Cope vs. hope

Much of life as a missionary and a physician in a rural, poor, marginal, and probably corrupt place involves push. By this I mean the extra effort required to make the system work the way it should. One could simply go the hospital, do what one can do, and throw up one's hands about the rest. Which is, after many years of stress and defeat, the passive way that many of our colleagues cope. And me too, some days.

But not today. As soon as I walked on the ward, I found out that my newest admission had died at 2 a.m. This was an extremely ill child with sickle cell disease and severe acute malnutrition, who had come on death's doorstep. Worrisome, but we've seen many similar kids revive. Only this time, the person who promised to bring the blood needed for transfusion never showed up, and no one noticed or did anything about it. I called him today, and he said the district had refused to pay for his transport, because all its funds were frozen due to failure of our entire district to pay taxes for who-knows-how-many years (and who-knows-where that money went).

This is not a new problem, and this lack of essential funds does not seem to have kept half the district health office from traveling to a seminar in another part of Uganda today. Meanwhile the blood transport question was tied up with the propane gas cylinders that we have advocated for the last month, which run the cold chain, which stores vaccines, which run the entire country's immunization system, which have been out of supply. Finally they were delivered to Bundibugyo town over the weekend. Just eight more miles to make it to the health center, but this required desperate pleading and phone calls to a half dozen people to accomplish. In fact, I just counted seven calls and nine text messages this morning-the effort to get someone with authority to agree to release a vehicle and fuel to bring the gas cylinders, plus a person with a motorcycle and provision of fuel from my own pocket to allow the blood-cool-box to go and get blood and bring it back for the next four patients with dangerously life-threatening anemia.

Though all this should happen automatically, it does not. The people affected do not cry out, they accept their inevitable problems. And those who have some ability to make a difference are overwhelmed by too many other issues.

Mid-morning I realized that a neighbor's baby I'd seen early at my house never showed up for a lab test as directed. Again, phone messages to the child's grandparents, pushing. An hour later they arrive, and the child turns out to have severe malaria, and sickle cell disease, and needs a blood transfusion.

Yet the child I thought would die lives on: Ivan, miraculously sitting up after a liter of IV fluid revives him, through the nonpassive effort of Assusi. Little 5-year-old Kabasa has turned a corner, he smiles and runs after a ball, new appetite kicking in on his second week of TB therapy, and the possibility of healing dares us to hope. Twins, and a 1-year-old girl whose mother had abandoned her but was convinced to return when she ended up malnourished, all go home today, cured.

New premature twins arrive, bringing our 2- to 3-pound speck-of-a-baby population up to four on the ward, too many for the side isolation room, so we cordon off an entire section of the ward after cleaning it well, and try to make it a safe preemie environment.

Very little of my effort today involved specific medical knowledge. Very much of it involved a few resources that most people do not have: about four dollars of air time, about four dollars of petrol, and the sense of outrage that growing up in a country that generally "works" lends to my perspective.

People who work in settings like this need prayer support, to not give up, to believe that a little more push is worth it. I know I do.

-Jennifer Myhre is a physician with World Harvest Mission living in Bundibugyo, Uganda. This is excerpted from the blog she writes with her husband, Paradoxuganda (paradoxuganda.blogspot.com).