Taking Stock

I’ve been in Mthatha just about four months. The clinic is closing for a two-week break and I’ll be spending the time with fellow missionaries. If I was in school, a term would be over and I’d be off on a break. It seems as good a time as any to take a step back and assess my progress in building a small bit of the kingdom in Itipini and fulfilling God’s mission of reconciliation.

On one level, I am shocked and quite pleased at how thoroughly I’ve been able to integrate myself into the Itipini community. People seem to respond to me positively; all of them know me by name; I can’t go anywhere without the children making air guitars or yelling for me to pick them up; my knowledge of Xhosa is improving, to the point where people talk to me as if I’ll understand their fluent Xhosa when I only manage to catch a word or two; I can joke and laugh with the other members of the staff and frequent patients; and people sometimes come to me first with their problems, rather than Jenny or someone more experienced.

The other day, I took a stroll out of our community center area and walked around the shacks where people live. Usually when I do this, I have a specific purpose in mind but this time I just wanted to get a glimpse of daily life. That I felt safe enough and familiar enough with the territory to do so was one accomplishment; that people greeted me and started talking to me as if it was no big deal I should be there was another. I am part of the “furniture” of Itipini.

As well, I can actually “do” something every day. I drive patients to the hospital (and I know which part of the hospital to take which patients to); I manage our patients with tuberculosis; I track down people in their homes; I’m working on a little library; I can do the logistical things needed to keep the clinic running when necessary; and I ask fewer questions about how to do certain tasks because I know how to do them.

So I have quite a lot to be satisfied with and grateful for as my first “term” in Itipini winds down. Of course, it’s not enough. I still can’t snap my fingers and cure someone of HIV or make a neglected child’s parents care about him or her or make sure the education the children receive is top-notch or make the men respect the women or make sure people don’t go to bed hungry or make someone with a chronic injury better. All I can do is fiddle around the margins of problems and hope a smile makes the day a bit brighter.

It is sobering at times to realize I have another eight months in Itipini, another eight months to sit around and think that what I am doing is not sufficient for the needs of the people here and to be confronted with the reality of that every single day. One challenge for the new year is to see if I can more fully internalize the message that who I am is more important than what I do. It is one thing to say that but it is quite another to actually believe and have it guide your work. Another challenge is to be satisfied that what I do manage to do is enough and to be satisfied with what I’ve managed to accomplish.

I liked this reflection from Salvadoran archbishop Oscar Romero when I read it first at mission training but it's another thing to actually believe it.

It helps, now and then, to step back, and take the long view.
The Kingdom is not only beyond our efforts, it is even beyond our vision.

We accomplish in our lifetime only a tiny fraction of the magnificent enterprise that is the Lord's work.
Nothing we do is complete, which is another way of saying that the Kingdom always lies beyond us.

No statement says all that should be said,
No prayer fully expresses our faith.
No confession brings perfection, no pastoral visit brings wholeness.
No program accomplishes the church's mission.
No set of goals and objectives includes everything.

That is what we are about. We plant the seeds that one day will grow.
We water seeds already planted, knowing that they hold future promise.
We lay foundations that will need further development.
We provide yeast that produces effects far beyond our capabilities.

We cannot do everything and there is a sense of liberation in realizing that.
This enables us to do something and to do it very well
It may be incomplete, but it is a beginning,
A step along the way, an opportunity for the Lord's grace to enter and do the rest.

We may never see the results.
But that is the difference between the master builder and the worker.

We are workers, not master builders, ministers not messiahs.
We are prophets of a future that is now our own.

I won’t be posting for the next three weeks or so, given my upcoming travels. (A good chance to re-read past posts is the way I see it! “Mthatha Mission Flashback”) I hope you’ve enjoyed the web log so far and I look forward to returning renewed and prepared for the remainder of my time here.

Just when you think you’ve seen it all…

…you realize things can get a lot worse.

There’s a patient who’s been occupying a lot of our time lately in Itipini. She’s three weeks younger than me (what different paths our lives have taken since August 1982), she’s HIV-positive (that almost goes without saying), she’s weak, and very thin. Last week, her 3-month old baby died in the clinic and she has no family nearby to help her out. I’ll call her Nosipho, which means gift, though that’s not her real name.

I took Nosipho to the hospital last week but they discharged her over the weekend so she’s stayed in the sick bay at Itipini for a few days and was looked after and fed. I took her back to the hospital for an appointment on Thursday, she stayed the night, and got the results of a blood test that showed her CD4 count is 54. (Below 200 is clinical AIDS in South Africa.) This qualifies her for free anti-retroviral drugs. Sounds like great news, right? (The great news is the potential for drugs, not the CD4 count.) It is great news, provided she can live long enough and has enough energy to navigate the health-care maze to get ARVs. (I have a long post inside me about the ARV bureaucracy but it’ll have to wait until the new year.) I got an indication on Friday she might not.

We had managed to convince a friend of Nosipho’s to accompany her to the hospital to advocate for her. On Friday, the friend came back to the clinic alone. She said Nosipho wasn’t strong enough to make it back herself and so was waiting at the nearest place a taxi would drop her off, about a 10-minute healthy-person walk away. I drove down to the gas station where Nosipho was waiting.

I don’t know what I was expecting but it certainly wasn’t what I got. Nosipho was lying behind the gas station, in the midst of a pile of garbage (they are everywhere in Mthatha), on a piece of cardboard, and covered with a thick blanket, even though it was one of the hottest days I’ve experienced so far here. The gas station is right next to a shopping mall and a liquor store so there were loads of people around but no one was interested in her. It’s been worn down in my time here, but this set my outrage meter off. It’s one thing to see a person suffering in the midst of everyday life; it’s another thing when you know her. Nosipho was too weak to walk very far so I picked her up, bride-crossing-the-threshold-style, and took her through the gas station and to the car. (I think all the time about race her – another future post – and I wondered what it looked like to have the only white person in the whole parking lot carrying a black woman.)

We got back to the clinic, loaded her up with nutritional supplements, food, clothes, vitamins, and so on. Then I carried her back to her shack and that was about all I could do. (She is so thin that it was relatively easy for me to carry her but her hip bone was jabbing me the whole way.) We are closing for two weeks for Christmas and New Year’s and there are some very good reasons for doing that but I wonder if Nosipho will be around when we return. She and her friend know the clinic they need to go to get started on ARVs and seem willing to do it but if she can’t walk, how are they going to make it there for the several necessary trips?

Post-script: I checked the medical file of the friend and she is 18 years old and has a child of her own and is still going to high school. I don’t know if I could have handled all that when I was 18 but she seemed to be doing it with a smiling face and willing heart. I wish more people here were like her.

Where do you sleep?

While meandering around Itipini the other day, I realized I had the Xhosa vocabulary to get some children to show me where they sleep.

Christmas at Bedford

I may live at Bedford Orthopaedic Hospital but I know very little about it. That changed on Wednesday when we went through the wards and handed out Christmas presents. I liked playing with the children’s new cars the best and later brought my juggling stuff back and entertained them a little more. Given how close the ward is, I hope I can make this a bigger part of my routine in the new year.

I’m Confused

I got sunburned the other day. The Internet café has “O Holy Night” on repeat on the CD player.

The days are getting longer. All the stores are decorated with fake evergreens and tinsel.

Schools have let out for summer vacation. We’re going around the hospital soon to hand out presents to the patients.

Hotels are raising their rates because it’s the peak season. There’s a carol sing in a few nights.

Welcome to a southern hemisphere Christmas. It’s weird!

Dignity

The word “Itipini” in Xhosa literally means “at the dump.” It’s an apt name for a community that grew up on Mthatha’s old municipal dump.

Before receiving their diplomas at graduation last week, the pre-school children had to make a little speech in English, saying their name, where they lived, and what they want to be when the grow up. Every child, of course, said, “I live at Itipini.” What they’re saying is, “I live at the dump.”

It’s not unusual for people to judge others on the basis of their address. Someone might live on the “wrong side of the tracks,” for instance, or in the “projects.” Jesus, in fact, was dismissed by one of his future Apostles for being from Nazareth (John 1:46). Conversely, there was a whole television show once whose basic premise was that people who lived in a certain zip code (90210) were necessary cool. After Friday, I’ve wondered what it would be like to say to someone that you live at the dump. Would the person who hears that judge you? Would he or she think less of you for living in a dump? Likely they would. People don’t choose to live at dumps; they live there because they have no other option. It can’t be great for your self-esteem.

Despite this, what continues to surprise me is the dignity with which people lead their lives here. Dignity is a bit of a degraded concept these days and it can be hard to use it seriously. What I mean is that the people in Itipini hold their heads high and lead their lives as best they can and as proudly as they can, even though they are surrounded by poverty and despair every single day. It’s hard for me to describe; you just have to experience it yourself.

Bob Dylan sings, “searching high, searching low / searching everyone I know / asking the cops wherever I go / have you seen dignity?” He should come to Itipini and find out.

“Not an ending, but a new beginning…”

Friday was our pre-school graduation in Itipini. (The school year in the southern hemisphere ends before Christmas for summer break.) We had about 15 six-year olds don caps and gowns, march in front of a couple hundred family and community members and receive diplomas from yours truly. The whole ceremony took more than two hours and was one of the most chaotic, joyous, out-of-control, and wonderful occasions I’ve ever been a part of. I’ve never seen so many people in Itipini so happy all at the same time.

It featured dramatic renderings of the Christmas story (with four or five magi – I couldn’t keep them straight), Little Red Riding Hood, and Chicken Licken (my favorite), all mostly in English, with bits of Xhosa thrown in when the children got flustered.

Apparently, I was supposed to give a keynote address but in typical fashion, I only found out about it when I was typing up the program the day before and saw my name on the draft. In even more typical fashion, I somehow got skipped during the program. Good thing I didn’t spend any time preparing it!

Often when a child walked across the “stage” to get his diploma, his mother would come running out of the crowd and either pick up the child and swing him around or start dancing and stomping wildly. The other people in the audience clapped and did that thing with their tongues I think is called ululating.

Before the children received their diplomas, they had to address the crowd – in English – and say their name, who their parents are, and what they want to be when they grow up. There were a lot of future teachers, nurses, soldiers, lawyers, and doctors. Hopefully, their family – with help from the African Medical Mission – will be able to come up with the money to pay for the school fees, books, and uniforms these children will need to continue their education.

I must have taken about 250 pictures on Friday. Here are only a few.

The children, with the help of their mothers, got dressed up in nice dresses or slacks and shirts we apparently have hanging around somewhere.

Then, they put on their robes and sashes.

They came in, not marching, but dancing and swaying.

Like graduates everywhere, they looked bored waiting for things to begin.

Our pre-school teachers Ncediwe (left) and Nthantisi.

I led the graduates in a couple songs. This is “He’s Got the Whole World in His Hands.”
It’s a popular event, involving the whole community.

Chicken Licken and friends in an off-stage moment.

SRO.

A proud graduate.

Some of the mothers celebrating the achievement of their children.

One size apparently does not fit all.

The post-graduation celebratory banquet.

Pictures, pictures, pictures

“What do you do?”

When I tell people here I work in a clinic, they often ask, “Oh, what do you do?” This question frustrates me to no end as my job is wide-ranging and varied, depending on the day and the needs of the people in Itipini. On any given day, I can be found bandaging wounds, dispensing TB medications, finding medical records, chit-chatting with the ladies in the kitchen, playing my guitar, fixing broken equipment, sorting books for the library, letting myself be used as a jungle gym, and starting water fights with anyone who is around. It’s hard to squeeze all that into a ten-second response, which, let’s be honest, is all you ever want when you ask someone what they do.

This aggravating question also totally neglects the more important part of my work, namely who I am, not what I do. But, not wanting to explain the doing-being distinction and knowing that if I answer honestly and say I play “Johnny B. Goode” for pre-school children the questioner will likely dismiss my work, I often reply with a vague, “Oh, this and that” or a joke, “Well, I’ve been playing a lot of ping-pong lately.” (Our after-school program has a ping-pong table I sometimes use in a quiet moment.)

One thing I actually do “do” is give patients rides to the hospital or a more advanced clinic. Transportation, I am learning, is a crucial and neglected part of health-care infrastructure. Car ownership is much more rare in the developing world than I am used to and virtually everyone relies on mini-bus taxis to get around. But it’s a minimum 10-minute walk to the nearest taxi rank from Itipini if you’re healthy and more if you’re not. If you’re weak and emaciated because you’ve got HIV or you’re sore and swollen because life in Itipini takes a dramatic physical toll on its inhabitants, you might not be able to make it to the advanced care you need. So that’s where I step in, driving patients where they need to go. Some of these cases are acute – like Fumanekile’s ride a few weeks back – but many are patients in generally poor but stable health.

The shortest distance I have to drive is 10 minutes but I often count on at least 20 minutes in the car with the patient, given the horrendous mid-day traffic in Mthatha and the distance Itipini is from the hospitals. That is a lot of time to be with someone. The trouble is, I never know what to say – everything from “sure is hot today” to “so, how’s it feel to have HIV?” seems inadequate and inappropriate. Even if I did know what to say, I’d barely be able to say it in Xhosa. As a result we ride in silence. At first, I found these car rides awkward but now they are just routine. The patients are universally grateful for the ride and genuinely so, so I take that as a good sign and resolve to re-commit myself to learning Xhosa even faster so someday I can say something.

I guess I could say to my questioners, “I give people rides to the hospital” but I don’t think that would satisfy anyone. Maybe it’s always that way with the ministry of presence.

What's Inside

We have all been taught that we are not to judge a book by its cover. Martin Luther King Jr. took this a step farther and said people shouldn’t be judged by the colour of their skin but the “content of their character.” The general idea is that what is inside is much more important than what greets us when we first see something.

I have to remind myself of this often in Mthatha because it can be easy to think that people are doing all right here. An initial glance shows them walking around fairly well-dressed, laughing and smiling, and – aside from the colour of their skin and the language they speak – generally not all that different than what I might expect to see on a similar city street in North America. But I’ve come to realize there are at least two things are different.

The first is pain. I’ll never be able to truly tell just how much pain some people are in but given how much physical exertion they subject themselves to – particularly the women – it must be enormous. Have you ever carried 50 pounds of water on your head? I can barely manage 20 without the pain forcing me to stop. Now try 50, countless times a day, over a much greater distance than I can manage. Without facilities I take for granted, like running water, heat, sewer, and so on, life becomes much more arduous. Add it all up over a lifetime of hard labour just to survive, throw in a few injuries that never healed properly because there just wasn’t the time to let them, and it makes for a difficult existence. One of my Xhosa phrases is “kubuhlungu pi?”, roughly “where are you in pain?”, and patients always indicate broad swathes of their body when I ask. One of most-asked-for medications at the clinic is methyl silyiciate ointment. I’ve never used it but our patients swear by its evergreen-scented healing properties.

The other is hunger. There’s no guarantee of three meals a day here and often what passes for a meal is a bag of chips or something equally nutritionally insufficient. Even though I can’t see it, hunger is a constant in the lives of the people in Itipini. I used to bring some food with me to Itipini to tide me through lunchtime but I stopped doing that because I’d never eat it since I felt awkward eating in front of children who just looked at me with longing eyes. Once, some children saw a bag of bananas in my car and relentlessly asked for them until I handed them out. Their intensity of their demand, underlain by a certain desperation, surprised me because it hadn’t occurred to me they might be hungry. To be clear, I haven’t seen any distended bellies and the people in Itipini aren’t on the brink of starvation. But they certainly aren’t going to bed with the contented and full feeling I routinely do.

I can share some aspects of the Itipini life – the hordes of flies, the unrelenting heat, the smell, the pigs and dogs that run around everywhere, the lack of electricity and running water – but not all. On the deeper, more fundamental questions, I can only guess.

Podcasts

Thanks to some local and long-distance help, I have recently discovered the magic of podcasting and am enjoying what I can access online. That being said, I have only been able to scratch the surface of what is available in my limited time on-line. So if you listen to podcasts and can recommend any ones you think I might be interested in, please let me know, either by e-mail or in the comments section. I’d really appreciate it!

Rev. Mazingo

Stephen Mazingo, my fellow Young Adult Service Corps missionary, was ordained a priest this weekend in the Diocese of Matlosane, South Africa and I was there to celebrate with him. He will probably be posting more pictures and more reflections on the weekend so I’ll just say I had a great time seeing Stephen, meeting his colleagues in the Klerksdorp area (and his rector from home), learning more about Batswana culture (as opposed to the Xhosa culture in Mthatha), and being a part of the overwhelming worship at Stephen’s church. (With the 4½ hour ordination service on Saturday and the 3½ Eucharist on Sunday, I figure I’ve paid my dues for some time to come.) It was a 2300-kilometer round trip in our faithful VW and I was thankful for safe travel and the chance to see many different parts of this really beautiful and fantastically diverse country. Parts reminded me of bits of North America I’ve seen before and parts – like the lake full of flamingoes – were like nothing I was familiar with.

I was Stephen’s “official” photographer and, as there doesn’t seem to be any opprobrium attached to taking pictures in church in South Africa, I elbowed my way right into the mix.

The South Africa caucus of YASC 2007

Last time in a deacon’s stole

A deacon no longer

Bishop Stephen Diseko – note the sweat stain on the mitre

The newly-ordained blesses his fellow missionaries – actually this is staged; the real blessing happened a moment earlier but my face was obscured by his robes

The S.A. caucus with Bishop Diseko, who I really liked because he let us stay in his house and eat all his food.

You Bet!

The Ones on the Edges

We have been celebrating the life of Chris McConnachie this week in Mthatha. The funeral today overflowed the cathedral and there must have been a couple hundred people at the grave at Bedford Hospital. I bet it is one of the few times a bagpiper has played at a grave under a palm tree.Yesterday, there was a memorial service at the hospital attended by many of the high and mighty of the Mthatha health world and beyond. I enjoyed listening to the stories of Chris’s work from his long-time colleagues and learning more about all the different ways he contributed to the improvement of health care in this region.

What struck me, though, was how everyone began their speeches by greeting, as is the custom, everyone on the dais, the assembled eminences, family members, and so on and so forth. Perhaps protocol always demands this but it occurred to me the people who were neglected in the introduction were precisely the sort of people Chris dedicated his life to: the neglected masses on the edges of society who need operations to carry on with their lives. It is these people who make up the bulk of the clientele at Bedford Hospital and it is these people who were the most direct beneficiaries of Dr. McConnachie’s work. The great thing about orthopedics, I hear visiting surgeons say over and again, is that you can see the results of your work; bones are fixed and people are able to use them again, to walk, to lift, and so on. When your life depends on your ability to do physical labour, these sorts of surgeries are tremendously important.

In some ways, I wish my cleaning lady Hilda had been given a chance to speak on Tuesday. The first time she saw me after Chris’s death, she was effusive (and this from someone who barely speaks English): “He was a great, great man. He saved my life.” She then proceeded to show me the scars from the operations Chris had performed on her after a car accident she was in a few years ago.

My first year in university I heard a sermon preached on Acts 19:7-12, the story of Eutychus, who comes to hear Paul preach, but isn’t quite sure of himself (so I infer) and sits on the windowsill on the edge of the group. He falls asleep (Paul liked the sound of his own voice), falls three stories, and is killed. But Paul rushes downstairs and brings him back to life. The message of the sermon was to be always mindful of the people on the margins of life, those sitting on the edge of the group; that I still remember it is a sign of its impact on my life. As I’ve been processing Chris McConnachie’s death, I’ve found myself thinking again and again of the Eutychus story. In many ways, Chris was a Paul-like character in the midst of the many, many Eutychus’ in this region.

Thresholds

We have an HIV/TB patient who is dying and can now barely muster the energy to get out of bed. He weighs 36kg and I can just about fit my thumb and forefinger around his upper thigh, it is so thin. The other day he showed me the washcloth he has been using to cough into. It was soaked with mucous and assorted other body fluids. I visit him in his shack to try to convince him to get out of bed and let me take him to a clinic. He speaks no English and I barely any Xhosa (though I’ve now got my first four-word phrase down – “kufuneka uyahambe iklinikini nomhlange” – “you must come to the clinic today”) so he lies in bed and talks past me and I stand there and talk past him. (He, incidentally, is the father of one of my “favourite” pre-school children.)

What strikes me about this situation is just how perfectly normal I find it. If you had told me a year ago that I would be standing in a shantytown in South Africa, talking in Xhosa to a HIV patient, I would never have believed you. Now it’s just my job and I’ve adjusted to the reality of it. What’s more, I don’t find his situation or suffering particularly noteworthy or shocking (though when I first saw his legs I was shaken). There are more people like him in Itipini and many more in South Africa.

It is amazing how quickly I am able to adjust to some of the realities of life in Itipini. My threshold for the shocking and amazing has definitely been altered and situations I used to find shocking or outrageous have now been reduced to the merely normal or mildly noteworthy. I could list several examples but here are just a few:

--The children who get in fights and start crying, all without any adult supervision or intervention. In general, the lack of adult supervision should be more shocking to me than it is.
-The drunk man who decided to go swimming in the Mthatha River that flows past Itipini and drowned. The police haven’t come to collect the body because they don’t put much priority on Itipini and no one else will go get it so the corpse is still out there somewhere. I’d rather not know where.
-The HIV-positive mother who brings in an obviously suffering baby with oral thrush and skin lesions. I take them both to the hospital, knowing that the baby will likely die soon. That thought no longer leads automatically to outrage.

What I don’t want to do is lose my sense of frustration, outrage, horror, etc. at the reality of the way our world works. But the more I am exposed to it, the more it becomes easy to dismiss as part of “the way things work.” And to dismiss the awful reality in this way is the easy way out. It’s the way of disillusionment, cynicism and, ultimately, despair. I’d like to not end up there but it’s hard work to be outraged so frequently.

Satisfaction

One of the most humbling and impressive parts of life in Itipini and Mthatha is seeing how much people can do with so little. Particularly in Itipini, people are scrapping by for everything they can get, absolutely nothing is taken for granted, and every opportunity is taken. I made the mistake of sorting through some donated clothes in the clinic the other day and before I knew it had given away half of them to the three young mothers and their babies who were waiting to be seen. If I have food in the car, I try to hide it because if a child sees it, he or she will say, “banana!” in such a hopeful and expectant voice I can’t not give it to them. These people aren’t being pushy or forward but they are also not about to turn down opportunities for a little bit more.

Around Mthatha, I continue to be surprised by how tiny the cars are, particularly the trucks, and how full they are. In Mthatha, the taxis are minibuses (smaller than an American minivan) that are crammed full of people (the joke is that no taxi driver ever thinks his taxi is full). Goods are delivered out of trucks that are smaller than, say, a Ford Ranger or a Toyota Tacoma, even gigantic items that sometimes make the truck look like a little clown car. I’ve been up and down the southern coast of South Africa and I’ve yet to see a full-size pickup, like a Ford F-150 or a Toyota Tacoma.

I came across the phrase “enough is already a feast” in my diocesan newsletter recently and I’ve been thinking about it a lot. The idea, as I interpret it, is that when we have enough, we are participating in the great feasts that Jesus talks about in the Gospels, like in Matthew 22. Most people here don’t have enough but I still see the feast in their lives. But that’s a hard lesson for us to learn when we are conditioned by the belief that bigger is better and our economic system is based on the accumulation of profit, or the accumulation of more for more’s sake.

I’ve been trying to apply this lesson to my time in Mthatha. I end up with a lot of free time, certainly more than I am used to, and sometimes I think I should be using that free time more wisely in service to the people in this region. But then I think that I expend a lot of emotional and physical energy working in Itipini every day and the free time is important for me to recover for the next day. What I’ve realized is that by working in Itipini every day, investing myself fully in the community, and doing my best to actually do something, I am doing “enough” mission work and simply enough is alright. As you can read here, I am certainly seeing the feast-like results of that work.

The English “satisfaction” comes from Latin words “satis,” which means enough, and “facere,” which is the verb for to do or to make. (I might as well just re-name this blog the Etymology blog.) When we are satisfied, we have done enough. But I think we’ve become conditioned that “only” enough is not satisfactory. What I’m learning here is that enough is a true gift and a blessing, both in what we have and in how we spend our time.

I Never Get Tired Of These Posts