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Tuesday, September 24, 2019

A Wedding after a Funeral

The above could be the story of life.  First there is death, then resurrection. First there is suffering, then joy.

Twelve years ago, we were in another busy Fall season, when mysterious deaths began occurring and we ended up in the midst of an Ebola epidemic. Our closest friend and colleague Dr. Jonah Kule died of the disease, and in the aftermath of that sorrow, we developed a program to send a handful of young people to medical school in his honor.  One of those was Dr. Ammon Bwambale, sponsored by the Laura Case Trust, who is now the medical superintendent and our boss as we work at the hospital.  (And cute enough, another redemption, the little boy and girl excited by the bride and groom in the photo above are two of his four children, both born very prematurely and both miracle survivors!). Another was Dr. Baluku Morris, who excelled in med school and was chosen by the government to be trained as an anesthesiologist. And who this weekend married his best friend, Phoebe.
with Dr. Ammon at reception

On Sunday, we found ourselves sitting in a church in Bundibugyo Town, with Dr. Ammon opening and leading the initial part of a wedding ceremony where Dr. Baluku was getting married. It was an 8-hour marathon of waiting, worshiping, eating, dancing, clapping, listening, speeches and prayers. First in the church with, then processing in cars through town honking horns, and then at a local restaurant venue with tents and booming speakers. At some point in the church service, it occurred to me that this day of joy would not have happened without the time of sorrow a dozen years before. Ammon and Baluku Morris would not be doctors, would not be leaders. We might not have even known them at this point in their lives.

Instead, this day burst with true happiness.  My favorite moment was when one of the dance groups played a very traditional scale and beat, which inspired about half of the seated audience of hundreds to move out of their chairs and out into the grass and join the dancing.  It was so spontaneous and people looked truly joyful. There are not many people from Bundibugyo who reach university, medicine, specialization . . . so the celebration was of marriage but also of hope.

Early in the day, Scott said, at least this is one party where I don't have to give a speech (after several unexpected invites over the prior few days). But mid-reception, it was announced that he would. And we are glad he did have the opportunity to remind people of Dr. Jonah, and of the way God brings good out of evil.

Outfit change to something traditional, long live Wakanda

Here is a quote from Kate Bowler's podcast interviewing Nora McInerny about grief: " Yes, I have a life I love and a life I miss.  Yes, I'm filled with happiness and gratitude and with an eternal ache.  Yes, we have all been broken before and yes, we could break all over again. The years will roll on, more joy, more pain, more possibility, more yes, more and more."

Saturday, September 21, 2019

The centrifuge of suffering

In Bundibugyo, the Paeds ward is a centrifuge that applies a centripetal force upon all the misery of the world and distills it down into the bodies of dozens and dozens of small people.

This beautiful place, like all others on our planet, has a hidden brokenness. As we round the mountain curves to return home, I see the smooth amazing pavement which has replaced one of the most difficult roads in the world. I see the outlines of palms and the vibrant green of banana trees, testaments to rainfall and abundance.  I see songbirds and sunsets, hear laughter, creativity, resilience, commitment.

But spin the globe a few times, and then enter the ward to see what settles out. Malaria, malaria, malaria, and the nurse tells me they lost one last night because the quick-acting and effective artesunate is out of stock. My first patient is a newly admitted 4-year-old, gathered on the floor on a mattress with her mother and little sister. I can see her skin is tortured with scabies (a mite) and her face puffy with marginal protein in her diet. Her baby sister's clothes, her mother's thin-ness . . . I am nearly certain that if we tell them to buy artesunate in a clinic, they won't be able to. We have a national medical store that supplies the district, but our population is large and growing, our malaria progress has stalled, the rain this year never stopped, and the vials of medicine run out too fast. We try giving her an oral dose which she immediately and dramatically vomits out. So I end up driving into the market and finding a private pharmacy where I can purchase 8 vials.  8 lives. $1.67 per life.

A few beds later, an 8 year old with HIV/AIDS. I had seen her just before I left for Serge meetings, suspected she was failing treatment, and obtained a specimen container from the lab for her to cough into to diagnose possible TB. We enrolled her for nutritional help, talked about medicine compliance, and left the student doctor to follow her.  Two weeks later, there she was. About four times someone had re-written the same plan in her chart, but nothing had happened. Her attendant grandmother did not have the understanding to complain, to push, to advocate. She lost the specimen container.  I found her not eating, breathing fast, coughing, vomiting, dangerously thin and dehydrated, not getting medicines, patiently waiting for a miracle I suppose. Caring for advanced immunodeficiency requires a fair amount of resourcefulness. To keep up with pills, with check-ups, with care. Clearly the decimated body of this child showed her family could not manage. We found an NG tube and I pulled a nasty looking fluid out of her stomach; not an ideal specimen but hoping it might show us if she has TB. We restarted meds, and a new plan for milk and hydration. The HIV virus is not highly prevalent here compared to many areas, but even 3% of 300,000 people is still 9,000 sorrows.

Across from her, a 2 year old with pale hair, big eyes, swollen limbs, skin ulcerations. His mother left him with his father as the marriage dissolved. His father, it seems, was nearly blind, in his 60's and in poor health, and really had no business getting this much younger woman pregnant.  Months later, he barely found his way to our outpatient nutrition program with his son having dwindled to near death, and the team quickly realized the need for inpatient admission. Thankfully the "divorced" mother's mother, the child's maternal grandmother, surfaced to stay with him in the hospital. His wounds look much better, but he lays stretched in the bed, listless. And his caretaker grandmother complains that while she gives him the therapeutic milk, she has nothing to eat herself. Adults suffering sorrows and making choices and having relational rifts that spin down to nearly kill a child.

Another twenty patients, sickle cell anemia, transfusions given, wheezy coughs, pneumonias, too-early weaning from breast feeding leading to intractable diarrhea, abscesses. I'm almost to the back wall when I see teeth way to big for the mouth of what looks like 3-month size baby. This twin is over 2 now. The mom tells me a story about going into labor too soon, delivering on the way to the hospital, an evidently poor birth outcome leading to severe brain damage. The other twin though looks normal. Something about this baby's spasms just grabs my heart, she really looks like she is suffering. How is it to be this mother and watch this happen, hour after hour, month after month, year after year, in a place with so few options? How is this baby even alive?

And so it goes. The day began with a nearly two-hour all-staff meeting about laboratory quality improvement, and ends with Jessie and I in the District Health Office trying to make sense of the large numbers of malnutrition patients in our books versus the small numbers in the hospital's reported cases. It takes a lot of time and effort to identify the point of the gap, and set up a meeting for Monday. Both of these sessions are very important, because donor money demands results, and the lab and the nutrition help we get will not continue if the data does not show competence. The list of problems to overcome to make changes seems daunting: interruptions in electricity, a broken generator, no service for the machines, running out of paper, out of medicine, out of forms, out of uniforms, out of staff, out of time. This hospital was designed to have 100 beds and serve a population of probably 50,000 in the 1960s. (Uganda and I are the same age, and population in the country in my life has gone from under 7 million to well over 40 million. ) The budget for Bundibugyo hospital for operating expenses (not counting the staff salaries and the standard medicines supplied by the government) is $12,000 A YEAR.  I suspect that keeps a comparably sized American hospital running for about 10 seconds.  So we problem-solve where we can, improvise, document, fund-raise, teach, help.

Budgets, education, lack of supplies, politics, power, accountability, belief--these huge and nebulous issues are hard to even grasp. But when the centrifuge spins, they bore down into the tiny lives left covered in insect bites, apathetic with hunger, shaking with fever.
Lord have mercy.
Give us wisdom and stamina.

Friday, September 13, 2019

An open letter to the question - are missionaries just modern colonialists or white saviours?

Dear person who might consider supporting Serge in East and Central Africa-

You are very correct to note that the history of Western involvement in Africa is a mixed bag at best, and the harm has been monumental. We have lived in Uganda and Kenya for 26 years and would be the first to acknowledge that for every way that we have sought to lay down our lives and show the love of God, we have done so with impure motives, pride, false assumptions, exasperation, superiority, and at times cynicism. We are still a work in process ourselves, not to mention the work we do.

However, if your concern is to support a cross-cultural effort that is founded in partnership, focused on empowerment, and genuinely living out the Gospel, your church would be hard pressed to find a better investment.

All of our teams in East and Central Africa exist at the invitation of our African partners. We do not work anyplace as lone rangers. There is no place that we call the shots or impose our unchecked will. In every new endeavor we first seek invitation, and we only go where we are asked. I will speak specifically of Bundibugyo, since that is where we are currently based, but the principles are broadly similar in our work in Kenya, Uganda, DRC, Burundi, Malawi and South Sudan.

Church—the handful of churches planted by Serge are part of the Presbyterian Church of Uganda, which is fully self-governed and self-supporting. We attend one of them, and the Pastor and elders are all local people, the worship leader, the music, the choirs, all leadership is Ugandan. Americans are participants in the congregation only. Our role now is to bring in occasional training, to pray together, to be friends.

Bible Translation and Literacy—the area’s language was unwritten when we came, and listed as a priority for SIL/Wycliffe. Our team started the project, which is now fully in Ugandan hands, with SIL providing consultation checks a few times a year, usually remote conferencing. The New Testament is complete and printed. We supply a local office space to the translation team and some minimal support; the rest comes from the community and SIL funding. The local translators are plugging through the Old Testament. Our team has brought in Ugandans from other parts of the country to do literacy work in the primary schools and funded literacy training materials, again the model of partnership.

Health Care—we very specifically never built a clinic or hospital, but from the very beginning worked completely in partnership with the Ugandan Ministry of Health (government, though other teams work in partnership with African church hospitals). Over the years we have funded rehab and upgrade of various infrastructure projects, extended immunization outreach, trained traditional birth attendants and community health workers, sponsored dozens of nurses, lab techs, doctors for training, and provided clinical care alongside our Ugandan colleagues with ongoing medical education. We work in a government referral hospital where the medical director is a Ugandan whom we helped train, and is now our boss. We work under the supervision of the Ugandan District Health Officer as well. Our role is to empower and work alongside as equals. The healthcare system IS getting more trained Ugandans, though none yet with the level of training and experience our team provides. Many of our other teams are integrally involved in medical education at the student, intern, and resident level, offering both expertise and discipleship.

Water—we built the original gravity-flow water system in the area that saved countless lives, but now the entire engineering/water/sanitation system is managed by Ugandans, with our engineer providing consultation or doing specific projects under their authority.

Youth Work—we have a library which we open to kids after school, and have at times done evangelism and discipleship through sports. Like the other outreaches above, this is in partnership with the Ugandan church. On some teams we work through sports to equip coaches as positive, loving figures in a child's life; on others we have equipped teachers in trauma healing.

Education—the one institution we did build was Christ School Bundibugyo, at a time when this district was in the very last place in the country for educational achievement. The purpose was to have a Christian secondary school that would train leaders in the District. That school now has a Ugandan head teacher and full Ugandan staff, including some graduates who have gone on for further studies.  Serge provides orphan scholarships for about 15% of the students, and a half-tuition-subsidy for the other 85% to enable the poorest people to access education. This half/half partnership with local Ugandan parents is, in our opinion, excitingly fair. Our board is 10 Ugandans and 2 missionaries. A missionary still works in a role of mentoring the head teacher and staff, and providing accountability for finances and direction for the spiritual care and overall trajectory of the project.

When we moved to Uganda we also assumed that 10-20 years would be fully adequate for a complete handover of all our assets and work. In fact, at the ten year mark, we led our team in an “exit strategy” retreat. We invited three respected African church leaders who did NOT live and work with us in Bundibugyo so had no skin in the game, to speak into our lives as a team. Should we accelerate our departure? Was it time to move on? They were familiar with the place and our work, and they told us NO. Bundibugyo, they said, needs the kind of change that is generational. They advised us to think on a longer timeline. So we did.

If you think about it, it makes no sense to Africans that what took Americans 300 years to achieve (moving from very basic hunter-gatherer existence with 50% child mortality and about a 40 year life expectancy . . .. .  to a very industrialized society with paved roads, running water, sophisticated health care, universal education and literacy, electricity, and 5% or less child mortality with 80 year life expectancy) should be achieved in Africa in 30 years or less. And that is speaking nothing of the spiritual journey. Our culture has had Judeo-Christian influence for centuries with high rates of access to the Word, and yet we still struggle. Imagine having only had the Bible available for the last two years. Bundibugyo had very limited contact with the outside world prior to 1950. The world view of the average person is still very much shaped by fear of ancestral spirits, and the great harm the spiritual world can inflict.

So yes, Africans are in charge of Bundibugyo. We do not work independently in the church, in health or education, or anything. Nor do we want to. But we do believe that the call to take up the cross and follow Jesus to all nations, to come and listen and work and serve in the most difficult places, is still relevant. Why? This morning my Bible reading included Micah 6, and we have verse 8 on our prayer card, so it’s as good a summary as any.  What does the Lord require of you, of us? To do justice, love mercy, and walk humbly with God.

JUSTICE-this is one of the primary themes of the Bible and a core character of God’s nature. American Christians enjoy a high proportion of the world’s wealth and education. As a pediatrician, I choose to work on the continent with the majority of the sick kids with the least doctors. It just makes sense. I did not deserve to be born to parents whose work and opportunities allowed them to purchase a home and cars, to live in a country where a public high school and state University gave me a solid education, to have excellent medical training, clean water, abundant access to electricity and books, almost no exposure to fatal diseases as a baby, and on and on. Even living in a remote place on the Uganda/Congo border, it is hard for me at times to imagine the life of my neighbors. Until I would be content for my own kids to live with those resources, I should be working to improve them.

MERCY-Thankfully, God does not only operate on justice, because all of us receive much better than what we deserve. Jesus modeled going to the margins. Jesus walked the dusty obscure roads, and lived His entire life in poverty and transience. The parables talk about seeking out the lame and the blind, calling those on the edges to come to the feast. Jesus spoke of being encountered in acts of mercy to the prisoner, the hungry, the naked. There is also a joy and holiness in going to places that are hard to survive in, to be the hands and feet of Jesus.

WALK HUMBLY WITH YOUR GOD--let me just leave you with that last idea about joy emphasized. Our team enjoys the people, the beauty, the challenge, the spiritual growth of living and working cross-culturally. It is a rich life in so many ways. Walking with God is a privilege we have. We love this life. It is also a path that leads to knowing God’s heart more deeply. And it takes decades for all this to happen. We keep learning. I probably thought I understood the place at the one-year mark more than I think I do now at the 26-year mark. Eugene Peterson and others write about the value of a long obedience in the same direction.

I have one more idea to add to that list, it is something I think about that is perhaps more from Ephesians 6 than Micah.  And it is this:
RESIST EVIL—we are in a struggle against principalities and powers that seek harm. And sometimes being an outsider gives us an independence, a platform that is harder for a cultural insider to have. A couple of days ago, I cared for an infant who was three weeks old.  Her father has AIDS, her mother was not yet infected at the time of her prenatal test. (Our team pioneered HIV testing and care here). But around her delivery time, this young mother was hospitalized and our team gave her nutritional boosts because she was so frail. She was also anemic, and needed a blood transfusion, something we have often supported. Sadly a few days after delivering and going home, this mother died. In most of the history of Bundibugyo, if a mother dies, the baby dies. It is assumed. But because we don’t assume or accept that, as outsiders, we say no, let’s do something for this baby. So we have a program that enrolls such orphans, and while we might give a few cans of powdered formula to tide them over emergently, our goal is to help the baby’s grandmother re-lactate. Yes, she is only in her 40’s and her youngest child is four, so it is not that difficult for her to produce breast milk again. For a few dollars of medicine and a few minutes of my day, I could talk to her, examine the baby, prescribe, encourage, and just be that little outside boost that helped the family bridge from death to life. There are so many ways that our presence is salt and light, that we draw a line against evil. One of the reasons we have kept our involvement in Christ School is that it is a tiny piece of the Kingdom of God carved out of a place that has known much darkness.  We don’t allow students to be beaten with canes.  We don’t allow teachers to sexually abuse girls. We don’t allow the staff to buy the answers to exams. We don’t allow sacrifices to spirits. We don’t allow extortion of parents. I promise you that those things are happening in many schools, but we have a role of being a little outpost to show a handful of students a different path, which we hope they will choose to stay on in their lives.  MANY have, and the impact shows! So there is a disruption that is good that we embrace. My husband and I did MPH degrees at Johns Hopkins on our first sabbatical. One of our professors there was actually a former missionary kid from India, and when we enrolled he was an emeritus professor of public health in his 70s. He wrote and taught about the power of the three-part partnership in transforming for health: the community must be involved to analyze and solve their own problems, the government must drive policy and provide infrastructure, and the outside “expert” catalyzes change by bringing new ideas, training, questions, connection.  I think that’s very insightful and applies to missions too. In fact, I daresay that our American churches could use some disruptive majority-world people asking hard questions about our patterns of evil, African missionaries to challenge our assumptions that it’s OK to be a church elder and live a lifestyle driven by consumption and accumulation, or to be a Sunday school teacher who is addicted to social media or gossip, or that it’s normal to worship only with people from the same social and racial background. We all have our cultural blind spots, and evil pushes in on all sides.

This has been a long answer, because we take the church’s partnership with Serge very seriously. I hope you and your staff take the time to prayerfully seek God’s heart on this. We don’t want you to go against your conscience and if you believe that your calling to the world is specific to your home town, and shouldn’t extend overseas, or that all cross-cultural commitments should be short-term, then our models would be incompatible and we would need to find our support elsewhere.  But for the sake of our missionaries and our partners on the ground, we do hope that you can come around us with blessing and care. And for your sake too, because I think your connection to people at the margins of your world will bring YOU blessing and joy.

Hoping to be your partners for the world’s good and God’s glory.

Thursday, September 05, 2019

Happy First Days of School: and next year yours could be happier!!

Next year, you could be having the best experience of your life. Don’t take it from me, listen to four voices below. I sent an email out to some former teachers with Serge, asking them to describe their time, and here is a sampling from the first installment of replies. I have grouped their long essays into five areas that most people mentioned as reasons they were glad they spent a couple of years teaching with us in Africa: the wonder of the people and place, the intensity of living in community, the uniqueness of the teaching experience, the relationship they developed with third-culture kids, and the impact on their personal life.  The voices below are from real men and women, serving in multiple countries, over the last decade and a half. If they inspire you, please take a step of praying and contacting us! As the 2020 school year starts, we anticipate needing a minimum of 7 teachers for mission kids and could use others in teaching and coaching cross-culturally too.

 First day of school, circa 1997, Bundibugyo

RMS in 2017ish (Rwenzori Mission School, Bundibugyo)

KHA in 2019 (Kibuye Hope Academy)

Ugandans and Uganda: Welcome and Beauty

I was a little hesitant  at first when I learned it would be rustic living and that we were so far from a major city.  But, everyday as I walked to the little school house and felt the warm sun and enjoyed the lush greenery and looked up at the beautiful Rwenzori Mountains, God would affirm that this was the place for me. (Anna D)

As a Christian it became clear that sharing a common faith with many Ugandans I became friends with, we had more in common than I thought! My Christian Ugandan friends showed me that we truly are brothers and sisters in our faith. (Pamela C)

What I did not realize in accepting the role to teach at RMS, was that I would also be able to serve in many other capacities on the mission team. I helped lead a small group at Christ School, helped to coach a cross country and track team, and work with the nutrition program. (Scott I)
Community Life

I also loved that I wasn't only a teacher, but a part of a team-  a mini picture of the body of Christ.  My teaching these children freed their parents to participate in healing in the local health center, run a large secondary school for Ugandans, provide nutrition and agricultural training, and most importantly together be sharers of the gospel.   I quickly developed a closeness to team that felt like family. (Anna D)

I loved cooking with and for others, enjoying meals together, praying together, seeing friendly faces as I walked down the road, walking and riding a bike everywhere, and just the simplicity of life. (Kim B)

My time with my teammates is one of my favorite memories of living in Bundibugyo. Team dinners, pizza nights, birthdays, traveling, Bible study, serving together, living together and being in close community was one of the best parts about being in Uganda with Serge. I miss my fellow team every day! (Pamela C)

Unique Teaching Experience

We had a sweet one room school house experience. We learned together, went for nature walks in the jungle, traveled to Kampala, Fort Portal and Kenya together as their parents needed to for different reasons. We had a cow and a pet goat living in our school yard, which entailed many mornings chasing an escaped animal or two! It was genuinely one of the best experiences of my life.  (Pamela C)

When I taught in the US I often left home in the dark, had an extremely busy day with, with over 100 students, lots of paperwork, and grading.  It was a gift to have 5 students, many less papers to grade, and a much more flexible schedule.  I loved taking my students on community field trips to see how cocoa was harvested, then fermented and dried.  We did nature journals following the cycle of the mango tree in our school yard.  We took walks to the river and collected local clay for an art project. (Anna D)

Although I was living in an intensely cross-cultural setting, the mission school provided a welcome haven for part of my day; a place where I could speak English without altering my accent and explore the treasures of children’s literature, mathematics, art, physical education, gardening, history and Christian education. With access to the internet, printing, and excellent textbooks, we had ample resources that made teaching in this remote, rural setting feel relatively straightforward.  Plus, the simplicity of an environment that was not ruled by technology allowed for a beautifully simple and sweet learning environment where we could spend time gardening, reading under shade trees, and using real dusty chalk.  (Scott I)

Relationship with TCK’s

I loved the depth of relationship I had with my students, and the freedom to involve faith in every situation. (Anna D)

Now 12 years later as I look back on my time in Uganda, my best memories are about being a part of my students’ life in school and outside of school. Eating meals with them, celebrating birthdays, holidays, etc. (Kim B)
Personal Growth

In some ways life away from the US was a lot harder and certainly different, but it had a richness that I had never experienced before, and I learned to walk more closely with Jesus and care more deeply about things that he cared about.  While I went with the hope that I would shape young lives, my life was shaped too in ways I could not have imagined. (Anna D)

God stretched me in ways that I didn’t picture for myself. I was pushed to be a leader and a friend to people that seemed so different from me. I saw the Gospel in a culture and context different from what I’d always known, and that helped me better understand my faith and who Jesus is. (Pamela C)

I realize the value of my experience when I think about how it’s changed my perspective of the world forever, and still impacts who I am today. I would not be who I am or where I am without my experience in Uganda and Sudan.I believe I am a better wife, mother, friend, stranger... because of my time with Serge in Africa. (Kim B)

Taking a leap of faith to “put life on hold” and take a year-plus to raise support, and move to Uganda felt like I was giving up something important, stepping off a track into a big, wide unknown. Now, 13 years later, I can look back and see God’s hand in re-directing in the paradoxical Kingdom way: in losing our life, we actually gain everything.   Before I moved to Uganda, I imagined fearful circumstances: insect infestations, heat, and an unfamiliar diet. While each of these concerns had some merit, what I gained living in community with mission-focused Jesus followers in a beautiful jungle setting and developing friendships with resilient Ugandan boys and girls – were gifts beyond what I could have ever imagined.  Those gifts were not only food for the journey in the moment, but seeds that grew into helping me to become the person I am today by allowing God to make me into something new.  It is impossible to imagine the story of my life today without the Bundibugyo chapter. (Scott I)