"Wow! That's a lot of beans"

As this year comes to close, for BundiNutrition, it ends with a wonderful gift to keep our quarterly distribution of food to our Kwejuna mothers - those who are living with HIV - going for another calendar year. Yes, through the very generous support of friends from my home church in New York City, Redeemer Presbyterian, we can continue to provide our mothers and their families with 20 kilos (about 50 pounds) of beans - grown locally in Bundibugyo and of course an excellent source of protein - along with a 5 litre jug of cooking oil and a 1/2 pound bag of salt, every three months. In 2007, with similar support, we were able to hold 5 such distributions and give out 725 servings of food. Good nutrition is important for all of us, but even more so for those living with HIV. It keeps their immune systems stronger and for those on HIV drugs (antiretrovirals), a stronger body helps these drugs to be more effective in slowing down the process of the virus replicating in their body. So we say a big 'THANK YOU (Webale, in Lubwisi) for this generous gift, to these women and their families, who are among the very poorest of the poor. And as our team leader, Dr. Scott Myhre put it, when he heard about this gift, he exclaimed. "Wow! That's a lot of beans."

PS. This is my last post on BundiNutrition... Sadly, my 2 year term in Uganda is over this month and I am returning to the U.S., but thankfully these food distributions will continue. Now that we have been given these funds, this aspect of BundiNutrition will be in the capable hands of my dear friend and teammate, Pat Abbott.

Living on the edge...

Several days ago, this Kwejuna mother, Bena, turned up at my door. She had travelled many miles to see me, probablyat least 20 kilometers. She is a mother of 6, including the twin girls you see here which she has named Patricia and Pamela, after Pat & I. She is very sick, has advanced HIV disease, and lost her husband who was a soldier in early May just before the twins were born. She is from eastern Uganda, but since her husband is from Bundibugyo and she has been away from her own area for many years due to her husband's work transfers, she has nothing to go back to there. Besides, culturally speaking, all her children belong to her husband's family, so it makes sense for her to remain here. But she is desperate: extremely weak, unable to afford to send her older children to secondary school, living with her in-laws in one room (she and the 6 children) which doesn't have walls that go up to the ceiling, no income, no land on which to dig and grow food for her family (land passes from husbands to male children only here), and trying to nurse twins.

When I first met her at Bundibugyo Hospital shortly after the twins were born, she had turned up in the HIV care clinic, for a refill of her antiretroviral drugs. She and the twins were suffering from a skin condition, and she was already struggling to produce enough breast milk for both babies. The next week, she made the trip to the mission and Dr. Scott examined her and prescribed some antibiotics for them all. Because she lives too far away to benefit from our existing nutrition program, I have taken to providing boxed long life milk for the twins, which her teenage son comes to pick up from Bundibugyo Town every 2 weeks. To my surprise and delight, they have continue to grow and thrive. At our last food distribution, when she heard I was leaving next month, she began to worry about how she would manage when I am gone and who would help her. She had come to tell me this and to see if I could help her with money to start a business. I reminded her that God is the one who has always helped her, (though sometimes he has used me to do so), and that he will continue to be faithful to her.... I believe those words, but does she?

As I look at her twins, just shy of 6 months, I wonder what their future holds. Should their mother die in a few years - if she lasts that long - what will become of them? What will become of her teenage son and daughter, or her other children? It looks like such a bleak situation, and yet I pray that for her, as for us that Paul's words ring true, that her "light and momentary troubles are achieving ... an eternal glory that far outweighs them all". I don't know if this is true for her because I don't know if she has a belief in the Christ who died to make this a reality, but I pray that if not, she will come to know in a real and personal way, the God of the universe who gives us a hope in a life beyond this one.

Grand Finale, and a tearful goodbye

On Monday, 29 October, we had our last (and largest ever) food distribution of the year. The day dawned bright and sunny and by 8.30am, about 90 women were already assembled and seated on benches in our community center, eagerly awaiting the start of regsitration. Over the next 7 hours, another 95 women and their babies trickled in and joined in the festivities. As in past distributions, all women were registered and weighed, those who brought their babies had them weighed as well, and 16 babies were tested for HIV. Only one of these tested positive, though she was only 6 months old and that test may reflect her mother's antibodies and not a true infection, so she will need to test again in 3 months. The rest of the babies tested were found to be free of HIV. Praise God for that!

After finishing rounds on the pediatric ward with Dr. Jennifer, our short term Physician Assistants - Rachel and Scott W - came to help, praying over those who requested prayer. Later, just before we gave out food, Rachel shared from the Bible, reminding the women of how much they are loved by God, and as we distributed beans, cooking oil and salt, Scott jumped into the fray and helped these women - some of whom are quite frail due to their health - to carry out their 40 pound bags.

During the day, I tried not to think about the fact that this was my last distribution, and the last time I would see almost 200 of our mothers and their babies assembled in one place, to receive food that will help them to supplement their diet. But as we gathered them all to begin giving out the food, I knew it wouldn't be fair to them or to me to fail to tell them that next year when they return, I will not be among them. Several women near the front audibly gasped when I said this, and that brought me to tears. Fortunately, despite my heavy heart, I was able to remind them that though people come and go in their lives, God always remains present with them and he is the one always sustaining them. I was preaching this to myself as well, for these are words I also needed to hear. As my time in Bundibugyo draws to a close in December, I will go from this place to face a future that is largely uncertain, and so I too need to be freshly reminded that God will indeed be my sustainer through the upcoming transition and that he has good plans for me. And so I leave knowing that God has already provided funds to keep this distribution program going for another year, a tangible sign of his never-ending love and care. A generous gift from a couple in my church in New York City makes this possible. Mukama Asiimwe! (Praise be to God).

Alice - one month later

On Sunday, I returned from a month away and had been back just over 24 hours when I was coming home from visiting friends and found that Alice was on her way to see me. She looked sadder than usual with her eyes large and heavy, and I soon learned why: her 3 month old, Kansime Edina, had died 2 weeks before. Though Edina was her 5th child, she was the 3rd child Alice has buried. What grief she must feel. She fought back tears as we talked through our translator, Pauline, who is an extension worker on the Matiti project. To make matters more complicated, as her baby's health had deteriorated, she had borrowed 70,000 Ugandan shillings (about $38) to pay for Edina's medicines and then ultimately used what was remaining for her funeral. Funerals are a big community event here. Since Alice personally didn't have this money, she used her goat as collateral and now she needed to re-pay the goatkeeper in order to get her goat back. I offered to cover the cost of getting her goat back, but until she is in a less "urban" situation, the goat, which was a gift from World Harvest's Mattiti project, will be returned and kept at the goat farm on the mission. Alice was less than pleased about this, but right now its really the only (and best) solution. She has nowhere to keep the goat and trying to care for it in the middle of overcrowded Nyahuka Trading Center, she risks losing it to sickness, death, or even theft. Then, though the baby has been buried, at the end of this month are the final funeral rites. This is another community-wide event where family and friends gather to pay their final respects, and involves feeding those who come. Understandly Alice wants to give her baby girl an honorable send-off from this world, but how brutal this seems. Not only is she grieving the loss of her third child, but she is struggling to find the money to bury her with dignity. I will assist her in doing so ( by providing a gift in the way of cash), but was reminded by Donato, my Ugandan colleague, that there are others in our Kwejuna Project just as needy as she is. Oh, for the wisdom to know how to best help these needy and vulnerable ones....

Alice

On Friday evening, as a rainstorm was beginning to blow in, Lamech, the Ugandan extension worker for our Matiti (goat) project, visited my home to tell me about the plight of one of our HIV positve mothers and goat recipients, Alice. He had been following up on her goat in the village where she lived, only to learn that she had moved into nearby Nyahuka trading center without her goat - whom she left with another goat keeper - but with her 5 children and her mother. Recently widowed, her home in the village was accidently burned to the ground by one of her children, and she was only able to afford to rent a small shelter. Lamech took me to her home, just behind a main road and I found her huddled in a tiny grass covered hut, smaller than the size of our 8ft x 4ft cho (pit latrine) and much less glamourous: unpainted mud walls and an unfinished floor. The door was ajar and she was cooking food just inside the doorway over a charcoal stove, with a newborn baby in her lap, and her 3 and 5 year olds playing on an old, tattered 4 inch mattress. I wondered to myself who got to sleep on it at night. Both of the children were coughing heavily and frequently. The room was so small that neither Lamech nor I could fit inside and so we sat just outside the door, our eyes tingling with smoke from the hot coals. All of Alice's wordly possessions were contained in this tiny room that she shares with 6 other people. As if that weren't bad enough, on the other side of one of the walls, inches from where they live, sleep, and eat was a pit latrine the same size as her shelter.

It was truly one of the worst housing situations I have ever seen, and I just couldn't help thinking of how vivid this picture was of what a terribly broken world we live in. We talked about her options- building a new home on property owned by her husband's family but Lamech said that would cost upward of 1 million Ugandan shillings (about $600) which is currently beyond what I can help her to do - or at least in the short term, moving to another place to live. She was confident that other rented rooms were available nearby, at least with cement walls and zinc roofs, even if they didn't offer any separate space for cookng. So I gave her money to rent such a place for the next few months. I then came slowly home with a heavy heart and a deeper appreciation for my 3 bedroom house, my electric lights, my running water which I heated for a bucket bath, my spacious kitchen, and the nutritious dinner I prepared and sat down to eat. My assistance to her felt like little more than a band aid because that's really all it was.

It was extremely humbling.

There but for the grace of God go I.

Beans, Oil and a Bag of Salt

This past Thursday, we had our second food distribution of the year and our largest ever: 130 women came, many with babies and young children and several with their husbands, to haul home 20 kilos of beans and a 3 litre jug of cooking oil. The beans came by lorry from Kasese, a town in the west of Uganda about 4 hours away from here. The oil was bought from Kampala-based Mukwano Industries, one of the largest companies in this country that supplies all sorts of household goods. After we had registered all the women, weighed them and their babies, and tested those babies and children who had not yet been tested, one of the women approached Donato, our Ugandan colleague, and asked him "Where is the salt?" Truthfully we had not planned to give out salt, but it is locally available in large quantities - though it actually comes from Kenya - and is very inexpensive. Plus it was a very reasonable request: salt will definitely make those beans more tasty! So, Scott and Donato drove down to Nyahuka Trading Center, less than 1 kilometer away, and within minutes returned with 150 bags of salt.

As I watched the women taking home their bags of salt, along with their beans and oil, I was reminded that salt was important to Jesus too. He told his followers, "You are the salt of the earth" and so he calls us to live distinctive (flavorful) lives that bring him honor and glory.

Donato

Meet Donato, the Senior Administrative Assistant for the Kwejuna Project, which serves HIV positive women and their families. Actually its a very misleading job title since Donato's role is quite varied. Donato has been with working with World Harvest for almost 4 years now, before the Kwejuna Project even had a name. He was one of the folks chosen as a community mobilizer in the fall of 2003 when Drs. Scott & Jennifer were informing communties about the upcoming HIV prevention project that was about to be launched for pregnant women. Donato did such an outstanding job of organizing these community events and liaising with the local village heads, that he was brought on to provide day to day support and supervision to what came to be known as the Kwejuna Project. His role involves making sure the sites - now 9 - have adequate supplies to conduct HIV testing to all mothers who come for prenatal care; helping to collect data for the monthly, bi-monthly and quarterly reports we are required to submit; and helping to work with the many staff scattered across the district. His latest responsibility has been to take on the procuring of over 3,000 kilos of beans from Kasese - a town 4 hours away - as part of our food supplement program. The latest shipment of beans arrived last Thursday, and have been stacked in our store, ready to be given out to the 125 women expected to arrive this Thursday. What a blessing Donato is to the Kwejuna project!

Corn-Soymeal, Beans & Oil

Yesterday was a glorious day where 115 Kwejuna (HIV positive) mothers came to the World Harvest Mission Community Center to receive food supplements for themselves and their families. This distribution continued right where we left off last year, and if you hadn't known that our previous food supplier, the UN's World Food Program (WFP), has left Bundibugyo, it would not have been evident. With some 100+ corn-soymeal blend bags and 70 containers of cooking oil left over from WFP; the generous support of a couple in my home church in New York City (Redeemer Presbyterian Church) which is enabling us to buy food locally; and the competence of Donato, our Ugandan colleague, who travelled to nearby Kasese (4 hours away) and purchased over 3,000 kilos of beans; we were able to serve our mothers as if it was business as usual. What a joy it was to see these women coming from near and far, babies in tow, defying the stigma attached to those living with HIV here, hauling home food for their families for the next 5 weeks!

"So do not worry, saying 'what shall we eat?'...for... your heavenly Father knows that you need them." Matt 6:31-32.

Both surviving & thriving!

This Wednesday at our HIV care clinic, two of my favorite patients, a set of fraternal twins showed up with their teenage mother and a 12 year old helper. Their mother is 18, about 4 feet 10 and extremely petite. When I arrived in Bundibugyo early last year, I met them for the first time, also at that clinic where their mother receives care, and they were both malnourised and underweight. The little girl especially, Nyakato (right), did not appear to be doing well. (There are a suprising number of twins born here it seems, but often both children don't make it.) I took a real liking to these kids and followed them with interest over the year. Their weights crept slowly upwards, but Nyakato always looked sickly beside her healthier brother, Nsingoma (left). Their mother was faithful in breastfeeding them, in addition to giving them the regular food supplements she received from our nutrition clinic - usually a corn-soymeal blend with oil and sugar - but mixed feeding (breast milk & solid food) from an HIV positive mother carries with it an increased risk of infection for the babies.

Since the twins were approaching the 18 month mark - they were born in October 2005 - I was eager to test them for HIV and have been praying that they would not be infected. Nsingoma screamed mercilessly during and after his finger stick test, but the temper tantrum he proceeded to have was worth it. (He subsequently fell asleep on his mother's back.) Both twins tested HIV negative! Hallelujah. This felt like such a gift, to have both children HIV free and doing well. Yes, they are currently thriving. But children can still get sick - from malaria or diahhreal diseases and go downhill quickly here - so they are not out of the woods, but to not have HIV as part of that mix for them is a real blessing.

When those barely surviving don't make it

On Friday afternoon, I returned from a 3 day meeting hosted by the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) in Mbarara, to learn that Kyamanuwa, the HIV infected boy I wrote about last week had lost his fight for life. I was deeply saddened. The last time I saw him, he was extremely thin and frail, but I was praying and hoping that his tiny body would begin to respond to the HIV drugs (antiretrovials) he'd been given. It was not to be. The following day on Saturday, Jennifer and I rode our bikes out to visit his family, armed with the name of his village and the names of both of his parents. After a few misguided sets of directions from well-meaning folks we met on the way who didn't really know the family, we located the house, and found both of his parents and his extended family grieving. The burial had been that morning and there were no more tears visible, but the sense of sorrow and heaviness was palpable. Like him, Kyamanuwa's mother has HIV. His father's HIV status is unknown because he's not yet come to be tested. Kyamanuwa is the second child his mother has lost. Only one more, a 6 year old, is still alive. I don't know if either of this child's parents will live long enough to see their child grow up. I also don't know if this child will even survive its childhood. But what I do know is that I have returned from the EGPAF meeting energized and encouraged to train our staff to implement a more complex drug regimen for HIV infected pregnant mothers to prevent transmission to their babies. It will be much more challenging for both staff, mothers, and babies because it means pregnant HIV positive women will have to start taking preventive drugs as early as 28 weeks into their pregnancies - until they deliver - and their newborn babies will have to take these drugs for a week after they are born instead of just a single pill for mother and single dose of syrup for the baby. BUT, if this can happen, the chance of having a baby that is HIV infected is reduced from 30% to just 2%.

Could this more complicated regimen have saved Kyamanuwa from becoming HIV infected? Only God knows the answer to that, but we can be confident that we will see Kyamanuwa again one day - in heaven. My prayer, as Jennifer prayed when we were there, is that his mother can share in this hope as well.

What is the Kwejuna Project?

The Kwejuna project is a World Harvest Mission program that is supported by a grant from the US-based Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) which Drs. Scott & Jennifer Myhre received at the end of 2003. The main aim of the Kwejuna project was to establish a district-wide program in Bundibugyo to prevent mother to child transmission of HIV (PMTCT). HIV infected mothers can pass HIV onto their babies during pregnancy, during delivery and through their breastmilk. The program identifies pregnant mothers who are HIV positive by offering HIV counseling and testing to all pregnant women at their first prenatal care visit. Most women agree to be tested, the results are available within 20-30 minutes, and before the women go home that day, they (and we) are aware of who is HIV infected. For those who test positive, they receive additional counseling about what this means for them and their baby and they are then given a single dose of an HIV drug called nevirapine to take during labor. The baby is also supposed to get this drug, in syrup form, within 3 days of its birth, and this combination of drug to both mother and baby, cut in half the risk that a baby will be born HIV infected. Without any drug intervention, an HIV infected mother has about a 30% chance of having a baby that is also HIV infected.

From the pregnant mothers attending prenatal care who were first tested in April 2004, we have so far tested over 21,000 (!) and identified a little under 600 who are HIV infected (which is an HIV prevalence of 2.5%). The program began in 2 sites that year and by the end of 2006 was operational in all 9 Ministry of Health-run health centers, and largely implemented by Ministry of Health staff that the Kwejuna project, with EGPAF support, has helped to train in PMTCT. EGPAF has also paid for us to encourage mothers to deliver at health centers by supporting the cost of a mama kit which is given as a gift/incentive for every health center delivery. (This is important because most mothers here, 70-80%, deliver their babies at home and this makes it really challenging for the baby born to the HIV positive mother to receive the nevirapine syrup in time for it to make a difference.) The mama kit, given out to all mothers regardless of their HIV status, includes a plastic sheet which covers the delivery table, sterile gloves, a tie for the umbilical cord, and a sterile blade to cut the cord. The highlight of the kit is a piece of local cloth, called a kitengye, which the new born baby is wrapped in (like in the picture) and then goes home in. Giving a kitengye to every new born baby in a health center has been a huge hit and in 2006 we saw a 30% increase in births at health centers across the district.

Other aspects of the Kwejuna project include linking our mothers into HIV care so that they can receive HIV drugs for themselves and remain healthy for longer. We also try to link any familiy members, including their husbands or babies, who are HIV infected into HIV care as well. Another aspect of Kwejuna is the provision of food supplements to these families. (See the 'God gives generously' blog entry for a description of that.)

The Kwejuna project takes its name from the expression of congratulations that are given to women here when they have just delivered a baby. Webale Kwejuna means thank you for surviving (the birth of your baby).

God gives generously

Several days ago, I wrote an introduction about myself and closed with describing one of the highlights of my role as coordinating bi-monthly food distributions for our Kwejuna mothers and their families. For the last several years, the United Nation's World Food Program (WFP) has been providing food supplements (usually corn-soymeal blend, beans, oil and sometimes rice) in Bundibugyo to malnourished babies and infants, primary school children, and most recently HIV infected mothers and their families. However, WFP decided to shift their emphasis to other areas of Uganda and closed their Bundibugyo office at the end of last year. Since having adequate nutrition is an essential component of good health for those living with HIV, we sought to continue to provide food supplements focussing on protein rich foods like beans, and adding cooking oil, with private funds that we hoped to raise through our supporters and churches. These food distributions serve not just as an opportunity to provide good nutrition, but also serve as a way to follow-up on our mothers, test their babies and husbands and link them to care, provide social support, and offer spiritual encouragement and the hope of the gospel.

In the days since I mentioned our desire to keep this food program going, I have received news that a generous couple from my home church, Redeemer Presbyterian Church in New York City, have donated the full amount to keep this program alive for another year! I am in awe of their generosity. As I shared this with the Kwejuna mothers at a family support group I was running yesterday, the women clapped and cheered loudly. It was thrilling to see their unbridled gratitude. I also had the opportunity to remind them- and myself- that this is ultimately a generous gift from God, the giver of all good and perfect gifts. Mukama assimwe! Praise be to God!

Surviving, but barely

Take a look at this beautiful child, Kyamanuwa. His mother is in our Kwejuna Project and when this photo was taken in early December, he was a picture of health. At that point, he had tested HIV negative and we thought he would be fine, but in the following weeks, he began to lose weight and become very sickly. Dr. Jennifer Myhre then re-tested him for HIV and found he had become infected (either because he may have already been infected when he tested negative but it wasn't evident because there is a delay in when antibodies to HIV show up on a test, or perhaps he became infected from his mother's breastmilk after testing HIV negative). What a cruel irony.... I saw him yesterday in the clinic and almost burst into tears in front of his mother. He was barely recognizable, except for his large penetrative, still curious eyes. He looked at me through them with recognition, but I couldn't coax a smile from him. No wonder. He was covered in a rash and looked like just skin and bones, as he tried to grasp a small piece of bread which he could then barely swallow. Dr. Jennifer has started him on HIV drugs (antiretrovirals) but so far his body doesn't seem to be responding to them. These drugs, when they work, can bring people who are on the edge just hanging onto life, back from the brink. Please, please join me in praying for Kyamanuwa. I truly believe that prayers offered up to our God - the one who created and loves children - on Kyamanuwa's behalf can extend the life of this precious child. (For Dr. Jennifer's story about Kyamanuwa, visit her blog at www.paradoxuganda.blogspot.com).

Pamela

Hi, I'm Pamela Brown-Peterside and I help to manage the Kwejuna Project, our program which aims to prevent the transmission of HIV from mothers to their children (PMTCT). Following 9 years of directing a community-based research site in New York City with high-risk HIV negative women, I first came to Bundibugyo in November 2004 to help out with Kwejuna when it was in its first year. I was drawn to coming here in large part because I was excited about moving into prevention with HIV infected women, serving on the frontline of the epidemic in sub-Saharan Africa and doing so living and working alongside other Christians. I stayed for 3 months, and then felt called to return for a 2 year committment and arrived back here in January 2006. My role in Kwejuna is largely administrative. I help to support our sites -we now have 9 - by providing supervisory support to the Ministry of Health staff who implement the program, ensuring they have have adequate supplies to conduct regular HIV counseling and testing for our pregnant mothers, and assisting with obtaining monthly reports from these sites, which give us a sense of how the program is doing. I also try to track the follow-up of women who are identified as HIV positive and faciliate their linkage into care. In Bundibugyo, there are 2 Ministry of Health clinics that provide HIV care and antiretroviral drugs to infected patients, and I help to facilitate the smooth running of these under-staffed and bursting-at-the-seams out-patient services. I have also worked with traditional birth attendants (also known as lay midwives) by providing training to them about PMTCT and encouraging a stronger relationship between them and professionally trained midwives who are hospital based. One of the highlights of my role over the past year has been to co-ordinate bi-monthly distributions of food to our Kwejuna mothers and their families, which up until the end of 2006 had been supplied by the UN's World Food Program. Now that these food supplements have ended, we are currently hoping to raise funds (about $15,000) to continue this program for an additional year. If you would like to contribute to this effort, please email me at PamelaBrownPeterside@gmail.com for more information about how to do so. Thanks!

I don't have a personal blog per se, but if you'd like to know more about my work in Bundibugyo with World Harvest Mission over the past year, please visit www.lamppostmedia.net.

Scott & Jennifer

Our team leaders, Drs. Scott & Jennifer Myhre, have been addressing health concerns in this community for well over a decade. Currently they are running the Kwejuna Project which acts to prevent the transmission of HIV from mother to child (PMTCT). They provide medical attention to the mothers and children. For over a year, they have been the conduits of World Food Program rations for HIV/AIDS mothers. Now they are looking for other sources of nutritional assistance. Jennifer has spearheaded the WHM/NHC Nutrition Program and continues to care for the sick children who are enrolled as well as those who are inpatient at Nyahuka Health Center. They have a great blog: http://www.paradoxuganda.blogspot.com/.

Pat

This is Pat Abbott. She has been an incredible assest to this team for over 15 years. Her warm way of interacting with people allows her to enjoy rich relationships with many Ugandans.
Over the past few years, she has run two weekly pychosocial support groups for people living with HIV/AIDS. She has also weighed, measured and cared for many young children in the World Harvest Mission/Nyahuka Health Center Nutrition Program.
Currently she is on Home Ministry Assignment in the States until May. She is hoping to catch up with a lot of you during that time.

Welcome

Welcome to Surviving and Thriving! There are many people on our World Harvest Team in Bundibugyo with a hand in nutrition assistance. We hope this blog will give you an overview of the work as well as a peek into the day to day happenings here.