Summer has arrived in Angola.  It is in the nineties every day with little cloud cover and rain (and we live in the milder part of the country).  When the rains come consistently (soon), the temperatures will be more mild, but now it is hot and dry.  The temperature inside our Cavango clinic is daily in the low-nineties and the working conditions are crowded and hot.  There is always a decent breeze outside which is not felt in the clinic rooms.  I removed a large, ulcerating hemangioma from the leg of a toddler yesterday and the biggest challenge during the 30-minute surgery was preventing my sweat from falling into the wound (along with the numerous flies trying to get into the wound).

 

People here are unconcerned with sitting and laying in the dirt (there is no grass).  It is not unusual to find ants crawling on the people I examine, after they have waited for hours outside sitting on the ground.  They aren’t even aware of the presence of the insects.

 

With the arrival of our first rains, the flies have returned.  Winter here is so nice with the minimal presence of most flying insects!  The flies can be suffocating.  As with the ants, the local people seem not bothered by the 20+ flies always hovering about their heads, but they can drive me crazy.  On my morning walks I must carry a small, leaved branch and smack my shoulders repetitively to keep the flies away from my face and ears (in addition to DEET).  Because we essentially live outdoors, the constant, buzzing presence of these insects is persistently irritating, and they always target one’s nose, eyes and ears….  Wasps are constantly hovering about, both inside and outside of the unscreened buildings.  They only sting if trapped, but always seem a buzzing threat.   The loud, persistent whine of the locusts now fills the air around our home and clinic.  I sometimes stop on my morning walk to watch them play their unique tune.  The spring wildflowers (photos) are everywhere, drawing bees and my admiration for their Designer…

 

Another insect that has now returned after about a three-month hiatus is the mosquito, along with the deadly disease it carries.  Our malaria cases have begun to increase (they never completely stopped), and this week six children arrived in coma from this awful parasite, and we hospitalized perhaps twenty kids because of the severity of their disease, while treating many with minor symptoms as outpatients (those who came in the first couple days of fever).  One three-year-old child died, this morning, of cerebral malaria, while all the others survived.  After last year’s severe malaria season, because there was virtually no treatment available except for the urban wealthy, this year promises to be a disaster.  Little medicine is again available (only in the city pharmacies at great cost) and, of course, treatment is an essential part of prevention, because if a mosquito bites someone with no malaria, it will not transmit the disease.  The more people with the disease, the more mosquito transmission…  This is quite early for this number of malaria cases in Cavango and it’s scary to think of the number of people (principally kids) that this disease will kill and maim this year, given its early start.

 

We had a first-time mom arrive in labor one evening last week and I examined her and told her that she would likely deliver during the night.  I hadn’t heard further and she gave birth to a blue and pulseless baby boy just as I arrived in the clinic the next morning.  The baby required over five minutes of chest compressions and mouth-to-slimy-face resuscitation before his heart began beating and he began to breathe spontaneously.  He had stool in his airway (meconium) and it took that long to clear the thick secretions (it also took most of the day and many scrubbings to get the meconium out of my beard :-).  The baby thrived and went home yesterday, healthy and fat.  The Wind!  I now have a new list of equipment to bring back with me from the US!

 

We had so many beautiful success stories this week, of people who survived a deadly illness because of basic, sound treatment and the Wind.  We flew one eight-month-old baby to CEML, our parent hospital in Lubango, with intestinal obstruction from intussusception, and she received emergent surgery and survived.  A sixty-year-old woman survived perforation of her stomach from an ulcer without surgery.  I told her that she needed surgery to survive and she refused, citing inability to afford the surgery.  Her shoe-less son-in-law (my age) works for us at the hospital (in a nonmedical capacity) and said that he has seen so many good things happen to very sick people at this hospital and he preferred our care to care elsewhere.  It really wasn’t a wise choice (or my choice) considering her condition and illness, but we treated her with antibiotics and she improved daily until going home completely recovered after about a week.  The Wind…

 

I shared on Facebook about this woman and a teen boy who both needed urgent surgery for intestinal perforations.  One of our contributing families (who already regularly gives to help the rural Angola people through our work) saw the post, messaged me and offered to pay for both surgeries (roughly $300 each).  We transported the boy to Lubango via MAF and he died before receiving surgery, but this woman survived.  Based on the encouragement from this US family and others, I told the mother of the baby with intussusception that someone from the other side of the world would pay for the baby’s surgery.  Because of the promised financial coverage, this mother chose to go and the baby survived an otherwise fatal disease.  I will be using our Rural Health Care Fund to pay for urgent surgery cases like these.  You can contribute to this fund at www.simusa.org.  This has been quite a process for me, as we have so many who need surgery and we can’t possibly pay for them all, but I will now choose those especially urgent and team with our supporters to financially help.  This has been a challenging area because about one of ten have been accepting our counsel to go for surgery and many have died in our hospital without the needed surgery, while a few have survived.  Working with such need and building a rural hospital work for the first time, in an unfamiliar culture… is such a learning experience…

 

The number of people we serve has grown so much over the past few years and we are needing to build more simple buildings, we need more beds, we need a generator and equipment, etc to accommodate the increasing numbers and complexity of illness (as more people access our hospital).  Today I saw a man in his sixties who came here specifically from Benguela (perhaps eight hours by car) because of the stories he’s heard recently from Cavango.  He has heart failure.  You will be hearing more about how you can help men like him in coming months.  After the first of the year, we will be in the US and would love to share personally with anyone interested in our work.  There are few places in the world with more desperate need right now (outside of crisis areas), and the opportunities are many to partner with us in the care of these rural people and your contributions go directly to the work.  If you have been following us at all, you know the situation here, you know our work ethic, motivation and integrity, and you know that you can make a very real difference, turning your work at home into contributions that provide saving care for many who truly cannot access the care themselves.  We pass on much of the cost to the patient (I believe this is healthy), but some of the costs, along with our infrastructure costs are your Kingdom opportunities, as you allow us to put oil and wine on the wounds of so many people hurting on the road to Jericho.

 

We have been yet unable to purchase and transport more beds and mattresses needed for our inpatients here, so last week I asked if we could hire someone to make fifty or so grass mats for our inpatients to sleep on (we currently have about 20 actual beds with mattresses).  At church this morning, the church leaders who work at our clinic asked each member of the church to make one mat for the hospital.  These are less than 1/4in thick and not at all comfortable but they are familiar to the patients (few people here sleep on mattresses) and will serve the people well.  We have also hired a village man to begin constructing metal beds for the hospital.  Everything must be made of metal or plastic because of termites.

 

We had a sharp, sixty-year-old woman return five days after receiving blood pressure and arthritis medicine complaining of dizziness and just not feeling well.  She was prescribed a blood pressure pill that she was to take once/day and she was taking one pill, but three times a day.  I found out about this when I asked her how much medication she had left.  Her blood pressure went from about 230/120 to 100/60!  I can’t believe this doesn’t happen more often, as this is an illiterate culture and the pills are put in small, plastic zip-lock bags with circles drawn as to how many and when to take their meds, along with a brief explanation.  Of course, when the person working the pharmacy asks a person if they understand, they all say yes (some things are the same in all cultures).  She will feel much better in a couple days!

 

We see so much heart failure, and all of those with this suffocating disease have been to multiple health posts and prescribed each time antibiotics for their cough and shortness of breath (if the health post had meds).  By the time they come to us, they are quite ill.  It is a satisfying disease to treat in most cases in that medication can often help greatly.  This lack of access to care is especially maddening, however, when it involves a kid with rheumatic heart disease because if it is treated in a timely manner, the disease process on the heart valves might be reversed.  Over the years here I’ve only had a few cases that arrived within the first few weeks and it was a blast to see the valves respond to treatment and the symptoms dissipate.  Sadly, however, these are the rare exception.  I saw a six-year-old today who had an obviously caring mom and dad as they had traveled all over three provinces to hospitals and no one had identified the problem.  He had classic heart failure symptoms and a loud murmur that you could practically feel.  We put him on strong anti-inflammatories (along with heart failure medication), hoping that it’s not too late for his valves to reduce their thickness, but fear that the damage is permanent.  His illness began a couple months ago with strep throat.  Please pray for Antonio.

 

I disagree with the idea that life is a marathon and that we must pace ourselves.  I think it is more a series of sprints and rest, a seemingly random compilation of starts and stops, and a battle against that which distracts us from our Father and His Kingdom.  An army motto is rest when you can because you don’t know when you will next have the opportunity.  Our Father emphasizes taking one day each week set aside for the purpose of rest, with the assumption that the other six days are a sprint in serving and loving Him and those in need.  One must always be prepared to battle, to run, to be poured out… and one must rest.  Rest is beautiful and satisfying when one has been spent.  … spent by our Father for the sake of another.  We haven’t found life until we have been consistently spent for the benefit of another.  So much is spoken of about “finding God’s will for my life”, but I’ve heard few concerns about God’s will from those who have abandoned this life, those who are rubbing shoulders with “the least” every day, those who have died to personal ambitions/fulfillment, those who are “seeking first” the Kingdom of God, those who care not” for the things of this world…