HIV in Africa: Churches Helping Churches

Perilous Passion

2011-06-27T00:12:00.000-07:00

“Is he always this passionate?”

The inquirer was making a site visit from the Department of Health and Human Services, Maternal-Child Health Bureau, checking us out regarding a federal grant we sought. The question was rhetorical, more a commentary on my exuberance and enthusiasm regarding the needs of women and children in San Bernardino County and our proposed solutions than a request for information, but the answer Vanessa Long, our most capable program manager would have given was a decided “yes”. Today the answer haunts me.

My just-completed four days in an excellent South African hospital revealed several key pieces of information about me and my little stroke. First, there is no evidence that the stroke was caused by a clot or bleeding inside the brain. It was deep in the brain in an area called the thalamus, not on the surface as many more debilitating strokes are. Speech and thinking are not at all affected, thanks be to God, and there is little if any weakness. I’m numb on the left side of my body and a little uncoordinated on the left. And my head feels spacey (good medical term, “spacey”). While there’s no plaque or fat deposits in the walls of my arteries, their muscles are thicker than average. But the most important information was that my blood pressure tends to go through the roof (192/106) under any emotional situation, positive or negative. The nurses caught it up there several times, though 130/80 was more common. The high pressure probably caused spasm in a small penetrating artery serving the affected area leading to hypoxia and maybe then “terminal” spasm. Intense reactions to normal stimuli? Perilous Passion!

The passion that got me here (“Something has to be done to help our brothers and sisters in Africa deal with HIV.”) could well take me out. And yet it has always created difficulties. Beginning probably in grade school, some of you will remember the kid on the front row who got C’s in conduct in part because his hand insistently waved to answer every question. That passion has suggested to some that emotion has clouded reason, though I think it usually follows a reasoned conclusion. Some people resist the causes that passion supports just because of its intensity. “For every reaction there is an equal and opposite reaction,” and that may be true even within the body of this passionate individual. The current question is whether that passion can be controlled, modulated to avoid its destruction of the body which gives it expression. Putting it in a box will not likely serve its cause.

A few years ago I was invited to a prayer retreat put on by Randy Harris, Rhonda Lowry, and the then youth minister at the Malibu Church of Christ. It was to run from early Friday evening until Sunday afternoon. Getting across the LA basin took more time than I had allowed, and the retreat was beginning as I turned off Interstate 5 and headed into the Santa Monica Mountains. I relished the challenge of the mountain curves in my Honda Civic with the V-tech engine, and I got there, stoked, ere long.

What I remember most of the retreat was my feeling at the end after nearly two days of mostly praying, together and alone, with a little talk of prayer and meditation sprinkled in for guidance. First I didn’t want to leave. The place was not of paramount importance, but the rural setting was conducive to our goals, and the things that normally intruded were not there, so I loaded my car after lunch on Sunday so as to prolong uninterrupted the open-ended afternoon session in solitary prayer—just me and God. When I finally did leave, I felt no reason to rush, so no screeching of tires or exhilarating turns going down the hill, quite in contrast to the drive up. I felt no pressure to get home, not just because I had no appointments that evening, but none of the usual pressure that appeared within me raised its ugly head, created by my own internal demands to be busy, to do something. And so I was content to stay amongst the big rigs at 55mph easing down the interstate toward LA in the right two lanes. I was at peace. I was convinced of the value of what we had done, but I was contrastingly almost reluctant to speak of it. That passion was somehow different.

That peace remained largely intact through the night. I made some changes in my behavior that were suggested at the retreat, spending more time in the Word, especially the Psalms, changes that have been largely maintained to this day. But, those things gradually became one more part of the “to-do” list, the must do list and over a few weeks that deep inner peace gradually slipped away, crowded out by the press of a plethora of commendable activities, unprotected by my reading of the verses in the Psalms.

Today I am convinced that what happened at that retreat is a big part of the solution to the problem my self-destructive body is presenting. Don’t get me wrong. I am quite aware that we all must die, but 60 is relatively young, even (or maybe especially) for our family. In addition, more than sixty years of resistance training for my arterial muscles probably will require medication to assist in the task of keeping the BP down (and I’m on it), but learning to approach life on a little more even keel will probably reduce that medication requirement, and medication alone probably won’t do it. Finally, it was and is a good thing, that peace, in and of itself, and my colleagues in the kingdom would probably get along better with a Bruce no less committed but with a little less edge.

Death of a (small part of the) Brain, Observed

2011-06-23T10:04:00.000-07:00

I suddenly felt light-headed and my left hand was tingling, then my toes. I was sipping a coke at one of our favorite cafes, waiting on my lunch. As they brought Beth’s plate, then mine, I shifted my weight, moved my shoulder, but it got no better. The left side of my mouth felt like I was at the dentist, but also the rest of my left face, top, middle and bottom (that’s not supposed to happen). There was no headache. Something was amiss, terribly amiss inside my head. A parasite (I recalled that pork kabob at Momma Mia’s, a little too rare, about a year ago) or a tumor had decided to manifest itself, or I was having a stroke. My left arm felt heavy, wanting to fall to my side, and when I eventually tried to stand, I had trouble walking. I needed help to stay on my feet.

“A stroke?! I’ve no risk factors for stroke.” My mind rebelled against the reasoned judgment of my new friend and colleague Jerry Koleski whose number I had at hand, an American internist at Partners in Hope hospital, a major HIV project in Lilongwe which helps with other medical needs in some circumstances. Denial was working hard, but my entire left side was still tingling. Lunch in Lilongwe was being interdicted by life, or maybe impending death. The owner of the Cappuccino Café rushed for aspirin suggested by my doctor friend who called back as it arrived: “Don’t take it. If you’re bleeding it’ll make it worse. Come on over to the house. I’m just three blocks away.” After an exam confirmed his suspicions of probable stroke, several hours of negotiating with insurance companies, led by Jerry’s wife Elizabeth helping Beth, an air evacuation to South Africa was arranged as Malawi didn’t have what we needed. It would be no less than 12 hours later and maybe as much as 22, but it all fell through when the chosen company called at the hospital late that night to say they didn’t work with our insurance company. Our missions minister visiting Tanzania en route to see us the next day with his wife and children got on the web (to which we had no access) and got us tickets on the commercial flight the next day at noon.

The 3 hour flight was relatively uneventful, and wheel chair assistance whisking through all immigration and customs stations got us into a taxi and out to Milpark Hospital the Malawi-based docs had used several times. An MRI followed our ER visit, confirming the stroke, an area of tissue about the size of an olive in the brain’s right thalamus being affected.

A stroke. Part of my brain dying, starved of blood, glucose and oxygen. How much will I lose? Is my work finished? I’ve not really gotten started. Am I finished? Will it get worse? Will it get well? Lord, what’s up? Why? What will I do? Will this eventually help in some strange way with what you want me to do? As we’d gotten into the car that first day to see our friend I’d given Beth messages for our children. As I went to sleep that second night I again had a little talk with the Lord. I knew he was there, but like Jonah, who didn’t find the presence of the Lord as manifested in the storm or the fish too comforting, I didn’t either. I thought my wife would've been more comforting, but she'd gone to stay with other new friends in Johannesburg.

I’m out of the hospital now. I’ve had a “lacunar” stroke, deep inside my brain. They often leave no symptoms (at least with the first one), and I’m walking better, but my whole left side is still tingling, including my left chest and belly, front and back. I’ve learned that my blood pressure tends to go up really high when I’m stoked or stroked. I’m on some meds for that, and one aspirin a day, though there’s no evidence that a clot played a part in this one. I left the hospital two days ago, and will fly to Malawi tomorrow, God willing.

I have no more idea “why” this happened than when it first began, but I am much more aware of my dependence on God for everything, including this breath. I am more humbled as to my place in the universe, and the importance of “my plans” in the will of the Lord. While I have no doubt the Lord is willing to work with me, to use me, in fact is working with me and using me to bless others through me, aware that I can and do have some part, however small, in the cosmic story he is unfolding, I am also more aware than ever that he doesn’t really need me. He is not dependent on me to complete the story or even to do “the task” that I’m currently called to do. Rather when he calls, my task is to answer “yes” to whatever he wills, even if the call is, “Come home.” If nothing else, I’m much more aware that, as the hymn says, “Today I’m nearer to my home than e’er I’ve been before.”

Welcome Home!!!

2011-02-25T10:30:00.000-08:00

We’ve been in Malawi less than 24 hours, and it’s good to be home.

We arrived at 2:00 PM yesterday, Thursday, February 17, 20 minutes early. A good start. All our bags arrived. Another very good start! This was the first time all our bags had made the transfer in Addis Ababa on these flights. The new Ethiopian Airways schedule with a slightly longer layover in Addis is working. Napoleon and Gracian were awaiting us. Also very good. It is so good to see them again. Welcome home!

A few hours after arrival we thought of supper but were told that the propane tank was empty. We had failed to blow out the pilots before we left (a mental note for next time), but after several meals on the plane we weren’t too hungry. We not uncommonly eat cold cereal in the evening, and there was some left and waiting, along with liters of long-shelf-life juice and soy milk. It was all good. We found some gas in the tank at the guest house, and swapped out the tanks for the moment. The first run to town would have to include a bottle of propane. Welcome home!

As we headed for bed, we discovered that the electricity had gone out in the back half of the house, at least most of the electricity. Beth had turned on the bedroom water heater and left it longer than usual. We found all the plugs in the bedroom and all the lights that are switched in that room out. One light, switched in the adjacent family room only, was still working. I tried the circuit breakers, and one, when turned off and back on restored the current. But sparks flew when I switched it either way. We left the breaker off, hauled out a transformer and a long extension cord and rigged up 110 from the front of the house into the bedroom. The fan and C-PAP worked fine. (I’ve used C-PAP effectively every night for the last—well, nearly 20 years—to counter sleep apnea.) We could sleep. Welcome home!

We took melatonin at bedtime around 9:30, at the suggestion of fellow-travelers (where do doctors get their continuing education?) confirmed by Beth’s pediatrician brother. It’s apparently great for helping kids and international travelers get their days and nights straightened out. At some time between 2 and 5 AM I awakened, took two or three long, deep breaths through the CPAP mask and dozed off again, only to reawaken almost immediately and repeat the process several times. Finally I was awake enough to realize that the electricity had gone off—all of it, all over the house. The C-PAP mask was now doing more harm than good, so off it came. But the melatonin and fatigue danced well together and after shedding the mask we woke up much refreshed at 8:30—11 hours sleep. Welcome home!

It’s rainy season, and despite the roof patching done in December just before we left, wet spots are still appearing in the ceiling of the bedroom—not as bad as it was, mind you, and not coming through on the bed; just keeping us alert to the unlikely possibility. It’s been this way for years, leaving stains throughout the house, and black mold penetrating the ceiling in a few. We hope to change the ceiling, once we get the leaking under control, when we get the leaking under control. But the bedroom still leaks. Then at mid-morning it really started to rain, a gully-womper. The wind wasn’t that high, but suddenly, water was gushing down the inside of the front wall and window, soaking the curtains and the floor. It did this one day last year when we had first moved here. I knew the patching of nail holes through the zinc sheets wasn’t going to handle it, and it hasn’t. We’ll have to look at that design problem in the attic where the roof meets the porch overhang and rethink this once more. Hmmmm. Welcome home!

The electricity in the back of the house is out again, and a closer look with the campus electrician reveals a wire too small going into a circuit breaker. The breaker didn’t fail primarily, but where the inadequate wire was burned at entry to the breaker, the breaker is also burned, ruined. A new one will be necessary. Welcome home!

We needed to let Wes know we had arrived safely and well. There is no internet access at the house today. At the airport the signal strength is uncharacteristically weak. But Beth got on and the message is sent. We are well. Welcome home!

There was a quarter tank of diesel in the car when we checked. Napoleon had told us there was a severe diesel and gasoline shortage. We’d read about it in the States. A demonstration had even been planned for the 14^th, but it had been thwarted by the police who’d picked up the organizers at the meeting site. Now we needed diesel. Napoleon instructed us: “If you wait on the diesel, you will never find it. If you go looking for it, you may not find it. But you have a quarter tank. You can go to town and back twice, if you don’t drive too much in town.” Welcome home!

We went to town, and asked at the first station—“No diesel or petrol.” Two semis waited at the second station for a delivery at some time in the future. A few trucks and buses were taking on fuel at the third station, but they denied us service; limited supplies were only for their big corporate customer. At the fourth we tried there was none. “Try the total at Maula.” As we neared, the line was evident, so we lined up, about ten or twelve cars back. One truck carried a very large tank on the back, several hundred gallons. Would there be any left when we got to the pump? Harold (the hospital administrator) walked off to take care of his business in a nearby part of town, and returned. We were next, and then we filled up--both tanks, enough for possibly two to three weeks if we are careful. Welcome home!

As we waited in the line for diesel, a European whose pick-up was in front of us walked back to chat. He was a Dutchman. He had driven from Rhumpi in the far north of Malawi that morning to attend a meeting scheduled for 4:00. He had found no diesel between Rhumpi and Lilongwe. Would he get through the line in time to make his meeting? We learned that he is a doctor, having worked as a medical missionary in Malawi for about 17 years, including one stint on an HIV-related public health project. All medicine in Malawi is HIV-related, but he is now attending in the public hospital in Rhumpi. “Churches are not doing near what they should be doing to combat HIV,” he noted, blessing our plans. He told us of a bi-annual meeting in Kenya hosted by the American Christian Medical Society, two weeks long, granting enough CME credits for two years’ requirements. It will be held in February 2012. We exchange contact information. Welcome home!

Out of propane. There's an extra bottle at the guest house.

Electricity problems. Our electrician friend is on campus.

The roof leaks. But less than before, and only rarely reaching our feet (or even our heads!)

Internet hard to get. But it will be better with a latte at the hotel (and it was!).

Vehicle fuel shortage. Two full tanks after only an hours’ wait—and a new colleague and encourager to boot!

Within a few hours’ time we are reminded why we looked forward to an “escape” to the States. But the reasons we were ready to return--the things we missed about Malawi--are still here, most of all the dear friends we made during the past year. And so we wander from here to there, thankfully never completely satisfied until we reach the home prepared for us and hear the words of the one who guides us from here to there: “Welcome home!”

Going Home

2011-02-05T22:38:00.001-08:00

The sun is probably well above the Doa Mountains by now. My friends the guards, Moses, Wilson, Kay, McNight, and others have long left their posts, are probably eating breakfast by now, and may be soon returning for some piece work on Saturday. Florence and Mtami would be coming soon for their occasional visits to the house in our absence, if today is the day. It could be raining hard, or have ceased after a steady rain through the evening, or be the day this week when the sun will shine. Whichever is possible as we enter the heart of the rainy season, and I hope the patches applied to our roof just before we came here are holding up well, and that those which seemed less than perfect have not become a fountain into our bedroom and down on our mattress.

I am sitting in a men’s retreat at the YMCA Camp Chandler on Lake Martin just north of Montgomery, Alabama. It’s 10:30 or so, and my mind has wandered to now’s early morning in Malawi. It is good to be here with a bunch of men, about 80, who are dedicated to following the Lord, all from the Landmark Church that is our primary sponsor in Malawi, but time to return home is approaching and my thoughts slip smoothly between the comforts and challenges of the present and those to which we return in Malawi. It is cold in middle Alabama tonight, but the room is warm, and the husky singing of this male chorus is encouraging. It is one of many other beloved and caring “suitcase stops” on this six week visit in the U.S. These faces have been a blessing, as have all that we’ve seen while home, kin, and kin in Christ, encouragers all, each in his or her own way. Folks in L.A. and Redlands, those from all over in Dallas at the medical missions seminar, in Kilgore and Shreveport, Jonesboro and, again from all over, in Searcy, now Landmark in Montgomery and University Church in Tuscaloosa next week. Then home.

Home. The U.S. is home. Malawi is home. Which is really home? Or, which is more “home” right now. For all the wonderful hospitality and welcome oh-so-friendly cultural cues from dearly beloved brothers and sisters, American brothers and sisters, we are ready to pull our morning’s fresh clothes out of the customary drawer in the bedroom in the house on the hill, and toss them at the end of the day, damp from the day’s humidity without and within, into their designated corner in that same bedroom. Our bedroom. Ours not by ownership but by use and custom. We’re ready to eat a little Weet-Bix (mixed with granola), to feel the surge of the six-cylinder diesel engine in the Patrol we’ve just been given by each of you, to hear the birds singing in the trees outside, to smell the smoke from the cooking fires, to hear the voices of the children from the orphanage, to see our friends.

Missionaries returning on furlough often long for something of home they couldn’t get “over there”. Dr. Pepper is a common object of such desire, and once going down it usually doesn’t taste as good as was imagined. We were deeply disappointed by the Starbucks we drank on landing at Washington Dulles. Now I look forward to a latte at the the Capucino Café in Lilongwe, and an expreso at the Italian Deli. I think that is a good sign.

Soon Harold will be unlocking the Hospital, Nelson will be arriving on his motorcycle, Napoleon may or may not be stopping by on his way to Saturday’s mission, but Salema or Berta will be opening the office. The workers at the plant will begin their weekly cleaning chores. But now it is 10:30 pm in Camp Chandler near Montgomery, Alabama, and I am being encouraged by the faith of brothers, and the words of my wife and my friend written for this occasion. Today, tomorrow and next week—if God wills--we will talk about our work and be encouraged by you and others, and then on Monday we will fly to Washington, then Addis Ababa, then Lilongwe: today’s home. And we will work to enjoy our new home, and prepare for the next, strangers and wanderers on this earth that we are.

"In Your Prime"

2011-02-05T22:30:00.000-08:00

The “Hello’s” we exchanged came natural, both of us being “southern boys”. I’m not sure who spoke first. I was raised in Texas, and we spoke to everyone, and the late teen with whom I exchanged was surely Alabama born and raised, as his accent portrayed him. I was walking across the Walmart parking lot in east Montgomery to get the car. He was in the driver’s seat of the older model car, double-parked, probably waiting on his mom, his younger brother sitting in a back seat.

As I crossed in front of his hood he lowered the window on the passenger side and hollered at me: “Sir, you know where I can get some good weed?”

“Excuse me?” Maybe my hearing is slipping.

“Weed? You know. Marijuana? Do you know where I can get some good stuff?”

“I’m so sorry. I really don’t have a clue.”

“But ya do use don’t you? You do a little every now and then, no?”

“No, ‘fraid not.”

“But in your younger days you did, didn’t you? You know, back in your prime?”

“No, sorry, never smoked a joint. I can probably count on one hand the times I’ve had a beer or a glass of wine?”

“Really? Well, thank ya anyway.”

“You bet.”

Marijuana. I’m not sure who was more incredulous. Those who know me know I am a connector, constantly suggesting that this one meet that one, that the guy in this business might like to know this fellow I met over there. But where to get good weed? And, “back in your prime”? I’m learning a new language, still running 10K on weekends. Moses was 80 when he finally got his big assignment. I’m only 60. I don’t think I’ve hit my stride yet.

Then it hit me. The beard. The beard which is heavily streaked with gray. I’m having a little “re-entry cultural shock”, though. Cultural cues. Misunderstanding. Miscommunications. It happens not only in Malawi, but here in the Walmart parking lot in East Montgomery also. And I am older than I admit to myself. The joints ache a little more, a little more continuously. But the time to quit has not come, though it will. And until the Lord does offer a little R&R, rest and then renewal, a new body with new joints to do new work in a new environment, I’ll do what he has called me to do, with all my might, sharing the story of how to live the best kind of life possible on this earth until he comes or calls.

“In your prime!”

Have a Green Christmas (In Malawi!)

2010-12-28T03:38:00.000-08:00

“Have a green Christmas”, our missionary colleagues wrote via e-mail a few days before Christmas. Far from a naturally consequential curse of over-eating (which some of you may have suffered), theirs is a sure blessing here in Malawi’s second month of rainy season. A white Christmas, barring a very rare heavy pounding of hail out of one of the frequent thunderstorms, is exceedingly unlikely. Today, on Christmas Day, arguably the most widely recognized, if not celebrated, religious holiday in the world, I thought I’d share with you what our first Malawian Christmas has found.

Backing up a few days, or weeks, we’ve noticed from our somewhat distant vista (we live about 30 minutes out of town and are not in the stores every day), the “Christmas spirit” did not really get off the ground in Lilongwe until a few days before Christmas. (The one exception: “Santa Plaza”, a variety store run by Muslims, complete with sleigh and reindeer blazoned on the front façade year round.) Yesterday (Christmas Eve) for the first time we heard carols playing over the loudspeakers in the grocery store. This late appearance of the Christmas “season” is a mixed blessing. We missed the music, but the blatant commercialization of Christmas is not so prolonged or extensive here as it is in America, largely because most of the population has so little money.

Gift giving in Malawi sounds somewhat like stories my parents told me about Christmas in the U.S. during the great depression, when oranges were likely the only gifts. Similarly, a special meal, chicken with rice rather than the boiled corn flour staple, nsima, is often the center of Christmas, if not its only manifestation for a family, if they can afford that. Christmas and New Year’s day are understood to be national holidays, and most workers get off, but the president didn’t get around to making the annual proclamation of such, essential for government workers to get a holiday, until late in the week.

Among members of Churches of Christ in Malawi, because an annual celebration of Christ’s birth is nowhere mentioned in the New Testament, Christmas is generally not recognized or celebrated, though there are exceptions. With the general lack of emphasis on gift-giving, the easily commercialized aspect of Christmas, and the pervasive poverty (political calendars are often wall decorations) it is easy to let this holiday slide, to ignore it completely, and often this happens. This is true of other more conservative, restorationist churches as well. Mainline churches, however, often have a service on Christmas Eve or Christmas day.

Christmas, at least on the surface of things, does not seem to be a big deal in Malawi.

Given this cluster of realities, what we should do as we interact with Malawi while having very different thoughts about Christmas is an interesting problem for a new missionary in early adjustment. Opening some boxes of Christmas things proved quite helpful as we found termites had destroyed the box, with no real damage to the contents. We decorated a tree, put a wreath on the front door and a collection of candles in an internal window sill, and wondered how these would be perceived by our colleagues. (We also mounted a full-scale termite search, which may have saved a lot of valuables.)

Beth gave Florence, the lady who helps her in the house, a bonus of about 22% of a month’s pay. We then took her and her apprentice from Mtendere village to town on Thursday (Florence’s first trip to town in about five years). They split a hamburger and fries and a pizza, which Florence particularly likes. They then went to the market where Florence bought a new wrap-around skirt cloth, a new purse, and a new blouse.

Beth also baked banana bread, giving small loaves to many of our closer friends on the campus around us and some off campus. On Thursday night we went caroling, as was the custom in both our families. We visited several workers on our campus, including Florence, who live in a row of “apartments” which you would probably perceive as small “storage units” based on their size and shape. We stood at the end of the short row of about ten units and sang the three Christmas carols we had found in the Malawian Chichewa hymnal. We then visited a family from church whom we knew would not be offended by our coming. Then we went to Mtendere, the children’s orphanage below our house.

By the time we got there it was after 8:00, and for the first time I saw no one out on campus at that hour. We sang the three Chichewa carols at five stations on the campus, adding “Joy to the World” at one point. Because of the tendency for hymns in Chichewa to be sung to African tunes and rhythms radically different from those we know, Beth had been concerned as to whether the caroling would be appreciated. The next day one of the boys described one reaction to our coming. When singing was first heard from the opposite end of the campus, one of the boys looked at another and asked, “Have angels come to visit Mtendere?” Then another said, “No, somebody’s got their radio on and put it in their window really loud.” Then, as we moved closer to their house and began again, the first went to the window and stuck his head out. “No, it’s Bruce and Berta!” (Beth’s most common identity—the Chewa don’t handle “Beth” well.) We’re certainly not professionals, but good music done reasonably well is generally appreciated across cultures, as it was here.

We had hoped to visit our son who lives about 500 miles east of us in Mozambique, but that proved impossible at the last minute, so we treated ourselves to a couple of days at a nice hotel in the Capital. Christmas Eve we hosted a couple who have no support—she’s from the U.S.A., and he is from South Africa—for a marvelous dinner and several hours of good conversation. I really appreciate their insights into African culture and the involvement of church leaders in the HIV epidemic, a topic of particular interest to them as well. We slept in this morning, Christmas. I ran, and then we had a late breakfast. We’ve rested, read the papers, watched a movie (August Rush—I recommend it), rugby and soccer games, and CNN news, all special treats to us. We’ve enjoyed the air conditioning in the humid weather and have skyped with several friends and relatives: our Korea-based daughter and her husband who are visiting a friend in China, our son and his family in Mozambique, Beth’s brother in Arkansas, colleagues in Turkey and Tanzania, and our always-supportive Missions Minister at Landmark Church of Christ in Montgomery, Wes Gunn. We still hope to catch sisters and our son in California.

Tomorrow we’ll visit a large congregation in town, and then head back to the house, thankful always for our Lord who came to live among us, no matter what day he actually made his entrance on earth, the many blessings he gives us to help in our adjustment to living with and for Malawians, and the many relatives and friends who support us in this mission. In the end, all the hype, glitter, gifts, playing of Christmas music, and other customs, the “externals” which are so different between our family and our Malawian friends, are not what it is all about, are they? Whether Christmas is a “big deal” in this sense doesn’t matter one whit, but the effect of the coming of God to live among us, his life, his death and his resurrection on our lives, whether we also live “resurrection lives”—that is what it, life itself (not just Christmas) is all about, isn’t it? If not, nothing else really matters. And by that measure Christmas may in fact be a bigger deal to the average Malawian than to the average American, in the heart, if not on the surface of society.

Funerals--The USA and Malawi

2010-12-15T09:32:00.000-08:00

I remember my first funeral well. Some older person in our church had died, but I didn’t know him or her, and the funeral was to be held in Grand Saline, about 50 miles away. My Daddy was the song leader in our little congregation, and he needed a tenor. I was taken out of school, it was about the 7^th grade, and carried to help form the quartet that would comfort family and friends with songs of heaven. It was a good, hands-off, impersonal preparation for my second funeral.

A few weeks later a boy in our small town (about 95 in my graduating class) was killed. He was one grade ahead or behind me; I think his name was George. He had lived, just around a corner or two, but we were not good friends. His single mom tried, but he ended up being one of the boys my mom didn’t want me to play with. That’s why he died. The square dance club met in the City Auditorium, an old frame building out by the rodeo arena. I was in that Auditorium only once or twice in my life. It was just the other side of the railroad tracks from down-town and our houses, mine and George’s, and about a mile down the tracks the other side of Main Street. Drinking was strictly prohibited in the Auditorium by the Baptist members who’d broken into square dancing, but not alcohol. The Methodists conceded, but some folks kept a flask under their front seat to loosen up their turns between dances. And in a small town, nobody locked their car.

The County was dry, and booze hard to get, but George had figured this one out. While the fiddle scrawled and the gentleman called, George was helping himself outside. He was pretty drunk when the dancing ended for the evening, but he made it to the tracks without being discovered. He didn’t make it home. He just laid down on the ties and gravel between the rails to rest a bit. He was drunk enough to sleep in that unlikely bed, but not enough to sleep through the 2:30 train that came through town. He was too low on the track to be seen until he raised his head just before the train reached him. I remember a few things about the funeral: almost everyone from school came; they didn’t open the casket; and it was generally very quiet but for his mother sniffling up front, fighting back the pain.

Malawian funerals are not quiet. No one is fighting back the pain. Men and women who are close to the deceased wail almost continuously, even through the hymns, except when a preacher calls for quiet for prayer or an exhortation. Most of the rest of the time, during visitation (12-36 hours) and the trek to the grave a host of mourners including the close family wail, and contort the body, some walking around outside the house where the body lies and calling on the deceased “mkazi wanga, mkazi wanga” (“my wife, my wife”) or “mlongo anga, mlonga anga” (“my sister, my sister”). My friend Steve Kay, who out of his own profound experience speaks and writes well about grief, especially male grief and its expression, would admire the Malawian men I think, bent at the waist, arms wrapped around their bent heads, weeping and crying, wailing and calling of their loss and for the departed. I am also reminded of the Biblical stories of funerals, where Jesus quieted the mourners before challenging death itself.

The body lies in state in the front room of a small hut, usually for less than 24 hours, but occasionally longer if some family must come from afar. Wailing women fill the small room, surrounding the body, covering the floor, spilling down the hall toward the bedrooms. A thin path through the legs from the door to the head of the deceased, and sometimes out the back door allows others to view the body, or at least the face, where only a small portion is visible, the rest, including the mouth and nose, wrapped in cloth. The closest female members of the family are literally and bodily supported by other family members, propped up where they are sitting on the floor.

Male family members visit the body periodically, joining the wailing on entering the door, and sometimes continuing in the courtyard as they walk off their grief outside. Clusters of men and women sit in their respective, quite separate areas all around the house, sometimes stretching throughout the neighborhood, but in these circles quiet respect reigns. Stores in the close neighborhood are “closed” though discrete sales through a cracked door allow life to continue in this world of many funerals. Some women bring in food (meaning nsima, the boiled corn meal which is the staple of diets throughout this part of Africa), while others stir the flour into pots of boiling water and prepare greens, beans or meat to add “relish” to the center of the meal. I’ve never seen a small funeral or memorial service. Honoring the dead is a core part of African life, and everyone shows up who knew the deceased and knows of the death. All the neighbors are there, and friends and relatives from near and far. Everyone is fed. Contributions are made, and a list of civic leaders who contributed, and how much they gave, is announced at the formal service before the shift to the graveyard. The village chief speaks of the deceased. An obituary is read. Singers sing. A preacher preaches.

When the grave is ready, or some other social marker unknown to me is reached, the body is witnessed by as many as possible as it is being transferred into the coffin. The tapping sound that followed puzzled me until I remembered the two hammer-bearers entering the house. The wailing, which had grown with the transfer of the body, swelled even more as the lid to the simple casket was nailed shut. The casket was moved to the bier, and the trek to the grove of trees marking the graveyard began, women leading if the deceased is female, men if male, but never mixing. Sometimes the grave is near, sometimes far.

At the graveyard there is more singing. More preaching. And more wailing, but now by isolated family members overcome by the grief of the moment. Some are comforted by others. One by one family members may be removed from the scene by friends or other relatives, perhaps because their display of grief is too much for that moment of the service, or perhaps for fear that the depth of their grief might become harmful to them on witnessing the burial. One wailing young man fell flat on the ground and was carried out, apparently unconscious. Later another followed suit but was left to lie. At one point a young woman near the grave stood, turned, gasped deeply, and let out a short but forceful cry which ended with her swoon to the ground, arms and legs flailing. Four women lifted her by her four limbs and carried her out despite the jerking of the appendages. Most sat quietly as the casket was lowered, the dirt returned, and the preacher preached on. A choir sang a few songs.

When thunder and lightning neared, women began to slip away. “Mvula! Rain!” One said to Beth. “You’re going to get wet! Tiyeni. Come with us.” The preacher continued. Men soon followed. The preacher himself soon gave up and the feeding began: nsima and goat. The rain mercifully held off another 30 minutes. Then we were on our way home, hurrying against the approaching darkness to get to the highway and then the city before the multitude of bicyclists and pedestrians scurrying home fade into the obscurity and danger of nightfall on the busy road.

Funerals in southeastern Africa have a major effect on business productivity, not only through the loss of skilled employees in their prime years (Malawi lost 6,500 teachers to death in the last three years) but also due to the massive social participation that is required of the living. Funerals take at least one day, often two, and not uncommonly three days away from work, and each worker attends multiple funerals a year. We attended three last week. Employers are expected to be major benefactors toward the costs of funerals in their role as the primary sustenance of the family. Funeral support is in the budget of every major business as a line item, but in one recent year a major civic unit drained that item long before the year was over. Some control of HIV (50% of those needing treatment in Malawi are getting it) and an increase in the line item budget for funerals have avoided the problem of running out of help in subsequent years, but deaths continue in large numbers.

The west has a short attention span, and the current waning attention to the African HIV problem is evidence of that. The US and Europe are moving on (actually around in a cycle) to attack once again Maternal-Child Health. While some shifts in AIDS budgeting may need to occur, the need for western government to support availability of the expensive medications needed to treat HIV still exists. Write your senators or representatives today. Western Christians need to support widow and orphan care by local agencies and churches in Africa. Just as the effects of previous efforts are beginning to be observed, the West is backing out. This is not the time to back out, but rather the time to press forward, to make treatment available for everyone lest the wailing never stop.

Here Comes the Bride--But Who is She?

2010-12-09T06:35:00.000-08:00

It was a beautiful wedding. We got there late, but the service had not yet started. In fact, though only a few more entered after us, the wedding party didn’t come down the aisle for at least 45 minutes after we arrived. We didn’t see our friends who had invited us, but that wasn’t terribly unusual. About 250 people were there, a good crowd in a much bigger building. Our friends were probably hidden on the front rows with other family members or helping out with last-minute, pre-ceremony details.

We didn’t know the name of the couple getting married, which calls for some explanation. You and I know how invitation lists are constructed for weddings in the U.S.: carefully and thoughtfully, and input comes only from the bride and groom and their parents. Even grandparents rarely have any say. In Malawi things are quite different. We’ve been invited to four weddings since we’ve been here. First, a lady who works here on campus invited us to her sister’s wedding. That felt really strange and uncomfortable—we didn’t know her sister. We politely declined, but afterward were repeatedly reminded that we didn’t attend her sister’s wedding. That was our first clue that things were different here. We knew the father of the bride of the first wedding we actually attended. The announcement was made in church, of which he is a member, and he lives near the church building. It was a triple wedding, three couples tying the knot at once, but separate receptions. It seemed to us like the whole village went to the reception we attended—another clue that things were different.

Then a couple who are our dear friends at church, the Gondwe’s, invited us to attend two weddings, a week or two apart, which were for children of their relatives. Our friends were responsible for many of the arrangements for these two weddings, but that wasn’t the big factor that led to our invitation. In Malawi any member of the extended family can invite his or her friends to a relative’s wedding. And family is defined very broadly by U.S. standards. We had a conflict for the first of the two Gondwe weddings, but we were here in this Presbyterian church waiting for the second to begin. With over two hundred people ready and waiting the keyboardist practiced his rifts and adjusted this and that. The music sounded great for a few bars, but invariably broke off too early for our satisfaction.

Finally the preacher appeared and the music continued for more than a truncated refrain. The first bridesmaid appeared in a purple dress and began her slow dance down the aisle. No simple walking, this procession. The beauty of the special people in special dress with special motion for the special occasion was designed to last as long as possible. As the maid neared the end of the aisle her groomsman counterpart appeared, matching her steps up the aisle to meet her then circling her on her left and catching up to her on her right, joining her in motion up and down, diagonally left across the aisle, then right, moving in multiple dimensions at once, but always steadily toward the dais. The church we were in had no center aisle, and the wedding party moved down the left cleft in the wooden theater seats. When they cleared the forward-facing main body of seats they worked their way right, toward the center, the groomsman leaving his maid to cross to the right side of the hall. As the ring-bearer, then the three bride’s maids, and finally the two flower girls (the children accompanied by supportive adults) each did their dances down the aisle and then were joined by their respective groomsmen, two gendered companies of swaying, stepping attendants assembled at the front.

Then the music changed, and after a bit the bride appeared and began her dance down the aisle, in the company of an older lady, apparently her mother. Her progress was repeatedly accompanied by the high-pitched trilling of the tongues of the women so characteristic of African celebration, a little slower than that of Hispanics, as tongues are wagged back and forth across the mouth. As the bride neared the front, the groom appeared, accompanied by an older man, apparently his father. When they met, the trilling gained intensity, and he joined her with the same circling motion his groomsmen had used, complicated a bit by the train and the extra people in the aisle. The older couple fell back and together followed the younger couple past the last few rows. The about-to-be-weds moved to the center, the music came to a halt and then all sat in the front row.

The hymns, prayers and sermon were in Chichewa, so the scattered words I picked up meant little to me, but the scripture passages were much like ones I hear in American weddings. The exchange of rings and vows was followed by prolonged demonstration of the respective rings as each in turn was held aloft for long moments on its newly found perch for life for all present to behold, as if proclaiming “this one is now wed and I mark her/his covenant made this day”. The pronouncement of husband and wife was made, accompanied by much more trilling. A final prayer was said, and the recessional of the audience began. We watched several pass by, looking for our friends, but now both aisles were being used, so we joined the exodus and sought a spot outside where we could scrutinize the door for the emergence of our friends.

Outside we found traditional dancers, a row of women backed up by a row of men, singing loudly and dancing to the traditional drums and occasional shrill piping of a whistle. No slow swaying here! Stomping forward then backward, left then right, the steps were interjected frequently by sudden, almost violent suggestive pelvic moves that should have put several joints I hardly, if ever, use out of place. Some were left and then right, some up and forward, then back and downward, but there was no sign of back trouble in this group as they celebrated the joy of the moment.

Eventually the bride and groom appeared and puzzled from the door about how to get from that observation point past the dancers to their car, appropriately decorated with colorful puffs of paper mums and broad ribbons. The dancers seemed oblivious to everything except the insistent beat of the drums and the shrill excitement of the whistle. But our friends were not present. The building was empty, and they had not been seen.

As we made our way from there, we called our friends' adult son who was Bruce’s second language helper. “Now, which CCAP church did you say your family’s wedding was to be at, the principal CCAP in Lilongwe? We’re in Mama Kadzamira’s church in Area 12. [Mama Kadzamira is the first among Malawian women, the former ‘first hostess’ for Malawi’s bachelor first president.] Your church is not in Area 12? Which Area is it in? You don’t know? Is it in Falls Estate? Yes? Ohhh.” We had attended the wrong wedding. We talked with Jeremiah a bit about the reception to begin two hours later, but as we had headed down the road we decided not to try. We had invested a lot of energy in this cross-cultural event, only to learn that it was the wrong one, and we were a bit deflated. We decided we needed a little time together, retreating a bit from our many cross-cultural experiences. We didn’t need to try a second one today. Besides, we didn’t know the couple who had gotten married anyway—at the wedding we should have attended, or the one we actually did.

P.S. To our amusement when we went to the Capital Hotel after lunch to try to find a spot where internet connection was available, who should we see but the bride’s maids from the wedding we had attended! We had inadvertently also shown up at the reception site of the same wedding.

World AIDS Day 2010: Bystanders Watching Death’s Onward March

2010-12-09T06:23:00.000-08:00

We spent World AIDS Day thinking about funerals. We didn’t actually attend any funerals on Wednesday, December 1, but we were getting over one and planning for two others. I did not medically take care of any of these folks, didn’t see their death certificates, so I can’t say that any of the deceased had AIDS, but three funerals in one week? Malawi’s adult death rate is very high, much higher because of AIDS than it was 20 or 30 years ago precisely because of AIDS. If AIDS played no part in any of these deaths, it would be rather strange. It may have kissed them all.

The first funeral, on Tuesday, November 30, was for a man about 50. He wasn’t close to us, I don’t know that I’d ever met him, but a relative of his was an acquaintance and he lived very near. We’d not been to a funeral in our neighborhood yet, and I did personally know several of his neighbors (which I found out when I got there). We walked down the hill a bit and thankfully were met out on the highway by a person we knew. Every other funeral or like event which we’ve attended we’ve had the blessing of a friend to act as a social coach, and I was wondering how to handle some of the unknowns of this event when God provided the person we needed, a former guard at our complex whom we hadn’t seen for some months. We sat on the ground with our respective genders, Beth with a cluster of ladies on the periphery and I with our friend across the way.

I was on the front row of the front cluster of several groups of men, scattered and strung out among the mud-brick huts in that part of the neighborhood. After we’d squatted on the ground I realized we were right in front of the bier, consisting of several tree branches lashed together, that would carry the casket to the grave from the house where it lay for visitation. Neither of us went in. My coach asked if we wanted to see the body, but I didn’t know the man personally and felt no need. Funerals, in my mind, are for the living.We had asked our coach how long we needed to stay, and he said, “Whatever time you want.”

“Thirty minutes or an hour?”

“That’s fine. You’ve paid your respects.”

I wanted to give some money to my acquaintance who was related to the deceased, as is the custom here, but I hadn’t seen her. I asked coach how to find her, since men aren’t supposed to be in contact with the women at funerals. Before we left, coach led me behind the house in front of where we had sat and motioned for one of the women who were cooking there to come. I realized it was Florence, Beth’s helper around the house who had asked the day off for the funeral. We I asked Florence to get our friend, and she went into the back door of the house where the casket lay and brought the friend out to us. I expressed my condolences with the one appropriate Chichewa word I know, “Pepani” (“I’m sorry”). She shook my hand, accepting the money: “Zikomo kwambiri”. She returned to the mourners around the body in the little house. We slipped back around the house, sat for about 10 minutes more, then got up and went to the road where we met Beth who’d seen us leaving. “Coach” went back to the group, and Beth and I walked up the hill to the house.

The next morning, World AIDS Day, we were awakened by Florence who brought the news that the husband of another neighbor and closer acquaintance had died, a man who was maybe 30. I had met him, but did not know that he was that friend’s husband. He’d been sick for some time. In fact she’d been off work the week before to care for him, but he’d gotten better. Then he’d suddenly gotten very ill, having extreme difficulty breathing. A car had been hired and he’d been taken to a hospital about 6 miles north of us. By the time they got there his breathing had stopped. There was a need to move the body to his home village, and could I contribute? I gave Florence what seemed a reasonable donation. The funeral would be Thursday and she would be back to work on Friday. Would that be ok? “Of course,” I answered. “Tionana lachisanu,” (“We’ll see you Friday.”) We made a brief visit to this funeral, at a town 30 minutes north of us, on Thursday morning.

Before dark on Wednesday I got a call from one of my best friends in Malawi, my running partner. His sister, who’d been bothered for three months with severe stomach pain and intermittent headaches had taken a turn for the worse early that morning. She had gone to the nearest health center where she’d been sent to the nearest hospital which in turn had referred her to the regional medical center in town where she’d died shortly after arrival. He didn’t know what she had. Her husband was alive and well, and she left two children under five. She was 38. Women who are 38 do die in Malawi, but usually in childbirth. And this was a fairly prolonged illness. I asked if she had AIDS. He didn’t know. As many of our staff attended the funeral to our north, Beth and I carried several others the 2.5 hours south to this one, staying through the burial, getting back about 7:30 in the evening after stopping in town for supper. It was a day full of funeral.

AIDS is not something that is discussed over the dinner table in Malawi, or much at any other time, at least in a personal sense. People seem to think if they just don’t talk about it then it will leave them alone. And it keeps on killing people right and left, making its presence known in powerful and painful ways, at the most inconvenient times, even on World AIDS Day, 2010.

P.S.: The publication of this post was approved by the my friends and acquaintances who were kin to those mentioned as deceased and the reason for my attending the funeral.

It's Rainy Season, and It's (Mostly) Cool!!!

2010-11-28T07:38:00.000-08:00

Rainy season has begun. We are sitting through our biggest storm of the new season, and it’s only our second. It rained on us Saturday afternoon, a nice little shower, as we sat in the parking lot of the fastest internet service provider in town trying to Skype with the Mission Vision Team of Landmark Church of Christ, our primary supporting congregation. Yesterday we got our first good rain here at the house, but not this heavy or brilliant. Now it is raining: cats and dogs, buckets, gushers, raining up a storm, a real gullywhomper thunderstorm.

And it is lightening. Most of the strikes are 2.5-3 seconds away. One was less, and threw our main breaker. I had just unplugged our laptop, the printer next to it, a heavy-duty surge protector which fed the electronic piano, and an uninterrupted power supply which carries our desktop. Then the blue-white flash of light and “Craaackkkk”. Our house is on the highest hill for some miles around. I am aware that we could use lightning rods, but our house built on a rock would have a hard time finding ground. How long can the lead wire be?

Two weeks ago it was hot, very hot. But about a week ago, as rain began to fall within sight of the house, the temperature graciously dipped as well. The clouds have been hiding the sun and the breeze has kissed our arms and brows after coming through the drops that we can see falling in the distance: relief from the heat. The sun has passed overhead on its journey south in relation to the earth, and will be back in a few weeks, after its overhead rendezvous with the tropic of Capricorn. Though my logic says it should remain hot, a critical point has been reached such that the updrafts provoked by those rays work steadily every morning lofting water droplets off Lake Malawi and the Indian Ocean which in turn cool, condense and fall to freshen the breeze blowing our way. Even from unseen parts we feel the results. Where seen, it is beautiful as the cumulonimbus billow overhead higher than we fly when coming here, sheets of rain fall, marching across the Lumbadzi River valley north and east of us, progressively hiding the Dowa mountains in the distance, visually demonstrating the process which brings us relief, and water to settle the dust and seemingly awaken the world.

Many have already planted. Others are doing so now. Napoleon and other large farmers are busy spraying herbicides before their fields are taken over ere the corn even sprouts. Fields prepared by hand have been ready for several weeks revealing freshly brown broken lumps of clay. A few are still being turned by hoe. But now it is planting time, and most are at it. The frogs form a deep-throated “amen” chorus, welcoming the gushers as the storm passes and the rain subsides to a drizzle. The birds sing after the rain as if it were morning again, and maybe it is, a seasonal morning of new life.

For several days now the little orange and blue-black beetles (see “Lava Bugs”, posted Wednesday, March 17) have swarmed our ceiling and walls. We’ve learned that the mosquito coils we use have no effect on them, but they occasionally do fall off the ceiling to crawl through hats and hair, down our necks or up our sleeves. Interesting little critters—they do keep you awake in the late evenings with dim light and the press of the day every heavier on the eyelids. The mosquito population has not changed much yet. But they will soon catch up. We’ve been trying to get the holes in our roof patched and some better screens on our house, whose windows are filled with an eclectic ensemble of American and African architecture, each having its respective advantages, mostly in its proper place, but together conflicting frustratingly and preventing the best use of each the other’s features. The carpenters on campus have been tied up for weeks on other projects of higher priority, so we are making efforts to get those underway—and hopefully finished—soon. Then the blessings of rainy season will not be slighted by its problems, and we’ll be able to enjoy without compromise the cool rebirth of life which will bless the next few months.

Then today I learned that a dear friend and her husband are both infected with HIV, and he is ill. I am poignantly reminded in this season otherwise refreshing of the wise preacher’s comment that there is a time for everything: a time to be born and a time to die, a time to be happy, and a time to be sad. And sometimes in the many lives playing out before us, those times come to meet each other.

A New Friend, Unwanted and Self-Detached

2010-11-20T08:05:00.000-08:00

I have a new friend. Without invitation or welcome he first came into my sight on a recent Monday. One minute he wasn’t there, the next he was, off to my right and a little above center of whatever I was looking at. I call my friend “Maejong” because he reminds me of some of the characters on the playing pieces of that game. This new friend looks like a nest of folding dark lines with weighted strings hanging down, at times appearing as a jellyfish, at times like a ranger dangling from his parachute. I knew from first sight that my new friend was somewhere in my eye, my right eye. I can’t see him well as I can’t focus on him; he moves with my eyeball, always off to the right, always a little above the level of the object of focus.

I thought it was my cataract. About a year ago my family doctor (yes, I have one) told me I had an immature cataract in my right eye. I just thought it had caught my attention for the first time, that I was seeing it layered onto whatever I focused on. There was, however, one problem. The parachutist swung in the breeze at the end of his lines. Whenever I looked quickly to the left, as my eyeball came to a halt, and with it most of my friend, the lower “strings” of my new friend swept up and left. When I looked right, my friend’s dependencies swung up and to the right. This is not what a cataract should do. Then the lights came.

Six days later after I first saw my friend, on a Sunday evening just as dark fell I was walking out to the Blessings Hospital portal to welcome some friends who were driving out to visit us. I was reading in the dim light and my eyes were flitting back and forth across the page. When they moved to the right I saw a flashing band of blue light, over and over and over, line by line on the page, running from the top of my eye to the bottom flashing through the spot occupied by my new friend. Light flashes are associated with retinal detachment which may cause loss of sight. My friend had my attention. But my impression was that there was no ophthalmologist living and working in Malawi.

Early the next morning I called my friend Perry Jensen, another family doc who has cared for AIDS patients in Malawi for ten years. Perry knew of two opthalmologists in the country, one at Kamuzu Central Hospital, the referral hospital for the central region of the country, the other was at a Nkhoma Mission Hospital about 40 km south of the capital, and Perry knew him. I chose Perry’s friend, gave him a call, and was encouraged to show up as soon as possible that day.

Mtendere’s driver was able to accompany us, and we took off, arriving a little before noon. After discovering that we had met the hospital’s volunteer optician from Luxembourg in the immigration office, I had a thorough exam by a young ophthalmologist who looked younger than my son. You know you’re getting old when your doctors look like your children, and I got another gentle reminder when the doctor told me my new friend was nothing to worry about, just the result of a “maturing” eye. It seems the vitreous in my right eye, the gelatinous stuff that fills most of the eye ball, back in the back, is drying out, shrinking, getting a little wrinkled, and doesn’t need as much space as it once did. Thus it has pulled away from the eyeball, a “posterior vitreous detachment”. Some strings of tissue are literally hanging loose in the space that is left. There is a slightly increased risk of a future retinal detachment, which would be accompanied by a different pattern of light flashes, but nothing really serious at the moment. He will see me again at a hospital closer to home in about six weeks.

So I confidently play with my new friend, aware of his faithful presence when I move my eye, especially at night, enjoying the blue light, usually a bar, at times a ring around my visual field, but always a reminder of the sixty-one years walking on this earth.

“Today I’m nearer to my home,

much nearer than before.”

Wheels!!!—Or, “Lessons on the Importation of Diplomatic Vehicles Already in Malawi.”

2010-11-16T09:46:00.001-08:00

Our quest for transportation for our ministry began at budgeting time about 18 months ago. We had been assured by Malawian missionaries that churches could import vehicles free of duty, so we counted on that, budgeting $55,000 for a Toyota Hi-lux or Land Cruiser allowing for addition of an extra fuel tank, bull bar, luggage rack, etc. A number of good folk shared with us generously (see below), but we always seemed a little behind on our budget, not quite getting there. Then we moved to Malawi, and a number of smaller “one-time” expenses came due, drawing down our fund.

Very early on here we learned that some Malawian churches had been passing out duty free vehicles to their senior members as benefits, not exactly what the law had envisioned when it gave churches duty-free status. So, seemingly overnight (was it by presidential decree?) churches were allowed only to import single cabin pickups, trucks or buses, none of which fit our needs for village visits in Malawi and travel to other countries in the region.

Our partner, Napoleon Dzombe, who is very well-known in central Malawi, and is also the imagination, brains and probably the biggest single contributor to the hard work behind the six different projects here on our campus, was sought out by the new Land Rover dealership to help them launch their sales campaign, trying to put Land Rover back on the road here. Napoleon encouraged us to try to get the same sweetheart deal he’d been given, but the problem was we didn’t have quite that much cash. Then when we got it, the Land Rover had gone up $10,000, and the next month it went up $10,000 more. We visited the Toyota dealership regularly and wrote letters seeking funds. Another foundation offered us a challenge grant which would get us close to the purchase price. But we just couldn’t seem to get over the edge. Then Napoleon went to Europe.

He had to get a visa via a European embassy here which, in Malawi, covers for its neighbor which Napoleon was visiting. The Malawian who was screening Napoleon asked him, “Would you like to buy a good car?” Napoleon learned that one of their diplomats was finishing his two year tour, and that he wanted to sell his personal vehicle which had only 30,000 kilometers (about 19,000 miles) on it. Napoleon looked at the car, a beautiful 2008 Nissan Patrol and knew it was a very good deal, even if not inexpensive.

He called us to a meeting before he left. “If you don’t buy this car, I’m going to sell you!” We made an appointment to see it and were given a ride by the same embassy worker. It was a very nice car. Not the luxury model, but very nice. It was not a steal, but the price was reasonable for what it was. And it would go to any village in rainy season as well as cover the mileage of southeastern Africa we'd be traveling. The price would more than double, however, with the import duty, and we didn’t have that much money. Some modifications would also have to be made to bring it up to the standards we were seeking (bull bar, etc.). A series of meetings with the diplomat began. He wanted to be paid in his home currency which would protect him against vacillations of the dollar. For the same reason, we would have rather paid in dollars. Others wanted the car, but had trouble coming up with that much of the diplomat’s currency. We could get the currency, as our money was in a U.S. bank, but we wanted a guarantee that we would not go above a certain dollar figure. We dickered over this point, the diplomat refusing to sign a contract we drew up until the currency exchange rate was no longer an issue.

The diplomat wanted to keep the car until the day he left and all the money had to be in his bank account before he would hand it over. We wanted the deal to be called off if an accident occurred on his watch. Eventually it became apparent that trust was necessary to make a deal, a trust greater than our brief friendship with this announced agnostic would support, even though he was also a gentle and wise senior statesman who cared deeply for the impoverished villagers and workers of Malawi. We could only trust him in spite of the many circumstance which could intervene to sour this deal by first trusting the Lord.

As the diplomat’s departure date moved back and forth we were rattled and frustrated. The dollar rose and fell against his currency, but never so far that the deal would have to be off. Finally we had to say to the good brothers and sisters at church and the bank in Montgomery, “Just do it. Buy the currency at the best possible moment and wire it to his account." The best possible moment became “anytime now”; then it was done, at least in America.

The currency was purchased and wired on a Tuesday. The diplomat had promised that his assistant would help us with the paperwork for the two remaining steps, importation and change of title, but the assistant wanted the week of his boss’ departure for vacation. We had to finish all the paperwork before the end of the previous week. To change the title we would also have to demonstrate that we had insurance. We priced insurance on Wednesday and sealed a deal with the best offer. On Thursday morning we changed money at the ForEx (foreign exchange bureau), and purchased the insurance, receiving the certificate and sticker we needed. We visited the embassy and got the diplomat’s signature on the importation papers verifying that he was selling the car to us, at what cost, and his original cost of the car. The assistant brought the car for inspection to Customs who verified the VIN and motor number and certified that the price was reasonable for that car. It was then discovered that a mistake had been made on the documents by Customs and new paperwork had to be signed by the diplomat. This would be done Friday morning.

Beth got in line at the bank Friday at 7:30 to get a certified check for the duty while I went to the embassy nearby to pick up the re-signed papers. With those in hand we headed back to Customs. At the proper office no one was in. They were all in a meeting. We took the check downstairs and paid the tax (greater than the selling price of the car!). On return, no one was there yet. An attentive ear at each door discovered the meeting, the door was cracked, the supervisor’s eye caught, and he came to help us. In five more minutes we were off.

At the regional road traffic office we were told that a diplomat’s car had to be handled at the national office, thankfully only two blocks up the street. We raced up the way, arriving at 10:30. The staff was very pleasant with the bad news: “Your papers are all in order, but the network is down. Please come back after lunch.” At that point the diplomat’s assistant left us to try to finish up some things at the office before his vacation. We were on our own.

We returned at 1:30. The staff arrived at 1:45. The network was back up, and we got in line near the front. Our turn came quickly, and the re-review of our papers was met with, “Where’s the letter saying the car is being sold to you?”

“We have this sales agreement, signed by both parties.”

“No, that won’t do. Here, use this one for an example,” and from the stack someone else’s letter appeared. Beth quickly took notes while I called the diplomat.

“We need you to sign another letter, sir. May we come over right now?”

“Another letter? My assistant said that would be all.”

“Yes sir, we thought so, but they say we need another letter.”

“Of course. I’m here packing. Come right over. I live in Area . . . Do you know the way?” I took careful notes on the directions.

And, “yes,” the clerk responded to our query, “you will have to have the car inspected to complete your paperwork, but if you get back before 3:30 we’ll be able to finish everything.”

Mtendere Children’s Village uses its truck on Fridays to shop for the next week’s operating supplies, so we had rented a car with driver for what we knew was going to be a harrowing and possibly feverish race against the clock. We were glad he was driving as Beth dictated based on the letter we’d seen, in the back seat I wrote by hand in a steno pad, trying to compensate for the bumps and curves. The assistant called me regarding why another letter was needed. His reply to my answer: “Oh, yes. That letter.”

We arrived at the diplomat’s home just as I finished writing, finding the house on the fourth leg we tried from the appointed intersection. The maid ushered us to the patio and offered much-needed water. The gentleman appeared, inquired about the rationale again, then signed the letter handwritten on both sides of a steno page. Then we told him we had to have the car inspected. This had not been contemplated by his assistant either, but the diplomat drove with us, I riding with him, Beth carrying the letter on ahead with our driver. The diplomat could not let someone else drive a car with his embassy’s plates on it.

The diplomat’s presence provided a little grease to the wheels of bureaucracy. As I mentioned his presence to the clerks, and that he hoped this process could be completed today, the information was relayed to supervisors, papers were placed on top of the stack and returned in a few short minutes. A first payment was made downstairs, a computerized form generated, back to clerk, back to supervisor, back across the hall to the clerk, a second payment was made downstairs, and then the “last step”. “Where do we find the inspector?”

“Oh, for that you have to go back to the regional office of the Road Traffic Department.”

Back in the two cars we hit the busy main street and pulled into the front lot of the appropriate office. A quick inquiry revealed that we needed to pull around back to the inspection lane. Having done so, I sought an inspector. One was engaged, took our paperwork, and eventually came out to inspect.

The inspection lane is a narrow alley between two buildings with a dangerously deep center pit for underside inspections (absolutely unused for any of several cars I’ve seen inspected there). With the diplomat in the car, the balding inspector, walking around the car to observe, shouted for him to turn on various lights and turn indicators. We could not figure out how to turn on the fog lights and the inspector gave up. They aren’t mandatory, just interesting. But it’s nearing 4:00 on Friday.

The diplomat was asked to wait on the side, the inspector slid behind the wheel, shut the door, sounded the horn several times, revved the 6 cylinder diesel, and popped the clutch. Smoking rubber was left on the slick cement both on takeoff and on slamming the all-round ABS brakes two seconds later. The triad was repeated with braking after a run of about 20 feet onto gravel approaching a curve with a steep upward bank guarding the far side of the curve. Our car joined the previous cars that had “Passed”, sliding into the curve with ABS complaining, coming to a halt before it hit the bank. “He’s no inspector, just a cowboy!” the diplomat expressed his disgust at the treatment of the vehicles. I was thinking about how much a tire balancing would cost and where I’d get it done well. But forms were checked off: “Pass”. This was verified, as required, by a second official. “What next?” I asked, as one man reviewed my papers.

“Take this and hurry, hurry to the front of the building and pay 1000 Kwacha. Hurry!!!” It was straight up 4:00. I ran.

The office was closed at 4:02 but two or three others bargained through an open window. As I joined them the diplomat pulled the car around in front of us. “Good afternoon. Please, this car is being sold by a European Diplomat, and he wants to finish today so he can leave the country shortly.”

“You live in Lumbadzi; you’re no diplomat.”

“Noooo. I’m the buyer. See that car out there? That’s the diplomat. See those plates? ‘10 CD 8’”. [CD = diplomatic corps.]

“Well, all right. That’ll be 6000 kwatcha.”

“I was told 1000.”

“No, it’s 6000.”

I handed over six thousand. “But I need a receipt.”

“That paper you have is your receipt.” There it was: 1000 Malawi Kwacha. I didn’t argue. The day was over. The deed was done. We had been helped. The cost of express service.

We left and hurried back up the road to the national office, all our papers in hand. “Is there anything else we need to do?”

“Just make your plates.”

“And where do we do that?”

“Just down the street here, at the bakery, just before the regional office.” The driver knew the place.

It made no sense, but we headed for the bakery as the diplomat headed home to finish packing. I had been told that one of several [Asian] Indian shops could make the plates.

We saw the bakery, surrounded by several auto parts stores and pulled in. As we hopped out, appropriate documents in hand, an employee on his way out the door of one of the parts stores turned around and ushered us in. Over the protests of the manager he asked for our number, the size of our plates (which we quickly confirmed on their samples), if ours was to be a private vehicle (yellow plates), grabbed the blanks, went aside to a machine, and quickly stamped out both front and rear plates. “Four thousand nine hundred kwacha.”

“I understood they were twenty-five hundred.”

“A decade ago.”

More express service. We paid up and walked out, paint still wet, carefully propping our new plates on the floorboard and in the back seat. One thing was left: the money for the sale had not yet arrived in the diplomat’s bank account. He had remarked that it was interesting that we were navigating the Malawian bureaucracy faster than we could that of U.S. capitalism. Sometimes that’s the way it is.

The diplomat called on Saturday afternoon to say that the money had been posted to his account. Would we like to come get the car? We declined, noting that we’d spent three days in town and were just “hanging low” at the house today with no desire to get out. We’d pick the car up on Sunday afternoon after 4:00 when we finished doing some internet work in town. A call from the diplomat Sunday afternoon noting an urgent matter at the embassy moved us to 10:00 Monday. We were able to get there in time with the help of Mtendere’s driver, change the plates out, and then drive off in the car which many of you have made possible.

We are thankful to God for this very unusual opportunity. We would not have bought so nice a car, but it was the only one we could afford. A new car never came within reach of our bank balance, and most used imports are 6-8 years old or older, too worn to take on international trips regularly. We are thankful to all those who contributed specifically to this effort (including some of you of whom I probably haven’t heard of yet), and those who are considering a contribution based on our recent appeal. Though I know we’re close, I don’t think the car is paid for yet. (I’m not sure where our current balance stands, and the final cost of the car was more than we had planned due to exchange rates and higher-than-expected taxes). To enable the deal, Landmark (www.landmark.org) has covered the difference to the end of the year. And, we still need some money for the add-ons I’ve mentioned and driving the car around the region next year for the seminars we will teach. Our working fund is supplying current, “without-a-car” needs, so one-time or regular contributions would still be of help.

Those whom I know have contributed toward our “one-time” expenditures, the largest of which is this car, include:

The Church of Christ Foundation (of southern California)

Christopher Matthews

Henriette Baker

Sunny Hills Church of Christ, Fullerton, California

Mr. and Mrs. Russell Presley

Otter Creek Church of Christ, Nashville, Tennessee

David and Rebecca Matthews

Peter and Pamela Bogdanovic Charitable Trust

Body and Soul Ministries (BandS)

Pleasant Valley Church of Christ, Little Rock

Warren and Phyllis Skaug

Boyd Pate

Ezell Foundation

Christian Service Committee, Searcy, Arkansas

Margaret Peters

Julie Commander

Summer Darnell

Kelley Maltby

An Anonymous Foundation Supporting Mission Efforts in Churches of Christ

Regular contributors include:

University Church of Christ, Tuscaloosa, Alabama

Chandler Street Church of Christ, Kilgore, Texas

Redlands (California) Church of Christ

Linda Taylor

George and Kris Conner

Henriette Baker

Robert and Allison Berger

Paul and Judy Teeter

Our primary salary and support come from Landmark Church of Christ, Montgomery, Alabama.

"To God be the glory,

Great things he has done,"

And continues to do.

A Needless Death-II

2010-11-14T06:40:00.000-08:00

She was about 25. She hadn’t done well in school, so at a young age she had decided to try her hand at something else where she might do better—marriage.

She found a man to marry her and they began their life together. No wedding, just a coming together with an announcement to the community: “We’re married now.” Two children were born. One died of malaria, and the community became suspicious of HIV.

A divorce occurred. Her brother did not know why or what the circumstances were. Now she was a single mom with one surviving child, and HIV.

Her test had been positive, and at some time she had begun on antiretrovirals, life-saving medicines that have normalized the life span of HIV patients who are diagnosed early in the disease’s progression and while they are still young—if they take their meds like their lives depend on it; they do. She was young, but apparently not diagnosed early. The hospital was not very far away, but she was sick a lot, and going even a few kilometers on foot was a problem when sick. She was very poor, and probably ashamed of her status. It was not easy to get a ride. So she missed an appointment and then ran out of meds. She may have stopped and started her meds several times. And then she died.

Primary Cause of Death: Unknown, but some opportunistic infection, possibly tuberculosis, malaria, or cryptococcal (fungal) meningitis.

Secondary Cause of Death: Acquired Immune Deficiency Syndrome—AIDS

Tertiary Cause of Death: Infection with the Human Immunodeficiency Virus--HIV

Contributing Factors: Stigma, Shame, Poverty, Unfaithfulness, Single Motherhood, Social Isolation. All these are things which the church must address in its God-given mission to help the helpless, defend the fatherless and the widow, offer forgiveness to the guilty and hope to the hopeless, to love the apparently unlovely whom Jesus loved enough to associate with, to care for, to speak up for (as his Father and ours has done since the beginning of time), and then to die for that we (yes, we are among them) might live to tell the story to others who need to hear it and to live that ongoing story in relationship with them.

“We are One”

2010-11-10T09:09:00.000-08:00

I have been reading psychiatrist F. Scott Peck’s, The Road Less Traveled, which was recommended to me by the late Dr. Henry Farrar, inspiring mentor to many of us, just two weeks before his death in February. Peck talks about the peace he had as his wedding approached, peace that lasted until he arrived at the altar where he was almost overcome by terror: he suddenly realized the magnitude of the commitment he was making, and the implications of that commitment being permanent, and conversely of it being anything but permanent.

A few weeks ago Beth and I began to eat lunch at Mtendere Children’s Village, the home for over 100 orphan children which is located right behind the house where we live. We looked forward to the help for our Chichewa from conversing with the children and staff, as well as the increased time with them. We paid the administrator of the orphanage, Gracian Chisema, for the first couple of meals, a very small sum, probably less than we spend at home to fix lunch. We missed several days after that and then started up again, and talked to Gracian about payment. “Talk to Tiwonge” [his operations manager]. “She’ll take care of it.” We talked to Tiwonge, and she refused to take our money, referring us back to the administrator. When we saw Gracian again, he said, “Yeah, Tiwonge talked with me the other day and said, ‘We all eat down there from time to time, and none of the rest of the staff pay, so why should the Smiths pay. They’re just as much our staff as anyone else.’ So, you’re not going to pay. We are one.”

“We are one.” That’s quite a statement. It’s a sword that cuts two ways. First, it’s a really high compliment. At this stage in our language learning to be told, “You are just as much a part of our staff as anyone else here,” is really an honor. We are not staff. Not for the orphanage, nor for the food processing plant, nor for Feed the Children, nor for Educate the Children, certainly not for the School of Agriculture for Family Initiative [SAFI], nor even for Blessings Hospital. We are students of Chichewa working toward a new HIV project which will be based on campus because we are here. We occasionally chauffer the staff here or there. I hold a devotional with the older boys of Mtendere two or three nights a week. One or two of the guards run with me most mornings. And, we are the only biological family living on campus. But we are not really staff. Something is happening, however, that is bonding us to them--and them to us. This blessed something is also a two way street.

With privilege comes responsibility. Beth and I have been reading a couple of relevant books: African Friends and Money Matters discusses the clashes between American values about money and African values about money, and Leading Cross-culturally points out that many American (and some African) values about money have their roots in the Kingdom of Darkness, the Kingdom of this World, not in the Kingdom of Heaven, the Kingdom of our Lord and Savior Jesus Christ. Africans are much more communal about money. Americans are much more individualistic about it. For Africans, what is mine, or yours, is often ours. For Americans, what’s mine is mine unless I decide to make it yours. And don’t push me! It’s still mine!!! For Africans, whoever has a lot of money is a welcome part of this sharing community, a tremendous potential resource. And though we Smiths may have much less money than we did not too long ago, we still are so, so rich compared to most of our colleagues. We thus qualify: we’re a tremendous resource. I must add here that this is not consciously nor conspiringly considered any more than “It’s mine!” is consciously or calculatingly contemplated. They are, respectively, each in the place where it rules, just part of the unconscious fabric of life.

I’m not sure I want to be “one” with anyone but Beth and the Lord, and at times I have my doubts about them. I want to keep what’s ours. I want us to use it the way we want to. I don’t want anyone considering mine to be his or hers. But (the books also point out) that is not the way of life in the Kingdom of Heaven. (Read the ends of the 2^nd and 4^th chapters of Acts.) And as I exhort some of you to give up some fairly large chunks of “yours” to help us do what we want to do here, I run a great risk of standing condemned on my own appeal. Now don’t get me wrong. In Africa there are ways of saying “No”, ways to save some money, there is wisdom and foolishness with regard to money. But current relationships are more likely to rule than the bank balance or fears for the future. Days are taken more one at a time. I think there’s something about that in a book somewhere too, isn’t there?

And so “We are one.” As we by fits and starts, through hesitation and willingness, stubbornness and submission grow in these new relationships and by so doing learn more of what the Kingdom of Heaven is like, what the guidelines are for really trusting the Provider of us all (and not our own strength, or financial acuity, or business skills or any other aspect of “me” which I’ve been really been given by Him for service to others, which I’ve supposedly entrusted to Him as part of our agreement), as we learn what the guidelines are for living the best kind of life possible, pray that we will receive them, live them, and demonstrate to the world around that we do know the One who is three in one, who invites us to be one with him, and with each other through trust, to his praise and glory, and the growth of this life-giving oneness throughout the world.

Of Good Grooming, Light Sabers, Working Wages, and the Lord’s Supper

2010-10-23T05:02:00.000-07:00

“My elders have reported to me that they are out of razors and have asked if I might help them get some.”

The speaker was K. Banda, a guard (yes, male) at our complex and a friend. He had asked me one Sunday in August to go with him and another brother to church in Mponela for a gospel meeting, which turned out to be a pleasant visit to a church in a village within Mponela’s jurisdiction, a village which neighbors K.’’s home village. We were able to meet K.’s wife and at least one of his children and lots of church members from all over Mponela who had come for the event. We know his church, which now needs razors.

I wondered why. Some African Americans have to shave regularly or grow longer beards with a dangerous interim where curly facial hair tends to turn inward and cause bothersome if not serious infections on the face. I presume Africans might have a similar problem, but I’ve not seen or heard of it firsthand. Kay asked me how much razors cost.

I use one of those multibladed gizmos which Gillette sent me and every other American male in the mail on the “if you try it you’ll like it” theory, and then I’m buying the heads from them for life--or until something better comes along. I clean up my beard once a week here and haven’t bought razors in ages. I have not a clue how much a pack of Bics would cost here in Malawi, but I’ve seen them and their Chinese knock-offs in the stores.

I’m trying to explain all this to Kay, who speaks very little English--I’m not even trying to touch this subject with my Chichewa. Malawians do not differentiate between the “R” sound and the “L” sound, so I begin to correct Kay’s English since I’m not making much headway explaining permanent handles and replaceable heads of multi-bladed razors. “Laser. That’s a special kind of ‘torch’ (the English word for flashlight in this part of Africa) which is very powerful, very strong. It can burn holes in things.” If I can’t explain razors how am I going to explain lasers which I myself hardly comprehend, but I’m on a roll. I write in the dust “Laser”, then “Razor”, then we do a little speech therapy. (I get a lot of this from Malawians. Turn about’s fair pay.) K., probably more frustrated than I am at this point, writes out in the dust his understanding of the word, “Raises” and we launch into the even more foreign concept, at least for Malawians, of getting paid a little more. Actually, this was a big cue to what he was really after, but I missed it completely.

Then, like the locks on some of our doors around here, the conceptual key finally falls into place and the mental bolt turns. Kay explains that he’s looking for “What’s used for Holy Communion instead of wine.” Raisins!!! In a laudable attempt to be Biblical about worship, to do what first century churches did, many congregations in tropical Africa, churches in villages which have no electricity and have no spring for a spring-house, soak and then boil raisins to extract the essence of grape as juice: fruit of the vine, African style. The only problem is that raisins are almost as rare as grape juice. Both can be bought here, but grape juice is considerably more expensive. Both are imported—no grapes are grown here, and it costs a lot to move all that water around the world. (Most liquids we consume, with the exception of hard liquor--greater than 100 proof--are mostly water, heavy and costly to move.) African struggles to do communion right, however, are another story.

Kay Banda was not looking for a shave for his friends at home, or a light saber, much less an increase in pay. His elders are just looking for a little help in getting raisins to make “fruit of the vine” for the Lord’s Supper. Transportation issues and other short-term problems have kept us away from the grocery store for several days, so we may be in town this afternoon, certainly before the weekend, and we’ll see how much raisins are for Kay and his church back home. And we’ll continue plugging away at better communication skills with our Chichewa friends here in Malawi.

"St-o-o-o-o-o-o-o-ppp!!!!!!!"

2010-10-09T02:10:00.000-07:00

It was all I could say, but it was enough.

The driver of the car was a young man, and in that exuberance and impatience of youth which most of us show at one time or another, he was anxious to be out of there, out of the parking lot that was much too small for its clientele. The ten shop mini-mall is shaped like the state of Mississippi, and the parking lot fills what would be that piece of Louisiana east of New Orleans. The lot will hold only about 12 cars max and today there was a 14-passenger van and a 25-passenger tour bus which the small car’s driver had to maneuver around. So he jerked his small sedan back out of its space next to the patio where we sat, and then forward. I thought he was clear to move ahead to the gate, but he thought otherwise, paused, and the back-up lights came on as he prepared to head my direction again—in reverse. He didn’t see the boy.

We were eating at the best Italian restaurant in Lilongwe, which occupies the southern extension of that map of Mississippi which this property forms. Where that southern leg joins what would be the main body of the state, right in the angle, there are steps going up from where we were eating to the rest of the “strip mall,” the first business on the left being an Italian deli. The toddler and his mother and father of course were eating at the first outdoor table at the top of the steps. The boy, probably tired of sitting as most toddlers shortly are, escaped down the steps, and failing to get his parents attention at first move, proceeded full bore into the parking lot. Dad had his back to the parking lot, and Mother was seated to one side. Neither saw what was developing until it was too late. Dad leaped down the stairs, but he wouldn’t get there in time.

I had seen the child’s exuberant escape, distracted from the weekly comics Beth and I were reading together via internet, but I thought the car would be gone before the boy would come into danger. The driver’s decision to insure his clearance of the bus was synchronous with the boy hitting the parking lot. As the car reversed, I was out of my chair. The boy came into the car’s path, saw it coming and froze, out of the driver’s sight well below the trunk line.

I was moving when the back-up lights came on that second time, but I wasn’t going to make it, and if I had, the car would have hit us both as I crouched to scoop up the child. I threw out my hands in front of me, still in full forward tilt, and gave it my best game voice, “St-o-o-o-o-o-o-o-ppp!!!!!!!” The car came to a halt, the father caught the child and scooped him into his arms, hugged him and started back up the steps. (No whipping or shaking, thank goodness.) With both adults and the child out of the way, the driver decided he already had sufficient clearance and accelerated out the gate.

The couple sitting at the table next to us said “Thank you.” Squished child does not help the appetite on the patio of even the best Italian restaurant. I thanked God the boy was ok. I guess it pays sometime to have a little ADD. Even our weaknesses, especially our weaknesses, can be used as a blessing to others to God’s praise and glory. Dd

A Needless Death

2010-09-26T06:05:00.000-07:00

She was 40. Her oldest child was 20, her youngest 7. Her second child, like thousands of other children across Malawi, is waiting the results of standardized testing at the end of “Form 2”, his sophomore year in high school. These results will determine whether he enters Form 3 or repeats the first two years.

Her husband died about four years ago, and she tested positive for HIV. She steadfastly refused everyone’s efforts to get her to take anti-retroviral medication. When she came down with active tuberculosis she also refused treatment falsely stating that she had several small children at home whom she could not leave for the intense initiation of treatment at the District Hospital. Instead, she returned home to the little house she occupied with all her children. Finally they convinced her to go to the hospital and begin treatment, where she died shortly after admission.

There really is no reason for anyone to die early of HIV. A recent study, admittedly in the west, found that people who started treatment for HIV early in the course of the disease and who were younger (I believe that was not yet 60) at the time of initiation of treatment were as likely to live to an old age as their peers who were not infected with HIV. While the medication that has been available in Malawi until recently (the protocols are undergoing revision) are not the regimens that are currently recommended for initiation of therapy in the U.S., they served my patients extremely well in the opening days of multi-drug treatment, leading to prolonged suppression of the virus for those who took them as if their lives depended on it. As it turned out, their lives did depend on taking them exactly as indicated, always. Some people had been on the medications for 10 years or more with no evidence of the virus in their blood since starting them.

Medications are not as readily available for many Malawians as they need to be. Some people have to walk many miles to get to a center that offers the life-saving drugs. That may have been part of the problem for this woman. Yet, that does not seem to have been the case. She was in contact with people who could treat her, and her family could have cared for her children intermittently. Her brother, a friend of mine and the source of this information, is a medical professional who tried to persuade her. Why did she not submit to treatment?

The reasons for this sister’s actions will probably never be known. She may not have held any hope for the medications. She may have heard how “horrible” they were, and difficult to take, full of side-effects, and thus refused, not wanting to add insult to injury. Often, however, stigma is the problem. People are afraid to take the medications because then people will know that they are HIV positive. “And we know good people shouldn’t be HIV positive.” Sometimes, however, the stigma is so deep that people stigmatize themselves. The worst kind of racism is that in which people hate themselves or others of their own kind because they belong to the group. This is also probably the worst kind of stigma around HIV. “Because I am HIV-positive I am a no-good, worthless person. I deserve to die.”

I have had a few other patients who had such an attitude. One never took medications for HIV and she died of her disease eventually, after being pulled “out of the fire” on several occasions for opportunistic infections. She was a deeply religious woman, Roman Catholic, and she made statements to the effect that she deserved to suffer, that her suffering might somehow save her. For another similar case, see my blog at this site, “Shame, HIV, and the Body of Christ”, February, 2010. I wonder if something like this was not working in the sister who died today.

At any rate, I am deeply saddened and very angry on the occasion of this needless death. Needless! All of us must die, but this woman need not have died leaving a seven year old and a son anxious over his grades, and others. She need not have died leaving her children with neither parent. The death of her husband should have been a wake-up call that saved her. But she refused to look to the help that was there. Why do we continue to accept death from the evil one when we could take life from the Father of us all? Pray that as we increase in linguistic skills and embark on this ministry we will be able to join the Lord in offering life, to compellingly offer the resources of the Kingdom of God for life, convincing the wounded and afflicted to reject the Evil One’s seductively compelling offers of death.

It's a Snake!

2010-09-23T10:51:00.000-07:00

We have a den of squirrels in the attic, and tonight a mouse ran across the living room floor several times, so it shouldn’t surprise us that our rodent zoo would be visited by a slithery friend. Last night, headed down the long hall to our bedroom, what should we see but a small snake moving right along with us.

Beth had passed into the bedroom when from the left of the hall it wiggled onto one of the steep down-hills and half slid down the slope. The brightly enameled smooth concrete floor didn’t offer much traction for crawling as the snake tried to reverse direction, so we had plenty of time for Beth to toss me a shoe (in this circumstance I have more confidence in a loafer in my hand than the identical shoe on my foot) and for me in turn to give it a few licks with the heel which eventually hit strategic places, and it lay still. I thought it was probably not poisonous, but this was our first encounter and I have yet to find a reasonable guide with illustrations of the snakes of Malawi.

We cut off the head for good measure, lest it recover from a traumatic swoon and seek to join us in bed (I’m not too up on vital signs in long, thin reptiles), and left it in the hall for a closer examination in the morning.

When asking locals, there are only two or three kinds of snakes in Africa, the cobras, the mambas, and the puff adders, all highly poisonous, some proving fatal within fifteen minutes. But the book on the flora and fauna of a neighboring section of Malawi that I saw in the bookstore on Saturday mentioned seven or eight classes, only two of which could present a direct health risk for humans, the cobra and the mamba. Alas, there were no pictures!

Everyone on campus who saw the snake said, “It’s a cobra!” In response to my query, “What about this snake leads you to that conclusion?” I was rewarded with, “If this snake bites you on the leg, your leg will swell up very much and you may die.” “Yes, but what do you see about this particular snake, this one right here, when you look at it that tells you it is one of those snakes?” The reply was, “It is black and the tail gets smaller and smaller to the final point.” Now, this may well define the African cobra adequately (I know that it doesn’t have a hood like its Indian cousin), but I’ve seen lots of round, black snakes with smooth, sleek heads back in east Texas, and they weren’t poisonous. But again, that was East Texas and this is Southeast Africa, and I think the diamond head of the pit viper of the southern U.S. is not characteristic of Africa’s potentially dangerous snakes.

Our snake measured about 8.25 inches long. It had a total of 167 body plates from just below the rear portion of the jaw attachment to the anal plate (I read something about number of plates in that book on Saturday) and I found no fangs of any kind while probing its mouth gently with my pocket knife. I must admit never having seen the “rear fangs” of one of Malawi’s poisonous snakes, however, so I may have missed them.

The snake probably entered via a garden door that opens into the hall and will not seal, though it has a double locking system. This week we’re going to the hardware store to buy rat and mouse traps. Somehow I think if we can get the mouse to take the bait, we won’t have him around baiting the snakes. In the meantime if there’s an amateur herpetologist among my readers, tell us what you think, and what I should look for to know if there’s really a threat. And if anyone knows what to do with the squirrels, please pass that along, too.

(A week later on our morning run we came across what looked like a large rattle snake without rattlers who’d lost a fight with something, probably a car. We finished our run and returned in the Mtendere truck. This one had a diamond head and fangs, and is probably a puff adder as it looked like the one my son killed in Mozambique in 2005. And they are colored just like a dried corn field. Add that one to the list and keep watch in the corn.)

Driving as Culture Shock

2010-09-11T07:13:00.001-07:00

Living in another place requires adjustment which doesn’t come without the experience of stress. High-speed driving in the U.S. is usually associated with the Interstate. In contrast, we live on the principal Malawian Highway, M-1. M-1 has two lanes, and usually narrow, considerably variable shoulders, with nothing but a very faded, dashed line “separating” you from the oncoming traffic. I drive M-1—on the left side of the road, with the steering wheel on the right of the car and shifting gears with my left hand—and I occasionally run or walk along it, so I’ve gotten a closer look than I want at times.

The shoulder along M-1 is defined with a yellow stripe, also quite faded. The shoulder may be as wide as a meter, or erosion may actually eat past the yellow stripe into the road-bed proper. The asphalt shoulder gives way to portions of gravelly clay undersurface which in turn transitions to the grass growing in the similar red clay of the surrounding soil. At times the transition from asphalt is very smooth, but even at entrances of dirt roads, it may present a four to six inch drop; at times it is up to 18 inches. At some points the deep indentations look like chunks of road bed have been taken by a giant “cookie monster”. This makes it difficult for pedestrians to walk beside the road or get off when the traffic is thick.

While M-1 is full of cars and trucks of all kinds, sizes and shapes, including double trailers with six axles on each, the motor-powered vehicle is not the principle means of Malawian transportation. There are many more pedestrians and bicycles than motorized vehicles on most sections of M-1. Pedestrians are usually aware, even wary, of the vehicular traffic, but occasionally they stumble home drunk as one young man I saw this evening. Some times children run toward the road, but I’ve never seen one actually on the surface who wasn’t carefully crossing and of an age to do so.

Bicycles present a bigger challenge with occasional cargo of grass bundles three meters long, one meter presenting on the highway side, or the man I saw today carrying about a dozen five gallon pails fashioned out of tin on the back of his bike; at least he was walking, using his bike as a cart. Mattresses, bamboo, goats and pigs, as well as people, get a lift on bikes, and these combinations present challenges coming down the edge of the highway. Today I saw a bike strapped crosswise on the luggage rack of another bike: a bicycle wrecker!

The most common means of long-distance transportation is the incredibly polyglot fleet of “mini-buses” that run the roads of Malawi. These 7 or 8 passenger vans which have been modified to optimally hold 12, but not uncommonly have 16-20 passengers, ply the roads, stopping suddenly to pick up or drop off passengers, re-entering the road with little warning, racing one another while fully loaded and occasionally resorting to blows to settle disputes with other drivers or passengers (they usually stop for this). Minibuses are crewed by a driver and a “conductor” who collects the fares and buys cans of gasoline while the driver recruits other passengers on the road side by the station.

Stress jumps a notch at 6:30 in the evening when it is already quite dark and many people are still working their way home, bright and errant lights shine in your face, and the ability to see and adjust for pedestrians or bicycles on the road is limited, and you struggle to time your approach to reach them when there is not an oncoming car preventing your “swinging wide”. The worst-case scenario finds bicycles on opposite sides of the road passing pedestrians while you meet a tobacco truck whose cargo is hanging over by about a meter on each side, and behind him is a mini-bus driver hanging over the center stripe looking for his opportunity to pass. At least the truck is driving slow, where a car wouldn’t be, so that either can make the heart race and surely raise the blood pressure as well. It really gets wild when the approaching driver has his high beams on, you reach down to flash your own lights, and find you’ve sprayed washer fluid all over your windshield!

Most modern autos on M-1 like to travel at 110 to 120 Km/hour. (70-75 mph), though the speed limit is 50 to a max of 80 (31-50 mph). The big trucks usually are well under limits by necessity, but that generates tremendous impatience in the lighter traffic and motivates risk-taking. Then there are the aged and decrepit. Saturday night as we returned home late, we saw a faint light in the distance rounding corners, going our way. As we quickly overtook it, a pick-up with no tail lights (we finally saw reflectors as we approached) putted along, its engine trying to keep up with its electrical system. The one front light was on the left and pointed toward the ditch; when on dim almost nothing of the road could be seen; when on bright you knew a car was there.

We drive no more than we have to (not having our own vehicle is a blessing in this) and we particularly avoid the hours just after dark. We absolutely refuse to be hurried on the road, and we take preventive measures to avoid the flying flak should others have accidents while taking risks around us. The most common cause of death for expatriates living in Africa is an auto accident, and we take care to not become a part of the numerator in those data sets. Pray that we may avoid the foolish and the temptation to become too condemning or bothered by others’ behavior on the road, that we may have eyes to see the obscure (go carrots!), and that we’ll never be perturbed by others’ impatience with us or their insistence that we get somewhere now. And as you enjoy your next drive down the interstate, send up a prayer for our safety on the road along with your own of thanksgiving.

The Breathing “K”

2010-09-07T03:34:00.000-07:00

What’s the difference between a guinea fowl and the possessive “my”? It’s the “h” that comes right after the “k”. Spoken language not uncommonly includes sounds that are not indicated in the written form. The “h” after the “k” is one such sound in English. Put the back of your hand right up close to your open mouth and say the word “Coke”. Feel the puff of air against your hand after the “c”? That’s the “h” (unwritten in English) that follows the “k” sound. “K” sounds in English when followed by a vowel, whether represented in writing with a “k” or a “c”, have that “h” behind them. We learn it as a part of the “k” sound without ever being told it’s there. So it doesn’t have to be written. “K” sounds at the end of words, however, such as the “k” in “coke” may or may not have the “h” after them! (Bruce doesn’t, Beth does. How about you?) And we learn that (whichever way we do it) without being told either.

For Chichewa, however, the national language of Malawi which we are learning to speak, there about as many “k’s” without the “h” as there are with it, even in the middle of words, and all are followed by vowels. So when a “k” appears you have to indicate whether you want the “h” with it, or not, (and, of course, say it) and the difference can be crucial. For example, the word for guinea fowl, nkhanga, has the “h” after the “k”, but an almost identical word without the “h” is one of the eight different ways you can say “my” or “mine” in Chichewa. (Yes, eight different ways, each with its own particular place! But that’s another story.) If you’re not getting the “h” right, though, there always the “n” before the “k” in nkhanga to distinguish “yours” from the fowl. But that’s another story too.

So try saying both “k” sounds in “coke” (or “cake”) without creating the puff of air which follows. I call it “swallowing” the “k”. You simply put the middle of your tongue up against your palate and pull it off just before making the vowel. It’s almost a quieter form of the cuckle or click you do when you pull the front of your tongue sharply away from your palate, and just one of a wide number of new sounds we’re learning to make. Instant regression to one year old! But also a reminder of the terrible frustration that must come to little ones when their sounds are not understood. It probably won’t take us 2-3 years to be saying sentences, understanding and being understood, or will it? Please pray that it won’t.

The Lava Bugs

2010-03-17T11:10:00.001-07:00

I was staring at the ceiling reciting a sentence from the “opening prayer” I am memorizing for use on Sunday morning (in Chichewa, of course), when an ill-defined shape on the ceiling caught my attention. It looked somewhat like a balloon, maybe six to ten inches in diameter, somewhat ovoid, somewhat transparent with a fuzzy demarcation of its outer limits, and it “oozed” its way around the ceiling. As I watched several other blobs with ill-defined borders appeared and disappeared. Some moved faster than other, some even seeming to dart, while most seemed to slide or roll, “ooze” is the best way I can say it, around and around.

It rained today, very, very hard. And some of the stains on the ceiling are a little larger than they were this morning, so I thought maybe I was seeing bubbles easing through a reservoir on the other side of the sheetrock. But these shapes moved forward and back, and always in somewhat of a circle on the ceiling. I then began searching for the source of the circle, as I realized these were shadows, and saw the bright light in the middle of the circle criss-crossed by lines, with a somewhat lesser light fading away from the darker circle in which the shapes moved. I was looking at the projection of the lampshade on the ceiling.

We (Beth had joined my observations) have recently been invaded by little orange beetles with pearly blue-black wings, and with today’s rains they had renewed their efforts to take our house by storm. At least thirty of the pesky little critters ( their wings work, but their flight paths are not always in agreement with those of us who presume that we manage the house) were crawling all over the lampshade, and those who walked on the upper rim were well-illuminated against the ceiling, magnified many times.

The projection on the ceiling reminded of those “lava” lamps whose oil and water contents (or whatever it is) are in constant flux. But our lamp had no such features. Just little orange bugs, like most of the rest of our living room (including the computer screen, and keyboard, and the front of my shirt, and sometimes the back of my hand. They really look wild walking across the upper rim of my glasses. No, I don’t eat them—see our newsletter at www.HIVemSA.org.) We laughed about our immediate choice of entertainment, perhaps excusable what with a limited selection of books (though we haven’t read all at our fingertips), no movies (some are on the boat), and an extremely intermittent and slow-when-its-there internet. But do we really need an excuse for enjoying the “nature show” projected on the ceiling while we work on Chichewa. No, we’re not going crazy, just making do quite nicely with what we have while being encouraged to work on what we’re here for.

Tiwonana (see you later)

Nsima and Finger Bowls—An Inadvertent Compliment?

2010-03-17T11:05:00.000-07:00

I noticed it first in the gas station. I’d gone in to buy water while adding a little diesel to the truck’s tank (yes, large bottles of potable water are sold in the gas station next to our favorite spot for doing internet), and the clerk stood up with an ear-to-ear grin to ask me in Chichewa if I wanted to buy water. Then at the airport the next afternoon, the agent at the fee booth rattled off a string of Chichewa phrases when I walked up to pay. In both cases I’d told them at a previous time that I was studying Chichewa and asked them to correct me if I made a mistake. I’d even carried on a considerable conversation at the fee booth at the airport, telling Joram (I remember his name after the third or fourth time) a little about my children, grandchildren and wife. Both had remembered me the next time I returned, and were taking me up on my implicit offer. I was studying Chichewa, and they were going to take their chance to teach me a thing or two. They both stretched me, and that was good. Thanks to the LAMP system devised by Dr. Betty Brewster of Fuller Theological Seminary, and her now deceased husband, the world is becoming my teacher, and the rest of them are enjoying it a little more than I am. But this is good.

The supreme compliment came at the airport restaurant, however, a place we’d also frequented to send an e-mail or two (no, we don’t have any internet access at our house). We’d also talked with the waitress a time or two, and she probably also remembered that I was studying Chichewa. I had ordered a vegetable curry with Nsima (a large patty of finely ground corn meal mush boiled down to a solid), while my friend had ordered the same curry with rice. When the two came, they didn’t look much alike at all. On his plate the curry was on a bed of rice which rose around the curry in a protective surrounding mound with cole slaw sprinkled around the outside. My vegetable curry came as a stew-like dish laid to one side of a normal dinner plate, with a relatively small amount of broth. On the other half of the plate were two slightly overlapping mattress-shaped patties of nsima. But the big surprise was that my friend had a fork and knife wrapped with a napkin, while I was brought only a rather large fingerbowl. I was expected to eat with my fingers.

Traditionally, nsima is eaten with the bare right hand, scraping off a small portion from the patty on one’s plate (or in the large central common bowl for the table) rolling it around the hand into the correct shape (or until it loses enough temperature to hold still, at least in my case), then opening a hollow in the ball with the thumb into which the vegetables and sauce of the curry are pushed before shepherding the whole mess to your mouth. Every three of four morsels it is necessary (for me) to rinse my hand in the bowl that is provided, or lick my fingers, though finger-licking is probably less acceptable in Malawi than in the US—I’ve never seen anyone else do it.

I’ve eaten nsima with a fork before, just last week at a banquet at a hotel was the last time, and I think all the others at the table ate it with their forks also. And while the airport restaurant is not quite as nice as that at the hotel where the banquet was held, “niceness” wasn’t the point. Nsima is a finger food, just like fried chicken is in the south and much of the rest of the U.S.A. So my waitress had assumed that if I wanted nsima that I would want to eat it the normal way, with my fingers.

We actually don’t eat that much nsima. This is only the third time I’ve had it since I’ve been here, which would say to most Malawians that I am extremely deficient somewhere, perhaps between the ears: nsima is eaten at every typical meal. Malawians often say, “Nsima is food. Whatever else you have is just relish." If you haven’t had nsima, you haven’t eaten.

I really can’t say for sure whether the absence of a fork and knife had anything to do with my language learning, but I like to think it did, that as the others have appreciated my efforts, were willing to include me, to stretch me, this waitress was also willing to include me, to treat me “normally” to serve me nsima without a fork. I would eat with my hands just like her father, her brother, her husband, and her sons. Just like she would. And that in itself is a little encouragement (I’ll take it where I can get it) to get back out there and play the two year old in the community, stumbling over words and laughing with all the others at who-knows-what I’ve just said. And, God willing, it will come.

Tiwonana (See you later!)

Slammed by Technology--But Why???

2010-03-17T10:59:00.002-07:00

With tele-medicine and the world wide web transforming the way business is done across the globe, including patient care, access to such marvels is of course of interest to us. Our own access to world-wide communications is multi-media: not really, it just seems that way. Actually, all our eggs are in one basket. It’s name is Zain, and for us it’s three cell phones.

One of the larger cell phone groups here in Malawi, advertised in a daunting hot pink color, offers a variety of services. First, the usual cell phone package. Though I’ve been told monthly contracts are available, almost everyone buys time as they go and adds it to their account via the self-same cell phone. The cost of a local call is not too bad, but calling the other end of the country can be costly, and calling the U.S., it’s prohibitive.

When I tried to call the States a few days ago, I went through most of my $10.00 allotment in just a very few minutes. We didn’t put a stop-watch to it, but we estimate the rate at $2.00 to $4.00 a minute. And when we called our colleague on the other end of the country (we’re talking about less distance than LA to San Fran.) the same sum disappeared in about 20 minutes. We were thus relieved to learn from that same colleague, Mark Thiesen and his wife Era, of a service in the US whose rates are about $0.27 per minute. I think we can live with that.

GlobalPhone pulls it off like this. You call on your phone to a US number and let it ring once, and only once, and then hang up. Detecting the “missed call”, the machinery on the States-side calls you back (at low-due-to-competition U.S. rates) and asks for the number you want, and then proceeds to connect you. They deduct up to a pre-authorized amount per month from your credit card at a fraction of the cost we’re now paying.

Zain, our current one for all, also sells modems which plug into your computer with a USB connection, but actually are their own little cell phones. When you connect to the internet you first plug in the modem and “activate” it via your computer, and voila! You’re connected! The neat thing is that it appears that the machine only counts units when you’re actively down-loading. So, connection is not a costly thing unless info-packets are actually coming down or up the wire. But you have to watch your account balance. Again, we buy about $10.00 worth of units (about 1,000 units) and “load” them via our computer. But they can run out. And the modems are decidedly not fast. (The estimate on downloading a printer driver for the printer, which was already here and driven by another computer e’er we got here—was 4 hours. No thank you. We’ll be talking about a disk with the next visitor, Jeremy.)

Needing to contact several of you whom we’ve invited to partner with us in our our project around transportation, and hearing of GlobalPhone, we fired off an application via internet, received a confirmation request asking for photocopies of identity documents to be faxed in. We got that all ready, ran down to the airport and sent those in last Saturday afternoon (at almost $10.00 per page, mind you!), and wondered when they’d get it up and going. Well, GlobalPhone apparently honors the Sabbath and Sunday too, because it wasn’t until sometime Monday that our e-mail came in with some important little access characters. We were in business, at least for a while.

So, we dashed off a test call of a very few seconds to our missions minister, and it worked! (Mark wasn’t sure that cell phones would handle it.) Then we called “one of you”, only to find you out to lunch, but coming back in 30 minutes. It’s bed-time here, mind you, but around noon where you are, but we’re going to get this communication thing worked out. We had some questions about our tax return, so we rang up the accountant and hashed through all that. Wonderful, though near the end of the call a pleasantly haunting voice chimed in: “You have only one minute remaining.” And then it got dicey.

I’d promised your assistant I’d call “you” back, and I’ve been trying to get in touch with you for weeks. We last talked three weeks ago, two weeks before I left the States, and we’ve played quite a bit of phone tag, so I didn’t want to be cut off in the middle of the call. Beth and I searched for the paperwork about the system. Somewhere it seemed I’d read something about security systems and “pro-rated rates of use”. Never found those explanatory papers, but did find an invitation to call a U.S. 800 number or fire off an e-mail if ever we needed a little more cash on our account. Now our internet modem is down to 37 units, about out of gas. We finally got into the new telephone account's information over the web. We’d spent four dollars of our fifty for the month, but we had only $0.31 available. (And only 3 units left of internet.) Security!!Call "you" and risk getting cut off . . . or call customer service for GlobalPhone. We chose the latter.

I heard the ring indicator sound on the other end and I hung up. About 10 seconds later the phone began to vibrate and ring. I answered, dialed the 800 number on prompt, and then that haunting, sweet voice: “You have less than one minute.” A menu is presented, another menu.Surely they won’t hang up while I’m asking them for access to a few more of the dollars I’ve already paid them! A voice comes on the line, “How can we help you?” overlapping at the end with the haunting lady: “You’re out of time. Click.”

Tomorrow I can run by the airport, literally, unless the driver brings the other key fob back in the morning. The keyless entry/security system on the pick-up has a dead battery. We got into the car, but can’t start it without a working “clicker”. (Now you see why we need transportation.) (As it turns out, though the keyless entry is weakening, I had left the lights on Sunday, draining the battery. Someone else is lamenting shared transportation.) At the airport I can pick up internet minutes and contact GlobalPhone, and maybe I can call “you” tomorrow night. Or maybe not. We’ll see. And we hear broadband is coming this year.

[We finally got in touch with "you", and you sent sent us $1500 toward the vehicle we will need. Thank you so much for your generosity, your patience, and your care for what we are doing. And, we've talked with folks who think they can reach us in six weeks or less with 1 megabyte/second internet speed at rates comparable to the U.S. Yes!]

Mentors in Missions: A Tribute to Henry Farrar

2010-02-20T03:09:00.000-08:00

I was about 14 and had decided I would be a physician. My seventh grade science teacher (and my Sunday school teacher) Margaret Beene had told us about her aunt who had a strange, little-understood disease called scleroderma in which the skin, inside and out, hardened to make the affected organs barely functional. In one form fingers could be resorbed from the tips due to the pressure of the skin on the bones, and internal organs such as the digestive tract and heart had major functional problems as their own “skins” hardened. Then Mrs. Beene got the disease, and I was going to find a cure for it: I was going to be a doctor.

We had traveled 50 miles from our small town to Tyler, the closest thing to a city nearby, to attend a service of an evangelistic meeting at the Omen Road Church of Christ. We met some friends, Howard and Betty Waldrip, there and were going to their home for a bit after the service. My parents had split up to assist in finding the Waldrip home, and I had ridden with the ladies. We were sitting in the parking lot about to head for their house when Sister Waldrip turned to me in the back seat:

“What are you going to be when you grow up, Bruce?”

“I’m going to be a doctor,” I answered from the back seat.

“And be a medical missionary like Henry Farrar?” she queried.

I thought, “No way! I’m going to do research and find a cure for Mrs. Beene’s scleroderma.” I had no idea who Henry Farrar was, but I was pretty sure that the kind of research I wanted to do and medical missions didn’t go hand in hand. But a seed had been planted.

A few years later my older sister married a latino evangelist, Victor Rodriguez, and the idea of missions came a little closer to home as they discussed possible work in Spain or Latin America. The seed had been watered just a little, and was ready for the warm sun of the missions youth rally which my dad organized. David Gatewood, already working through forays behind the “iron curtain”, spoke along with Kenny Sinclair who was finishing graduate work toward a long life of service in Malaysia, as well as a young lady whose name now escapes me. On a card that bares David’s name, along with that of Maurice Hall, I pledged a life of medical mission service to Spanish-speaking people. The seed planted with the name of “Henry Farrar” was germinating.

Dr. Farrar continued to appear in my life. First, on arriving at Harding and discovering the library, I read about him in the Christian Chronicle, his establishment of the Nigerian Christian Hospital, and the troubles that institution had during the Biafran war. I heard stories of his making his way through war lines to check on the hospital and serve the people he loved, of slipping an old, invalid passport with an otherwise valid visa inside a new passport that lacked those stamps and signatures and by God’s grace making it work, getting through to do God’s work.

Most recently I’ve been impressed that Dr. Farrar has read and can discuss in detail or is even teaching from every book that I’ve read or been recommended on spiritual growth and development. His mind is still racing to know and to live under the lordship and teaching of Jesus Christ. The arthritis that has bent his tall frame in recent years belies the sharp mind that operates behind eyes keen once again after cataract surgery and under the blooming almond tree of white hair that foretells the wisdom to come from his lips. But his intelligence, sharp as it is and has always been, and his wisdom pale beside this man’s most marked characteristic, his faithfulness, the incredible trust that Henry Farrar has in his God, the Father of us all, and in Jesus Christ, our model as God’s only son, himself a medical missionary, as Henry has always reminded us.

I’m pretty sure Dr. Farrar was present at the first Medical Missions Seminar held by Churches of Christ in the fall of 1968 or the spring of ‘69 at Harding, though his quiet demeanor pales in my memory beside Joe Cannon’s more bombastic faithfulness and charges to physicians on that occasion: “You don’t go to the mission field because you’re worried about your 401K’s and your retirement funds. Why don’t you work until you’re done and then just die and go to heaven?” If it was Joe who said it, Henry Farrar has lived it. The closest to a word of complaint I ever heard from Doctor Farrar was that he was “underworked and overpayed” when he returned to practice in the States. I know nothing of his financial affairs, but he educated several children, one a surgeon, one a doctoral level RN, and one a missionary, and he has continued to give liberally to others who work faithfully in Nigeria and other places. Money never seemed to be a concern of his: the Lord cared for him and for others through him.

At other medical missions seminars that unfolded over the years Henry encouraged successive generations of candidates to just finish medical school and get on the boat, go to the mission field. He seemed to disdain the urging of others to study culture and language, which they said was necessary so that inter-personal ministry on the field could be enhanced. But when my wife and I spent a few weeks at his hospital during my senior year in medical school, staying in what had been his home, I was pleasantly surprised to see an Ibo grammar as one of only two or three books remaining on the bookshelf of the mostly empty house. And he was not just respected in that part of Nigeria where he worked, but truly loved by the people there. He had not ignored language or culture, but his gentle servant spirit, his personal sensitivity, had been the primary catalyst for developing close cross-cultural sensitivity and relationships.

I think Dr. Farrar’s “get with it” advice may have been motivated by the fact that more than 90% of those who said during pre-med years that they were going to do medical mission work ended up in a private practice in the U.S., never doing any long-term work. The acculturation to American private practice and its seemingly intractable pull on mission candidates was probably discouraging to Dr. Farrar, and it remains a challenge to the needs of medical missions around the world. Henry’s practical answer was “just do it”, the sooner the better.

When various circumstances suggested that the Farrar family return to the States for an indefinite period, Dr. Farrar flexibly “reinvented missions”, leading a wave of itinerant service by multitudes of physicians and surgeons, beginning at Nigerian Christian Hospital and expanding to numerous other facilities, a growth that continues today among some perhaps ignorant of its original inspiration. It is probably not an overstatement to say that these methodologies, itinerant surgical missions, owe their practice in Churches of Christ to Henry’s need to be here and be there, a need he has heeded up until the present. Thus he was able to not only continue to meet his own family’s needs and serve in Nigeria, but also to involve many of those who had said they would go, only to find themselves somehow unable or in some way unsuited after finishing their residencies. At least in some sense, a sense that has been a blessing on both sides of the service, the seemingly betrayed intentions of many have been fulfilled through imitation of the latter part of Dr. Farrar’s life, and not uncommonly through his personal invitation.

The influence of Dr. Henry Farrar in medical missions in Churches of Christ would be difficult to overstate. Though he is probably too humble to say the words, what he has done and the Christ-like spirit with which he has done everything cry in the words of the apostle for us to “follow me as I follow Christ”. It is at least fair to say that none of the rest of us might have ever been there had he not gone, so that Sunday school teachers, visiting missionaries, and Bible professors across the nation could invite those of us considering the practice of medicine to be medical missionaries “like Henry Farrar”, and thus like Jesus Christ.

P.S. Dr. Farrar fell Tuesday morning on arriving at his work, suffering a concussion and a fracture of his first cervical vertebra. He has awakened and is lucid and communicating, but is paralyzed from the neck down and is unable to breathe on his own. The family appreciates your prayers.

Any errors in the above stories are mine, as I remember them.

Margaret Beene lived to be 90 years old by the grace of God and the good care of many able physicians, some of whom she surely outlived. She always encouraged my decision to be a medical missionary, to the last years of her life.

Shame: HIV, Death, and the Body of Christ

2010-02-06T19:15:00.000-08:00

He glided behind me as he passed the front desk. I didn't have to be there, and he didn't need to stop there, but he seemed to avoid being seen. Somehow I knew he was my last patient of the day. We hadn't met, but as I perused his slim chart, it was evident there were problems. We'll call him Mr. P. The amount of HIV virus in Mr. P's blood had dropped, but not nearly as fast or far as it should have. There were suggestions that he had been on several medications since his infection was discovered, but the documentation was not all there. Then there were his current meds. All of them, nearly a month's worth in most of the bottles, had been last filled seven weeks ago: one bottle was nearly full, another was dosed at half the amount it should have been, and there was only one pill left of one of the meds. "And I don't get paid until Friday," he said from under the bill of his cap. "That's when I can refill it." Three more days. Missing a single dose of your HIV meds each month can increase the risk of resistance developing over the year by 10-15 percentage points. This man, like many of our patients, needed help taking his meds.

He looked to be in his 60's or 70's, but he said he was only 45. As we talked about his disease and what was going on, he wouldn't look at me. On several occasions I asked him to, and he did. Briefly. And then the head was down again, the bill on the cap shading his eyes, hiding his face from my attempt to know him.

"How has this disease affected your life?"

"It's affected me a lot. I'm angry. Angry a lot. I don't know how I got it," the voice spoke from behind the cap.

"Does anyone else know about your disease?"
"My sisters. They know."

"And they've handled that OK?"

"Uuuuh-húh. Oh-Kay. One of them is ok. One of them, she has me drink out of a plastic cup." There was a silence.

"And then . . . she throws it away?"

"Uuuuh-húh," the voice swung up in affirmation.

"But my other sister, she's ok. She feeds me. Lives across the road from me."

His brother-in-law had brought him to the clinic, the husband of the sister "across the road". Without lifting his face Mr. P affirmed that the in-law knew of his disease and that he would sign a release for me to talk with the brother-in-law and sister. I went over a number of things with them, separately, in person with the brother-in-law in Mr. P's presence, and then on the phone with his sister after he'd left. We talked about the CD4 lymphocyte, what that white blood cell normally does, how HIV infects it, then destroys it while diverting the CD4 from its primary mission of protecting us to the role of producing more HIV viruses. We talked about resistance, and the need for adherence to the medication regimen, the need to use a pill box, and possibly for someone to assist him. Then I mentioned to Mr. P's sister his hidden eyes.

"He won't look at me," I began.
"No. He won't look at anybody. Me neither."

"Has he always been this way, or just since he knew he was infected?"

"Just since he's been infected."

Then it hit me! He's ashamed! He's ashamed to be infected with HIV. He's so ashamed that he can't look at anyone. For those who don't know, he's afraid they'll learn, as if by looking into his eyes they would see deep within his brain the "HIV" in red letters, stenciled on the gray matter of his mind. For those who do know, he's ashamed. I was almost overcome with anger and sadness at this man's situation, this man who is now almost Gollum-like, shriveled and be-deviled, his "image-of-God" humanity defaced more than usual because of this disease, the way others deal with him because of the disease, and his fears of what he might receive. Head down he tries to hide in his own dark cave between the bill of his cap and the flaps of his partially zippered jacket. It may be that some of his shame is due to his guilt for how he caught the disease, but that is not my impression. Yes, few know, but of those who do, only two treat him well, treat him . . . normally. And he is overcome with anger, fear, and shame.

This shame, and the fear of it, immobilizes people around the world, keeping them from getting tested in a timely fashion when treatment is most affective and complications are least likely, driving them into caves of despair when they know they are infected, afraid of rejection, loneliness and death, not the stopping of that pumping muscle in their chests, but the death of their spirits through loss of interaction with the rest of us who've been imparted spirits from the One who is Spirit. These fearful ones have not known Him, except through those whom He has created, those He seems to have given life, and now the "living" will, thinks Mr. P, withdraw and leave him absolutely alone, dead. Those who claim to live forget that it is their privilege, their responsibility, at precisely this moment to offer life.

I praised Mr. P's sister and praised God in her presence because she is accepting him, affirming him, loving him, she and her husband. When I see him again I will inquire about shame and if it is confirmed I'll discuss the possible why's of it. If he is guilty, I will offer him the forgiveness that God has given me. "Your sins are forgiven you." "Neither do I condemn you. Go, and cease your life of sin." That is how the Lord dealt with shame. And he has sent us to do the same.

Meanwhile, I am saddened and angered by the way we are, "we" being what too often passes for church, community, and even family in this man's life. That which should be gracious, loving, offering forgiveness, even at the cost of its own life, but rather is too often, especially in this situation, proud, exclusive, condemning: polished, beautifully painted gift boxes full of dead men's bones. "If you were blind, you would not be guilty of sin; but now that you claim you can see, your guilt remains."

Lord, do what is necessary to open eyes, minds and hearts, to impart fear where it needs to be, and courage where it needs to be, so that this disease may be stopped not just in its destruction of bodies, but in its destruction of souls, its defacing of your image in those you made to bear it. Teach the church to be your body, courageous not only in righteous living but also in gracious offering of forgiveness, love and hope, that men and women may know they are loved by you, and can truly live in you.

And What About the Barber Shop?

2009-11-18T21:30:00.000-08:00

The topic has come up at almost every seminar we've done: "What about the barbershop?" Do barbers, through their scissors clippers and other instruments for cutting hair, pass HIV? For many of us this requires some cultural awareness, if not sensitivity. The folks at our seminars generally have very short hair. Some of them shave their heads to avoid the problem of those little, curly hairs heading back toward their point of origin and causing all sorts of problems. And when folks get their heads shaved, they almost invariably get cuts. "Couldn't this spread HIV?"

Well, surely someone has thought of this, but I've never read anything about it. So in Zambia, in 2005, I went to the barber shop one afternoon in downtown Lusaka for a cultural awareness session. With the head barber's permission, I just sat there and watched two or three men get their hair cut by the same barber. Straight razors were not used, but clippers, electric clippers (there are also similar hand-powered clippers used in the bush) consisting of a row of tiny fixed blades coming to a not-so-sharp point, paired with a set of moving blades crossing over their fixed partners very rapidly. Think of 10-15 (I didn't count them) pairs of tiny, adjacent scissors with one blade moving really fast.

Now, these scissors, the blades on the clippers, are normally not just hanging out there. Usually they are separated from the scalp by a plastic guard which can be from either a fraction of an inch to several inches long such that they only cut hair. But, when the objective is a truly shaved head, then the guard must go. Now the blades are directly on the scalp, and any irregularities in that scalp might find themselves in the teeth. And so they do.

As the barber worked across the scalp, first using the shortest guard, then going over once leisurely without the guard, then carefully and tightly trying to get all remaining stubble off the scalp, I periodically saw the customer flinch, jump, express through total body language not unlike being electrically shocked his very short-lived but very evident pain at being cut. Usually two to three times per hair cut. When the customer was finished, after payment was made, the barber picked up a squirt bottle of purple liquid and sprayed the blades, then wiped them with a towel.

"Could I see your bottle?" I asked as he handed it to me. ("Methylated Spirits" it read, and I'm thinking quickly, going back in history and chemistry, "spirits" are drinking alcohol, ethyl alcohol, and the "methyl" is one carbon with three other hydrogens attached, so "methlyated spirits" would be isopropyl alcohol, what we call "rubbing alcohol", or the alcohol on those little pads that is used to clean the arm before you get a shot.) But is isopropyl alcohol deemed adequate for HIV prevention? No. [It turns out I'm probably wrong, with apologies to my professor of organic chemistry, Dr. England. "Methylated spririts" is denatured alcohol, that kind of drinking alcohol that's sold in shot glasses and fifths but with a little methanol, a highly toxic alcohol, added to it to render the ethanol undrinkable. But that combination is not recommended for killing HIV either.]

So ever since that day I've asked of the public health types who should know, and they've assured me that the barber shop is not a problem. And, we would probably expect more men to be infected than women if the barber shop were a significant source. Except that women also get their hair cut with the same kinds of clippers. In Swaziland we were able to ask the epidemiologist whose work was the first to show that circumcision was protective against catching HIV, leading to the current revival of circumcision (men are lining up for a 50% reduction in risk) in Africa. He assured us that the barber shop was not a significant risk, but he may have been distracted by his enthusiasm over shaving another set of heads. The problem is, I've never heard of a study where the question was truly addressed.

Then this year, in Tanzania, an Infectious Disease doc on the scene admitted that he thought it couldn't be brushed off so easily. It is for this reason that you can't get a shave in a U.S. barber shop anymore. At least not in southern California (I haven't asked here in Alabama). When AIDS hit, the cost of adequate sterilization of straight razors outweighed any possible benefit of continuing the services. And while the multiple tiny blades of the clipper may not inflict as deep a cut as the straight razor could, they can cut. They can cause bleeding. They just might transfer HIV. So they are never used "guard-less" in a U.S. barbershop.

The upshot of all this is that while we know a lot about HIV, and about its transmission from human to human, there are many questions that remain unanswered, not even addressed in any formal sense. And Beth has our personal barber clippers, unused for 20 years of California life, in one of those boxes marked "TO GO". One spouse/one barber/one clippers. And always with a guard.

HIV Transmission in Africa: What More than Sex?

2009-10-10T15:08:00.000-07:00

The work of arresting the spread of the HIV epidemic has centered around changing sex practices: reducing the number of partners, encouraging fidelity between partners, delaying the onset of intercourse, preferrably until marriage, and using barriers such as condoms during sexual relations. There has been much discussion over the utility of some of these as compared to others, but not much disagreement over the fact that sex is what the spread of HIV is all about. The Anglican Canon Gideon Byamugisha from Uganda, mentioned in my last post on condom use, first raised the question for me as to whether there might be other activities equally important as sex for the spread of HIV. He referred in his teaching DVD to a scientific paper showing that about 70% of a small cohort of Rwandan women with HIV had a history of only one sex partner who himself was negative for HIV infection. How did the women get it?

In the summer of 2003, Dr. David Gisselquist, then of Penn State University Medical Center, Hershey, and his colleagues published a review of data collected before 1989 on risk factors for acquiring HIV. Across this multitude of papers they reviewed, some of high risk groups and some of the general population, he came to the conclusion that the most common risk factor, accounting for 48% of the HIV, was exposure to injections or procedures in the health care system, defined as either western or traditional health care. About 25-29% of HIV transmission in women, and 30-35% in men were due to sexual behavior. These papers were published in the International Journal of STD and AIDS in the summer of 2003, generating considerable discussion via letters to the editor and other correspondence.

Gisselquist has subsequently been vilified by many but none have adequately contested his review of the data. He himself notes that the data are far from perfect, that in the early days of the epidemic there was little knowledge to improve the precision of the data collected. He still admits that sex may be the predominant form of passage, but that health care of various sorts is so important that it must be addressed, and studied carefully, not ignored as is being done now. What did not happen, but could have, however, was the careful analysis of the data that was collected (such as Gisselquist has now done) and the subsequent careful design of studies to answer the questions it presents. Why did this not happen?

First, as Gisselquist describes it, the data from the US and Europe were very good, showing that homosexual behavior and intravenous drug use were the predominant causes in the industrialized west, with heterosexual behaviors coming in a distant third. But there was good evidence and consensus that homosexuality and intravenous drug abuse were extremely uncommon in Africa and non-contributors to the HIV epidemic. Thus says Gisselquist, "most infections were assumed [emphasis mine, BS] to derive from either sexual or health care exposures. The 90% estimate for adult HIV from sexual transmission hence rested on the belief [emphasis mine, BS] that health care transmission was very low, despite abundant evidence to the contrary." And what about those women who said they had only had one sex partner ever, and he was negative for HIV? They were and are often dismissed as "unreliable historians"--liars.

Several anecdotes suggest the accuracy of Gisselquist's data-driven conclusions. First, Sam Shewmaker, an African missionary born and raised in Zambia, was travelling with his wife between two African countries by land. It was brought to their attention at the border that their cholera vaccinations had lapsed. In order to bring them into compliance with the regulations of the country they were visiting, the health worker at the site went to a jar full of milky liquid to fish out a needle to use in injecting them. Questions arose in their minds: How long has the needle been there? How long has the liquid been there? Was it properly diluted when prepared? How does the worker know which of the many needles was used last? They were able to persuade the worker to spare them the injection with the promise they'd get another on their return to their own doctor in just a few weeks.

In 1985, Dr. Monte Cox, then a missionary in Kenya and now the Dean of the College of Bible and Religion at Harding University's Searcy, Arkansas, campus, took his two year old son to the pediatrician for immunizations. Dr. Cox and his son were waiting in a room with 11 other parent-child pairs when the doctor came into the room with one syringe full of vaccine and began to work around the room injecting one child after another. Dr. Cox's boy was last. "Are you going to use the same needle to inject all the children?" he asked.

Looking at the speaker, then the needle and back to the speaker, the doctor retorted, "Well! Not your child", then left the room, returning a bit later, presumably with a new needle.

In 2004 while speaking in the village of Ateiku in western Ghana, I apologized for having left a slide of a syringe in the section of the presentation on risks for HIV infection, acknowledging that they did not have the problem of IV drug use in their village. A woman on the front row inquired during the question and answer session, "You are right that we don't have any IV drug use in our village, but if addicts sharing needles could spread HIV, wouldn't it also spread HIV when the mid-wife uses the same instrument to test all the women in her clinic for anemia?" I assured the woman that she must see a new lancet taken from an unopened paper before it is used to check her for anemia.

The data Gisselquist has published have powerful possibilities for reducing stigma in us and in Africans. Nobody knows precisely how a given individual got his or her HIV, especially in Africa, though this should not matter, particularly to Christians. People are in need. Many of us have solutions. Sharing is the right thing to do, no matter how someone got infected. Our work involves sharing these ideas with church leaders so that they can be better informed and transformed to be the life-sharing neighbors, both in prevention and in care, that are needed in villages full of disease, fear and death.

And then there's the barbershop.

"My Wife is HIV Positive--What Can I Do?"

2009-08-06T12:00:00.000-07:00

(Note: this blog contains some fairly explicit material regarding sexuality, HIV, and condom use. Parental guidance is suggested in its use.)

“My wife is HIV positive, and I am not” a participant in our Tanzania seminar offered at 6:30 pm on the opening day. “What can I do?” Our seminar had begun at 9:00 A.M. “African time” (11:00 by the clock), and while we had not put in quite eight hours of work, the group was very tired. I’d been answering questions about HIV for several hours and this question offered a great segue to a discussion on condoms, so I wanted to hold it until the next day.

“That’s a great question,” I offered. The rest of my answer brought down the house: “Don’t have sex tonight and we’ll talk about that first thing tomorrow morning.”

The next morning the group offered three possibilities for the inquirer (whom I learned later was asking a hypothetical question and was not disclosing the status of his wife who was sitting next to him when he asked):
1. Divorce his wife.
2. Stay married and don’t have sex.
3. Stay married and take the risks of sex with an HIV-infected wife.

No one offered a fourth suggestion. After a long discussion of Jesus’ teachings on divorce and Paul’s teachings on sexuality and marriage, everyone agreed that the first suggestion was not legitimate, the second was totally unfeasible and the third was not very desirable either. But no one suggested condom use. Finally, as I continued to entreat the group for a fourth alternative, a very old man who had showed up for the first time on the morning of the second day offered in a subdued but firm voice, “Condoms”. After he confirmed his answer a little bit louder, I turned to the group and asked for their thoughts about his suggestion. It was a hard sell.

The very idea of condom use in any context sometimes quickly heats up the conversation among many Bible-believing church leaders in Africa, though it is always an area we explore in our seminars. “Condoms are the cause of the HIV epidemic,” suggested one participant. Several heads nodded agreement, and then another chimed in, “We didn’t see much HIV until condoms became freely available; then people started dying right and left.” This answer is listed as an incorrect choice on the pre and post test I did not utilize in the Tanzania seminar, but this was the first time it had ever been suggested so explicitly by one of our seminar participants.

Most church leaders simply associate condom use with illicit, extramarital sex, and thus find them sinful in and of themselves. It is often difficult for these church leaders to see that condoms might have a legitimate use, and it is hard for them to see that using a condom doesn’t even make Biblically illicit sex more sinful. So I borrow from Canon Gideon Byamugisha, an Anglican Priest who addresses the issue well. Canon Gideon points out that sex may be licit or illicit, safer or not so safe, two concepts that are not equivalent, (though admittedly not totally independent). Licit sex, sex within marriage, is usually safer than illicit sex, but only if your partner is known to be negative and unexposed to HIV. In a society where 15-25% of the adult population is infected with HIV and there are means of transmission other than sex, assumptions shouldn’t be made. In a case where one’s spouse is infected with HIV, licit sex can still be safer or not so safe.

Similarly, illicit sex, sex outside marriage, is always illicit whether a condom is used or not. Condom use does not make extra-marital sex illicit. It is sinful on its own merits. Though condom use does make illicit sex considerably safer, it is no absolute guarantee of safety. Unless one believes that the only way God can punish people for illicit sex is through the transmission of HIV and other sexually transmitted diseases, and that condom use is thus somehow thwarting God’s punitive will, then condom use should not be seen as wrong, certainly not during licit sex, but really no more so in illicit sex. And innocent children and faithful spouses might be spared. We point out Jesus’ stated objective “not to condemn the world, but to save the world” which suggests that the work we should be doing is the same.

“But aren’t you killing a new baby when you use a condom?” someone asked during the South African seminar. A careful review of the anatomy and physiology of conception and pregnancy reveals that a new being is not formed until after the union of egg and sperm, so preventing that union through condom use is no different than not having sex. In fact, condoms are probably the least likely of all birth control methods to working by interrupting the pregnancy process after the union of sperm and egg.

“But isn’t wasting sperm sinful?” another inquires, and we go back to Genesis 38 to look at Onan’s condemned use of birth control (no, he didn't have a condom, but read the story if you're having trouble remembering the details). Again, a careful review of the text reveals that Onan’s sin lay in the failure to fulfill his social duty to his brother, his unwillingness to be a good family member. If he had never had sex with his sister-in-law he would have been just as guilty under the rules of his society. An older brother in our Tanzania seminar group shares the physiologic fact that one sperm out of millions fertilizes the egg, demonstrating that God is not worried about “wasting” sperm. Some feel the earth is not yet full and that we must still fulfill God’s creation command to “fill it up”, but a reminder of children dying of malnutrition and Paul’s note that those who don’t care for their own are worse than unbelievers convinced many that mankind had probably fulfilled that mandate.

In the end, several of the four planning groups in the Tanzania seminar listed education in condom use as part of their plans for combating HIV. Did they get it? Will they teach it? Or were they just saying that because of my dogged insistence? Condoms will not solve the AIDS crisis, and they are not the primary means we suggest for HIV prevention. They are certainly not the cause of the epidemic, however, and there are instances where condom use would help even licit sex to be safer for committed and faithful married couples. How then did one partner in such couples become infected? More about that next time.

John: Infected and Affecting Others--for Good

2009-08-01T10:16:00.001-07:00

John was not the average participant at our most recent seminar in Nduha, Tanzania, about 1.5 hours south of Mwanza, Tanzania’s second-largest city. (Mwanza lies on the southern shore of Lake Victoria near the borders of Kenya and Uganda with Tanzania.) John had known he was infected with HIV for several years, and had been on anti-retrovirals (ARV’s) for most of that time. According to Kevin Linderman, the missionary who was our primary contact for this seminar, John had frequently made casual public remarks about his medications in contexts that revealed his status, but John had never had the occasion to openly address the problem of HIV before other church leaders. Our seminar provided just such an opportunity.

One of the most powerful events in our five-nation teaching tour in 2005 was a presentation by the female president of the Kenyan Association of Religious Leaders Infected with or Affected by AIDS (KenAReLAA). We shared with John about the positive effect of her talk on the church leaders attending that seminar, and asked if he’d like to address his group. While encouraging him with the thought that his presentation could be equally powerful, I offered him the option of just answering some questions about his feelings about the disease and its effect on his relationships, and we assured him that he should feel under no obligation to speak at all. We left him to think about it overnight.

The next day John told us he was ready to speak. I thought he was just going to answer some questions, but when he got the floor he took off. Though I can’t tell you all (or even most) of what he said (my translators were more interested in listening to John than telling me what he was saying) I can tell you that it was powerfully delivered and captured the attention of our group. Among other things, he addressed the problem of the prejudices of his friends and neighbors. John said he knew many people were wondering what woman he picked this up from. John answered with the testimony of his life.

“When I planted the church in your village,” John asked, indicating one of the participants, “did I pick up a woman there? And when I planted the church in your village,” he asked another, “what woman did I pick up there? And how about your village,” he asked another. “When I planted the church there was I with a woman?” John had planted churches in many villages, and his faithfulness to his wives was as evident as his evangelistic skill. He had come to those villages on behalf of the King of kings, and his life reflected that commitment.

Yes, John had been a polygamist. His first wife had died some years ago (perhaps of HIV-related infections), and he had divorced his third wife after repeated instances of unfaithfulness on her part, perhaps another opportunity for infection. He now lives faithfully with his second wife, who was present in the seminar and who avidly supports the many facets of his ministry. John is now a grandfather, and through his encouragement his children have all been tested and found to be negative for HIV.

I asked John how long he took to reveal his HIV status, which was discovered during hospitalization for a nasty leg infection that wouldn’t get well. He told his immediate family about two months after the diagnosis, then his extended family after a year. He began to tell other church members after about two years. The reason for his delay: fear; fear of rejection. While some of his relationships have suffered since his diagnosis, John’s aggressive defense of his life’s record has stood him well, and the unquestioning support of his family has been an added comfort.

Our seminars attempt to address the stigma of HIV infection in several ways:
1. Recognition that all of us are sinners, whether we have HIV or not.
2. Recognition that those who have sinned in ways other than sexually are just as much sinners, and thus in need of God’s grace as those who have sinned sexually.
3. Recognition that there is good evidence that a great deal of the HIV in Africa, at least early in the epidemic, was acquired through other than sexual means (more about this in a later blog).
4. Recognition that our task on earth as the Body of Jesus Christ (the church) is to invite all sinners back to God for healing, not condemnation. This was Jesus’ work, which he did not only in word, but also in his attitude and social behavior, and which he expects us to continue as his followers.
5. Recognition that those infected with HIV are in great need of care in many ways: socially, physically, mentally, emotionally, and often spiritually and financially, and that the church is the best institution to deal with these needs because it is really the only institution that can deal with all of them.

John’s participation in this seminar added a very special dimension to it. He is a respected leader of the churches in his area and the father of many of them. His ministry has the opportunity to acquire additional power for the Kingdom as his weakness (his HIV infection) becomes a Kingdom strength, a point for connection with his neighbors whose lives are being crushed by their HIV infection, no matter how they acquired it. It is a blessing to know John and to count him a friend and partner in the work we are doing.

Aa Malawian Feast of HIV Knowledge

2009-07-14T02:56:00.000-07:00

A virtual feast awaited us in Lilongwe, Malawi, in our first week in Africa. The National AIDS Commission had invited all groups doing HIV research in Malawi to present their results at a national conference which occurred on Thursday and Friday, the 2nd and 3rd of July. One member of the Landmark Church group, with which we are enjoying the Malawi portion of this summer’s trip, saw a sign in the center of the city advertising the event. A few days later we drove by the sign, saw that the event would be at the Crossroads Hotel the following day, then headed for the Hotel, learning that the event was sponsored by the National AIDS Commission. On the way home we dropped by the Commission’s offices where we were invited by two different staff members to attend. So we did. It was a very worthwhile investment of two days’ time.

A paper by epidemiologists from the Ministry of Health reported that at the end of 2008, 147,500 patients (about 50% of those needing it) were on treatment at some 211 clinics across the country. Over time progressively more patients have been added to treatment each year, and those patients beginning treatment are increasingly younger and earlier in the progression of their disease. Men have continued to get tested and start treatment in smaller numbers than women, and the men usually have more advanced disease when they come to treatment.

The Malawian Ministry of Health (MOH) and Howard University noted that 100 laboratory technicians had been trained in the last six years to do complex laboratory procedures such as counts of the number of CD4 lymphocytes (the primary target of the HIV virus—basically, the more you have the better) and the “viral load” or the number of HIV viral particles themselves in patients’ blood (the less you have the better). More than 80 additional working technicians had received updates in these procedures. More availability of the CD4 count will spread the ability to track the success of HIV treatment under current Malawian protocols, and access to viral load determinations will apparently prepare Malawi to move to treatment follow-up based on the more precise and sensitive (though also more expensive) use of the viral load for follow-up.

GOAL Malawi reported good results in several senses from having fathers participate in the counseling sessions for pregnant women in which their newly-discovered HIV infection and the medications they would take to reduce risk of transmitting the virus to the baby are discussed. As a result of this special effort to include fathers, the number participating doubled to between 60% and 85% of the number of mothers attending the participating clinics. Male membership in support groups increased by 82.5%. Other desired and possible outcomes that were not documented included reducing emotional and physical abuse by their partners of pregnant women found to be infected with HIV.

Dignitas International and their partners found that provision of HIV care in 16 decentralized sites in one area of the country (as opposed to only 6 in addition to the central hospital in the pre-study period) decreased death and drop-out rates in persons beginning HIV care. Another session found the use of trained community volunteers helpful in enrolling patients on medications, keeping them on medications and ensuring return for clinic appointments.

The Malawi Interfaith AIDS Association found in a national survey that clergy were well-informed regarding the way HIV works to cause disease but most were very opposed to condom use. Thirty-two percent believed that prayer could be an effective treatment for HIV, a fact that seemed to disturb at least some of those present. While I do not think we should ignore the wonderful gift from God of the medications currently available for treating HIV, I wonder why only 32% of church leaders believe that prayer can be an important and efficacious part of an effective treatment regiment.

For a number of good reasons African protocols for treating HIV are generally simpler than those usually used in the USA, including treatment for pregnant women. A group named Sant’ Egidio for the Roman Catholic renewal and discipleship movement of which they are a part reported on their efforts to treat pregnant women with more aggressive protocols, in some ways more like those in the U.S. and western Europe. A part of the Sant’ Egidio protocol was using full anti-retroviral treatment starting early in the pregnancy, while another, quite different from the U.S., included continuing full anti-retroviral treatment of the mother for the first six months of the baby’s life while the mother was breastfeeding. They found that all outcomes were improved, including maternal death, miscarriage, still-birth, pre-term birth, as well as HIV transmission from the mother to the baby. The results were impressive, but not surprising. One member of the audience was encouraged by the outcomes to ask if they were sufficient to seek a change in Malawian policy. A more aggressive protocol for preventing mother-to-child transmission of HIV might yield better results nationwide.

We were impressed with the variety of projects as well as with the rigor of the evaluations. We learned a new technical term with a special meaning in this field--“task shifting”-- which means the delegation of certain medical tasks to personnel with less training than is usually required. We were able to meet many people including the regional representative of the Clinton foundation, an epidemiologist from the CDC, multiple personnel from the Ministry of Health and the National AIDS Commission, and physicians from Baylor Medical School’s project in Malawi and the Sant’ Egidio project. We were encouraged by many to come and join them in the fight they are waging against this disease in Malawi, and we are anxious to return and do so.

When the Tail Wags the Doc, Does the Lord Care?

2009-06-27T12:11:00.000-07:00

“I cried out to the Lord in my distress, and he answered me.”

The first phrases of Psalm 120 took on new and extremely personal meaning for me last Wednesday as we drove out of Albuquerque, New Mexico, toward Oklahoma City, Jonesboro, Arkansas, and eventually Montgomery, Alabama. I was driving the Civic pulling the small, antique (originally “Nationwide” brand) trailer containing the wedding gifts and other possessions our daughter and her husband were unable to carry with them to New York last January, while Charley and Martha Roberts followed behind in the Penske truck containing our things and some for our niece/about to be bride from my wife’s mother’s things.

The road climbs steadily out of Albuquerque for a few miles, and then suddenly begins its descent, turning to the left at the crest as the descent begins, and then sharply back to the right perhaps 1/8th or ¼ mile below. I was caught a little off guard by the crest and turn, which I entered at about 65 miles per hour. The trailer suddenly began to swing left and right behind me in rapidly widening arcs. In a few seconds I knew I was in trouble, shortly later, very serious trouble.

Though I was afraid; I did not panic. I tried to think through the problem. “The trailer is swinging. If I can just pull it straight for a bit, maybe I can track out of the arcs.” Other traffic was giving me wide birth (who wants to try to pass a trailer that might slam into you!), so I cut diagonally across both lanes, and then back across both. But the winding mountain road demanded turns, and if any relief was attained temporarily, it was soon lost. “The trailer is trying to run faster down the mountain than the car. If I can just speed up ahead of the trailer perhaps I can force it to track straight behind me, like an artificial pacemaker capturing a racing heart by forcing it faster.” That may have helped for a moment, but eventually the trailer and gravity caught up on the steep grade, and if you think a widely oscillating trailer is scary at 65 mph, try it at 85!

I was more frightened than I’ve every been. I truly thought I might die. I screamed: “God help me!” and later, “Lord, save me!” The trailer’s machinations were jerking the Civic itself back and forth. Between the sensations of being jerked from behind and the panorama of cris-crossing trailers in the mirrors, I thought of several possible outcomes: being drug off the mountain, the car and trailer rolling over and over down the road, the car and trailer turning on their sides and sliding down the road, or just the trailer turning over and sliding down. I was blessed not to have Charley and Martha’s view as the trailer swung to the left, leaving the right tire open to their view several times, 18 inches off the ground! The trailer was literally skipping down the mountain.

Then it was over. I could attribute the change to nothing I had tried, but the trailer calmed down, the arcs became narrower, then disappeared. I was left with only the pounding of my heart and the sensations that vessels in my head or mid-back might split open with each pulse. I countered the pain by holding my breath and bearing down, opposing the pounding pressure in my arteries as my blood pressure soared and then finally calmed. We pulled off at the next exit and caught our breath, shared our views, then, thanks to God, proceeded more cautiously on.

Martha drove the Civic much of the rest of the way, both that day and the next. Her skills as a marriage and family therapist were greatly appreciated in mediating the seemingly star-struck relationship between driver and trailer, and perhaps her gentle touch at the wheel was better for the trailer. We redistributed some of the weight on the trailer, checked with the expertise of some of you (with special thanks to Dave Borgelt), worked to keep the track very steady with gently initiated turns, and completely repacked the trailer, lowering its center of gravity before turning it over to our children. As we met for the wedding of Beth’s niece in Jonesboro, I especially appreciated the reunions with Betty, Tom, Trudy and David, all of whom have survived to this day life-threatening illnesses or trauma. I think most of the obstacles we encounter on this quest will more likely be of the boring, wear-you-down slowly type. This one was acute and terribly frightening.

“I cried out to the Lord in my distress, and he answered me.” Blessed be the Lord.

A Pertinent, If Unexpected, Question

2009-06-23T18:41:00.000-07:00

“I need to ask you . . . ,” the question began innocently enough as I recently closed my presentation regarding our proposed work in Africa to our church of 19 years and opened the session for questions. What followed, however, was anything but conventional. Mary, one of our senior sisters, mother of one of our elders, wife of a former elder, a godly woman whose ministry is praying for others, had literally stepped forward from her seat in the second row, taken both of my forearms in her hands, looked me in the eyes, and asked her “question”, “I need to ask you . . . for your forgiveness.”

“When I first heard that you wanted to go to Africa, I was very much against it,” she continued. “I told you so, and even wrote you a letter saying that I was sure that you had been called by God to be with us, and that you shouldn’t leave us because he still wanted you here. But I was wrong. I now understand why you want to go, and you need to go. What you want to do is needed and right, and you should go, and you will have my blessing, support and encouragement.”

Mary had from the beginning opposed our thoughts of moving to Africa, and had, as she confessed, even written us a letter explaining that God had brought us to Redlands, and therefore we must stay in Redlands. I had come across the letter the night before as we sorted through papers, tossing, saving, packing. But now Mary saw things in a different light.

She now understood the danger HIV presents to many African peoples, that we might play a meaningful role in helping some communities escape or recover from the scourges of this disease, that it would be good, perhaps even the will of God Almighty that we would move to Africa to engage this ministry, even as he had brought us to Redlands. So Mary would support us in this ministry, encourage us, pray for us. Would we forgive her for having opposed us?

Mary’s “question” and confession were no doubt more helpful in galvanizing the support of our congregation behind our new efforts than her own opposition had been in encouraging similar reluctance in others. Our answer was, “of course”, and the outpouring of encouragement and well-wishing from so very many of you has been very greatly appreciated as we make these transitions. Leaving has proven much more difficult than we anticipated, and your encouragement has increased our appreciation for you while making our going a little easier. Thank you all, and especially Mary, very, very much.

El Viejito

2009-05-29T05:57:00.000-07:00

"I've been telling my friends, 'No sé que voy a hacer sin el viejito.'"

Beginning one HIV ministry necessarily entails closing another. This has been much tougher than I ever thought it would be. Over the last three to four months I have been carefully telling my patients that I probably wouldn't see them again, that I was accepting another position to work on HIV in Africa. With some we have literally "walked through the valley of the shadow of death", while others have been patients for many, many years and done well all along. With others we have struggled to find a medication regimen they could tolerate. Some didn't and joined others who died, and some are surviving spouses whose presence reminds me of the dead. Then came the little homeless man who lives in a field not far from the clinic.

I had seen him in February, and he says he's since made an unexpected visit to his parents in Mexico with transportation supplied by Uncle Sam. He had come back just a day or two before his appointment. Before the visit ended I remembered to ask, "I did tell you I was leaving, didn't I?"

"Yes," he responded. "I've been telling all my friends I don't know what I'm going to do without el viejito." El viejito?! The little old man?! At first I thought he was talking about my dear friend and colleague, Harvey Elder, the senior statesman of our group, and maybe a little shorter than I. Then I realized he was talking about me. We both erupted in laughter. The "ito" suffix is in Spanish a term of endearment. It almost always means that one is greatly appreciated. But, I'm not used to thinking of myself as "the little old man". I realized I had graduated once again.

The other time something like this happened to me was in San Antonio when Beth and I had just moved there for me to start medical school. At first appearance in our new church I was asked to teach the teenage Sunday School class, and after evening services that night we went over to the teen center to meet some of the young people. One of the young ladies, Holly Lee, shook my hand and said, "Good to meet you, Brother Smith. Brother Smith?! That was my grandfather! I had hardly ever heard even my dad called that! The splash of cold reality began to sink in that I was no longer a teenager but rather an adult. I was 21 and Holly Lee had respectfully helped me to see myself as I really was, or at least to begin to.

And so now I'm el viejito. The little old man. Or maybe just "the old man" with a nice spin on it. My patient has affectionately helped me, at the threshold of 60, to see myself as I really am, and given me a good laugh at my resistance to the truth about myself. The steps over this threshold of our lives are often painful as we take leave of a great company of colleagues at work, brothers and sisters in our church and others throughout the region, and, yes, long-term patients too, all carefully, purposefully and graciously included in our fellowship by our Father over the last nineteen years. We trust that He will allow el viejito and his wife to assemble with this pleasant company again some day for a wonderful reunion, along with an equally beneficent (even if sometimes painfully so) set of colleagues, friends, brothers and sisters and patients from the ministry which lies ahead.

Moving on . . .

2009-05-17T23:02:00.000-07:00

After three years of seeking a church to support us in working on HIV in Africa, the Landmark Church of Christ, Montgomery, Alabama, has accepted our proposal, and has asked us to be based in Malawi, in or near the capital city of Lilongwe. We will be moving from Redlands, California, to Montgomery the middle of June. We'll be visiting Malawi briefly this summer, leaving Montgomery June 26 and leaving Malawi July 9. We'll be holding an HIV seminar in Malawi and making preparations for language study and moving, and then will be traveling to Praetoria, the Republic of South Africa, and Mwanza, Tanzania, holding in each of those cities a two day HIV seminar for church leaders. We will close the summer's travel visiting our son and his family in northern Mozambique before returning to Montgomery on August 8. We will move to Malawi after the first of the year and begin language study in Chi-Chewa, an official language of Malawi along with English. Leaving-taking of one sort or another occupies our every minute, and has been harder than I anticipated. But more about that next post. Visit our web site at hivemsa.org for more information on our proposal and timeline.