THE NEWYORKER, APRIL 13, 2020 53miniature Santa so that she wouldn’t pull
ornaments off the tree. “I was a super
plain-Jane, straight-up white girl.” But,
not long after she got her high-school
diploma, members of her church told
her that an orphanage in Jinja, Uganda,
needed volunteers. A town of eighty thou-
sand on the northern edge of Lake Vic-
toria, Jinja is a bustling place, where peo-
ple sell bananas and backpacks from stalls
along red-dirt roads, and hired motor-
cycles weave around crammed minibuses
decorated with pictures of Rambo and
Bob Marley. Bach arrived in 2007, join-
ing a large missionary community. “I felt
very at home and at peace there,” she
said. She loved being immersed in a for-
eign culture and absorbed in her work.
When Bach returned to her parents’
house, nine months later, she didn’t know
what to do with herself: “I was really
trying to seek out what school I was
going to go to, what career path.” Then
she had an “almost supernatural experi-
ence,” she told me. “It became really clear,
as if God was, like, ‘You’re supposed to
go back to Uganda.’ ” She laughed, rue-
fully. “This sounds like such a white-sav-
ior thing to say, but I wanted to try to
meet a need that wasn’t being met.”
Bach decided to start a feeding pro-
gram, with money raised through her
church, offering meals to children in Mas-
ese, a neighborhood on the edge of Jinja
that she described as “very slumlike” but
vibrant. “There were a lot of people from
the internally-displaced-persons camps
up in the north,” she said. “People from
a lot of different tribes and clans.” Bach
needed a headquarters, but she struggled
to find a house to rent. “Masese was on
the side of a hill, and everyone lived in
mud homes—when it rained, all the rain
would wash houses away,” she told me.
“Every person that I contacted, they were
all, like, ‘Why are you moving there as a
single white girl? You’re going to get
robbed out of your mind!’ And I was, like,
‘No—I just feel really strongly that’s where
we’re supposed to be.’” Through a friend,
she found a sprawling concrete house to
rent from a government official who was
away in Entebbe, and she started offer-
ing free lunch on Tuesdays and Thurs-
days. She hired a few people to cook,
serve food, and help with activities, like
craft day and Bible club. By the end of
the year, Bach estimates, she was feeding
a thousand kids a week.
The recipients of her program con-
tended constantly with illness, but
nobody could afford to go to the doc-
tor. In Uganda’s public hospitals, patients
are frequently expected to pay not only
for medicine but also for such basic sup-
plies as rubber gloves and syringes. For
many families, even the cost of transport
to the hospital was prohibitive. So Bach
often drove sick kids to the
town’s pediatric hospital—
which everyone refers to as
Nalufenya, for the neighbor-
hood it’s in—and paid for
their care. “Looking back,
that wasn’t—well, actually,
nothing we did then was sus-
tainable,” she said. “But it
was just a way of being like:
I don’t know anything about
medicine, or health care
here—or even about Uganda. But I can
pay for your malaria medicine so you
don’t die.”
In the fall of 2009, Bach received a
call from a nurse at Nalufenya, who told
her that the hospital had some kids it
was “refeeding”—bringing back to nu-
tritional health after bouts of severe acute
malnutrition. “She said, ‘They’ve been
here for a really long time, and they can’t
pay for their stuff anymore. They’re med-
ically stable. Can we send them to your
feeding program?’ ” The hospital promised
that a nutritionist would visit every week
to check on them. Three toddlers and
their guardians came to live with Bach.
Tending to those children opened
her eyes to the omnipresence of malnu-
trition in the area. “It was almost like
malnutrition was the stepchild of health
care,” Bach said. Perhaps, she thought,
this was why God had sent her to Uganda.
She could care for malnourished chil-
dren and hire nutritionists to educate
their parents, then ask the families to
help in her community garden. “They
would be giving back to their child’s re-
covery, not just getting a free handout,
and learning at the same time!” she posted
on her blog.
Bach was astonished by the response.
A twelve-year-old came with her infant
sister. A neighbor brought in a baby she’d
found in a pit latrine; the mother was
fifteen years old, dying of H.I.V. and tu-
berculosis. (That baby was Selah, whom
Bach later adopted.) Medical professionals
throughout the region quickly realizedthat Bach had access to resources they
didn’t. “We were getting referrals from
twenty-seven districts—people were trav-
elling for eight or nine hours to get to
our center,” she said. “We were, like, ‘How
did you even hear about us?’ But, all of a
sudden, they’re knocking on the door.”
Serving His Children registered as an
N.G.O. with the Ugandan government,
and received a certificate to
“carry out its activities in the
fields of promoting evange-
lism; provide welfare for the
needy.” Bach hired a Ugan-
dan nurse named Constance
Alonyo to care for the chil-
dren, and, as she raised more
money from America, she
brought in more nurses, nu-
tritionists, and eventually
doctors. But she did not get
S.H.C. licensed as a health center for
nearly four years. Bach insists that this
shouldn’t have been confusing: “All of
our clients signed a release stating, ‘I re-
alize that this is not a registered hospi-
tal, this is a nutritional-rehabilitation fa-
cility.’” The forms were in English, one
of more than fifty languages spoken in
Uganda. Many of S.H.C.’s clients were
illiterate.
Medical supervision was crucial, be-
cause treating malnourished children is
not a simple matter of providing meals
or milk. In a state of severe malnutrition,
the body starts to consume itself in order
to survive; intracellular enzymes stop
functioning properly, and so do major
organs. When nutrients are introduced,
a huge shift in electrolytes can cause a
potentially deadly condition known as
refeeding syndrome. In world-class pe-
diatric intensive-care units, physicians
closely monitor patients’ electrolyte lev-
els and adjust treatment accordingly.
Bach, of course, could not provide any-
where near that level of care. But nei-
ther could the hospitals that were call-
ing her to take patients. “Tomorrow I
am picking up 4 more children from the
hospital,” Bach blogged in July, 2010. She
asked her followers to pray for the chil-
dren’s recovery, adding, “I also ask that
you please pray for my sanity.”
Bach was overwhelmed by what she’d
taken on. She asked around to figure out
how to keep medical charts that would
be intelligible to staff at Ugandan health
facilities. “Everyone would be, like, ‘Just