Mosquitoes, Cuba, Access, Suspicion…

 

As we converse every morning with new group of patients and their families about improving their physical and spiritual health, the conversations can become theological. This morning we were discussing pneumonia and colds and how to recognize the difference. When I shared that pneumonia, Malaria and diarrhea were the major killers in our region, a woman asked whether I thought malaria was decreasing in Angola (minor diversion). I explained that malaria comes and goes in each region with the rains and the fluctuating mosquito activity. I joked that I didn’t understand God’s purpose for mosquitoes. A man then responded with certainty (as if he were quoting from the bible) that God sent mosquitoes when man turned away from God. As everyone nodded, I was smiling, “perhaps with the rains and the flood?”. Deep stuff…

 

We have the beautiful Helmholdt family (from the US) staying with Mer and me this month with their spirited three young children. They are in Angola for two years to build airstrips for our MAF ministry, the first in Cavango. They’ve brought energy, smiles and life into our home and have been a delight. They are staying with us while Jason works with heavy equipment, donated my AGA, to construct an airstrip and completely renovate the mission property in ways that are leaving the villagers profusely thanking God for sending him.

 

We have about 6-8 people (several children) arrive monthly for their injection of long-acting penicillin to prevent the worsening of their rheumatic heart disease (acquired from untreated strep throat). It is an injection that is particularly painful and I suggested to our nurses to use lidocaine (to numb the area) instead of sterile water to mix the medication. Florindo, our beautiful nurse director and dear friend, said that, to an Angolan, pain in an injection equals power. He said (with a smile) that if it doesn’t hurt, the patient will question its value. As an aside, we see 1-2 patients/week with large abscesses in their buttocks because of injections given elsewhere without cleaning the injection site.

 

Because of the destruction of virtually all education infrastructure in Angola during 30 years of war, national physicians were not trained in Angola. For the last decade, therefore, the majority of physicians working in Angola have been imported (mostly from Cuba). This month, Cuba is removing all of its several thousand doctors working in Angolan government hospitals (it’s a government health care system) because Angola reportedly hasn’t paid Cuba for the service of these physicians for four years. Also, the Angolan government has reportedly told its own new medical school graduates that they must work for two years before receiving payment (there is no recourse when the government is in control). So, the Cuban doctors are leaving and the Angolan doctors will soon be leaving (there is great need in other African countries), making an already desperate situation more so. Most of these physicians work in the major cities, so it won’t change the already great need for our work in the rural areas, but it makes it highly unlikely that the horrible health care situation in Angola will change anytime soon.

 

There are so many consequences to such lack of access to decent and simple physician care…

 

One of the flatbed truck drivers that we periodically hire to transport material from the city to our mission is 32-year-old Avelino. Avelino had tooth pain for several weeks and thought he could tough it out. It swelled and continued for several more weeks and then the pain lessened but pus began leaking out of the side of his face, so he wrapped a towel around his neck day and night and continued to work. About three months after he began using his foul-smelling towel, he saw me in the clinic and could only open his mouth about 1cm. I told him that he had a bone infection in his mandible (incredibly common here because there is no dental care) and needed surgery to clean out the infection and allow it to begin to heal. I saw him (and his towel) three months later and he still hadn’t gone to the city to have the operation. He said, “It’s a long way!”

 

We had this morning a 27 year old woman who tolerated the same for 8 months prior to her visit to us (which took her a full day’s trip on a motorbike). Her face is massively deformed, leaking pus and she can’t open her mouth. She didn’t know that anyone in Angola could help her! We are taking her Wednesday, with 6-7 others to our mission hospital in Lubango (see the CEML link above) for their necessary surgeries.

 

Word is spreading about the benefits of our simple, sound medical care in Cavango and trust in our care is growing in this region. After my absence from Cavango for two weeks to work in the remote MAF clinics in July, I returned to 60+ patients waiting to be seen at our clinic, most having waited for up to a week for my return, sleeping on the ground around fires outside the clinic (it currently gets down to about 40F at night). With family members, there were over 150 people camped outside the clinic as we drove up the night before. It was quite a sight.

 

A glimpse of what I saw that day: 3 men blind with cataracts in both eyes (we will take them this week to our friend Dr. Collins in Lubango for sight restoration surgery), Leprosy, several cases of severe malnutrition, several cases of pneumonia, several cases of newly diagnosed heart failure from untreated strep throat, several cases of advanced cancer, severe hydrocephalus in an infant, several cases of malaria (we are out of season), several cases of TB, several with severe arthritis, and almost nothing minor (we have space for 7 surgery patients on our trip into Lubango and the car was full after that day). So many people had been waiting for so long (some of them years) to get to a doctor because there are no other options. Almost all had been to a traditional medicine “healer” who had used chanting, drinks, enemas and scarring rituals involving burning the skin near their affliction (no other options). Each of these people were loved, treated and prayed for because of the sacrificial support of many of you to send us here… If you haven’t joined our team of supporters, you are invited to make a huge difference in a dark place full of hurting, beautiful people…

 

 

A 23-year-old young man visited this week, arriving with severe shortness of breath and chest pain for about a month. He had a murmur so severe in both phases of his heartbeat that I could almost hear the murmur without touching the skin with my stethoscope. An echocardiogram revealed severe regurgitation of blood through the mitral valve, explaining the murmur and his symptoms. Suspecting acute rheumatic fever (from untreated strep throat), we began aggressive treatment and three days later, he had no murmur and no symptoms! It was a dramatic turn-around, the significance of which he will never know. This is an illness completely preventable and easily treated, and without treatment often fatal. We usually don’t see these folks (so many) until the heart damage is irreversible… This is a disease that I had never seen in the US because Strep throat is so readily treated.

 

We had a teen this week survive epiglottitis, an illness involving swelling of the fold of tissue that blocks the airway when one swallows.   She same in with a severe sore throat and unable to swallow her own saliva, while her throat (what I could see) looked normal. Diagnosis was confirmed with ultrasound. This disease has been all but eliminated in the west by vaccinations, but is still a common killer here.

 

A team from CEML (see link above) visited us this week to do surgeries under local anesthesia. It was a delight to host them and to see them help people who would never make it to the city for surgery. One man had a hydrocele causing his scrotum to grow to the size of about 2 softballs. One woman had been shot in her jaw 30 years ago during the war, and had surgery with a plate and screws in her mandible. The screws came loose, as did the plate, and she hasn’t been able to see a doctor for three years, since one screw eroded through the skin and she developed an open ulcer at the site of another. Our visiting surgeon (from Germany) removed her hardware and replaced her much scarring with a simple, linear repair. She has had no one to go to who could actually help her for all these years …

 

There is also ignorance as to what solid medical care can provide. We had a 12-year-old boy this past week arrive in a coma with frank meningitis. He improved a little over the first 72 hrs (awoke, drank liquids, fever resolved…), but spoke with much confusion and slept most of the day. From the father’s perspective, there was little improvement and little hope, and on a day when I traveled to Huambo to purchase medicine and supplies (a full day), he took his son home to die, which he did 5 days later. There was actually much hope for this boy and I was disappointed and quite surprised, as I never expected the father to abandon treatment the way he did. This disease, as well, has been practically eliminated in the west by vaccinations, but we see so many cases here, most resulting in permanent neurological damage including epilepsy (most of our many cases of epilepsy began with meningitis), mental disability, blindness, deafness, etc) or death.

 

We were visited last week by the leaders of the Angolan government in charge of air transportation. They suspended our work on the runway complaining that we didn’t have all of the necessary documents turned in for such a project. They flew an hour and then drove 4 hours to suspend our work. This was after we were given permission to begin the work and then visited on at least 10 separate occasions by government leaders “inspecting” the runway construction (driving on awful roads for 1-5hr to arrive here). Then yesterday we were visited by two large army helicopters (for the second time) carrying 5 provincial officials and 5 men armed with AK47s who stood guard over the helicopters after landing. Why would they come on a dramatic, surprise visit like this on a Saturday?  They found Jason renovating a soccer field with the bulldozer (leveling 2 termite hills, each the size of a house) and our visiting surgeons doing surgery (our nurse said they were likely embarrassed). Such extravagant cost to travel to a little mission in the middle of nowhere, doing simple medical work and constructing a dirt airstrip to facilitate the same…

 

The paranoid suspicion demonstrated by the government for our work in Angola is both comical and angering, but so emphasizes the importance of trust in any relationship. The leadership in many developing nations has good historical reasons to not trust people from foreign countries who say they want to help. There is a long and sad history of exploitation for personal gain that we must overcome in our work here. Beyond this, the US government supported the rebel group in the civil war here in the 1990s, and the government officials have a good memory.

 

This is a government that is struggling to overcome the destruction wrought by 30 years of war.  It is a wealthy government (oil revenue) which historically has little to show for its declarations of concern for the wellbeing/health of the “common man” (its population is one of the poorest in Africa), so why such passionate (and extravagant) interest in an airstrip 4-5hr drive from the closest city, built to serve the rural poor?  It is likely that many in leadership have a difficult time believing that all people aren’t motivated like they are (a common psychological trait in all of us) and have a difficult time believing that we are simply here to help (they seem convinced that we, like them, have ulterior motives centered on self-advancement and adulation).  In conversing with so many officials in the past several years, it is clear that, to some of these men, Jesus-in-us is an attractive, unfamiliar light (churches here are so much about religion and little about intimate relationship with Jesus) and they are drawn to it in curiosity (like the men with Jesus on the road to Emmaus), while to other (most) officials we are an irritation and a stumbling block to their personal agendas (they want control over as much as they can control and fear anything or anyone that threatens their hold of power over the people and resources).  Hence, the multiple visits to our mission to try to expose what we are really doing (beyond our health care work).  Remember another time last year when we were escorted out of the dormant volcano in army helicopters by armed soldiers for simply holding monthly clinics for this isolated people group that had no health care access…  The rumors behind our removal from that mountain were that we were mining diamonds and/or harvesting organs (ulterior motives)…

 

Though characteristics such as hospitality, service, respect, honor, and customer service are commonly seen among the rural poor, they are difficult to find among government leaders, who seem to thrive on the outward (only) adulation of their “subjects”.

 

We must remember that those who love the darkness will always be critical and suspicious of those of the Light, and those of the Light must know that they will always antagonize the darkness. John the Baptist was criticized for his outwardly sacrificial, strict and simple devotion to God, as was Jesus for His more relaxed, gracious, loving devotion to His Father.  They were both a constant irritation and source of conflict to the cultural leaders because they had earned the respect and adoration of so many people (what the leaders longed for) and because the purity of their lives and motives exposed, by contrast, the self-serving motives of the leaders.  Our lives and work seem to be doing the same in Angola.  Jesus lovers will always be criticized by men, and we can bow to men and compromise our devotion to God or bow to our Father and compromise our devotion to men…

 

It’s tempting to bow to these men of earthly power (or fear them), thinking that, by befriending them, we will further our work. Jesus didn’t do this…

 

Jesus sought not to change the world through its political systems (or bowing to their leaders), but rather He sought people who would follow Him, who would share the good news of His grace, and who would serve the hurting and confused people that He loved, even if it cost them their friendships with the world, their livelihoods, their reputations, and/or their lives…

 

His was an approach appealing to people (vs political systems), to individuals, to families, and to small communities, from the roots up, from the “bottom” of society to the top…

 

You and I can change the world today (Jesus’ way) by embracing our neighbor, by serving our offensive co-worker (or family member), by raising our children in humility and respect, by seeking the outcast…

 

2 comments

  1. Tim, I am always humbled and encouraged when I read your blog of the work you and your family are doing in Jesus name. May God give strength to face these challenges in serving the least, in face of your own harm. God bless you brother.

  2. Hi Tim and Betsy,

    You live in a most desperate place. What suffering. And you are really living out what you talk about. I loved the last sentence in your post.

    “You and I can change the world today (Jesus’ way) by embracing our neighbor, by serving our offensive co-worker (or family member), by raising our children in humility and respect, by seeking the outcast…”

    May God bless you and keep you strong,

    Warmly,

    rb

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