As I always come to realize when I adjust to a new culture, the human person is highly adaptable. Take people who live in war zones. They go about their normal business – squeezing ripe fruit at the market, tilling the soil of their fields, having babies and baptizing them – with bombs and shrapnel flying all around them.
Or, take relatively-peaceful Uganda. With roads that look (and feel) like hell and little expendable income to spend on a personal car (or car maintenance…or gas, for that matter) and living near a city that grows more sprawling every minute, matatus are the perfect answer for the average Ugandan’s commute. They are cheap (usually only 1,500 shillings, or 0.66 US cents, to get from Entebbe to Kampala – which is easily 20 kilometers away). They are plentiful (you usually only wait one minute before another comes flying down the road). And they put the scary-ass job of driving on these Ugandan roads into the hands of a “professional,” when you yourself may not have even a license.
However, don’t be fooled. Though “convenient” (HA!), using the matatu as your main means of transportation requires a certain amount of esoteric knowledge (i.e., tips and tricks). And we, matatu-riding professionals, are here to bestow such knowledge upon you. So, buckle your seat belts…
1)Actually, don’t even try to buckle up because there are no seat belts, except perhaps the two seats by the driver. You may look like a total square, and definitely an “overly-cautious” mzungu, but if you see a seat belt, use it. Also, be especially wary if the driver himself wears his seat belt. This could mean two things: A) he doesn’t want to get pulled over by the next cocky, rifle-toting policeman for not wearing his seatbelt or B) he knows it’s going to be a crazy ride. Just assume both are true and you’ll be safe.
2) Stay out of the first two rows behind the driver, if you can. Yes, they are easier to get into initially; you don’t have to crawl over five people and trip over the wheel hump to get these seats. But don’t let this entice you. The conductor’s sole job is to cram the matatu until it is overflowing so that he can make his quota for the day as early as possible. It is these first two rows that are likely to fill up first. Though they “comfortably” seat three, they usually seat 4, sometimes 5. And if you’re lucky, you’ll also be sharing the seat with a huge pound of potatoes headed to the market for sale.
3)If you are going some distance (at least a few stops), try your best to squeeze over to the window. That way, you can sit there comfortably without being asked to move when the person next to you needs to get out. Otherwise, you will find yourself getting up and out of the matatu every time someone to your right needs to leave, as well as any others along the left side ahead of you in the matatu. This is very annoying, and usually very awkward, especially if you are wearing a skirt. It’s hard to get in and out of a matatu quickly when wearing smart clothes.
4) Sometime during the trip, the conductor (usually sitting on the lap of someone in the 1st row) will turn around and yell something in Luganda. Don’t be alarmed. He’s probably just asking for money. You are under no obligation to give him the money right away. Rather, like the other passengers, gaze out the window for a while as if you didn’t hear him. Then, he will ask again. This time, slowly rifle through your purse or pocket until you find some coins and count them out in your hand. But don’t give them just yet – the matatu could break down before you get to your stop, and you’ll be out of money. If you see your stop in the distance, feel free to surrender the fair. It is also possible if the conductor keeps asking around that he is looking for change to break a rider’s large note. The opposite of this may occur when the matatu pulls over to fill up on petrol and begins seeking riders with large notes so that they do not have to surrender their smaller notes in order to be able to give riders their balance.
5) Like most places in Uganda, it’s best to have correct change when getting on a matatu, or else you may not get your proper “balance” in return. The entire population of small notes and coins in Uganda are in the hands of matatu conductors, giving the illusion that they can break large bills. However, don’t take the risk. Hand over the correct change when able. If you do not have the correct change, hand him the next largest bill, then bore holes in his head with your eyes as you patiently wait for change. Do NOT leave the matatu without receiving your change, or else he’ll “forget” and drive away with your money. He will usually return your balance once he realizes you are a matatu-riding pro and know exactly what’s going on.
6) It is common knowledge that the conductor will try to squeeze a few extra hundred shillings from any unsuspecting mzungu who boards his taxi, particularly mzungus who assume that prices are fixed and conductors are honest. Neither are true. There is a MINIMUM price, but not a fixed price. First, find out the cost of the ride from someone nearby (not another matatu conductor). Then, as you board, don’t ask for the price. Otherwise he will assume you are bartering with him and will automatically quote something higher. He may volunteer the price himself, just as you are boarding. If he says “Kampala, two-thousand”, feel free to say “No, it’s one-five.” And he will nod and point to one of the seats. If he continues to quote the wrong price, persist in responding with the “right” price. If you are unsure, ask a fellow passenger. It’s also helpful to watch other people pay their money – keep a close eye on any change they receive. This will let you know how much you should pay.
7) There are several ways to indicate your desired stop, with “Masow” (Stop here) being the most affective. You may also choose to say a landmark, such as “Shell” (gas station) or “University”. Also, you can “stage”, though it is ambiguous as to where exactly these stages (taxi stops) are located. You may yell stage and the driver doesn’t pull over for a kilometer. Other times, he pulls over right away. The subtly is lost even on these professionals. There are other Luganda words, such as “Awo” (There) that work, too. If all else fails, feel free to say “Stop the damn taxi” and you will probably get your wish. If you’re really lucky, when you state to the conductor as you board where you will be getting off they may even announce your destination upon arrival.
Matatus are small and, as a result, personal space and privacy is neither a privilege nor a right. Be prepared to be elbowed, stepped on, and sat on (see #2). If you are reading a book or sending a text message, be prepared to have either read by the passenger next to you. If you are a mzungu, be prepared to be stared at and, occasionally, greeted. For reasons lost on even these professionals, some people choose not to move from their seats when passengers need to slip by from the right, which means you may find yourself sitting on someone else, or at least having your butt in their face in order to de-board. This is expected and is normal. Also, on rare occasions, be prepared to have your butt touched when you are leaving the matatu.
9) Matatus can accommodate some luggage and other carry-ons. You can either have them placed in the boot, or carry them on your lap. If you are carrying on live animals, such as chickens, you may want to place them in a plastic bag up to their neck to ensure that they don’t poop on you or a fellow passenger. Also, if you are carrying something exceptionally smelly, such as a rotting carcass in a bag, you may be kicked off that matatu at the orders of an offended driver (and everyone else). And everyone knows it’s never good to offend the driver.
10) If loud music or talk radio is unappealing, bring ear plugs. Many matatu drivers like to listen to the radio very loudly and, therefore, the passengers listen to it loudly, as well. The best way to avoid being subjected to this noise pollution is to sit in the front seat, away from the speaker. Or stick your head out the window for the majority of the trip. The worst place to sit is the 1st row where the speaker is located directly overhead and pointed right at you.
11) For inexplicable reasons, your matatu may be stopped by an angry armed official, such as a military person or an officer. You will find that the military person will open the door, yell loudly, and passengers will shuffle off in a confused but obedient fashion. It’s best just to follow the passengers rather than remaining stubbornly in the matatu, or else you may end up at the police station. When the officer gets in the matatu and rides away, don’t be alarmed. This is protocol. Simply walk along the road and wait for another taxi. Also be prepared for no explanation regarding the previous incident.
12) It’s best to bring a book, especially when boarding a taxi at a taxi park. In order for the taxi to leave, the conductor waits for the taxi to fill all the way up, which means on particularly slow days, you could be sitting there for an hour. So, instead of complaining, get out your book or your crossword puzzles/Sudoku/etc and see it as a much needed break from the hubbub of urban life.
Over the past several days, Denise and I have received some interesting comments (via email) regarding our spirituality presentation. In hopes to explain more clearly why we believe the distinction between spirituality and religion is important, and in desiring to share a bit about the role of witness and evangelism (and good theology) in hospice, I composed this. Sorry, as usual, for the length:
It’s typical to hear the average American say “I’m spiritual, not religious.” And those of us who proclaim a faith rooted in a certain historical event and figure, and in a certain peculiar people known as the Church and a certain set of beliefs known as the Nicene Creed, this distinction makes no sense to us (and rightly so). For us, as Christians, spirituality and religion cannot be divorced; in fact, they are two sides of the same coin. So, like many, I find the average Westerner’s postmodern attempt to extricate herself from the “religious establishment” (i.e., the Church) in order to maintain her own private, self-originating “beliefs” (i.e, opinions, choices, truth(s)) extremely problematic.
Not to boil this down to semantics, but I would argue that we are talking about two different things, not to mention the fact that we are operating in two different contexts. Distinguishing between spirituality and religion in the context of hospice care (and care for other economically “useless” people), particularly non-Western hospice care, does not breed false consolation rooted in the Enlightenment project, but is a necessary (I would argue vital) distinction that must be made in order for caregivers to work effectively with patients of different faith traditions. The distinction is a practical, rather than theoretical, one.
Part of the necessity of distinguishing between spirituality and religion in this instance/context/culture is three-fold. First, though the majority of Hospice Africa staff are Christians (like most hospices in America I believe), not all of them are. We have several Muslim staff members who do not believe that “God saves people in Christ,” however True that may be. Secondly, though the majority of patients Hospice Africa serves are Christians, some are also Muslim, or pertain to some traditional religion. Therefore, we have on our hands a Christian-friendly but religiously pluralistic organization that aims to provide holistic care to those who are dying, including psychological, clinical, social, and spiritual support. Thirdly, the staff members of Hospice Africa, the majority of whom are clinical (nurses, doctors, etc), have no idea how to assess the needs of their patients when those needs are non-medical, especially because there is no chaplain on staff.
For instance, the staff spent an hour discussing a man who said he was “at peace with God” yet hadn’t been to church in 10 years. According to the staff, this man was “spiritually” needy, even if he himself expressed a peace with God that was clearly independent of weekly church attendance (it should be noted this man’s illness, AIDS, rendered him bed-ridden and unable to leave his home for any reason, including Sunday worship). The staff was unable to listen to the patient’s testimony regarding his spirituality and instead focused purely on those outward “religious” signs – church attendance, participation in sacraments, etc – as a measure of his spiritual state. We felt this was both judgmental and inaccurate, so we decided a presentation on the distinction between spirituality and religion was important.
According to Duke Divinity’s Institute for Care at the End of Life, religion in its broadest sense can be defined as “a system of beliefs and practices relating to a higher power and shared by a group of people.” Religion also “provides a community for groups of people to join together and give expression to their common beliefs, values, and spirituality.” Spirituality, on the other hand, is defined as “the inner search for meaning, purpose, and understanding of universal questions of human existence.” These universal questions (asked of all humans regardless of religious affiliation) may include “Why am I here?”, “What is the purpose of my life?”, “Who am I?” In this sense, religion includes particular beliefs and practices held in common while spirituality represents the universal “need” found in all human beings, as universal as the need for food, shelter, and oxygen. Spiritual needs make include, according to ICEOL, “the need for belonging and relationship, the need to explore the meaning of one’s life, the need to explore meaning of suffering, and the need for reconciliation.” That need may be met through religious practice and expression, or it may not. Spirituality is deeply personal in that sense.
With regards to theology: I, too, believe that the only true hope is grounded in truth, in the forgiveness of sins and the resurrection of the dead. But I also think that any good, robust theology must stand the test of the deathbed, which is why I think hospice care is uniquely prophetic and wonderfully edifying for the Church, and for the average theologian. Imagine you have grown up Muslim all of your life, prayed 5 times a day, went to the Mosque, had a good relationship with your imam, etc. Now, imagine you are in the last stages of pancreatic cancer. You have days to live and hospice workers have come to make your final moments more comfortable, according to your wishes. After a long struggle with coming to peace with your death, you, with the help of your religious community, feel that this is God’s will and you take comfort in that. Now, imagine as you lay in bed, preparing to leave this world, a hospice worker comes in and instead of respecting your beliefs, your religious tenants, your heritage and identity, she begins to unravel your faith in Allah, telling you that there is no way to heaven but Jesus Christ. Honestly, I can’t imagine the sort of pain and upheaval this would cause at the end of this individual’s life, particularly an individual who has finally, with the help of his religion, come to grips with his own mortality.
Now, imagine you are a Christian. And imagine if on your death bed, a Muslim hospice worker began sharing with you “the hope that is only found in Allah.” I can’t imagine something more intrusive or unwelcomed. According to ICEOL, such an intrusion can result in “spiritual pain,” which is in direct opposition to the “Do no harm” model of hospice, and the medical community at large. How, then, do Christian chaplains (or Muslim chaplains, for that matter) who are deeply convicted of the Truth of their faith address the spiritual needs of those patients who are religiously Other? This is the tension of living in a pluralistic society with which chaplains must contend. In fact, it is a tension every Christian who believes in the uniqueness of the Christian story must come to terms with, as well.
There are some Christians (and other religious groups) that operate under the assumption that they are the sole instruments of salvation for those with whom they come in contact, and that if they don’t “save” them before they die (i.e, “urge them to accept the truth”), they will be condemned to hell for all eternity. Frankly, I find this anthropocentric soteriology unsettling, not to mention theological untenable. The goal of hospice care is not to win the souls of the dying before it’s too late. As a Christian caring for the dying, I am called to recognize them as the mysteriously “blessed” of the beatitudes – the weak, the mourning, the sad and broken and poor. And with those people, I both encounter and proclaim Christ.
I think that most hospice workers would say that impinging their beliefs, however True, upon a dying patient is wrong. Urging a patient to “accept the truth” as they lay dying rather than resting in the knowledge that our (and their) salvation lies in the hands of a crucified and risen Lord (who, through his own death, raised us all to life) borders dangerously on the edge of self righteousness. I do believe Christ can be “betrayed” by completely eliminating him from the death bed conversation. But I also believe that our attempt at orchestrating death bed conversions, particularly for patients who have already made peace with God and are ready to die with dignity, is also betrayal of Christ. To assume that the main access to faith is purely cognitive and didactic is in and of itself a diminution of the Christian message.
My job is not to secure their place in heaven, because in my theological opinion, Christ did that on the cross two thousand years ago (see Karl Barth). Instead, my job is to care for them, to listen attentively and without judgment, to answer honestly when asked, to speak truth when truth is ready to be heard, to change bandages on incurable wounds and hold trembling hands, to experience their suffering as my own, but ultimately, to give as Christ has given to me. And I firmly believe that those who are “on their way out” so to speak are in a far better place to ponder (and perhaps understand) the Truth of God’s saving work, not to mention the power of the Resurrection, than a healthy, able-bodied, able-minded Duke Divinity MDiv student like myself. So, I’m not sure if we need to equip ourselves with a sophisticated account of how God’s saves people in Christ in order to minister to the dying. What hospice workers, and chaplains, need most are those habits of being and doing that witness to the Kingdom of God to those already broken by the fallen world. I think Catholic lay-woman, doctor and hospice worker, Shelia Cassidy, says it best:
“I believe that those who work with the handicapped, the dispossessed and the dying have very expensive ringside seats at the fight: we have a close up view of players who are stripped of sophistication and pretence, of the comforting outer garments with which men cover their nakedness, their vulnerability and their shame. Surely then, we have a duty to report back the truth of what we see: that the facts are friendly; that the blind see, the lame walk, the lepers are cleansed, and the good news is proclaimed to the poor – that the kingdom of God is among us, and that herein lies our hope.” (Sharing the Darkness: Spirituality of Caring, 3)
Witnessing the Christian message involves becoming the Christian message, Christ’s hands and feet. We as the Church are called to embody Christ through our actions as a sign to the broken, fallen world. In the words of St Francis of Assisi, we are called to go forth and proclaim the good news of the gospel wherever we go, and “when necessary, use words.” As Michael Cartwright states, “what Christians throughout the world can do – with confidence and humility – is to bear witness to the good news by fostering the kinds of habits and practices that enable would-be disciples of Jesus Christ to remember the saints and the martyrs.” If we truly believe that God has created all, loves all, and seeks relationship with all, we can safely speak of this as the universal spiritual need of human beings to be in relationship with God. And if we want to truly and faithfully witness to that God, we can do so by our ethos, as signs pointing to God through our care, particularly our care of those deemed useless by society (the dying).
St Francis’ prayer is, I believe, a perfect prayer for those who work in Hospice: “Grant that I may so much seek to be consoled as to console; to be understood as to understand; to be loved as to love; for it is in giving that we receive, it is in pardoning that we are pardoned, and it is in dying that we are born to eternal life.” Could it be that the simple, embodied acts of patient consolation, humble understanding, and compassionate love proclaim the True Hope in found in Christ to those dying? I think St Francis would say so. And could it be that, in turn, caring for the poor and weak and broken-bodied assists us in working out our own salvation, coming face to face with the True Hope found in Christ? I think St Francis would say so, as well.
(Disclaimer: I just finished reading David James Duncan’s Brothers K for the second time. I read almost half the book in a single sitting, and I woke up feeling hung-over with it, it was that good. So, please forgive me if my writing style sounds or feels a big Duncanesque. Those of you who’ve read him will know what I mean.)
We met up and stayed with Alisha Damron this weekend, who had just moved into her new flat in Bunga (not to far from the Hospice) when we arrived. She plans to be in Uganda at least for the next 2 years (after spending a total of 10 months here in the last three years, when you combine all the summers together). And I must say – I envy her. Of course, the people she loves are here, including her boyfriend. Not only that, the place she loves is here. Her heart is here, buried in the Ugandan soil. Falling in love with places is different than falling in love with people, though they are connected, of course. It’s hard to love a place when the people you love don’t inhabit it. Or, you don’t love the people who do reside there in the first place.
Anyway, falling in love with places, with entire countries or regions, is different than falling in love with people, because places remain relatively static. You may flit about making or breaking plans, loving or hating the inconveniences of your new living situation, cursing or praising certain cultural practices or beliefs, etc. But Uganda’s personality remains relatively the same, even in the face of “development”. It’s really you that has changed, matured, converted, apostatized.
I’m sorry to say that my hometown, Manassas, falls in the Least Loved category of places in my life….though right now it’s practically filled to the brim with PEOPLE I love, which changes my heart a little. Though Romania was a hard, often desolate place, I left a little of my heart there, up in the Carpathian Mountains, within the snow-covered forests and smoky communist bloc apartments where my friends ate curry and drank spiced wine and raised their babies. And I fell in love with Costa Rica, though that felt more like a one-night stand, because I only saw “gringo” Costa Rica while roaming around on vacation. And I remember falling in love with Ronda, Spain….a white hill town with cobbled streets and remnants of Moorish Spain around every minaret-tiled church, every masala-spiced tea shop. I fell in love with Boston’s North Shore, where I spent 4 years in college puttering around old fishing villages and seaports, eating the best clam chowder and roast beef and marveling at the immense snow of winter and immense beauty of New England Autumns.
And I am falling in love with Durham , too, slowing making it my own, a place with strong memories and wonderful friends.
Uganda was, therefore, not the first or only place I fell in love with but it was the first time I felt that fierce, searing love that marked me forever, and because of my time here, I wasn’t and will never be the same – almost like being baptized , if I can say that as a seminarian. As Father Stephen says, you must embrace Africa in order for Africa to embrace you. If you don’t, you will find yourself miserable here (as a Westerner), always impatient with the slowness, always angry at the inefficiency of transportation and various other aspects of life, always unsettled by sticking out (if you are white) in a crowd, always ill because you tell yourself the food is making you sick, always terrified of the safari ants and the dog-sized cockroaches.
But if you embrace Africa (let me say Uganda to be precise), then Uganda will embrace you, wrap you in her pain and her joy, her beauty and her sorrow, and you will feel like you are meeting a real, live person whose faults and follies are laid bare for you to accept or be repulsed by, rather than an illusory place filled with big-box stores and cement parking lots and cars, and definitely “no” poverty.
Grant it, I am repulsed sometimes when I am here, nearly every day, in fact – the flying ants wiggling under the doors, the dead cat in the drainage ditch, the lascivious glances from the boda boda drivers. But it’s the fact that Uganda DOES repulse, unashamedly so, that gets me, as opposed to clean and bright American every-towns . I guess the problem I see is that American (or British, or Swedish, or South African, or perhaps someday, Uganda) every-towns with their every-stores and every-culture normalize that lifestyle into every-ness. I can’t speak for others but I can speak for myself.
Growing up in an every -town, with 5 strip malls all in a row, and plenty of housing developments with single-family homes filled with couples who do not know their own neighbors, multiple movie theatres, well-trimmed lawns and pot hole-free roads, and an Olive Garden-Loews-BestBuy- McDonalds-Walmart-Starbucks-Panera on every corner, served to NORMALIZE that life for me. Not only that, television and the movies further normalized the ever-town, because that’s all you would see (a whole other blog entry: global cultural industries and Ugandan teenage pop culture …..yikes).
Now, all things I encounter must measure up to That Which Is Considered Normal in my experience — the American suburb – which is really not normal at all but completely abnormal. The majority of people living on this earth do not live in every-towns where traffic runs smoothly and efficiently, where no one walks on the street and everyone rides a car, where trash trucks come every week to pick up your garbage and haul it to a mysterious land to never be thought of again, where the water out of every tap is safe to drink and roofs on buildings are generally not in danger of caving in, and most children you see outside are wearing disposable diapers and are probably inoculated for measles, mumps, and rubella, and most meat consumed is safe to eat and bought in sanitized shrink wrap from the grocery store, the adolescents sitting at the bus stop are likely going to high school totally for free (and both of their parents are probably HIV-negative), and the policeman on the corner is probably doing his job without bribe money and the local politician has probably never shot one of his opponents, and local library is most likely stocked with enough books for the entire town to read if everyone decided to pay a visit at once.
This is not normal.
This is rare, strange, in some senses a model for development (Free schooling for all children? Access to clean water? Transparent politics? YES! YES! YES!), and in other senses, it is a model that breeds isolationism and materialism. But I digress.
I feel deeply, madly in love with Uganda, not because it is a better place by any means (because it’s not), or because it made me a better person (because it hasn’t), or because it has something which America may lack (it might, but probably not). I fell in love with Uganda because Uganda represented to me a corner of the earth that was actually…. normal, as statistical earthly standards go. Normal for me has changed drastically as a result. And “normal” in many ways is heart-breaking. That’s the hardest part, to know that these daily frustrations, these inefficiencies, these epidemics and droughts, this corruption and political terror and human brokenness are normal.
But it’s eye-opening to also discover that close family ties, the desire to look to the past (with emphasis on tradition), an agrarian notion of time, the dirt that coats my feet on walks to the market and washes down the drain in the shower, the vast stretches of horizon uninterrupted by buildings or power lines, the fly in my soup and ant in my bread is…normal.
Of course, I’m not saying that this “normal” is good or correct or best. Good Lord, some things in Uganda need to change, stat. Believe me, every time I return to the US, I feel like praising God that I can fill up my water glass straight from the tap, drink it, and feel reasonable sure that I won’t contract cholera.But I am less quick now to measure my Western normal up against the world I see out my window as I type this. I am less quick to judge something as “bad”, “under-developed,” “evil”, “dirty” and the like when my standard of normal is just not sustainable for this culture, country, continent, and the planet.
I’ve had to adjust my standards a bit about what normal actually is. But doing so has incredibly transformative. Frankly, I will never be the same.
Here is a reflection I wrote on human suffering and the broken body of Christ, written on 5/27/09. Sorry for the length….
Yesterday, we spent most of our time with the children at the hospice day care in Makindye. There weren’t very many because school is back in session, so the children that were there were especially sick, because they had to drop out of school. Gloria, who is maybe 16 or 17, has poor eyesight (a glassy stare), because of (what we think she described as) a tumor or seizure in the brain that impaired her basic functioning. Her motor skills or slow and she speaks rather slowly, even for a Ugandan. Another girl, whose name has escaped me, had a very deep, very phlegm-sounding cough, as well as a distended belly and pencil-thin arms. She told me she was 16 but looked about 11 or 12. Later stage AIDS? Hard to tell. I didn’t ask. Another little boy had one eye. Most were pretty active, most likely because they are HIV+ but are on ARVS, so they feel healthy enough. Except for Patience, who walks slowly with a crutch, due to a bad leg, or perhaps something more grave, as in neurological.
The daycare for children doesn’t consist of much programming, for better or for worse. Just a lot of sitting around, talking and joking with one another. For those who feel healthy, perhaps a game of football or catch. They speak mostly in Luganda, so it’s difficult to know what’s going on, but they all seem genuinely happy, easy going, despite their grave diagnoses. I’ve wondered what this sort of experience would be like in the US – spending the afternoon with dying children, children who are supposed to surpass me in years, but will likely die within the next 10. I’m not sure if the atmosphere would feel the same in America….I have a hunch that it would be pretty difficult, even though (or perhaps because) America has much better health care. In a place where sickness is the norm and medicine is not a god (or at least an unreliable deity), one must learn to live with illness better, or accept it as a normal fact of life.
In America, to be sick is to be a leper; few terminally ill people are seen in everyday life, just like people with disabilities. Their illnesses or malfunctioning bodies do too much to remind us of our own mortality and frailty, and in a nation so obsessed with the Baconian project of immortality, it’s best to shut up the ill and frail in institutions rather than allowing the incurable to teach us something that Amy Laura Hall describes as ‘embodied discipleship’ through caring for real bodies, bandaging real wounds, seeing real scars and imperfections on the human body, scars and imperfections similar to those witnessed by the disciples when Christ appeared to them in the Upper Room after his resurrection.
I saw a man yesterday with a gigantic hole in his leg, maybe an inch wide and an inch deep. Both legs were extremely swollen and he said he was in pain. When he pulled up his pant leg, my first instinct was to look away, as we are apt to do in America out of respect (or, more realistically, out of fear and revulsion). But this man, Richard, seemed to take comfort in our presence there with him, knowing that he could reveal his broken body to us without judgment or disgust on our part. There is some sort of imparted dignity, some sort of empowerment or respect that comes with witnessing the wounds of others. In my witnessing, I bear the pain and burden of the one who is sick. I begin to have compassion (which literally means “co-suffering”). The wounds of others are there and they are real, and I, a mere observer, am only a witness to that pain. But through that witness, I must come to grips with the reality of what I am seeing, rather than pretending to live in a world where bodies are perfect and suffering is nonexistent.
Jesus laid his wounds bare for us. St Francis, when he received the gift of stigmata, struggled with whether or not show his wounds to the world, though he eventually decided that they could serve to edify the Church. Mother Theresa, whose feet were deformed from years of wearing the cast-off shoes too small and ill-fitting for her (or anyone’s) feet, let her feet serve as a witness to her discipleship. I think there is a lot of mystery surrounding the physical healings that Jesus performed, but I think we can glean some meaning from the fact that Jesus didn’t heal everyone. The healings he did perform were, according to the author of John, SIGNS of God’s power, glimpses of heaven, of God’s intention for the world. But those left broken in body were no less loved and blessed by God. In fact, through Christ’s death on the cross, their brokenness has itself become a sign of God’s love for the world. Just as their bodies are broken, so was Christ’s, on behalf of the sinful world. Just as they experience the pain of mortality and falleness in their bodies, so Christ bared that pain in his own body, thereby redeeming human flesh through the incarnational mystery.
In no way am I trying to idealize suffering nor am I attempting to make it sound better or more holy than what it actually is. I do not want to minimize the need for good medical care, research, and institutions. But in light of modern medicine and ever-growing medical technology, we cannot forget the cruciform Christ, the body BROKEN for us on the cross and at the altar. Each time the Eucharist host is broken, we remember Christ and God’s saving work. Could it be, also, that when we gaze upon the wounds and brokenness of our fellow brothers and sisters, that we, too, can remember Christ? Could the suffering we experience in our mortal bodies serve to remind us of the suffering servant, our lord and master, Jesus Christ? Perhaps suffering is not an absence of God or a question of theodicy. Perhaps instead it is an opportunity to identify with Christ’s own suffering, for as Christians, the cross lies at the center of our faith.
Here some of the books I’ve read (or am currently reading). I recommend them!
M Scott Peck, Denial of the Soul (sort of cheesy and confuses spirituality with psychology a lot, but interesting anyway.)
Sheila Cassidy, Sharing the Darkness (talks a lot about l’Arche as well as hospice, and finds good parallels between the two. Forward by Jean Vanier)
Mitch A(?), Tuesdays with Morrie (I’d heard a lot about this and never read it because, frankly, I thought it would be cheesy. But it’s really good. A short, fast read. Very touching.)
Duncan, The Brothers K (One of my favorite books. I’m rereading it again. A lot of baseball references, but even if you don’t like baseball, like me, you will still find it great.)
I’ve had no experience with hospice in the States, nor any real, personal experience with death and loss (minus the death of my cats, which was surprisingly traumatizing). In fact, I have never even been to a funeral. So, of course, when I was asked to pioneer an internship at Hospice Africa, I felt completely out of my element. Strange to think that it is still possible in this world to have death and suffering not be one’s “element,” as we are all human and all destined for death eventually. I am realizing through my time here that the culture I grew up in was one both simultaneously afraid of death (to the extent of even denying its existence, especially in light of new, innovative medical technology) and obsessed with it (violent video games, gory movies, sky-rocketing gun violence, etc). These two tensions (with which Freud would undoubtedly agree) have done nothing to prepare me to think about or talk about death. let alone encounter people who are in the brink of it.
Taking a class with Dr Smith this last semester (Death, Grief and Consolation in Early Christianity) was helpful, particularly in helping to lay a good theological foundation regarding the Christian attitude toward death and grief. However, I still left the United States feeling inadequate (anemic?) regarding my understanding of death, particularly death from incurable (and often preventable) diseases like HIV-AIDS that have killed millions across Africa’s continent.
I still feel inadequate, but I think that’s why I am here: to learn more about hospice, palliative care, and end of life issues that are relevant not only to people here in Uganda, but people in Europe, North America, and around the world, as well. Death, the great leveler, has something to teach all of us on this planet.
As I said above, I knew very little about hospice before coming here, and I still feel somewhat “in the dark” about what hospice care looks like universally (i.e, it’s hard for me to compare hospice in Uganda with hospice in the US since I have so little experience with either!). But I am realizing that, too many Ugandans (most, I would say), ‘hospice’ is not a scary word. That’s partly because their requirements for hospice care are not as restrictive as they are in the US>. Back in North Carolina, if I was suffering from a terminal illness and hospice showed up at my door, I would know then and there that I had a diagnosis of 6 months or left to live. Perhaps some private hospice providers are different, but most that receive govt funding must restrict their care to only those patients who are close to death. Of course, it is possible to ‘graduate’ from hospice if your disease does not worsen, but eventually you will find yourself back in.
Hospice Africa in Uganda, on the other hand, is primarily focused on pain management, which means that anyone with a terminal illness, even if they have years to live, can receive care from hospice. Of course, those with HIV who are without pain do not necessarily receive care from HA, but that’s because there are so many NGOs here focused specifically on those patients. But HA does care for children with HIV who are on ARVS, as well as many HIV+ patients who have developed cancer and other diseases as a result of their diagnosis.
That being said, there are many patients here who have been receiving care from HA for 6 years or more. Some, as long as 10 years! I met a woman named Robeena who told me that she is now walking because HA was able to manage her pain. I believe she had a cancerous tumor in her leg which was operated on, but left her with incredibly pain, leaving her bedridden and unable to move. HA came in and taught her how to administer oral morphine, and she eventually moved from the bed to a wheelchair, and then a wheelchair to a walker. Though her diagnosis is terminal, she is living a fuller, richer life in her last days because her pain has been managed. And very often, if the pain is managed, patients will live much longer because they are no longer under such physical and psychological stress. It’s really amazing to see the correlation between pain management and extension of life.
Hospice Africa has over 80 hard working staff and many different aspects, including clinical and educational. They have trained thousands of health care workers, community volunteers and spiritual care givers how regarding end of life issues and palliative care. They visit people at their homes most days of the week and also host a day care when patients come to the HA compound to eat a meal, relax, and get to know other patients. They also learn basic crafts that they can use to support themselves, like bead making or mat weaving. They also visit patients in the hospital in the cancer wards. Denise and I spend a fair amount of time observing and being helpful where we can. Yesterday, I accompanied the staff social worker as she evaluated particularly impoverished patients who are receiving basic living funds from HA. The hope was the some of them would no longer need the funds because they were able to generate an income. We were in the slums of Kampala, and some the houses we visited were concrete blocks, as small as the average walk-in closet. One woman stayed in a tiny room with 4 of her children on one bed. I have never witnessed such poverty so close….only through the windows of my Uganda Studies Program bus or in pictures. But yesterday, I found myself in the thick of it…the flies, the urine-soaked drainage ditches, the moldy couches and children playing near steaming piles of trash, the desperate need. HA does much more than care for the ailing body. They are also attempting to lift some people out of poverty through micro-financing, and after what I saw yesterday, I am so thankful.
I have not found myself overwhelmed yet, though it’s hard to think about the fact that all of the patient friends I am making could be dead within the next 6 months, some…within the next week. “Welcome to hospice care,” Denise said to me when I made this comment. I guess this is the nature of the work. And, perhaps, everyone we encounter should be greeted with the same understanding that our lives our fleeting, and our present is precious. I read Tuesdays with Morrie yesterday (a fast read!) and appreciated the word of wisdom shared from a man dying of ALS. There really is something to be said about dying teaching you how to live. Many of the patients I meet are living their lives more fully than those healthy individuals I pass on the street. It’s a strange paradox. And one we should all ponder, I think.
Anyway, time at the internet cafe is running short. Tomorrow is Uganda Martyrs Day, supposedly a HUGE deal, so Denise and I are still debating whether or not we will go and brave the crowds at the stadium!! Always an adventure.
It’s raining outside, and we are set to start our long commute home, but since everything stops when it rains in Uganda (people here have no concept of the Portland-like way of going about business with total disregard of the constant rain), we thought we would get in some internet time here at the Hospice.
A bit more about the weekend: We left at 2:00am from our house after experiencing a insect plague of biblical proportions in our house. We had left the porch light on, which attracted the large, flying ants that come out of the termite mounds to mate. Well, they were creeping under the door, through the cracks in the window, and swarming our house in the wee hours! All Denise and I could do was turn off the lights, sit on the stairs, and wait for Fr Stephen to pick us up. So, we survived!
We went to mass with the children at the seminary and then headed out on our loooong trip. We loaded 150 students, plus priests and other teachers, on to two gigantic buses, complete with a tv mounted to the roof. Denise and I were subjected to incredibly loud rap, hip hop, and rock music videos from the states, and the kids knew all the words! The best one was probably the Creed video I remember from junior high. We told our seatmates that this song was almost ten years old, but they wouldn’t have it.
Of course, we stopped at the Equator and took some ’snaps’ (photos) and moved on to Kabale…..a 7 hour trip with many stops along the way. Then we made our way over and down beautiful green, terraced hills. This is why Uganda is known as the “Switzerland of Africa.” The place couldn’t get any more prestine. The locals have learned to farm on the hillsides and have terraced them in such a way that the landscape looks like a giant quilt had been thrown over gently rolling hills. We stopped at Lake Bunyoni and had dinner (rice and beef…the whole weekend). After getting terribly lost (we went 25 km out of our way) we finally arrived at the seminary where we were to stay the night, and received amazing hospitality from the priests there. I enjoyed a late night Nile Special and hit the sack at 12, only to wake up at 4am to be on our way again.
Then, off we went to Queen Elizabeth National Park, located north of Kabale. There is a stark contrast between the landscape of Kabale and the Rift Valley. After driving down an escarpment, you are in another world……a world that is flat and scrubby, with gigantic cactus-like trees and wild-looking ‘tooth pick’ trees with giant thorns. Many of the students had never traveled even out of their district, nor had they even seen many of the animals that we in the West have already seen in our own zoos. The belief that Africa is just roaming with wild game is a myth (or at least, it’s no longer true). Animals are restricted to certain areas and are not great in number, do to Idi Amin’s habit of shooting elephants and lions, etc., for fun. But numbers are replenishing. I often assumed that my Ugandan friends thought lions and elephants were old news, but just as many Americans have never laid eyes on a moose or a bear, they have never seen these animals, either. We weren’t able to see much, but we saw a fair amount of hippos and Cape buffalo on our boat lunch, as well as some antelope, waterbucks and elephants!
On our way out, we visited a salt lake, one of several and the largest in Uganda. Many of the locals, as well as people from other districts, harvest salt from this lake and sell it at market. A British man said he even saw salt from this lake in a grocery store in London. They have their own “plot” or pool made out of mud and stones and filled with the salt water through an irrigation channel. The salt harvesting process looks extremely arduous. Much of it involves sedimentation and enduring long, hot, dry days that that the water evaporates, leaving the salt behind. Rock salt is harvesting from the largest pool and people must immerse themselves in the water up to their chest and break apart the rock salt from the bottom with their feet, which they then place on floating rafts to bring to shore. I saw children and men without shoes carrying what looked like very heavy slaps of concrete on their backs and loading them into trucks. Turns out those heavy slabs were salt slabs…..salt before it is processed. Strange and interesting. Every time I pick up a salt shaker, I will remember that experience.
Then we moved on from QENP to Fort Portal, another beautiful part of Uganda, where the majority of Ugandan tea is grown and harvested. We drove by acres and acres of green hills covered in tea plants. There are a few processing factors in FP, but not many, hence Uganda must export much of its tea to Kenya for processing. If you ever buy a box of Kenyan tea, it’s most likely you are actually drinking Ugandan tea, even if the label doesn’t say so. We stayed at a beautiful “major seminary’ (the equivalent of ours in the US in terms of age) and I enjoyed a nice, hot shower and some delicious food. But my sleep depravation put me to bed early and I slept like a log.
The next morning, after a few historical sites (including the place of the Toro king, who came to power when he was 3.5!), we made our way home. What an enjoyable, albeit CRAZY trip. I can’t wait to head back to the seminary sometime this week and talk with the friends we made on this trip. They are a riot. And I can attest that teenagers in Uganda are not unlike teenagers in the US. I heard American slang (“dude!” “awesome” “totally cool!”) all weekend!
Until next time,
Heather
We are back from a crazy trip to the western part of Uganda with 150 Catholic school boys. I have a lot more to say about this of course but time at the internet cafe is running low. We were able to see, in my opinion, Uganda at its best, including Kabale, Lake Bunyoni, Fort Portal, and Queen Elizabeth. Of course, we also snapped a picture at the equator!! We saw elephants, hippos, and cape buffalo, and ate a lot of rice and drank beer with Ugandan priests. Can’t complain! More soon…..
Heather
Denise and I have landed in the Pearl of Africa. We arrived safely after a 26 hour journey that took us from RDU to Newark (we were able to reroute our trip directly in New Jersey and skip Charlotte, thankfully) and then across the Atlantic to Amsterdam and then on to Entebbe. We were very tired when we arrived and had to wait a fair amount at the airport, to verify that we didn’t have swine flu and to receive our visas/passports. But Fr Stephen was waiting for us and we were so thankful to finally meet!
Our house is lovely….Bethany House in Entebbe. We have a breath-taking view of Lake Victoria, which is only about 1/4 of a mile way, from the look of things. The sun rises over the lake in the morning which is an amazing view. The sky at night is filled with bright stars, more than you’ve ever seen in your life. And you can see the Southern Cross and the Big Dipper at the same time, as we are on the Equator. The night is filled with exotic bird calls, peepers and bullfrogs on the lake, the buzz of mosquitos and lake flies, and some howling stray dogs that live down the road. These noises are what I missed the most when I left Uganda five years ago (well, maybe not the howling dogs). Bethany House is very spacious. Denise and I share a room, but there are three other bedrooms for guests traveling through. I believe Dr Emmanual Katangole will be staying there in June and then David Toole (also from Duke Divinity) will be arriving next Wednesday. We have a large kitchen and a nice living area. And, drum roll please, HOT WATER (though it takes a bit of time for it to actually turn warm). This experience is definitely different from my previous experience in Uganda, living in a very small dorm and sharing a bathroom with 11 other women!
We reside in Entebbe, which makes the trek to Kampala a bit of a hike. We walk about 1/2 mile to the main road to hail a matatu, and then we drive along the Entebbe-Kampala road for about 45 minutes to Uganda, with many stops along the way, and then we get off, walk along a very busy road in Kampala, cross the street, and hail another taxi that takes us to the hospice. So, that’s almost a 1.5 hour commute! We have a wonderful house, but we are considering some closer housing that will allow us to commute a shorter distance. We will see how it all shapes up.
We had a wonderful experience at the Hospice but I will need to write more about that later. Currently, we are at Fr Stephen’s seminary using the internet and they just rang the lunch bell, so we must run! Hopefully, more about the Hospice tomorrow!!
Blessings to all,
Heather (and Denise)
…’till it’s gone. I know I’m going to get to Uganda, with the slowest internet connection in the world, and want desperately to update this blog. And yet, here I am soaking up highspeed, yet I haven’t updated this thang since March 30th! Oye. Anyway, lots of packing the last few days (or, to be honest, yesterday). Same story — I don’t get motivated until the last minute when a burst of stress and immediacy prompts me to get things done. I am my father’s daughter. Speaking of daughters, I’m going to miss everyone terribly, but it will especially be hard to leave Tennyson, mainly because babies grow so darn fast. We were looking at pictures of her when she was three months old and she looks entirely different. A whole new set of skills, a whole new curiosity (instatiable!), lighter hair, bluer eyes. We all predict that she will be walking when I return from Uganda. Walking! That’s what real humans do! And then she’ll start speaking and driving a car and dating boys and that’s the end of childhood. Babies are so sweet, even Tennyson so is a sour apple sometimes. But even when she is sour she is sweet. Anyway, I will blog more reflectively later today/tomorrow. I fly out on Saturday and arrive in Uganda on Sunday. I will be in the air a total of 24 hours, due to all of the layovers. Not really interested in that. But I AM interested in sinking my teeth into a delicious Ugandan pineapple. The best in the world!
