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Thursday, December 19, 2019

13 Magi and g-nuts, soya and morninga: a 2019 visit to the vulnerable

Today is day 12 post-flood and landslide.  Now the SUV caravans of UNHCR, CRS, Save the Children, Uganda Ministry of Disaster Preparedness, Ministry of Health, NGO’s that care for internal migration, the Red Cross, are moving up and down the road (or what’s left of it), calling meetings that suddenly disrupt normal work in the hospital or government, that pull people into the priorities that each group brings with their tarps and money. Mostly this will eventually be good for Bundibugyo. Some press, some concern, some supplies, some effort. Only one water system has been repaired to functionality, and Josh is still problem-solving and infusing some relief funding to keep the water tanker trucks filled and moving to the hospital and camps for the displaced.

Meanwhile though, since we have actually been living through all this rain and muck ourselves, and since we are connected to a small flexible organizations and donors who are quickly responsive, we were able to supply about 500 people with emergency survival items last week, and we’ve now completed nutritional surveys at both IDP (internally displaced persons) camps this week. We gathered and trained a team, purchased supplies, and visited one camp yesterday and one today. At each place we began with prayer and a good-news story, grounding the relief effort in the reality that even in sorrow, God sees and cares. Then women and children were registered, receiving books for recording health visits since their possessions were lost. We gave each child a dose of Vitamin A and emergency supplies of ORS (oral rehydration) and zinc (tablets) that they can use in case of diarrheal illness, a life-saving intervention after floods and rocks destroy waste disposal and cut off clean water. Next each was weighed and measured, then the results analyzed to identify any that were moderately or severely malnourished. In a normal situation, we’d expect 3% or less of kids to qualify. This week we found 16% of the children were malnourished (40 moderately and 5 severely, out of 185 screened).

The good news is that all of the children received a kilogram of supplemental protein rich food, a peanut-soya-morninga leaf blend that will boost their nutrition. The malnourished ones received a quadruple supply!  Plus antibiotics, and a follow-up appointment.

Hungry kids are vulnerable kids. Poor nutrition increases susceptibility to disease, and negatively impacts brain growth and development. It is one of the cycles of poverty that is very difficult to break without an infusion of help from somewhere—food to make people survive and thrive, heal and grow, learn and play, and eventually care for their own families.

Our team has had a focus on nutrition for decades, because it is an intersection point where spiritual truth, parity in relationship, justice in economics, wisdom and kindness in social circles, education and achievement, all meet. Real religion is just this: caring for the orphan and widow in their distress (that’s in the Bible).  In fact we are thrilled to have Serge Apprentice Jessie Shickel spearheading this program right now, and would very much like to have more help. The work this week not only identified and helped another almost 50 families . . . It was a visible touch of God’s mercy in a place that needs to see it.  It was an opportunity to learn new skills and serve for 13 mostly CSB alumni. It was a little taste of the Kingdom for us all.

And it was a reminder of Christmas (isn’t everything), because the young child Jesus was born displaced in a makeshift camp . . And then was sent fleeing as a refugee across borders. The magi came with their gifts, people of resource who studied the situation and came with their aid. Re-imagine the scene of the gold, frankincense, and myrrh, expensive gifts, as an aid distribution. Some portable goods the family could use to survive. Brought out of the respect and curious wonder of people from far away, who wanted to help.

Tonight we will meet with the district leadership and a number of NGO’s. The disaster response is hopefully turning a corner where the bigger agencies will take on an increasing role. Our team will continue to support nutrition and water, and look for gaps we can fill. And Scott and I will head tomorrow to our own Christmas break meeting our kids. We are deeply, deeply weary, feeling the weight of sadness around us, the desperation. At the same time, as much as we are eager for a break and for a reunion, we will truly miss this place for a few weeks. Where you pour your treasure, there is your heart. We’ll be back in January, hopefully with a little rest and perspective.

Let me close with a photo of our team this week, the young men and women who have worked hard to make all this happen.  These are my 2019 Magi.

Tuesday, December 17, 2019

Canaries in the coal camps: on children and malnutrition and Christmas and terror

We are now day 11 post-landslide and flood. The boulders have been bulldozed off the road. Three of the four wash-over spots have now been redirected to culverts, though a roaring muddy stream still churns over broken asphalt and a steep erosion at the worst spot. Silt and mud still fills many homes, and the barren rock fields that flattened and erased many homes remain as now permanent features of the landscape. Five days ago we distributed immediate survival relief supplies to 77 families. The government has been collecting a large store of beans and tarps and other supplies to deliver soon, and Red Cross has been providing some food relief in the camps. World Vision sent a survey team. And our water engineer Josh continues to network and trouble shoot, providing solutions on the spot. Yesterday, for instance, as I drove to the hospital I noticed way too many people lugging yellow plastic Jerry cans of muddy stream water up the hill to town. As soon as I saw the medical superintendent, he confirmed, the hospital is out of water.  Josh spent the day getting a tanker truck to be filled with 8000 Litres on our mission, then delivered to the hospital tanks.

But our main focus this second week is on the frailest of those who survived the floods, the children under age 5 and the pregnant women. A few days ago, as World Vision did their quick initial assessment, we got a call: can we help any malnourished kids? Jessie met the three they had found and admitted them to our hospital inpatient program. But with estimates ranging from hundreds homeless to thousands who lost something to tens of thousands affected in some way . . . Those three we knew were just the beginning. In our WV home area’s coal mining history, canaries were used in coal mines because they are so small, their little bodies succumb to dangerous build-ups of carbon monoxide before the levels harm miners. In the same way, the youngest children (and unborn with their maximally-stressed mothers) are the fragile harbingers of larger lacks. When the economy turns down, when there are droughts or floods or wars or epidemics, the first place we see the impact is in the bodies of the babies.

So Saturday evening, we had a planning meeting to generate the impetus for large scale screening of all under-fives and pregnant women in the two gazettes camps for displaced people this week. Monday Jessie and I came home from our hospital day to meet with the team our nutrition admin Bwampu had selected, training them to take weights, lengths, and mid-upper-arm-circumferences, to read charts, to record data, to dispense medicine and supplies. Today the boxes of ORS, zinc, Vitamin A, Amoxicillin arrived and are being packaged up into 400 units. Meanwhile the women whom we have been buying soya-gnut-moringa leaf home made plumpynut from for a decade and a half (thanks to our nutrition team in the 2000’s, especially Stephanie Jilcott Pitts and Scott Ickes who helped us develop this product and the little cottage industry for women to produce it) geared up to more than triple their production this week. Tomorrow we pray all this comes together for screening the first camp, and Thursday the second. Every child will receive an emergency pack for surviving the inevitable diarrheal diseases we expect to come, but the malnourished will be enrolled to receive ongoing supplemental high-calorie-density supplements.

All of this is possible because of the generous outpouring to our Bundibugyo Emergency Relief Fund. We thank you. We spent 2/3 on the distribution to the families last week, and the remaining 1/3 will fund this nutrition outreach, some of the water emergency solutions, and be held in reserve to combat cholera should it appear.

So what does all this have to do with Christmas? Generosity, yes, giving gifts to people far away who cannot in any way repay mirrors God’s gift to us. Presence, yes, standing with the soggy and trodden who were literally shaken to their cores follows the Emmanuel, God-with-us, reality of Jesus coming into a cave for animals, lying in a feed trough.  But a part of the Christmas story that rarely gets much press is found in Matthew chapter 2. The coming of God to earth was relatively hidden, humble, unexpected, but also accompanied by signs of a cosmic power shift for those who knew how to look. Stars moved, rulers pondered the implications. And one of those responded with a full-scale massacre. Herod sent his soldiers into the town of Bethlehem and all its districts, searching for male babies and toddlers, and killing them. Terror and weeping arose in the wake of God coming to earth. Mary and Joseph and Jesus escaped, but in the wake of their flight to Egypt many other families were devastated.

This is a mystery, one of those times the sword pierces our own hearts too. Innocent children still die as collateral damage in the war evil rages on Jesus. Yesterday, just as we were almost finishing rounds, Dr. Isaiah disappeared and then I saw him bustling to get gloves and a syringe. He called over his shoulder that a very sick child had just come in, and he was getting samples for malaria and blood transfusion. I followed him into the ward as the parents placed what looked to me like a very limp 5 year old girl in the table. “Is she alive?” I asked, which evidently had not been the question on anyone’s mind yet. I listened for a heart beat and watched for breath and checked her pupils all at the same time . . . Nothing.  She was cold, had been dead for some time. When I tried to gently tell her mother, her mother fell on the floor in a writhing screaming cascade of intense grief. Her father began to weep and pull out his Nokia simple cell phone and make a call. She’s gone. They had come to a private clinic on Friday in town, one run by a doctor who is assigned to another health center. But he wasn’t there, he was seeing patients for money. He appropriately realized that she was in poor condition and wrote for a referral to the hospital. I don’t know if they just thought they had to pay him money to get medicine, or went home to gather supplies, or didn’t understand, but three days later they returned too late. A voice was heard in our hospital, lamentation and great weeping, Rachel weeping for her children, refusing to be comforted, because they are no more.

The slaughter of the innocents puts an edge of challenge to the way Christmas has been packaged as coziness and cheer. Birth is joyful, but surrounded by pain and loss. Jesus is good news, but the reason we need that good news is seen in the lengths to which powers of evil play out in the easy death of the vulnerable. A star and an angel choir led a few witnesses to the diorama of the birth, but the unseen reality was mirrored in the raging soldiers and the crucifixion earthquake: this world is being shaken. The old ways of might makes right, me-first, make us great, take care of mine . . . No longer have the upper hand.

A landslide tore through Bundibugyo. Innocent children were the majority of the dead. And in its wake, the babies and toddlers and unborn will be the ones who suffer the most. This is the world we live in, but it is not the world as it should or will be. Because of that birth there is an entire process of redemption and restoration that is spreading like yeast, growing like a mustard seed. There are a dozen young people packing medicine right now, there is an engineer from Florida hauling water. There are women pounding peanuts into a buttery paste for the hungry. There is a young man who found Jesus at Christ School who is preparing a story of hope about Noah and floods and survival and God and love to share tomorrow to people who need to hear that truth.

Friday, December 13, 2019

#bundibugyofloods: this is real christmas

 Six days ago, the slopes of the Rwenzori mountains in Bundibugyo crumbled downward in multiple avalanches of boulders, silt, mud, water, trees, taking everything in their path. Some homes were filled with torrents of water and mud, others were pulverized into non-existence. Unknown numbers of people died; about 20 bodies were recovered in the first 24 hours but no one seems quite sure how many are still missing. As a team here, we witnessed the destruction, struggled to find passage through the buried road, and came face to face with the sorrow. The day after we began trying to feed some displaced people sheltering at a church, but as we shared the photos and saw the response from our friends and families, we believed we could do more. We requested and received immediate approval for an advance of $15,000 (Ug shillings 55Million) and the Serge Home Office worked quickly on Monday to code a web giving page and funding mechanism. By Tuesday donations began, and  we chose a team of 3 CSB grads with whom we have worked to manage the details. One, Sam, lived in the epicenter though his house was intact, so he had first-hand knowledge of affected families. Tuesday afternoon they were in the field registering an anticipated 50 families to help, which quickly became 70. Wednesday they traveled to Fort Portal over the mountains to procure supplies. We anxiously waited up for them that night as their miserably untrustworthy hired lorry broke down too many times to count. It was well after midnight when we finally started unloading in the Community Center. Thursday was a day to organize the relief and mobilize the people, so that today, Friday, 77 families could be served. These families varied from 2 to 12 people, but most were 8-ish,  so that’s ~500 affected individuals.

Each family received a life re-starter survival kit. Two mattresses, two sets of bedsheets, two blankets, a set of 8 aluminum saucepans, 5 plates, 5 cups, 3 liters of cooking oil, 15kg of beans, 25kg of rice, and two plastic jerry cans for carrying water - and Ush 50,000 cash.

The woman who lost everything, whom Scott found just sitting on a massive stone on Sunday, was there. A woman who had been struggling to get out of the sudden rush of flood waters with her one year old, and the one-year-old was swept out of her arms and never seen again, was there. Let that sink in. Six days ago, the raging flood stripped this mother of her child right in front of her eyes, right out of her grip. And on an on.

But today, the atmosphere was beautiful.

Scott shared from Matthew 1 about the prophecy from Isaiah foreshadowing that "the virgin shall bear a son and call his name Immanuel (which means "God with us").  He emphasized that despite the loss, the destruction, the sadness - God is with us.  And that these relief supplies tangibly express God's love and care today here and now.  He slowly detailed the Relief Package - and then said that many people would see that something was missing (and that might be different for different people-charcoal, matches, clothing, utensils).  In an effort to address those dashed expectations, we added a Uganda shilling 50,000 note (~$14).  A cheer went up that caused goosebumps. 

A few other thanksgivings...the team of CSB grads we worked with continually amazed us. John, Bwampu, and Sam led the effort but they drew in another dozen or more friends to load and off-load, to tally and organize. Long hours. Practical wisdom. The capacity to stretch the funds to 77 families instead of 50. The good decisions about what the essentials should include. Perseverance through mechanical setbacks and a grueling 8 hour trip. Meticulous records. An extremely well-organized distribution process with stations and documentation. Detailed thinking and forethought. And mostly, a pervading sense of the privilege of serving. Each told us how good it was for them to be able to do this, to administer God’s mercy in the form of donor largesse to people in their own community.  It is now possible in Bundibugyo to hand $15K to 20-somethings and have it accurately and efficiently spent for good.  That was not possible 15 years ago when we were managing our large grant from the Elizabeth Glaser Pediatric AIDS Foundation.  We had to do our own procurement and accounting.

Second, the team from World Harvest Mission (Serge . . . We kept the old World Harvest name in Uganda). The trauma of the landslides and flood knocked our hearts. Most of our team is pretty new, and young. We all felt guilty for even noticing our own inconveniences in the face of devastation, but it does wear you down to live for days and days without water and power and internet and phone, to have uncertain blips of service that disappear randomly, to be cut off by the road destruction. But this week we really saw the value of the opportunity to participate in Redemption. Rather than just bemoaning the brokenness, we were able to get up to our elbows in pushing back against the evil. Some of the mission kids even donated all their allowance money they had saved for two months to help a handful of affected families.

And thirdly, the survivors, with their resilient spirits. Their ability to be thankful, when this is far from justice. Their kindness and patience in waiting and receiving. Their delight in fresh new sheets and clean colorful household items. Their smiles when Scott brought down our boom box and blasted Christmas music through the day’s process.

Lastly, one more hidden beauty, our donors. So many responded quickly and raised the funds we needed to show this community that God sees. Emmanuel, God with us, rings true. We have a God who also suffered, who was also pierced and crushed by the evil of this world, who stands with the poor, who walks into the storms. Each person that sent their money became part of the visible love of God to Bundibugyo, part of the light that the people walking in darkness were able to see.

The impact of this rainy season, this time of rising temperatures in the Indian Ocean and torrential rains streaming down the Rwenzori valleys, will continue. Today we were able to directly help 500 people who lost everything they owned. But hundreds more people lost crops, or possessions, or relatives. Thousands and thousands have been put at risk by the damage to water systems. We have a long road ahead. But tonight as we wearily conclude this week, we are grateful for the picture of Christmas, of gifts, of redemption.

Monday, December 09, 2019

Bundibugyo Emergency Relief Fund Giving Opportunity

Two days have passed since the devastating floods and landslides which displaced and killed many in the place we call home - Bundibugyo District, Uganda.

Thanks to the hard work of many colleagues in Serge's Philadelphia Home Office, we may now receive donations to assist displaced families.

We hope to raise $300 per family to provide mattresses, blankets, cooking pans, and foodstuffs for 50 families.  More to follow if funds allow.  But we believe we can mobilize more quickly than some of the larger scale relief agencies which will come in with more substantial relief - but at a later date.  Our goal is a rapid response.


Sunday, December 08, 2019


This will be a hard post. A tragedy has occurred in Bundibugyo, a disaster of climate irregularity, deforestation, population growth. Who can trace all the causes? But the effect was dramatic and deadly. 

On Saturday morning, a heavy rain began in the darkness of pre-dawn. 2019's rainy season has been intense and prolonged. Making another rainy morning not so surprising.  . . But around 10:30 that morning the earth gave way. At Busaru, Kirindi, and the Tokwe bridge into Bundibugyo, at least three massive mud slides of rushing water and heavy boulders crashed down the Rwenzori slopes. The Kirindi slide split in two, so the debris actually crossed the main (only) paved road four times. 

When that force of water, of earth, of stone, is released, it destroys everything in its path.

The house above had a boulder run right through the back wall, with torrents of water. The news reported 20 dead. But there were most likely many more.

L, a former worker with our mission group here, was back in the district. She still runs a Bible memory club and comes to the area every couple months to supervise and have prize days. She had just finished her club and was driving back north to Bundibugyo Town for a wedding, and by God's mercy the slides happened behind and ahead of her. She was stranded though for hours. We drove the several miles up the road to the slide closest to us, meeting hundreds of people, rushing muddy water, banana trees and rocks all over the road, erosion, silt. We saw a house that had been filled with water and debris where the inhabitants had died. We tried to walk further to reach L but had to turn back. The military had arrived, and were assessing the damage. Thankfully the grader started working from the other side (Bundibugyo town) and reached her area, so she was able to drive out. Scott went back this morning (Sunday) and found the Red Cross actively documenting the damages and registering  those who lost homes and property. He ended up touring the disaster area with the local government officials.

This is the swath that was created through gardens, cocoa plantations, homes, hills.  A wide leveling of everything and nothing. 

Scott found this woman sitting on boulders where her home used to be. She had gone out that morning, as had her husband. She had only a small exercise book with some writing in it left. Many people were sorting through debris, finding anything salvageable, perhaps broken and dented roofing sheets that could provide temporary shelter. Below, some of her neighbors at a home that was mostly destroyed but not completely leveled. 

Even with photos, it is hard to describe the force.  

Psalm 46 says, God is our refuge and strength, a very present help in trouble. Therefore we will not fear, even though the earth be removed, and though the mountains be carried into the midst of the sea; though its waters roar and be troubled, though the mountains shake with its swelling.

Well, the mountains shook, the earth moved, the waters roared. And in the aftermath, we saw people pulling stones off of smashed motorcycles that had been swept from the road, following the trail of pooling blood to estimate where to excavate for bodies. The stone below that was stopped by a tree was about 8 feet across, yet tossed like a pebble. At least two friends have told of toddlers completely swept away, unfindable. 

A mattress, some timbers, a scrap of metal, all that is left of someone's home and life. 

It is hard to know how to respond, how to respect the people who have lost their lives, how to wrap our minds around the enormity of sorrow, let alone describe it. But I think it is one of our callings to bear witness. When you read about a mud slide, or a flood, those are real people who were one Saturday morning picking their cocoa or heading to market, washing clothes or cooking rice. A crashing unstoppable disaster swept through. And as people who live within a few miles, we should acknowledge their loss.

Besides bearing witness to the loss, we also bear witness to the resilience and kindness. The Red Cross and the government are actively seeking to assist. As a smaller organization with immediate access, we also have begun responding. A Christ School graduate, in fact the SAME young man who had helped me care for the mentally ill patient last month, lives in the epicenter. His home was spared but he told us about 50 people from 5 different homeless families were camping at his church. So the first need was food, and we could quickly purchase enough for a couple of hot meals today and tomorrow.

We don't even know yet what all the implications of this flood will be. There will be homes to rebuild, dozens if not more. There was damage to the protected piped water system intake, so all of our end of the district which is served by that clean water project now has no water. Josh, our engineer, will go in the morning to inspect the damage and start working on a repair. Post-flood sanitation problems could take more lives from cholera than the landslide itself.  The power was out for a day, but mostly back (not ours yet . . ). The road was cut off for a day, but now at least a single lane is open and vehicles are passing. Two team families were caught out of the district and had to wait but made it back today. The road tarmac still seems to be intact under all that water. We'll see. 

But like all disasters, injustice insidiously makes it worse for the poorest people. The ones who build houses on steep slopes, because the better land is taken. The ones who skimp on solid materials, because they can't afford them. The ones who do very little carbon emitting, but live in the tropical rain zones affected by post-industrial climate alterations. The ones who, when they lose a mattress and clothes and shoes and papers, have no bank account or insurance. 

The second week of Advent, our theme is Peace. Comfort, comfort ye my people, speak peace. These were not words for people who were already comfortable. They were words for people who were suffering. If the Gospel makes sense, it has to make sense in Bundibugyo too. When the mountains slide towards the sea, when the rebels raid, when Ebola strikes, where is our comfort? How can we have peace? When we get the news that our former colleague here, Dr. Travis, who has been battling metastatic colon cancer for seven years now, has a new lesion in his brain? Our comfort and peace cannot depend upon being far from floods, or immune to illness or sorrow. No, our Isaiah 40 comfort is that God's promise to be present, to be our help, is unshakeable. That even in the shadow of death He will provide, He will sustain the survivors and take the departed ones to Himself. That nothing can ultimately harm those living in His love, because we belong body and soul to Him. 

Pray for the Peace of Bundibugyo. For the families who lost so much. For Dr. Travis and family. For our team.

Our mission (Serge) has set up a Fund to receive donations towards immediate relief for displace families.  CLICK HERE to link to the Uganda Emergency Relief Fund Giving page.

Saturday, December 07, 2019

Hope, the elusive door in a dreary world

Hope, the theme of Advent this week. We hope for what we don’t see, and yet every day the not-seeing-yet just feels like a mire.

Just one day of examples, here’s Friday. No major tragedies, just the slog.

Friday mornings start with staff CME (continuing medical education) at the hospital, and our newly minted doctor Isaiah is presenting. People trickle in, the computer doesn’t work at first, the usual glitches adding up to about a 45 minute delay, but he has a well organized presentation and an active teaching style.  I’m proud of him, but I only get to hear the first 15 minutes or so before our nutrition team, whom I have given a ride to, calls me back to the ward, saying there is a really sick patient. Since there is no real system of vital signs, handover, or emergency response, it is not until they walk onto the ward to weigh people that the little 8 year old in the first bed who is writhing in delirium attracts any notice.

I hurry over from the CME building to the ward, and find the night nurse miraculously still present, When I ask who is sick he’s aware that it is this patient but has no information about her, and has not evaluated her in any way. So it takes me a while to piece together from the family and her scribbled exercise book which is a medical record that she does NOT have cerebral malaria . . . In fact she has sickle cell disease and a cough and when I take vitals her oxygen saturation’s are in the 70’s and her lungs are full of pneumonia. She’s right next to one of our two oxygen cylinders (thanks to Dr. Marc’s project) because she’s next to another boy with acute chest syndrome from sickle cell, so I take the oxygen and put it on her, and it’s amazing.  She calms immediately.  She was writhing from a sense of suffocation, and now she relaxes into breathe-ability.  Her dad tells me, she was on oxygen part of the night but the nurse removed it.  I ask the nurse why, and he says, she had been on it too long. Because of the scant nature of oxygen supplies, they tend to parse it out and as soon as my back is turned they turn it off.  Deep breath for ME and patiently try to explain to him and the day duty nurse that we must monitor patients and not just stop oxygen based on time, but on a patient’s improving response. But now we have no oxygen for the other boy, whose saturation’s are 80% (up from 60’s), which means calling the med sup to replace an empty tank which had ironically been left on with no patient attached while they turned off the one for the girl who needed it . . . And when that arrives, finding the small wrench (spanner) that allows changing regulators and opening it.  And climbing up on a table myself to open the replaced tank. And so it goes. Nothing is as simple as simply writing a dose or ordering a lab. We diagnosed TB by taking a gastric aspirate gene expert sample two days ago, but . . . The mom didn’t understand she had to walk over the TB clinic to get the meds, and the nurse just injected ampicillin and moved on. This toddler is actually a defaulter on therapy.  I diagnosed her previously this year, but when her mom had a baby three months ago it was too hard to come back to the hospital and her toddler was better so they quit. And it seems the grandfather is probably coughing out TB at home and reinfecting everyone, but refusing to come in, so I told them they can’t be discharged home until he comes. They seemed to get it. The second-sickest (per the early call) was a 12 year old boy unconscious after a shotgun of anti-psychotics and seizure meds (not making this up, 5 different meds) were injected in him overnight. The “mental health” nurse is on leave, but he thankfully takes my call and COMES IN ANYWAY for which I am deeply grateful. He actually talks to the family and finds out that the boy’s father died and this month the uncles took back the land and house he and his mom had inherited, and tore the house down, leaving them homeless. We narrow down to one antidepressant and counseling, but what he really needs is justice.

And so it goes, about every three patients on the packed ward I get pulled to this issue or that crisis, and it takes me five hours to make it to every bed, alone. I know my attention and patience are wearing thin. There are some bright spots. I take a moment to rejoice in two children who had been ones I thought would die, they came in barely alive from cerebral malaria and both were going home.  One was malnourished too, and still needs nutrition follow up, and the other will see the physical therapist for some residual weakness, but they are 90% back to normal and alive. A couple of parents also express thanks. Resurrection is beautiful. But there is little time to be happy about that handful when there are so many with high fevers, pale eyes, swollen limbs, listless attitudes. A young lady who grew up with our kids comes in with her jaundiced two month old, and I am deeply concerned. By the time I get to the very last patient, Dr. Isaiah has popped back over but is immediately sucked back into other work. I see a malaria patient ready for discharge, and her mom then thrusts a book into my face for another infant. I really want to say NO I’m only seeing the admitted patients . . But I dutifully take a look and it turns out to be the 5 month old baby of this lady’s sister, who died 4 days ago.  The baby is malnourished and obviously needs to stay. Sigh.  It’s now about 2:30 as I drive home, rushing to make it to an afternoon meeting.

The meeting is for our little Rwenzori Mission School PTA. For the first time in our history, we had no missionary kid teacher to start the year this year, so the two families (7 kids in grades K/1, 3, and 5 ) have been collaboratively homeschooling, meaning they have to pull back from other ministry and also juggle their two younger-than-school-age kids too. They have risen to the challenge, but we’re all thankful that Lindsey Knapp arrived like Mary Poppins with practical service and kid-oriented grace and enthusiasm.  But even Mary Poppins would find all 7 and 4 grades a bit much for one teacher, so we’re working out a delicate transition of some parents doing less and Lindsey moving into more. Anna is our PTA chair and school advisor so that helps a lot, and everyone is kind and honest and willing and tired. Precious things are on the line, the good of kids who had no choice in the move to Uganda, and the friendships of families and cohesion of community. It’s a good meeting and we have a solid way forward, but we NEED MORE TEACHERS. Again, the reality of hope is that you only experience it when things are NOT OK and you are waiting. But how long??

It’s pouring rain. The power company worked on the mission transformer and everyone else has power, but we don’t. Two of our kids had minor car accidents this week on the same day, no one hurt, but it does raise fear on one’s heart. I miss them. My computer died a month ago so all my work has to be done on a phone, which is tedious. It’s Christmas cookie season and I don’t have the ingredients. It’s sometimes just the little things that drag my heart down.

So hope, that elusive entity. We march on and acknowledge that all of the above is, in the big picture, kind of a whine. We are alive and dry in a comfortable house and so many people we know and love are not. But that’s missionary life too, the guilt of even saying one’s day felt long and hard.

For Advent, we want candlelight and community, warmth and expectation of all shall be well.  And it is that. But it is that in the context of a lot of dreary reality, of broken wires and parasitic muck and human cruelty and powerless longing. Come, Lord Jesus.