Leprosy, Criticism, Mondays, Being Understood…


A fit young man of about 25yr presented with a large hypo-pigmented area on his face and the same on both arms (see photos).  They were large areas, he’d had them for over a year and they were insensitive to a pin prick.  He is our latest case of leprosy and our 15th active case (those diagnosed who have not yet completed the 12-month course of therapy which effectively kills the offending agent).  I asked one of our nurses to get him his first month of therapy and he informed me that we were out of leprosy meds.  I was angry.  We travel monthly for a full, very rough day on dirt to visit the governing authorities over us, who regulate and dispense all leprosy, TB and HIV medications.  These meds are free to the government and they are given the responsibility of distributing them to those with the disease, but every time we arrive, we are told that they only have a few months of therapy (for one patient), which we take and divide as best we can to keep our active cases on their meds without failure.  It is quite a burden for us to distribute these few meds effectively to all of our patients, who often travel a full day to arrive at our clinic.  This was the first time we were unable to even begin therapy for a week or two.  There is no excuse for this and so many people suffer because of the incredible negligence and laziness of a few in authority.


We went back to our governing authorities last week and they were tactfully and (quite) firmly confronted because, though I always want to demonstrate respect for the authorities over us, who will advocate for these rural people?  We left with about 10 months of therapy, which is more than usual, but it won’t last long.  When we spotted a shelf full of these meds and confronted them again, they said they were saving them for the active cases in their proximity (we’re the largest leprosy treatment center in their jurisdiction).  There is nothing I hate more than telling a patient that we don’t have a certain therapy for their illness.  So much time and effort goes into prearranging treatment for every type of illness or injury that might arrive at our clinic/hospital, and it is quite difficult (and unnecessary) to purchase leprosy medication outside the country.  We face the same problem for our 50+ tuberculosis patients, who pay $20-$30/month (a common laborer’s salary is $1/day) for the medications that we purchase outside the country (at great effort and expense), instead of receiving the medications that are globally abundant and free to this country’s government, yet unavailable to the rural population.


One’s community is identity forming and a primary source of a healthy self-image, especially where people live difficult lives, and where interdependence promotes the survival of everyone in the community.  I have yet to meet a young adult here who doesn’t communicate with intense affection about his/her own community and family (when one speaks of family here, the implication is always extended family).  One’s identity is firmly established in his/her community, and in such a positive light.  How many (young) Americans do you know that speak so highly of their community and who so dearly love their extended family?  I am struck every day by the respectful and honoring way that these people treat each other, often marked by this sense of intimate, life-giving community.  How do we get this back in the US?


For the creation-lovers among us, it is a source of wonder to me that exponentially more money is spent on Africa’s wild animals, per capita, than on its indigenous people populations.  The animal populations (elephants, lions, rhinos, buffalo, hippos, giraffe, etc) are monitored, tagged, followed, fed, analyzed, and their diseases known and treated.  Their freedom is aggressively protected and their survival passionately cherished by people from all over the world (which is beautiful!).  A brief video of the wonderful team from National Geographic that we met as they camped near us during their study of the river systems feeding Okavango Delta can be seen here.  The animals and their environment are devotedly and financially cared for, while the people have little freedom, are globally dismissed and forgotten, are left to fend for themselves and have the lowest survival statistics in the world (because of easily and inexpensively treatable and preventable diseases)…


Complaining and criticizing have always been common, but today they are considered normal and even “cool”.  Most people would intellectually admit that, though complaining and criticism (two shades of the same color) feel good at the moment (our reason for partaking), it is unhealthy to criticize and complain about what one cannot change.  Observe the political dialogue today in the US for a pretty good indicator of the mental health of the population.  We are shamelessly and blatantly critical, disrespectful and uncaring toward those with whom we disagree (even among those who call themselves followers of Jesus).  Our critical words are natural, self-promoting and self-protecting and we are largely numb to their poisonous effects on those who hear… 


On the other hand, constructive criticism among flawed creatures is profoundly healthy and productive – criticism in the context of a relationship, which humbly offers a remedy to which one can contribute.  This healthy criticism, however, doesn’t much feed our ego, because it carries with it a burden of personal responsibility. Constructive criticism or disagreement that is honoring, mature, respectful and offers personal effort, is not often heard today.


We must, of course, critically analyze situations, behaviors and methods in order to improve and we practice this in the US with little inhibition.  It is fascinating, by comparison, that the Angolan culture is one in which there is almost no critical analysis of anything, and one which yields virtually no progress.  The rural people with whom we live, accept, quite fatalistically, all calamity and pleasure with little evaluation regarding cause, effect and potential improvement.  The relational benefits of this compliant, subject-like (humble) attitude are attractive to one coming from such a highly individualistic, analytical and critical culture, but I’m realizing that this is another area of life where health is found in tension between two extremes.  An attitude of negative criticism, where nothing is acceptable, is one extreme (idolizing progress/perfection at the expense of relationship), and complete lack of critical/analytical thinking the other extreme (no conflict and no progress).  So, one extreme is confrontational and relationship-challenging, while the other is conflict-avoiding and relationship-promoting.  These cultural extremes are fascinating to behold, and more a matter of cultural differences than cultural rights and wrongs.  Each tendency has plusses and minuses, advantages and disadvantages, and strengths and weaknesses.  Africa has, for example, seen virtually no industrial/technological development (ever) because of lack of accurate and critical analysis, but the people are likely the warmest relationally in the world, avoiding conflict at almost any cost, for the sake of keeping relational peace.  As I reflect on these cultural differences today, I am challenged to guard against all critical thinking and speaking (as I write critically about criticism) except that to which I can constructively contribute a remedy.


I love in-patient rounds on Mondays.  Our therapy has had two full days to help and so often, especially on this day (though other days are quite similar), there is a virtual parade of very sick in-patients demonstrating marked improvement.  The ill person (and their family) often also knows and appreciates the change as he/she can remember how they felt when they spoke to me on Friday or Saturday.  Participating in our Father’s redemptive work in this way is such a joy, especially in a region of the world where there are no other available options.  I would encourage each one of you who contribute to our work (80-100 individuals and families, many sacrificially), to take a few moments during this Holiday Season and reflect on what you have done in 2017, and can do in 2018, for the rural people of Angola, so dearly beloved by our Father and forgotten by the world.  If you have not contributed to our work, please know that you have an opportunity to directly help so many through our multi-faceted work, where we treat all with evidence-based medicine, pray for each person, share daily talks with 50-200 patients and their families about improving their physical health and about the Kingdom of our Father, embrace with dignity those who are suffering and dying, and honor our Father in so many other little ways.  We can do nothing without you and you can do nothing in rural Angola without usThis work is a truly beautiful, Kingdom partnership…


The Wind…  I often cannot explain why one person survives and another does not.  I saw a baby this past week who was six months old and had never nursed.  He had only been fed the local corn drink since birth and appeared fit and unaffected by such a deficient diet.  His mother presented with near-fatal TB, was severely anorexic and hadn’t produced milk since delivery.  The corn drink is the only daily beverage that anyone in rural Angola drinks and it is made with corn pulverized to powder and mixed with water and sugar.  No other ingredients.  As we began treatment for this mother, we augmented this baby’s diet and he will now thrive, but it is difficult to explain his relatively good health compared to the many children we see die of malnutrition on diets with more variety.  We also have a woman of about 35yr (Severina) who has been an in-patient with us for more than three months.  I didn’t think she would survive three days when she arrived.  She is one of the many I have written about suffering from the toxic effects of the readily available “all-natural” traditional medicine.  She has severe cirrhosis, caused by toxins in the “herbal” cocktail/concoction she received for a minor illness, and we must drain her abdomen weekly of about two gallons of free liquid (see photos).  We’ve spoken at length with her about her imminent demise, her eternal value and our Father’s desperate love for her, yet she keeps eating and drinking and breathing and I can’t explain it compared with the many we see with the same condition who don’t survive even a month.  In medicine, we tend to believe that we can explain all illness and recovery naturally and scientifically, but we simply cannot.  We know our Father most often works through people (He loves people helping people and even orchestrates the same through the activity of His Spirit within people) and uses other tools such as mud, spit (Jn 9:6), medicine, wise nutrition or therapy, etc., but He also operates in ways we simply cannot explain.  Sadly, way too many “Jesus-followers” chase after miracles rather than embrace sweaty and sacrificial service, but our Father uses both to touch those He loves who are in need.


One of the toughest things about serving cross-culturally is the lack of relatable, understanding fellowship/friendship with those with whom we live and work.  We can relate with each other on many levels, but no one in Cavango understands our joys or (especially) our struggles and the chasm is wide.  Our major challenges involve, for example, separation from loved ones and living in a culture/environment that remains largely unfamiliar.  Real connection happens through the sharing of joys and struggles and we are consistently facing the tiring, unfamiliar and uncertain (struggles), and it is always with some difficulty that we communicate with others, in a language other than our “heart language”, about that which is dearest to us, including our Father and His Kingdom.  Though they live otherwise very difficult lives full of uncertainty, the local people live in what is, to them, familiar, they live in close proximity their loved-ones, and they communicate every day in their “heart language” …


We lost a uniquely dear friend during our time in the US this past year.  “Pastor” Vasco was likely in his 80s (no one here knows their accurate age) when he finally saw Jesus face-to-face (he spoke often of that day).  He looked just like an African Shrek, remains a genuine Jesus-lover (likely doing some serious dancing on his previously severely arthritic knees) and is a man who has been faithful to his Father, his community and his family through 30+ years of brutal civil war/conflict with so much loss, transition and uncertainty that I’m quite sure there are few who could relate on any level.  He left his home in mid-life and went to live among the rural people in this region, joining them in all of their struggle, labor (only eating, for example, what they grow and raise) and loss (like everyone, he lost several cherished children as toddlers), evangelizing and planting churches everywhere he lived.  His family is quite unique in this culture of natural fatalism, as it is full of Jesus-lovers and they bear quite a testimony to this man’s simple, real and pure devotion to Jesus.


Vasco was a missionary in his own country and had an appreciation and understanding of our sacrifices and challenges more than almost anyone we know, both at home and in Angola.  He would visit us every time we returned to Cavango and thank us for our presence, our sacrifice in leaving home, family and the familiar to serve “his” people, and for providing an opportunity for the people of the Cavango Mission to again serve the people in this very remote part of Angola (interesting in that he was more excited to see our work as an opportunity for “his” people to serve than to be served).  He counseled us once that we shouldn’t remain isolated from “our own” people, and that we needed other like-minded people in Cavango so that we could remain in this work for many years.  He was one of a few people that I’ve met who had no fear of man combined with a sober, persistent, contagious joy centered in humble reverence for His Father.  I severely miss his humility, his smile, his passion for his Father and for those who yet didn’t know Him, and his care and appreciation for Betsy and me.


I could not maintain the pace and Kingdom perspective needed in this work apart from my Father’s clear encouragement, peaceful presence and foggy-yet-certain guidance every morning on my hour-long misty walk to the river and back, as I share with Him all about the events, interactions, losses and joys from the previous day, while seeking His thoughts about the same.  I still see much failure on my part in remaining dependent on Him throughout my day, and I can’t imagine how anyone can maintain self-denial and passionate intimacy with Jesus apart from communing with Him daily.  When I miss “seeing Him” in the morning, I feel my lack the rest of the day and long to return to Him again the following day, if not for anything else, just to share with Him about everything from the previous day.  I am now jogging slowly some mornings (better exercise than walking) and this is quite different than the conversational pace of a walk.  I’ve had no angina since my heart procedures in South Africa in June, and my replaced knees are tolerating the activity quite well.  I am trying to seek a balance between my need/desire for this time “at Jesus’ feet” and my need/desire for physical exercise.  My communion with Him is not based in study (loving His letters and written messages happens at other times), but rather intimate fellowship with the one and only living, interested and interactive Alpha and Omega.


Betsy and I are on our way back to Ohio for a month of intimacy with our kids and family (I’m writing while over the Atlantic from JoBurg to Atlanta).  We are sure looking forward to this special, special time!


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