroke; the collapse was due to the electrically ineffective rhythm his heart went into.

Yesterday was the Bartkoviches' 15th anniversary. I can only barely imagine JD's experience of finding Kevin lifeless on the street and doing the first CPR she's ever had to perform, on her own husband. By the time she got her 4 year old twins cared for and got to the hospital, she had no idea if Kevin was alive or dead, since she had last seen him put into the ambulance after the first two attempts at defibrillation were unsuccessful. Her family, and many friends, have rallied around her now. His prognosis is far from clear, he is certainly not out of the woods, but we hope and pray that he will recover without major impact on his brain. He will eventually need a replacement of the abnormal heart valve.

Where is God's mercy? We can not see it as clearly as we would like; we say by faith that it must be there. Here are two glimpses.

One, since this event stems from a life-long silent heart defect, it could have happened any time during the Barts' ten years in Africa. Kevin's final weekend he hiked over the mountain pass with teachers from CSB, a strenuous endeavor hours from any road or phone, not to mention hospital. He coached soccer and jogged around the school track. If v-fib occurred here, he would not have survived. Even if he had gone down most places in America, he might not have been revived in time. This happened five minutes from one of the premier medical centers in the world. This is a small vision of the way God sends His angels to keep us from stumbling, even when we don't know it.

And glimpse number two, this occurred in the midst of Christ School crisis. Yesterday the students were becoming very restless and threatening violent strikes, the immediate issue being the school's new policy of having a "spot exam" (pop quiz) period at the end of every day. The bigger issues are complex, related to being teenagers, poor, reckless, with little to lose, no skills for non-violent conflict, distrustful, many with histories of abuse and abandonment. We got the news about Kevin while students and staff were in the midst of meetings over their complaints. The meetings turned into prayer meetings for Kevin. This was a needed reality check and change in focus, at least for the day.

Please pray for the Bartkovich family, for bigger views of God's glory and merciful care as they walk through the valley of the shadow of death. And pray for the school that they devoted a decade of their lives to found, for us to see God's glory and mercy there, too.

Monday, June 08, 2009

Hitting the pavement

Tim and Doug landed Monday morning: we basically waved Luke through security and as he entered the ticket line for his flight back to Nairobi, we ran down the stairs to the arrival area to greet Tim and Doug. Grief, parting, juxtaposed with greeting and beginning new relationships. Doug had been en route without sleep for two days so he opted to crash into bed on arrival, but Tim had spent the last several weeks within an hour of our time zone (in Spain) so was up for immediate adventure. Since we had a lot to accomplish in one day, we left the kids at the ARA and Scott and I split up, and I was very thankful for Tim's company. We plied the minivan taxis out to Mukono where our student Basiime gave us a campus tour of the impressive Uganda Christian University, the Anglican-founded institution. He led us to a professor whom we had contacted earlier as a potential educational consultant, for a brief but hopeful meeting. Back into Kampala, crawling traffic, crumbling side walks, profusion of wares, bodas weaving in and out of traffic, sunshine and breeze. Next goal was the top of Namirembe Hill where the Church of Uganda has offices for the diocese of Uganda, including a director of education. Another interesting meeting, then a walk around the hundred-year-old cathedral and the sobering gravestones of the missionaries and Ugandan believers whose lives were spent to establish churches, hospitals, and schools more than a century before. Gives one perspective. By this time I knew I was starving Tim, but he was good natured and kept going on a few bites of samosa and a bottle of water. Next stop, the EGPAF country offices, where the early report had been that we would not only fail to receive medicines for our patients, but due to some clerical misunderstandings the funding expected for closing out the project as we transition to Ministry of Health leadership, was cut off. Needless to say the prospect of returning to Bundi 20K dollars short of expected funds and empty-handed of medicines was not appealing. After an unsuccessful morning meeting there, Scott had left to run other errands and plead for prayer and planned to return in the aftenoon. Mercy preceded us, so that by the time we met up there about 3 pm the person whom we needed to see returned for the first time to work from two weeks of being sick . . . and the director looked upon us with favor, so that the whole situation was turned around and we left with at least a temporary supply of two of the three medicines we needed, and a plan to recover the funds. Scott had filled the back seat with groceries, and so by 5 pm the three of us were heading back to the ARA together, celebrating God's care in allowing us to advocate and bless the people He has called us to serve. Now if we can just work out a funny click and play in the steering column, we could pack up and head back to Bundibugyo today . . .

Saturday, June 06, 2009

A Weekend Off

A weekend off . . . perhaps seems ill-timed in the midst of
desperation. We are grateful for those who have written and called in
support of the AIDS-drug crisis. Lots of foot-work and phone-work on
Thursday we hope will pay off by Monday, as we have appealed for a
portion of the limited supplies. Not a long-term solution, but still

But a mercy of God is that with a kid at RVA, we take a mid-term
breath-catching pause. From Friday to Sunday this week we are a
family first and only, putting aside worries about patients and
robbers and polio and funding and the future. Our job, for the
weekend, is to be with our kids. And they're a pretty fun group to be
with. This is what they like to do: play ping pong and tennis and
soccer, swim and read novels, watch Mythbusters and World Cup Football
qualifiers, eat Thai, Indian, and Italian food, catch a movie in the
theatre, laugh at Calvin and Hobbes jokes, jump on the trampoline, and
read some more. And talk, about schools and travel and people and
chaos and God. It's a welcome break from the day to day reality of
Bundibugyo. We are usually on the move, heading to a conference, a
meeting, or at least a game park when we're on a school break. This
weekend we're just in Kampala, impersonating a normal American
expatriate family going to restaurants and relaxing. It's been great.

And we're back at the ARA (the American Recreation Association), a
place where we have history, where some of the same staff watched
these same teenagers when they were toddlers learning to walk and
later to swim. This is the very room where we landed to recover from
rebel attack in 1997 without a single change of clothes to our name,
where the managers let us rustle through the lost and found. Year by
year as Bundibugyo became home, the ARA also reminded us that we're
still Americans, too, who like a hamburger and a room with a fan. It
has been a safe place to escape into order, a place of respite.
Sometimes all the more frustrating for the illusion of American-ness
without the reality, sometimes a disconcerting dose of parallel
universes of rich and poor . . . but mostly a great escape.

So we're thankful for the weekend off, storing up the memories and the
resilience to hit the ground running again on Monday.

Wednesday, June 03, 2009

On heaviness and enlargement

My soul melts from heaviness
Strengthen me according to your word . . ..
I will run the course of Your commandments,
For you shall enlarge my heart.

These verses from Psalm 119 (28, 32) jumped off the page for me this morning.  My soul is dragging.  Some burdens are part of the territory of love, loving kids who cry when their heels hurt, loving team mates who struggle with the negative aspects of this culture's intrusive neediness and manipulation, loving patients who can not get the medicine they need, loving a piece of this earth that has been scarred so deeply by evil.  Some of the burdens are part of the territory of sin, wanting to fix things my way (phone calls and letters to newspapers can be good, but underneath I know my own heart is not fully right), the weight of self-righteousness and self-justification that has to be uprooted daily.  And some of the heaviness comes from not knowing the territory well enough to distinguish WHERE the heaviness comes from or how to lift it. So Psalm 119 offers this:  the concrete truth of God's word, brought into our souls to enlarge them.  Truth leading to expansion.  It would be easier to protect my heart than to enlarge it, and the temptation is strong.  Sometimes I don't even want to make eye contact with a parent of yet another child teetering on the edge of survival.  And there is a legitimate limit to the pain I can absorb, and a God-given command to rest and refresh, so I am looking forward to a weekend of respite in Kampala with kids.  However I would also pray for a large-heartedness that comes back from the rest to embrace the battle once again.


Today I saw 6-year-old Anita, who has been my patient since birth. She was one of the first children started on ARV's (antiretroviral drugs) in our clinic, and responded wonderfully. Her CD4 counts are excellent, her mother caring and faithful. She does not miss appointments or forget to take medicines. She is exactly who USAID, EGPAF, Uganda MOH, JCRC, Baylor, etc. etc. labor to save, and infant who would likely have died by now but instead turned into a growing normal-looking girl. And up until today, she represented the way things are supposed to work. But today, there was not ONE SINGLE antiretroviral pill in our clinic, or in any other clinic in the district. We've watched the supply dwindle. We've made reports, follow-up phone calls. We've switched regimens to economize and use every possible pill. We've been told to ration, to not start any new patients on drugs, to be patient ourselves, to hang on because the supplies are coming. But they never did. The margin has long been tenuous, but the shocking truth is that today dozens of clients left the hospital without medicine. By next week half of the hundreds of people on ARV's in Bundibugyo will be off therapy. And even more shocking: a phone call to Kampala confirmed that this is a nation-wide stock-out of drugs. What happens in the world if one of the countries with the highest number of AIDS patients, one of the places were the epidemic began and gathered momentum, suddenly takes thousands and thousands of patients off meds? In the short term, some people who were barely surviving, early on therapy, will die. In the long run, it sounds like the perfect scenario for a drug-resistance nightmare. I sat outside our clinic in the hot sunshine after my phone calls, crying. Crying for Anita, for injustice, for the inefficiency and poverty and poor management that led us to this point, crying for my own frustration of impotence to do anything about it (these drugs are tightly controlled and not available to just run out to the store and buy). So at least I will give voice to the Anitas of Uganda.