Sheep don't normally survive in the presence of wolves!

Matthew 10:16-18 “I am sending you out like sheep among wolves. Therefore be as shrewd as snakes and as innocent as doves. Be on your guard; you will be handed over to the local councils and be flogged in the synagogues. On my account you will be brought before governors and kings as witnesses to them and to the Gentiles.

Karaomjung sheep

This isn't exactly one of Jesus' promises that we learn as little kids or one of those promised that we cling to as adults. But I'm trying to do a better job seeing Jesus' words without the lens of what I "want" to see.  I don't really want to think of myself as a sheep with a promise of persecution. But the fact is Jesus gave this as a promise to his disciples. Of which I strive to be one. I am to be like a sheep. But this seems not very good for the sheep, uncomfortable and possibly dangerous actually. I'd like to cling to the promise from Jesus that once we decide to follow him it is all comfortable. But if I'm honest, I can't find that one. The opposite seem true actually. Repeatedly, He seems to promise that impending persecution isn't merely a possibility but for those that obey, a certainty. If I'm striving for comfort, am I actually being disobedient?!  What if the command to be as sheep among wolves is to be the calling of every person who is a real disciple?  Is there a way to be faithful and comfortable at the same time? Can  we be both obedient and safe?  If the answer to these last two are no, does that mean that those who are comfortable and safe are not true disciples?
As much as I don't like the conclusion I'm coming to I have to judge based on Jesus' life and I think we see that suffering and persecution and sacrifice are necessary parts of His ultimate strategy. The fact is that God does not reward obedience with success and security. When I think of all the big characters in the bible, like Moses or Paul, the more obedient they were, the harder life seemed to get for them!!

Well, this isn't exactly an encouraging and uplifting post.  But that is what I'm wrestling with this week. Let me know if you have any insight.

Prayer Request

If you have a moment will you pray for Betty and I?  It seems that she has been threatening suicide and self harm. I'm going to go to her home tonight to talk with her mother and see what can be done to help. There is a chance that she will come to live with me for a few weeks but I'm not yet sure that is the wisest route. She is really struggling with lots of things, one of which is a possible rape several years ago but she has a history of lies so it is hard to know that is true and what is manipulation to get sympathy and support from westerners. Will you pray for her that she know, really know, God's love and promises for her?  Will you pray that I can be loving and supportive?  Please pray for Godly wisdom to do what is best for her.  Thank you!

Mud

I'm just hanging out in Soroti these days waiting for rainy season to let up. Here are a few pictures showing the Soroti-Moroto or Mbale-Nakapiripirit Highways. 

 There are a few places where it isn't the mud that has closed the roads. Like here:

This is entertaining to read if you know the area: 

Be informed that the road conditions in Karamoja region continue to deteriorate.

Today at around 1200 UNDSS Karamoja team together with WFP conducted another road assessment to determine the extent of road damage caused by the heavy downpours.

• Moroto-Nakapiripirit road remains closed, drivers are advised to use the alternative route of Kangole-Lotome and Lorengdwat.
• Nakapiripirit-Namalu-Mbale road is inaccessible. All vehicles to use Mbale-Soroti-Lotome-Lorengdwat to Nakapiripirit.
• Soroti-Moroto road is accessible although with bad spots with trucks getting stuck around Olilim, Iriiri, Alekileke, and Nakicumet. Drivers to be extra caution while on this road.  (This is my route. I only have to worry about getting stuck in 4 places.)
• Moroto-Lopei-Kotido road is completely inaccessible, the rains have destroyed culverts along that route.
• The Lopei bridge remains flooded and a threat to both pedestrians and motorists.
• Lopei T/C to Matany hospital is also inaccessible.
• Lion Bridge and Akodokodwe Bridge in Nyakwae -Abim road are also inaccessible due to flooding. Vehicles are stuck in that area.
• Amuria road to Abim is muddy and slippery and the road is very bad.
• Lopei-Matany road completely cutoff. Lopei bridge completed submerged by water
• Culverts heavily damaged on Moroto- Kotido road.  Heavy trucks cannot access this route

Advisory:

All drivers intending to travel to and from Karamoja region should avoid these routes.(There are no routes are left!) Ensure that vehicles have good working radios both VHF and HF, and have all recovery tools. Regular contact with radio room for updates.

Stay safe.

Road update as of 8th Sept 2014

Push!! No no, don't push!!

I felt like I was in a movie. A low budget, confusing, irritating movie, but a movie none the less. Here is how the story begins. I had planned on checking in on the VHWs (village health workers) in Nakayot and dropping august's meds off to them but after spending the night in Lormoruchbae listening to it rain for hours I knew my plan might be changing. I packed up the truck and headed out with several guys from the village to just see if it was possible to get out there anyway. Well... we made it 2/3 of the way before I miscalculated and slid down into some bad ruts where the mud was just too deep. After more than an hour of slogging around in the mud, sweating, digging it out from around the tires, cutting branches and piling stones and a lot of good natured pushing we got unstuck. After a brief discussion the decision was made to continue on. It was mid morning and the sun looked like it was going to really dry things out so we'd head on to Nakoyot, spend a few hours there and then we should be able to make it back through later in the day. That was the plan at least. Until we got stuck again 5 minutes later.  Two guys headed into the bush at a jog and it was explained to me that Nakayot was only a few km "through the bush" (translation: as the crow flies) so they were going to recruit more man power. They came back with several more guys. At this point I suggested we just unload the meds, and they carry them into the village and we just leave the vehicle until the mud was less muddy but no one except me seemed to think this was a good plan. And as I wasn't the one pushing I didn't fight with them. They pushed the truck out a lot faster than the first mud hole and it was smooth sailing the rest of the way. After we got into the village I set off to the home of one of the VHWs but had not even gotten there when some women came running up to me. There was a woman in labor and would I take them to the hospital?  (But if you are still trying to picture this as a movie you need to have in your mind several women yelling at me in a language I don't really understand in the middle of a very remote village, covered in mud, struggling to figure out what their crisis was.)  They led me to the home where in a dark, smokey hut a woman girl was laying on the ground. At this point one of the VHWs found me (but they don't do birth as they are all men and that is NOT a man's thing here) and translated for me that she'd been in labor for three days and the women were sure something was wrong. The girl looked exhausted, pale and was clearly dehydrated.  After listening for fetal heart tones and getting numbers persistently 180+ I decided that was all the exam I needed to do and we were going to brave the terrible road about 6 hours earlier than I wanted to. The patient, her mother, mother-in-law, sister and daughters to the sister all piled back into my truck together with a basin, blankets, a jug of sour milk and 10 kg of sorghum (to pay the hospital fees) and we set off again. Very shortly we got to the place in the road where we'd been stuck before. I got out and walked it first to see if there was a better way through. But the road was just too slippery and I couldn't keep the wheels out of the deep mud. The women all hopped out. I did have to give them a lesson on how we needed to rock the vehicle but once they got that I had to just shake my head that the women were clearly far stronger then the men that had been pushing 30 minutes before. We made it though quickly and everyone scrapped the mud off their bare feet and legs and piled back in and we set off once more. I was trying to watch the patient and had to ask "Is she pushing?!". “Of course” is the answer I got back. “You tell her to stop pushing!” It was at this point that we hit the initial muddy place where we'd been stuck so long before. I had been praying pretty hard by this point and there were all the branches and stones we'd already put there and the sun had been drying things out for a bit and these women took their vehicle pushing very seriously so we managed that .2km in less than 25 minutes! I did take a few minutes when we were stopped the second time to throw in a line and hang some NS as the patient wasn't even keeping down sips of water (or sips of the sour milk which is what the mother-in-law kept insisting on but I over ruled and told them they had to use water instead) but then we were on our way to the hospital and got there in less than 2 hours. And by 6 pm she had a little girl. It was determined the mother had a bad case of malaria and there was a lot of meconium at birth so I'm really glad for the sake of both the mother and baby we made it to the hospital. And by 10 am the following day she was already back at home.  And they all lived happily ever after. The end.It was at the point where I was leaning out the window yelling “push!!” and then looking over my shoulder into the back seat saying “But not you. Don’t you push!” that I felt like it was the script for a bad comedy. All we needed was a sound track. 

Not in Karamoja

Was it really last month that I last posted?!
I guess that is what I get for mentioning in the last post that life has been a bit less adventurous lately. I'll never do that again.
I was supposed to be in Karamoja tonight but I spent a few hours today trying to get up there but the road is REALLY bad so in order to ensure that I didn't spend the night in a wet muddy tent next to my truck stuck up to its axles in mud I turned around and came back. Both Nakayot and Lormoruchbae have called begging me to bring malaria treatments so I feel really bad for not making it but I'll try again if we can get two days in a row without rain. On Monday I was getting stuff across the street from the beer depot and some guys recognized me (or my truck) from last rainy season when their 18 wheeler blocked the road and prevented me (and 20+ other vehicles) from getting through. They strongly suggested on Monday that I shouldn't go and it seems like it has done little but rain since then so I really should have known I was going to make it.
Anyway, enough about the terrible road. What else has been going on?
While you all are doing the back to school thing we are just beginning third and shortest term and getting read to wrap up the school year. "My" kids are keeping me plenty busy with correcting their practice exams and other end of year stuff.
It seems I've had more patients lately too. An old woman came to Obule church last week asking for help. She is a widow and all of her children were killed. She thinks she is 100+ years old but I estimate her closer to 80. She has several significant health issues so I spent several hours with her getting some blood work and other diagnostics. She seems to have very advanced breast cancer. But even with this bad news she was a pleasure to be with and so appreciative of the help. I've gone out to visit her and now that I'm not in Karamoja I plan to see her again tomorrow to make sure we've still got her pain under control and that she has some help around her house.

Prayer and praise

I was looking at a few blog posts I put up two years ago at this time and I'm so thankful for a few things:

• My work permit that allows me to stay here. Two years ago I was having panic attacks because I'd been denied a visa (again!) and was trying to figure out how to stay. Now I have a work permit and I don't have to think about it again for two more years! Thank you Lord!
• Better roads to Karamoja. Two years ago at this time I'd spent hours stuck in the mud coming or going. The roads are much better and I'm very happy for less adventure. 

  

  July 2012 Several trucks stuck in the road blocking the way. Waiting for 6 hours to get through.

I have some prayer request too:

• I'm headed to Karamoja tomorrow and am thinking I'll stay through Sunday. Please pray for God's will to be done and His kingdom to come in that place. 
• There is a big several day youth conference in our little church in Obulle and Ronnie and I are the key speakers for the 200 young people who have been invited. Please pray for fun (youth rarely get to have that here) and TRUTH!

  

  Obulle church where the youth conf will be held.  My friend Ronnie leading worship.

   

....treating autoimmune diseases by deliberately infesting patients with parasitic worms, such as whipworm and hookworm....

Here is a deep, stimulating topic tonight, though not quite like the last post I put up....
I was doing some reading this afternoon and did you know there are "drug" trials going on using parasites on people with diseases like Rheumatoid Arthritis, Colitis, Multiple Sclerosis, Hay Fever, etc...  (Autoimmune Disorders)?!?  I guess the thinking is that instead of having the body attack itself, give it a parasite to keep it busy. (That would be the extremely simplified, non medical version.) But these studies are pretty conclusively showing that it is working. It is called Helminthic therapy if you want slightly more precise and scientific explanations than the one I gave.
I guess I find that so fascinating because I live in a place where 75% of the population is infected with one type of parasite or another. And I never see any autoimmune diseases. Who would have thought it? Pin worms are good for you. (By the way, don't google pin worms, you will regret it. And you will notice this post with conspicuously without a picture. You are welcome.)
I wonder if I can get CEUs for this afternoons reading.....

Running out of time

I've been feeling this for weeks now and I know some are going to read this and scoff but I'm feeling especially convicted today. We are running out of time. Christ is coming back for His church and I believe it will be soon. Maybe I'm totally wrong and 200 years from now (in heaven) I'll chuckle over it, but the fact is I don't believe I'll ever stand before God and he'll say that I shouldn't have lived like Jesus was coming back in my lifetime. But, that terrible run-on sentence aside, I really do believe the time is soon.
In Matthew 24 Jesus is sitting with his disciples and they ask him about how they will know when he is coming again.  He tells them that many will be deceived by false teaching. He warns of wars, famine, earthquakes, terrible persecution. Each coming like birth pains, which in my mind means they will only keep getting stronger and worse until the end.  (I encourage you to read it for yourself if you are not familiar with it. Matt 24) It seems to me that unless you have not watched the news at all you would have to agree that possibly this is happening. Christian persecution around the world is getting worse. That and wars and disease and immense suffering around the globe seems to just be getting worse:

• In China China's Christians fear new persecution after latest wave of church demolitions. July 5, 2014
• In Ukraine Putin's Complicated Game in Ukraine June 25, 2014
• In Israel  You don't even need a headline here. Just read anything on BBC's Mid-East page. 
• In West Africa- Ebola- Liberia's Health System is falling apart Aug 10, 2014
• In Nigeria Boko Haram Overruns Town Killing Dozens Aug 7, 2014 (This is the same Islamic extremists that kidnapped those school girls) 
• In Iraq ISIS Beating Iraqis and Kurds Aug 9,2014

Now, I'm not trying to be an alarmist. I'm just trying to remind all of us, myself included, that we may be running out of time. If I knew I would see Jesus tomorrow what would I do differently today? Would I waste as much time on facebook?  Would I hesitate to share with people I don't usually talk to? Would I re-evaluate how I use every minute of my day?

And in piling up all these articles I feel like I need to do something. If you feel the same I want to encourage you to hit your knees. We Christians need to feel burdened and we need to pray. Cry out to God for the salvation of Islamic Muslims. Pray on behalf of persecuted Christians in China, Nigeria and Iraq. Pray for those living in terror of death in West Africa, that they would trust God when no one else can save them. Pray for God's love to prevail in the Middle East and for justice for his chosen people. Pray most of all for God's salvation to come to the whole earth. Pray now because we are running out of time! 

Five Star Hotel

I've slept in four different places in the last few days and I'm sitting here tonight realizing that the features that for me make a "perfect" hotel have changed A LOT in the past few years. I've decided I don't really "need" anything anymore as I can now fairly contentedly sleep in the back of my truck wherever I am. However, I have a few things that I really like. My five stars are as follows:
1. No smell in the room. Musty or dusty are very common. Even occasionally smelling like animals.
2. Hot water in the shower. Seems like few places I stay are guaranteed to have hot water.
3. Tolerable pillows. Ugandan pillows are terrible. Tolerable means something between 1 inch and 6 inches thick and a least a little soft. Seems most places here like one inch or nine inches and so hard I'd rather use a towel.
4. Bathroom with a western toilet (instead of squat toilet). See photo. Even better if the toilet doesn't get wet when the shower is on. Seems with most bathrooms with a squat the drain for the toilet is the same as the drain for the shower.
5. Bed with springs. I've only had this three times in four years.
If a room has all five of these, five stars in my book! I can do without but if I'm treating myself these are now the things I look for.

Last night's toilet

Kampala

Tim, a team mate, wrote a bit about Kampala and posted some pictures. I'm on my way to Kampala right now, coming back from western Uganda. This is our second day of driving and we have one more before we arrive back in Soroti!!

Kampala

Batwa

I've been out of my usual sphere down in western Uganda. Teammates, Dr. Daniel and his wife Rachel, were headed down to Bwindi to do a rabbit training program. (Not on how to train rabbits sadly, mostly on how to keep rabbits as livestock.  Much less entertaining, as you would expect.) I tagged along as a quick break and because seeing other parts of Uganda rocks- especially the tropical rainforest. 

The Batwa are pygmies who, until 1992, lived only deep in the rainforest. They've been displaced from the only place they knew how to survive and have had to begin again. The have never kept livestock and because they are so small they don't like keeping bigger animals like cows or pigs. But rabbits are perfect for them and very similar to the wild ones they used to hunt and eat.  This is all a very simplified explanation of who they are and why we were down there. We were working with a group called the BDP (Batwa Development Project) so if you want more info check out their page. 

Also, they have some better pictures than the few I have. 

I'm headed back to Soroti via Kampala tomorrow! 

Pearl of Africa

Need to apologize for not blogging much right now but I'm traveling and that always makes updates trickier. I needed to go to Kampala for some maintenance on the truck and then I headed down to western Uganda for just a few days. I'm enjoying the time away. I'm sleeping under a blanket at night and I love it!! I know that seems silly but it is really nice feeling a bit cold. It is 55 degrees right now compared with the roughly 70 it is in Soroti at night. Refreshing change. Crossed the equator today, I guess that means that I'm in the northern hemisphere so it is winter here now.
Uganda is called the pearl of Africa and there is no denying that it is a beautiful country. I love seeing new places in Uganda but I really don't like the actual travel that it takes to get to these beautiful places. It took us nearly 8 hours to travel from Kampala to Bwindi even though I think it is only a few hundred km. I read a quote the other day that seemed to fit well. "The road was so cracked and pitted the vehicle seemed to have square wheels." (-Theodore Dalrymple)  Very applicable on this trip.

But I'm here now and it is beautiful and I had a wonderful day visiting people and hiking around so I'm not complaining any more than that. 

Sunday School

Nothing quite like 16,  2-4 year olds to keep your Sunday mornings interesting. I've only agreed to do this class occasionally so that the other sunday school class (5 years to 15) can better focus without being responsible for their little siblings.

It was only slightly less stressful than preaching. But less preparation time. 

On a side note it felt strange knowing most of these kids since birth. Or even having attended several of their births. 

"Due date", are you kidding me?!

Another few days of teaching this week. The topic was supposed to be family planning but within the first hour it was obvious that that ship had sailed. All the ladies in the class were already pregnant. So I abbreviated my normal lessons and asked them if they wanted to talk about antenatal care (prenatal for the non British speakers) for the last two days.  They all agreed. The next day I tried to bring in some pictures to supplement our discussions.  This might have been a bad idea on my part.  They kept wanting to talk about how I had taken these pictures. It was made increasingly complicated when I showed pictures that were magnified.

This 8 week old baby is actually the size of a bean. The women couldn't really get the idea of the photo enlarging it. 

But they seemed to enjoy it. We talked a lot about nutrition and caring for themselves.  And they were astonished a few things, like that pregnancies are always 34 to 40 weeks long. Two women got up to testify that they had been pregnant for more than a year. They also all thought I was ridiculous for trying to figure out their due dates. Babies come when ever they want.  But overall I think it was helpful and I'm thinking I'll be formalizing my "curriculum" and teaching it again in the future. 

Closed head injury

I got a call in the night last night from some team mates. They were with a 16 year old boy who had been in some sort of traumatic accident and was neurologically compromised and would I please some down to the clinic.....
Oh dear. I never like receiving calls in the night. If it isn't imminently life threatening people wait until morning to call me. If it is life threatening there is usually nothing at all I can do. I've made it a rule to not do CPR here because why? It isn't like I'm buying time until an Intensivist or even an ambulance arrives. The same goes for pretty much any acute life support interventions. Those are all stop gap measures to get someone into surgery or ICU, neither of which are going to happen here.
All of this is going through my mind as I'm headed to the clinic in the dark with my gloves and flashlight in my pocket. The kid was pretty much unresponsive except to pain which elicited some incoherent mumbling and tossing and turning on the table. (GCS of 11= moderate brain injury). The story was he was hit by a bicycle while walking home in the dark. I've come to be suspicious of almost every story I get here and this one was no exception.  Nothing seemed to line up. The boy had a swollen eye with a tiny cut and a small abrasion on the opposite temple. That's it. No dirt, bruises or abrasions on knees, elbows or palms that would make it look like he took a tumble. Besides the swollen eye, his head and neck were normal. The nurse at the clinic had already given 500cc LR and was in the process of giving 1g rocephin though I'm not sure her rational because neither of his "wounds" were even deep enough to need stitches.  I know that I'm going to die of drug resistant bacteria here because of misuse of antibiotics but that is for another post.
Where I'm going with all of this is that there was nothing we could do for this kid. The nearest CT machine is hours away and there is nothing that can be done for a closed head injury. I hate that feeling and it makes me want very badly to go back to work in the States where there is something I can do. Where my ACLS training is actually useful and my answer to practically every issue doesn't have to be "give it time and see what happens".

Night away

I had a really nice night away with my friends last weekend. We just went over to Mbale but it was refreshing. Honestly, we spent most of our time eating and with options like these who wouldn't?!

The Chef's creativity? Yes please! And I'm sure I need some babbly crepes with flakes and other stuff that has been gratinated.

Ronnie ordered the beef teriyaki and it actually was VERY aromatic (I think. If that means smelled very strongly then yes). 

The skewed chicken was actually skewered but good none the less. 

Unfortunately the chocolate fudge in a pool of chocolate sauce left a lot to be desired. Like enough chocolate actually. Who would have though?!

Manifold meal

I've mentioned before that I attempt periodically to cook meals on the manifold of my truck. Most of the time it is because I want a hot meal when I arrive in a place where hot meals are hard to come by without building a fire and slaving over it for a few hours.  Occasionally it is conserve cooking fuel. This last attempt was really because I had no other choice. The reason is irrelevant, this dinner rocked.

I made pot pies and froze them a few weeks back for faster meals. After driving for 6 hours on my last trip out to drop meds off to the health workers it was awesome to have a hot dinner under my hood.

You know you are jealous. Come on out to visit and I'll make you one! I promise it doesn't taste like dust or diesel at all!