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. 

Foot update

Way the heck back in May I stress fractured my foot. Either caused or exacerbated by plantar fasciitis. It has been persistently bothering me since then.  I cut way back on running but I didn't actually change my activity level other than that. All floors here are cement and between the clinic, walking a lot and just life here it just was not getting better. Until a few weeks ago. I have finally turned the corner on the pain.  (Possibly because I spent practically a solid eight days doing NOTHING because of malaria). I've been to a doctor in Kampala twice who has been very helpful but this last follow up appointment, which I had lots of hope for because I feel so much better, was discouraging. The doctor says she didn't see enough healing on the x-ray to make her happy. She said absolutely no running and I have to continue to be off it as much as possible. I've worked with a physiotherapist who was very helpful and also painfully blunt ("Lose 10 kg and most of your foot problems will go away".) They talked together briefly after this last appointment and even tossed around the idea of surgery. I'm nowhere near ready to discuss that yet and want to just ask for more prayer. I thank God that it feels so much better and I trust that He  will heal it the rest of the way.
I've seen through this that I really miss running. It keeps my head screwed on straight. It keeps me from getting depressed and helps me stay much more content with life and even keel with the people I interact with. (And there is lots of science and testimony out there that I'm not the only one. I recommend it for anyone.)  I'm really ready to be running again!

Benjamin and Christina are back!

Benjamin and Christina are back in Uganda which means my niece and nephew are too!! They wrote a great blog post about why they left Uganda quickly the second week of July. Their blog is here. 

I picked them up from the airport and helped them get back to Jinja on their first day in country.  Honestly, it was a bit of a rough day as Uganda did not ease them back in gently. Within 30 minutes of our arrival at the guest house from the airport (well after 11pm) the power went out so on top of their jet lag they had to figure out how to bathe and settle their exhausted kids in a very dark, unfamiliar room. Then, after less than 5 hours of sleep we packed up, attempted (unsuccessfully) to get breakfast from the guesthouse (No coffee?!?) and try to get through Kampala before the morning traffic jam (also unsuccessfully). For points of reference here are two intersections we spent significant time waiting in. (not my pictures) 

In the roundabout in the second picture I was hit by a blue car (lots of blue paint still on my truck)  who was trying to squeeze into a third lane. Earlier in the morning I'd been hit hard while turning by someone who was passing on the inside at 120km per hour. He knew he was at fault so didn't really stop. Parts from my truck were picked up out of the road and we continued on. 

 Anyway, after hours of driving we finally got back to Jinja, unpacked all their stuff and got them settled back in. I hung out in the tree house with Izaac while everyone else took a nap. 

Now, I'm back in Soroti, already planning my next trip up to Jinja!