Reality, Sensitivity, Dancing…


I admitted to our little hospital an adorable eight month old baby boy with fever who had lost his appetite over several days.  He was admitted to a city hospital one month prior and told he had malaria (apparently test-positive).  He was treated for several days and released, still having a fever.  The fever never subsided and continued daily until his mother (her first child) brought him to our clinic.  His exam was completely unremarkable, but because of his history, we prayed for him and admitted him and treated him aggressively for malaria and typhoid fever, both very real possibilities in this clinical situation.  The fever subsided over the subsequent two days but the boy’s appetite remained minimal.


The mother then brought the baby to me one morning, saying that he had vomited blood and his stools were black (indicating blood).  I couldn’t figure out why he would have intestinal or gastric bleeding combined with his other symptoms, so I prayed for him again and told her that we would observe him, continue the current meds (none of which would normally cause bleeding) and hope that the internal bleeding would stop over the course of time and treatment (malaria can cause hemorrhaging, for example).  He wasn’t pale and still appeared quite stable.  That night, a nurse came to our house (there are no phones) and said the baby had much bloody diarrhea.  I went to see the child and the rags used for diapers were full of blood and clots (a large volume for a baby weighing 6 kg), though he hadn’t vomited further.  He was now quite pale, a significant change from earlier.  From my perspective, I didn’t know why he was bleeding or where he was bleeding from, but he now critically needed blood to survive.  I prayed for him again and told his family that I would take them to the nearest hospital (four hours, off-road) for a blood transfusion.


I went home and grabbed a hurried sandwich (it was just getting dark at 6:00p) and went to their village to pick them up.  The scene at the village was so memorable (I wish I could have taken a picture, but it wouldn’t have been appropriate).  Candles and lanterns, mud huts with grass roofs and dirt floors, pigs and chickens and about 30-40 concerned people gathered at this family’s house in the drizzling rain.  Every person had tattered clothes covered in dirt (it had been raining and everyone was in the fields planting), all were barefoot, most of the kids had extremely snotty faces (snot is obvious in white kids and much more so in kids with dark skin), small kids were running around chasing after wheels (their only real toys), and the adults were quietly murmuring among themselves, while the mother and grandmother scurried around gathering necessary items for their trip.  Several people approached the mother and handed her a few crumpled up bills.  The pastor arrived and gave her some money, as well.


It’s been said that these people living in the bush don’t know any different and, therefore, handle adversity (illness, pain, death, loss, hunger, inconvenience, etc) better than those in the west.  The scene at this village indicated otherwise.  These people were full of the same sober anxiety, concern, helplessness, sadness and preoccupation that you would have had if your precious first-born (or that of a loved one) was gravely ill.  The Mom loaded up some belongings in a rice sack (the most common “suitcase” used here), with a little food and we began our journey to the waves and hugs from concerned family and neighbors. Our journey was rough and uneventful, except for driving the whole way in a torrential downpour, which made our trip last more than five hours.  I dropped them off (after 11p) at the very-third-world city hospital, explained to the head nurse (there are no doctors on staff there) the urgency of the situation and left for home.  We found out the next day that the baby was immediately transferred to another hospital (another two hours) and died while a transfusion was being arranged.


We currently have 10 kids with rheumatic heart disease in our immediate area, three of which won’t survive without a valve transplant.  A 23 year old young man arrived the other day in fulminant heart failure and we have an 18 year old young woman and thirteen year old girl, all with the same illness, resulting simply from untreated strep throat.


We now have 16 people with Leprosy in our immediate area who have not received an appropriate full course of treatment because the government is “out” of the medication (they have plenty, it just isn’t getting to the people).  Because the government completely controls the leprosy, HIV and TB treatments, I can’t purchase these meds anywhere in country (and it is illegal to receive them from elsewhere), and these people are without treatment and without recourse.  It is irresponsible, unjust and unethical for this extremely wealthy and corrupt government to create such restrictions and then not supply the promised medications.  A recent study revealed that 70% (!!!) of the federal budget last year was unaccounted for, and these simple, beautiful folks go without simple, inexpensive medications, and die.


Our flight clinics were quite busy this month, as malaria is now everywhere with the arrival of rain (and mosquitoes) in much of Angola.


One young man at Mukwando (the isolated people group in the dormant volcano), who spoke good Portuguese, asked me where I was from and I told him “Estados Unidos” (“United States” in Portuguese) and he had never heard of the place.


A little 4 year old girl came to see us because she had suddenly lost all strength on her right side.  She was in a government hospital previously and was treated for malaria, and was discharged home still having a fever.  Several days later, she became paralyzed on one side of her body, not even able to hold up her head.  Her parents brought her to us and we prayed for her and began aggressive treatment for malaria and meningitis.  Within two days, her fever subsided and her appetite returned, she was holding her head up without difficulty and she was smiling, though her arm and leg remained flaccid.  We discharged her home after a week of treatment and will see her soon in follow-up.


The realities of life and health here are not pretty, though we do have quite a few positive outcomes.  This morning’s community meeting was canceled because of a funeral.  There seems to be a funeral to attend at least weekly…


A 35 year old woman, carrying her tenth pregnancy (three children died before age 5), arrived yesterday morning in active labor at full term and was about 4 cm dilated.  This morning, I visited her at her house and she was completely dilated but no delivery.  This afternoon at her house again, no change and waning contractions.  I suggested to the head nurse that we move her to the hospital and begin Oxytocin to enhance her weakened contractions, but the nurse said it was late (5p) and because there was no power at the hospital, the woman would be more comfortable at home (on blankets, on the cracked dirt floor, and also without power) and if she didn’t progress by morning light, we could move her to the hospital and begin oxytocin.  After consideration and prayer (over a few moments), and in complete disagreement with the nurse’s “treatment plan”, I relented.  Honor and respect vs. appropriate treatment and care…


It’s quite a “dance” when one, especially a foreigner, enters a new community and culture.  He/She must interact with sensitivity and humility, communicating much honor and respect.  Too many missionaries (“christians” in the US often do the same) passionately dictate what is best and biblical, without appreciating that no information has value without trust (none of us really listen to someone we don’t trust).


Our Father clearly understood the value of trust in communication when He told us to be witnesses (our words validated by our lives) and to make disciples (through relationship), not to primarily “preach the word”.  In His own ministry (Lk 4:18) and when Jesus sent out the seventy two, the emphasis was all about relationship-building (Lk 10).  Sharing about your passionate love for your Father will always be a part of being a solid witness and of making a disciple, but it is NOT the primary focus of a Jesus-follower.  Our lives and care earn us the right to be heard and must always be primary.


I’ve learned many times in my marriage and in treating patients (both of which involve communication between people from very different backgrounds), that expressing care and concern has much more value than does a solution.


Without trust, communicating truth is like tossing seed onto concrete.  We often forget that trust (developed over time and with demonstrated integrity, love and care) is a key “soil changer”, as are God’s spirit, circumstances, grace, etc.


When we christians (and missionaries) preach and teach about God, health, life, etc, we must realize that we often imply that the established beliefs and methods of those listening are flawed and, unless our message is communicated with great sensitivity, we communicate significant dishonor and disrespect.  This has, unfortunately, been a huge historical part of christian evangelism and missions, and so much damage has been done while preaching truth in Jesus’ name without love and care, both in our own culture and in other cultures.  The offensive and rude christians then see themselves as “persecuted” when, if fact, those rejecting them are actually responding quite appropriately to their disrespectful and offensive behavior.  In our daily interactions, we must remember the importance of sensitivity and concern and the necessity of earning (through building trust by our lives and love) the right to be heard.


Luke recently described to me a striking scene from his U.S. college campus that Jesus must’ve loved.  A completely dishonoring fire-and-brimstone group of “christians”, complete with hate signs and angry bible preaching, was railing against gays and lesbians and waving their bibles and yelling that they were all going to hell (and Jesus did this when?), and the director of the LBGT sat down and tried to have a civil conversation with the leader of the “preachers of truth”, to no avail.  The “sinner” loving and embracing the religious bigot.  The irony, of course, is that the guy holding the sign is every bit as screwed up as those he’s sending to hell.  A beautiful Kingdom illustration that Jesus would have used to demonstrate His heart for sinners, his passion for grace, and his hatred for religion…


In our twice-monthly community meetings in Cavango, there is much enthusiasm for constructing a new church building.  I understand the community’s desire, but there will be a “dance” over the next months and I would appreciate your prayers.  This is a very religious culture and they would feel so good holding services in a spanking new and beautiful building.  The problems are 1) that the current adobe building isn’t full (though small and simple) and 2) there is virtually no sharing of the Good News, discipleship or mentoring occurring (all of which need no building).


How important is it to spend quite limited resources on something (a church building) that frankly is of such low priority to our Father that it isn’t even addressed in His letters to us?  Our Father prioritizes so many things before a church building (love, patience, kindness, community, service, discipleship, mentoring, etc) and I will be endeavoring to guide the discussion over the next months to Kingdom priorities.  Personally, I’d love to see foreign money construct a huge playground that zillions of kids would enjoy every day vs. a building that would be minimally used for (adult) gatherings that could be held anywhere…


An issue that must also be considered is unhealthy dependence on outside help.  We want to encourage and model dependence on our Father and each other and not on the perceived deep pockets in N. America.  In our enthusiasm to help, we can promote unhealthy dependence and can destroy both human dignity and the creative use of local resources.  We can also make local resources and products seem quite inadequate when we bring in outside money.  Kingdom priorities: we can use outside money to serve ourselves (the church) or to serve those needing help.  This community has some outstanding leaders, and we want to use the gifts and talents that our Father has put here rather than search for others from the outside.


Yet… our Father loves to see His kids sacrificially contribute to neighbors in need (“when you saw me hungry…”) and so many of His beautiful kids in N America desire to help these folks, who are living such difficult lives.  A dance…


How different a church building is from, for example, a vehicle to transport sick people to the hospital!  Our church in the US is raising money for a vehicle to transport people to our hospital from miles around.  There are NO other options for transport (many people now walk for days to arrive here) and this will have such value in directly helping so many hurting people who otherwise would not receive care.  Foreign money can have tremendous value, if contributed with wisdom, Kingdom priorities, and an outward focus.


Helping isn’t always good; enthusiasm, passion, and zeal require direction; giving can be harmful; preaching isn’t always appropriate; and love needs wisdom to be effective…


But our Father will direct our steps and I’ve much need today for wisdom from our Father’s Counselor and Helper.  Please converse with our Father about our work and share with us what our Father might say to you…


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