Photos and videos of travesty in Sudan and South Sudan

News in photos from South Sudan http://www.nytimes.com/slideshow/2012/07/01/world/africa/20120701-SUDAN.html?ref=sudan#14

Sudanese Seek Shelter in Swampy Refugee Camp http://video.pbs.org/video/2255209377  These are Northerners who have fled their bombed and burned villages to come into South Sudan. Unfortunately the UN cannot keep up with the need for boreholes, tents, food, etc. Many are stuck in this flooded/disease ridden camp on the Sudan/South Sudan border while they wait for the UN to allow them ot move to better refugee camps--like the one on my beloved Doro.

sharing the world

Today a couple of my teen friends dropped in for an impromptu visit. Karissa was with me and so we were able to talk quite freely, not limited by my Mabaan and Arabic. We chatted about our families, boyfriends, hair weaves, clothing, school, food, language, etc. They laughed at my Mabaan and I laughed with them.

At one point one of them asked where my mother was and was I going home before Christmas. Well, we ended up giving them a geography lesson in an attempt to explain how far from Doro my home in America is. I was shocked to learn that they don't even understand that Africa is a big continent with many countries and even more people groups and languages and that is is surrounded by water separating it from the rest of the world. These girls are 14-15 years old and blessed to be in 2nd and 3rd grade (with very sporadic school attendance), but they didn't even know this about their country or continent. To help you from their perspective a bit--in Mabaan there is one word for home, village, town, country, continent, etc. It is a very limited language.

Karissa and I used water bottles to represent the earth and the sun and how day and night happen at different times for us than you in America because of where we are and how the earth is always turning. You should have heard their exclamations of surprise and even disbelief! It was so entertaining and so fun to watch, but also discouraging that their education is appallingly neglected. I sketched the world with the continents and then showed them where Sudan was, then South Sudan, then Doro and how we are such a tiny speck that we don't even show up on the map of Africa.

Final 24 hours in Doro
sorting
washing
sweeping
weeping
laughing
hugging
sighing
giving
receiving
praying
blessing
beleiving
promising
thanking
talking
photographing
remembering

Nyajima

Two weeks ago Nyajima, a two year old girl, was referred to the Nutrition Program after being assessed and treated in the Doro SIM clinic. Her mother reported a three month history of diarrhea, no walking or playing for about two months and a one month history of refusing all food. She was slumped in her mother's arms: emaciated, weak, dehydrated and weighed about half of what she should at 5.3 kilograms. She was refusing food, having frequent bloody and watery stools, vomiting breast milk and medication, etc.

For the first three days in our care I thought she would die of multi-organ failure due to her severly mal-nourished state. Her mother held her, bathed her and breastfed her but showed little interest in giving her the F-75 milk formula for severe malnutrition which we provided every three hours around the clock. Her bony face held no expression and she would close her mouth when we offered the cup of milk. We provided a syringe and taught the mother how to give the milk slowly. Milliliter by milliliter. Nyajima was so weak her eyelids were making hood like shades over her eyes. However, she would swallow the milk a sip at a time when we put the syringe in her mouth. Her mother still did not seem to understand the necessity of getting calories into her--or perhaps she believed she was going to die and did not have the heart to force the milk. She appeared depressed, never smiling, and she spoke little. We had great difficulty communicating with her as she is from a distant village and speaks neither the tribal language of our staff, nor Arabic. Occasionally a relative would visit and translate for us, but we felt she still did not fully understand our questions, instructions or encouragement.

Nyajima actually lost weight in the first four days of her admission. On day five, after heroic efforts on the part of our staff to get more milk into her with the syringe, her weight began going back up toward her admission weight. However, there was little change in her expression, her energy level, her interest in drinking anything but water--and little change in her mother's outlook.

Last Friday we finally began to see an improvement in her interest in life and her activity level. I painted her fingernails and she surprised me by trying to hold the bottle of polish and later held onto a balloon. This was the first interest I'd seen her take in her surroundings since admission, other than to follow us with her eyes as she had been doing since day two. Her mother began to laugh on this day and interacted with her child in a way she had not until this time--teasing her and smiling at her. I believe she began to believe for the first time that her child might live. She began to work harder to get her to drink the milk and the child began to eat small amounts of Plumpy Nut, a peanut based product mixed with milk powder, oil, sugar and vitamins. On Saturday, nine days after her admission, she finally surpassed her admission weight. On Sunday she actually stretched out her hand and cried for the Plumpy Nut sachet. I almost danced with my excitement! Since Sunday she has been eating two sachets of Plumpy Nut per day--a total of 1000 calories and yesterday she began eating some of the staple food common in this area--the flour made from sorghum grain.

Today has been a beautiful day for her! On her weigh-in this morning she showed that she has gained 0.7 kilograms since admission. This afternoon she took a few steps holding her mother's hand--that is the first time she has walked in at least two months. She continues a slow but heart-touching recovery after her brush with death. Her mother smiles and laughs often now. It is a blessing to celebrate with her.

She has two or three diarrhea stools per day and is still weak, but is making significant progress. Medically we have treated her for Amoebic Dysentery, Campylobacter, Thrush and worms. We have prayed for her daily and communicated with the mother that God is the one who heals. We have provided education, nutrition, encouragement, support and a friendly environment. Only God knows the outcome, but each day I'm more confident that He has a plan into the future for this little one. We had told the mother at the time of admission that we would do what we could with medication, nutrition and care, but that God is the One who heals and that we were praying for her. My hope is that Nyabell, the mother, sees God's hand of mercy and grace in this and that she will some day give Him the glory for the life of Nyajima.

Nyajima at the beginning--emaciated, dehydrated, weak, apathetic

On the day of her discharge--not fat--but getting there, strong, spunky, beautiful. 

Today I visited Roda, one of my young girl friends at her "marriage house". She ran away with a young man about a month ago--that is the traditional way to begin "marriage" here in Mabaan . Now they share a tukul on the property of her family and for about two months the young woman is forced to stay within the house and a small grass enclosure that provides enough space for cooking on the gound, storing some watch containers, a bed and firewood. She isn't permitted to be seen outside that enclosure. She was cooking kisera when we arrived. It is a thin bread cooked over a very hot fire with fermented sorghum flour mixed with water. She allowed me to try my hand at it and we all had a good laugh at the comedy of errors.

Her hands, forearms, feet and ankles were covered with henna.  Her head was uncovered.  Her tukul scented with insense they use when entertaining as newlyweds.  Two days ago they held the "Badida"--one of the many events involved in the months of "marriage" traditions.  She had her hair newly woven and the henna done for that party. She also had bleached the skin of her face and I missed the warmth of her usual dark, dark skin. Many of them believe beauty is to be found in lighter skin. She invited us to eat when we told her it was our curfew and we had to get home. Well, you have to be careful not to offend when offered food so Karissa said we could eat a little bit quickly. Well, a lot of food later we hurried home--after curfew again.  Oops.

I'm warmed by our visit with this beautiful young girl, learning to live as a married woman in this interesting culture that holds her captive for two to three months while her husband comes and goes as he pleases. Her oldest maternal auntie is responsible for training her in cooking, cleaning, mudding, etc and will decide when she can leave the forced secluded life and return to normal village life where she can come and go as she pleases.  (Seclusion isn't the right word--she can recieve female guests.) 

She is in the process of marrying David, a young man who is the son of Tabitha who cooks for some of our missionaries. David is currently working for us by helping build a brick kitchen at the Nutrition Program. Usually buildings of grasses and mud are used for "kitchens" but we decided to make a more permanent building.  He is a hard worker and a blessing to me.  He speaks some English and I've been able to use him to translate a bit with the mothers when my other English speaking staff members were not present. Roda was one of the first people to invite me into her home when I arrived in Doro two years ago. Friendships like ours--though limited in some ways by the barriers of culture, language, age and circumstance--are precious to me.  Hospitality, generosity and acceptance in this culture humble, bless and challenge me.  May I be more open and generous to those in my life...

Roda confidently makes kisera on a giddle over a stick fire just a few inches off the ground. It is so much harder than it looks!

Holiday in Ethiopia--April 2012

I've been blessed with the opportunity to spend four days of my quarterly Rest and Relaxation in Ethiopia. The bulk of it was spent in Bahir Dar, a Northwestern City becoming famous for Lake Tana and the mouth of the Blue Nile. Although it is dry season still, the area has great potential beauty ready to burst forth with the first few rains, expected anytime. I stayed with a Canadian family that has made Ethiopia their home for about two decades. Like much of Ethiopia, Bahir Dar has a war torn history. I actually procured a horn that is made of mortar from the war. In the mouth of an Ethiopian is makes a beautiful sound, it's not so beautiful when blown by me. I love that some of beauty and functionality (they use it as they go through the streets to gain people's attention before making city announcements) is coming from something that brought death and destruction many years ago. In the market place I smelled the strong odor of urine on a couple of women. Most likely those women have urinary fistulas. This is tragic condition caused by early marriage (11-13 years of age for girls) where their bodies are two immature to be able to deliver a baby without extended labor and great difficulty. The multiple days of labor can result in damage to the pelvic area. For many of these women a surgery, or a series of surgeries, can repair the "hole" between their bladder and vagina that allows urine to leak, uncontrolled, malodorously, constantly. Many become outcasts in society and even a "shame" for their families and remain hidden away, abandoned by their husbands. Ethiopia is a fascinating country. To name a few things: It's emperor for many decades was/is believed by some to be the messiah. Haile Selassie. The Rastafarian movement is a big part of that belief. The air smells of Eucalyptus in areas where the trees grow tall and proud. This was the scent that greeted me when I walked out of the Addis Abeba airport upon arrival. I believe it is the only country in Africa which has not been colonized, though it was occupied by Italians for a few years in the late 1930s. They have their own calendar and a different time system. They are credited with the first coffee--which they began refining and drinking when they noticed their animals were very energetic after eating the raw, red beans. Some believe the Ark of the Covenant from the Jewish faith is hidden within the country. The building where it is believed to be held has fierce security.
The country and people of Ethiopia came upon the horizon in my life back in the 1980s during a tragic famine that claimed countless lives.  We didn't have a TV in our home, but the media coverage was so widespread that I managed to see images in the newpapers, magazines and occasionally on TV in others' homes.  Since that time I've often thought of the beauty and needs among the Ethiopians. It was a dream come true to see a bit of their life and culture. I know there are very poor and undeveloped areas in the country, but the part I saw was much more prosperous and developed than South Sudan.  Communism had a lot to do with that.  Good can come out of most anything. 

My Dad

Jan 21, 2012

My father is dying. This complex man: father, encourager, preacher, alternative treatment enthusiast, supporter and would-be comedian is finishing his time on this side of eternity. It is 2:24am and I sit sleepless and sad beside his ICU bed. He has chosen to have Do Not Resuscitate status and so I am torn between wanting him to be comfortable and in control of his own outcome (as much as God allows) but otherwise wanting him to accept the medical treatment options available to him. Part of my jet lagged brain screams, “No, we cannot just let him die! How can it be ethical to allow nature to take its course when there are so many options available.” But the prevailing thought is that he made the choice to die a natural death when his mind was still good and I can honour him but supporting that decision.

Dad’s condition has been deteriorating for a couple of decades. His care for himself was a complicated and inconsistent regimen of a myriad of natural supplements and miracle cures and a disdain for FDA approved pharmaceutical medications. He firmly believes in a number of unorthodox things like IV Vitamin C for deadly diseases. For years he took several herbal supplements to cleanse his body of toxins all the while eating chemical laden processed foods. I guess he would be described as a stubborn man, but there is sweet naiveté about him and the way he makes decisions for himself and sticks to his guns regardless of the criticism.

We did not realize how sick he was before this illness. He has had atrial fibrillation for 11 years and as he refused the recommended medications, his body has grown weaker and weaker. We do not know when the Congestive Heart Failure began but now his body is weak and his heart is not pumping adequately. His kidneys have recently become damaged and so his body is filling up with water causing respiratory failure. For three and a half days he has worn a machine that pushes oxygen filled air into his lungs for him as his own breathing was inadequate. He has told us several times in his usual roundabout way that he does not want the machine and said once, “If it is time for me ot go then I want to go.” Yet he has allowed us to keep putting the uncomfortable mask back on him after his times of eating a few bites of his meals and talking with us. Each time there was a growing misery in his face as we assisted the nurse or physical therapist in fitting it to him. Finally last night he refused it in his gentle way. Now he is receiving oxygen only through a nasal cannula, a specially formed tube that directs the oxygen into his nose.

Before long, carbon dioxide will build up in his blood and his mind will become confused again, probably for a number or hours or perhaps a couple of days before he lapses into persistent unconsciousness. Death will occur without him waking again unless God performs a miracle. How does one accept an elderly parent’s choices? I think it can be likened to the way I accepted his word as law, not understanding his reasoning but trusting him as the parent God gave me to. I think about respect and my father and I thank God that He has enabled that in me. I have been disappointed with some of the decisions Dad has made for over 65 years, but with maturity and the grace of God in my own life, He has enabled me to extend grace to him. The older I get the more I realize the beauty of grace given and my desperate need for it.

This man would rather make people laugh than do anything else, close behind that charming but sometimes annoying trait, would be his desire to see people come to know the saving grace of our God in Jesus Christ. Dad has always been one to repeat himself to make sure that we understood the things he believes so passionately. Repeating himself is sometimes a way to convince himself and sometimes it is because his firm beliefs must be shared or he will burst. I have heard some of the same stories and sermons more than 50 times.

He just woke again for the hundredth time tonight and drank a little water. He said, “Thank you, Hun” and dozed off again. What will be the last coherent words this man says to me? Oh how the lump in my throat grows when I think about the near future. I arrived in Arkansas about 30 hours ago after a rushed departure from the bush of South Sudan with the aid of the UN who flew me out to the capital city where I could catch a flight to Kenya and then to the US. During the whole journey I kept trying to prepare myself for the news from home on each layover that he had already passed, but each time my sister told me that he was watching the clock, knowing that I was coming to see him.

This man loves combinations of chocolate and peanut butter, an affinity he passed on to me. He hates to feel the seam in the toes of his socks and will not tolerate it. He helped assemble thousands of Ford cars back in the 1960s and has a knack with fixing engines with his own special flare. He called me knucklehead and “shua” (meaning stinker in Choctaw) as a child and calls me his girl or "Hun" as an adult. He has remarkably slow metabolism and has been overweight all of my life. He has a unfathomable faith in any person or piece of literature that says diseases can be cured naturally. He has a hope in Jesus that has brought him to tears of joy countless times and looks forward to heaven with a refreshing hope.

He has had the same hairstyle since the 1950s. He loves for people to wear bright colours, his favourite is turquoise. He says, “Of all things...” proceeding statements that he feels awkward, embarrassed or frustrated about. He is always supporting and encouraging of the work I do. He has the heart of a missionary having himself served God among several American Indian tribes and gone on a few independent trips to Mexico. He thinks the best cars are Renault and has kept his old Renault van for over three decades though it has not run for at least half that time.

He loves affection--from family, friend, pet, etc. and found great joy in raising guinea pigs while we were children. He spoiled them outlandishly purchasing endless supplies of celery, lettuce, carrots and other fresh things for them to supplement their guinea pig pellet diet causing intestinal issues for them which he was happy to overlook since they enjoyed the excess fresh stuff so much. He would hold Iski, a favourite, for a long time every day allowing the pet to sit on his shoulder. He broke his arm taking care of a pet goat when he was 60. He likes to mimic the sound a donkey makes and talks about God’s sense of humour and creativity in the personality of a cocky rooster.

He can make his eyebrows dance and has done it several times here in the past day as he communicates his desire to make us laugh when words take too much energy. He has no arch in his feet—a genetic trait that prevented him from joining the army during the Koren conflict. He loved his mother and respects her memory always. He drank iced tea every day of his life except a few days following surgery in the 1980s and this week in the ICU. He thinks you can never get too much ice in his cup and if it isn’t packed in there all the way to the top then the drink is not cold enough. He went through a phase about 20 years ago in which he planted about 50 trees in his yard in the space of about two years. He does not like cold weather and talks about “Old Arthur” when his joints become stiff and painful. He bit his fingernails until he had to get dentures.

He has always been eager for me to marry, desiring a loving relationship for me, but has never given me a hard time that I have not made that step yet. He has never looked as old as he is and I think he has passed that trait on to me along with a rather too curvy backside. He likes playing games but gets quietly irritated when he does not win.

When I look in the mirror sometimes I am startled to see his face in mine. He has a really large mouth, another trait I have taken from him. When I was a kid he was always helping someone in need. Back then he would pick up hitchhikers and even allow them to sleep on our couch if they did not have anywhere to go. Until this week, he read ten chapters a day of the Bible since coming to know Jesus. He recently was trying to compute how many times he has read though the Bible, but I did not hear the result. He has hair growing out of his ears in the curious elderly man kind of way, but he does not seem like an elderly man to me, just a very sick man.

He tells corny jokes and gets tickled when he can make others laugh. He loves to talk—-he is a verbal processor and one has to be assertive to get a word in when he gets going. I will think of his puns when we have turkey at Thanksgiving and Christmas. EVERY single year when he arrives for the meal he says, “I smell a ‘fowl’ odour in here.” I think I will start saying that for him. Corny puns once causing me to inwardly roll my eyes will be dear to me after he is gone.

Butha

Today I discharged a little malnourished girl for whom we have been providing care for over a month. I couldn't hold back the tears when her mother, Tubia, walked away with her. Instead of a "discharge" due to resolution of an illness, we discharged her because there is nothing more we can do for her. We referred her to a facility where she can receive TB treatment. We cannot officially diagnosis TB without lab and x-ray, but due to the process of elimination and the treatment we provided for all the other possibilities, we are pretty sure that is the problem. Unfortunately the closest TB treatment is a few days walk away. They are trying to catch a truck going that way this evening. Leaving the village to come to our clinic is one thing. But to go some days away to a strange city is a big emotional and family challenge for pretty much anyone we refer to Malakal. There is big fear of the unknown among the Mabaan. Many choose to allow death to occur in the sick person rather than to face separation from family and village for an unknown length of time.

Butha has persistent Kwashiorkor type malnutrition--that is the kind where the body swells due primarily to a lack of protein in the diet and a breaking down of the blood vessel walls.
It can also be related to severe anemia or tuberculosis infection. Butha has consistently had edema (swelling) in spite of medications for malaria, worms, giardia, thrush and pneumonia. She also gradually developed a good appetite--but the edema didn't go away as it does in most children when they go through our program.

A day filled with drama and suffering

This morning we learned that Titus, a lovely older man who was bitten by a rabid dog two months ago succumbed to death after a week of suffering pain, muscle spasms, insanity, hydrophobia and confusion.

Jima, a little malnourished boy who came on Thursday and was making great progress died this morning. He was making gains every day and was out of the woods as far as we were concerned. Yesterday I thought I would discharge him into the outpatient nutrition program this afternoon. However, I guess the grandmother wasn't pleased with his progress and took matters into her own hands. After he died this morning (after Dickson spent almost the whole night at the clinic saving him) we learned that the grandmother had fed him leaves and herbs yesterday. That explains why he suddenly became so sick and not in any of the usual ways we see life threatening illness--usually respiratory infections, dehydration and malaria are the things that kill, or almost kill. Dickson said he couldn't understand what happened because the boy was doing so well.

The other inpatient families told us about the leaves and herbs AFTER he died and the family took him away. They saw what the local "medicine" did to him. Something in the leaves or herbs slowed down his heart and breathing rate and he just went into death quietly--a type of poisoning I guess. The grandmother was probably sure she was helping. I wish the other families who observed this had told Dickson last night when he could have done something about it. This was the young mother's first baby. Please pray for her comfort and that the grandmother will learn from this tragic mistake.

Later in the morning I treated a woman for snake bite. She is suffering great pain and walked for hours on the swollen, painful leg to get medical treatment. She will be ok, but will have pain for a few weeks.
Angelina, a tiny, wasted malnourished child was given a concoction of roots by a witch doctor about 2 weeks aog. She has not spoken or eaten since, but finally drank some special milk for malnourished patients today. Such a sweet sight to see her little throat moving with the swallows. She still makes not a sound--neither speech, crying, laughing or moaning in spite of injection, certain pain, hunger, fear, etc. Her eyes have been expressionless but today she following me around with her eyes. Progress! Hum d'Allah!

After a long day at work I rode to the nearby market town of Bunj to take photos of my friend Magdalena’s family (her husband is in town for one week away from this job as a driver in Malakal). On the way a dog tried to attack me but I managed to get away without it actually making contact. I then nearly ran over my teammate on his bicycle. In town we enjoyed visiting and doing the "photo shoot" and eating the always present boiled pumpkin, such a huge part of the Sudanese diet this time of year.

As I was parking my bike by my tukul I noticed my neighbour Judy's' porch was glowing orange. Jokingly I called out "Judy, is your veranda on fire?" and then I realized there really WAS a fire, by the time I'd thrown my bicycle down and run to her she was pulling a blazing kerosene cooker out of her house on a rug. The scary part is that it rolled off with flames shooting several feet into the air right under her dried grass thatched roof. I knew if the roof caught the tukul and contents would go up in flames very quickly. Praise God with everyone helping dirt was thrown on the kerosene flames and the roof didn't catch.

That is a lot of adrenaline rushes in one day. I would like a boring day, but those don't ever really happen here.

Sharing the World

Today a couple of my teen friends dropped in for an impromptu visit. Karissa was with me and so we were able to talk quite freely, not hampered by my limited Mabaan and Arabic. We chatted about our families, friends, hair weaves, clothing, school, food, language, etc. They laughed at my Mabaan and I laughed with them.


At one point one of them asked where my mother was and if I were going home before Christmas. They wanted to know how long it would take to walk there as that is how distances are measured when you live in the bush. When learning that it would be impossible to walk to my home to visit my family they were primed to hear about how big the earth and solar system is. It blew their minds that it takes over a whole day to fly to America because they do know a bit about planes being fast because of regular exposure to our charter plane that drops us into and takes of out of their lives.

We ended up giving them a geography lesson in an attempt to explain how far from Doro my American home is. I was shocked to learn that they don't even understand that Sudan is one of many countries in Africa and that Africa is just one of the seven continents. I shared a bit about people groups and languages and that Africa is surrounded by water separating it from the rest of the world. These girls are 14-15 years old and blessed to be in 2nd and 3rd grade, but they didn't even know this about their country or continent. To help you understant their perspective a bit--in Mabaan there is only ONE word for home, village, town, country, continent, etc. It is a very limited language. Because of a lack of education and opportunities, their world view is very, very small. They call the English language "Tuuk Khawaja" meaning the language of the white foreigner, not understanding that there are many European languages. I didn't get into that yet, a lesson for another day.


Karissa and I used water bottles to represent the Earth and the sun and how day and night happen at different times for us than you in America because of where we are and how the earth is always turning. You should have heard their exclamations of surprise and even disbelief! It was so entertaining and so fun to watch, but also rather discouraging that their education is appalingly neglected! I sketched the world with the continents and then showed them where Africa was, then Sudan, then South Sudan, then Doro and how our village is such a tiny speck that we don't even show up on the map of Africa.


We took the opportunity to tell them that even though we are so tiny in the grand scheme of the earth STILL God knows all about us every one of us, the number of hairs on our head and when one falls out. Their incredulous expressions were priceless. I would have loved to have captured them on camera but that would have ruined the moment.


This day ranks up there in a 1000 special moments in Doro. : )

Cerebral Malaria

Tomato (yes, that really is her name) came to us unconscious but moaning in the arms of very worried family members. We started treatment for cerebral malaria but she soon went deeper into a coma without speech or movement. We sustained her with IV medications, injections, cool sponge baths and suppositories for fevers. At the 72 hour mark she moved for the first time on her own.  With closed eyes she reached with her hand and touched her ear. I think I danced in celebration. The next morning I called her name loudly several times in her face and she slowly and weakly opened her eyes. What an exciting occasion! She either lapsed back into the coma or went into a deep sleep after that but a few hours later opened her eyes again and swallowed a bit of water from a syringe.

We are so thankful. Cerebral malaria is scary and a quick killer. Sometimes people come to us complaining of mild malaria symptoms for weeks--this usually would be one of the three less severe/sudden onset kinds of malaria. In those kinds of malaria people often survive without treatment but are weak and sick for a long time. But with Falciparum (cerebral) malaria often an unconscious person will be brought who has been sick for only a day and they are already near death. Quick action is necessary.  I've seen strong, other-wise healthy young adult men be flattened by it to the point of fainting within hours of the onset.

Falciparum malaria is caused by the bite of the Anopheles mosquito.  The female anopheles mosquito is the one who carries and transmits the condition.  She needs a very warm climate and requires a "blood" meal to be able to reproduce. The males survives on nectar and other sources of sugar. The males do not bite humans. The female is not damaged by the malaria parasite she carries...but she will only live for about 30 days anyway. She has contracted the parasite from a blood meal she has taken as a young mosquito from a human with malaria. After about 10-20 days the parasite has matured in her to the point of being passed on through the her blood meals. She is only going to have 15 days or so to infect people with the matured parasite within her--but it certainly happens a lot in South Sudan.

About 10 days after being bitten, when the human host body has allowed the reproduction cycle of the Falciparum plasmodium parasite to take place  (in the blood and liver), there is an onset of symptoms.  The spymptoms in the human with Falciparum malaria will include fever, severe headache, dizziness, weakness, chills--sometimes accompanied by seizures, unconsciousness, joint pain, nausea and diarrhea.

I'm so happy to report that Tomato has recovered well and is at home.  She and her family are neighbors of one of my good friends in the closest town.  Her mother reports she is doing well.  Normal.  What a wonderful thing "normal" is! 

New sisters

These are some of my new sisters. Between April and July seven young women vocalized a desire to know God in our village. I had them over for a small party and some spiritual encouragement.

Rasala, right, is quite the poser. She picked up my sugar bowl (a Nutella jar) and proceeded to strike a series of poses with it. This one, where she was cracking herself up, is my favorite.

She is the vivacious and lovely daughter of Giine, the lady who does some cleaning and washing for us. Ginne has Rasala in school (she is one of the few teen girls I know who attends school regularly). I'm excited for her future.

Tears

As many of you know, I'm a rather emotional person. I laugh--and cry--very easily. I feel things deeply and I think this is difficult for others to understand and they sometimes misinterpret what shows on the outside of me.

Recently I cried at the clinic over the suffering of a boy with tetanus. I removed myself from the presence of the patient and family, but some of the missionaries, Kenyan staff and CHWs saw me. Later, I'm sure the patient's family could see the evidence of my tears on my face when I resumed care of him.

A few days later, one of the Kenyans on our team told me she thinks I should never let the patients, their families or our staff see me crying as it might be construed as a lack of faith in God. While I appreciate her input and her attempt to help me understand her culture--I don't completely agree with her.

I need to give this a lot of thought. Would you like to weigh in? I'm particularly interested in your thoughts if you are African or have lived in Africa for some time.

Blessing!

Today I met a woman named Blessing! This is a huge blessing to me!

While riding my bicycle with Karissa through a residential area of Bunj I heard someone say, "Hi Girls", in a casual, friendly manner. Wow! You have no idea how good that sounds when you are starving to chat with the women you live among!

I long for deeper relationships with the Mabaan women around me, but I'm so limited by my small grasp on their language and their absolute lack of English. Before meeting Blessing, my friend and co-worker at the Nutrition Program--Orpha, was the only Mabaan woman I knew who was fluent in English. Orpha is long-suffering with me as I deluge her with questions about language, culture, work, relationships, etc. Now I'll be able to spread out my questions and not be such a burden to her.

Blessing has just moved to the area and taken a job with the UN. We will become friends, I'm sure of it!

Thankful!

Bombs and Bubbles in the course of a day in South Sudan

Today has been an atypical day.

I slept in until 7 since it was a ministry day for me—ministry day means I don’t have to be in the clinic and can do things like visiting, studying language, hanging out with nutrition program children, etc.

This morning during personal devotions I heard a strange sounding plane pass over, but only gave it a moment;s thought. About an hour later I learned that is was an Antonov, an old Russian bomber being used by the Sudan army. 30 minutes after it passed over us it dropped bombs on Kurmuk, a largish town in the disputed Blue Nile State. Fighting had ensued during the night in another town in that State between the Governor and the Sudan army, but I was unaware of this until I heard about the bombing. Needless to say my heart fell when I heard about this upsurge of violence in a new area along the border. There have been fighting and bombings taking place in South Kordafan State and the Abyei region, but it was limited to those two areas since Independence Day (as far as we know) until this week.

After hearing this news and praying, I carried on with my original plans and spent the early morning preparing to lead devotions at the TBA meeting. This is a quarterly continuing education meeting for the Traditional Birth Attendants in our area. We provide them with information, pertinent to births in this part of Sudan, and with birthing kits so that they can help women have safer, healthier deliveries at home.

Midmorning, during my time with the TBAs, a plane landed on the dirt airstrip near our compound. A teammate ran out to find out what was going on. It was an AIM charter plane that had just done an emergency evacuation of Kurmuk and Yabus, two towns just north of us. Both towns were bombed within minutes of this very plane departing from their airstrips. We praised God that they were removed safely just before the bombings occured.

When I finished devotions with the TBSs I ran to the airstrip to greet the people who had been evacuated from Kurmuk and Yabus. Amazingly the conversations were relatively light. The people in Kurmuk and Yabus had a very stressful night and morning, learning of the need for their immediate removal around 3am--but having the delay of waiting for a flight to come from Kenya to evacuate them. By the grace of God, everyone was able to smile, though the smiles of the two pilots were a little tight--they were making a second flight into Yabus for two more missionaries who did not get on the first evacuation flight.

After seeing the plane off to return for those missionaries, I went to my tukul and threw together an emergency bag in case we also needed to leave in a hurry.

Thirty minutes after take off from our airstrip the flight returned with two shaken passengers who had been at the airstrip when the bombing occurred following the first evacuation flight. They had run for their lives into the bush at that time and made the decision that they needed to evacuate as well. However, they had to wait for the plane to leave its passengers with us in Doro and return. When it did return for them it was on the ground in Yabus for only a minute to remove them.

Back on our airstrip in Doro the evacuees, nine in total, loaded back up and flew off for Kenya. Thank God for AIM missionary pilots John and Jay!

After waving them all off, I resumed my usual Friday afternoon ministry--always one of the highlights of my week. Our nutrition program has an inpatient compound where malnourished sick children are admitted and monitored while receiving special nutritional milk formula every three hours and medications for their illnesses. The mothers and children (strangers brought together by the diagnosis of malnutrition from many different villages) live together in tents for a few days to a few weeks while we daily weigh, assess, feed and medicate them. On Fridays I go and cut the children’s dirt caked finger nails and do manicures and pedicures for the mothers and grandmothers. This is a treat for them as such things as fingernail polish, clippers and lotion are only possessed by the wealthy.

While there I introduced the Mabaan women and children to bubbles! Oh what fun! One little girl shrieked in fear initially, but within seconds was giggling and trying to catch them. By the time I left, all the older children—who are not so sick--were blowing bubbles and having a grand time. There is something about bubbles that lightens every heart.

Throughout the remainder of the day no further news of fighting or bombing reached us, but let me tell you--I take notice and my heart starts beating a little faster than normal when I hear any aircraft now.

I arrived home wet, muddy and shivering as it rained while I was a the nutrition compound and I got a little wet trying to get everyone’s nails done. It drops into the 70s when it rains and when you are accustomed to 90s and 100s all the time, that is cold! I kicked back for about 30 minutes with a book about inspirational women in the Bible and then helped my teammate Karissa prepare dinner for the team. We did our best to make Mexican food, something we sorely miss here in Sudan without cheese, chicken, salsa, guacamole, etc.

As it is Friday night, our team is now having Movie Night in the common room watching a movie on someone's laptop. This little escape from the reality of Sudan is a weekly indulgence for us. I’m sitting this one out as I’m so behind on correspondence and wanted some time to process this roller coaster day. This was an atypical day--but one I wanted to share with you.

God has been faithful in protecting our SIM team in Yabus and other ex-patriot friends working in Kurmuk, but we know that the nationals haven't been removed from danger by any outside power greater than their own legs taking them into the cover of the bush and God giving them the strength and opportunity to do so. Our prayer is for them, that God will cover them with His feathers (Psalm 91:4), that He will show Himself powerful and a Rock of defense for them (Psalm 62:2). We ask Him to end the violence and bring reconciliation between Sudan and South Sudan, between governments and armies, between races and tribes...

Galatians 3 talks about a world of people who are one in Christ and therefore reconciled to God and each other. Sudan is very, very far from that place, but ultimately that is why we are here and we do not lose hope.

"Now that faith has come, we are no longer under the supervision of the law. You are all sons of God through faith in Christ Jesus, for all of you who were baptized into Christ have clothed yourselves with Christ. There is neither Jew nor Greek, slave nor free, male nor female, for you are all one in Christ Jesus. If you belong to Christ, then you are Abraham’s seed, and heirs according to the promise." Galatians 3:26-29

Will you pray for reconciliation with us as well?

Tempestous Emotions

My emotional nature often gets the better of me and I find myself with tears running down my face prompted by things that are only slightly sad, or with laughing too hard at something only marginally funny to others but that has me in stitches, or with tight anger burning in my chest--with little provocation. Did God make me like this or is this my sinful nature? Sometimes I can take intense sadness or frustration with some grace and respond the way most of the rest of the Christian world would in the same circumstances--but other times I become an emotional basket case.

This past week was a case in point. We had a 12 year old boy arrive at the clinic with tetanus spasms. I had never seen a patient with tetanus and I hope never to again. It is a extremely painful and distressing disease. The body begins this response 5-15 days after exposure to the tetanus toxin. First the jaws begin to get stiff and within a day the body goes in to repeated spasms where the muscles clench all at once--creating what my Kenyan teammate refers to as the "Devil's Smile" where the body arches backward creating an unnatural curve head to toe as the muscles contract simultaneously, painfully and completely out of control. Unlike some other conditions that are distressing, in tetanus, the patient's mind is completely lucid so they are fully aware of how much they are suffering.


For the first day of Abuth's care I maintained decorum and did not cry as I provided care for him--pushing sedatives through his IV to relax the muscles for a short time and giving him injections for the pain. I was oncall that night and the strain wore on me as I saw his condition worsen in spite of the increasing amounts of sedative I gave him. As his distress increased my poise was finally lost the next morning. I went out behind the clinic building and sobbed. I returned some 10 minutes later but the evidence of my tears was on my face. I'm now told this could have been distressing to the family and made them think I had no hope for their loved one and/or no faith in God. That further burdens me. Obviously I do not want my emotional reaction to a patient's illness to make anything more difficult for the patient or the family!

For the next two days my heart was heavy for this boy and his family. He died during the third evening of his illness in the hospital closest to our clinic--a 30 minute plane ride away. I was alone in my tukul that evening and heard the mourning begin. My heart sank, but still I hoped that there was another reason for the wailing sound coming from the next compound--where some of his family are our neighbors here in Doro. Two teammates and I went and sat with them that night as they began the grieving process (following a phone call they received from the uncle who had accompanied him to the hospital.)

The Sudanese are usually very stoic and we are often left guessing as to what they are thinking. However, in death, the stoicism is gone and the raw pain comes out in their posture, faces, voices and flows over to all those around them. When there is a death immediately the women begin wailing and preparing the body while the men begin to dig the grave. Female friends and family gather around from the nearby villages and mourn with the immediately family--joining their voices in the haunting wails and songs. We sat on the ground in the dark without even a fire to light the night. We sat in support, we sat in silence, we sat in prayer. Suddenly there too I once again lost my composure and began sobbing. I hoped my sobs, different from their crying and wailing, were lost in the noise.

It was late and they gave us water to wash our faces with before sending us home. The next two days, while we were still at work in the clinic, many more friends and family joined them sitting on the ground in silence, sharing their pain. I appreciate their cultural way of sharing the grief. In Western culture we often try to fill the silences with words, uncomfortable with our thoughts and really not knowing what to say-but babbling on anyway.

I found the Mabaan mourning process comforting and honest. However, I'm concerned that lately I have been far more emotional than usual--when I do not have the excuse of a tragic death.

I've said "I'm wired this way" as an excuse for my occasional emotionally lability. Today in a Bible study I looked at my inadequacy and God's strength in my weakness. The question about when I feel most inadequate was easy--it is when I'm emotional. The Word tells me to fill myself with His Truth, to form my mind around Him and the wealth of information and life instruction He has provided. I'm told to ask for wisdom and to cry out for understanding. In the wake of last week, I'm doing that.


I wonder often what it really means to "guard my heart" as instructed to do. Lately my heart seems to be all over the place. In Proverbs 4 it tells me "Keep your heart with all vigilance, for from it flow the springs of life. Let your eyes look directly forward and your gaze be straight before you. Ponder the path of your feet; then all your ways will be sure." Prov 22 "Hear, my son, and be wise, and direct your heart in the way."

My heart is surely wayward, following after this passion and that cause, blown about by the persuasive opinions of people of influence in my life. My emotions swing this way and that depending on my level of fatigue, physical hunger, the people I'm in the presence of, the fluctuations of my chemical make-up, my abilty to lean upon God, my sin weighing me down, the encouragement-- or lack there of-- from my friends, etc. 2 Tim 3 tells us that the Word equips us. I know sometimes when I'm studying, it is particularly piercing and so relevant to my life at that moment. But my life is so full of work, people, stimulating influences--distractions-- I forget so much of what I read and find myself floundering about, having my confidence and joy stymied, failing to stand upon the Truth of who God is in who I am in Christ.

Would that I could always "Be strong in the Lord and in the power of His might..."

2 Timothy 2:22 "So flee youthful passions and pursue righteousness, faith, love and peace, along with those who call on the Lord from a pure heart. Have nothing to do with foolish, ignorant controversies; you know that they breed quarrels. And the Lord's servant must not be quarrelsome but kind to everyone, able to teach, patiently enduring evil, correcting his opponents with gentleness."


Longing for more self-control and peace in the tempest...

A typical day

A couple people have asked about my typical day here in South Sudan...

6:30 Hit snooze
6:35 Dress in my “uniform” of a long skirt and colorful blouse and run to the latrine.
6:40 Brush teeth and put on eye make-up. Prep for devotions if it is my turn to lead
7:00 Attend devotions with my SIM teammates
7:30 Eat a breakfast of oatmeal
7:52 Power-walk to the clinic
8:00 Attend/lead clinic staff devotions—right now we are going through the Gospel of Matthew. Many of our South Sudan believing friends do not have the concept/see the value of reading the Bible on their own. This is a valuable time for all of us studying the Word together.
9:00 Begin care for patients
10:30ish (Or anytime through the course of the clinic day) rush back to the compound storeroom for medications we are running out of in the clinic
2:30ish Walk back to my tukul for a lunch of bread and peanut butter or Ramen noodle soup and a carrot (if I’ve been so fortunate to have some flown out of the recent charter flight).
3:10ish Return to the clinic to continue patient care and supervision of Community Health Workers
5:30ish Finish work at the clinic, settle the inpatients in for the evening
6:00ish Begin cooking dinner. This year I’m blessed to have a small gas stove so this process usually takes less than an hour compared to 1 ½ hour last year using charcoal.
7:00 Share the meal and debrief about the day’s events and patients with my dear friend and teammate Karissa
8:00 Check online Sudan news, email and facebook
9:00 If on-call, go to the clinic to check on overnight patients, IVs, administer medications and pray with them
9:55 Take my malaria prophylaxis medication and brush teeth.
10:00 Remove the remarkable amount of sweat and grime I’ve collected in the course of the day, with a bucket of cool water, while looking up at the stars through the Neem tree over the shower enclosure.
10:30ish Crawl under the mosquito net, talk to God and read His Words to me
10:50ish Sleep!

If on-call (every 3rd or 4th night and every third weekend) there is always the possibility of the guard waking me to go to the clinic for an emergency or an IV that needs attention. Many days are not typical--but this gives you an idea of how things go when they are routine and there aren't any "fires" to put out.

Reflections on a year in Sudan

June 28, 2011

Dear Friends and Family,

Greetings from Doro! This month marked one year for me in Sudan and I have been reflecting with amazement on the opportunities, relationships, miracles and life lessons that have filled my time. One year is merely a blip in time compared to the years most of my teammates have been on the field and I definitely feel like the baby of our group. It has been perhaps the best year of my life, albeit also the most challenging and heartbreaking. The needs here are great and it is easy to become discouraged with the limited impact we are capable of having. If you know the story of the starfish being thrown--one by one--back into the ocean after the storm left them stranded on the beach, you know what I’m thinking… “It made a difference to that one”.

The week of my one year anniversary I had malaria and spent most of the time in bed with debilitating fatigue. While grounded there I had some really amazing conversations with God and am now enjoying sweet times of refreshing with Him. It is too bad that I needed to be knocked off my feet to be still long enough for that to happen, but I am now able to appreciate that rather miserable week.

It is nearing time for my quarterly break when I will leave Sudan for Kenya for about 11 days. I am feeling the strain of the work more than last year and am anticipating a step back from the intensity. It is time to recharge, reflect, shop for supplies, fellowship with other missionaries, and plan and pray without the daily demands of the medical work—which I love, but recognize its drain on my emotions. Some psychologists have determined that individuals working in environments such as Sudan need a break every 10-12 weeks and I am now a big fan of that recommendation. Before I came to Sudan it seemed excessive to spend such a large amount of my support on flights into and out of Sudan every three months, but now I am so grateful for SIM’s arrangement and requirement of quarterly rest.

There are a few things in particular that I would like to ask you to pray about. South Sudan continues to be a nation of unrest. In the past four months literally hundreds of thousands of people have been uprooted from their homes in the Abyei and Nuba Mountains areas--with hundreds dead as a result of skirmishes between the northern and southern armies. Many of the people killed were civilians. Please pray for resolution in the disputed areas as South Sudan’s Independence Day approaches July 9th. Please pray for shelter, protection and food supplies for the internally displaced people crowding into other areas, without homes, the opportunity to plant crops, healthcare, etc.

There have been eight young people in the choir of the Doro church who have expressed an interest in knowing Jesus in the past two months. I am seeking time with each of the girls and hope to do regular discipleship and fellowship with them. Please pray for guidance and for me to find a way for quality time with them regardless of the language barrier and my clinic schedule constraints.

Please also pray for healthy team dynamics among our national staff and the missionaries. There have been some difficult situations lately. One of our Community Health Workers (CHWs) took a second wife and thus removed himself from employment with SIM. There has been some low morale and several illnesses among the other nationals, stress on the missionaries who have to take on more responsibilities than they can reasonably manage, disillusionment with the internship components for some of our newly graduated CHWs, political instability about 50 miles away, and the evacuation of our team in the town there, etc.

On the other hand, some of the highlights of this quarter have been a slight improvement in both my Arabic and Mabaan language skills that allow me, on a good day, to hold an awkward but heart-warming conversation with some of the ladies in our village. We always share laughs as we struggle to understand one another and share the joy of conversation—something I hope I never take for granted again.

We prayed for more help in the clinic and I am happy to inform you that two Kenyans--Dickson, a Clinical Officer, and Judy, a nurse, have joined our team for a year. They are a tremendous help! This past quarter has been exhausting and I cannot imagine what it would have been like without their support. My supervisor has taken on a more administrative role, so I am now the lead person in the clinic—as a new nurse and a new missionary that is a considerable challenge. As most of you know, leadership is NOT one of my gifts.

I have great news following another prayer request in my last letter! Pastor Bulis is back at work at the clinic providing a wonderful role model for our young staff, providing counseling and prayer with patients, providing translation in a pinch, and teaching a Bible lesson each morning with the waiting crowd.

Other highlights have been seeing many patients return to good health who I thought would surely die. I am amazed by the power of prayer and the resilience of the Mabaan people, many with medical conditions that we are not well equipped to treat—but they pull through, to the glory of God.
• Omna had probable Stephen Johnson’s syndrome and I despaired of her recovery, but after a week of treatment and prayers she was able to walk home and now comes back for follow-up visits smiling. In my year here I have seen only one other adult so close to death.
• Butros, a tiny triplet, who was the weakest of the three came to us with very serious pneumonia. Our solar power system was out and he needed oxygen. Our builder rigged a generator to our oxygen concentrator and with that added help the little guy made it through the first rough night. After several days of IV medications he is now home with his two brothers and happy parents. Their mother is involved in our Nutrition Program and receiving Plumpy Nut (a nutritious peanut based product for mal-nourished children) to help her produce enough breast milk for all three.
• Tenne, a 2.2 pound premature infant was with us for the first seven days of her life. On day five she quit breathing and required resuscitation for several heart-stopping minutes. (For you medical people—this was done without oxygen, epinephrine, intubation, etc.) I truly feel I witnessed a miracle. Just today we were able to get a charter flight for her to the nearest hospital through an African Inland Mission pilot. At the hospital she will have a more stable environment, more suitable medications and around the clock care that we are not staffed to provide in Doro. She has a long road ahead of her and I would greatly appreciate your prayers for her development. I had tons of time with her mother, Mary, and look forward to continuing a sweet friendship with her.

I will try to write more frequently and not make the letters so long. Thank you for the inquires many of you have sent. Thank you for your prayers for me and the people of Sudan. I love and appreciate having you with me on this incredible journey.

Grace and peace to you,
Sheila

“Be still, and know that I am God. I will be exalted among the nations. I will be exalted in the earth!” Psalm 46:10
Some images of our lives…

This is Little Tenne during one of her brief bonding sessions with mom outside of the cardboard box incubator.

During dry season the Falatta/Ful’ba nomadic tribe live in Doro They don’t like their photo taken but their camel didn’t mind.

Kamal, Community Health Worker, assesses the nerves of a leprosy patient in the village of Piekage

Fascinating Cultural Experience

Today I shared a remarkable experience with my Mabaan clinic co-workers.


Usually on Thursday afternoons we close the clinic and do some continuing education training for our Community Health Workers. Instead of our usual medical lecture today we decided to show them the inspirational movie, Gifted Hands. I was a little concerned before we started about how they would perceive the racial issues in the '60s and '70s but it turned out it was the public displays of affection that made them the most uncomfortable. I've never been more aware of how vastly different our cultures and world views are until today! Throughout the movie I was trying to understand how they would perceive it and also enjoying/but nervous about their thoughts of American culture.

If you haven't seen it, Gifted Hands is a lovely, wholesome, inspiring movie of a young African-American boy who has very humble beginnings but through hard work, the encouragement and strength of his God fearing mother, and prayer he becomes the leading pediatric neurosurgeon in the US.


Some of the awkward moments in the movie are 3-4 times when the young man briefly kisses his fiance in public. The Maaban watchers actually gasped the first time and then fidgeted with uncomfortable laughter. Let me help you understand where they are coming from. Mabaan husbands and wives do not sit together or even really talk to each other in public. If there is a need to go somewhere together they don't even walk side-by-side to get there. The man walks in the front with the woman usually about 10-15 feet behind him. When they arrive the man goes and sits with the other men and the woman goes and sits with the women. They do not speak or interact at all. They certainly wouldn't touch each other! The men make all the decisions, have all the control, can beat their wives for no reason, wouldn't ask a woman what she thinks, etc. Today my national friends saw the main character talking to, listening to, discussing his future together with his fiance and later as his wife, holding hands and sharing a brief kiss in 3 different scenes. Imagine the shock that is to them!

To be culturally sensitive on our missionary team are careful not to touch members of the opposite sex here except for shaking hands on greeting and touching during examinations when the medical work requires it. We try to avoid walking anywhere together if there is just one woman and one man going to that place. In church women sit on one side and men on the other. Men file out of the church at the end of the service and stand in a receiving line. When they are all out the women file out and stand further down the line. Usually when the hand-shaking receiving line is finished the men group up and talk and the women group up and talk. The only time the women and men mix during the fellowship after church is when we missionaries do it to talk to the men (the only Maaban who speak English are the men because they have opportunity for education that the women do not get).


For some of the viewers today (we included the Nutrition Program staff) it was their first time to watch a movie. They saw a different continent, a different culture, a different world view, definitely a different view of women. I'd love to know what they are all thinking....

one year in review

Eyye, a extremely mal-nourished patient in our Nutrition Program--encouraged to eat the speciality food--Plumpy Nut.

Tea and Cake with some of our neighbors.

My first birthday in Africa came while I was at a team conference in Kenya. Real bday cake and candles surrounded by about 40 of my Sudan teammates.

Feeding giraffe at a refuge in Kenya. One of the few touristy things I've taken time to do.

With the ladies in New Khartoum

With the 2010 Doro Primary Health Care Center team plus visiting Dr Mike and Dr Rob.

My first experience putting in sutures.

Thanksgiving Day 2010 with my lovely friend Karissa.

With my friend Orpha who works with malnourished children at the Nutrition Village. She is the only national woman who speaks English in my area. She is gracious to help me with language, culture--tons of questions every time I see her. She translates for me when I do ministry at the Nutrition Village with the mothers once a week.

With the 2010 class of Community Health Workers on the day of their graduation.

At the UN peace keeping compound about a kilometer from where I live.

This is how we cook--over charcoal and it takes FOREVER! This was the lovely group of girls who were on our team when I arrived. They have all gone back to America and Canada now and our team is much smaller.

Seeing a patient at the clinic.

Visiting my friend Roda (far right) at her home in New Khartoum within a week of arriving in Doro.

The first baby I helped deliver in Doro.

Our 2010 Community Health Worker team the day we sent Masir to open a satellite clinic in an area desperately in need of medical care. The people there were walking six hours to come to our clinic.

Sushi night! Well, sort of...

A year ago today I left America for Sudan. It has been one of the best, if not the best year of my life. I am so thankful that God has allowed me to live and serve Him here. He is so good to me.

the second wife issue gets closer to home

Today I learned that one of our best and most experienced Community Health Workers has taken a second wife and due to details in his contract with us--this means he can no longer work with us. I'm filled with disappointment and concern. I haven't heard his side of the story, but from this side, I just cannot see why he made this choice.

Roda

A shared meal with ladies of the Green City church back in July 2010. Roda is the one with her hand on my shoulder.

In my first month of life in Doro Sudan I accompanied SIM team members to a church in a town called Green City about an hour's walk away. After the service we were welcomed into the tukul of a woman named Roda. She was only the second Maaban woman here that I met who spoke some English--though her English isn't much better than my bit of Arabic...

Anyway, I really felt like we connected, but the next couple of times I visited that church I did not see her. Today I was working in the clinic and saw her so I greeted her warmly and sat down with her on the cot where she was waiting to be assessed. She was there to be seen for complications in pregnancy and possible preterm labor but I would never have known from her demeanor. She was so delighted that I recognized her that she grabbed hold of me and didn't let go for a while. She took off the handmade bracelet on her arm and put it on me and then sat arms linked with me. As a touchy feely person I just ate that up! The Maaban are not big huggers, but they are hand holders. I appreciate the touches I receive so much! This is the way here--we can become close friends after only one meeting and pick up where we left off. : )

Her medical condition is very troubling. On Wednesday she had been carrying a load of heavy wood on her head and began leaking what she though was amniotic fluid that day as well has having abdominal and lower back cramps. The leaking continued but slowed on Thursday and she arrived in our clinic on Friday after an hour's walk--a long walk is the last thing a woman who is threatening to miscarry needs--but here it is almost completely unavoidable unless the patient has connections with owners of the few cars in town or can afford the equivalent of about $8 to hire a donkey cart--but few of the common people have money like that.

We assessed the fetus to be at seven months gestation and were able to find a strong fetal heart tone after a couple minutes of searching, as she is not carrying the fetus in the normal position. It was such a relief to be able to tell her we found the heartbeat. In the States we would have the ability to test the fluid leakage to see if it is indeed amniotic fluid. If it is--she is at high risk for infection and very high risk of preterm labor and miscarriage. In the States an infant born at this time would be kept in the newborn ICU for several weeks and most likely live, but there is not such ability to care for such a premature baby here.

If I were a physician or a midwife I would have done a vaginal exam to check to see if her cervix was still closed. I may have been able to ascertain this myself, but in the event that it isn't and she really is leaking amniotic fluid, I could have put her and the fetus at greater risk.

She has been having pain with urination so I'm hopeful that the leaking was not amniotic fluid but a complication of a bladder infection. We prescribed an antibiotic for an infection and I put her on bed rest for three days instructing her that someone else MUST do all the water and wood fetching, cooking and caring for the children. The people here live in community. there are no families who work or eat alone so there will be others to help her. However, there is enough work for all 8-10 women in each little community of tukuls so her work will be missed. Oh how I pray her little one is OK. She has three living children and has not had any miscarriages--which is quite rare here. Most women have had at least one or two. I hope she does not have to experience that.

If she does have a miscarriage she probably will not seek medical care, although I told her to come back to the clinic if the leaking continues or she begins to bleed. The women here are accustomed to handling such problems on their own at home and are expected to recover quickly both physically and emotionally. Oh how I wish I knew more about women's health. We have a mid-wife joining our team later this year. We are so grateful. I hope to learn much from her!

Please pray for Roda and her unborn baby.

Where women have few rights

This afternoon I went off happily to visit some Maaban ladies with my fellow missionary, Karissa, who is very good with the Maaban language. Our lighthearted afternoon quickly became sad. We arrived at our friend Ula's compound to find her laying on a cot outside her home. She did not greet us with her usual enthusiasm and we could tell something was wrong.

She told us that her husband decided to take a second wife. When she told him she didn't agree to it he began to beat her. She has a broken hand and a painful, still swollen eye and temple from where he struck her with a handmade weapon called a bwam about two weeks ago.

He has already built a house on their property for the new wife. Ula said the woman came briefly and left. She said if she comes and remains that she, Ula, will leave their husband. Ula is one of the strongest and most respected women I know in Maaban County. Realizing how badly she is being treated--and knowing we nor she can do anything about it--is heartbreaking, frustrating and despairing. Women have very few rights in this culture. The men have a right to beat them but are not allowed to kill them without consequences. They are free as far as culture is concerned to practice polygamy.

Karissa and I prayed with her, tried to express our care and support for her and left in tears. As we walked home deep sobs wracked my body. There is such a helplessness in us when we see our people suffering, often as a result of someone elses greed, pride, anger or lust. I do not understand this culture yet.

Please pray for Ula as she decides what to do. In other marriages in this tribe I've heard that the woman must bear with the choice of the husband and even though the women in the village don't approve of polygamy, they won't speak up in defence of the first wife. They do not believe it is their right or the right of the first wife to resist the humiliating, frustrating and non-Biblical practice of polygamy. They stay silent (at least officially) and let the men do what they do--they are the ones with the rights and the power. For Ula to "leave" him is a very big step and a loud statement in this culture. I don't know what to think, but my heart aches.

I'm home!

Today I arrived back in hot, dusty Doro after four months and three days of uncertainly. It is wonderful to be back and I feel giddy about seeing my Maaban friends and co-workers, but at the same time, the knowledge that the next month is going to very busy and most likely stressful, dampens my enthusiasm down to brimming excitement and ridiculously wide smiling every time I see an old friend and share a long, pumping handshake or hug with them.

Within two hours of our rather bumpy dirt airstrip landing I found myself at the clinic assessing a burn patient. Fortunately, though the burns were significant and painful, she will be ok. The race to the clinic following the call of "you have an emergency patient", with the unknown condition of the patient waiting for us had me nervously telling a co-worker "I'm not in medical mode yet!" Thankfully I found that my needed "medical mode" kicked in when I arrived. It was super to be back and to be helping a person in need. Love it! So thankful to God for this opportunity to serve Him.

Playing the tourist

I had an opportunity to visit a giraffe refuge in Kenya in March--and feed the giraffes from my hand! Nice!