on changing the world

I wanted to change the world. 

During undergrad, a group of my friends started cooking "downtown dinners" - a weekly collaboration of boiling excessive amounts of spaghetti and warming marinara sauce (or on fancier nights, making minestrone soup). We took the food to a courtyard in downtown Gainesville where those who were chronically homeless tended to congregate. The point of the evening was to talk to those who had come to eat. To hear their stories. To listen. 

Being there was hard. It is tough to take in the stories of how someone becomes homeless. It is tough to face the societal issues that underscore these stories: systemic racism, unequal education, untreated mental illness, substance use, trauma. Each week these stories would come out - sometimes cohesively, sometimes shaped by paranoia, loose associations, and angry outbursts. We would listen.  

I don't think any of us were under the illusion that we were making a difference. After three years of these dinners, little changed in the lives of those we sat beside each week. Miss Mary and her collection of mangy dogs still lived in a decrepit tiny house without running water or electricity. Ed kept pushing his shopping cart full of garbage, telling anyone who listened about his mother who had been stolen.* Even though we knew we weren't changing anything, we still showed up each week with pasta in hand. 

A decade later, I found myself working on Skid Row** in Los Angeles during my HIV fellowship. For a year, I took care of the sickest and poorest people in this country.  Most were not housed; for those fortunate enough to be sleeping under a roof, that housing was generally not stable.  For a year, I followed a panel of patients for whom HIV was negligible in comparison to their daily battles for food and shelter and against addiction and mental illness. At the end of our year, my co-fellow and I reflected on our time there: for almost all our patients, little had changed.  A couple patients managed to secure housing. Many more had disappeared from care, lost in the throws of addiction or incarceration. One was murdered. Most are still in the same struggle simply to survive. But we were there. We fought for them to get the medical care they needed.  We listened to their stories. We let it shape our own. 

Now I work in the wealthiest county in America, where poverty and homelessness remain invisible behind the wealth that saturates the Silicon Valley.  Many of my patients are homeless, or will be once they are released from jail. I know that the thirty minute encounters I have with my patients are never going to be enough to undo the injustices in their lives. I can choose the best medicine and carefully explain their health conditions in terms they can understand. But the reality is they leave their visit with me and return to worlds I can't imagine.  Whatever love and compassion and patience I put into our encounter, it can't undo the crack their mother may have smoked while she was pregnant, or the multiple foster homes they were shuffled between, or the gang that was the first place they felt accepted, or the meth addiction that fuels cycles of incarceration, or the criminal charges that unfairly limit future employment and housing and the right to vote. 

There are millions of places of brokenness in this world, and as Sarah Kay so beautifully puts it: "No matter how wide you stretch your fingers, your hands will always be to small to catch all the pain you want to heal." 

I've stopped wanting to change the world. I still seek out the places that are broken, where injustice seems to have won. I still sit and listen and ask the questions whose answers will break my heart. But I don't go to change anyone, because I can't. I go because God is there. I go to love.  

I got a text this week: you saving the world today? 

Nope, never saving the world. Just trying to be love, and praying that in this world that has gone mad with violence and hate, that Love would be what saves us. 

*his mother had not, in fact, been stolen. We did track her down; she was living in a nursing home, trying to recover from the strain of years of caring for him and his profound schizophrenia. 

**yes, this is a real place. 

offering hope

The most common question I get asked when I am seeing a patient who was just diagnosed with HIV in the emergency department is: am I going to die? 

Over and over, I offer reassurance: this is not a death sentence. 

Even to the sickest of patients, I still reassure: this isn't a death sentence. Throughout this year, I've seen people on the edge of death because of complications from undiagnosed HIV. They have severe pneumonia, brain infections, meningitis, or cancer. A handful have had single-digit T-cell counts (normal is around 1000; AIDS is less than 200), and they still manage to survive. 

Recently, a young man came to the emergency room with severe pneumonia like so many others I have seen this year. He was diagnosed with HIV in the emergency department. His T-cell count was 10. When I met him, he begged me to tell him that this wasn't a death sentence. I reassured him that even people with low T-cell counts can start treatment and live long healthy lives. Nothing suggested he might not survive. But things took a turn for the worse; he died a few days later. At age 38. Within 2 weeks of his HIV diagnosis. 

I felt terrible. Because I reassured him that this wasn't a death sentence. Because by itself, HIV isn't. Even with pneumonia like his, it almost always isn't. For him, it shouldn't have been. I hate when patients are given false hope. I felt like I had lied to him.   

Last week, another patient came in. Instead of pneumonia, he came in because he was confused and weak. In addition to being newly diagnosed with HIV, there was a huge mass in his brain. This time, I knew that the odds of his survival were probably low. Like everyone who finds out they have HIV, he begged me to tell him he isn't going to die. I struggled to find the words. We don't know yet exactly what is in your brain. It's probably cancer, and it's probably not good. But no matter what, we are going to be here and take care of you. He died eight days later. 


Most cases of HIV that are diagnosed in the emergency department are not this severe. Most are people who came to the emergency room for something minor: an abscess, a stomach bug, a cold. Because an HIV test is ordered for everyone, it is discovered. 

In these people who are otherwise well, I struggle with how to offer reassurance without minimizing the realities of living with HIV. Because it isn't a death sentence. Because there are amazing treatment options available. Because most people with HIV live long, healthy lives. Because most people with HIV in this country die from something other than HIV. But it still is a life-changing diagnosis, and those promises of health are contingent upon rigid adherence to a combination of medications. There are still losses to grieve. Life won't be the same. But just because life won't be the same doesn't mean it can't still be beautiful.   

healthcare privilege

The first time she stumbled into our clinic on Skid Row, she was on the brink of death. A huge wool coat hung over her 83-pound frame even though it was 90 degrees outside. Thrush crawled out the corners of her mouth and over her lips. She'd been in the ICU last month; she never finished the antibiotics for the AIDS-related pneumonia she had. Now her cough (and every other concerning symptom possible) was back: 

Her blood pressure was 86/40; there was no choice but to send her to the emergency room. We gave her a liter of IV fluids while waiting on the ambulance to come because we knew she might wait a while to see a doctor once she got to the hospital. The wait to be seen by a doctor at LA County Hospital can range anywhere from 8-36 hours. We hoped that sending her by ambulance might expedite things. Sadly, it was almost 24 hours before a doctor saw her, and 28 hours until the necessary chest x-ray was done. The previous pneumonia was still there, though slightly improved. She was released the following morning after a couple doses of IV antibiotics, back to the court yard on Skid Row where she slept. 

Martin Luther King, Jr. said, "Of all the forms of inequality, injustice in healthcare is the most shocking and inhumane." These inequalities become more glaring when I find myself on the privileged side of healthcare. On the same campus where LA County Hospital sits, half a mile down the hill, is a smaller private hospital. Recently, I found myself having to access their services.

I was sent from my doctor's office to the hospital's equivalent of an emergency room. It was less than ten minutes from when I checked into the emergency department until a doctor saw me. Over the weekend when I felt worse, the on-call doctor sent me back to their emergency room. Within thirty minutes, IV fluids were running into my dried out veins. And two days later, when it was finally clear I had to be admitted, it took under an hour to transfer me from my doctor's office into my room. 

Beyond the speed and access to services, I carry additional privilege: speaking the same language as my doctors, having the knowledge to ask questions about my treatment, and being able to read the prescriptions I was sent home with (and a home to return to). 

I struggle with this privilege. Because there is no reason my patient should wait 28 hours for a chest x-ray, when in that same amount of time, I made it to a room, saw the medicine team taking care of me twice, and watched 17 episodes of Friends on TBS. Though our country is trying to lessen these disparities with things like Obamacare and the expansion of Medicaid, we still have a long way to go until everyone has equal access to healthcare. Until then, I'll keep fighting for my patients to get the care they deserve. 

p.s. - in case you were wondering, my patient is doing great. She is now on HIV medicines, has gained 40 pounds, has been living in a medical-transitional housing unit, and will be getting her own place next month after 28 years of living on the streets. 
and i'm doing much better too. :) 

Christmas candles

The recent losses and outcries for justice in Ferguson and New York hit close to home because twice a week I work in the Los Angeles County jail, caring for men who were fortunate enough to survive their arrests. Most are young black men, who are arrested disproportionately compared with their counterparts of other races. 

I never ask my patients why they were arrested. 
Instead,I ask: what are your goals? 

The answers are humbling:
I'm taking classes so I can keep custody of my son. He's nine months now.
I want to have my own Christmas tree someday.
I'm gonna open my own accounting firm; I only need six more credits to finish my degree. 
I want to be a hairdresser. I have a lot of sisters; I'm really good at doing hair. 
I've never walked on the beach with my friend; I want to do that someday. 

So as Christmas comes, I light candles:
A candle in memory of the lives who have been lost. 
A candle for peace, that there would be racial healing and justice in this country. 
A candle of hope, that these men will get the chance to live out these dreams. 

Wishing you a new year filled with hope and peace. 

you can't give hugs in jail

First, some background: 
The LA County Jail is the largest jail system in the country (and possibly the world). It is made of up 9 different facilities that house 15,000-20,000 inmates at any given point in time. 

Men's Central Jail is one of these 9 facilities. It can house up to 5,000 inmates. It is located on the northeast edge of downtown Los Angeles. Five percent of the inmates in Men's Central Jail have known HIV. I work there 2 days each week providing HIV care.

To enter the jail wards, you have to go through a sallyport (aka cage) - where you enter through one gate, which closes behind you, then wait until the second gate opens into the ward. It's a little intimidating. 

I was given a couple pieces of advice for working in jail:
1. Wear pants. (Pants as opposed to my usual dresses. Not pants as opposed to nothing.)
2. If you get lost inside, don't wander. Just fall to the ground and start shaking. A security camera will eventually see you and send help. (I have yet to need this.)

One of my first patients was a young man who recently moved to LA (as always, details changed to protect privacy). He found out he had HIV a while ago but hadn't seen a doctor yet. Despite violence in his family growing up, he'd come far in life. He was credits away from bachelor's degree and had plans to open his own company. He was well-educated about HIV and what it meant when someone had progressed to AIDS. But that knowledge didn't prepare him for the fact that his infection had gone that far. So this beautiful boy, who I'd already invaded with personal questions and now broke crushing news to, started to cry. Because he hasn't lived a quarter of a century and already has AIDS. Because whatever hope led him to LA has been derailed by incarceration. Because his momma sits across the country and has no idea her son is in jail or that he has been living with HIV. 

In any other setting, I'd reach out and touch him - place a hand on his arm or pat his shoulder or offer a hug. But you can't give hugs in jail. So I willed my eyes to speak what I couldn't communicate with touch so he would know he is not alone. Over and over, I reassured him: this is not the end. things can get better. you can get better. 

He was released the next day. He knows where to find the clinic where I work. I hope he comes. I owe him a hug.  

taking in stories

It's crazy to think it's been more than a month already. There is a lot of HIV in LA. I have spent a lot of time listening. I have taken in a lot of stories.

(billboard on my drive home each day)

The stories start to run together. It's not that they are the same - it's just that there are so many:

A woman who was diagnosed while she was pregnant. She told her oldest child but still doesn't know how to tell the young ones. 

A father who didn't want to spread his cough to his baby girl, so he came to the ER to get checked. Now he asks if it's safe to hug her ever again. (yes, it is.)

A woman who was raped while she was crossing the border. Her child and family are still in Central America; she hasn't told them what happened. 

A grandmother who needed a blood transfusion years ago. 
A traveler from Europe who felt sick during his vacation.
A rapper with big dreams who ended up homeless and addicted to drugs.

People who have fought HIV for years, and people who found out only minutes ago. 

People in good relationships and bad ones. 

People who sleep on the streets and people who live in mansions.
People who laugh and cry and fight for life with a resilience I'll never know. 

A lot of the time, the sorrow of these stories is overwhelming. And despite huge advances in medicine, having HIV is difficult - whether it is the hurt or shame of how it was acquired, or the discrimination that those with HIV still face, or isolation from family, or struggling to break free from the addiction that led to becoming infected, or being unable to work due to illness, or simply having to remember to take medicine every day from now on. I'm still figuring out how to take it all in, how to keep listening, how to keep offering hope. 

"Compassion asks us to go where it hurts, 

to enter into the places of pain, 

to share in brokenness, fear, confusion, and anguish." 

-Henri Nouwen

new job, new pager

I started being on-call for the emergency department this weekend. LA County Hospital(LAC+USC) has a HUGE emergency department. I am told they see 180,000 patients each year (compare to Allegheny General Hospital ED which sees 38,000 patients per year, and Temple that sees 130,000 per year). The wait to be seen ranges from 12-36 hours.

Every patient who comes into the ED receives HIV testing (unless they opt out). When someone is newly found to have HIV, I get called to go talk with the person. Sometimes this involves telling them their diagnosis if no one has told them already; mostly it involves talking about what that diagnosis means and connecting them with our clinic. I think I am a bad luck charm becaues I was called about 4 new patients in the first 24 hours.

Not everyone comes in suspecting that they have HIV; in fact, most don't. They come in with coughs and headaches that have gone on too long, only to find the underlying thing causing their symptoms is not only HIV but AIDS.

My first patient (details changed to protect privacy) was younger than me, but life had been unfair. He'd been living on the streets, earning money however he could - even if that meant doing things he didn't want to do. Drugs made doing these things easier. He suspected for a while that he might have HIV, but couldn't find the courage to be tested until now. After 20 hours of waiting, he had his answer. So at 5am, we sat and talked in a quiet corner of the chronically-overcrowded ED. He spilled out stories of his life; of trauma; of how he wants to live now. We scheduled an appointment at our clinic. He'll start treatment. He'll probably be fine. Or at least his HIV will. Most of what he carries, I can't fix. But I can keep hoping for him.  

(view of downtown LA from LAC+USC)

 

the i-don't-knows

i have answered "i don't know" no less than 286 times this month when asked details about moving.

some have been logistical questions that finally have answers:

where will you be living?

monterey hills (east of downtown LA)

have you packed?

finally, yes.

what will you be doing?

it's an HIV corrections fellowship.

i'll be at LA County Hospital's HIV clinic, the LA county jail, and a clinic on Skid Row.

yes, Skid Row is a real place.

yes, I said the jail.

yes, my mom is nervous.

will you miss pittsburgh?

YES!

a lot of questions are more complex, and i don't have answers. i have no idea what to expect. i don't know what it will be like working in a jail. i don't know what my patients will be like or how i will fill my days. i know data and statistics about hiv and jail and homelessness, but i don't know anyone's stories yet so i feel at a loss.

the good news is, i've done a lot of things before where i haven't known anything other than facts:

i moved to swaziland knowing only the perinatal hiv rate (42.6%) and the number of orphans (100,000 of a national population of one million). what i found were amazing friends like zandi and jabu who taught me what it is to hope.

i worked in alaska for a month at a native alaskan hospital. i knew rates of alcoholism and domestic violence were horribly high, but it wasn't until bruised women shared with me their stories did i start to understand.

so now i start this next adventure with all of my not-knowing, and am waiting for the stories to begin.

"instructions for living a life:
pay attention.
be astonished.
tell about it."
-mary oliver

world aids day

remembering these beautiful women today: 

 

and, as always, praying that hiv would end. soon.

changes

"Africa is never the same to anyone who leaves it and returns again."
Beryl Markham, West with the Night

 

i knew when i left swaziland things would be different when i returned. bulembu has changed. a daycare that i imagined has now come and gone. but now, she is gone too.

 

and now, the thought of returning makes my heart ache. without her, i feel like i will be a visitor again rather than one returning home. i feel i will be starting over, a wide-eyed white girl who has to prove herself. without her, i feel that swaziland is irreparably changed for me.

 

but more than how swaziland will change, i wonder how life here will change.

 

i worry that without her telling me she can't afford the CT scan she needs, i'll take for granted the health care dollars i consume to get the right medications and see specialized doctors and monitor my blood levels.

 

i worry that without knowing she needs new shoes, i might buy the shoes i want without thinking.

but most, i worry that without her, the hundreds of thousands of women in sub-saharan africa who fight HIV will become a nameless, faceless mass. i need her stories. i need to know there are days she can't lift her head and the nearest hospital is a 3-mile walk followed by a 15-mile bus ride away. i need to remember the hungry children she so beautifully cared for. i need her so that my heart stays soft, so that i continue to pray and give, so i don't forget how much bigger the world is than just me.  

 

when there aren't words

i read the message twice: she is unable to speak right now. please pray now.

i knew zandi had been getting progressively sicker, the blood clot, the t.b., the hiv all summing to struggle for survival.

as i read the message, my mind flashed back to seven years ago, to another friend who couldn't speak. that time, we wheeled my near-lifeless friend jabu in the same hospital where zandi was now. jabu miraculously survived that day. when she described it later, she said: i couldn't open my eyes, i couldn't speak. but in my heart i prayed "lord, extend my days." and he did. i will never forget what the lord has done for me.

and so for zandi, who couldn't speak, my own heart cried out: god, extend her days.

only this time, god did not.

this time, another 3 children joined the 100,000 orphaned children in swaziland.  this time, a grandmother added 3 more grandchildren to her home; she already was caring for the 2 children of her daughter that died of AIDS last year.

this time, the world lost a woman full of life and hope and strength.

this time, i lost a friend.  

"precious in the sight of the Lord is the death of his saints."

-psalm 116:15

pray with me. please.

"no matter how wide you stretch your fingers, your hands will
always be too small to catch all the pain you want to heal."
- sarah kay, "if i should have a daughter"

over and over i'm reminded of how powerless i am across an ocean.

for months we were inseparable, wandering the hills of a near-abandoned town that previously thrived from its now-closed absestos mine. she taught me to quickly drink a can of coke after eating bad meat so the acid will hopefully kill any bacteria (i don't know if this actually worked). she built a fire to keep me warm when fever and chills left my teeth chattering and body shaking. she fed me swazi comfort food as i recovered from a crazy parasite (fyi - soured milked poured over maize meal is not a comfort if you are not swazi). she sat next to me during my first swazi funeral, translating all that was happening despite her own need to grieve. she dragged me over a mountain so we could play in a beautiful hidden waterfall. she brought me fresh donuts from the bread truck on my last morning in swaziland. 

now her places of need grow larger by the day:

...it's a bad headache. they say i am lacking blood...
...i'm losing my job, we are shutting down...

...i made it to the hospital in the capital but it was not easy to walk there. there is a blood clot in my leg. the doctors put me on a medicine called coumadin. i need a c.t. scan but it is very expensive. praise god it was not a stroke...

...the people of this town, they have no mercies for me. they want rent for the house while i have no work and am sick... 

...i trust god won't test me with something i cannot handle... 

my heart breaks over again with every message. i spread open my hands trying to catch her pain. i send out frantic emails until i find an expat who i can send money to that can get it to her. i cry out prayers and tears and beg for her to be healed. i message words of love and put airmail stamps on hallmark cards but her pain deepens.

and so...can you pray with me for zandi? for healing. for a job. for hope. for her amazing faith to continue to strengthen her. and as always, for hiv to end. soon.

hope without healing

honored to be here today:

I first read about Swaziland when I was eight. I learned a few key facts: Swaziland is surrounded by South Africa (I know you were wondering where it was), it is ruled by a king, and there are no lions there... (keep reading)

what death looks like here

"Public health is the art and science of deciding who dies,

when, and with what degree of misery." - Bill Bicknell

Swaziland, December 2005
she'd been sick for a while, sent home from the government hospital because they had nothing left to offer her. HIV and t.b. combined forces to drain the life from her body. she spent her final days at her homestead, with her momma, sister, and baby boy at her side. her last night on earth was spent singing and praying. she offered up prayers of forgiveness - for the one who gave her the virus that took her life and the life of their firstborn child. my friend tells me she was at peace and that was why she could die that day. she was 27.

United States, May 2011
he'd been sick for a while. cancer and age and recurrent infections numbered his days. he spent his final days at a long-term care facility, his life sustained by machines. his heart stopped on three occasion during his last night on earth. two of those times it was forced to beat again with the help of electricity and chest compressions and chemicals pumped into his veins; ultimately, his 80-year-old heart refused to beat any longer. 

one of these deaths was inevitable. one was preventable. one called on every bit of science and technology available; the other called out to the heavens. one was alone in an ICU bed, with doctors violently attempting to bring him back to life. the other was surrounded by friends and filled with peace and acceptance. 

i know that you can't put a cost on a human life. i know we don't get to decide who lives and who dies. but i struggle with how we can spend millions of dollars to extend a life by months while not spending the hundreds of dollars that would extend a life for decades. i hate how being born on the wrong side of the equator with the wrong color skin means your life might be thirty years too short. i hate the days i go to work and order tests and medicines that will only sustain a person with a terminal condition for a few extra days. i hate that my inbox fills with messages from swazi friends who can't get to doctors or can't afford medicines for things that are treatable. i hate living between these two worlds, of seeing the injustice and disparity. i hate the powerlessness - both in futily treating terminal conditions in order to honor a patient's wishes and in being unable to treat curable conditions in those without choices or options.

it's not fair.

i can't do this.

i can't have my heart break across an ocean.

i can't hear that she's sick. i can't hear how there's a special doctor that she can't afford. how she can no longer work. how she lays in her house helpless. 

i have so many questions for her. questions i ask my patients every day. when did this all start? where does it hurt? what makes it better? i need to know what is going on.

my mind reels...i count all the kinds of headaches that can kill you when hiv has invaded your body. she can't have one of them.

she tells me what medications they've given her. clearly they aren't working because she feels like she's been cut into four pieces.

if she were here, everything would be different. there are blood tests and ct scans that could tell what this is. there's a prescription pad in my pocket that could fix this. but she's there.

anger wells up because it's JUST NOT FAIR. 

why is she there and why am i here and why is life always so hard? why do i get a hospital bed for 3 days for a pneumonia that would never kill me while she keeping walking on red earth as her blood counts continue to drop and her body crumbles in pain? why does she have the technology to message me updates in real time, yet she still wastes away from a treatable, preventable disease? what if they can't fix this with their limited resources? what if she has to wait too long? what if i don't make it back to see her in time?

my heart cries out, how long, o lord? and as always, may hiv end. soon.

The nearest hospital, Piggs Peak Government Hospital

one of those days

"i think part of the struggle just of everyday life is

remembering that the love is there...to wake up in
the morning and realize that love is there in the world -

if i can do that, that's half the battle." - kathleen norris

i was grumpy. and exhausted. and sick.  and i had an out. 

but i was also stubborn and trying to prove i wasn't that weak, and i said i would go see patients in clinic that afternoon anyway.  then take a sick day tomorrow. 

i regretted that decision as soon as i walked into the building.  it hit me how very tired i was. how i could be home napping instead. but it was too late now.  oh well.

the first chart i grabbed wasn't that heavy. i figured it would be an easy patient. until i realized that this was chart volume 2.  i scanned the face sheet: hiv. bone disease causing 2 hip fractures. cancer. depression. chronic pain. neuropathy. 

as i was heading down the hall, the nurse practitioner gave me a heads up: he just got a new electric wheelchair. and he cut his hair.

i walked in the room, expecting someone grumpy and bitter and sick.  instead, he was smiling. 

how are you, i asked. honestly, i think this is the best i have been in my life, he said. 

how is the pain? it's there. but i have this new wheelchair and it's totally opened up the world for me. i can go places now, i don't have to sit in my apartment. i may try to take a computer class at the senior center soon. they offer them sometimes.    

i hear you cut your hair?  yeah, i donated it to locks of love. i wanted to give back. i smiled inside, wondering what kind of wig would be made from middle-age, graying, ex-hippie hair.

the attending physician came in. we talked some more, sorted out some medicines, set up follow-up visits.  at the end, the attending prayed with him: god, we thank you for the blessings you have brought in this man's life, for his health, for your grace.

i cringed inside.  blessing? very little of his story felt like blessing.  but he took those small moments - leaving his house without the pain of walking and giving away his hair - as gifts.  and i was humbled...because i know there is sickness in my body too. there are limits and exhaustion and fevers and feeling like i am missing out on life and worry that these little symptoms now could be harbingers of a coming disaster. but there are moments of grace too - people that notice when i need a day off, sunflowers blooming on my walk home, sisters who don't care if you use their popcorn maker, dinners with friends, and patients who remind me to name the good in my life.

on healing

do you think god will heal anyone who asks and has faith? my sister asks me. 

me, who witnesses sickness every day in the lives of my patients.
me, who lived in the nation with the highest hiv rate in the world, who buried friends before they reached age thirty because they were born in the wrong place as the wrong gender.
me, who carries sickness in my body every day. 

if the answer to her question is no, then why pray?

and if the answer is yes, then where have my prayers for healing gone? why do my swazi friends still fight HIV despite their prayers (and lives) of faith?  why does my body still feel like it's breaking even though i have lit candles and cried out, "how long, o lord?"

i don't have an answer for her question. i only have a story, one i re-tell myself in the moments i feel faint:

i met jabu shortly after i arrived in swaziland.  her name means "happiness" and that is what she was.  she got sick quickly though as HIV spread through her body.  she shuffled slowly down the hill as if every step took all that she had.  she seemed to get smaller every day.  soon, she just stayed home. 

i stopped by to visit jabu one afternoon, like usual.  only this time, she was barely moving, barely opening her eyes. her mom stood fanning her, trying to move the heavy african air across her feverish body.  we lifted her into the car and sped across the 30km of curving dirt roads to the nearest hospital.  by the time we got there, she wasn't opening her eyes at all.  her blood pressure was unreadable on the archaic cuff they used to measure it, barely palpable.  the doctor looked at us sadly: we have no beds left. and there is nothing we can do anyway. 

 we begged for them to keep her, knonwing if we took her home, she would surely die.  knowing too that if she stayed, she would still likely die.  the doctor finally caved, offering the floor under the bed of another patient.  we left her that night, her tiny body on the floor under the bed of another dying woman.  chickens walked past her spot on the floor.  a meager bag of IV fluids hung - the only attempt at treatment offered for her. 

the next morning she could open her eyes, and was discharged to home.  miraculously, over the coming weeks, jabu regained strength and life. 
we were sitting on her bed one afternoon, laughing and talking. i asked her what happened that day when we thought she would die.  she answered: i was lying there, and i was flat. i couldn't open my eyes, couldn't speak. but in my heart, i prayed "lord, extend my days." and he did.  i will never forget what the lord has done for me.  

she never forgot. she never stopped praising. one month later, jabu went to be with the one who had heard her prayer and extended her days. i'm pretty sure she's still singing her praise.

why i hate missions

a letter in the mail, penned across an ocean.  i know it is filled with words of grief.  recently, her sister lost.  but her words of loss go deeper: the leaders are fighting with the donors, and they are no more sponsoring our town. 

it was a town imbalanced from the beginning.  built up the sides of two juxtaposing hills, the potential for rifts and separation is always present.  i don't know what happened here before the british colonists, before the asbestos mine opened in 1939.  i do know that the mine owners and skilled laborers built beautiful houses on the higher of the two hills.  and i know the unskilled miners were allotted small mass-produced homes that were packed onto the side of the smaller hill.  those who lived there at the time tell me it was split black and white, with the swazis getting the short end of the stick. 

as if colonialism (further tainted by apartheid spilling across the south african border) wasn't enough, the town took another blow.  the mine closed.  initially only portions of the mine closed.  then in 2001 it completely closed (likely due to the world-wide awareness of the dangers of asbestos). workers were told they had 24 hours to leave. so jobless and homeless, they scattered.  the town was abandoned.  textbooks left in school desks, the night's assignments still on the chalkboard.  hospital wings lined with beds and posters describing treatments for tuberculosis.  houses with large pieces of furniture, dishes, anything that couldn't be carried.

for four-ish years, the town sat empty.  the surrounding villages fell into further poverty, cut-off from the only local economy.  and hiv swept through the country, reaching even these abandoned places with further destruction.

a christian missionary with a vision saw this abandoned town as a place to breathe life into a dying nation. valley of hope, he named it. he relocated several missions groups there: a home for abandoned babies. a church-building company. a school. a clinic. food donations. a continuous stream of short-term mission teams from the united states eager to renovate the abandoned houses to become foster homes.  

it was imagined as a microcosm of good.  but there was fighting. there was racism and elitism that lives in our hearts, that comes out even in the places we are supposed to be loving.  a similar split to the old mining days occured, this time with white christian missionaries in the beautiful houses on the higher of the two hills.  it took a few years, but that organization crumpled.  another one quickly took its place.  this one continued many of the programs already started, and added some of its own, including a dairy farm and bakery in hopes of creating a sustainable economy.   apparently, there is fighting again, and a withdrawal of funds that empties the economy of this mal-developed town.

which brings us to now.  to zandi.  who lived through the closing of the mine. who was employed then unemployed by the first mission organization.  then employed again by the second. who now sits in uncertainty again, yet still fiercely believes in the god in whose name all who have destroyed her town have come. 

i don't know what to pray for this town that has changed my life, to this town that angers me yet taught me hope.  i don't how to end this, so i close the same way zandi closed her letter:

I said in my heart, God will judge the righteous and the wicked,

for he has appointed a time for every matter, and for every work.
-ecclesiastes 3:17