More First Steps

I just returned from a remarkable three days at an outlying hospital in Caluquembe.  It is a rural mission hospital that serves nearly a million people and is located in the interior of SW Angola.  It is operated by nurses and has no full time physician.  A surgeon from our mission hospital in Lubango travels there once/month for three days and sees patients and does surgeries that are reserved for him/her.

I went with Dr Steve Foster and essentially learned.  I saw so many people suffering with the local killer diseases, many of which I’ve only seen 20+ years ago in multiple trips to Haiti.  The disease patterns are so different and more serious than those I saw in the Brazil Amazon.

I also began to learn how to perform urgently needed surgeries possible under local anesthesia (Cesareans, hernias, appendectomies, etc), began to touch, smell and see the local diseases and the treatments available, and saw first hand, once again, that there are remarkable people doing beautiful work in the most remote places.

One of my goals this year will be to soak up all I can from Steve Foster and his breadth of knowledge from 30+ years of working in the interior of Africa.    I will return to Caluquembe with Luke on Monday for two weeks to learn all that I can from the incredible nurses serving with so little in this rural hospital.  It is an ideal place for me to learn because where I desire to go there will be virtually no human health care resources and few other health care resources.  We also will be wanting to train people to practice basic medicine in very rural conditions, similar to the conditions in Caluquembe.  Of course, we will not seek to reproduce such a hospital, but rather reproduce the same quality of health care on a smaller scale.

It is a Christian hospital, originally a Swiss mission hospital originating in the early 1900s.  I gave a message to the staff about how different God’s perspective is from ours.  It was well received.

We flew over some beautiful countryside in our small plane for our 45 minute trip.  I saw hundreds of traditional villages, from 5-30 houses, a mile or two apart, with thatched homes arranged in a circle, and no electricity or running water.  Exactly the folks we wish to serve.  When we arrived at the dirt runway out side of the small town of Caluquembe, the plane had to pass a few feet over the runway to scatter people and animals on the runway to clear it for landing.  We were then swarmed by the local people as we departed from the plane.

Our living conditions were simple, with a barrel of water to use for washing, a mattress over a reed mat for sleeping, and work from early morning to late night.

I experienced my first encounter with a type of swarming, “army” ant that is common in the rural areas here.  When we arrived to our house after dinner on the first night, one of our Angolan colleagues approached the front door and began yelping, laughing, jumping up and down and waving us away.  As we cautiously approached the house, we saw thousands of ants on the path leading to the door and on the exterior front wall of the house.  When we went inside, the ants were pouring into the house through the windows.  We left the house quickly and someone came and poured diesel around the house and several hours later, there were no ants in the house.  Without the diesel “treatment”, we were told that they typically swarm the house and eat anything and everything alive in the house, moving through in a couple hours.  They laughed and said it’s the best treatment for cockroaches.  They told stories of dogs and other animals being eaten while trapped inside the house.  The bite of the ant is painful, like a good pinch.

It was a very full, tiring, great three days and I’m so looking forward to returning, learning, and serving these hurting, beautiful people.

The people were so impressive.  Most of them had awful injuries or diseases for so long and bore them with such kindness and grace.  I was treated with such gratitude and respect.  I want to learn from these folks (and I’ve so much to learn).   I sense a love already developing for them that I haven’ t made any effort to “work up”.  Thank you, Father.

Some of what we saw in Caluquembe, where there is no surrounding health care:

A baby with most of its scalp burned, much of it needing skin grafts (cooking fire burns are common, especially in toddlers).

A young man who lost most of one thigh to the bite of a 6 foot crocodile while he was wading in familiar, knee-deep water.

An illness called Guillain-Barre Syndrome (the medical people reading this will appreciate this) that almost completely paralyzed an otherwise healthy 30 y/o man.

Many large bone fractures (femur, tibia, etc) requiring months of traction in a hospital bed.

Too many cases of various types of sadly well advanced cancer (there is no radiation or chemo therapy available to these people).

There is a large population of albinos in this region and they all (at a young age) have deforming skin cancer, as well as deformations resulting from the surgeries to remove the cancer.

Way too many cases of cerebral malaria.  Young, healthy children and adults lying in comas.

Dr Foster did five vagina-bladder fistula repairs, caused from labor failing to progress, resulting in a still-birth and a hole between the vagina and bladder of the mother.  This otherwise healthy young woman is then the scourge of her community as she has no way to control her urine and her odor and condition cause her to be unbearable to everyone.  She is shunned and rejected.  There are thousands of these women in this part of Africa and these repairs are as beautifully life-changing as the initial event was devastating.

There is a large population of families with neurofibromatosis in the region with a variety of marked cosmetic deformities (Dr Foster removed most of the chest of a woman whose neurofibromas had turned to cancer).

On our last day there, I finally felt somewhat at home when a man arrived at the hospital from a car accident, having been thrown from the flipping car.  They called me and initially he appeared to have only a few scratches, but I did a quick ultrasound (with a portable machine sacrificially donated for our work here by a very good friend) which revealed a lot of blood in his abdomen.  We took him quickly to surgery and Dr Foster repaired the internal bleeding.  A little ED medicine sure felt nicely familiar in this very unfamiliar environment.

I assisted on several Cesareans and did most of the last.  This will be a very helpful skill for me to have where we will be working as the infant and mother mortality is very high in the remote areas, mainly because the 10-15% of births anywhere that need this surgery to save either the baby or the mother (even from the above fistula), isn’t available.  I hope to do many of these surgeries in the next couple weeks, under only local anesthesia, so as to be prepared to do the same in someone’s simple rural home (hut) when needed over the next many years.

I saw so many cases of TB.  TB of the lungs, of the joints, of the abdomen, of the back.  It’s everywhere, just like it has been worldwide for most of history.  It’s a devastating illness and it’s wonderful to be able to offer solid treatment to those afflicted.  Just yesterday, I saw a young man of about 30 with extensive TB of one lung.  He had been on treatment for two months and had been hospitalized with a chest tube for 40 days.  We told him that he likely needed surgery and another chest tube and he and his father (who had traveled with his son a day from the coast to get here) broke down and cried.  All of these beautiful people that we are seeing in the interior of Africa are you and me, with broken hopes, dreams, and such real pain.

In between surgeries, I saw 50 or 60 people in consultations over the three days and this helped me continue to learn the regional illness and the treatments available.  I was also able to observe Steve do some of his 50+ surgeries and attend to people in the hospital and in the clinic.  I learned so much.  I told Steve that I frustratingly felt like a resident again, knowing so little; but also, like a resident, I again feel the wonder and awe of learning more knowledge and procedures in order be in a position to help someone suffering.

Well… I’ve been going on early walks with my Father lately and working through the incredible gratitude I’ve been feeling regarding where I now find myself… and why it took so long to get here.  I alternate between moments of regret/questions and hours of gratitude.

It seems that my life has been leading to this point of purpose.  I’m thrilled to be here.  I’m understanding that from the time he called me to this type of work almost thirty years ago, He has been preparing me for the task (obviously, I needed a lot of work).  The beauty of His divine working in our lives is that He is always doing many things at once.  All along the journey, He leads, uses, builds, shapes, and prepares at the same time.  I’m recognizing that trusting our Father is not only the key to experiencing peace as we consider our present and future circumstances, trusting Him is also the source of peace when analyzing our past.

Believing that He rules over every moment of the journey, and every choice (ours and others), can be a real source of joy.  I can trust in His rule, timing and preparation for my life or I can acknowledge that I am where I am by chance.  Fruit accompanies each, and I am familiar with both the peace of trusting His ever-involvement in yesterday, today, and tomorrow, and the anxiety/regret/loneliness of forgetting the same.

There remain many questions… about calling and timing… about world suffering… about how He prepares the both the hammer AND the house… about what I can and cannot understand.  But…

As the above fades in and out, words simply cannot express how grateful I am to my Father for allowing me to participate in His work in Angola by loving these dear, beautiful people, many of whom are so suffering.  I’m also grateful to you for supporting us so that we can, with you, participate with our Father in His work.  It isn’t necessarily a pleasurable task, but it is so very good.  There is perhaps no greater privilege in this life than being a tool in the sure hands of the Carpenter, especially where tools are few.  The carpenter’s work is all His, and I’m so thankful today to be (with you) His hands/feet/mouth, as He carries out His present work here (touching physically and spiritually those that He loves in Angola).


  1. Kalukembe. What a wonderful place. Bring some baby bananas back to lubango for your family. Suku a kalai lovai. God be with you.

  2. Thanks so much for sharing your heart Tim. I, too can understand the wondering why it took “so long” but our Father has His perfect reasons (Isa 55:8-9). I know that He will use you and your family even as He continues to transform you. I talk to Father daily for your all.

  3. Wow Tim, sounds like a tattered and torn people. It’s so hard to hear the things these people go thru on a daily basis, much of which maybe could’ve been prevented at some point earlier. God bless you as you continue to work for God and His good purposes. I miss you and love you. kelly

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