"There is a vast plain to the north where I have sometimes seen, in the morning sun, the smoke of a thousand villages where no missionary has ever been." So said Robert Moffat, a nineteenth-century missionary to South Africa, to his son-in-law, David Livingstone.

Like that plain in South Africa, Karamoja is also a vast plain, located in northeast Uganda. It is the home of the Karamojong, a people proud of their traditions, religion, and Nilotic heritage. Life for the Karamojong has, for the most part, remained unchanged for thousands of years. Western technology, medicine, dress, culture, and Christianity, found in varying degrees throughout Uganda, have made virtually no inroads among the Karamojong. Geographically, ethnically, and politically, Karamoja is, for all practical purposes, a country within a country. For better or for worse, the land and its people remain a vestige of precolonial Africa.

The Divine Right to Cattle

The plains of Karamoja are well populated. From Kadam Ridge, where we are standing in the photo, the horizon is generously scattered with manyattas (Kiswahili for "villages"). Each manyatta is surrounded by an impenetrable living fence with only one entrance. Within the fence are anywhere from eight to fifty huts.

In the center of each manyatta is a corral. Every night, all the village cattle are herded off the plain into the corral in order to protect them from cattle raiders from other tribes. That the corral is situated in the center of the village indicates the worth of cows to the Karamojong. For centuries, the Karamojong have been pastoralists. Every day is spent the same way, leading the cattle to greener pastures.

The Karamojong believe that God has given all cattle to them. The implication of that is that God has not given any cattle to their neighboring tribes. Unfortunately, the Pokot in Kenya, living right on the Karamojan border of Uganda, have the same conviction about their divine right to cattle. As a result, both tribes are continually trying to re-collect "their" cattle. Violence occasionally results. It is no wonder that our guide calls Karamoja "the Wild West."

For all practical purposes, the Karamojong have never heard the gospel. Only the Roman Catholics have any foothold in the land. There is no Protestant witness. Speaking of the spiritual hunger of his people, a young Karamojan said sadly, "The Catholics never preach about Jesus. We want to hear about him."

Plans for Medical Ministry

The Presbyterian Church in Uganda (PCU), with which the Committee on Foreign Missions (CFM) of the Orthodox Presbyterian Church is working, desires to see the gospel preached among the Karamojong, leading to the establishment of PCU churches and ultimately the formation of a new presbytery. But because of the desperate medical and physical needs in the area, and the warlike nature of the Karamojong, the PCU feels that the best way to reach them is to begin a medical ministry of mercy. A medical work would both prove our peaceful intentions and demonstrate the love and mercy of our Lord. The crowning jewel, however, would be the opportunity to preach the glorious gospel of our compassionate King.

Accordingly, the Rev. Dr. Tony Curto and I have been working under the direction of the CFM to research the possibility of beginning a new evangelistic medical work in Karamoja. If the results of the research seem good to the brethren, and to the Holy Spirit, we will plan to return to Uganda in June 2000, after our furlough, to begin the work.

The medical ministry would initially take the form of a roving mobile clinic, which would visit the larger manyattas of the southern Karamojan plain on a regular basis. Adult and pediatric primary care and community health would be emphasized during this phase of the medical work.

The advantages of beginning with a mobile outreach and progressing to a more permanent clinic are twofold. First, it would identify those areas of South Karamoja that are in most need of medical care, and it would help to determine the site on which to build a permanent clinic. Second, it would allow direct access to the villages and provide an opportunity to preach to the entire community, not just to those who are ill.

Preparation and Prayer

In order to prepare myself for such an undertaking, I will spend roughly two months, beginning in April 1999, learning how to perform Cesarean sections and appendectomies at Kijabe Medical Center in Kijabe, Kenya. Pray for me—I'm an internist, not a surgeon! Sometime during furlough from June 1999 to June 2000, I will take a course in tropical medicine in Liverpool, England. This is a must for a doctor establishing a hospital in the bush.

Oh, brothers and sisters, what an opportunity we have as a denomination! To preach the gospel where no man has preached is a great privilege indeed. I don't know when our Lord will return, but pray that the Karamojong may hear the gospel before he returns. We have work to do! Pray to the Lord that he would open the door for the East Africa Mission of the OPC to get into Karamoja.

Pray that our God would prepare the hearts of the Karamojong to receive his word, repent of their sin, and believe the gospel. Pray that they would lay down their arms and make peace with the Pokot of Kenya. Pray that the kingdom of our Lord Jesus would be firmly established in Karamoja. May the sovereign Lord of Hosts be glorified as yet another nation bows before his exalted throne.

The Lord says, "It is too small a thing that You should be My Servant to raise up the tribes of Jacob, and to restore the preserved ones of Israel; I will also make You a light of the nations so that My salvation may reach to the end of the earth" (Isa. 49:6 NASB).

Reprinted from New Horizons, April 1999.