We were swarmed by army (driver) ants again this week. I awoke from a nice Sunday afternoon nap and walked to our front yard to look at some blooming flowers Betsy had planted. I wasn’t paying attention and stepped onto the ants. It’s difficult to describe these guys but picture your yard covered with enough coffee grounds that only the top of the grass shows. And the coffee grounds are uniformly moving, each about the size of a grain of rice. I stepped onto this creeping mass unaware and was immediately notified that my presence wasn’t welcome. I danced out after surprised by perhaps 6-8 bites and looked up, only to see a swarm that went beyond the yard and they were beginning to advance up the side of the house (see video in “Photos” of a small portion of them beginning to climb our house). After a little further investigation, two sides of our house were being swarmed and these things can be pretty destructive if they get inside.
I ran (walked briskly) to our generator shed and got a bucket of used oil and a can of diesel. I needed to pour a ring of fuel around our house, but I knew I had to walk over (through) them to do it. I think I felt like a kid preparing for an injection. I walked around the house and got the fuel down, only sustaining perhaps 15-20 bites (more of a pinch than the sting of a fire ant). My shoes and ankles were covered in ants (they really dig in) after just about a thirty second jaunt around the house (a few had already made it up under my shorts and let me know). The remedy worked, however, as the ants turned away from the fuel and I didn’t see them again after it took them about 2-3 hours to clear out. The numbers in these swarms are enough for a horror movie and they pass by our house about twice/year.
I often write about difficult/sad cases because we see many people after they have waited so long that an illness has had time to be quite destructive. These cases abound, but so many more leave our hospital healed or radically improved after we pray for them and provide evidence-based (studied/proven) medical treatment. One morning this week I sat down after inpatient rounds and was struck by the number of smiling and markedly improved people I had seen in just those two hours. The Wind is beyond our control and, after treating so many thousands of patients over the years using the same proven remedies for the same illnesses, it is quite clear to this observer that the Wind (Jn 3) is more of a determining factor on the outcome than is my remedy. I control one variable out of hundreds, while the Wind oversees all, such as how many infected mosquitoes bite the child in one night, how long the patient/parents wait until seeking treatment (and all the variables affecting this decision), the nutrition and immunologic status of the child (and all the variables associated with this), when/where and to whom a child is born (and all the variables…), the mental/physical health and motivation of the patient/caregiver (and all the variables…), transportation available (and all the variables…), finances (and all the variables…), medicines available in the region (and all the variables…), the decisions of the doctor, etc. A few of the thirty or so inpatients I saw that morning are described below (and shown in Photos):
The day prior to that morning, a five-year-old and a two-year-old arrived in a coma secondary to cerebral malaria and had all the signs of impending death. Who will likely survive severe malaria is sometimes predictable at presentation and much has to do with the duration of their illness (both lived a great distance from the clinic and had been ill for more than five days) and which organs have been damaged. It was obvious that these two had altered blood flow to their brain because of their coma, but they also each had lost more than 2/3 of their blood to the disease and both were breathing rapidly, indicating likely damage to their lungs (ARDS). I told both sets of parents that death was likely (for example, we had three kids arrive and die yesterday evening between 5p and midnight with the same presentation), but that we would ask our Father (the Wind) to touch them and we would leave their care to Him, while doing what we could to partner with Him in killing the malaria and supporting their bodies in the struggle. The five-year-old was my first patient of this particular morning and she smiled, sat up and reached out to grab a sucker out of my hand! I saw the two-year-old an hour later awake, nursing, crying and behaving like a normal two-year-old (he was also quick to grab the offered sucker). Both were unexpected survivors. What a joy!
Eduardo is a 54-year-old man who works as a governmental nurse in his village (when the government provides medicines, but it’s been years), about 10 miles from us. He is a beautiful, caring man who I have known for several years and who attended our recent meeting with village leaders about improving the health of the region. He presented quite dramatically with profound, symmetrical weakness in both arms and legs (unable to move his fingers and toes), a fever and stiff neck that had developed over several days. There were several possible causes, including bacterial or TB meningitis and Guillain Barré Syndrome (we currently have another man in our hospital with this rare disease). Because of lack of diagnostic testing (a simple spinal tap would have helped tremendously), we must treat all possibilities, the most dangerous primarily. He didn’t respond the first few days to treatment for bacterial meningitis, so we began treatment for TB meningitis (for readers in health care, he maintained brisk reflexes, making GBS less likely but still possible), though his presentation was pretty unique for this illness. Over about a week, his weakness remained profound and he stayed in bed, unable to feed himself or care for himself at all. This particular morning, however, I found him sitting in a chair under a tree about 50m from the clinic, smiling broadly, and moving all four limbs freely. What a radical change from the previous day, and just when I was losing hope for him…
The previous day, Teresa had arrived acutely short of breath at rest and unable to tolerate any exertion, complaining of severe left-sided chest pain for several days. She arrived from a city almost a day’s travel from us by motor bike, saying the major hospital there told her they didn’t know her problem. With ultrasound, her diagnosis was easily discovered and we removed over two liters of purulent fluid from her left chest. Taking the fluid off of her chest turned out to be quite an ordeal, however, as she demonstrated a normal fear of the large needle we must use for such a procedure! But she held still (whimpering), endured, trusted this foreign doctor and watched the fluid drain into our cleaning bucket. This next morning, she bounded into our exam room, almost giggling, wanting to show me how much better she was! I laughed out loud at the sight of her and the memory of this frightened and hurting 22-year-old the previous day.
At one point during the morning I heard deafening screams mixed with intermittent shouts of a melodic “Halleluiah” over and over. I walked toward our treatment room and saw a tearful screaming 3-year-old exit on his mother’s shoulder. His cheeks were tear-stained and he continued to shout and cry as mom walked away. Our nurse walked out and told me that he is receiving daily injections (I can’t keep track who’s receiving what without a chart in front of me) and he begins the screaming and “singing” when he sees the treatment room and continues until he leaves the area and he knows the process is completed! This three-year-old has already learned the benefit of the ancient and proven Kingdom truth, “For the spirit of heaviness, put on the garment of praise.”
Abel smiled to greet me, having arrived several days prior with his son after traveling 14 hours by motor bike on dirt paths. He has severe TB with difficulty breathing. How many hospitals are within a 14-hour drive of your house?
Esmiralda and Francisca both arrived the same day with a large protruding abdomen (resembling a woman at term pregnancy), like the women I’ve described in previous posts, secondary to toxic hepatitis/cirrhosis from taking traditional (natural) medicine (unstudied concoctions of plant and animal products) for minor ailments. This morning both were smiling, both were responding well to our treatment, and both had lost several kg of weight (liquid). They will likely survive the liver destruction (in their case partial/temporary) that kills so many in this part of Africa, where evidence-based medicine isn’t accessible, and where “all-natural” marketing is alive and well, attracting the vulnerable, discontented and unwise, and harming many.
Florinda is 74 and was carried into the clinic by her family unable to breathe, after riding on a cot, pulled by a motorcycle, for several hours. These “Zambulances” were made in the US (originally for a mission in Zambia) and we have delivered eight to various communities to bring sick patients to us for care. They are helping tremendously! Florinda had severe pneumonia and was walking and eating (and smiling) this day, three days after arrival.
I was preparing to confront smiling Bemvinda because I read her chart and she had completed seven of eight months of TB treatment, was doing much better, and was now arriving after she ran out of meds a month ago (she walked a half day to arrive). I asked her why she abandoned her treatment (in hindsight I could have used a kinder word)? Her mother said that about a month ago her 1-year-old baby died after five days of fever. She was apologetic that she didn’t keep her appointment! I know not one adult out here over 30 who hasn’t lost at least one child…
Domingas is 12 years old and had arrived a week before this particular morning with severe abdominal pain and fever. We treated her for suspected Typhoid Fever and, though her fever lessened, she improved very little over the course of the week but never showed signs of an intestinal perforation, the primary risk of this disease, until two days prior, when her pain worsened and her exam revealed peritonitis and ultrasound confirmed the presence of new free fluid in her abdominal cavity, indicating that a perforation had, indeed, occurred during the night. She could tolerate nothing orally and her fever was back. I decided to send her to our surgeon colleagues in Lubango via MAF and prepared her mom for the same, when she walked in that morning smiling for the first time in several days and said the pain was diminished and she had not vomited all night. Over the next several days she continued to improve and it looks like her perforation was small, closed quickly, and she will likely recover without surgery. It is quite rare to survive an intestinal perforation without surgery, and all the more beautiful because Domingas’ wonderfully caring mother had voiced concern that they could never afford the transport and surgery.
Cecilia is 43 and arrived two days before with severe throat pain, unable to swallow her own saliva for two days and unable to breathe unless her head was in the “sniffing position”. Her epiglottitis (swelling of the flap that blocks our trachea when we swallow) showed little improvement after the first day of treatment, but I was pleased that she had survived the night (we have no means of intubation/ventilation here, the normal life-saving remedy for this disease). This second day she also smiled a greeting and spoke in an (almost) normal voice and demonstrated for me how she could swallow. She will also recover from a deadly disease and she knows it. Suffocation has a way of communicating its severity to its owner!
Nowiba doesn’t know her age (my guess 80’s). She arrived at our clinic because she hadn’t been able to sleep lying flat for weeks because of difficulty breathing. She had traveled by foot for almost a week to arrive on a Saturday. She and her husband (same age) had to wait for two days for help in crossing one of the two large rivers between their village and our clinic. She has had a goiter the size of a baseball (or two) in the front of her neck for better than fifty years and never considered getting it removed because she has had no contact with anyone who knew the capabilities of modern surgery/medicine. She didn’t come to us to have it removed, but because she couldn’t breathe (unrelated). When we examined her with ultrasound, we found bilateral plural effusions (free fluid between her chest wall and lung), a large pericardial effusion (fluid between the sack that holds the heart and the heart itself) and severe right heart failure, all resulting from a severe infection with tuberculosis, which had likely progressed over years! She has responded well to our treatment and was also smiling as she greeted me that same morning.
If you sacrificially support this ministry, please know that your role in these remarkable recoveries (those mentioned above are such a small sample of what we see every day) is as significant as mine, as I couldn’t be here without you. We are all sacrificing for these beautiful people because they are worth it! On what could you spend your effort, time, and hard-earned money that has more value?! I’m so grateful for your partnership with us. Please know your Father’s pleasure in you! The thousands that our Father heals here (exponentially more than charismatic “healing” ministries that raise millions of dollars) have no one else to turn to, depart as new people with new beginnings, and will never know you, which is so kingdom-like because it is, after all, ultimately His work and for His honor. I wish you could embrace them, share their sadness and rejoice with them.
We all have the incredible privilege of participating in the care of these beautiful people, not unlike the Good Samaritan on the road to Jericho (Lk 10). Picture, if you will, the injured man in the story unconscious and not waking until after the Samaritan is gone (doesn’t “meet” him). This version of the story would be an excellent illustration of every person who contributes to our work. If you haven’t done so, please join our small team (click “Contributions” above) and become a part Jesus’ body serving our neighbors in rural Angola.
Perhaps one day around His Throne, our Father will open our eyes (like he did those of Elisha) to all those we helped, and to all who helped us, throughout the course of our respective journeys. What a day that will be, when we finally see that we were chosen, cherished and insignificant threads in a wondrous and indescribably complex tapestry, so care-fully, thought-fully and purpose-fully weaved together for the Artist’s good pleasure…