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).

Makuni goes home...

Today was a big day for Makuni. Two months after being admitted, he went home! He's still not able to walk unassisted, but looks much more like the 4 year old that he is than when he first arrived. Home is over the border in Congo, probably at least 10km from Nyahuka health center and a few hours walk, at the very least. He left in the arms of his father, accompanied by sister Annet, and a brother who showed up today for the first time, with a bicycle. The bicylce was used to wheel a big bundle full of all the possessions they'd used for their hospital stay: sheets, blankets, towels, a few items of clothing, cooking dishes and utensiles, and rags which Makuni sat on in bed, instead of using diapers.

Makuni knew he was headed home and appeared fine with that: no tears of protest or sadness. Though there is no mother there to welcome him (she died some time ago), it seemed he was happy to be going back to somewhere known and familiar. Pat bought him sweets at the gate, and I sent him home with a new outfit (recently arrived from friends in the US) and his sister in a similarly "new" dress. He also went home with 24 boxes of milk to last him for the next 2 weeks when he should return for a weight check. Thank God for the way he has turned the health of this child around. Its quite remarkable really, and continue to pray for Makuni's family to care for him well at home - his foot still needs a daily dressing -and for him to gain even more weight in the next 2 weeks.

And as Makuni heads home, there are others now admitted - also severly malnourished - and in desperate need of care and prayer: James, Ngonzi, (both of whom are HIV infected), Masereka, the list goes on..... Pray for God to meet their needs as he did Makuni's.

Makuni laughs!

Makuni has made noticeable improvements though he is still very malnourished and continues to need much prayer and love. Last Friday when I visited, the edema (swelling) in his eyelids had all but disappeared and his eyes were open and he was looking around, alert and interested in what was going on in the bed next to him. He was also holding a cup of milk and drinking it himself. This may sound minor for a 4 year old child, but the previous week, he'd been too weak to hold his own cup and we'd been feeding him milk spoon by spoon. Then on Tuesday, I found him sitting outside on the veranda with his father. Its been very hot here in the afternoons so I was glad he was getting some fresh air. He looked up at me with his large, sad eyes. I had brought a small green rubber ball for him, though I'd been reluctant to give it to him because he can't chase it. He is too weak to walk and spends most of his day sitting up in bed - with no back rest. Anyway, I gave the ball to his father, who gave it to him, and he looked at it and then smiled. No actually he laughed! It was the first time I've ever seen him laugh or smile. He continued to look at it and chuckle to himself with glee. Then he rolled it back and forth between his skinny outstretched legs and began playing happily with it.

I know that Makuni's improvements are evidence of God's love for him and a reflection of the many prayers that are being offered up on behalf of him and his family. THANK YOU. Please don't stop praying. Makuni has a long way to go before he becomes a healthy 4 year old. Continue to pray for his appetite to increase and for him to receive healthy, calorie-rich foods, and pray particularly for healing for a terrible wound he has on the top of his left foot where the skin has been eaten away - a symptom of extreme malnutrition - exposing red, raw flesh.

Motherless Makuni

Meet Makuni, a 4 year old boy who weighs just 8.5 kilos or about 19 pounds. He has an enlarged head, bloated stomach, and blotchy skin. His shoulder blades protrdue glaringly out of his back, his tiny body not more than skin and bones. He is from across the border in Congo and his father brought him to Nyahuka Health Center about a month ago in a severely malnourished state. Makuni's mother died sometime ago - its unclear exactly when and how but its likely Makuni's malnourished state has something to do with her death. He is cared for largely by his 10 year old sister, Annet, (pictured with him) and although his father stays with him at the health center at night, frequently during the afternoons when Stephanie and I tend to visit, he is noticeably absent.

Please pray for this little fighter! I first learned of him when Jennifer asked for prayer for him at one of our team meetings and then I discovered him one day early last month in the new pediatric ward when I was visiting the daughter of one of our Kwejuna mothers. He was sitting up in bed - alone - and crying quietly. His eyes were large and sunken and sad. In recent days, he has taken to keeping his eyes closed most of the time. When I first saw him with his eyes closed, I feared he'd gone blind, but when I gave him a small teddy bear to cuddle on Thursday, he felt it, then opened his eyes and screamed in fear. An unexpected response, but a good sign. He can still see! However, its likely he doesn't have the muscle strength to keep his eyes open all the time, but he continues to hang on. He doesn't talk but but responds to yes/no questions and seems quite aware of what is going on. We're giving him high energy milk - a mixture of boxed whole milk, diluted with a small amount of water, and a small bit of oil and sugar, and though he is largely spoon fed at this point, he takes the milk drink with relish. Another great sign. He is not rejecting food and has an appetite. Yeah! (Sometimes kids at this advanced stage of malnutrition lose all interest in food.) We've also provided his father with eggs but its unclear whether Makuni himself is getting them to eat.

Please, please pray for this child, and pray for this family. They are grieving the loss of their wife and mother, and struggling to care for a very sick child who needs to be fed small amounts 6 times a day. It is laborious and consumes much energy, and we see signs of them tiring of this. But we know God loves this child and he loves this family. Pray for God to bring him back from the brink of death. Pray for this family to be encouraged and strengthened to continue to care for Makuni. Pray for the health center staff to have hope too. Our God is able to do all this and more.

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!

Pauline

I’d like to introduce you to Pauline. She is an animal husbandry extension worker. She came to Bundibugyo in Sept 2006. She began assessing the health and condition of the dairy goats that had been placed in villages earlier in the year. She went on maternity leave and is back with Keith, a healthy young boy.
Currently she is supervising the 2 projects on mission property: the chicken coop and the Dairy Goat Breeding Station. She will arrange for supplies from Fort Portal like grain feeds, medicines and vaccines. She’ll manage coop changes for the chickens as they grow. She’ll direct the breeding, record keeping and tagging of goats. She will be responsible for identifying and treating sick animals.
She is also designing and overseeing the fodder (animal food) fields as well. There is a small garden for the chickens greens. There will also be a demonstration garden. It will show local people how to grow food for their family on their plots of land, while interspersing it with goat food to get the most out of their land.

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.

Keren

This past Tuesday we had our monthly milk distribution for the motherless infants in the area. 42 children were brought from as far as the Democratic Republic of Congo (DRC) despite the pouring rain. We were so pleased to see many chubby children and others who were making good progress. We enrolled 6 new motherless infants, a set of premature twins averaging 4 pounds each, and a severely malnourished 8 month old who was about 9 lbs 9 oz.

The newborn pictured here has a neat story. Her caretaker lives in DRC and for a year has been breastfeeding a little cutie named Sukrani. He was a relative to her divorced husband, but the woman volunteered to nurse the child. We assisted the caretaker, whom we now call Mama Sukrani, with a food stipend to keep up her milk supply and some porridge when the child was older. Pat would say that if she would be any child in this program, she’d want to be Sukrani, because he was so well loved and cared for. We were not the only ones who noticed. The little girl pictured here lost her mother soon after her birth on New Year’s Day 2007. The community knew immediately what to do. They found Mama Sukrani and asked her to breastfeed her. She willingly agreed. Later, she gave her my name, Keren.

Stephanie

Hey everyone, I’m Stephanie Jilcott. When I was a World Harvest intern in Bundibugyo 2 years ago, I worked on the World Harvest Mission/ Nyahuka Health Center Nutrition Program. After completing my graduate studies in nutrition, I decided to return to Bundibugyo for 18 months to continue working with the WHM/NHC Nutrition Program. I am also working on decentralization of the current Program to 2-3 additional health centers in the district; with decentralization, we hope to transition to providing patients with locally available foods. One locally available food is eggs - We have nearly finished construction of a chicken coop as part of a demonstration project to use eggs for children in the nutrition program. To educate the community about the importance of healthy young child feeding practices, we have commissioned nutrition dramas to be performed in several villages. In January 2007, we collected anthropometric data from 900 children from 30 different villages in Bundibugyo to guide programmatic efforts.

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/.

WHM/NHC Nutrition Program

The World Harvest Mission/Nyahuka Health Center Nutrition Program has been operational for over 3 years. Missionaries, Nyahuka Health Center workers and community volunteers have worked to provide food to moderately to severely malnourished children, motherless infants and children affected by HIV/AIDS. Bi-weekly, children come to be weighed, to receive food rations and medical attention.

o FOOD: World Food Program has donated food for that past few years, but has recently given us the final food allowance, as they are funneling their resources to Uganda’s war-torn north. We will use the remaining food for extreme cases only and it should last a few more months.
o MILK: World Harvest Mission’s Uganda Infant Diaconal Fund (funded by individual donors like you and Bread & Water for Africa) has been supplying the program with milk. A stipend is provided for women who act as surrogate breastfeeders. Boxed milk or formula is provided for those who have no wet nurse. It costs about $1/day for these artificial milk feeds. We’d like to provide families with dairy goats as a more sustainable source of milk (Matiti Project).

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.

Karen

Hi, I’m Karen Masso. I’ve been living in Bundibugyo since 1995. The nutrition projects I’m currently involved in are the Matiti Project and the World Harvest Mission/Nyahuka Health Center Nutrition Program which carries out regular food distributions.

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.