Eternity, Diagnosis, Time, Intimacy…

 

This past month I traveled with MAF to the Rivungo region, along the Zambia border, in the southeast corner of the country, in the province of Cuando Cubango. Our trips to Cuando Cubango alternate monthly between the regions of Mavinga and Rivungo. Two rivers border Cuando Cubango, the Cuando in the east and the Cubango in the west. These rivers frame a desert land, which is currently facing a severe drought, which is pretty much annual, as the yearly rainfall in this region is minimal. The southeast part of the province is part of a huge international reserve, extending into Namibia, Zambia, Botswana and Zimbabwe, so it isn’t unusual to see an assortment of wild animals while traveling here.

 

The region is sparsely populated (less than a million people in the entire province, the size of Ohio and Indiana combined, most living in the capital of Menongue) by people who are poor, simple, and hard-working (necessary in order to eat), and who have virtually no access to health care or the gospel, because few people (foreign or Angolan) travel to these folks living so remotely, as transportation is expensive or grueling. With MAF’s small planes, we gain access to these most remote areas, which are almost impossible to access by car. Rivungo, for example, is 3-4 rough days by car from Lubango (by night, because the hot sand is too tough on tires) and it took us about 5 hours to arrive by small plane. SIM sent out a recent mailing seeking funds specifically for our work in this region. Please support this work through SIM (www.sim.org) and you will be a part of bringing health care and the Good News to many who know neither…

 

The heat is suffocating, always over 38C (100F) in our clinics. The impact of this heat and the lack of water (all drinking water must be carried from rivers to one’s home) was revealed in Jamba Luiana where close to 50% of the adults we saw had heart rates greater than 100 beats/min at rest.   I had never seen such a thing in 25 years of medical work and it has now occurred in several consecutive visits. I have likely never been that dehydrated in my life and many of these folks live in such a state daily.

 

Angola is still (about a year) facing an economic crisis with the global price of oil minimizing the revenue coming into this country (a heavy exporter of oil). The toll of the crisis is seen in many places, especially in the (“free”, government-run) health care sector. The hospital in Rivungo (a center for a large region) has no medications and the outlying health posts haven’t received their “monthly” supply of medications for 12 months. The nurses in the health posts haven’t been paid for 18 months and continue to work and try to help sick people as best they can (a doctor/nurse without medication has little value). One man (head of the local health post in a village in which we worked for a day) choked up as he described the conditions, the lack of food and the number of children who have died from malaria over the past year because they haven’t had any anti-malarial medications.

 

I listen, I see the horrid conditions daily, and I fluctuate between anger and despair, before I remember that these conditions have been the global “norm” for thousands of years. Starvation, war and disease have consistently devastated mankind, creating a life expectancy of about 40 years for virtually all of history. This life expectancy has only recently increased (in the past 100 years) with the advent of modern health care, which exists today only in the economically wealthiest countries (almost half of the world’s population lives on < $2/day).

 

Jesus’ Good News is about eternal life, uninterrupted by inevitable death. It is about hope… in the midst of pain, hunger and loss (Jesus stated that in this life we would all face trouble and difficulty). The reality of His Kingdom offers hope for a life eternal, better than anything this world can offer. Our choice is to believe and pursue Him or to believe and pursue that which we see, feel and understand. The Kingdom message of eternal life is real hope for the rural people of Angola, each of whom will likely attend several funerals this month. Every time I speak to someone, they have either just returned from a funeral or are preparing to travel to one.

 

There is no deception here about the brevity of this life or the reality of pain, hunger and loss. All rural Angolans know they and their children will likely die sooner rather than later. There are no expectations here of healing or prosperity (they’ve prayed and hoped too many times), no wish lists, no bucket lists, no “pursue your dream”,  no “follow your heart”, or Christmas morning expectations. Reality doesn’t allow these and the preservation of one’s mental health permits no false expectations. Tomorrow is not a given and there is little pleasure to pursue. This is the history of mankind… Terrorism has been an ever-present reality, as has brutal dictatorship, war and famine (these folks in Angola have personally experienced all of the above).   So when I speak of the Good News in my interactions here, I speak of the hope of eternal life because this was Jesus’ focus. Hoping and praying for a better earthly life is futile for an Angolan man or woman, but Jesus’ promises of eternal life can be trusted because of the One who spoke them.

 

“Abundant” earthly life has always been “daily bread” with peace and contentment and nothing is new under the sun.

 

I had two children in the hospital this week in critical condition and they have not responded to our treatment. These situations are not uncommon here, where a certain diagnosis can be elusive in a setting of no diagnostic testing (except ultrasound), electricity, lab, x-ray, etc and limited treatment options… and the weekend was a tough one for me…

 

I thought a little one-year-old girl most likely had Typhoid Fever (though I was quite uncertain for several days), a common disease in developing countries, but not in the west. We treated her for a week and saw no improvement and she then worsened overnight and I was able to confirm an intestinal perforation (a common life-threatening complication of this disease) with ultrasound (Monday), so I drove her a couple hours to the nearest town with an ambulance (though it’s rarely functional, I was so grateful that it was operating and available), where they were to drive her another 5-6 hr (awful conditions with much rain on the dirt “roads”) to a hospital where we hope there is a surgeon (hit or miss). I’m hoping she had urgent surgery on Tuesday…

 

A little eight-month-old boy has fever and respiratory distress, likely from Pertussis, (a life-threatening, vaccine-preventable illness – very few rural children here are vaccinated) that hasn’t responded to our various aggressive treatments for over a week. I told the parents of each that many people from all over the world were praying for their child… Please pray for Albertina and Clementino.

 

I saw several cases of early “River Blindness”, or Onchocerciasis, in Cuando Cubango this month. It is a parasite that is transmitted by a small black fly abundant near rivers in Cavango, Cuando Cubango and much of this part of Africa. The parasite enters the host through the bite of the fly and travels to about anywhere in the body, predominantly to the skin and the eye. In the skin, it produces profound itching and chronic scratching causing “elephant skin” – leathery, thick and quite uncomfortable. If the almost-microscopic larvae swim around in the eye in significant numbers long enough, they cause a chronic inflammation that often leads to irreversible blindness. In many villages virtually all of the elders have lost their sight because of this disease, which is easily mass-treated once/year with one dose of a medication in pill form. The manufacturer offers the medication free to developing countries… I saw the evidence of inflammation in one man’s eye, which looks quite unique in its early stages and, because I brought medicine from the US to treat this disease, I gave him the appropriate dose. The local nurse working with me insisted that the man apply a nursing mother’s milk twice daily (they have a fascinating array of “home remedies” because modern medications have historically been so absent here) and I wondered what I would prescribe if I was a caring health care worker with no medications…

 

My colleague, Dr. Steve Collins (eye doctor), told me that in the same week he saw over 100 cases of this disease in another part of Angola, most of them beyond treatment (already blind), and he had no medication for them because this particular disease is completely under government control. The medicine is free to any country in the world for mass, annual treatment of everyone at risk, yet the medicine is unavailable in Angola…

 

I had several frustrating conversations with our driver, a very bright man about my age, who drove us from Rivungo to the outlying villages and back each day, making many turns on paths that all looked the same, and never making a wrong turn over several hours (of course, if he made a wrong turn I wouldn’t have known). In my wearied state at the end of each day, I would ask him how long of a drive we had to the village the following day and he would say, for example, three hours. Then he would say that if we left at 4a, we would arrive by 8a, and if we left to return at 16h (4p), we would return to Rivungo by 18h (6p). A few minutes later, as I tried to get more specific, he would say that the village might be 4 hours away, so even if we left by 4a, we could arrive by 6a.

 

It’s strange to converse with very bright people who have no use in their life for numbers or hours. They leave according to the sun and arrive when they arrive (this is why we usually leave between 4-5a in Rivungo, because it begins to get light a little after 4a). He would be very “accurate” using the sky to tell me that if we left when the sun was (about) here, we would arrive when the sun was (about) there. Watches are uncommon, and the most important “hours” are sunrise, mid-day, and sunset, because they are rather specific. All other times are estimated and punctuality, as we know it, is irrelevant in this culture.

 

The director of the clinic (!) in Rivungo had malaria for three weeks, testing positive several times. Rivungo is one of the larger towns in the province and, as mentioned above, the medicine shelves have been empty for months. Urbano continued to work daily with fever/malaria and was so grateful when he found that we brought an abundance of malaria meds. He immediately began treatment and when I saw him several days later, he looked like a new man.

 

TV antennas are being raised all over Angola (by the government) and wherever they are, people are watching (more in the cities, but also more and more in the rural areas). The rural people are seeing the news put out (only) by the government and they are seeing “life” played out on soap operas like they’ve never seen it (or imagined it). Young people are moving to the cities to experience what they see on TV and, of course, the life they see on TV is not there… What would this world be like if movies and TV shows were not a primary source of expectation/discontentment?

 

During these days of turning the soil, creating rows and planting, the most popular medication in our clinic is a heat rub that likely does nothing but provides superficial comfort (and smells great) to the aching muscles and lower back of the folks who work in their fields 8-12hr/day now that the rains have begun.

 

I’ve written before about the profound humility in these people, demonstrated in how they live in community, always considering the opinion and good of the community (others) before their own. Rarely are life decisions made without community input. I’ve seen Paul’s words in his letter to the Philippians played out so many times and I marvel at the beauty of God’s instruction to us. An accurate and challenging application of verse 2:3 might be,

“…in humility, count others’ opinions as more significant than your own…

 

Jesus…

You came to rescue us…

So that you would have a people who would…

Worship You,

Give our lives back to You as a sacrifice of praise and gratitude,

Be Your hands and voice in both trial and ease, bringing Light to those in darkness and freedom to those captive, an

Abide with You in ever-increasing and imperfect intimacy, both today in this world of pain and difficulty, and tomorrow face-to-face in your Kingdom, without tears, separation or loss… 

 

***  During this season of wonder, we hope for every one of our dear friends and encouragers, memorable moments of intimacy with your Father… unique, special and just between the two of you…

 

 

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