Malaria, Tonsillectomy, Moon Time, Illiteracy, Uniquely His…

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!


  1. as always, a thought-filled post. Thank you for your thoughts and your heart to seek the flourishing of others.
    Perhaps i am not understanding your point thoroughly regarding illiteracy. In the era Jesus entered, the Jews had a scripture-soaked experience that, even if they could not all read, they heard God’s revelation regularly (or had to work at not hearing it), with regular reading of the law in the villages. Jesus was one of those itinerant rabbis who visited such villages and read and expounded on the law. The point seems to be that, it was (and is) very important to regularly hear God’s word and have it taught to us, literate or illiterate. Even if we are illiterate, preaching the word is highly regarded (Acts 6 even shows us how the apostles put preaching the word above caring for basic human needs such as physical food in terms of importance). We ought to pursue literacy so that people can, as the psalmist says, hide God’s word in our hearts. How else can we do what our loving savior commands unless we know what he commands? (He asks that if we love him, we must do his commands). This means we at least we have to hear his Word. And this means that we ought to empower more people to be able to read his Word to burn it on their hearts that they may share it with others. i’m not equating literacy with sanctification. But it is a tool that we ought to pursue for others to have in order to draw others closer to their Maker. God with us; God speaks to us!

    1. Thanks for your thoughts, Daniel. Let me try to bring more confusion! I sure agree with you re. the beauty of God’s word and that “hearing” God’s word is good and necessary for our spiritual, emotional, physical health. We want to share God’s word at every opportunity, in season and out, because it points to Him. My point, not made very well, is that God’s word was written not to know, but to “do”. We can be hearers (know about him) or hearers and doers (walk with Him). As you know, Truth and the Word are a person and Life is found in relationship with that Person. I can study and study and study Betsy and about Betsy and this will only help so much re. our relationship. Some knowledge is necessary in relationship but there is such a difference between knowing about and knowing (as in relationship). We are to hear and to do, to learn about God in order to know Him. Life is in knowing Him, not knowing about him. Hearing and doing. I think the key point is that hearing is not the end but a means to the end of knowing Him (doing). Knowing God’s word is not life, but knowing the author (who God’s word points to) is Life. His words point to Him and in Him is life. The Pharisees are the prime example of knowing and not doing (relationship with the Father). As the American christian church, we can make pharisees (very knowledgeable hearers) or Jesus-lovers, who love God’s word but whose passion is relationship with the Author.

      I don’t know if this muddies the waters, but I don’t mean at all to minimize the beauty of God’s word, but rather remind us (me) that we can walk with God (know Him), or we can study and know the bible (about Him). Paul emphasized walking in the Spirit rather than study, study, study. As a church, do we make the same emphasis of walking with God, or do we emphasize study, study, study (knowing about God)? Is life in God or in His words? Is life in bible principles or in a living, interactive Father (God with us, God speaks to us)? I believe these are relevant questions for much of the church today.

      My reference to literacy was that, so often what is communicated in the church today is that the more we study God’s word, the more we will have life. But the majority of the world’s population today and historically would not be able to study and study and study (because of illiteracy, lack of access to bibles, etc), and this is ok, because the bible points to LIfe but isn’t life in and of itself. We can have revelation of God through hearing (or reading) a bit of His word, for example, and apply it well to our relationship with Him and to our life, and be building a foundation of rock. God can use the little seeds of His word that we scatter because people don’t need to know all of God’s word to know Him (the goal), as their relationship with Him will grow in depth for thousands of years. As missionaries, we aim to reveal God to those who don’t know Him, so that they can walk with God. We do this through His word, His power, our lives, etc. So what I must continually remember is that the end goal is people walking with God (in relationship), not people with more bible knowledge.

      Thanks for your comment and your thoughts, Daniel. I hope we can kick this and other things around in the near future!

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