Typhoid, Confrontation, Ashes, Beauty…

 

Jesus has called each of us to be, first and foremost, servants… not leaders, not missionaries, not doctors, business men, teachers, laborers or pastors…  In whatever vocation or role we assume, we are to always find ways to humbly serve…

 

He has specifically called us to serve these beautiful rural people… sometimes as a doctor, sometimes as a teacher, sometimes as an encourager, sometimes as their advocate before the government officials, sometimes as a carpenter… and sometimes simply as a driver…

 

What a week. It began on Sunday evening when two urgent patients arrived at our clinic at the same time. Their vital signs indicated that both were in shock from overwhelming infection and dehydration.  One was a man of about 60 years who arrived on motorbike after six hours on an awful dirt road, riding between his two adult sons, who held him upright as he winced and screamed at every bump (every few seconds). He had not eaten or drank anything for several days and had severe abdominal pain. On exam, he had a surgical abdomen, firm and quite sensitive to tapping on my still finger lying on his belly. We hydrated him and gave him antibiotics and pain meds and told him that we would transport him to a surgeon in the morning. The other was a 28 year old woman who had given birth a month prior to a beautiful baby boy. She complained of severe pelvic pain and fever and also had not eaten or drank anything for several days. Ultrasound revealed a large abscess in her pelvis that needed to be surgically drained. We told her that she was quite ill and would need to be transported the following morning, as well, and we initiated antibiotics, fluids and pain meds (injectable pain meds here have about the potency of ibuprofen).

 

The following morning the husband of this woman refused transport, stating that they simply couldn’t go to the city (a common response from these rural folks who have never done such a thing).  After she walked to the consultation room, we discussed the situation for about 15 minutes, and I told them both that the woman wouldn’t survive without surgery.  Fifteen minutes after this discussion, I was called back to the room… the woman had promptly and suddenly died.   For those who think that death is simply a physical/material occurrence, this situation would offer a challenge. I’ve been practicing for 25 years and haven’t seen anything quite like this…  This young, otherwise healthy woman had actually looked better that morning, her vital signs had stabilized, and she ambulated without difficulty… When all hope is removed from someone facing significant pain and/or difficulty…

 

We loaded the man in the VCDC truck lying down and drove for 4 hours over nonstop bumpy and rolling dirt roads, during which he yelled or groaned about every 3-5 seconds, and vomited consistently. We arrived in Cachiungo and explained the situation and the receiving nurses said they would transfer him to Huambo (an hour away) right away to receive emergent surgery. We left, ran some errands, and had a very good meeting with the director of health for our region. She is new to her role and was quite supportive of our work. We explained the challenges that we faced in our work and our need for advocates in the city. I was impressed with her and encouraged that we finally had an leader who would be an advocate who appreciated the challenges we face and she seemed committed to helping us in any way she could.

 

We came back to a very full day of consultations in our clinic the next morning, which included a 38 year old woman with vomiting and severe abdominal pain of several days duration. She, too, had a surgical abdomen! We saw her about noon, confirmed the diagnosis via ultrasound by seeing free air and fluid in her abdomen, and faced a tough decision. Do we leave immediately for a rough four-hour drive to the hospital, an hour there and a four-hour return, or do we leave early the following morning? What is best for her and what is best for the long line of people waiting for a consultation? This is a tough call, and one that we face often when working in the interior, away from the cities and all that cities offer, including hospitals with electricity, etc. The distance to further care often forces choices that are not commonly faced in a more advanced health care setting. We told her that she would need to be transported the following morning and we planned for the same. We were glad we didn’t take off immediately, as later in the day we saw a young woman with (what appeared to be) localized cervical cancer who needed surgery soon, though not urgently, and we told her that we could transport her the following morning, as well.

 

We left the next morning at 4a for the very rough trip and the woman endured it with vomiting and much groaning. We dropped her off at the same hospital and the receiving nurses said they would transfer her promptly (with also the woman with the tumor on her cervix). We then found out that the man we had brought to them 2 days prior had died the following day, having never been transferred. I was livid, and couldn’t imagine why he hadn’t been transferred to receive life-saving surgery. I stormed to the director’s office to hear an explanation, and he smiled and apologized and said there was nothing that could have been done as the ambulance wasn’t functioning (the norm). I told him that we had dropped him off in a car and could easily have transported this man to the surgical hospital (on pavement, an hour away). No one had said to us that the ambulance was out of commission. I lost it. I told him they could have used a taxi or a donkey cart, or the director could have put the man on his shoulder and walked… as I had emphasized clearly that the patient would die without surgery that day. I went on and on…

 

Before he could respond, the director of health for the region (the woman mentioned above) entered, having heard that I was in town, and she had come to ask me if I could transport the man’s body back to his village. I was livid (still/again).   I told her that she had some serious courage, after what had happened, to ask such a thing of me. She also got an opportunity to hear some passionate verbiage about patient care. During the animated discussion, I found out that she wasn’t aware of what had happened, and I was therefore glad that she had the opportunity to be part of the discussion. I also found out that the hospital director was absent the day all of this happened and he was also quite interested in hearing my perspective (he was surprised by my “passion” – better word than “anger”). I steered the meeting to a discussion about how the system could be improved (rather than personal accusations) to accommodate the care of these patients so that something like this would never happen again. They were both mature in their responses, admitting grave mistakes and voicing commitment to working together going forward.

 

We tried on both visits to town to see the administrator (mayor) of the city, and both times he was out. He had offered no defense for us when our runway work was suspended and these trips were tangible demonstrations of our need for the airstrip in Cavango. The director of health completely appreciated (and empathized with) the obvious need for the airstrip and said she would speak to the administrator personally. This was so much better than me stating again the same things I had personally said to him many times.

 

What began as a tragic system breakdown that resulted in a preventable death, ended on a very positive note that may benefit many in the long term. The health care workers here are often apathetic, with a fatalistic approach to their care, resulting in poor, slow, and incomplete care. These leaders witnessed some animated passion (in a missionary blog, “animated passion” is better than “anger”) as to caring for people demonstrated in the conversations, but also in our two consecutive brutal trips (that they would never make) to save the lives of these few individuals. They also were in the humble position of being caught in obvious errors that resulted in a preventable death, causing them to be open to stepping up their care for our patients (and taking steps that would make changes happen). If they follow through with their stated desire to improve care, the day was truly a kingdom transformation of ashes to beauty. I believe their attitude toward us will never be the same and perhaps they will modify their care based on the events of that day, as well as support the construction of the airstrip here.

 

We (the man’s body and his son) left and began the 8hr trip on dirt back to their village, where the body was received with much grieving. After dropping off the body, I then traveled the 4hr home from his village, completing a very long day.

 

 

The scene as we dropped off the man's body at his house (left)

The scene as we dropped off the man’s body at his house (left)

 

 

 

 

 

 

 

 

The next day, our clinic was packed again, but this time no one needed transport for surgery!

 

Both surgery patients likely had intestinal perforation caused by typhoid fever, a disease that we are seeing more of these days because it is the end of the dry season and the water areas are fewer and more concentrated.

 

It was a nice intervention opportunity with the young woman, as well, as we rarely have the ability to offer a surgical cure for the various common cancers here, as most cases we see in this tough people present much too late for a cure, especially in this country where medical resources (and surgery) are so scarce.

 

On our very full trip to the southeast last month, in one location we saw 5 cases of advanced, undiagnosed AIDS one day before lunch. We saw many other cases, as well.  Because of the long war and little movement in and out of the country, Angola has one of the lowest rates of AIDS per capita in Sub-Saharan Africa. Now that there has been no war for more than 10 years and the fact that Angola is surrounded by countries with high rates of this disease, the prevalence of this disease is increasing dramatically, especially around the borders. This disease is a death sentence here, where as in most of the world (because of antiretroviral medication) it no longer means a shortened life expectancy.

 

In one of our locations, we must be picked up at the dirt airstrip and driven about 20km to the town in which we hold our clinic. It is Jamba Luiana, in the very SE corner of the country, and on the drive to town, we saw two wild elephants, an adult mother and her calf. They saw our approach and ran away from us, but it was quite a thrill to see such massive, beautiful creatures in the wild. There are many in this region and “Jamba” means elephant in the local language.

 

Betsy just returned from two nice months in the US to help Ben get situated at Wheaton. I’ve never seen this recommended in marriage counseling manuals, but our life style necessitates much time apart (2 weeks/month and 1-2 months/year) which makes us appreciate more dearly our time together (and our reunions). It sure is nice to have her back. She returned with Meredith (how delightful to have Mer home), who had a wonderful time with dear friends in Lubango over the past month. Absence does make the heart grow fonder…

 

After lives lived physically apart, how beautiful one day will be the union of Jesus and His bride, face to face…

 

3 comments

  1. Dear Tim and Team,
    Thank you so very much for your great heart, putting yourselves often in harmsway to seek and save the lost. We are praying for you all. We thank God who has given you to us. We love you. Be encouraged.
    Maranatha!

  2. Bless you Tim, and Betsy and Mer,

    You must have many emotionally exhausting days! Those are quite the stories. May God strengthen you as you advocate for the poor.

    I prayed for you this morning.

    Warmly,

    rb

  3. I really enjoy your honest transparent news letters..They are encouraging and challenging at the same time.I pray for you and your family daily..”You go down into the well my brother i will hold the rope.” Hudson Taylor.

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