rotating header

Friday, August 30, 2019

Half-Empty or Half-Full?

This is a petrol station. At various intervals along the road, one sees little boxes or tables with two, or at most three re-purposed plastic water bottles now filled with fuel. In the mornings the gasoline glows pink with the rising sun as I drive east towards Bundibugyo Hospital. There is usually a quarter-litre (1 cup) or a half-liter (2 cups) option.  Which means, people are buying gas a cup at a time. For comparison, that's 1/16 of a gallon. And when was the last time you only bought ONE GALLON of gas, let alone one sixteenth of that?

My first reaction to these stands is that they are the picture of poverty.  Poor people buy in small, small increments, because that's all they can afford. A boda-boda (motorcycle taxi, interestingly the name is literally "border, border!" because that's what taxi drivers called out to attract customers, hey, who needs a ride to the border?!) gets a passenger, then stops to top up his tank with a cup or two of petrol. There is no margin to keep a full tank, only the eeking-by lifestyle. Sadly this means the poor pay more. No Costco-bulk discounts are possible when you buy your sugar, your washing powder, your oil or eggs in tiny packets. 

But when I step back, I also realize these little stands represent progress. Hope. Development. I notice them now, because when we lived here before, they did not exist. The road didn't really exist; it was a muddy marrum path winding up and down the terrain twisting around potholes and boulders. Certainly bodas were much fewer; and there was no easy and available transportation to town. Petrol stations did not really exist, we had to lug extra jerry cans of fuel from Fort Portal. When we first came, plastic water bottles didn't exist, and while I can't see their proliferation as development at least recycling bottles is better than throwing them on the ground.

So is the tiny petrol bottle half-empty or half-full? Is this a picture of poverty, graphically demonstrating the limited purchasing power of the people moving about in Bundibugyo? Or a picture of positive change, that there are roads and motorcycles and people willing to buy rides?
Zoomed out for perspective, I think these stands represent can-do innovation (note the creative balancing here), entrepreneurial spirit, appropriate provision of resources, efficient transportation, and the harbingers of change for the better.

And this parable probably represents most of our life. It's easiest to focus on on the half-empty nature of all that is wrong. Where is the staff, why is there only one nurse on a ward of 50 patients showing up at 11 am? Why is the power off so the laboratory shuts down? How do I respond to this mom telling me the children's father abandoned them and her own father died, so her child is hungry and she's desperate? Where did the day go, as I try to finish rounds, and am stumbling over words, hours in Lubwisi leaving my brain drained? What did I miss on the patient that died yesterday? How do we confront a system in which staff were busted for falsifying a patient chart in order to steal medicine? How can I get the clothes dry when it rains incessantly? What will we eat tonight? Where will the money come from for the needed improvements at Christ School? How can we recruit more people to pour love into the floods of school kids around the district? Will the judge decide fairly about our disputed land? Will Ebola pop up on one of our teams this week, as another patient from Congo crossed into Uganda with the disease? These are real concerns of this afternoon.  A lot of half-empty vessels. An aching sense of the not-enough. And lamenting them is both important and Biblical.

But the truth is more complex, and more hopeful, more half-full. Here are examples from yesterday and today:

The hospital staff this morning, engaging with those hard questions and coming up with ideas.

An opportunity to teach makes me glad to be on the team.

Fresh paint, even half-full-up-the-wall, definitely improves the classroom block.

Fixing a leaking roof morphed into re-doing this block of staff housing, and it is unrecognizably better.

While we wait to welcome new team, enjoying the sweetness of our summer small-team.

Sampling of new text books for CSB, thanks to donors.

New doors for the dorms to enable us to move the new metal beds in and out!

Scott on his never-ending project inspections . . 

And working with the school bursar to parse the budget, helped by a new computer.

The nutrition team teaching moms to mix milk for their hungry kids-thankful for partnerships that bring food to the hungry.
Action photo in the nutrition office, lots of energy poured into evaluating and treating all these kids as this is the hungriest season. 

While we pray and hope that one day rampant thievery and rebel threats and disobedient students will cease, so that we can live in easy harmony in our urban school setting, for now we really need the safety of a stronger fencing wall, first section in progress. 
Day three of therapeutic feeding, and he's holding the cup with appetite! Still a lot of swelling in his body, but this cup is definitely half full.

Hope you can look at your day and acknowledge the half-empty places, but then get a perspective on just how half-full your life might be. And thank God for that.

Saturday, August 24, 2019

Home again home again, jiggity jig and into the mire . . .

Saturday in Nyahuka and while literal pigs are going to market, we are thankful to be 1. Together 2. Back "home" in Bundi 3. Reunited with the truckload of stuff we packed last December in Kenya. 4. Hearing the news that Steve moved to rehab. What a week. I will recount a bit here since I know people prayed, and it's good to tell the realistic side of the inter-continental life which is more disjointed than one might think.
the goods arrive--shelves, chairs, a bike, a fridge . . .

While I was being re-routed through Munich to Brussels to Kigali to Entebbe, Scott was on the phone continuously with the truck contractor and our clearing agent. As I landed late Thursday night (24 hours later than scheduled, and with neither of my two bags making it) the truck was spending its third night hostage at the Malaba border. It seems that in the list of requirements for importing our household from Kenya to Uganda, they forgot to mention that we would need a personal interview with the Uganda Revenue Authority.  So 7 am Friday we headed to the URA headquarters in Kampala. It took us a while to figure out who we needed to see, and the supervising person was pretty unpleasant at first since our agent had not made a required appointment. He sent us out to come back at a time more convenient for him, with about 20 documents that we were thankfully able to download from previously applying for our work permit, to prove we were missionaries, that we had lived in Kenya, that we now had work permit/visas for Uganda, that we were with a recognized tax-exempt NGO, etc. We really had no idea what we'd do if he refused to clear us, but thankfully our relationship improved with each passing hour and by 1 pm we were all smiling. Thinking the truck was going to be on the way any moment, we skipped any errands or meals or shopping, and hit the road to reach Bundibugyo by not-too-long after dark.  Which we did, pretty exhausted from multiple flights, time change, the murkiness of getting through tax exempt, the 7+ hour drive. As it turned out, the Malaba border agents managed to still delay the driver until 6 pm!  So we thought they would sleep in Kampala and perhaps arrive this evening.

But as we walked to the market this morning to buy eggs and fresh milk, having stopped in at Christ School to check on the flurry of projects initiated during the student break between term 2 and 3 which started Friday, we got a call that the truck was arriving! They had driven straight through the night, from the eastern to the western border of Uganda.

Thankfully we could call one of our foster-son old students who collected one more, and they helped us take everything off the truck and re-stash it in a room we had built back in the day as a guest room between two containers at our old house. There is a mirror that the Massos gave us as a 20th anniversary present, and it survived moving to Kenya and back to Uganda once again. Kind of amazing. It's complicated, but for now we will stay in our borrowed quarters (the Dickensons have been graciously allowing us to inhabit their place) but as they return and others leave our former house will be empty mid-October. We didn't want to wait to bring our appliances and furniture then, because we have new team mates and meetings and a CSB 20-year party and a language intensive and a pastor training . . . all before we move. So this was the best time. I pulled my keyboard and bike out, and Scott reclaimed the nearly-defunct espresso machine. Otherwise we are trying not to mix our things and the Dickenson's so we will wait to unpack for another two months.

Steps forward and steps back, as always. Uganda is feeling more like home. But within an hour of our successful truck arrival, we also had an email threatening a law suit from someone who is working against us and the mission here. But, that's OK, it's why we are going to all this trouble to move back for this season. The Kingdom comes, but in slow increments. A few months ago, I remember being very moved as we sang "there is power, in the name of Jesus, to break every chain" in the church service at Kibuye in Burundi. At that moment, my heart was full of prayer for the adoption of a team child to be finalized after two years of angst and delay. That chain was broken and she is forever part of the family now. God sees the details, the single orphan, the marginal school, the struggling church, the near-death episode. And we trust that the power which brought us to this point will see us through, in spite of those back-steps and weariness.
midnight dinner after putting in claims for lost bags . . . still hoping they are found!

Wednesday, August 21, 2019

A blurry week, a miracle save, 4 countries, and not quite home

Typing this from an airport hotel en route back to Uganda after a family health crisis drew me back to America Sunday a week ago, and moving all our household goods from Kenya drew Scott there a few days go. Deo Volente, and I mean that sincerely because at this juncture we cannot assume the next minute . . . Scott and I and a truck loaded (and unloaded, and reloaded, and jumbled) of furniture and appliances will all reunite in Kampala tomorrow.
Monday 12 Aug 
Tues 20 Aug

Quick story because I've not posted here though about a thousand or so people heard and prayed via facebook, instagram, my sister's church, caring bridge, our mailchimp prayer letter, and a myriad of other networks. My sister's husband Steve felt unwell after mowing the lawn 11 days ago, sat down in the bedroom, and by God's mercy my sister and niece returned home from errands and walked in to find him gasping and passing out as he went into cardiac arrest from a life-threatening arrhythmia. Janie started CPR, the EMT's responded amazingly fast and well, four shocks later his heart was at least beating again, and so began a saga of vigil in the ICU under a cooling, paralyzing, induced-coma protocol to find out how much brain and other organ damage ensued from the period of near-death, and to find out what caused all this in the first place. I heard about it a few hours into the ordeal and by evening was able to pick up, pack, drive with Scott to Entebbe (a convenient 7.5 hour airport trip) and fly to Charlotte. At that point we knew the odds favored not surviving or surviving impaired, and I just wanted to be with my sister and her family in their moment of crisis. As the week wore on, Steve woke up and though we haven't had detailed neuro-psych testing he certainly seems very normal now, talking, answering Jeopardy questions and sports trivia, juggling details about future plans, telling stories. He's got a few sore ribs from the excellent CPR that enabled him to survive, and his body is weak from the long days of being on a ventilator. But with some physical therapy and time we expect he will rebound.  As to the cause, his cardiac cath showed 95% blockage in one of the three essential coronary arteries, which the doctor opened non-invasively by placing a stent. On the tiny possibility that the strangled blood supply to his heart was NOT the cause of it going into ventricular fibrillation (the non-beating spasm rhythm that caused his arrest) he has also had a medical device implanted under his skin below his left arm. Leads will continually monitor for return of the v-fib and if it is detected, deliver an automatic shock to re-set the electrical impulses to normal.

Needless to say, I've been reading and researching every couple of hours because the medications and procedures for a middle-age male in high-tech USA are NOT the ones I use in my day to day life in Uganda.

Meanwhile back at the ranch, Scott stayed to deal with a sad (truly we grieve when young people make harmful choices) situation of some of the same kids at CSB who were inspired to riot in June deciding to steal several hundred kilograms of staple foods (rice, cornmeal, sugar) from the supply store.  And once that was sorted out, he's been working on the term 3 budget, complicated by lots of financial loose ends from the administration change (which gives us more confidence the change was needed), and then he headed to Kenya to meet a truck we hired to pack up our "stuff" from a storage container.  Back in December 2018 we left our rented house in Naivasha and packed everything (beds, curtains, mattresses, table, shelves, kitchen wares, washing machine, fridge, stove, photos, books  . . ) into a storage container thinking that we would save on rent since we didn't yet know where we'd go after our January to May time in Uganda. Well, we have been clearly asked to stay longer in Uganda and we see a lot of value in that, so we thought we should probably just admit it and move there for the next season. We've camped out in the Dickenson's house since January, but they return in early November.  Our old house will open up mid-October. We have a half-dozen things going on then and so we wanted to get the cross-two-countries move accomplished early, piling it all into storage in Bundibugyo until October.

Which brings us to tonight.  My flights were delayed causing me to miss my connection to Uganda, so I'm in Belgium for about 21 hours. Scott just arrived back in Uganda, but the truck is still at the border where it has been stuck for two days. We met with Uganda Revenue Authority people and border clearing agents before we even made this plan, and tried to go by the book and follow the procedure, and were told with our work permit and the East African community we would not have to pay taxes,. But of course the border agents seem to be holding things up for their own hope of gain. Praying that by this time tomorrow night, we're all together (maybe even my bags from the flight too, it was total chaos in Charlotte when I left with delays and cancellations on United so who knows).

As we wrap up this time of going in crazy disparate directions, this time of near-loss and intense-investment, here's a few things we're thankful for:

  • The technology and funding to respond to our family. Our families give up the day to day or month to month or even year to year assurance of relationship, and it takes a toll that cannot be erased by one timely trip, but it helps our hearts to be able to just BE with them.
  • The excellent response Steve has had to all his care, with hopes of a full recovery looking realistic and not fantastical.
  • The fact that 3 of our 5 (everyone but Luke and Abby) live in NC now meant Julia, Jack, and Caleb all came repeatedly to Charlotte to cheer us and help us. And the cousins got more time together than they usually get in several years. In spite of the somber circumstances, we had some good meals, card games, talks, walks.
  • The bonding blessing of serving each other that deepens ties.
  • The CSB staff resilience and unity as they worked with Scott on another week of hard decisions.
  • The safe trip so far of our household items across dangerous roads in Kenya. Still praying nothing is too badly damaged or stolen in the process and we don't get extorted.
  • Some good news in our Area, particularly a ten-year funding grant for medical education in Burundi, the LaRochelles flying into Nyankunde (DRC) tomorrow, the newest teacher for Litein Sarah Pleasant being cleared to arrive this month in Kenya.
I'm running on a couple hours of airplane sleep so that's about as clear or eloquent as it gets at this moment. Thanks for joining our story and rooting for Steve and praying for all of us. We do live under the Mercy.

Monday, August 12, 2019

An evening miracle: on healing hate

Blog readers may remember the end of the CSB football season, when a crucial match against our rivals at St. Mary's Simbya ended with me rushing a bleeding teacher out of an unruly mob of their students who had punched her in the face, and Scott getting tear gassed as the match devolved into chaos and soldiers fired guns in the air.  It was frightening and dangerous and a depressing reminder of the way that a sense of scarcity, of fear, of blaming others, of division, can escalate into violence. It was only a football match . . . but underneath was the perception that CSB wins too often and the perception that Simbya was cheating. Each side skeptical, wounded.

Multiply that by ready access to automatic weapons, and you have El Paso and Dayton and hundreds of other American events. When we choose to see others as threats to our survival or just success, as less human or deserving of life, it is a short jump to throwing punches and rocks and pulling out guns.

There are many things I admire about Africans, but one of them is the readiness to forgive. Our CSB staff, since the changes in administration, have been looking for ways to reconcile with Simbya and in fact to demonstrate a spirit of collaboration with the district. Scott has spoken of this numerous times and his leadership shows. Yes, we are deeply invested in Christ School, but as a means to the end of life for Bundibugyo in general. We can only educate a few hundred students per year; it is good for the people if there are other strong school options!

So when we heard that the CSB staff and Simbya staff planned a "friendly" football match, teachers against teachers, we were hopeful but nervous. We had not met as schools since the violent implosion. And we knew that the best laid plans for reconciliation can be derailed by thirst for victory, by competitive spirits, by perceived slights.

On Friday evening, the two schools fielded squads of teachers. I had envisioned a slow-paced mixed male and female low-talent game.  But no. Each school put their youngest, fittest, fastest teachers on the pitch, including some stretches of the definition to recent grads who may have once helped teach something. Crowds came in the gate, students cheered, the sun was setting as rain clouds threatened.  CSB was behind, then scored the equalizing goal minutes from the end. The match ended 3-3.  Perfect.

But what happened afterwards was even more amazing.  All of the students who attended from both schools were seated on the midline, for a short ceremony. One of our teachers, Baguma Godfrey, preached the Gospel of reconciliation. Unity. Love. The students were laughing and happy, hugging and relaxed. Then each head teacher (we have our deputy acting as HT now) was given a chance, and the DJ played dance music over the loudspeaker as these two men busted out moves!! The students went WILD with delight. Then Scott was called up and he did the same! It was festive, joyful, fun. Talk of mutual success, of academic collaboration as well as sports. We have already shared exam preparation materials with the association of secondary schools.

In the old days, clans in this district held dance competitions as a proxy alternative to warfare. I think sports and music and dance all give that opportunity to excel and shine and be seen, to blow off steam and prove oneself, without death.

Let's pray that this spirit continues in Bundibugyo. The pitch was a swirl of color as the uniforms from two rivals mingled, the music played, and everyone left hopeful. Nothing prevents violence as well as the humanizing lesson of actually being together face to face.

So let's support people who respect our common humanity, promote understanding and the mutuality of success in a non-zero-sum universe. And those with some good dance moves.

Basime is the school librarian whom we sponsored for university . . he has had more than his share of sorrows (orphan, nearly blind, lost first child) but his two daughters are about the cutest ever. Here he is in uniform with his post-game fans!

One of our greatest joys is reconnecting with our kids' friends. This young man took the parallel Ugandan path of service to Caleb's American one. He was on leave and came to visit.

Tuesday, August 06, 2019

The grace of five and two

Today I had an hour-long conversation with our newest Serger, approved a few weeks ago and optimistically hoping to arrive mid-Fall to teach MK's at Rwenzori Mission School and otherwise assist families.  This will be the first year I can remember that we will begin the school year teacherless. Meaning a brand new family will hit the ground homeschooling for the first time, and our medical family will have to cut back their work and return from Home Assignment essentially full-time homeschooling too. And when our sole kid-focused worker does arrive, bear in mind that she does not have a teaching degree (though she does have kid-program church experience) and that our team this year is exploding from zero kids now, to 15 when we turn the corner into 2020. Depending on how we define school age, 7-8 need regular lessons and another 3-4 could use preschool. In most of our time in Bundi we had two teachers at a time. . . . so this year looks humanly difficult to say the least.  Thankfully this new Serger has a flexible attitude and a heart of gold.  Pray for her.

Earlier, Scott went through a tally of critical-priority projects at Christ School.  Like fixing a leaking roof, or replacing cooking pans with holes in the bottom, or buying 200 needed books (that's only 2-5 copies of any given text, to be shared, but we have 6 grade levels and more than a dozen subjects). We're not talking about luxuries here, we're talking about fixing doors and repairing a fence and buying Bibles. We tried to do the math through to the end of the year to see which would be possible.  Certainly not all.

Yesterday, within minutes of arrival at the hospital, I'd been pulled in to see a baby with a massive congenital defect of his abdomen, probably not survivable, and we couldn't find a single sterile bag to place over his exposed intestines. Then a child on his last breaths because the oxygen cylinder was empty and his blood transfusion and malaria treatment delayed by lack of IV access overnight (the handy junior doc threw in an intraosseous while we gathered the other supplies). Then a kid who nearly drowned in a pit because of the heavy rains and standing water, and critically ill even ten-year-olds with malaria not to mention all the toddlers, and even more depressing, we re-admitted a child who was severely malnourished and has TB because last week he caught measles from the kid in the next bed.  It took five hours to plod through the entire crowd of mattresses on the floor and people in the hallways, examining and doing my best to understand, decide, calculate, write, and communicate quickly then move on to the next.

Always, the need far outweighs the resource. 

Always, that seems unjust.

So the story of the loaves and fishes popped out in a new way once again. Overwhelming crowds, hungry, distant from solutions, disturbing a needed rest, expectant, needy. Twelve learners, who throw up their hands in exasperation and half-jokingly say, here's what we have, five rolls and a couple of dried fish. Only Jesus does not laugh, or explain, or problem solve. Instead, he immediately thanks God for the tiny resource they have.

And then he spends it, breaks it, gives it away, and it multiplies to satisfy them all.

Maybe I can remember that tomorrow, to thank God for the one vial of medicine instead of complaining that I need a hundred. To thank God that an old friend wrote today and sent money to replace the sauce pans, instead of feeling discouraged about how little of the fence we can fix. To thank God that we have a kid-volunteer, even if we need an entire elementary-school staff. To offer up what we have, not begrudgingly or ironically but with true thanks. Because the paltry limited resources we have are the very place where God is at work. Our constant imbalance and need keeps us from feeling superior or smug. Our dependence on others throws us into the same boat as everyone around us. It actually IS good for us, even though the uncertainty of it all feels as painful and ludicrous as it must have been to start serving thousands of people with a handful of fish.

It is certainly to the glory of Christianity that it has been most insistent on the point of responsibility to others whose only claim upon one is the height and depth of their need. This impulse at the heart of Christianity is the human will to share with others what one has found meaningful to oneself elevated to the height of a moral imperative. But there is a lurking danger in this very emphasis. It is exceedingly difficult to hold oneself free from a certain contempt for those whose predicament makes moral appeal for defense and succor. It is the sin of pride and arrogance that has tended to vitiate the missionary impulse and to make of it an instrument of self-righteousness on the one hand and racial superiority on the other. (Howard Thurman, Jesus and the Disinherited, as quoted by the Center for Action and Contemplation blog)

WE don't have the abundance from which to feel loftily generous.  Instead we have a desperate need hour by hour, day by day, just like our neighbors and friends, and by staying in the place of discomfort we just might be holding the basket as a witness of a miracle.

Monday, August 05, 2019

Surfing the Wave of Transition

When the moon pulls and the currents flow, washed up water recedes and a force of new water rushes in.  And a few people get to ride right on the crest of that turbulence, which can be exhilarating. Or one can feel like drowning.

This, it turns out, is cross-cultural life in a place where tradition is in flux, the old is sucked out to sea as the new crashes over our heads.

And perhaps nowhere as clear as in music.

Yesterday we spent a very sun-drenched political 8 hour spell attending a presidential visit to our district (to be respectful of our local leaders who asked us to come).  And prior to that, like every week, we attended the church service held at Christ School.  Both were events with a fair amount of music and dancing, which led us to reflect. At CSB we have 260 kids from the primary cultural groups of this district, Babwisi/Baamba and Bakonjo.  They have grown up with the receding influence of a rich cultural tradition built on family, community, spiritual fear and vulnerability, flutes that blow an airy minor scale, stamping feet and jostling bells, stringed damos with their twangy riffs, rustling grass skirts and the strong syncopated percussion of goat-skin drums. We used to hear this regularly at night, as any family with a death would be gathering to honor the departed and ward off potential spiritual harm. Sometimes it was close enough to feel eery, other times it was distant and barely perceptible. Or at circumcision ceremonies, or official gatherings. In the even older days there were competitive dances, a way for the young people of one clan to challenge another and perhaps find partners. (The best groups still come to things as important as presidential visits.)

Then came a handful of outsiders, with churches and hymns, mosques and schools. Then came the radio, with music from Uganda and beyond. Then cell phones and internet and the world-wide culture of music videos.

Now in 2019, these young people have as much or more exposure to YouTube as to clan gatherings. Dance moves that perhaps originated on this continent and evolved have beamed back by satellite. So on any given week, our musical exposure might include:

  • multi-part harmony slow acappella voices singing a hymn tune that might be familiar, with translated words
  • a group of a dozen girls singing a praise song that one of them wrote using a traditional Lubwisi cadence and tune, and dancing in a shuffling loop that nods to traditional dances, while one or two boys drum their hearts out
  • a group of six or eight or ten lip syncing as they do a choreographed, high-energy dance with moves that would be admired on any hip hop stage, to a reggae-sounding gospel track from Kampala or Nairobi
  • a string of common worship songs that would be found in any large pentecostal East African church, in Swahili or Luganda or morphed into Lubwisi or even in English, shouted out in a clapping stomping breathless stream
  • a hillsong-type American track in English being played as a student sings into a microphone, striding back and forth across the stage with a virtual keyboard/guitar/drum accompaniment
  • or if we go for double-church-services, historical western hymns translated into Rutooro words from across the mountains set to slightly jauntier tunes that have been around for decades now
Culture is never static. And the late-teen population seems to me to be the ones to pick what moves them, what appeals, and somehow ride that wave of past and future cresting into the present. Stirred (we hope) by the Spirit, and grounded (we hope) in the truth.

*Scroll down and watch the videos with audio!

Love in the time of cholera, parties in the time of Ebola . . . bleach handwashing stations as we approach the presidential venue, a school ground with tents and chairs for the VIP's and a smashed-together standing room crowd for the rest.

After washing hands, each person screened for temperature

The warm-up speakers, Members of Parliament and Party loyalists, elevated in a truck to be seen and heard.

The President in white, accompanied by his plain-clothes secret service and a hovering drone, walking from his chair of honor to his own special podium-truck from which he lectured the crowd on saving money and building a prosperous country. He noticed our presence when making a point contrasting traditional inheritance (divide between sons, something he is not in favor of) with European (which he feels tends to pass land intact to one one family member) referring to "I see you have some outsiders here with you" which the MP translated "You see Dr. Scott here with us".  Ha. 

Friday, August 02, 2019

A Year of Ebola as we end the week and begin the month

A year ago, we were preparing for our East Africa retreat when we got the news of a new Ebola epidemic confirmed in the DRC . . . followed shortly by a dreaded phone call from one of our teams that they suspected a case had presented to their hospital. We had to make hard decisions about their travel to the retreat, potentially bringing a world-panic virus across international borders and potentially putting at risk our entire Serge group of workers. Because the story didn't stack up and we were fairly certain their lack of connection to the early cases at that point meant the chance of their patient being an Ebola patient were very very small, we decided to proceed on faith, and all was well. But a year of mounting cases, the setbacks, the worries, the one actual exposure which occurred months later, the prayers, the anguish over our people and our Congolese and Ugandan colleagues, the scanning the news, the checking email, the phone calls day and night on holidays, the political insecurity, the attacks on treatment centers, the dwindling vaccine supply, and the relentless surging on of this virus takes a toll.
Our hospital entrance, but the handwashing jug here is empty and there is no one in the tent . . .

We remain peripheral. The one case that came to our Serge team's hospital in the DRC was handled with remarkable discipline, and NO OTHER CASES occurred from that patient. Our Bundibugyo team remains much closer to the past and current epicenter, but inexplicably protected. The bleach hand-wash station was empty when I checked mid-day, and the temperature screening tent was unmanned.  Yet God has been gracious to not allow the disease to cross over to Bundibugyo.
the red arrow points to our DRC team, the green arrow to our Uganda team, the box is the epicenter and the size of the circle reflects the number of cases. 

This past week was significant for the epidemic, however, because for the first time, Ebola was not only carried to Goma but transmitted in Goma.  Goma has been under scrutiny for some time, as it is the largest city in the region with a million people, and sits perched on the Rwanda border close to the Ugandan border too. It's a gateway type of place where international NGO's set up their programs. And until now, it was far enough south of the epidemic to be safe. But a father-of-ten miner working hundreds of kilometers north evidently passed right through the hot zones on his way back home to Goma, and picked up an infection which went unrecognized for a week. He and his 1-year-old daughter are dead, his wife is sick, and between him and his sister who fled town there are now another 200 at-risk contacts. Meanwhile the DRC's minister of health resigned when the President's office took control of the epidemic response, and the epidemic was finally declared an international emergency, as two new attacks near Beni by the ADF disrupted that epicenter and many other Congolese fled to Bunia displaced by a separate internal war.

Everyone points to the Congo as the reason this epidemic is smoldering. People are mistrustful. They attack each other. They refuse to be vaccinated. They lie about their origins or symptoms, they disappear, they don't follow protocols.

But what if it's actually much more complex than even that?  For instance, if there was a nearly universally fatal disease that had spread over a large portion of the state of New Jersey and infected 2,713 people killing 1,823, and there was a vaccine 97% effective, wouldn't we have immunized everyone in New Jersey by now?  Think about it.

Or if the New Jersey epidemic caused an influx of Russian and Iraqi doctors, who started driving around in flashy cars and upbraiding Americans for dwelling on the Cold War or 9/11 as ancient history and telling them to trust the new treatments they had brought, would people be lining up for care?

Or if the government and world approved funding to build a brand new hospital that would be dismantled as soon as the epidemic was under control and placed it in the very place where New Jersey residents lacked care, would they consider that to be legitimate?

Yes, Eastern DRC is a complicated, murky, often dangerous environment, but focusing on that seems to me to border dangerously on blaming them for a problem that the vast majority of those infected have little control over. That strikes me as hypocritical coming from a country where the anti-vaccine movement thrives, where people get their facts from social media, consume calories and avoid exercise to their death, and support the right to assault weapons even as the number of school shootings rivals the number of Congolese rebel attacks. We're all pretty much the same.

It seems to me that the best thing we world could do now is to:
1.  Ramp up vaccine production and immunize the entire region.
2.  Send in long term bridge-building people who are willing to do the hard and risky work of taking on life in Eastern Congo alongside the Congolese, listening, working together on common goals, generating trust.
3.  Fund the small local on-the-ground hard-working health workers who are the front line day in and day out.

None of that will be easy. Uganda is way more functional, yet today my first few patients were all children with malaria and severe anemia and THE MALARIA MEDICINES WERE OUT OF STOCK. The nurses were late. People kept jamming their problems into my hands. So much felt out of control--a child sent two days post-op from a complex neurosurgical procedure with high fevers and cerebro-spinal fluid leaking out of her head, a child with TB infected by an uncle whom we have yet to track down but suspect drug resistance, a child who has spent three weeks with an infected wound that almost never gets bandage changes, a child in pain with sickle cell disease who has not had pain medicine dispensed, trying to problem-solve so we can split vials of medicine and share doses, a child with malnutrition not improving whom I gather from the dad and the neighboring beds is rarely on the ward because the dad takes him home between rounds to care for his other two kids since his wife left him, a patient with measles breathing virus on the open ward because the isolation order wasn't carried out.  Not a single patient with a vital sign taken. It is just this side of complete chaos and frustration. But minute by minute hour by hour God's people touch, listen, think, talk, care and slowly by slowly, patient by patient, treatment is given and transfusions hung and a remarkable number improve.
Reasons to hope: a faithful mom of twins feeding her malnourished cuties, and the team that enables her to get the food.

Another reason to hope: data.  The Kwejuna Project that Scott started has become standard care for the District, and here we are in a weekly staff meeting poring over HIV and TB follow up and outcome data !

Likewise, a year on, Ebola is still lurking and spreading, but the people of Congo are also still hopeful, loving, fighting on, working, caring for each other, performing educational dramas, tracing contacts.  Slowly by slowly the good will prevail. Just wish it could be a little faster and more definitive!