Sunday, April 19, 2009

A Closed Reduction and Renewed Mind in Kigali

A wide load on the road to Kigali. These can be quite hazardous to pass.


As I begin this blog entry, Sunday evening, I am seated beside David who is watching a Baby Einstein video (Baby Mozart) on half the screen so that he won’t scream while I try to get down all that happened this week on this blog. I have put it off to the last possible minute, not because I have little to say, but because I simply have too much!

For those who hold by superstition, Tuesday did prove once again to be a day of trial for us, but it did include a true blessing as well… but let me not get ahead of myself here.

We had been looking forward to this week. After several busy and difficult weeks, we felt we had earned a 3 day vacation and had planned to go to one of the forests in Rwanda to hike around and see some wildlife. Oren was on his second week of spring break, making it difficult to do much office work anyway. We planned to combine this diversion with a necessary visit to partners in Rwanda: driving up on Monday, business on Tuesday, vacation Wednesday through Saturday.

First thing on Tuesday, we met with partners at Friends Peace House. African-style meetings involve starting with relational conversation before getting down to business. April is a month of mourning in Rwanda, as people remember the 1994 genocide. We had a very meaningful conversation with them about changes they see in this 15th year of commemorating the genocide. They felt that at this point, there was a real opportunity for survivors to extend forgiveness, and offer offenders a key to unlock the prison of shame and guilt they still are trapped within. It was wonderful to hear their reflections on actions they themselves have taken as survivors. An hour later we got down to signing checks ;-). I’m glad our job involves both the personal and the practical.

After that, we squeezed in a trip to the bank, priced appliances for our incoming workers, and shopped for personal items not available in Burundi. At 5pm we had accomplished just about everything and realized we had time to run over to the hospital to have Oren’s cast removed. The doctor who set the bone in Kigali had told us a fracture in a 3 year old would heal in 3 weeks and we could come in and get it removed. Tuesday was exactly 3 weeks to the day from when he had the injury. We went to the hospital and after some confusion, did find a pediatrician who could remove the cast. Before doing so, he sent us down to X-Ray to make sure the bone had healed.

I took Oren in to get X-rayed and at that point had an ominous feeling about what we might find. I had seen the original break and the unseemly angle of the bone in the arm angling upward. When he was being cast I had even asked the orthopedist if it would be straight when the cast was off. He assured me that the gentle traction he had applied as well as the cast would straighten the bone.

The X-ray went quickly and the technician came out with the X-ray in hand. He gave it to me to take the doctor. My curiosity was piqued and I took it and immediately held it up to the light. I am no orthopedic surgeon but it took me about two seconds to see that there was a real problem hidden under that cast. The radius and ulna were still both broken and the radius was badly out of line.

The pediatrician, on seeing the X-ray immediately called the orthopedic surgeon and they all agreed that Oren needed to have a ‘closed reduction’ of the fracture. That is to say, he would need a procedure that involved putting him to sleep so that the surgeon could reset the bones without making any incision.

They told us to come back first thing Wednesday morning and the doctor would meet us at 7am to do the operation mid-morning. Rebecca and I really had no choice. We were grateful to get this attended to immediately, and were feeling like we would need to trust God about having this done in Kigali, as opposed to flying somewhere else. But we also understood that our plan to drive 3 hours to Volcanos National Park and spend three days there was not going to happen.

That evening we had made arrangements to meet the Thomas’s, a missionary family (Dave and Debbie are the parents of four kids between 5 and 14) who work with the Evangelical Friends church. We have wanted to make a connection with them for a while. We got there late for dinner because of our hospital saga, but they were very hospitable and sympathetic when we arrived.

I was not really in a mood to be visiting others at that moment, but I am very grateful that we did. Hearing Dave and Debbie’s story, especially the early years of work, was definitely a message to us from God. They described their first two years as being very difficult and they often felt demoralized and defeated. I can identify now with that feeling of despair about what we are doing. There is a kind of ‘stripping away’ that is necessary for this kind of work, because I think we often come bristling with a sort of short-term burst of adrenalin—ready to do everything in our own strength. But we lose that initial thrust very quickly. That initial momentum is sapped even more quickly in the face of the stubborn obstinacy of violence, suffering, poverty, and need. These problems do not go away, and you come to the realization that there is nothing you can accomplish in your own power to ‘help’ anyone.

In the past several years Dave and Debbie have begun a new approach to working with communities. It begins by committing to work regularly with a community for five years. Absolutely NO financial assistance is offered. They take a Biblical approach to community development beginning with the premise that development is not something that is done to a person or community, and it cannot be done from the outside at all. “Development is first and foremost a transformation of the thinking of the individuals in a community.” It begins with recognizing the (human and material) assets that a community has, what they want the community to be (vision), what is lacking (needs), and how the community might ITSELF address those needs. If they need to seek government assistance for training, etc. so be it, but THEY need to develop the capacity to address their needs, not an NGO, or outsider.

It apparently takes years to help a community develop to a point where they really see themselves as having agency to change their circumstances. But this approach has had some really good results in several communities in Uganda. I was intrigued by it personally because of the problem of the Aid Trap I see. It seems like it is hard not to have communities develop dependency rather than self-sufficiency as they approach us and other NGOs to ‘help’ them. I am very interested in a development plan that does not start with money, or doing, but by changing the minds of individuals. (For more info, there is a link here: moving mountains)

“..No longer be conformed to the pattern of this world but be transformed by the renewal of your minds…,” Romans 12: 2

What I came away with from the evening was a real sense that God was with us, but that, as I said, there is much that must be stripped away. I do feel like I am being broken down by Him. I am finding my own enthusiasm, will, and spiritual strength withering away over time, the challenges seem daunting, my incompetence becoming more obvious, and the work, especially travel, unappealing. Added to that is the difficult adjustments that the rest of my family is making to all the changes and my own shortcomings as a husband and father. And yet, I think the day is young. I believe that patient endurance is what is being required here. Seeing the Thomas’s walk of obedience in the past 12 years (with no plan to return home soon), I am inspired. They are now at a point where they can see the way that God is using them to do his work in this place. I pray I can reach that point as well in time.

After dinner we went back to the guest house we were staying that night and got ready to take Oren back to the hospital the next morning. I was skeptical about arriving there and having everything go according to plan, and sure enough, when we got there the next morning we were lacking an ‘admission form’ that delayed us about 2 hours in the waiting room while they looked for it. When the doctor arrived he apparently wrote another one, and by 10 am Oren was admitted to the hospital.

I will let Rebecca pick up the story from here:

The pediatric private and semi-private rooms were all full, so we ended up on the general pediatric ward. I was quite an experience to bet here. Fortunately, Oren had read “Curious George goes to the hospital” over the past few weeks, and the ward looked a lot like what is described in that book. By 10 am, they were finally ready to do the blood work and they put in an IV line. Oren screamed bloody murder, but then was able to function. He enjoyed having Paul read the new Tintin book we picked up yesterday for our "Vacation" (Red Rackham's treasure). Around noon, we still hadn't talked with the anesthesiologist, and received word that he was in another surgery, probably wouldn't be free until 2 pm. Then five minutes later they said, quick, let's take him down. Apparently an operating theater had become available. So he was in surgery around 12:30 pm. The anesthesiologist told Paul that he would try sedation only, but doubted that it would be enough to keep him out for the procedure without general anesthesia and intubation. We don't actually know what ended up happening (but Oren wasn't complaining about his throat in recovery). And they did perform a closed reduction, no incisions, and they put on a much firmer-looking cast. They wouldn't let us into the recovery area -- probably it's a good policy, for cutting down infections. But we started to hear him sobbing from the waiting room and in a few minutes, a nurse carried him out to us in her arms. It was so, so heart-rending to see him in so much pain, and just so disoriented and feeling awful. He cried for about an hour on and off, shivering from the anesthesia., while the suppository paracetemol took effect and the IV fluids started dripping in. He hadn't had anything to eat or drink since 9 pm the night before. We tried to distract him by telling him all the fairy tales we could think of. For the final two hours in the hospital, he seemed a little better, but he just refused to get out of the bed into a wheelchair to go downstairs. We eventually carried him out and were able to check out at 7:00pm—12 hours after we arrived. It was good to get back to the guest house again for dinner.

The X-ray pictures I posted are the same view of the arm before and after surgery. It definitely looks better now, although he needs to have the cast on for 3 more weeks.

Because we did not feel we had enough time left to head to the forest, and were not sure how Oren would feel, we decided to spend two days of vacation in Kigali. We got a mid-priced hotel and did some touristy things. We got back to Bujumbura on Saturday, in time for another Saturday evening Scottish Country dance at the Carr’s. It was a lot of fun, and Jodi was down for the weekend as well for supplies. (She left Sunday morning.)

I will say that going on vacation with two children under 4 is not exactly restful, and I think we are really looking forward to the relaxing pace of our daily routine in Bujumbura with Oren back in school.

Bonus photo: I am sending this full size, it makes a nice desktop photo for a laptop. It is a picture of Bujumbura with mountains in the background next to the shore of Lake Tanganyika. I took it a couple weeks ago on a clear day.

3 comments:

Anonymous said...

Great to get your summary of this momentous trip to Kigali and the insights offered at the 15 year point of Rwandan survivors. We are glad that Oren's arm is straightened out and that he is looking forward to school again. BRAVO in keeping it all together and dancing at the end.

Paul, Rebecca, Oren and David Mosley said...

Here is a note by Dad sent by email in regard to this blog entry. It is interesting and mentions Bryant Myers' book AND his own reflections on development. Reflections worth considering:

Dear Paul – As you can see in the next paragraph, I started this email in Bali - but realize that I never got it off to you. So here it is now.

It is Monday morning in Bali and I have just finished reading your latest blog post. I really appreciated your reflections from your time with Dave and Debbie Thomas. What you described in terms of what it takes to achieve development is exactly the message of Bryant Myers in “Walking With the Poor” – that is “transformational development”. As you know, a message we give in our leadership course is “Development can be neither given or received, it must come from within.” I like your quotation from Romans – “be ye transformed by the renewing of your minds…” This is our leadership message about “mental models” – you cannot achieve more than your “vision” – and if your vision is constricted, so will your accomplishment.

Jesus, of course exemplifies the perfect leader in every way – and think of his “vision” for the disciples – to “go out into all the world and make disciples…” – a message that the disciples could not begin to comprehend since they had no idea what “all the world’ meant! And as you so well recognize – they could in no way do this on their own – they needed His power given by His presence with them “…always – even to the ends of the earth.” Just think – what ever you do in His name will be accomplished by His power as He promised.

Of course, the most obvious implication of this for us in this day and age is that money cannot buy development. Indeed, it can buy “measurable indicators”, which is what the donors want to see, but these mostly are short term, and, given the corrupting influence of donor money – too often just “feeds the dragons” of the status quo and therefore stagnation, or even regression as various factions fight among themselves for the donor money.

In this context, several books and other publications have come out (some from former World Bank employees) that say that donor support in Africa in particular has not only not led to development, but has even retarded the process. Some recent books are proposing stopping all development aid altogether!

Let me add that when I talk about a corrupting process that reinforces the status quo, I am not only talking about poor African societies, but also the rich donor community as well, and all of their “partners” in the process – the contractors, and even the universities. As long as there are the “needy” then we have to be given money to “take care” of them – the dependency syndrome afflicts both the donor and the recipient! (After all, look at drug addiction – there is a mutual dependency between the addict and the provider.) So, we have “donor dependency” and “consultant dependency”, etc., etc.

Paul – another message we teach in our leadership course is that “To change others, you have to change yourself first.”” It sounds like this is the process that God is bringing about in you. It reminds me of the story told by a missionary pastor, I believe who said “When I started out, I wanted to change the world, but then I found this too difficult, so I decided to change my community, but this was too hard too, so I decided to change my family, but I could not do this either; finally I realized that the only person I could truly change was myself.” Of course, Jesus, who came to “save the world” recognized that this started with His personal commitment to “serve God” (Matthew 4), and then His mission was to bring this change in the lives of others – one by one – the disciples, Nicodemus, the woman at the well, the blind man, the lame man, the demoniac, etc., etc. And their personal transformation came as they were “born again”.

Actually, Ben Lozare and I have this same philosophy in our teaching over the years – we believe that if we can truly have an impact (make a deep change) in the life of just one person a year, it will be a great accomplishment. Of course, this is not the way the world judges things – and Jesus’s ministry would hardly have been judged a “success” – after all, he only “produced” 12 disciples, and one of these was a traitor! Think of Paul’s ministry – how many times he was persecuted, thrown in prison, beaten, chased out of town, and finally on trial for his life. Yet God used this is miraculous ways – we would not have his God inspired letters from prison if this was not what God had planned for him – and for us (and millions of others down through the ages!)

Paul – I wish that we had had more time for some in depth discussions while I was there, but I know that you had an incredibly full and challenging week – with Zachee’s flood and your fever, etc. But at least we do have email for rapid communication these days.

You, Rebecca, Oren and David and your ministries are in our prayers continually,

Love, Dad

Anonymous said...

Yes, I'm there with your Dad on the value of both a different perspective on 'helping' people, and on the value of being transformed, stripped down yourself in order to an agent of more powerful change. I've experienced it, too, and it's quite disorienting, but makes space for more exciting things in the future. Bravo for your willingness to be changed, and to take the ego blows. That's hard. And to admit it, that's so great and rare, too. Even harder for men than for women to do. Wow.