Visitors, expected and otherwise

We welcomed two more visitors today, Dr. Naomi who is spending two weeks with us in the midst of her family practice residency to further pursue God's call to missions, and Brian a friend of the Pierces who came for a similar period of time to encourage them. The MAF flight that swooped out of the clouds to deposit them into our lives also took Pamela out, after a brief but full visit of reconnecting with life and friendship here. So more hugs, introductions, hellos and goodbyes. Pat and I took Dr. Naomi almost directly to a burial, perhaps an inauspicious first hour in Bundibugyo, but somehow appropriate. The oldest daughter of a prominent community leader died of AIDS yesterday, and pretty much everyone we know had turned out to show solidarity and sympathy. As we walked away from the grave with the crowd, I got a phone call: Please come to the health center RIGHT NOW, we have more visitors.

So Scott and I biked down, to find most of the staff milling about, and within a few minutes an entourage of four fancy SUV's pulled in. Dr. Sam Zaramba, the Director General of Health Services for the country of Uganda, had arrived. This senior official serves at the very top of the government health structure, second only to the Minister of Health himself. He was accompanied by Dr. Amone who has become a friend and supporter of our work since our ebola days together, and by our chief of health in the district Dr. Sikyewunda, and a half dozen other officials from the Ministry in Kampala and from the district. They toured the health center, which is seems has a national reputation as one of the most functional health centers in the country (!). At one point Scott had the opportunity to give his focused and articulate advocacy speech: with facts and figures he explained how the patient care at Nyahuka Health Center is equivalent in volume and service level to that offered at the hospital, with 1/20th of the budget. After the tour we all sat down with the staff, and these officials thanked "the Dr. Scotts (that's me too!) and World Harvest Mission" for the support in buildings, personnel, training, drugs, and equipment . . and mentioned specifically that Scott attended to Dr. Sessanga when he had ebola and when NO ONE else would go in his house, which spoke volumes and has not been forgotten even now . . .it was a little embarrassing but OK we admit kind of nice. However the most hopeful thing: Dr. Zaramba was the one who came up with the whole health system structure for Uganda, and he declared that highly performing health centers should have different budgets than barely functional ones. As his underlings took notes he promised to address the budget, and increase it!

I was asked to open the meting in prayer, and then as they got ready to go they asked me to pray for "traveling mercies" once again. I really loved the opportunity to pray by name, loudly, for the health leaders of this country. Amen.

Grief and victory

Mugume went home today:  the child who arrived on the 22nd of May, as severely malnourished as it is possible to be without being dead.  He had this incongruous body shape with grossly swollen limbs below the knees and elbows, but skeletal ribs and skull, he was listless, cool, moaning, hardly responsive, with a pregnant mother and distracted father who had traveled from Congo on foot and seemed confused about his name and age let alone anything concrete about his history.  Initial feeding only made his Kwashiorkor swelling worse, and  I felt there was very little chance he would survive, expecting every morning to find he had passed away during the night.  But somehow, he held on, through weeks of milk and antibiotics and searching for the cause of his illness.  At the end of the first month he had made no progress other than survival, and we decided he might have TB.  We started the TB drugs the day before my birthday in late June, and the response was immediate and dramatic.  For the last three weeks he has made steady, daily improvement, his face rounding out, reconnecting with the world, standing on his spindly weak legs, reaching for my pen, even beginning to talk and smile.  I love seeing this time-lapse resurrection, this flowering of life in a body that was nearly dead.  And I love seeing hope emerge in a mother.  After nearly two months, it was time to send him home.

But directly across the aisle, Masika died.  This little girl was severely brain damaged, developmentally delayed, abandoned to her grandmother, and found during her admission to have sickle cell disease as well.  No child should die of hunger, and though her overall life prognosis was poor we struggled to feed her and bring some measure of health into her life.  But over the last 24 hours she deteriorated, and in spite of a blood transfusion and IV antibiotics, become worse and worse.  By this morning her long-gone mother had returned only to wail and mourn as she breathed her last.  That was brutal, the screaming despair of this mother went on and on, perhaps compounded by her guilt in having been absent for most of the last year of her daughter's life as she had moved on to another marriage.  

There is no simple way to make sense of these two stories, two stories repeated over and over bed after bed throughout the ward.  For every few kids that are rescued, that respond, that revive . . .. there is another that dies.  In fact as soon as Masika's bed was cleaned up, another severely handicapped child with a similar story (mom gone, grandmother the caretaker, spastic cerebral palsy with a tiny head and terrified eyes and peeling skin . . .) moved into her place.  Why does Mugume get another life, But Masika does not?  

I can't answer that, and it is not my job.  I can only hope that through the lens of eternity, God's goodness will triumph over the sorrow in both of their lives, and we will see the mercy of extended days on earth and the mercy of an end of the suffering in Heaven, both in perspective.  

Weekend in Bundi

On Saturdays, I try to be a real mom, the kind of person who has pancakes ready when her kids wake up, who sews on missing buttons and bakes cakes and cuts hair and cheers at soccer games. I am all too aware of the many times my kids do not get my full attention, and appreciate their understanding, but on Saturdays I look for some balance. The day goes by too quickly, even with the effort to be purely domestic and ward off medical consultations and other problems. A half dozen kids who have been friends with ours for many years (well, mostly with Julia, who is the friendliest) help us finish off the leftover pizza for lunch, and then I hear raucous giggling in games of chase. This week we ended the day to slowly realize as we watched that someone who writes movie reviews has rather different ideas of comedy (which involve a dark and bloody plot, drugs, suicide attempts, organized crime . . . this is funny??). At least we could laugh at ourselves for choosing it. Oh well.

Sundays we have a big long breakfast, making cinnamon rolls and pretty amazing coffee with fresh hot steamed milk. This week we drank in Pamela and Pat's fellowship as a welcome addition to our usual crowd. Church was uncharacteristically timely, where the sermon series through Acts continues, a convicting sermon challenging us to visit each other in our homes like Paul and Silas did. We moved our weekly "family soccer" game (which usually includes our extended family of team as well) up into the heat of the afternoon to be sure we could spend that hour, which means a LOT to our kids. Then up to Bundibugyo town to visit Dr. Jonah's grave with Pamela, and reminisce about the days of ebola, painful memories but so good to share them with a fellow-mourner, and to pray for his family. We timed the visit so we could then pick up the first of our two anticipated educational consultants for CSB. As his bus came limping in at a very severely tilted angle we could glimpse the relief on his face as he waved through the window. His first words getting in the car: how did you people ever find yourselves in this place?

Yes, Bundibugyo is the end of the road, even for a middle-aged well- educated well-traveled Ugandan who has been pretty much everywhere (including America). We made brief stops at the two other biggest secondary schools in the district to help him get a context for comparing Christ School. As we approached Nyahuka, he asked again about the selection of the location, and we told a bit of how the campus had once been out of town, but due to rebel insurgency in the late 90's the town expanded massively with IDP's who never went home, and we suddenly found ourselves entrenched in a very urban landscape. His response gave us something to ponder for the evening, something like this: "Well, you're missionaries, so you want to be where people are, right? Because the big mainline denominations in Uganda historically built their churches and schools out of towns, and thereby lost their greatest chances for impact, compared to the more recent emergence of Islam which has centered itself squarely in the middle of towns. Let's think of how to take advantage of this crowded urban environment for the sake of the Gospel." Hmmm. We passed the professor off to David and returned home at dusk for a quickly concocted dinner combining anything left in our fridge, and then a fun slideshow of Scott and Caleb's America adventures.

Monday is just around the corner, with all of its attendant demands for the new week. I'm thankful for the weekend.

wholeness, again, among the saints

Pat and Pamela arrived for team meeting tonight:  Pat after 3 months in Kenya and the US on a short HMA break; Pamela after 18 months in the US working with Redeemer Presbyterian Church in NYC.  As we sang and prayed, I sensed the same wholeness that came with Scott and Caleb's return, the relieved comfort that something is back in place as it should be.  Our team relationships extend through space and time, renewable with shared memories and hugs.  We had set aside this week's team meeting to reflect on ways God was moving by prayer and partnership to invest in emerging Ugandan leadership as we work together to show the compassion of Jesus to the poorest.  Very encouraging to recount the concrete ways this vision has taken on flesh, and also challenging to pray for the next steps.  

The next month looks, well, FULL, as we pray and partner on ahead. We will enfold entirely new people into our lives for short periods of time, and we will be pursuing stability and sustainability and leadership transition in our ministries.  Scott turned in his last Kwejuna Project quarterly report; we are no longer functioning to channel the money between EGPAF and the district.  One of the nurses we sent for nutrition training is stepping up to take initiative to train other staff.  Next week the first of two consultants we hired to advise us on Christ School will arrive, a Church of Uganda-affiliated professor of education (with a PhD from University of Minnesota).  The process of praying for a Ugandan headmaster, and accountant, has already been set in motion.  In important ways we see our role changing.

Changing, but not ending.  There will still be gaps to fill.  Today I was referred a 1 year old whose nonspecific viral-crud sort of illness had left him suddenly unable to walk.  I found an otherwise healthy child with a floppy, immobile left leg, a clinical picture consistent with polio.  So that triggered a series of phone calls and forms and lab samples that will tell us if a wild-type polio virus has infiltrated once again, a sobering reminder that the battle for health still needs vigilance and effort.  At our weekly staff meeting the in-charge presented data compiled by a national survey of health facilities, and on many axes we still have miles to go, much work to do.

So tonight we pause to look soberly ahead at the road before us, and to thank God for all the saints with whom we travel this path.

Grace

The nature of grace is that it finds us when we aren't looking for it.  (Skip Ryan, That You May Believe)

Scouring the Byways

The pediatric ward is full of some pretty pitiful people, and this morning I found my hard heart wishing that it wasn't. When I bent over to examine malnourished twins and smelled the alcohol wafting up on their mother's breath, I was annoyed with her. Then there was the two-year-old with a tiny head and puffy body whose father admitted he was tired of this handicapped child who cried all the time, which explains why the kid keeps landing on our doorstep as our problem in spite of months of supplemental food (third time he's shown up for admission in six months). Another frighteningly malnourished child's grandmother started complaining that she had not brought pans with her to cook in (which everyone does) and as we talked I realized in spite of her apparent helplessness and angling for yet more assistance, there were three competent women in this girl's life, both maternal and paternal grandmothers AND HER OWN MOTHER, gathered around the bed. It seems that when her father was arrested for stealing cocoa, her mother abandoned her to the care of one grandmother, and three years later they are all suddenly realizing that the girls is inches away from death. Then there is the abandoned-to-another grandmother cerebral palsy kid whose problems already seemed pretty unsolvable, even before she also tested positive for sickle cell disease today. Or the little girl with severe malaria whose mother complained she had no mosquito net, though whenl I pointed out that it was documented on her chart that she had received two within the last year, she quickly explained those had holes in them. In short there is hardly a patient on the ward whose suffering is not in some way related to poor parental choices, marriage quarrels, neglect, substance abuse, carelessness, or just plain hard knocks in this life. And it is like there is a neon sign on the roof of the hospital, calling all of the most un-fixable problems, the most mired-in-distress families, to pour on in.

But isn't that just what Jesus would want? Sure, I'd rather invite the relatively competent, "deserving", one-concrete-medical-issue-only types into the ward, the kind of kid that gets three doses of Quinine and smiles and walks away healthy. The kind of kid that one can feel a sense of accomplishment in helping. Instead Jesus tells the story of filling his feast from the highways and the byways, pulling in those at the margins, those that have messy lives and dysfunctional relationships. Because in reality, that is who we all are. Struggling parents, making bad choices, failing to love and provide, and needing grace.

Praying for a byway-scouring heart.

Boys are Back

It has been such a relief to welcome Scott and Caleb back I did not
bother to post the good news . . . but Monday evening the big red
truck pulled into our yard, 20 days and 12 hours after it left, with
Star yelping and Jack and Julia jumping onto the running boards and me
running out to say welcome home. We had a great reunion, just the
wholeness of being back together again. As we finished cooking our
coming home feast, I realized I was SO HUNGRY, for the first time in
three weeks, the cloud of stress of surviving alone had lifted and
left me with an appetite! We laughed a lot, and opened trunks of
goodies (shoes, clothes from the grandparents, chocolate chips and
good coffee and nuts and pepperoni, a few dvd's and books, Christmas
in July). Then we called Luke on the phone and it was almost like
being a whole family again. In 10 days he'll be here, too. I'm so
thankful for my family, the best people on earth.

Semilki Forest Hike adventure, part 1

Here are Jack and Tim in front of the hot springs, an eerie area of sulfurous vents where boiling water steams up through cracks in the earth. We took the interns on a weekend camp-out in the Semiliki National Forest: hearing turacos and a flash of blue, watching monkeys chatter and drop through the trees, staring down baboons on the path, and every few minutes pulling viscious biting ants out of our skin. It was great. As the mosquitoes and dragon flies buzzed us around our campfire I told them it was an amazing thing to be sitting in what may be the epicenter of insect life on the planet! Lunch on the trail, thanking God for His creative powers and unfathomable might, and taking a break from the strenuous 7 hours of hiking and ant-battling. Julia always sticks right with the guide--nothing incongruous about a 12 year old learning to plait palm leaf fibres (used in making hats and mats) from a man in fatigues toting and automatic weapon. This board walk covers the open wetland around one of the hot springs . . the rest of the day we were in dense tropical rainforest.

Semilki Forest Hike adventure, part 2

This is the view of Congo , 10 km from our starting point . . . Not seeing any crocodiles (this is the very area where the biggest one on record was found) we went down and touched the water, then hiked 10 km back through the forest. On the way home, a peculiar clunking sound, which was not solved by a change in tires. No trip is simple here, but after extensive pondering, bolt-tightening, and a call to Scott we risked driving on home at a very slow speed (at one point I remarked that we were being passed by a butterfly). Now the Bat-mobile (aka former Bart-mobile, aka Zoolander) will wait for a mechanic to examine all the bushings and pronounce the verdict. We learned Heidi is pretty adept at popping the clutch for a roll start (the electrical system is also touchy on this vehicle, with temperamental starting and frequent random waves of the windshield wipers). Thankful to be home!

Not the end of the story

After a long game of tag in the moonlight last night, our interns, team, and kids settled down for one of our Africa-film series videos, War Dance.  This excellent documentary puts faces with the stories of three real children from Pader district in northern Uganda, and I've posted before about the power of the artistic images and the grip of the compelling story.  This time through I was struck by a short scene in which an elderly teacher who has returned from the big city, Kampala, to help this small primary school prepare for the national music competition where they will compete, stands in the front of the classroom and talks to the kids.  We've just heard one 14-year-old boy tell his story to the camera of being abducted by rebels and forced to kill a man with a hoe.  The teacher says:  Yes, you are children of war, that is part of your story . . . but it is not the end of your story.

Those words offer such hope, to the children who practice and dance and sing and prepare, who travel to Kampala and shine as they represent the Acholi people.  And they are wise words for all of us scarred by evil, our own and others.  Yes, we are children of war, children of the earth, and that is part of our story . . .but not the end.