Medair Advent devotional and news of the week!

Greetings all,

Christine & I want to share with you an Advent devotional put out by Medair for this advent season. There is only one devotional per week. But you might find it significant as you prepare to receive anew this year the One who came as a refugee, only to become the Lord of all! Here is a link where you can find it: https://app.box.com/s/xxzbfxak3pkn9l0qa7xlfux514ezomj4.

Our international team here in BGD is again doing our Dietrich Bonhoeffer Advent devotional that we did last year as well. We are looking forward to preparing for Advent together.

The Rohingya  volunteers  role playing during training

We had a very productive work week this past week. Phil is so thankful for all the things that his team accomplished. The nutrition transition has presented a number of staffing and logistical challenges. But two logs staff created a spreadsheet yesterday to help us all think about some of these challenges in a new way. One of the nutrition officers, Saiful, brought his outreach supervisors from the 3 current nutrition sites to the project office to train them so they could in turn hold trainings with their Rohingya volunteers. That was a direct application of a training of trainers that he attended last week. It is always nice to see those applications.

More role playing

Praise:

1. A very productive work week!
2. Opportunity to talk with our kids on Thanksgiving morning!
3. Significant growth in our Bangladeshi staff all across field office and our programs.

Prayer:

1. Wisdom for negotiating with UN partners for health and nutrition programs
2. Wide open doors for continued ministry to the Rohingya through our programs. 

The complexities of refugee life

I have always been intrigued by the tendency of some media to paint things in broad strokes which tend to envision things in black or white. It is either total despair or absolute joy - there seems to be little in between these polarities. Obviously this is a broad generalization. But I sometimes wonder if remarks such as, "Wow, this trip made me realize just how blessed we are in the US," are born out of such a bipolar worldview that tends to only see the material realities of people's lives.

Saleem showing a picture of his
home in Myanmar

When Florian Ecuyer, a media employee from headquarters, was here in September, we talked some about this inability of media to nuance the realities of refugees' lives. And I think that Florian's photos from that trip do a great job of pointing to the nuances.

This first photo of Saleem is fairly neutral. He no doubt has remorse over not being able to live in his home, but rather has to live in the largest refugee camp in the world. But he is able to show people a picture of his home in Myanmar - maybe in some way this is healing for him. I don't know. But it also is probably part of his ardent desire to be able to return to his home country and the place of his origins.

The joy of Children

Children are often more resilient than adults. And one sees this in the camps. Kids will be kids.... There are kids playing everywhere in a camp of 1 million people. Florian did a great job of capturing that joy that children continue to feel - maybe wherever they are, in whatever circumstances they find themselves. And this is true of the Rohingya children!


This is not, however to deny that there is anguish and pain in the camps as well. Florian captured this well in this picture of a man carrying a woman on his back. Honestly, I don't know the story. It is hard to whitewash the fact that this woman has to be carried wherever she wants to go. But she was leaving a health clinic. And the fact is that she likely has access to better healthcare than she would back in Myanmar.

One of the ironies of life in this mega refugee camp is that life for the Rohingya here in the camps is, in some very existential ways, better than it is for their family members who have remained back in Myanmar. There are those in the host community here in Bangladesh who also contend that the Rohingya live better than they do. That is a difficult equation to work out. But the fact is that the life of the Rohingya here is not black and white. It is not simply a picture painted in the broad strokes of despair. And it isn't a portrait of people living an easy life either.

The sun setting over the rice paddies
surrounding our office/home

But isn't that life for all of us? It would seem, given the staggering number of refugees and internally displaced persons in the world right now, that none of us is all that far removed from a life of displacement. How would you respond if you were forced from your home? Would you be able to find joy? How would you combat creeping despair? What would be your strategies for resilience? These are questions to which the Rohingya work to find answers each day.

We are thankful to be able to walk alongside the Rohingya, in their delight and their jubilation, as well as in their desperation and their hopelessness. Isn't this what Jesus did when walked he on this earth? And we are asked to do no less.

Praise:

• For a good R&R
• For the Nutrition sector continuing to move forward in the plans to move partners to new camps
• For the Gambia opening a case against Myanmar for the systematic injustice against the Rohingya - a real source of rejoicing for them!

Prayer: 

• For ongoing work to be done for moving Nutrition clinics
• For project proposals for Shelter and Health sectors
• For the courage to continue to walk alongside the Rohingya in the complexity of their lives

Changes in the climate for refugees

There have been significant changes over the last couple of months in the climate in which the refugees live. Some of these changes are almost inherent in the lives of long-term refugees. This article summarizes the challenges well: https://www.theguardian.com/global-development/2019/nov/04/our-only-aim-is-to-go-home-removal-plans-raise-tensions-in-rohingya-camp

Praise:

• For renewal of our visas in August
• A time of refreshing as we are currently on R&R
• A really positive review of the nutrition (NUT) program by one of the funders - WFP

Prayer:

• The nutrition sector (which is made up of all UN agencies and NGOs) has decided to integrate nutrition programming by having one NGO responsible for all nutrition activities in a single camp. This means that we will be handing over our current 3 nutrition sites to other NGOs and taking on 4 new (to us) camps beginning next year. The transition process will be quite involved and we ask for prayers that it will have minimal impact on the children and PLWs (pregnant and lactating women) whom we serve. This is an exciting move but will mean a huge amount of work for the Nutrition team as well as support teams like logistics and HR. 
• We have had 3 US team members who have failed to get visas from the Bangladeshi embassy - pray for breakthrough!
• For a number of project proposals currently in the works for our Bangladesh program. 

LD family news

Thanks so much for praying about the rain! We heard from a few of you that you were taking this call to prayer very seriously. About the time that we wrote our last blog those heavy rains started diminishing. And the rest of the monsoon season has been much more moderate.

Our family (without Anna in this pic) after Commencement

Thanks for walking with the Rohingya in this way! The weather is, currently, the least of their problems. But that was not self-evident when we wrote that last post.

Since most of you know our family we want to update you on everyone. We have had two wonderful times together with our whole family this year. (Ironically, when we took a trip in 2004 we wondered if it would be our last big trip with all of us together)!

The 2019 Nursing class at pinning ceremony

At the end of April we were able to return to the States to celebrate Annika’s graduation from Goshen College’s nursing program. We found an AirBNB in the Goshen area so we could be together as family during the weekend we were in Goshen. We are so thankful to the Lord for how Annika thrived in her studies, socially and spiritually at Goshen College!

After commencement weekend we left Annika at Goshen (to prepare for the nursing exam) and had more time in Minnesota with extended family as well.

Annika passed her nursing exam in June and started working at Mayo Clinic in Rochester the end of August. She has a great roommate, and has started working 12 hours shifts as a nurse on a medical-surgical ward. Please pray for her in this adjustment.

Back to Minneapolis on mom Lindell's birthday to celebrate

In July (when we came to the end of our 1 year contract with Medair) we met all the kids in Vienna in order to bike along the Danube river. We have dreamed of this trip for some time! We spent basically a week on the bikes. We generally biked 5-6 hours per day and found campgrounds to stay in for the night. We biked from Vienna to Budapest (probably around 400 kms in total) and then spent a few days exploring Budapest (an incredibly alluring city!). Then we took the train back to Vienna with our bikes and dispersed to our various corners of 

the world.

Nathan and Anna are in Minnesota now. Anna is working with a study abroad program (with which she herself went to Ecuador a few years ago). Nathan will start working with a new immigration law firm the first of October. So they anticipate being in Minnesota for the time being.

Lydia and Annika had planned to graduate from college at the same time. But because Lydia struggled with Lyme disease during most of her college career she took a semester off last year and therefore was not ready to graduate at the same time as Annika. (One of the ironies of our life is that people would occasionally ask us how we could take our kids to Africa and expose them to terrible diseases – and then Lydia contracted Lyme disease when we were back on furlough in the US, was diagnosed immediately from the telltale bullseye rash and treated with antibiotics – yet she has continued to struggle with it). So she is finishing up her last semester doing independent study classes while volunteering on a Native American reservation in northeast Montana. She is on her way out there as we speak.

On the train from Budapest back to Vienna

As all of our kids move on from their undergraduate college careers, we are incredibly grateful to the Lord for how God has worked in their lives and sent professors and faculty into their lives who have been instrumental in their formation. We are also grateful for how each of them grew in their relationship with Jesus, the body of Christ and the larger community around them. Their experiences in college have varied greatly! And it is probably safe to say that each of our children has taken decisions that we would not have taken in their place and had adventures of their own which we could not have imagined possible. But that is normal. And we are so thankful that each of them continues in their desire to follow the One who has been the motivation for what Christine and I have done with our lives, as a couple.

Christine & I are back in Bangladesh and continuing to enjoy the work that we are doing with the Rohingya. Our extended contract goes through the middle of January at this point. Thanks for your love for our family over the years! This has helped to shape who we are.

Monsoon rains flooding the Rohingya Refugee Camp

I'm sending this link to a BBC article that just came out. We've been experiencing torrential rains for the past week. The flooding is really getting bad. Please just be praying for Rohingya -

https://www.bbc.com/news/world-asia-48905031

This article talks about Camp 6 where we have one of our nutrition sites. Beneficiaries were not able to come to the site today because flooding was so bad they couldn't reach the site. There is a photo in a market area which is a path we take to get to the nutrition site. For us to access this site we have a 30 minute walk - it is right in the middle of the huge refugee camp. It's ironic, over the past few months IOM and other organizations have been frantically trying to set up anti-erosion measures using sandbags, drainage, bamboo, etc to try and avoid flooding and landslides. However the volume of rain we've gotten over the last few days means there is just no where for the water to go.

Mass MUAC Screening by community nutrition volunteers (CNVs)

For those of you following our blog I, Christine, am managing three nutrition sites that provide curative and prevention services to children under 5 years and all pregnant and lactating women (PLWs) in our catchment area. These nutrition sites are located in 3 of the camps that make up the larger refugee camp with a population currently of over 1 million displaced Rohingya from Myanmar.

Our 3 camps cover a population of over 70,000 people of which close to 20,000 are in our program. In the past year we served over 18,000 children and 4500 PLWs. We are in the process of doing a mass MUAC screening exercise to figure out if we indeed have all the eligible children and PLWs that we should be providing services to actually enrolled in our program. This is what is technically called determining coverage.

The MUAC tape

I'm assuming most of you are not familiar with measuring rates of malnutrition in a population as this is not something that is ever done in the USA or other countries with high levels of development.  The standard method of doing this in a quick and fairly easy way is to do a mass MUAC screening. MUAC stands for mid-upper arm circumference and is a measurement that is used to give an indication of nutritional status. The measurement is done with a glorified measuring tape with color bands on the tape corresponding to nutritional status. The tape is wrapped around the mid point of the upper arm and pulled through the white end where there is a window that displays the centimeter measure and corresponding color.  

Checking for children under 5 years of age

The goal of the mass MUAC screening is to identify and screen every child under the age of 5 and PLWs in the catchment area. Steps in the process involve visiting every household and finding out who is under the age of 5. This is done with a stick and a mark on the stick for 110 cm. Any child under 110 cm is considered under 5 years. 

Checking for edema

Once identified the child is then checked for edema – a common sign of a more serious form of acute malnutrition. This is done by pressing down firmly on the tops of both feet for 3 seconds and then removing one’s fingers. If an indention remains then edema is present. 

Determining where to place the MUAC tape

The third step is to identify the mid way point on the upper arm. The child bends their arm at a right angle and the measurer finds the bone at the top of the shoulder and the bone on the elbow. Then the halfway point between those two points is marked on the side of the child’s arm. 

Wrapping the MUAC tape around the arm to see
nutritional status and tallying it on the form

This is the spot where the tape measure is wrapped around to determine if the child is in the red (acute malnutrition), yellow (moderate malnutrition) or green (healthy) section of the MUAC tape - a quick and easy way to screen children in a community and get what is considered to be a proxy GAM rate (Global Acute Malnutrition) rate. The child's MUAC is recorded on a simple tally sheet. On the top section are all children receiving nutrition services. On the bottom section of the page are children who are identified to not be receiving nutrition services. They are then referred to our nutrition site to be enrolled in our program.

Volunteers with a decorated bamboo measuring stick

This exercise has taken about 10 days in total to complete including the initial training focusing on the forms that needed to be filled out. To get a better sense of the logistics involved we have community nutrition volunteers (CNVs) that are assigned to sub blocks in each of the camps in which we work. All together we currently have 140 CNVs throughout the 3 camps with each one responsible for 60-200+ households. They were paired up to do this exercise and together needed to visit every single one of the households in their own and their partner’s assigned block. The CNVs are quite used to their own areas and visit each of their households monthly. This is just an additional exercise to make sure no households and eligible children or women are being missed. To make sure that children were not afraid of the bamboo measuring sticks as a team we worked one evening to do some decorating!

New volunteers learning to use the MUAC tapes

PLWs in our program are also screened using the MUAC tape. Obviously the bands used for children are different than those used for adults. We had to take on some female volunteers to help us do the MUAC screening of PLWs in our program since men are not allowed to touch women. One of the challenges of doing this with females in this setting is that it is necessary to remove the clothing on the arm to get a good measurement. In our nutrition sites, where this is done when women come on a biweekly basis, we have one whole side of our nutrition site that is female only – that includes curtained cubicles to offer privacy to the women while being measured. In the community this is done privately in people's homes.

This exercise was just completed on Wednesday. Now we need to enter all the data that has been collected and find out our coverage rates (in the humanitarian aid world the standard in a refugee camp should be >90% coverage) as well as our proxy GAM rates. This will give an indication of malnutrition rates. However in the nutrition sites we also measure all children's height and weight which is another measurement looked at to determine malnutrition rates.

WFP (World Food Program) provides all the food commodities that we are distributing to children and women coming to our nutrition sites. They are involved in quite a few other services in the camp. I just found out yesterday that they are sponsoring a program called WFP storytellers. Here is a link to one of the storytellers. 

https://www.youtube.com/watch?v=NWiDmAmW24M#action=share

Praise: 

• The Mass MUAC survey has been completed
• Recent funding has come through from two different organizations for our health and nutrition programs

Prayer:

• For a 2 day refresher training for all 52 nutrition staff on June 23-24
• For refugees around the world. June 20th was World Refugee Day. 

Medair Logs Workshop 2019

In early April we had a Medair Logistics workshop in Dubai. Logisticians from all of the Medair programs around the world came together to discuss different aspects of logistics - from the new procurement software that Medair will be using to negotiation skills. We also talked about a lot of

Medair logisticians from around the world!

nuts and bolts issues such as how to avoid disallowances with donor auditors.

One of the reasons we held it in Dubai is that this is one of the few countries in the world where Afghans can get visas.

It was an amazing group of people! Here are some of the nationalities represented: Kurdish, British, Afghan, Cameroonian, South African, Dutch, Syrian and Bangladeshi (my senior logs officer, Juwel, attended with me – he is in the middle on the other side of the table that I am at). So it was really amazing to interact with such a diverse group of people doing amazing work in all the different countries where Medair works and at headquarters!

Logistics (logs) varies so much from one country to another. The South Sudan program, for instance, is one of the most complicated logistics programs (along with Afghanistan and the Democrat Republic of Congo). South Sudan and Afghanistan are both long-running programs, which means that there are multiple bases in each of these countries. So logs often is buying at a central location (like the capitol city) and then expediting to far flung bases around the country. In South Sudan a lot of that expediting happens by air cargo, which is obviously quite expensive. In Afghanistan there are places in the highlands were all supplies are moved by horses. In comparison, Bangladesh is a pretty simple program. We have one base alone. And we have good enough roads to move all our supplies with trucks and other vehicles.

Simulation NSAG

One aspect of the learning during the workshop was negotiation training. There is, obviously, a lot of negotiation involved in logs. One of the primary procurement principles we live by is “best value for money.” So we are negotiating to get that best value for the money that both donors, and individuals like yourselves, give to the Bangladeshi program. But while we were at the workshop a Cameroonian colleague relayed to me how he had had to negotiate with an armed faction in a neighboring country for the release of a couple of his staff who had been taken hostage. This picture is from the simulation we did during the negotiation training. This simulation had to do with negotiating with Non-State Armed Groups (NSAG). My colleague from Afghanistan played the part well! But the training was really helpful! Negotiations are not something that I would say I am necessarily naturally gifted in. So it was really helpful to learn more about negotiating methods and styles.

The things that we learned at the workshop will definitely help my team to better execute our duties. I am grateful for the learning opportunities!

Prayer points:

1. Pray for Medair logs personnel around the globe: for integrity, for strength and for grace to offer others.
2. Pray for Christine as the UN Food Programme project reporting system weighs on her these days.
3. Pray for Rohingya and Bangladeshi alike as almost all celebrate Eid al Fitr over the next 3 days (https://en.wikipedia.org/wiki/Eid_al-Fitr)

Time recently came out with a great exposé on the Rohingya. Check it out!

http://time.com/longform/rohingya-muslims-exile-bangladesh/