The ground is cursed…
All your life you will struggle to scratch a living from it.
It will grow thorns and thistles for you,
though you will eat of its grains.
By the sweat of your brow
will you have food to eat
until you return to the ground
from which you were made.
For you were made from dust,
and to dust you will return.” Genesis 3
“I tell you the truth, anyone who believes in me will do the same works I have done, and even greater works, because I am going to be with the Father. Jn 14
Eighteen-year-old Florinda arrived this week at our hospital in the middle of the night on one of our Zambulances (a stretcher on wheels pulled by a motor bike) from a village about twenty miles away (a rough two-hour transport on dirt) after 4 days of pain, 48hr of hard labor and 8hr of pushing after nine months of a “normal” first pregnancy. She was leaking dark brown, thick meconium (baby’s stool) vaginally but not hemorrhaging and her labor pain was regular and strong, about two minutes apart. An ultrasound assessment of the baby revealed that she was alive, but in significant stress. A pelvic exam revealed that the cervix was fully dilated and that the head was stuck in the bony pelvis, face-up. I was hoping that vacuum traction, position changes, pressure on the abdomen, emptying the bladder, etc might permit this baby’s head to move past the obstruction, but after two hours of trying everything I knew and seeing no movement, I had a decision to make.
I needed to either call MAF to transport Florinda to our tertiary mission hospital in Lubango for a Cesarean, putting the baby’s survival at risk because of the current fetal stress combined with the long time to surgery (perhaps 7-8hr) or perform a symphysiotomy (google it :-), which would allow prompt delivery of the “stuck” baby, but put Mom at risk because I had only done this delicate and (in the age of Cesareans) somewhat barbaric procedure twice, many years ago under supervision. For the sake of two lives, I decided on the latter and after about fifteen minutes of carefully cutting (during contractions to minimize pain) through the pelvic symphysis of this courageous, yet moving target, Florinda’s pelvis opened up and the baby finally delivered. To my great disappointment, however, the beautiful, fat newborn girl was blue and flaccid with no respirations or heart beat. We dried and agitated her briefly while we cut the cord and, seeing no clinical change, began aggressive chest compressions and mouth to (slimy) face respirations. We continued this for close to ten exhausting minutes and, just before giving up, suddenly the baby began to breathe, she “pinked up” and her heart rate was strong. She continued to improve and after several minutes was even weakly crying, though with a cough (from aspirating the meconium).
As I returned my attention to Mom, I realized that she had significant vaginal tears that involved her urethra (tube from bladder to outside), as we could not successfully place a catheter into the bladder. She was hemorrhaging profusely, either because of her extended labor or because of my procedure. We gave her medication and (painfully) massaged her uterus, packed her vaginal canal and decided that, because of her significant and ongoing hemorrhaging and her probable urethral tear, she needed to see our surgeon colleagues at CEML (see CEML above this article for more information). One’s biggest concern in performing this procedure is cutting the urethra (runs just under the symphysis), causing a very difficult and sometimes impossible surgical repair, and it appeared that I had done just that.
After giving orders to our nurses for fluid and antibiotics, I left the clinic for home (1km) to arrange transport via internet with our extremely busy MAF pilot, Marijn (on his day off), and to notify our surgery colleagues of the mess they were receiving later in the day. I returned to the hospital to find diminished hemorrhaging and stabilizing vital signs, with baby sleeping and breathing soundly.
Florinda survived the almost-two-hour ride in the Vineyard Ambulance (much water on the dirt “road”) to the airstrip, and the 2hr flight to Lubango on a stretcher and the 30min ride from airport to CEML. Upon her arrival at CEML, I was notified by my surgery colleagues, Steve Foster and Rebecca Zacharia, that lab analysis indicated that she hadn’t lost enough blood to harm her and that they had repaired her many tears and her urethra and that full recovery was expected.
Nothing about this was easy, for Mom, baby, the family, and the caregivers. There was much sweat, effort, uncertainty and second-guessing and there was stool, urine, sweat and blood all over the place when we were done – quite messy. There is much talk today about “healing” and I know some misdirected “christians” who revel in “biblical” healing fantasies who wouldn’t consider this mess a “divine” healing. I would disagree and say that this whole event was a radical demonstration of a painful and beautiful collision of the Kingdom of God with this earth’s “cursedness”. The real invasion of the Kingdom into this world of thorns and thistles is most often sweaty (much effort), messy (we – Jesus’ body – are so flawed), unpredictable (we’re clueless) and often unexpected (we can be quite blind)…
Most prolonged labors like this one, especially in the rural areas of the world, end in two deaths or the baby’s death and severe disability for the mother. As I sit this evening and reflect on the day with much gratitude, the profound beauty of Jesus’ body and kingdom illustrated in this one event gives me pause. Jesus chose to work through a “body” of flawed people imperfectly surrendered to Him (“I am going away and you will do greater works…”), and, although every body has blemishes, illness and wounds that can distract from its beauty, Jesus’ body has been remarkably, beautifully and sacrificially loving and serving this world (most often unnoticed) for 2000 years. Please follow with me as I describe some of the hands and feet that participated in saving these two precious lives.
Cavango is in the middle of nowhere Africa and was a leprosarium in the 1950s and 60s and a hospital in the 70s before being leveled brick-by-brick in 1976 by one of the armies during the long civil war. Samaritan’s purse built our simple clinic building here ten years ago. A beautiful missionary couple lived here for several years before our arrival and re-established a reputation for caring and a Jesus-focus. In 2013, we began the first medical work since 1976, continuing the same focus. All of these contributed to the trust necessary for this woman and her family to come to the Cavango Hospital in a crisis.
A Zambulance delivered this woman to our hospital in the pre-dawn. This stretcher-on-wheels was manufactured by homeless people in LA in a ministry led by a man who wants to creatively help those in low-resource-cultures who don’t have car transport to a hospital. These “Zambikes” were delivered in a pickup from LA to CO (for loading onto a container to ship to Angola) by a passionate 89-year-old man who had a vision for these being used in this very rural and needy area of Angola. This same Jesus-loving man came to Angola last October to assemble them and we then delivered them to eight villages at the beginning of this year. All of this contributed getting this laboring patient to our hospital for life-saving treatment.
The vacuum apparatus, the ultrasound machine, the surgical instruments, the dressings, the meds, the IV fluid, etc used to assist in this delivery were all purchased with money donated to SIM in our name by our extremely faithful, Jesus-loving team of 80-100 people interested in helping women just like Florinda and, if it wasn’t for this team, Betsy and I could not be here to assist in this delivery of otherwise certain death times two. These same faithful and caring contributors help purchase the fuel and maintenance for the MAF plane that picked up Florinda and her Mom at the airstrip and transported them to Lubango, by our passionately loving MAF pilot on his day off. They will pay her medical bills at CEML (she wouldn’t have agreed to the transfer otherwise – no money). Our Jesus-loving MAF mechanic (and his Jesus-loving contributors) had the plane ready to go in a jiff and the plane is in Angola because of the numerous, passionate MAF-supporters who wish to do their part to save women, babies and others in crisis. A Jesus-loving local driver (trained with money donated by our home church, VCDC) who loves to serve the hurting in this way, drove Florinda and her mother (and her new baby) to the airstrip in an ambulance that was donated four years ago by Vineyard Church of Delaware County (VCDC) to help women and babies just like these. This car is functioning today because our MAF pilot, Marijn (and all who support his ministry), came and spent three days repairing it last week. Two Jesus-loving local nurses tirelessly assisted me through the long morning.
Our Jesus-loving Angolan CEML administrator arranged ambulance transport from the Lubango airport to CEML and our ever-faithful, over-worked, Jesus-loving surgeons (sacrificially supported by hundreds who contribute to their work for times such as these), took Florinda immediately to surgery and repaired her wounds in a manner that will allow her complete recovery, and in a way I could not have even attempted out here.
Loving and serving people in rural areas is the work of fools (inadequate equipment, harsh environment, impoverished and malnourished population, isolated from friends and family, strange foods, no routines, misunderstood by even those you serve, an offense to the government, etc). Because of the above curse, nothing good happens without cost. So much sweat and imperfect improvisation guided yesterday because of lacking technology, faulty tools, and light by a window in horribly unsterile conditions… But…
…if you join in a harsh and difficult place (of thorns and thistles) a faithful bunch of Jesus-loving, people-loving fools, the result is sometimes pretty beautiful, times two…