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Monday, July 26, 2021

Where relief and development meet: A day with COVID relief packages in Bundibugyo

 If you have followed World Harvest Uganda, or Serge in Africa, for the coming-up-on-28 years we've been bearing testimony . . . you're aware that our vision is large and holistic, and our methods are long-term and slow. Christ School has been a 21 year marathon. We have teams with people finishing two and even into their third five-year terms, places where we don't just construct a hospital building but also train class after class of students and interns, or track malnourished kids over years, or plant churches that have gone on to plant other churches, teach pastors who go on to create other programs, disciple coaches who reach into slums and villages. Real understanding takes study, and that study can only happen by living alongside the language, the culture, the challenges, in real time. Real change takes trust, and trust requires relational capital that only grows with multi-year presence and investment.  In the NGO world, this is called "development"; in the Christian world it is called "incarnation". Jesus didn't beam in for a dramatic moment, he took on our bodies and walked our paths.

But sometimes, a response to a crisis means that we shift into "relief" mode.
A war sends people on the run into camps, and we might do immunisations or nutrition screening or supplements for kids. A landslide knocks down a swath of homes, and we might buy mattresses and cooking pots to get people back on their feet. Ebola or Covid shut down an area, and we might help fill a financial gap to sustain health centres. In the last few years in Bundibugyo, our spending is about 5% relief and 95% development, which is appropriate to our Kingdom purposes. Pushing on for the long term change that makes the community more resilient and capable of crisis response, but ready to respond to the overwhelming situations that arise. Jesus spent most days walking and talking with disciples, instilling a love-God love-neighbour ethos to change their ways and hearts. But the Gospels are full of dramatic miracles too. Not every blind person in the Palestinian area was remarkably healed or every hungry person fed in those years, but the ones who were pointed out the nature of the world to come, the reality we are made for and long for and press on to inhabit.

So . . . when we went to formally greet the new post-election District government this month, both the LC5 (locally elected governor) and the RDC (centrally appointed representative) asked us to respond to the economic distress of the COVID lockdown in our District. They noted that we had provided quick immediate help when Congolese refugees started filling our local transit centre, so reasoned we should also help our Ugandan neighbours (equality is a very very very strong value). We can't do anything meaningful for 260,000 people, but they proposed a list of registered community groups for the vulnerable, and we agreed to fund a small relief package for one group of up to 30 families per sub-county and township. That's 25 x 30 or 750 families, scattered across the whole district. Some were widows' groups, some disabled, some the unemployed boda drivers (as I saw in a political cartoon, the boda (motorcycle taxi) driver is an essential worker both for most of the health care and commerce in this country but also for providing for his own children), some people living with HIV/AIDS. With the government's leave to transport and gather small groups under COVID protocols, we could proceed in a time where churches, schools, and even driving are prohibited. 

Thanks to donors, even a last-minute two churches who spontaneously wrote and asked how they could help in this COVID time, with the balance of what was raised last year for floods and not fully spent on refugees . . we came up with a budget of about 100,000 USH per family ($28) to purchase, transport, and distribute a 25-kg (55 pound) sack of rice, a 5-kg (11 pounds) sack of beans, 1-kg (2 pounds) of salt, and a crisp 5,000 USH note to help as needed (hauling the goods home on a motorcycle boda, or buying cooking oil or firewood). Over the weekend our administrator John Balitebia supervised the purchase and importation of this food while sending out trusted mission colleagues (Christ School grads who stay active as alumni) to verify each group and prepare them, and yesterday his team of 5 trucks, each with a trained crew of distributors, reached every corner of this district. 

This entire exercise was beautiful on so many levels. First, it was an open door to show God's love sprinkled into hard-to-reach places with word and deed. These recipients were just a sample of the people on the margins rarely tallied in COVID impacts, who have found the austerity of this time to be a heavy burden. Each distributing team shared a short message to the waiting crowd. I listened to one, and the "preacher" was a former CSB student from a different religious background, an orphan, who met Jesus through the discipleship of the school, and gave his own testimony while pointing out that God is a God of seeing and presence, who reaches into the resources of people far away to recognise those who are suffering, and has brought them this food. So the whole thing was a lovely picture of the Gospel right there. 

But secondly, as we have done this a handful of times over the last few years, our World Harvest Uganda team has become quite trustworthy and efficient.
John is competent with a spreadsheet and a plan, and others who are mostly all CSB alumni know how to mobilise in the community, check the facts, arrange the trucks, control the crowd, preach and distribute. We instigate and observe basically, while the young generation who were toddlers when we came, who grew up with our kids, who played and learned math facts and Bible stories in our yard and around the mission, who came to Christ School, whom the teaching staff invested in with skills and personal discipleship, whom many have helped with scholarships . . . do the work. And do it well. 

So in the end, relief and development meet.
The long arc of decades of development means that the relief work can be done by local people who know the villages, speak the language, and have the capacity and integrity to carry on with the service.

We pray that the rice and beans fill hungry stomachs, and the experience of hearing and seeing God's love fills tired souls. We are all tired of this pandemic. But that doesn't matter, troubles don't end when we're tired of them. God asks us to stay in the fray, to keep at the margins with service and stamina. Thanks to donors who in their own weariness see that the suffering, like the vaccines and oxygen supply, is not justly spread over the world. Some pockets are harder than others. Thanks.

If you would like to contribute to the Uganda Emergency Relief Fund--CLICK HERE

Sunday, July 25, 2021

The Flaw of the Excluded Middle

 Such is the title of an article written nearly 40 years ago in a missiology journal by Professor Paul Hiebert, a theologian and anthropologist who was one of Scott's professors at Trinity. He draws upon his childhood and early work in India to make us aware of our own blind spots culturally, which is one of the values of getting out of your limited experience and into the messy diversity of the world. The article argues that somewhere in the 1800's our Western culture embraced dualism, drawing a sharp divide between a secular scientific palpable visible reality (body) and a religious unseen invisible reality (soul). In the process, we lost sight of the "middle", the spiritual powers, ancestors, demons, saints, magic, that most cultures across most of time had taken for granted as real.

As cross-cultural workers, we need to understand the world views we move in. And in our culture here, the "excluded middle" is the most important reality of all. Sure there is a creator God and an afterlife. Sure, there is a tangible cause and effect world with mosquitoes that bring malaria, and injections that can cure it. But in the middle lies the question of why my child is bitten and not yours, with whether my crop will bring enough money to buy the injection or not, with who might be manipulating spirits and charms to bring me harm. A theology of a God who saves souls, and a science that creates pills, without explanations of how humans live together in a broken world, falls flat.

Interestingly, Christians through most of history have not forgotten this middle. 

Take the reality of sin and evil for instance. The puritans and the Anglicans talk about the a triple layer that is somewhat parallel to Hiebert's scheme. The devil reminds us that we have a spiritual enemy that opposes God. The world reminds us that we live in a broken system since the Fall, where thorns and thistles grow, drought and heat oppress, life is a terminal condition as Kate Bowler says, it is more difficult for some people than others to get a good education, and spiritual forces interact. And the flesh reminds us that our own center is awry, we choose greed and lust and hate, immediate gratification and security, self over neighbour, comfort over holiness almost every time.

As Americans, we can learn from other cultures to look back at Scripture with fresher eyes. When Jesus was faced with a man blind from birth, the religious establishment wanted to narrow the cause down to someone's personal sin (the flesh). Was it his, or his parents? Neither, Jesus said. This was a broken-world issue that became an opportunity for Jesus to show the nature of the Kingdom, a place of healing and sight. Jesus refused to be forced into reductionist world views, and so should we. Almost every time we encounter an evil, we can find many layers of cause and meaning. The preemie admitted Wednesday by Kacie, born too early, as his mom walked the path to the hospital in labor, the first twin falling out onto the dirt of the road and later dying, this one surviving, mom only 17, and already the child from her first pregnancy and the first twin from her second pregnancy dead. Who sinned? Hard to pinpoint that, but within the story there could likely be a predatory man who got her pregnant, or a school head teacher that took her parents' fees but failed to give her the skills to continue on.  But there is also a vast social and spiritual reality that expects teens to have babies, that doesn't plan for delivery, that spends money on other priorities, that applauds billionaires playing with rockets while accepting as inevitable the high infant mortality of this continent. There is a malevolent evil that opposes the life that God brings, that whispers lies. 

These are important questions, because as God's people we are called to a holistic proclamation of the Kingdom. Personal, individual repentance and change. Yes, many stories of that in the Bible and this is a core way that reality shifts, one person at a time. But the prophets also called out the courts and the Kings, the money changers and the hypocrites. Jesus also turned over the tables in the temple where a system of charging the poor for sacrifices had led to barriers to worship, where the gentiles had been unfairly excluded. And we fast and pray against capital-E Evil, the spiritual forces of darkness we read about in Ephesians 6, the principalities and powers that seek to control this world against the good will of God. Here in Bundibugyo, we preach and teach, invite kids to learn truth, train teachers and pastors, so that individuals can have new life. We also shore up a wobbly health system, sit on committees, plan school curriculum and nutrition outreaches, develop literacy programs, work on a community level for public good. And we pray and testify to the power of Jesus over every spiritual force that is harmful. 

The church in most places and most times has done the same. If the American church today approached the evil of the after-effects of centuries of enslavement in the same way we've approached abortion, think where we could be? For abortion, Christians go beyond individual choices one by one, we campaign and vote and take the abortion struggle to courts, attempt to change laws, work to provide options for health care and adoption, etc. Very much a systemic approach. And we continue to pray. So the same energy and breadth needs to go into all our work for justice!

Here's a glimpse of what's happening around Bundibugyo with our team over the last few days, which I think gives us hope that people of faith can work on micro and medium and macro levels to testify to God's goodness:

First, read this post by the McClures about their exciting data from the literacy work. They have built on earlier work to train teachers to teach children to read, and are trying to seed that out into more schools. Since schools are shut, we have small Kwegha Camps (outdoor, masks, spaced) going on this summer too.

Our kids went to learn about basket-weaving (Kacie is the field trip planner extraordinaire) and our interns about pottery making (thanks Ann). These are ways we celebrate the beauty of Bundibugyo, the skills of our community, put ourselves in a learning posture, and support indigenous arts.

We continue to try and support the medical care of this district, Scott in maternity and buying electricity for the oxygen concentrators, me in NICU and Paeds seeing baby after baby. The wards are crowded and sometimes desperate, the improvements are multi-layered one-patient-at-a-time, teaching and improving systems for all, and prayer-based.

Scott also spends time on projects like the new chapel, and most recently organising paint for the girls' dorms, trying to take advantage of the down time. 

But we also try to redeem the opportunity to paint!

And this weekend John was helping us prepare to distribute relief packages to 750 needy families identified by our district government, more on that collaboration later.

Meanwhile our interns went with our nutrition team to follow up some kids who had been discharged, and confirm they are still growing. So encouraging to see the way 12 weeks of gnut and soya paste, plus education, prayer, encouragement, can change the trajectory of a life!

And we continue to meet together, to encourage one another, to pray, to celebrate. This is our 6th week with Sunday morning sermons from around the continent, to learn to see Scripture from African view points with our interns. Today we celebrated Svitlana's birthday with a coffee cake too!

Keep praying with us, keep addressing the communal and systemic steep uphill climbs our neighbours face, keep working one by one too for everyone to live in the love of Jesus.

Thursday, July 22, 2021

Triple Strand Strength--Outsiders, Community and Government

 When we did our MPH degrees at Hopkins, we were blessed to sit in a class taught by Dr. Carl Taylor, one of the founding fathers of International Health as an academic discipline. He grew up as an MK in India and dedicated his life to the intersection of faith and science, service and academics. Truly a remarkable man. But what I remember from his class was a concept he taught about the triangle of actors that produce change: the community, the government, and the outside "expert" (his word, but we could just say outside actor). 

The community is a must, obviously. They are living the life, know the issues, have the motivation, must be convinced of the value of a new idea, stand to benefit or to pay. Dr. Taylor used a lot of community mapping methods --involving the community gathering its own data-- to raise awareness of problems. Then the government must align to scale things up, to provide infrastructure and jobs, to sort out policies. Lastly the outside actor comes in with ideas from other places, perhaps studies, innovations, fresh perspectives, training that would otherwise not be available--to catalyze change like an enzyme.

Yesterday, we accompanied Josh to do water sampling at his newest water project in Mabere. As we were huffing up the steep (20% grade) narrow foot path, a 3 hour climb from the last passable road to the source in a mountain cleft at the edge of the Rwenzori National Park land . .  . we stopped to catch our breath and snap a photo. And when I looked at it, I saw the very three-strand strength that Dr. Taylor taught. First, the community of Mabere started their own project, managed to build a little dam but never got pipes in the ground. Yesterday, the local village chairperson stayed close by, advocated for which houses needed to be served, and provided young men to carry water samples. And we are very much dependent upon a local water project technician, Tembo Justus, who connects us to the community, leads and guides and arranges. Second, we brought along water engineers from Uganda's Ministry of Water. They were there to certify the collection of samples, and will take them for testing in Fort Portal and Entebbe. They represent the government, who must certify the safety of the scheme. Already our local district officials have been to the site and signed off on the plans, and in fact they are the ones that chose this particular project as a priority. And lastly, Josh represents the outside actor, in our case a faith-based NGO that brings in engineering expertise and raises charitable and grant funding, manages the funds accountably, moves the project forward on behalf of the community and under the authority of the government. 

Sure, it might sound easier to just find a water source, buy some land, set up a system, and think that the obvious value will lead to buy-in. Over time, it is slower and more frustrating to collaborate every step of the way with the community and the government. People have to be heard, understood. We have to adjust, and sometimes we have to convince. I think that's why we see proliferations of projects . . . outsiders come in, things feel corrupt or opaque or slow or unjust or frustrating, and then they just break off and make a private scheme. There are times for that. But for basics of public health and sanitation, for broad programs like prevention of HIV or provision of safe deliveries and vaccines and literacy . . . for acting out God's rain-on-the-just-and-unjust mercy in society, this plodding three-partner approach is valuable.

If you follow our team for a day, you'd see this everywhere. At CSB, parent-teacher-association and government Department of Education strands twine with our mission's efforts. At the hospital, we work with our community colleagues, the government pays salaries and provides some essential drugs, we provide other help and ongoing education and support. In literacy and Bible translation and after-school programs, we collaborate with government schools, local parents, pastors, teachers. In nutrition, the same, we are just one strand that strengthens what the government and community also contribute.

Being an alien and stranger, an outsider, is often disorienting and dehumanising. We all get tired of being singled out and called names and laughed at, or being the last to know what's really going on. And yet, that very outsider-ness is part of what we have to offer. It's alienation and embrace, both - and, we have to be different enough to generate ideas and change and demonstrate grace . . and yet close enough to be heard and to love.

Yesterday was a solid picture of what that can look like. And the result will one day be clean water for families living in very simple homes, farming steep slopes, on the edge of anyone's radar. But right in the center of God's love.

Friday, July 16, 2021

Power and Vulnerability in a 6 pound package: the wisdom of babies

 Most days are pretty hard. The grid electric power has been off a lot this week, and it is not unusual for our team to juggle shut downs in electricity, water, and phone for hours or days, one at a time or sometimes all three together. As a doctor, if I lived elsewhere, it would be really unusual for a random patient to simply find my house and knock on my door and ask for free and immediate consultation and medicine. Here it is a daily experience, requiring that we set some boundaries, which sounds wise but still feels hard when you know that a choice not to hear a person out and hand over money or something from our little stockpile of pills could mean an untreated malaria that results in death. Something toxic bit my foot resulting in days of intense itching, burning, swelling, heat. Morning to mid-afternoon is usually focused here on the hospital, team, mentoring, meetings, visits. Later afternoons and evenings tend to fill with zooms, emails, policies, reading, responding. Nights for catching up with kids and moms. Every week there is preparation for leading a hospital Bible study, teaching our  interns from Somalia a medical topic, leading a hospital CME, preparing a culture study for team and a team business meeting, preparing a Sunday morning plan for interns due to lock-down of churches. Monthly commitments are scattered through the weeks as well, connecting with other teams in our Area and with our organisation centrally. We actually love this life most of the time even when it is hard (well, not the power outages or the fact that we're down to hot-spotting on the only functional phone line left or the mystery bites, but most things). But frankly it's relentless and hard to stay hopeful and engaged sometimes. 

Then there are moments of picking up the avocados and mangoes that fall and slicing them for a salad, or a surprise visit by a sweet little neighbour, or an encouraging note from someone who wants to donate to help. And almost every day, there are babies.

Babies who through no choice or sin of their own end up born too soon, or breathing too hard, or burning with too much fever. They can't talk or complain, they can't knock on the door, they can't even get out of bed. But they can cry and they do, and that has power to pull attention and action. Diane Langberg used that example to demonstrate that both power and vulnerability are part of the human condition: we all have both. (Part of a great talk about abuse in the church and all institutions and how being like Jesus heals). And often they are just sleeping, stretching, batting eyes, or snuggling into their moms. No matter how hard the day is, I have to smile when I'm uncovering little bundles in the incubators and find them dressed in a superhero blanket, or wearing a hat crocheted by friends across the ocean.  Babies, quintessential humanity.

In Matthew, after no doubt exasperating days much harder than mine, Jesus prays (11:25) "I thank you Father, Lord of heaven and earth, that you have hidden these things from the wise and prudent and have revealed them to babes." Literally, infants. Baana bakelembe, in my Lubwisi NT, and even though I'm a paediatrician, bakelembe was an unfamiliar word. Not just children, but the most simple and immature of that category. Really?

The whole passage is about Jesus' identity, who gets it, who does not. And immediately after that we hear about the lowly-in-heart King who offers a light yoke and defies the heavy Sabbath rules that rob rest. So what is revealed to babies? Babies know who their caretakers are. They don't hesitate to express their needs and emotions. They are born trusting, expectant, hopeful, dependent, relational. Babies know their parents. That's the kind of knowing that we need. That's the kind of knowing that brings comfort and rest.

NT Wright puts it like this: Jesus had come to know his father as a son does: not by studying books about him, but by living in his presence, listening for his voice, and learning from him as an apprentice does from a master, by watching and imitating. And he was now discovering that the wise and learned were getting nowhere, and that the 'little people'--the poor, the sinners, the tax-collectors, ordinary folk--were discovering more of God, simply by following him, Jesus, than the learned specialists who declared that was he was doing didn't fit with their complicated theories. 

I think of my nephew, and other extra-chromosome people, who err towards love. The empathy, the attention to connection. The unfiltered truth spoken by the marginalised. Yes, that's what Jesus is talking about that the so-called experts miss. And this is where power and vulnerability become not opposite ends of a spectrum, but an integrated paradox. Jesus' power comes from the cross. The more we are like Jesus, laying down our lives, the more our love has power.

Back to me, to us, running around our days feeling the stress of COVID, of loss, of lockdowns, of problems. What can I learn from the babies? 

  • One, that love is the most real presence, the foundational constant, the beginning and the end of the Universe. God is with us, offering to hold us, to care for us. "Come to me", Jesus says.  
  • Two, that it's OK to cry when you're hungry, to say what is true and what is wrong. To ask for help. To be openly vulnerable and not necessarily polite.
  • Three, that all healing takes time and community. We're not in this alone. And we're not out of the mess in a day or a year, this is a life-long arc of knowing and growing.
Today the babies in my care were pink and active and cute. Weights were edging up. Most of the news was encouraging, though the healing burns on one newborn are suddenly seeming to put her shoulder at risk of contracture, two one-month-olds have puzzling syndromes and are not yet thriving, malaria meds were skipped here and there. Not perfect, but better than we often are. And . . . 

Today our dear friends Jessie and Ike, who completed their short term work in Uganda a year ago, will release their 5 day old into the hands of the cardiac surgeons. Jack was born with an under-formed heart that does not pump enough blood to his body (hypoplastic left heart syndrome). He faces three stages of pretty intense surgical reconstructions now, in a few months, and in a few years. It is dangerous and draining. But like a good knowing baby, he's snuggling into his parents, blinking at his nurses, waiting for his heart to be fixed and his needs to be met. Praying today that Jack's heart is restructured to do its work, and mine is too. That all of us know the love that holds us, speak the truth that needs to be said, and stay close until the world is restored to its glory.

Friday, July 02, 2021

On Taking Heart

 The anchor of our days here: early morning runs in the cool dark, followed by coffee and Bible reading and prayer as the kingfisher trills and the weaver birds start their ruckus. In early Matthew, Jesus says "cheer up" multiple times, to desperate people seeking healing. And our Serge founder Jack Miller was fond of repeating it, usually in the context of yes, you're a mess and so is the world, but that's not the end of the story. Cheer up, there is a force of grace so powerful that no evil can withstand it. Sometimes I try to re-read the passage in Lubwisi, and found that what my NKJV translates as "cheer up" the Lubwisi calls "ogume mutima." Mutima is heart, and Ogume is a command to grow strong, from the same word that describes the development of a child over time as transformation, tallness, muscle, wisdom. It does not sound trite at all in Lubwisi, it sounds like a call to a battle. Take heart. Summon your courage. Strengthen your soul.

Take heart, a needed word this week.

COVID infections in Uganda are spreading like wildfire, as the delta variant lit the blaze with only 1% of the country vaccinated. Every day we hear of deaths of famous people, established leaders, senior doctors. And of other health care workers on the front lines. Last night we lost our first worker at Bundibugyo Hospital, a man on the cleaning staff. Once again the marginalised pay the price. As we share dinner in a small group with a team mate, she gets a text that two friends have tested positive. Even though most people will recover well, as we have learned over and over these last 18 months, even 1% mortality feels tragic when it is 1% of a very large population based number. In our district alone, that could be 2-3 thousand people. I don't think it will be that high, we are 50% children here, and the older people may be staying home, and Ugandans are excellent with public health. We have sunshine and breeze and we live outside the walls of buildings. We also have hope.

Still, in the morning meeting, we learn of a 2 year old who died within a short time of admission the night before, with pneumonia. Which could be baseline for a district with considerable under-five mortality, or could be another harbinger of COVID worsening to come. Meanwhile this is a place with holoendemic malaria. With extreme rates of sickle cell anaemia. A place where the top killers: prematurity, neonatal sepsis, birth asphyxia, pneumonia, diarrhea, and malnutrition, show up every day, sometimes every hour. So COVID notwithstanding, the hospital is still busy with the normal patients and the normal problems. Someone stole a lightbulb and now the outpatient waiting area is dark at night. The scale batteries for weighing newborns have finally been fully drained. A misdiagnosis nearly ends the fertility of a 25 year old heading into theatre for a hysterectomy, but thankfully Scott's ultrasound shows she's bleeding from a miscarriage not fibroids. We sort through three new sets of premature twins in small, medium and large (and by large, we mean 4 pounds . . ). The smallest one is 890 grams, less than two pounds, cradled in a power outage for warmth by a surprisingly engaged dad, which gives us hope. There are calculations and fluids, negotiating longer stays, warning a mother with a child whose bone is infected that he will need weeks of antibiotics. There is teaching our interns, greeting and thanking the nurses, pulling in our nutrition team, reminding everyone of the importance of vital signs. The usual. 

So what give us heart? 

Daily rhythms, which in a crisis do become anchored life lines. God told us how to stay human and healthy, and when we listen it helps.

An intentional search for the themes of beauty and grace. Noticing that even on a morning of grief, how awesome is it that our new pharmacist chose to preach from Luke 8 instead of giving a talk on malaria meds? Seeing what we have done taken up by others. Or just noticing the brightness of Jupiter setting. 

Community. Commonality. The moments when we can work in harmony with common purpose. With each other, our team, our colleagues and partners. The nurse that pulls out Dr. Marc's protocol and suggests a new antibiotic on a baby in pain. The intern that patiently jiggles the pulse oximeter until it reads, or counts breaths. The team mate that is working on clean water or teaching children, that sense of being part of something bigger, something God is doing through many. The friend that brings spinach from Fort Portal. The ever present reminders that we lean on the great cloud of witnesses who pray, who give, who care.

And lastly, remembering purpose. Today I read a reminder that we are not sent because we are anything special, quite the contrary, we are ordinary. God is extraordinary. So God plucks a few unlikely sorts and pushes us into a sojourn of discomfort in order to highlight that we are all loved. That this story has a good ending, eventually, in resurrection. That the road right now that feels dark and uphill . . . will broaden onto ways scenic and smooth. We are called to live as if that were true, by doing things that only make sense if it is. So be it.

As usual, we need to preach this to ourselves. Ogume mutima. Take heart.