Good, Bad and Ugly, Mountains, Valleys, The Question…


Betsy and I experienced a marital first this month, as we (together) battled malaria at the same time.  We both felt poorly for several days (woozy, weak, achy) and then Betsy had a night of severe fever.  We both immediately began treatment because we are in the middle of malaria season, my symptoms resembled hers (without the fever) and I am taking prophylaxis (after my rough bout with the disease last year), which blunts the severity of the disease (it helped).  Once we began treatment, we began improving within 24hr and were fully recovered within a week.  Taking into consideration the incubation period, we contracted the disease in our first couple days back in the country.  Welcome back to Angola!


A sixty-year-old woman fell one month prior to her clinic visit and was then unable to use her left leg because of pain.  This barefoot woman had endured a broken hip for more than thirty days and nights prior to seeking help and had ridden several hours by motorbike on dirt paths to arrive at the clinic!  Keep in mind that stick and grass village homes don’t have chairs and people sit on the ground, rocks or logs and do a lot of standing.  She sleeps on the ground.  We identified the fracture and displacement via ultrasound and explained that with surgery she would ambulate pain-free once again.  We explained the (nominal) cost and recommended that the woman stay with us for pain control while her son returned to her village to collect the money necessary for surgery.  They refused treatment and mom and son returned to their home on the same motorbike over the same “roads”, with ibuprofen for pain.  I hope they return soon.


I am greatly enjoying my morning “runs” to the river and back and if you might wonder if my speed has picked up, my dog yawns at least 4-5 times during each 40min “run”!  Losing one’s ability to do something for 20+ years can sure create appreciation for the same, regardless of how well it’s done!


A two-year-old boy had gradually lost his ability to walk over the course of two months.  His legs were symmetrically weak and atrophied and his head measured large for age.  He had new-onset hydrocephalus, likely acquired from cerebral scarring from malaria at the end of last year.  Cerebral Spinal Fluid is constantly produced and eliminated around our brain and spinal cord and his outlet channels have become blocked while production of the fluid continues.  I shared with them the likely cause and the near certainty of successful treatment, but they returned home (refusing admission), to return in a week. They haven’t returned in three weeks and I hope they change their mind before the damage is permanent.   Surgery at our hospital in Lubango (click on “CEML” above) is free (for this surgery because of beautiful international funding) and quite successful in similar cases, especially when diagnosed within the first several months.  The simple surgery (for our skilled surgeon colleagues – not for me) shunts the excess fluid in the head to the abdomen, relieving the pressure and allowing normal development.


A 59-year-old woman had been suffering from severe abdominal pain for several weeks, accompanied by persistent vomiting.  We were able to identify a large pancreatic tumor with biliary obstruction (the cause of her pain) and gently and compassionately tell her that the cancer would end her life within a year but that surgery could greatly minimize the pain she experienced in her final months and that it was possible, though unlikely, that extensive surgery could be curative.  She remained with us for a week for symptomatic relief of her persistent vomiting and pain.  Her daughter returned to her village to discuss with her family the cost of the surgery and to make a decision as to whether the cost was worth the questionable benefit.  Her parents (in their 80s) then walked here to tell us that they were unable to spend their life savings on such a surgery, with limited potential benefit.  Such a beautiful woman and such a beautiful family, expressing gratitude for our help at every turn and humbly accepting our request of our Father to heal her or to prepare her and her family for their temporary good-byes and to prepare her for her first face-to-face encounter with the God who made her and loves her dearly.  Our ambulance is down and Betsy is driving her and her mom home as I write, about an hour on dirt.  Her 85-year-old father left the hospital this morning to walk the 15 miles home, with no shoes.  In any culture, there might be nothing worse than saying good-bye to your beloved child, or seeing your child suffer, no matter their age.  God sent His son… to suffer and to die… He knows a parent’s heartache…


A forty-five-year-old woman arrived by motorbike barely walking and barely breathing.  She shuffled into the consultation room supported by her husband.  During the night, she was “attacked” by difficulty breathing for the third time in the last two years.  Both other times she arrived at our clinic similarly and barely survived.  Her severe adult-onset asthma will likely kill her one day, but this time she wisely left home immediately after her dyspnea began and she will likely recover.  EMS saves the lives of many such people in the US because they can arrive within minutes of an acute attack and begin appropriate medication.  This woman lives several hours away by motorbike and most motorbikes here don’t have headlights, so waiting until morning to navigate the trails is their only option (they left at first light).  We will send medicine home with her to hide in her wall (a covered hole in a mud wall is about the only place safe from the ever-marauding insects) for when her next attack occurs…


After several successful pregnancies, a 24-year-old woman hadn’t become pregnant for a year and visited the local Shaman for a “cure”.  She was given a potion (made of plant and animal products) which destroyed her liver over the course of about two months.  She arrived with a tight, protruding abdomen, so much so that she had difficulty breathing, walking and sleeping.  We identified her severe cirrhosis by ultrasound and drained over 10 liters of fluid from her abdomen.  Within about 48hr, the fluid was back, resistant to all medications we have to offer.  She will survive several months at most (with frequent draining of the fluid), because she lives in a culture without access to basic medical care/counsel.  We currently have in our hospital two other beautiful, young women the same age with the same story and same prognosis…


The many decisions described above are about in whom we place our trust.  Some of the most important decisions in our lives revolve around, “Whom do I trust?”  We would be wise to trust thoughtfully and prayerfully in this world full of deception and unmarked dead ends, each one lined with smiling faces appealing for us to join them, “This is the way!”  “Every man is right in his own eyes…” (prov 21.2)


This extremely rural culture is without glass/mirrors.  No one has seen a photo of themselves.  When they do, it has little significance, because self-image here has little value.  Women wear scarves on their heads (their hair remains short because it is too brittle to grow out) and men shave their head about once monthly (no scissors, only cheap razor blades).  There is no style, per se, as everyone wears used clothes that arrive in bundles and is sold cheaply.  Fit is all over the place and they try to wear what is comfortable, but have no embarrassment in wearing something 3-4 sizes off.  Men wear women’s clothes and vice-versa without thought.  They often are seen with one shoe or two right or left shoes.  No one wears socks and few wear underwear (silly to spend precious pennies on something so unnecessary – defined differently in this poor culture).  There is never mocking or needling about appearance.  Teeth are all over the place, as there is no dentistry at all.  Most have lost about half of their front teeth by early adulthood.  This place challenges so much in me, including the significance I can place on something so superficial as image.  Would I look differently on someone with no front teeth, or horribly deformed or crooked teeth, or a large facial scar from an unsutured childhood laceration that then – naturally – became infected?  Or an executive who arrived at a meeting with a suit full of dirt stains and 3 sizes too small?  Or a man wearing a pink and frilly winter coat on a 90-degree day?  Or a woman with her hair full of lint and grass?  Or a leader with pants four inches above his ankle with two right, shoestringless tennis shoes with his suit?  How much of our opinion of someone is based on image?  The more I live here, the more I am also aware that there is never a critical thought towards another’s appearance.  So attractive….


I heard from the man I wrote about in my last post.  He has graciously offered to help, so I look forward to seeing how he and his resources (work, sweat) might partner with us to help these beautiful people.  First impressions can be false, and I hope so with him.  Jesus indicated that what we haven’t done in the past, our previous broken promises and our unfulfilled good intentions are irrelevant compared to what we will do today (Mt 21.28-31).  I think I’ve become somewhat jaded as I hold another baby with a horrific illness (see photos with parental guidance) because there is simply too little being done by Jesus’ people for those who have no access to help.  Please zoom in on the photo of the little boy and consider the pain he has endured for 3-4 months!  Then close your eyes and imagine… Take my place…  Pick him up and feel him feverishly shudder against your chest.  Smell the rotten flesh.  Swat away the ravenous flies, observe the movement within the deepest part of the wound from several very active maggots and perhaps understand why I am passionate about so many remarkable and basic needs being met with equally remarkable and pathetic apathy in the American church.  Neither writer nor reader of this post have held a more precious child.  Some variation of this little guy happens every day in our little Cavango hospital and we have a small, beautiful team of supporters in the US who are helping us do what we can for the children in this rural area.  Would you join them?  Please click “Contributions” above.


The church seeks mountaintop experiences with God, while our Father is calling us to abandon the pursuit of self-fulfillment and self-edification on the mountain in order to serve our hurting and confused neighbors in the valleys.  Journeying with Jesus is valley to valley with, perhaps, some mountain trails in between.  The temptation is to wander the mountain trails, where the scenery is beautiful, the air is crisp and clear and the water cool and pure… but His beloved “least” are in the valleys, where the hustle and congestion allow no pleasant view (except of the distant mountains), where the thick, hot air saps our strength, and where the contaminated water leaves us often ill.  Our choice…


We have a beautiful physician (MD/PhD) visiting with us this week from the US, who will return to Angola in 2019 for two years.  This work has its riches.  We work alongside, and are often visited by, people I deeply admire, who forego the riches and earthly security of a career in the US because they would never want to be counted among those who passed by the wounded man on the road to Jericho. (Lk 10)


Lena joined me in clinic today and at lunch told Betsy that this morning she witnessed the “good, the bad, and the ugly”.  She met several people obviously recovering from critical illnesses (heart failure, cerebral malaria, asthma, wounds, etc), she met the woman with pancreatic cancer mentioned above and witnessed my delivery of the crushing news to her elderly parents, she met the women with end-stage cirrhosis, she observed a woman refuse admission for her child with severe malaria, and she saw the incredible facial wound in the whimpering little boy who arrived just before our talk this morning on dental problems (his wound, known as “Noma”, was likely originally caused by severe malnutrition and a mouth infection that went untreated far too long – nowhere to go – until they made the trek through two white-water rivers to our hospital).  We are sending him to our incredibly skilled surgeons in Lubango to see what they can do.  His is one of the worst facial wounds I’ve seen and, if he survives, he will undoubtedly wear a permanent scar commemorating his malnourished childhood.  If you were born here, he could easily be your son…  


He is why we are here.


He is why our MAF pilots/mechanic fly.  He is why our missionary surgeons tirelessly operate in Lubango.  He is why a few young physicians like Lena, Heather and John don’t consider the prosperity of the US of value in their decisions re their futures.  He is why missionaries of all skill sets (teachers, mechanics, accountants, administrators, builders, translators, laborers, church planters, etc) leave all that’s dear to them and go to the valleys.  Anyone can come here and travel village to village, and teach about nutrition and dental hygiene and raise funds to help those without (and prevent the above scenario), and share about the love of our Father and His eternal promises…  The Good Samaritan on the road to Jericho needed no special skills to do what he did…


Whatever can you and I do to help?  Our lives are worth giving… for him.


The primary questions are not, “What can or should be done?” or “What can the wealthy or my government do?”  There is no value in shaking one’s head and criticizing the unjust state of the world, ignoring it or wishing it away.  In light of the resources and knowledge you have been given to share/steward/distribute/give away, the only question that will ever matter is,


“What will I do?”


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