Twenty-four-year-old Teresa arrived in Cavango about two months ago, extremely short of breath, gray and barely alive. Her blood oxygen level was below 60% (normal > 95%), she was breathing greater than 60x/minute, she had almost no blood pressure, her legs and abdomen were grossly edematous and she couldn’t lie down to sleep. She had been coughing for several months and had been severely short of breath for over a week. She had “cor pulmonale” or muscle failure of the right side of her heart caused from trying to push blood into high pressures in her lung vessels, resulting from severe and wide-scale inflammation in her lungs from tuberculosis (we’ve had three patients in the last month with this same problem from severe TB). She also had a unique complication in that her heart was beating very quickly (>150x/min) and in an irregular rhythm called atrial fibrillation (where the top portion of the heart – the atrium – beats at a rate greater than 300x/min – really more of a “vibration” of the heart muscle more than a contraction. On top of all of this, we discovered with our portable cardiac echocardiogram (one of the few diagnostic tests we have in Cavango), that her left atrium was full of clotted blood.
Teresa would be a challenge anywhere in the world, but we prayed and began cautious/aggressive treatment. Without treatment, she wouldn’t have survived more than a day or two, and it was highly likely that our treatment could kill her, as well. This is because when a person converts from this “vibration” of the atrium back to normal contractions, the clot in the atrium is often “sprayed” into the circulation, as emboli to all parts of the body, often manifesting immediately in loss of consciousness because of a stroke, as the emboli lodge in various vessels in the brain, cutting off blood supply to these areas. Yet, she wasn’t tolerating this fast and irregular rhythm because of her weakened heart muscle, so we put her on our only blood-thinner (aspirin) and gave her other medicines to reduce tension on her heart and slow her rhythm.
I was pleasantly surprised the next morning when Teresa walked into our consultation room (she was carried in the previous day) and smiled (a smile communicates a lot in the critically ill) as she indicated that she slept well for the first time in over a week and was feeling much better. Another echocardiogram revealed that her a-fib had resolved and that the large clot was still quite present in her left atrium. She had lost almost 2kg of fluid and her blood pressure was dangerously low, but she was alive. I told her how pleased (and surprised) I was and that each day she survived (without spraying this clot all over) would be a victory and that it would take about 2-8wks before we knew how much her lungs might respond as we killed the ultimate cause of her illness – TB.
She walked in to see me similarly every day for over a month before we left for 11 days for meetings and clinics in and around Lubango. The clot remained and she looked better all the time (sleeping, walking without difficulty), though never looking “healthy”. When I returned to Cavango I didn’t see her for a few days (it’s always quite hectic after an absence) and I asked our clinic director about her. He told me that her family came and took her to their village traditional medicine “doctor”. He had tried to emphasize the precariousness of her condition, but they still left and she hasn’t returned for over a week (she had been told repeatedly that she wouldn’t survive without her heart medication). This resulted in a variety of deeply and commonly felt emotions as situations like this among the completely uneducated are not unique – science is unknown and health and illness are total mysteries – but they remain difficult to endure. This beautiful young woman, who I had enjoyed seeing daily for over a month and whose every subsequent breath was a marvel, demonstrated again to me that the battles we fight for one’s health are much more than identifying an accurate diagnosis and treatment (though these alone can be quite challenging in this setting). I was also reminded how little real control I have in any person’s well-being (because of a plethora of influences outside of the obvious), and that my interaction and influence with anyone is equal to about a word on a page in their many-chaptered life’s story… There is only One who knows and can truly influence and intervene… and He might or might not use in a significant way the “word” that I contribute…
It was also another illustration of the importance of trust in all of our interactions. Our words/knowledge/skills are ineffective unless accepted and they will only be accepted (and applied) in an arena of trust. This applies to medicine, evangelism, and advice/counsel of any kind. Trust is fragile and always involves risk, but the outcomes of our lives are very often the result of whom we choose to trust. For whatever reason, she was unable or unwilling to trust me and my recommendations, despite her marked improvement over the month. Our work in rural Angola is full of victories, satisfaction and joy… and loss, frustration and sadness…
Socks, bras, underwear, belts, toilet paper, toothbrushes, eating utensils (as we know them), diapers, deodorant, indoor plumbing, electricity, napkins, soap (as we know it), beds, towels, insect repellent, pillows, furniture (as we know it), mirrors, sheets, and shoes are all historically quite new, and this is reflected in the fact that virtually no one in rural Angola owns them.
Twenty-four-year-old Domingas has been married for six years and never been pregnant. She and her husband waited until marriage to have intercourse so neither had children via another partner. This is unusual in this culture, as normally I can ask an infertile couple about other children and, invariably, one or both have had children with another partner. Neither had remarkable symptoms, Domingas had some inflammation of one fallopian tube via ultrasound and both demonstrated their concern and desire for children in that they drove from a major city for 6hr by motorbike, on the rocky dirt, on a Saturday (when they were off work), to Cavango because they had heard that remarkable things happen here (I never know what happens to most people when they leave our hospital). I treated them for various types of infection that can cause infertility, explained a woman’s fertility cycle through the month, and emphasized what most people commonly forget about anything so familiar: that only God gives life. I said that we would ask him together for this miracle (every life is an absolutely crazy-incredible miracle). I prayed with them that our Father would give them a child and Domingas began weeping, apologizing through her tears as her husband held her. Such a beautiful, caring, conscientious, couple, with a (simple) desire for a child, struggling to find hope after six (long) years. I encouraged them to trust in their Father’s love and purposes for them, and we will see what our Father might do. I believe they traveled all that distance because of several other similar couples from their city who we have prayed with who now have children. One never knows when and where the Wind will blow, and Jesus implored us to ask what we will… If I hear from them, I will let you know.
Some young guys brought to our house a Pangolin (see photos) they had captured in the wilderness, not far from our house. I had never seen one and marveled at the uniqueness of this shy ant-eater. Covered in large, hard scales from head to foot, it looked truly prehistoric. After some internet research that demonstrated that it is endangered, highly hunted and often sold for high dollar amounts to those who advertise potions and oils made from the scales as medicinal (more all-natural bologna), we offered to buy the animal to set it free. We offered about $40US, which is huge money in a part of the world where a good salary is $2/day. They said they wanted more for the animal and we sadly watched them walk away. Seeing this animal left me in awe of its marvelous Designer, and somewhat angry at the way we so often take for granted and abuse the miracles He has placed all around us…
Our daily discussions at the clinic are such a joy. Every day our patients and their families form a different group from the day before, usually about 50-200 adults. Our clinic is a revolving door of rural folks from several provinces. They hear of how they might improve their physical health and take this information back with them to share with those in their villages. These almost-completely-unchurched people also hear specifics about Jesus and His Kingdom, many for the first time. Many will never forget their morning talks at Cavango. They often tell us that they have never heard talk of Jesus outside of a religious setting, like a church, and almost none have ever been a part of any church. One 60+ year-old man this week said he was glad he became ill and had to walk a day to get here because he was able to hear about Jesus in our morning talks! He is a funny, one-shoed man who told several stories and had us all in stitches. He’s been here all week and one morning we talked about back pain prevention and he demonstrated how he planted his field one year when he greatly suffered from back pain. He showed us how he “squat-walked” through his field planting his corn, because he couldn’t bend over. I wish I had captured it on video!
As we navigate through life, wisdom calls our attention, at times, to the “big picture”, while at other times it is better to observe and address specifics. One analogy often used is the forest vs its trees. To a large degree, it is concern for “the forest” that compelled me to abandon my “normal” life in the US to address health issues facing “the poor” and to tell those who haven’t heard of Jesus’ affection for them. The big picture. I have found, however, in cross-cultural work among the globally neglected and forgotten, that maintenance of my personal sanity and genuine compassion is dependent upon a sustained focus on individual “trees”, along with an intentional disregard for the “forest”.
On the “front lines” of missionary work, I have learned why Jesus most commonly calls His church to minister to people more than to crowds. He calls us to be “narrow and deep” in our outreach, a phrase I’ve heard often over the years from a man whose perspective I respect greatly, my retiring pastor in the US, Danny Meyer. I believe this is because it fits our humble capacity as we are truly incapable of impacting the world on a large scale. There is great temptation to cast a wide net, hoping to impact many “fish”, but in this temptation we can forget that we are primarily called to love (not make converts), and love requires a person in the context of a relationship. In my arrogance, I can forget that my capacity for caring, real relationships is limited. I’ve learned that the multitude (forest) is far better entrusted to my Father, while I care for the few persons (trees) in front of me at the moment.
It is fascinating that Jesus’ revolutionary and world-changing impact was not the result of a political and large-scale emphasis, but rather an exponential multiplication of individuals loving and serving individuals. Jesus’ emphasis was what we would today call a “grass-roots” movement, and this “small-scale” focus must remain my priority.
I have learned this by trial and much error, often pushed by despair back to a more intentional focus on a few. The despair results from my gaze wandering to the “big pictures” (the politics of corruption in Angola, the ill health of the general population, the general apathy of the American church for those in Africa, the enormity of the task of getting Jesus’ message of His affection to everyone, the lack of basic education and literacy among those I meet, etc).
Jesus spoke to crowds, but changed the world through just a few, who knew Him so well that they trusted Him with their lives, abandoning all of their earthly pursuits to seek out “trees” who didn’t know the beauty of the One they trusted, to proclaim the message of His eternal Kingdom, and to serve those “trees” in such a way as to demonstrate their value in the eyes of their King… while leaving the care of the “forest” to the care of its King. We can do the same.
Please join me today in disregarding and not fretting over that which we cannot impact, while devoting our energies and resources to that small area which we can influence. Which few neglected “trees” has your Father planted near you today? Which few, forgotten “trees” is He calling you to care for, outside of your immediate area?