The Ninety-nine or… the One…


While still dark this past Friday, 28-year-old Lussinga rose from the straw mat on the sand in her small stick house and gathered her three young children to begin her 10-mile trek through the deep and shifting sand to Fazenda Tchincombe, where that day we were holding our monthly clinic.


She arrived at about 10a and waited with the rest of the crowd to be seen.  I saw this young mother of four just before noon as she presented her “complaint” of intermittent vaginal bleeding for a month and increasing pelvic pain for the past week, denying pregnancy.  She admitted to intermittent fevers, as well, and no other symptoms.  She had a concerning exam, with significant lower abdominal tenderness and localized peritonitis.  A malaria test was negative and, though a diagnosis of a pelvic infection seemed certain (so common here), I wanted to do an ultrasound to make sure she didn’t have an abscess or another urgent concern.  The battery on our portable ultrasound, however, had already died that morning and we needed to set up a small generator for further use of the machine.


After pulling a tooth (actually, Meghan, the daughter of dear missionary friends and a high school student interested in medicine, expertly removed the broken tooth) and doing several other ultrasounds with generator power, we were able to see Lussinga again, near the end of the day.  The ultrasound exam revealed an empty uterus, cysts on both ovaries and a large heterogenic, “disorganized” mass near her left ovary.  Although seeing this mass confirmed for me that the likely cause of her pain was an infection (with an abscess), my experience in emergency medicine (neurotically concerned with “What is the worst thing this could be?” rather than “What is the most likely thing this could be?”) and my even greater experience in having an incorrect first impression, prompted me to collect some urine and do a pregnancy test, which came back positive.


This changed everything.  We now faced a diagnosis of a (ruptured and bleeding) tubal pregnancy (the mass that I had thought might be an abscess) and the need for urgent surgery (few survive this condition without surgery).  We were in a remote village, about two hours from pavement and then another two hours to Lubango.  We normally could call the small MAF plane in a situation like this, but the plane with larger tires to navigate the thick sand of this region was down for repairs (which is why I had driven in early that morning).  Our only remaining option involved wrapping up the clinic quickly and driving to Lubango.  We had some daylight left and this was good, as I prefer off-road driving in daylight.  First, we had to drive to Lussinga’s home, notify her family and prepare for her trip.


By the time we left the clinic area and drove about 30 minutes in the sand, we arrived at Lussinga’s house in the dark.  It was beyond simple and, even after many years in this type of work, I was taken aback.  It was set in a fenced-in area (sticks stuck upright in the sand) of about 1000 square feet, in which were three “houses”, each made of sticks (no clay) and a grass roof, enclosing one room of about 100 sq ft (about 10ft x10ft).  Those present began calling and yelling and soon a group of about 20 people (and the same number of laughing, playing kids running around in the dark) had gathered and I explained the situation to the family and friends.  The husband was beautifully responsive and prepared to accompany us and care for his wife, and Lussinga’s mom (see photos), three women and three children asked if they could be dropped off on the way (never is a car seat left empty on trips in the “bush”).


As we pulled away about 6p, the rain began, a torrential downpour that didn’t let up throughout our 5hr trip to CEML, our mission hospital in Lubango.  It was slow going on the now-sloppy dirt and then also on the pavement because of severely limited visibility, so many now unseen potholes (each a potential bent rim and flat tire), no edge lines on the road, and virtually all drivers coming from the other direction using their high beams.  When we arrived at the hospital, I handed Lussinga off to the capable staff, contacted our OB physician, Sarah Hudgins, about the need for a morning surgery, and headed to where we were staying and collapsed after a 22hr day (I had been called in to CEML at 2a the previous night for a couple of urgent concerns and then left at 4a for our clinic day at Tchincombe.


The next morning, Sarah, Esther (a visiting FP from Canada) and I removed a coin from the esophagus of a toddler (almost a daily “surgery” at CEML), did rounds, and took Lussinga to surgery (the pregnancy test at CEML came back negative!), where Sarah identified and expertly removed the bleeding Fallopian tube which contained the deadly ectopic pregnancy.  Lussinga is recovering in stable condition.


This is the work that you support.  Your prayers, encouragement and finances send us to the remote areas to find those like Lussinga, and either treat them or get them to where they can be appropriately treated.  Sometimes I am a doctor, sometimes a dentist, sometimes a teacher… and sometimes a driver…


I have friends who will say today’s election result is pleasant and friends who will say otherwise. Our Father allows both pleasant and unpleasant to further His kingdom. He allowed both Nero and Washington. Whether the election is better for our country and the world in the short-term remains to be seen. From His eternal perspective, the result IS better for the Kingdom (He has chosen/allowed this government authority for our country for this time). Will our response please and honor Him?


I’ve had a full and enjoyable three weeks doing consults and helping in surgery at CEML.  Too many stories to tell…  We will now be leaving Angola Thursday for the US and have a week of meetings in Missouri and North Carolina before arriving in Toledo the following week to spend time with our family.  We have plans to do little for a couple weeks and then hope to see everyone possible before our return in mid-March.  Please contact us to set up a time that we can get together (we will try to make most of our connections in January and February) to share with you about our work and perhaps find a way for you to be a part of our team that helps so many like Lussinga in rural Angola!


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