Trying to pull back

There’s these two brothers in Itipini I’ve mentioned in a previous monthly e-mail.
On the left is Zanethemba; on the right is his older brother Lizwi. They aren’t always so dour (well, Lizwi is). Here’s Zanethemba in a lighter moment.
Zanethemba came across my radar first back in March when he tested positive for tuberculosis and also had a low CD4 count. He was pretty sick. A few months later, Lizwi came in with the same set of symptoms more or less. He tested positive for TB as well, which is not surprising given that they both share this shack, which is about seven feet on a side.
That was where the story ended until a little while ago. It is nothing unusual in Itipini - people have HIV, people get TB. In this case, they just happen to be brothers and live together.

It turns out, however, that Lizwi has a few children, at least three, in fact, none older than 10. One of them is Siphisihle, the young girl who had TB when I first arrived and whom I invested a lot of energy in then. They had been living with their mother but she dumped them on Lizwi a few weeks back because she figured Lizwi was about to die and she was going to move on to a man who could earn some money. In addition, Lizwi’s wife’s oldest daughter dumped her young baby with Lizwi and took off. That daughter happens to be Tunyeswa, whom just a few weeks ago shocked me with the sharp deterioration in her condition.

Here are all four children.
At one point, the youngest of the three siblings had a very bad lip infection and couldn’t eat or even really open her mouth until the antibiotics went to work. But the children look after each other and care for one another. Here’s Siphisihle and her younger brother Siphamandla.
So now there are four children and two adult men living in a tiny little shack with only two beds just a few feet apart. Neither man apparently knows how to be a father and Zanethemba can’t always remember all the names of his nieces and nephews, mainly because I don’t think he’s taken the time to learn them. Lizwi would like nothing more than for us to figure out a way to get them into a home someplace that could look after them.

There’s all kinds of reasons to be concerned but one I think about often is the potential spread of TB in that shack, especially as Siphisihle has already had it. The TB guidelines call for us to test the people a patient lives with but children need a Mantoux test and in order to get that we have to get them all to a certain clinic on one day of the week. Given how hard it was to get the one child with the lip infection to take his pills, it is easy to get exhausted simply thinking about the logistics of organizing those tests.

We’ve repeatedly called the social worker for help and guidance. Nothing. (Remember how I said the government has an informal relationship with Itipini?) Siphisihle and her older sister go to school. The younger children hang around the shack all day. It is cold this time of year and they don’t always have a lot, or even any, clothes. Lizwi and Zanethemba get food because they have TB and it is easy to include the children in that and check on them every day. The greatest source of hope in this situation is that the children actually do a reasonably good job caring for each other and are in good spirits.

But there are no easy solutions and I want to scream at the complexity of the situation. Tunyeswa has disappeared since she last came in looking so sick. I’m concerned about her health but also about her siblings and child. If I ask her about her children when I see her, will that make her less willing to listen to my advice about her health? I want Zanethemba and Lizwi to get better (and they are, especially Zanethemba, who has improved in leaps and bounds) but I don’t want to absolve them of all responsibility because they’re sick.

And in all of this, I know I need to hold back and not get too involved because I’ll be gone before the situation begins to improve, if, in fact, it ever does.

This is what incarnational ministry gets you. You learn all about the contours of a situation, which is a blessing of sorts, to begin to realize the true complexity of life. But you don’t necessarily get any closer to a solution. You just have to hope that knowledge of the situation is good enough. It feels particularly unsatisfactory.

Hard to find time to do much writing lately but I am taking plenty of pictures

Much like the Beatles, my last concert was on a rooftop

Bossy

Some of you might remember the story of Pakama, a woman who about this time last year was very sick and on death’s door. She has since got the right combination of pills and is thriving.

When Pakama was sick, a dominant characteristic of her personality was her strong desire to live. She was always directing me and telling me what to do, how to push her wheelchair, when she had another appointment, which pills she had to take when, and on and on and on. I’m convinced that it was that will to live that helped her survive when I’ve seen many other people in her position die.

Now that she is better, I see a lot less of her and her bossiness is a lot less endearing, for instance, when she comes in the clinic and cuts everyone in line. I often thought she was only pushy with me but then I watched the other day as the HIV support group in Itipini set to work planting their part of the garden.

Pakama is at the top of the photo in the dark shirt, taking a sort of supervisory and managerial role while everyone else works.
She closely supervises this woman.
Missed a spot!
And another!
And only at one point does she deign to bend over and help out, though being careful not to get her shoes dirty.
I find this series of photos hilarious and stood on the rooftop and watched her work for sometime but that may only be because I know her so well.

No winners in this situation

Itipini is what is known as an “informal settlement.” The organs of government in the municipality have an informal relationship with the community. Most of the time, I think they’d prefer to think it doesn’t exist. That had tragic results this week.

On Wednesday, there was a young resident of Itipini wandering around with a giant bush knife, threatening to kill one of the employees of the Community Project, whom we call Mrs. Nani.
The young man claimed that Mrs. Nani was a witch and had put a spell on his girlfriend. (Snippets of Monty Python immediately flashed through my head when I heard this and I wanted to go searching for a duck. Then I realized how serious things were.)

I know this young man reasonably well and I also know his girlfriend. She is hands-down the most well put together young woman in Itipini. I can’t see how anyone could think she has been bewitched.

On Wednesday, the young man was mentally unwell and drunk. (In addition to the bush knife, he was walking around with a paint can full of home brew.) Understandably, he was making a lot of people nervous. So we called the police. No answer. (Really!) I took one of the pre-school teachers, Nthantisi, and went to drive to the station. On the way, Nthantisi was very critical of the station we were going to and said they wouldn’t help us. Instead, she called the local emergency number. They answered the phone and promised to come right down. Unfortunately, they didn’t know where Itipini is. (These are the police! They know everything!) So we waited to show them the way. After five or ten minutes, I suggested we call again to see what was going on. The folks at the local emergency number said police officers from our local station were on their way. That was the same local station Nthantisi had just been criticizing. So we returned to Itipini to wait for them. They never showed up. Itipini is less than five minutes from their station.

Mrs. Nani didn’t go back to her home on Wednesday afternoon and slept at a friend’s place. I wondered as I went to bed that night if she would be alive on Thursday.

I was wrong, thankfully. She lived. But late on Wednesday, her shack went up in flames. Absolutely nothing was saved.
The fire department had shown up long after the place was beyond saving. When I arrived this morning, it was still smoldering.

On Thursday morning, the young man was still around. Evidently, the community had performed a little vigilante justice, as he had a bandage across his head and looked like he’d been beaten up. (Why do they always wait until after the fact instead of intervening beforehand?) But he was also quite docile so Jenny took him and Mrs. Nani to the local police station. The young man was arrested and Mrs. Nani made her complaint. But later he was released and is now back in Itipini. Why? Because there's no food at the police station to feed the prisoners.

I’m only tangentially involved in this situation but I get only marginal satisfaction from the outcome. Mrs. Nani lost her home. And the young man isn’t getting what he needs either. Clearly, he needs medical care, mainly psychiatric and substance-related. Jenny commented that he looked pretty pathetic as he was led away.

What kind of police station makes you come to them to get service? Where were the police officers who might have been able to prevent this? And given how much of a problem substance abuse is in Itipini, where are the people and programs to help address those issues?

People in Itipini don’t treat each other right all the time, it’s true. But it seems like the government never treats them the way they deserve.

Skipping School

A well-known obstacle to education in the developing world is attendance. Sometimes kids just don’t go to school and there’s no truant officer to make them. And oftentimes, they have legitimate reasons for not going.

Luleka, one of the students we support in high-school, missed a day of school because she had to take her younger sibling to the clinic. Their mother was busy taking their brother, who had just had a seizure, to the hospital. Luleka got the role because she’s the oldest daughter.

I don’t know the name of this student but her mother had to work in town one day, which meant the older child had to bring her younger sibling to the clinic and miss school in the process.

Xolelwa, the oldest child in this picture, is one of eight or nine daughters (I keep losing track) in a family. She’s also already an aunt several times over. The three children in this picture with her are a few of her nieces and nephews. I haven’t seen Xolelwa miss school because of these nieces and nephews but she spends a lot of time caring for them in the afternoon. I wonder what it’ll do to her back, having to carry them around from such a young age?

I used to get frustrated when I saw children we support not in school. Now, I just give a resigned sigh. I don’t know how money alone can solve a problem like this.

It's a tough life being six weeks old

Meaty Mission and Ministry

I was recently asked what I mean when I use the phrase “incarnational ministry.” Excellent question! Before I moved to Mthatha, I had heard that phrase a lot but never quite understood what it meant. Now it is the foundation of my ideas about mission.

Incarnate means to make flesh. (The -carn part of the word is from the Latin word for meat, hence the title of this post and the word carnival, to say goodbye to meat.) The Incarnation is when God became flesh and choose to live as a human. That’s why Jesus had the name Emmanuel - God is with us.

I consider my mission and ministry in Itipini to be incarnational because I have made a decision to share a particular existence with this group of people. As Jesus came from heaven to earth so I chose to come from North America to Mthatha and live in a place that was completely different to what I knew. (That’s about as far as the Jesus/Jesse analogy goes.)

Incarnational ministry also takes time. Jesus spent 30 years on earth before launching his public ministry. Maybe he was using that time to figure out how things worked and how best to calibrate his message. I’ve spent two years here and am still in the dark about so much.

Incarnational ministry is foundational to my thinking about mission because it is the necessary first step to everything that follows. You learn best about a place when you are incarnate there. You build relationships with people when you share a common existence. Such efforts towards reconciliation as you can manage are premised on this knowledge and these relationships. Nothing I have accomplished here could have happened if I had stayed in North America. That’s obvious, of course, but points to the importance of incarnational being and doing.

There are dangers, of course, not the least of which is that you is expose yourself to potential danger and harm. Choosing to be incarnate requires a certain willingness to take on a measure of vulnerability. Jesus did wind up on a cross after all, which definitely wouldn’t have happened if he had stayed in heaven. But if he had stayed in heaven, he also wouldn’t have been able to rise from the dead and rescue the world from sin and death. Life is full of trade-offs. If I had stayed in North America, I wouldn’t have ended up with countless gastrointestinal illnesses. But I also wouldn’t have had a transcendent and life-changing experience. On balance, I’d say I got the better half of the bargain.

Mission, as I’ve noted often, doesn’t just happen overseas. It happens wherever there are people yearning for right relationship with God and with each other. As we consider our mission opportunities, whether it is down the street or across the globe, the first question is the same: “how can we choose to be incarnate among these our brothers and sisters in Christ?” That is the foundation of rich and enriching mission.

The TB Express

Our tuberculosis caseload has increased notably in the last few months. I don’t know why. A lot of the new patients have had TB before, which means that this time they have to get 56 doses of a drug called streptomycin. The only way to give it is as an intramuscular injection. Since this is something I learned to do when I was an EMT, for the last several months it seems I have spent a good portion of my day jabbing patients - mainly older, smelly - men - in the butt with needles. (They are pretty funny about making sure I alternate cheeks.) Poor guys. Fifty-six is a lot of doses. But it works, for the most part. They get dramatically stronger and healthier over the course of the treatment.

A few patients aren’t strong enough to make it to the clinic on their own so I load up my syringes and make my rounds. I call it the TB express.

Mandla is first.He lives in one of the tiniest and most tumble-down shacks I’ve ever seen - and that’s saying a lot.
Mavis was always next.
She lived in this small shack.
But I learned yesterday that she died on Friday, shortly after I took that picture of her. Is it exploitative to post it here? Is it wrong to mention I was one of the last people to speak with her?

She was close to the end of her regimen of injections and just had not been improving at all. In retrospect, I imagine she had multi-drug resistant TB but she was never tested for that and, like many others, has slipped through the cracks of the health system despite our best efforts to prevent it.

Luxuries

It’s obvious that if you spend even a little time in a place like Itipini, you learn a lot about what you’ve taken for granted - running water, insulation, a roof that doesn’t leak, electricity, etc., etc., etc. But the more time I’ve spent getting to know the people here, the more I realize how many intangible things I’ve taken for granted.

I’ve already written about what I’ve noted about the capacity for leadership. Here’s a short list of a few more:

An environmental consciousness - It is appalling how people here treat the environment. Mthatha is a city full of litter. It never ceases to amaze how people casually throw away their trash with no thought of where it ends up. They throw it out the window of cars or taxis, they drop it wherever on the ground. I can’t stand it. The rivers and drainage ditches are clogged with trash.

Privacy - People here have so little private space. Going to the bathroom, bathing, changing, even sex are not private acts here. Personal details about a person - particularly concerning their health - are a lot less private here than I am used to.

Sabbath time - When your existence demands a huge amount of daily physical labour, the idea of taking a break is almost laughable. You simply can’t. It certainly puts new light on the fourth commandment as I imagine the Israelites were a lot closer to the people of Itipini than to us.

Planning ahead - When you don’t have a savings account or a steady job, planning any farther than the end of the day is difficult. The question is, how will I make it to tomorrow? Then the next day? Then the next? I’ve realized that planning my life one year at a time, as I have for the past several years, is a luxury.

I’m sure there are lots more but that’s a few for now.

Rhini

For the last two years, every few months or so I’ve headed down to Grahamstown (or Rhini in Xhosa) to visit my fellow YASC missionary, Matt. Matt and I arrived around the same time two years ago, he stayed on a second year, and is now, remarkably, staying for a third.

Here are Matt and I after church on Sunday morning.
He goes to church at the Mariya uMama weThemba monastery where he works after-school with these four boys.
Nomamiesi is the Xhosa woman who prepares the snack for the after-school program Matt works at. She also is raising several of the children in the program at a farm outside town. On every visit, Matt and I pay her a visit, drink LOTS of tea, practice our Xhosa, sing, and generally enjoy the benefits the surrogate motherhood.
On Sunday, I drove her and a few of her large brood to church.
I’ll miss Grahamstown.

Sitting and staring