Changing

Going from this to this might take me more than a week or two of orientation.  But I'm glad I have a job. I'm also glad for well trained co-workers and actual physicians calling the shots. I'm glad for adequate pain control for my patients so quickly. And what feels like unlimited resources. (Actual lab work?! A CT scan within 30 minutes of arrival?! ) I don't think we are in Kansas anymore Toto!

In other news I'm trying to stop carrying a water bottle in my bag all the time. Did you know you can get clean, safe, free water practically anywhere here?! And I think I can take my Leatherman out of my bag too. I haven't used it in weeks. So I guess that means I can also stop carrying it around. But we've been through so much together.....

October Newsletter

Well, in the HTML publishing the newsletter is there. But seems like it isn't actually there. So maybe it is easier to just follow this link?  By the way, if anyone knows how to help me actually make this embedded feel free to let me know.

Always thinking about Uganda.

I've been I've trying to send this last newsletter out for a while now but I realized part of why this is proving to be so difficult is how final it feels. (Side note: If you didn't get my newsletter and would like to let me know, otherwise I'll try to put it on a post tomorrow.)
Anyway, I'm having trouble right now with these things that feel so permanent. When I first arrived back in MI I had to purchase a few things but I realized that in the back of my head I was always thinking these will go back to Uganda with me whenever I go, for example running shoes or underwear. But now I need to start to get some winter things, or other things that I'll never need in Uganda. Like a belt.

I desperately need one here for the pants I had in storage but none of my Ugandan skirts have belt loops.  So I'm having a terrible time bringing myself to purchase one. I'm using a piece of paracord right now, which I think is fine, but my mother rolls her eyes at every time she sees it and if even she is judging my fashion choices I guess I might need to reconsider.
Same with warm clothes. And work uniforms. Seems like I can go back to work at Saints Mercy Health with the 2.5 old uniforms I have remaining from eight years ago, right?
This block is for pretty much anything I need to purchase that I won't ever need in Uganda. Which is the same issue as this newsletter. I'm having such a hard time bringing myself to do it. To admit that I can stop thinking about returning to Uganda for a bit. To stop having Uganda impact all my decisions, purchases, etc...  But I want to know when I'm going back. I want to have a date, even if it is six months down the road. Because this all feels so permanent.  And I really don't like it.

Medical scams

A missionary friend just shared this video, discussing one of the many problems facing health care in Uganda. The video discusses how Chinese "clinics" are opening up around Uganda, telling people they can diagnosis and treat all their problems but are nothing more than scams offering fake but believable (for uneducated, inexperienced people) diagnostic testing and very expensive supplements as though they are medicine. This news reporter is right on.  She doesn't address the problem in locations outside of the capital where it is far worse because people have even less understanding of physiology and disease.
I've encountered these "clinics" in Soroti, not run by Chinese, but by Ugandans who are part of the scam. The patient gets hooked up to a "machine" which is nothing more than an electrical tester, and gets a very thorough and very bogus diagnosis. The practitioner then gives them a list of "medicines" that the patient "has to" take.  One family spent more than 500,000 for this (keep in mind that this is about $140.00 for a family that probably makes less than $20.00 a month) went home with a bottle of weeds. (and not the good kind of weed)
 But people are attracted to the testing and the confidence.  I often had to tell people the testing they needed was not available to them or that there was actually no treatment possible. (The best laboratory is 8 hours away by bus for my patients and even that lab can't reliably do things like liver enzymes or ABGs at all. There are about 5 CT machines in the whole country and one MRI. There are  only two places in the country people can receive chemo so needless to say we don't treat much cancer.  And people don't understand that there is no fix for things like cerebral palsy or downs syndrome.) People want to grab on to hope, no matter how unrealistic is is and this huge scam really preys on the most poor, most desperate and most uneducated.

Obule Youth Conf

200+ youth from around Soroti, singing, games, dramas, teaching, baptisms... it was a busy three days but well worth the work!

Closing the "rabbit project"

I've been doing an informal rabbit revolving loan project with a few of the girls I sponsor in school. This was a really nice "closing" to their project. I got to see their newest litter of six and "handover" two to the next loan recipient. Really, they need their mother for a bit longer yet but now the next girl will start planting rabbit foods so she has something growing when she receives the babies in a few weeks. And we butchered one of my many males and roasted him. They had not yet killed one. They keep selling then for money but I've been encouraging them to also keep some for meat.
They practiced and agreed it was much easier to kill/clean/prepare and taster than chicken.

 Janet, in the black shirt, is the current recipient. She has told me that having rabbits to sell (an income) helps the neighbors respect her. (She has shared with me in the past that because her mother is a prostitute she is often mistreated.) In the blue shirt, Vicky, will be starting. She had lots of questions and Janet successfully answered most of them. (Seems there is still a bit of confusion on how to tell a male from a female but at least eventually, the one that starts having babies is surely the female.)
Sorry that I don't have any pictures of all of us feasting (nine people on one skinny rabbit isn't actually my idea of a feast, but anytime these kids get an actual piece of meat, rather than some broth with just bones and bits of meat is their idea of a feast) but my camera battery was dead by the time I finally got it back after the butchering. They took 400 pictures but I'll spare you the other 397. But at least you get an idea of how much the whole event was enjoyed.

Too many goodbyes

Recently said good bye to these two families.
This is Judith, her little baby, Anna, was the one who died back in March. When I went to visit she told me she was worried that she was never going to see me again after the burial. We had a really nice time just sitting and talking. (Usually the women insist on rushing off to cook when I come to visit and we never get to actually talk.) She is still convinced that witchcraft killed her baby so keep praying for her faith in God.

And Ester and her mother. Theirs is the baby that died the first week of June. It was the hardest burial I'd ever been to. Ester is mentally ill but remembered me and was actually happy to see me this last time. (The previous two times I'd seen her, when she was in labor and when we were bringing her baby's body back she was combative and angry at me- understandably.) Her mother cried when I told her I was leaving Soroti and said I was the only person who had ever loved them. I know that with the stigma of mental illness they are often criticized by the community and discriminated against. Even the other midwife at the clinic wouldn't help them because of Ester's status They insisted on giving me a chicken and a bag of cassava because I couldn't stay to let them cook for me. I know how they are barely scraping by to feed themselves but they would not let me say No to their gifts. Please pray they would feel loved by God. 

(Because literally everything I own at this point fits in one of two bags and I have even handed the keys over to the landlord so I don't have a place to give this chicken water, I needed to give it away again quickly. Unfortunately, it overheated in the back of my truck on a typical Soroti sunny day but the town's resident homeless guy didn't care and happily took both gifts.)

Sara and Lazaro

I've written about these two many times. I went to see them one last time. Goodbyes are never pleasant but I was very happy to see that Lazaro had been provided a wheelchair and Sara's small business is bringing in a bit of money. She has an old school sewing machine she powers by hand and does a little bit of taloring. She also is selling a few tomatoes and onions in her roadside stand. We didn't get to see Sara's baby, Steven, because he had been sent away to an auntie's house because the family decided it was time to wean and that is how they do it here. But they reported he is growing well and is healthy.

Remember Jarod?  The little one year old with a head wound, story here.  His wound is really closing well. Still pretty malnourished but coming around slowly with some food support from Obule church. Praise God!

I've been really cut off lately. I got a new smart phone while in the US and it should have been rather straight forward to get it connected to a Ugandan network. But nothing in this country is straight forward. I needed to do a sim swap and went daily to the network shop and initially they didn't have 4G cards to sell. Then the cards arrived and the staff person who knows how to swap wasn't working and they weren't sure when she would be back. Then finally (after several days off) she showed up for work and she said their internet network wasn't fast enough to do it. Which, I should have seen that coming because for the first two weeks here I've had no internet to speak of. I mean, I paid 300,000/= (about $125) for data on my modem and it connected but it was too slow to even connect to e-mail. But, seems like I didn't actually want to be following the news this week anyway.

On being anonymous

I have not been here long enough to miss pizza yet or even have gotten over my jet lag. But I already really miss some things from Michigan.  

Turns out the very first thing I miss from being in the States is being anonymous. I’ve gone for three runs since I’ve been back and I’ve already lost count of the inappropriate comments, the kids yelling at me or the people pointing and laughing.

A few weeks ago, when I was training for the tri, I had decided to go to the beach to do an open water swim workout (in Michigan). On the way there I couldn’t help but think, people don’t go to the beach alone, and they really don’t swim laps back and forth beyond the swim bouys, and people are going to stare at me. But, turns out, it didn’t matter. No one even looked at me twice. (Or if they did it was subtle enough that I didn’t even notice.) And I loved it!

Yesterday while in market several people welcomed me back. Which seems like it should be nice. But the conversations went something like this:  “You’ve been missing!” “Yeah, I went to go visit family.” “Next time, you take me with you!” or “I always want to go to America! Get me a ticket!” I kid you not, roughly some variation of this conversation happened three times. This seems to be a bit of a running joke with Ugandans. But it is not completely a joke. They say it to most foreigners and they mean it. They really want to go to America. But the truth is, very few of them will ever get the chance. So what is my response supposed to be?  Do I just smile and laugh?  However, I’m very sensitive right now to how unequal things are. I don’t find it funny that they will never be able to travel to neighboring Kenya, let alone America. And the truth is, they are actually sensitive to it too. They joke about it but only because it is something most of them really, really want. So, I really don’t like having this conversation. Especially with people whose names I don’t even know and who don’t know my name. Why is it OK that the guy I purchase meat from once a month demand I get him an airline ticket to the US?!! Yet, I can guarantee it will happen many more times this coming week. I would rather walk through market and not have anyone recognize me.

Here is another one. Still in the market, I was having a lady measure out 5 kg of rice for me (which takes a surprisingly long time considering she does it 200 times a day) when the lady in the neighboring stall picked up her toddler and pointed at me and said “See muzungu!?”  This is also very common.  Like if you saw a deer while driving you’d say to you kids “See the deer!?”  But they do it with white people. And they tell their kids that we will eat them if they are naughty.  I am not the bugy man! And I don’t think it is funny when you scare your kids with me.

Anyway, back to the lady measuring rice. While my hands were full with my other market items, and I was trying to make change to pay for my rice, and juggle the 5kg bag she was handing me, her young children, probably six and four came up to me and tried to greet me. They were actually pretty cute but I declined to shake their hands. So as I walked away I heard the two ladies talking about how terribly rude I was. And maybe I am. But I was going to have to set something down on the floor in the market to shake their hands.  And they were filthy. Their hands were covered in grime from playing in the mud. And the truth is those ladies would not have expected any Ugandan to shake their child’s hand in that situation. But all day long I’m expected to greet the children who are screaming greetings at me. Maybe I’m just being overly sensitive about this. But when a group of children in my neighborhood are playing (and they are always in a group!) One will see me and start yelling “Muzungu, Muzungu! How are you?!”  And if I ignore them they eventually go back to whatever they are doing (though not without yelling several more times in case I’m just deaf.)  My neighbors think this is terribly rude. I guess it is. But if I actually respond to them, every single one now has to ask “How are you.” I am not exaggerating. I will have to hear “how are you?” and say “fine” for every child there.  No Ugandan has to do this. Children would never scream at them as they walk or ride by.

And don’t even get me started on the inappropriate comments from young men. Let’s just say that “Hey baby, you’re just my size” is the thing said to me yesterday that bothered me the least. 

Ok, this rant has gone on far long enough.  

Back in Uganda

Travel this time was mercifully uneventful. It was three plane rides totaling more than 22 hours, two layovers of two hours each then eight more hours of drive time. But no luggage was lost, no connections were missed and I wasn’t harassed by any TSA agents. Overall, a success. Benj and Christina met me at the airport and delivered me to Soroti.   

I'd have pictures for you but the internet is just too slow. You'll have to just believe me. 

Triathlons

Back in January I felt like I really needed to start training for something and a triathlon seemed achievable.  Then reality set in and most of the time it felt like I’d never be ready.  But June in Michigan proved fortifying. I got some solid swims in and the change from my antiquated and poorly maintained Ugandan bike to my racing bike made it seem possible again.

Transition 1

This swim was terrifying!

So, I managed to complete my first Olympic distance Tri and do far better than I thought I would. The mile swim was cold and long but I completed in 33 min, then a 40K bike ride (25 miles) in just over an hour then a 10k run in 52 minutes. I was the 5^th female to finish and the 14^th overall out of a field of about 150. Final time: 2 hours, 45 minutes.

I'll walk again eventually. 

The following weekend went up to Big Rapids and after an eleven year hiatus, I reclaimed my title of fastest female in the CHR sprint triathlon. All the distances felt way to short and painfully fast after the long one but it was a fun day and didn't require nearly as much recovery time. 7:30 for a 400m swim, 20 min for a 5 mile bike and 25 min for a 5k and barely two min in transition I had a final time of 55:11.  (1st Female, 6th Overall out of a field of about 75).

Look! Only four seconds behind Michael Phelps!

Transition 1

2006 and 2017

Lots of family and friends came along to cheer and we had a nice picnic lunch (and a recovery nap!) on the beach after.

6/24

On this blog I've always wanted to be honest about  my flaws and humanness. Just because I'm a missionary does not mean I've even remotely got things figured out. As soon as I start thinking about outward appearances I see it first here, on social media. "What can I post or write or show pictures of that make me look good (or at least like I'm not falling apart)"?  So here is me trying to be honest again. I need to admit that I'm a bit unmoored right now. Webster says this means "to loose from anchorage." But the second definition is "to bring to the state of riding with a single anchor after being moored by two or more" and I like that one better.

I know in my head that I can't keep functioning the way I was in Soroti. After this break I could go back to it and survive and maybe even do some good for people for a bit again but I'll be right back to this place. The suffering and needs are just too much. I don't know how to give what I can and not be overwhelmed by the magnitude of the remaining needs. So, something needs to change. I don't know what that is. Do I need to find a medical team to join? Possibly in Karuma, or Jinja or Mbale? Do I need to do something radically different in Soroti?  Am I still being called to work in Karamoja?  Am I supposed to be done in Uganda for now?  I don't have the answers to any of these questions and God has been very quiet when I ask (over and over again.)

So for now I'm resting and praying and trying to take small steps. I'm trying to deal with false guilt and real anger.  And for the first time in awhile I experienced God's presence in a reassuring way. I'd been missing it for a frustratingly long time. God reminded me in my quite time today how important my daily bible reading was. I was still readying and studying it but merely as a hoop to jump through early in the morning. Thanks so much to all of you who have been praying for me because "you have not because you ask not" applies to our scripture reading as well.  I had not been asking or expecting anything from the scripture I was reading for quite a while now.

Setting your mind on things of God leads to enduring delight, genuine joy. I'd been missing this for too long. The suffering and daily grind seemed to be all I could see. There was no joy in it. But, He is restoring His joy. Mostly it is in swimming and my nieces and lots of manual labor but I'll take what I can get.

Newsletter

I sent an update/newsletter out early May but I'm realizing how few people got it. For those of you who didn't, sorry and here is the bulk of it.....

It is always an adventure here in Soroti. My watchman just came to the door to tell me he saw a cobra in the garden and he suggests I keep the kitchen door closed. So besides snake hunting, I’m keeping very busy with regular clinic work three days a week, lots of home visits and occasional teaching in a variety of venues.

Because my work permit is now being issued through the church in Obule I’m in the village almost every day of the week and the needs are overwhelming. It seems like there is almost always a woman laboring in the clinic or someone who needs to get to the hospital or malnourished kids who need follow-up. I love working with my tiny village church that really has the heart of God and serves sacrificially. The daily grind, however, has really worn me down. The needs are endless. I’ll be honest, I’m struggling right now. So I’m taking some time off. I’ll be back in MI for six weeks to rest, pray, spend time with family, take a break from this place and get my head on straight. June 21st to Aug 7th. It is a short time and isn’t a furlough so I won’t be doing the regular home assignment activities.

Prayer Requests:

• Wisdom and discernment. I’m inquiring of God if He has ministry changes in store for me. Please pray with me that He would show me His will and I would have the strength to be obedient to it whether it is to change or keep doing what I’m doing. 
• I’ll be attending a spiritual retreat for cross- cultural medical providers and also meeting with a counselor to deal with some burnout when I’m in MI. 
• Rest in God’s presence and trust in His goodness.  Peace, contentment and joy in Him alone.

Travel

If you ever have the opportunity to travel internationally with me, may I make a suggestion?  DON'T. I do not have a good track record lately. I'm pretty sure I've missed more connections in international airports than any other person I know. This last trip was no exception. I left Soroti at 6am and got to the airport in plenty of time, around 4pm, with a scheduled departure of 6:30pm. By 7pm the plane was still not to the airport. We learned later that Saudi airspace was closed and so the incoming Qatar plane had to add two hours of flight time in order to go around. Then turn around for the plane in Entebee took at least an hour because Ugandan's just can't move quickly so our departure was more than three hours late. Then the five hour flight took seven so I arrived in Qatar more than two hours after my flight into the US left. So I was re-booked (along  with the majority of the plane so it took awhile) at 4am for a new flight that didn't leave for seven more hours. We were all given meal vouchers and reminded that it was Ramadan so food couldn't be purchased or consumed after sunrise. I was so tired I found a tolerable chair and fell asleep for awhile, was woken by a cleaning crew at 5:30am only to discover I missed sunrise.  I tried to tell myself I would be fine but after doing the math and realizing that it would be more than 12 hours since the last time I'd eaten if I waited for the next in-flight meal and I was already too tired and irritable I'd be dangerous if I added really hungry to the mix, I pretended to be pregnant so I could buy a juice. This lie doesn't bother me at all.  Another challenge in Doha was that I somehow needed to get word to my family that I would not be coming into GR on the flight they thought I was. But my little Ugandan phone was useless and due to the airline electronics ban (for all flights into the US from middle Eastern countries), I had checked anything else I could have used. The airport does have a place where you can use computers so I got a message out but I suspect it was a bit cryptic.....

Anyway, I did finally arrive in Chicago though that continues to be the worst airport in terms of courtesy and reasonableness. You are treated like a criminal in customs and immigration, even if you are an american citizen. I can't imagine what it is like for foreigners. I want to make a shirt that I'll call my travel shirt. It will say something to the effect "I have not slept prone for more than 36 hours, I'm eight time zones ahead of you,  I've eaten nothing but airline food and I've tried to use several currencies. I want to be compliant but I need you to speak more slowly, enunciate a bit and stop yelling at me." I know it is too much for a shirt but a girl can dream right?   Three or four weeks ago, in Soroti, my watch broke and I kept trying to duct tape it but when it got wet the tape would slip. So I used a heavy gauge retention suture and stitched it on. I didn't even think of it in the airport and had made it through at least six security points before Chicago but it was there they pulled me out because I had to take my watch off. I tried to explain that it was sutured on. They said it didn't matter, it had to come off. I said, I'm willing to take it off, just not physically able. If they wanted to give me something sharp to cut it I would. They explained it was a security point, no sharp things allowed. I kid you not, it took me more than an hour to clear this check point.
Anyway, 9pm Thursday night, almost exactly 48 hours after I began traveling from Soroti, I arrived in Grand Rapids. I think my mom fed me and I'm pretty sure I found a bed but it is all a bit hazy.

So, cat is out of the bag.  A few of you saw me at church on Sunday. I'm back in MI a few weeks early. I came back because.... you know, if you say "I'm not sure I can do this anymore" out loud enough times, it becomes true.
Friday AM found me headed to the hospital to do some teaching about HIV and I got a frantic call from the grandmother of baby Jennifer. (First blog here.) She told me Esther had dropped the baby and she was now "acting strange."  I met them on the way in from the village and it was obvious from the moment she handed her to me this was a dying baby. We rushed into the hospital and I commandeered a treatment room for a set of vitals. Later, upon further questioning it seems Esther actually shook the baby because she wouldn't eat. She was extremely dehydrated when I first got her so I'm not sure if there was something more going on before the trauma or not. We rushed into the NICU where we did all we could with our limited resources but at noon I unhooked her from everything and handed her back to her grandmother to take her final breaths. Then grandmother needed help transporting the body back to the village so I took them home. Esther didn't know yet the baby had died and it was terrible to see. This mentally handicapped mother knew she was the cause of her baby's death. She started screaming and throwing herself on the ground. Most of what she was yelling was in Ateso but she would switch into English and tell the baby over and over that she was sorry, so sorry. The culture uses wailing to notify all of the neighbors of a death and everyone comes over to see and mourn together and this was no different. Grandma and Esther started the wailing and each new woman who arrived added to the weeping and keening. This baby's death just seemed so needless. We had done so much to give her a good shot at life. I loved this little peanut.
Between her and a few other cases I just needed a break.  The suffering and need is never ending. I tried to take Saturday off and my phone rang all afternoon and there were several people knocking at my gate. It is just as hard to say No and send them away as it is to engage in their need. On Sunday at church a woman brought me her two extremely malnourished children and with tears in her eyes begged for help. I just wanted to go to church and not be responsible for a few hours. But it seems there is no way to be off duty. I feel wrung out and like I've got nothing left to give. I can't seem to find contentment and I know I'm working in my own strength instead of God's. So it is time for a break.  Some prayer and perspective.

Another little one to pray for

Jarod is one year old and is suffering the effects of someone dumping concentrated quinine into a sub-q scalp IV. Poor little guy has been in for surgical debridement twice and still has a long road ahead of him. 

Holding him down as anesthesia wears off before they are finished.

He is at very high risk for sepsis, meningitis, or any of a whole host of other unpleasant diagnosises on top of the fact that it is really painful and he is terrified. He is extremely malnourished (as is his mother and five year old sister who is the size of a three year old. His cheeks look nice and fat but that is edema from Kwashiorkor.) His father is an alcoholic and I've been out to their home three times and never met him.
We have him admitted at Bethesda because he needs twice daily dressings under sedation and IV abx but I really had to push for his admission. (He was discharged after the first surgical debridement but was feverish and lethargic yesterday and I just can't give him the care he needs at home.) I'm having a terrible time trusting him to the staff there and I just really want this little guy to have a good outcome. Please pray for them and me.
6/6  Update for all of you praying: He is doing really well and loves eating atap and meat at the hospital. He is still inpatient there but all signs look good. Praise God!

Esther's little baby

Esther's little baby died early this afternoon at 18 days old in Bethesda's NICU. She weighted 1900 grams. I wrote about them last here. Please be praying for Esther and her mother.