Balancing on the Tip of a Spear


Guest written by Kacie Forrest, RN, MedSend Grant Recipient 


I dip my hands into the warm soapy water and fish around for the last of the silverware. The pieces clank against one another. Not too many. About ten more of these, and then I’m done. 

But then I hear it. A faint knocking at my front door. This sound is a part of the ebb and flow of my days. It’s become so familiar that it is even a language unto itself. A soft, short tapping like this is a stranger in dire need, or one of my kids’ shy friends wanting to play.  

I dry my hands and go see who’s there. 

It’s a woman, who looks to be past childbearing age. She’s holding a bundle of carefully folded white blankets. Out from the top pokes a contented face.  


My nurse’s brain takes note. A full-term newborn. Well-fed. Healthy looking.  

A fully developed baby like this one is a beautiful, robust sight. Like a rose in full bloom.  

I work with premature babies in the NICU of an understaffed, under-resourced government hospital in the East African country of Uganda. The hospital is located in a rural town called Bundibugyo. If you zoom out from Bundibugyo, you will see it nestled next to an expansive mountain range, complete with equatorial snow, plodding its way from Western Uganda into Democratic Republic of Congo.  

In the foothills of the mountains, where I live with my husband, three children, and a team of other missionaries- the land has been cultivated by farmers and families to grow cocoa, plantain, and bananas. (Trader Joes even has a chocolate bar using cocoa beans from Bundibugyo!) The entire region is awash in shades of green, prolific birdlife, and people moving steadily about tending to life’s demands under the dominion of the equatorial heat. 

I sit in the shade, on a hand-crafted chair made from wood and dried reeds. I want to hear who this woman is, and why she has come to my house. She speaks the local language, Lubwisi. When she gets to the part of her story and I hear “akuye”, I stop her. This woman isn’t asking for money to buy malaria medicine, or for a bag of rice. She’s telling me of a recent traumatic experience, and I can’t fumble my way through this.  

Akuye means “she died”. In a place where pregnant women are tragically said to be balancing on the tip of a spear, or when one of the greetings to a new mother is thank you for surviving (childbirth), I’ve heard the word akuye enough now to pick up on it.  

Our multilingual gardener is busy cutting grass, but I ask him if he can interpret for me. Now there are three adults and the baby, together on my front porch. 

She looks down as she tells me that the mother of the baby died two days after having a c-section. This happened at the hospital where I work. As far as she knows, there weren’t any complications with the surgery, everything went fine. Until a few days later. Her daughter-in-law began to have excruciating pain in her abdomen, radiating around and up her back. The pain got worse and worse. Then she died. 

I hear the story and I’m flummoxed. I have more questions, but most go unanswered because she doesn’t have the answers to them either. Instead, she’s left with a heavy heart and the burden of a motherless grandchild. 

The baby is 8 days old today. She asks, can I help provide her with formula to feed him? 

How have you been providing for him up until this point? I ask. 

She’s been using condolence money from the funeral, but that is gone now. 

I want to know more about her community. Does she attend a church? Has she asked them to pool donations yet? Has she shared her need with her neighbors? 

The answers to these questions breed more questions. People’s networks are interdependent and interwoven as a delicate web. But from what I’ve seen, that doesn’t mean an orphan baby will be fed. It’s not that people don’t want to, it’s that they can’t. Like the equivalent of asking a new empty nester in an average American household to take on someone’s college tuition. The finances aren’t readily available.   

The average person in our district barely has enough money or food to feed their own children. How can they provide for one more? If they do have the capacity to take on another child, then they already have. 

As a person who’s been born and bred in a culture of plenty, I still struggle to really understand this. But I saw an orphaned newborn starve to death Christmas week because nobody had the capacity to assume care of him. He showed up to us too late. I will never forget his face and the harsh reality that lives really do slip through the cracks. 

But I see the determination in this grandmother’s eyes. She has gathered up the courage to walk from miles away, to knock on my door, and to ask me to consider this child. The weight of her love rests in the very careful way she tucks the blanket around his chin, as she waits anxiously to see what I will say.  

Personally, I am tired today. My dad has just died. I’ve returned back from a short trip to the US, to spread his ashes. The plan was to recover from jetlag and go back to work. But Ebola is starting to spread through our country and I’m trying to decide if I’ll return to work in a hospital that has no personal protective equipment or running water. I’m wrestling through big questions. I’m wondering what life would look like if I chose to be a nurse outside of the hospital during this time. And I’ve been asking God to show me what he wants from me.  

She says her name is Mary. And her grandbaby is Douglas.  

Sitting with Mary and Douglas brings me peace. It reminds me why we choose to live here, whom we want to enter into relationships with, and how we want to spend our resources. 

I ask to hold Douglas and she hands him to me. 

A country’s maternal mortality rate may seem like just a number, that is, until you are looking into the eyes of a newborn who will never know his mother. 

I tell her we can help. It would be an honor. We will provide the first tin of formula, and she will have to return for the second. She’s more experienced as a mother than I am, but I still give her a brief teaching of how much to feed him, how often, and proper preparation techniques. Then I connect her to Serge’s outpatient nutrition program, called BundiNutrition. This is the only local program addressing the needs of malnourished children in our region. Enrollment starts for babies who are 6 months or older, but the national health staff at BundiNutrition will be a great resource for her until then.  

The next week she comes back and the BundiNutrition team has given her metoclopramide, a drug that will help her produce breastmilk. Her face lights up when she tells me that she takes the drug every day, multiple times a day. Douglas is feeding well off the bottle, but she looks forward to feeding him breastmilk soon. I give them another tin of formula until then. 

A week goes by. She shows up again to my house and sits on the bench out front. I greet her, and our gardener comes over to rescue us with his language skills. 3 week old Douglas starts to squirm and cry. Instead of pulling out a bottle, she pulls out her breast and gives it to him. He suckles (with a nice latch even) and quiets down.  

“Do you have milk now!?” I say, delighted. 

She replies that her breasts are heavy, she lifts them up and down to show me. She feels like the milk is almost there. But not quite. She prays every day. Boiling water is a hassle, she says.  

I haven’t been to her house yet, but I’m pretty certain she cooks over an outdoor fire like everyone else in our town. Which means she has to collect extra firewood (and it’s rainy season). And probably fetches or sends a family member to fetch water from the river. Feeding this baby is no small task.  

We talk on the porch, and I’m buoyed by her perseverance. My youngest child is four years old, and it’s difficult for me to imagine going back to the long nights of interrupted sleep during those baby days. But again, the way she looks at Douglas, it is clear she has taken up the call and is doing a good job. Douglas is growing a double chin. 

She makes sure to reiterate that she is grateful for the formula we’ve been providing each week. But I can see this without her saying it. In the way she extends both her hands out when I give her a tin. How she lowers her eyes and bows her head. How her entire body seems to release in relief as she packs it away in her small cloth bag.   

But it doesn’t really feel like the formula is from me 

It is God’s plan to feed this child. He’s shuffling resources around. From the Holy Spirit who prompts generosity, to our supporters in America who give the funds, through us, through Mary, into this tiny body. He’s making sure this child gets fed. I’m just one set of hands along the way.  

So, when she thanks me, I say the local response of webale kusima, ‘thank you for thanking’. I also share with her that although I’ll accept the gratitude, the resources aren’t really mine to begin with. She hears this and nods understandingly. We pray together, thanking God for who He is and how He shows up.  

Then I let her in on an inside part of my life. “For me to survive here I also have to ask my people for money.” This is how missionaries survive 

She smiles.  

We’re in this together. There’s a spiritual connection in how we both live. But in reality, of how we all live. We are bearers of light and life, imperfect and needy, conduits of God’s grace in us, completely dependent upon Him. 

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