Wrecked

Yesterday Josh preached a sermon about identity in Christ. The focus was on II Corinthians 5:11-21. But we also looked at II Cor. 6:1. I'm a fellow worker with God. A co-worker. Working together with Him. This particular thought grabbed me. I decided to meditate on it a bit this week. Prayed about seeing myself as God's co-worker.
So today.... first phone call for help at 4:30 am. Judith, an expectant mother with a hydrocephalus fetus. In labor. So ran out to the village, found her (a challenge all by itself) and  transported her to the hospital and got the c-section ball rolling. Mostly. Bethesda was a bit slow that time of the day but good FHTs and not super active labor so I tried to just take it easy. At 8am picked up Rachel and headed back to the clinic. 20+ prenatal women with a teaching session. Also a child with a burn, Kristine Emeru, two other kids, mouth sores and pneumonia. Another adult or two with general complaints.  One of the new mothers was fifteen years old. Makes me nauseated. One of the women was in active labor and wanted to go to the hospital. Another mother I couldn't get FHTs on. Got a call from Dr. Elisabeth around 12:30 to please come back quickly so packed up the two mothers who needed to go to the hospital and we headed back to Bethesda. Judith's baby had arrived. Very complicated. Very sick. Not breathing well. Cleft palate on top of the extreme hydrocephalus. Finger and toe deformities. Who knows what else?

Meanwhile got a call from the surgeon in Kumi (and several from Joyce and family) that they were not going to do surgery this week and she needed to be discharged. So ran out and picked them up. Came back and headed straight back to the hospital. The mother who I couldn't get FHTs on was just sitting in the waiting room. So I tried to figure out what the plan was for her. IUFD. Induction tomorrow. Discovered she didn't know any of this . So sat and had to tell her the baby had died. Explained the plan and maked sure she had the things she needed to get through the night. Tears just rolled down her face while she tried to hide them.  Then I went to check on Judith. Awake and alert. Asked what she knew about the baby's condition. Almost nothing. So tried to break it to her gently. Went over to the nursery, discovered the baby was completely alone.  The staff had been totally unable to get a line in. She had knocked her oxygen off and thought her breathing was a bit better, her sats were still low on room air. She was also quite cold. I asked Judith if she wanted to hold her and then carried her into the postpartum room (where there are currently three patients plus Judith) hoping they would do a little skin to skin.

Poor Judith was shocked and horrified at the condition of her baby. I guess I wasn't frank enough. She told me she didn't have the strength to hold her. I convinced grandma to hold her for a second but she didn't want me to remove any of the blankets. Practically every other woman and their attendants in the ward (of which there were many!) pushed their way through the curtain to see. Everyone made comments to Judith. (Most in Ateso so I don't know exactly what was being said). I could tell Judith just wanted to cover her head and cry so I told them the baby needed to go back in the warmer and scooped her up and took her back to the nursery. Even I wanted to just cry. This poor little child just needs to be held by her mother and loved for her probably limited time on this earth. At this point it was after 5pm. I was mentally, physically and emotionally done. Just done. 12+ hours, lots of grief and loss, lots of significant decisions, too many miles of driving. So I tucked the little baby girl back in, promised all of my hospital patients I'd be back in the morning and clocked out.
This was my day of meditating on being God's co-worker. Seems like I could and should ask God what the heck He was trying to teach me today but instead I'm just going to call it a day and go to bed.

Quick update on Joyce

This afternoon after church I ran out to Kumi to check up on Joyce. The good news is she is in good spirits and having a lot less pain. However there is lots of bad news: She is not actually in traction. She says it hurts when the leg is pulled so she just slides down in the bed. Which, in her defense, it is the dumbest traction I've ever seen as it isn't really attached to her leg with anything except the gauze that was put on days ago when her leg was swollen twice its normal size anyway. And because it isn't weighted, just tied to the bed, all weight can be taken off without Joyce even realizing.
Also, a doctor hasn't even seen her since I dropped her off Wednesday. I asked for his phone number, called him and he said he was rounding tonight (after 6pm) and I could wait and see him then if I wanted. He said he thinks he'll operate tomorrow but he isn't sure as he has not seen her yet and he has a whole week's worth of patients waiting so he isn't sure how many he will get to anyway. He told me all of this frankly, as though it was my fault for bringing her in when there were no doctors working at the hospital.

Lastly, I asked the nurses about paying because I know they won't operate without some payment and I'd hate for that be be a reason to hold things up tomorrow. They told me they don't know how much the surgery will be yet as the doctor is the one to determines the cost. They also confirmed that they won't even consider her without 1 million deposit. I told them I was willing to make that deposit and they said I can't as the accountant doesn't work on Sunday, I would need to come back Monday. I explained I was also working Monday and wouldn't be able to come back and asked what should we do? They said "No problem, surgery can wait until Wednesday" (which is the next operative day. I guess Tuesdays are for resting after operating on the forty waiting people on Monday.) I love this job. 

All poured out

Four requests for help before 9am. First a phone call well before 7am. Judith, a pregnant woman from prenatal clinic Monday, who needed an ultrasound. I had set it up for her (for free) on Tuesday but she missed the appointment for some reason. I tried to call her the day of the missed appointment but her phone was off. Today she called asking me to set up a new appointment for her today, and this time I should come pick her up she said. Second request for help, Vicky pounding on my gate at 7am on her way to school. Her mother was supposed to come to school to sign some forms but she didn't do it before she went to the village and now the forms are due, can I please some to school and sign them? Shortly after this I was headed out and discovered my truck wouldn't start. This has been an ongoing problem as I have an electrical short somewhere and the work around has been that I just have to unhook the negatives on both batteries before I let it sit more than an hour or two. But last night I was tired after a very long day and a hospital run to a different city and just forgot. So dead this morning. Headed into town with both my batteries and I on the back of a boda to get them charged. Got a phone call from the family I dropped off at the hospital yesterday (see last post), can I please come back and bring them some things? (More than an hour round trip).  Right around 8:30am I got a phone call from Obule that there are several sick people, can I please come see patients in the clinic today? (Thursday is not my clinic day and there are two other staff who should be working today and the person calling has called me more than five times in the past week for various problems.)
I explained to Judith that she should be able to take care of her own transportation but I'll meet her at the hospital. I promised Vicky I'd come to school take care of her mother's paperwork before the end of the day. I explained to Joyce's family that there was no way I could make another trip to Kumi today and some other family members would need to step up and help them but I would provide some money for transport. I asked the person from Obulle to please stop calling me.  Oh wait, I just wanted to. I didn't actually say that. I told him I couldn't come out today, that I'll be back in the clinic Monday.

I don't like saying no. I really wish I could help every person who asks. But I just can't. I kind of wish the people making requests of me knew how many others are asking requests of me. They might be more understanding when I have to say no.

I wish people didn't have so many expectations of me. Like that I can drop everything and come back to Kumi because they didn't bring all the things they needed the first trip.

Back to Judith, my first request for help today. We got her the needed ultrasound, and confirmed she is 36 weeks pregnant. She has been trying to get pregnant for years. Being "barren" here is considered a curse. Practically all of a women's identity is in the number of children she produces. Judith is 37 years old and has miscarried many times. She didn't have any early prenatal visits because she was sure she was not going to maintain the pregnancy. But she did. So at 35 weeks she finally came in for a visit. I found a heartbeat without difficulty but beyond that the exam was abnormal. Anyway, today's hospital visit confirmed that the baby has profound hydrocephalus. Judith just sat and cried when I tried to explain it to her. She is scheduled for a c-section in two weeks and I promised that we will do all we can to get the baby to the neuro hospital in Mbale after she delivers.

This job is hard. And I feel like I've got little left to give today. Time to head back into town to see if there is any way I can get my truck back.....

Joyce

There are a few things that have the power to really ruin my day.  When my truck isn't running well and I just don't know what to do about it (or just can't spare the DAYS it will take to get it working again).  When I waste an entire day trying to get some reasonable care for a patient. When the people I'm interacting with are being lazy or don't have any common sense. These things drive me crazy more than most challenges here. Unfortunately all three of these things converged on this day. It is seven pm, I've survived the day but I am just weary. I'm eating my first real meal of the day and headed to bed very shortly.
But first I wanted to ask for prayers for Joyce. She was hit by a drunk driver last night on her way home from school. This is the last week before they take their PLE exams (which determines if they can go to secondary school or not) so they stay at school until after dark studying. She could have been hurt much worse but she has a displaced femur fracture and a tibial fracture. We spent far too long getting this diagnosis and trying to get an ortho consult. Finally we packed up and headed to Kumi, a near by town which has a large orthopedic hospital. But no surgeon there either. He'll be back Monday.

This is us in the back of my truck feeling lots better after 1mg IV morphine. 

So she is about to spend the next four days in traction waiting for surgery. She has a lot of pain and she is frustrated because she will have to repeat P7 as I've learned there is no way to make up this test. For any reason. No matter how valid.


10/27 Addendum- I went to her school today to beg for a makeup test date. They said there was absolutely no way as the test is administered by the government and it just is not possible. Their suggestion was that if Joyce can have the surgery Monday I can bring her back to Soroti that night and she can still take the tests Tuesday.  Less than 24 hours post-op. That seems like a great idea. So when I was at the hospital I was just discussing with the Ugandan nurses and they confirmed that there was no way to miss the test. Their idea actually was that I go get her now, have her take the test and bring her back for surgery the day after she finishes. A displaced femur fracture. That also seems like a great idea. Are you kidding me?!?

I have an idea....

Barbara on the left with a new mother and baby

We have an emerging challenge at the clinic in Obulle. The midwife, Barbara, has been working there about 7 months now and word has spread that she does deliveries. (The clinic didn't used to do them. The nurse provided prenatal care but people either got transport for the 20km into town or delivered at home.) They have also discovered that if something is wrong I'll get them free blood work or an ultrasound if needed. I also have been pushing prenatal visits and giving a free "moma kit" (supplies need for birthing like soap, gloves, etc with a little onsie and blanket) for the third prenatal visit they attend. Well, this has brought in several mothers in labor, trying to get their free baby things in a third visit before delivery. And just a lot more pregnant clients overall. Which is a good thing. That is what the clinic is there for. But this means we are having more and more deliveries. And more and more mothers coming for prenatal visits. I'm not complaining. But clinic days are becoming increasingly stressful for me. This morning we were trying to assist two laboring mothers while doing more than 40 prenatal checks. On one bed. With only two of us staff. Then suddenly there was a bad second degree perineal tear that I spent far too long trying to put back together and the day just seemed to get away from me.

And now I'm tired.  And Barbara is too. But we are expecting three more deliveries this week. Which leads me to my idea.
I'm seriously considering apprenticing a young lady or two from Obulle and training them to be assistant midwives. Young women who don't have their own kids yet so aren't too tied down. Who are functionally literate and can read our charts. Who are trainable in basic skills like fetal heart tone monitoring and blood pressures and who can support laboring women in the clinic. They will need lots of training before they can be independent. But I think they will really be of benefit to their community.

This post actually started out as one of the ones where I'm just writing to myself to process out loud. But I decided to clean it up, add today's pictures and toss it out there to ask for you to pray over this idea with me. I see lots of potential problems if this idea is actually going to happen. First off anyone who fills this role will need to make a small stipend. Which means I'll have the challenge of hiring and managing people. This will change my status in the community. Also, the local government officials may not like it because they would rather we just hire another district midwife. Which I don't want to do for so many reasons. An "apprentice" is a much more logical fit. But it will need to be the right person or people. There are lots more potential problems but the idea makes me quite excited. And slightly less tired already.....

Water

So, it seems like whenever I'm in Karamoja a water post soon follows..... 

Alakas used to have a capped spring well for clean water. But has dried up. Now they go further "upstream" (it is an underground spring) to get water from this dirty mud puddle. This wont last long for the number of  people and animals accessing it. Then they will have to set off again searching further and further away. 

Also, Lormoruchbae's spring has dried up. They say they don't even bother hiking up there any more. The good news is Water Aid put in a new borehole but they stayed far from any of the land UWA is claiming so the people of my village walk nearly four miles. That is a minimum of an hour of walking and most families will make that trip several times a day. And carrying water is hard work. And the animals all have to be herded out there. It seems like these guys just can't get a break.

Kidepo

I had a chance to visit Kidepo National park. It is topographically stunning and I highly recommend it to anyone who has a chance to get up there. It is very remote and as far north as you can go in Uganda, bordering both S. Sudan and Kenya. We stayed in tents in a campsite and heard lions in the night. Unfortunately, a large number of the animals have moved out of the park right now so we didn't get to see much but it was peaceful and a nice night away. 

Buffalo, zebra and jackal, giraffe and patas monkey. Unfortunately no elephants, lions or cheetah (which is what this park is known for) but I guess that just means I'll have to go back another time.

Deworming in Karamoja

Last week I was up in Karamoja with some missionary friends. I've been wanting to do a de-worming campaign for a while now (here is the rational if any of you are interested in that kind of thing) and finally managed to do it. We had to hike out to Alakas as the road is completely spoiled and my teammates were troopers in the 100+ degree heat on what is not really an easy trail.

But we managed and were able to treat nearly 200 children. We also delivered two boxes of meds and testing kits to the VHT.

Later in the evening we reached two more villages and we also treated Lormoruchbae (where we were staying) so all together we treated more than 400 children and more than 100 pregnant women. It was a full two days but it was good to be back in Karamoja and good to have friends to work with.

Turkey Committee

Several months back my little village church started a new project. I really like being a part of it and have lots of pictures in my camera so I want to share with you. The church selected several church members to be on a "Turkey Committee." Then we sat together and vulnerable community members were selected to receive turkeys. These included orphans, needy widows and HIV positive people who lived (mostly) within walking distance of the church.  All of the selected individuals are considered poor by people who live on two dollars a day. So you know they are the most desperate.

Those people were informed that they had been selected to receive a pair of turkeys and they needed to come to church and be trained in the care of them. This got them in the door.

Dr. Daniel, the facilitator of the project, then discussed feeding, care and breeding of turkeys. He started with biblical stewardship and also told them about how the church desires them to be successful in this program so will be coming to their homes to check on them. 

Turkeys were then distributed. Turkeys are a great protein source but also a good income as they can sell offspring. A male and female pair will make a significant difference for a family struggling with food or who needs a little more income to purchase medications.

Now, once a month the committee members go visit the homes of recipients. They check up on the animals but more importantly they also sit down with these community members, talk with them about their challenges, pray with them and offer words of encouragement. I have seen several of the recipients cry when they get visited.  Lonely widows and stigmatized folks with HIV feel valued and surprised when we come to their home.
I'm happy to report most of the turkeys are already becoming fruitful and multiplying.

One Sunday morning a few weeks back we visited two recipients who live too far to come to our church but they have a tiny church where they can pray. They invited us out and asked us to join them in worship. Unfortunately, that means I had to preach but the Holy Spirit used it and I think it was one of the better sermons I've given. Lois testified how God knew she needed these turkeys and gave them because He loves her. She got up and danced to show how happy she was. 

After the service we were invited back to her house where we all sat and ate oranges while she made us tea and hard boiled eggs. Hospitality is such an important part of life here. This elderly widow is poor and crippled and uses a stick to walk but worked so hard to make us something to eat.

After eating Charles and I were asked again to "bring a word of encouragement".  This means another sermon.  Practically the whole church had followed us to Lois' house so we had a captive audience. They asked all sorts of questions about what we had talked about in the sermon and Charles had a chance to share about freedom and grace. 

These are two of the recipients, Lois on the right and Itabu on the left. Itabu is HIV positive and has been very sick several times but right now is doing better. Both are so appreciative of these birds. Itabu recommitted his life to Christ and another committee member talked with him about his fear of death due to HIV. 

 Several participants excitedly tell us about how many eggs have been laid or if their hen is sitting on a nest. Lois practically dragged me into her tiny bedroom so show me that her hen is sitting on a nest practically where Lois' pillow would be (if she had one.)

This is an encouraging program to be a part of because it is Christ's body, the church, taking care of people who really need it. My church is seeing how important reaching out to the most vulnerable is.

Would you be praying for the committee members?  Taking time to go visiting is hard for people who are already working every day for their next meal. Also pray for the recipients. I could tell you about Penecas who is weak and old and senile and his family is struggling to care for him as best they can. For Janet, Dinah and Naomi who are all old widows without family to help them. For Mary who is alone with nine children, two of whom are sick. For Simon, Deborah and Justin who are living with HIV. May we be the light of Christ in their lives.

A whole week's worth of work

Yesterday: 20 patients in prenatal clinic with no other staff on duty this week. After assessments, charting, prenatal vitamins and tetanus for all of them, cleared them out to see the 8 other people waiting. One was a 102 (?!) year old woman in significant respiratory distress. Needless to say, didn't get out of clinic until late. Headed into the the hospital and got the old lady admitted. Then quick checked in on my other two admitted patients. Then to the pharmacy to get my order for the month placed. Got a call that Amecet urgently needed their IV pump back for a critical little one. Spent a little time over there (Pictures on their blog- here and here) When you are only 1.6kg (3.5 pounds) a sudden turn for the worst is a crisis. I was finally heading home, ready to call it a day when I got a call from the village that there is  no one working in the clinic, can I please come back to suture up one of the school kids. So 8pm found me trying to figure out how to close this nasty lac.  I really need to improve my suture skills.

Today: No less busy, just with less urgent cases. Couple of malaria tests, a follow up on a patient diagnosed with cancer last month. Couple of sick little kids. But I think that all together I had almost 40 patients in the last two days. I think that is enough for this week......

I like co-workers!!

Last week I mentioned on FB that I had a preeclamptic patient with pressures 170's/120's.   I had a few hours of panic trying to get her the medical help she needed. She was at Safe Motherhood which is a free service for pregnant mothers but they were not taking her case very seriously and they suggested she go somewhere else in the city and get an ultrasound. (By the way, if you are ever a pregnant mother in your third trimester with pressures that high, please don't get on the back of a  motorcycle or bicycle and look around for a place with an ultrasound machine.  Just find yourself a dark, quiet place to lay down.) 

 Anyway, got her over to Bethesda Hospital where the nurses took us seriously right away. Got her into the doctor and got her admitted. These nurses are from the states and have been here a few weeks. I LOVE having them around. It felt so nice to actually leave the hospital and know they were still there fighting to get Mag started, check pressures often, make sure they were going to get her scanned.  All the things that I normally have to stay and fight for. They know best practice and will do their best to get as close as possible here.
Unfortunately, her pressures didn't respond to IV meds and she earned herself a c-section but both mother and baby did well. Heather (one of the nurses) is a NICU nurse so baby kept her hopping for a day or two as he is tiny.

He had a bit of breathing trouble initially and couldn't maintain his sugars. This was tricky as there is only one IV pump in the whole city. But we borrowed it from Amecet and it helped him a lot. 

 Anyway, the point of this post is that it is really nice to give report to fellow nurses. One of my clinic days last week I had to bring 4 patients into town for further studies. Some needed lab work, two needed scans, two needed consults. I got them registered, sat them in the waiting room, explained to Heather what they all needed and went back out to catch up on home visits. It was really nice not needed to hang out all day at the hospital waiting for results and hounding the doctors to get some diagnoses. Thanks Heather and Courtney!!

Time alone with God

(I didn't write this. I'm just sharing some food for thought this morning from desiringGod) 

Imagine walking up a mountain alone. But it’s no ordinary mountain. The ground beneath you is shaking, and the entire mountain is covered in smoke. At its peak is a thick cloud with lightning and thunder. God descends onto the mountain in fire, and each time you speak to him, he responds in thunder. This is what Moses experienced in Exodus 19.

Now compare that experience to your last time in prayer.

Distracted, obligatory, ordinary — I doubt any such words came across Moses’s mind as he ascended the mountain. But some three thousand years later, we rarely marvel that God permits imperfect humans into his presence.

How did the shocking become so ordinary to us? Is it even possible for our experiences with God to be that fascinating?

A mentor of mine lives in India. Last year, he called me on the phone crying, distraught over the state of the church in America. “It seems like the people in America would be content to take a selfie with Moses. Don’t they know they can go up the mountain themselves? Why don’t they want to go up the mountain?!?”

When was the last time you enjoyed meaningful time alone with God? Time so good that you didn’t want to leave. It was just you, reading God’s words, in his holy presence.

I was fifteen years old when my youth pastor taught me how to pray and read the Bible alone. Now, more than thirty years later, I still can’t find a better way to start my days. I can’t imagine what my life would be like if I didn’t refocus daily by going up the mountain.

It is alone with him that I empty myself of pride, lies, and stress.

• Pride: standing before a Person clothed in unapproachable light has a way of humbling you (1 Timothy 6:16).
• Lies: speaking to an All-Knowing Judge tends to induce honesty (Hebrews 4:13).
• Stress: kneeling before the God who causes men to fail or succeed replaces our anxiety with peace (Psalm 127:1).

We often spend a lot of time and effort gathering believers together. We’ve become experts at gathering Christians around great bands, speakers, and events. Where we have failed is in teaching believers how to be alone with God. When is the last time you heard someone rave about their time alone with Jesus in his word? Gathering believers who don’t spend time alone with God can be a dangerous thing.

Dietrich Bonhoeffer writes in Life Together:

Whoever cannot be alone should be aware of community. Such people will only do harm to themselves and to the community. Alone you stood before God when God called you. Alone you had to obey God’s voice. Alone you had to take up your cross, struggle, and pray, and alone you will die and give an account to God. You cannot avoid yourself, for it is precisely God who has called you out. If you do not want to be alone, you are rejecting Christ’s call to you, and you can have no part in the community of those who are called.

The word community is thrown around quite a bit in Christian circles today. But our gatherings can be toxic if we do not spend time alone with God. I’ve been in many groups where people share their insights. The problem is not only that our insights are not as profound as we think they are, but that we’re so eager to share thoughts originating in our own minds, when we have a God who says,

          My thoughts are not your thoughts,
               neither are your ways my ways, declares the Lord.
          For as the heavens are higher than the earth,
               so are my ways higher than your ways
               and my thoughts than your thoughts. (Isaiah 55:8–9)

I want to know the thoughts of God. I want to gather with people who have been reading God’s words, people who have prayed and interacted with him. I want to fellowship with those who fellowship with God. I couldn’t care less if you have a doctorate in theology or sixty years of life experience. I would rather talk with a fifteen-year-old who has been in the presence of God.

Can You Love Sermons Too Much?

There is so much discussion around books, sermons, and conferences. I’m not against those. After all, I’ve given a significant portion of my life to preaching sermons and writing books and going to conferences. But sometimes I wonder if it’s time to shift our focus.

We have to look at the facts. American Christians consume more sermons and books than any other group in the history of the world, but consider the state of the church. Has the increase in resources led to greater holiness? Greater intimacy with Jesus?

You could argue that the state of our churches would be even worse without the resources. Maybe that’s the case. Or could it be that these resources (and even this article) has the potential of distracting people from the Source itself? Maybe all of these books and sermons about Jesus have actually kept people from directly interacting with him. It may sound blasphemous to suggest our prayer lives may be weakened by all of the consumption of Christian material. Nonetheless, I want to throw it out there.

We live in a time when most people have a difficult time concentrating on anything. We are constantly looking for the quick fix and for faster solutions. So the thought of sitting quietly to meditate on Scripture and praying deeply in silence can be eagerly replaced by listening to a sermon while driving to work. While it’s definitely better than nothing (considering all of the other messages we are bombarded with daily), the point of this article is to say that there is no substitute for being alone with God.

We must learn to be still again.

Something Has to Go

It was simple for Paul. He loved being with Jesus. “To live is Christ, and to die is gain” (Philippians 1:21).

Knowing Christ deeply consumed him (Philippians 3:8). There is no substitute for being alone with God. If you don’t have time, you need to quit something to make room. Skip a meal. Cancel a meeting. End some regular commitment. There is literally nothing more important you could do today.

God literally determines whether or not you take another breath. “He himself gives to all mankind life and breath and everything” (Acts 17:25). Could anything be more important than meeting with the One who decides if you live through this day? Could anything be better? How can we not make time to be with the Maker of time?

What plans do you have today that you think so important that you would race past the Creator to get to them?

Celebrating with some and grieving with others

I have several good friends and fellow missionaries who have huge hearts and have adopted in this country. Last week they all went before the judge....

With the judge!

The good news: Rossers got a positive court ruling after four years of battling the system! They still have a few steps with the US embassy and stuff before they can travel but they will finally be able to head back to the States (with their kids!) for a well deserved trip home. If you'd like to read more about them and their work their blog is here.

Aggie

Silas

The bad news: The Grahams are in the same situation and also saw the judge last week and did not receive a positive ruling. These guys have been through the ringer with this stuff and have done everything correctly and are still hitting a wall every step of the way. They are understandably frustrated. They have also have not been back to the States in several years and are in need of a well deserved break. Their blog is here.

Nathan

Will you join me in praying for these missionary families? Satan has so many ways of discouraging and hindering. May this not be one of them.