So now I’ve had the disease that I treat about twenty times a day. I hurriedly (sometimes feeling compassionate) pray for them and get them the medication most appropriate for their individual circumstance (pregnant or non-pregnant, age, degree of illness, complications, etc). I will now “see” each a bit differently. Malaria hurts, badly, and warrants compassion. It put me down and I simply couldn’t get up, for days. I had many caring encouragements to take care of myself and rest, and I appreciated the caring sentiment. We had, however, 4 of our 6 clinicians (five nurses who see out-patients, and myself) working with malaria and I didn’t want to make it 3/5 to see the 100-150 people each day. Even the little I could do helped (the arrogant doc always thinks he must be there!). I faced the same choice that you do every day – do I care for myself or care for many, do I abandon myself or abandon by brother, etc? It’s not heroic or noble (or foolish). Like you, I’m just fighting to keep Jesus in front of me and forsaking me for Him, rather than the other way around…
My first day back after my malaria “rest” was quite busy. Though still feeling pretty rough, “many hands make light work” and, likely because of this, I was warmly and excitedly greeted by the hospital staff. My first three patients on this Monday morning seemingly would have died with one more day of their weekend treatment. Several nurses staff the weekends and admit and treat sick emergency patients and typically do a great job. But this weekend they admitted three patients and missed their grave diagnoses. Two young women were admitted with severe abdominal pain and were started on medicine. Both had peritonitis which is severe inflammation in the abdomen, commonly here caused by a perforation in the intestines from appendicitis or typhoid fever. Few survive nonsurgical treatment. We transferred them to the way-overwhelmed-already city Central hospital immediately. The third was a five year old little boy who arrived in a 48 hr feverish coma with convulsions from malaria, but had not been started on malaria meds. We began the IV meds right away and he woke up by the end of the day. We’ll see tomorrow if he has any lasting brain damage. I also saw a man my age whose body and teeth violently shook and chattered respectively throughout the entire 10-15 minute interview. He had been that way for three days…
These incredibly tough folks not only face loss and death far more commonly than those of us in the west, they experience so much pain in life as normal. During my illness, a friend wrote me and shared that she once shared with a man in Malawi that someone she knew had malaria FIFTY times! The man responded that this friend of hers “was sure lucky”.
If you’re curious about malaria, it is not unlike influenza, times two. High fever, shaking chills, with aches, headache and congestion and a painful, frequent cough, with or without vomiting and diarrhea (I had neither). The fever seems to only partially respond to tylenol and/or ibuprofen. The weakness is profound, as there was simply no standing up at all. And recovery is taking some time.
On the same day, a four day old arrived having not nursed at all since birth. She was listless, her skin had lost elasticity, and she was barely still breathing (about one breath every ten seconds). Both mom and daughter tested positive for malaria and we began treatment. After aggressive IV hydration, the baby was nursing (strongly) after 24 hrs and will go home today after three days. She’ll complete her treatment from home. Congenital malaria (contracted from the mother during pregnancy) is a huge killer here.
Out of the “Beverly Hillbillies”… We had a chunky eleven month old arrive extremely dehydrated, without eating or drinking anything for 3-4 days. He’d had measles, fever and, of course, malaria. There was also another curious reason that he wouldn’t swallow. He’d had a tonsillectomy… at home… without anesthesia… by his grandmother… who had done “many” in her past. This is not uncommon here. A child has tonsillitis (common after measles, which is common in this largely unvaccinated culture) and the family notes these large balls of pus in the throat and takes them to a traditional “doctor”. He/she digs out each tonsil with her fingernail, without any other instruments. Hmm… This type of surgical care could help bring down the US health care costs… Where there is no health care…
No one here uses watches, clocks, or measurements. If something happened twice last month, they will tell me where the moon was when it occurred (this sure helps this icalendar-dependent, spoiled american doc!). If it happened during the day, they’ll tell where the sun was. They’ll put their hand up so high for how tall/long someone or something is. NOTHING is specific. If something hurts, it’s always a general area, never the shoulder, but the arm. Never is right abdomen distinguished from left. The whole hurts. To compare one pain to another (which is worse) doesn’t work, either it does or it doesn’t. Nothing is more specific than a lot or a little, long or short, loud or quiet, large or small.
I gave a presentation to the nurses of our small hospital on critical care of the child/infant. They absolutely loved it and are asking for more “courses”. To see this kind of hunger for learning is such a joy. They so want to learn, to help, to have an impact, to play a role in saving lives. Several very critically ill kids come to this hospital daily and many others arrive quite ill. We lose a lot of these kids, but every one that survives, like the little girl and boy above, is such a joy.
As I mentioned, I work with five beautiful nurses, one from Holland, two from Argentina, and two from Angola. There are many other local nurses, as well, but these are clinicians, who have developed expertise through experience and humble hunger to learn. They see patients, diagnose, and treat and are very willing to ask for help several times/day. They treat with compassion, they love the people and their work, and they work hard. They ran the hospital quite well in my brief absence.
I’ve spoken at local churches in recent weeks, speaking on the passage in John 21 of Jesus’ interaction with Peter on the beach. This is such a rich passage, highlighting our Father’s heart toward His kids after they fail (we ALL do!) and his desired priorities in His kids. The passage demonstrates that 1) His love for us is ever present, regardless of our failings. 2) Nothing is more important to Him than our love for Him. 3) If we love Him, He would have us care for those He cares for. I am so grateful for my Father’s heart and will worship Him for who He is for thousands of years, and never stop being in awe of His love and character. If only more can see Him and know Him as He is without the distortions of Him presented by so many who call themselves by His name.
We write our prescriptions as little picture diagrams because the majority of the population that we serve is illiterate (as have been most people who have lived throughout history). Our theology, as our medical communication, must fit reality. Doctrines popular in some forms of american christianity simply don’t apply here (and haven’t been applicable to most people historically). “To grow in our walk with God, we must study the bible (know the word, etc)”. The bible is God’s beautiful revelation of Himself and we are rich to meditate and internalize God’s communication to us, but does the person saying this realize how few people today or historically could study a bible, even for a day? We create theology in our present cultural and historical context without realizing it. Jesus addressed this directly when speaking of hearing and doing (Jews, especially the leaders, also placed a high premium on study, because, as knowledge typically does, it made them feel superior). If there is one thing that characterizes many christians today, it is that their faith is destroyed by storms, having constructed spiritual foundations of sand (much hearing). If we would remember that what makes us like Him is not how much of the bible we know, but rather walking closely with the author and doing what He does. Many teach that more bible study and knowledge will strengthen our faith, but Jesus pointed out that a little applied is better than much known.
A group from one of the churches we had visited came to our house one day to pray for me during the malaria (the illness is so common, yet so respected). They came into the house (I was sleeping) and prayed for me quite differently than what we are accustomed to (per Betsy). Our weekly small group is done quite differently than any we have ever attended (over 20 years). The church services here are very different than our “normal”. At one point in the service, they typically ask if anyone has a word or a song to share, and several usually do. It’s different each time and it’s simple, quite human, flawed, and beautiful. It seems that, over time, they’ve come to manage this appropriately so that not the same people speak every time, the speaker/song is normally less than 4-5 minutes, and the people seem to come soberly prepared.
This is all quite beautiful in that our Father’s children are relating to Him as they are, uniquely made and uniquely formed through experiences, culture, etc. These differences are cherished and valued by many, ridiculed and criticized by others. We spent the day traveling with a local pastor and regional director of one denomination and it was remarkable to me how he spoke of the other major denominations and pastors with such honor. I love how our church in Sunbury, Ohio has prioritized honoring and serving brothers and sisters with doctrinal differences. Honor is highly valued in this Angolan culture (lepers are among some rare exceptions), it is communicated respectfully, soberly and reverently and it is sheer beauty to behold.
We only have about ten days remaining in Luena and then we have the 30+ hr drive home, mostly on dirt and quite isolated. We will stop on the way in Cavango (nine hrs from Lubango) and do a couple days of clinics. Hopefully the trip is not worthy of a blog entry!
I’ll try to post another entry before Christmas, but if not, I hope you have a unique season of joy and worship, remembering that Jesus abandoned all, left His home and family, came to this uncomfortable and foreign land, and gave His very life, for but one reason, our Father’s radical and extravagant love for me, for you, and for the forgotten, beautiful people of rural Angola. And we can follow Him!