A Little Push

In 2010, I came across an article written by Dr. Jennifer Myhre, a physician serving in Uganda. Although it is more than a decade old, it is still one of the best illustrations I have seen of the tension between holding a western worldview and expectations while working in a developing country.

In much of the developing world where individuals have little autonomy or control over their circumstances, there can be a sense of passive resignation. If one’s choices or desires don’t matter, whether because of corruption, poverty or oppression, it is an understandable response to that powerlessness. A Muslim might say “Inshallah” meaning, “If God wills.” In East Africa, this comment can often feel more like resignation than faith in God.

So, how should a foreigner called to work in the developing world respond? How should one work to improve the condition of God’s creation and children with humility? When does cultural sensitivity become passivity?

Dr. Myhre calls this difficult balance “push.” That description is both accurate and consistent with our experience.

I discovered recently that Dr. Myhre is still in Uganda serving and blogging at paradoxuganda.blogspot.com. Dr. Myhre and her husband serve in the medical division of Serge International in a Western Ugandan town called Bundibugyo. They have raised 4 children in the developing world. In her spare time, she has authored 4 books. Sure, why not?

Because I cannot describe the concept nearly as well as Dr. Myhre does, here is her post in its entirety.

Cope vs. Hope

Disease, poverty, and corruption require daily push against passivity

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

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

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

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

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

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

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

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

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

Please keep us in your prayers as we navigate the narrow path between seeking high standards and professionalism and recognizing that we are foreigners invited into Uganda. It is a difficult balance and we covet your support.