Walking with Jesus is not a life filled with “Aww”, “Sweet”, “Precious”, or “Awesome” circumstances. We need look no further than His brief life on earth to see that following Him is rather characterized by sacrifice, pain, sweat, humiliation, misunderstanding, sleepless nights, hard work and battles against principalities and powers unseen within us and all around… Walking by faith is trusting the unseen Alpha and Omega (though revealed in every flower, bee, deer, mantis, butterfly, star, cloud, fossil, tree, puppy, person…) who says that all the real treasures we seek are also unseen, and found only in Him (love, joy, peace, goodness, patience, kindness, faithfulness, gentleness, self-control). The (unseen) abundant life spoken of by Jesus is knowing the reality of these treasures in exhaustion, humiliation, rejection and insignificance, even while mourning the injustice all around us and hurting from the poisonous effects of gossip, greed, self-gratification and arrogance (Mt 5). This unseen abundance (love, joy, peace, goodness, patience, kindness, faithfulness, gentleness, self-control) is found only in Him, so the closer we journey with Him…
This week I traveled with MAF to the harsh, desert southeastern Angolan province of Cuando Cubango (CC), described by National Geographic as one of the most remote regions in Africa. It’s always an exhausting trip full of surprises, and this time joining us for the adventure were two highly skilled journalists from Holland who are in Angola filming for a TV documentary series the work/life of our Dutch pilot, Marijn, his wife, Noortje, and their two kids. They were a joy to travel with and expressed great appreciation for our work. It’s our hope that, through their work, the people of Holland will appreciate the severity of the conditions here and see the beauty of Marijn and Noortje’s heart for the remote people of Angola, and some might respond likewise. We had formerly traveled to Cuando Cubango monthly and quit two years ago because of finances. MAF Canada has now raised the money to purchase fuel for the long flights necessary to reach this area and we are beginning our trips again, likely four times/year. On this trip alone, I was in the air for 18hr. The value of MAF transport is illustrated in that Rivungo is 23hr from pavement in Angola, so to travel here regularly by car would require prohibitive amounts of travel time.
On Sunday we traveled from Lubango to Rivungo, about 4-5hr in the air, with refueling at one stop and leaving fuel in Jerry Cans in another location for the return trip. On Monday we met with the provincial and local leaders to introduce ourselves, communicate our desire to help and gain their support. Every leader we met was new to their role since 2-3 years ago when we were visiting their respective areas, yet each went on and on about stories they had heard re both the effectiveness of our work and the lengths to which we were willing to go to serve their people. They had heard stories of how we had flown into these towns monthly and had then hauled our medicines in broken down cars for 1-3 rough, predawn hours daily on the brutal cattle trails to villages quite isolated, serving the local people in broken down buildings until sunset, and hauling our stuff back to the main town to sleep (no electricity or plumbing) until repeating the “adventure” the next day. If I am remembered for one thing, I would love it to be the lengths to which I would go to serve those my Father loves!
One story especially dear to me that was recounted to us by the health care workers in Rivungo was of a woman blind in both eyes from cataracts and only 60-years-old. We diagnosed her in Rivungo and MAF flew her 3hr to Menongue (23hr trip on dirt by car), where our 80-year-old colleague Steve Collins was operating on people with cataracts. Her vision was restored and our whole team was involved in her healing. “Greater works than these will you do…” Jesus’ body can be quite beautiful. Without our visit, MAF’s ability to transport her, and Dr Collins’ surgery, she would have remained blind and likely not survived (few people survive blindness in the developing world). We saw her this week for another health issue and her sight was excellent. We also saw many people with cataracts, including a man about the same age, blind in both eyes. We will try to get him to Dr Collins in the next few months.
The day of meetings was full of typical Angolan delays (nothing is punctual and all things move slowly) and at about 3p we had about two and a half hours before sunset and we were looking at a flight of about two and a half hours back to Rivungo. We had about ten minutes of grace (ability to see the dirt airstrip after sunset) but we were also facing a stiff and variable headwind (which greatly impacts these small planes). The stuff of life in the developing world… We took off, knowing we would pass a dirt airstrip about half way where we could land if we were flying too slowly to make the sunset landing. We flew over the dirt airstrip, calculated that we should land right at sunset, and decided to continue, taking the risk so that we could begin our clinic in the morning in this municipality of 33,000 people which hasn’t seen a doctor since our last visit in 2016. We desperately wanted to make every minute count the next day (and not miss half day because of stopping half way) and it seemed to both my MAF pilot, Marijn, and to me that the risk was worth it. What risk? If we couldn’t land in Rivungo because of lack of light, we wouldn’t have enough fuel to get to a lighted airstrip (three hours away with two hours of fuel), which meant that there would be nowhere at all to safely land in the dark… We touched down just as the sun disappeared below the horizon because of Marijn’s brilliant flying and calculations. I hope to not cut it that close again.
On Tuesday we began our work in Rivungo, where we did about 90 consultations over two days. One highlight was a 24-year-old woman who had fallen off of a roof two days prior and fractured her humerus. It was markedly displaced and had been casted in such a way as to cause a compartment syndrome (swelling so tight that nerves and circulation are compromised) and loss of radial nerve function, resulting in inability to extend her fingers and wrist. We removed the cast and put her in painful traction for two full days with a plastic bag full of sand tied with a rope and hung from her elbow. Her bone aligned quite nicely and her nerve function showed improvement. We also did an ultrasound of her pregnancy and discovered healthy twins of about four month’s gestation. Marijn prayed for her several times over the two days and saw not only her arm respond well, but also her disposition change quite dramatically, leaving her smiling and expressing gratitude for our work at our departure. When we walked into her hospital room at dusk on the first day, we were greeted by about a dozen bats that flew past us and out the door as we entered. The room was literally buzzing with mosquitoes (bat attraction) and neither the bats nor the mosquitoes seemed to bother her at all. We left the clinic and went to the outdoor market and bought “Vongu”, a local delicacy of fried, salted and crispy (mostly) caterpillars, especially for the enjoyment of our visiting journalist friends, Michael and Remco.
Our first patient on day one was a soldier who had a severely inflamed and painful red eye. He said it had been that way for three months (!) and he had visited multiple military clinics and city hospitals without resolution. On exam, he had a 1mm foreign body embedded in his cornea, which we easily removed with a sharp, vibrating magnet that I carry with me for this purpose and rarely use. The nurses were amazed at the ease with which the little fleck of metal was removed because they had tried without success. It was also helpful to be able to anesthetize the eye prior to pulling the metal out! The right tools make all the difference and the forethought and effort that goes into what I carry in my five medical boxes (over 250lb) seemed worth it as he grinned his gratitude… There were many other good results in Rivungo, tempered by the fact that we likely turned away more than we saw because of lack of time. That hurts.
The following day we flew at first light (about 5a) an hour to Jamba Luiana, where we had but one day to work. We knew from the past that one day would be horribly inadequate, and it was. Nothing was ready, so we didn’t begin until 11a and we saw about 50 people from 11a – 9p, which is about my average – 5 new patients each hour. We were delayed by two difficult cases, the first of which was a one-year-old boy who had crawled under a parked car (there are only about 4-5 cars in this village of 7-8000 people) and then had the car’s rear tire run over him when it pulled away. The only witness to the actual event was the five-year-old watching him and she didn’t know which part of the baby was traumatized. The baby was brought in unconscious, drooling with severe breathing difficulty. I did a quick exam and couldn’t find obvious deformities and then used the ultrasound to rule out internal bleeding in his chest and abdomen. We couldn’t evaluate inside his head, but it had no obvious bony deformity. We observed the child through the night and he seemed somewhat better in the morning, though crying constantly from apparent pain of unidentified origin, but with no neurologic deficits or surgical injuries. With so many people waiting, it’s frustrating devoting so much time to one patient, but it was nice to use my EM experience for his benefit and it was also nice to find nothing surgical, as we would not have been able to help him surgically. The baby will likely survive. It certainly helped that there are no roads here and the ground is thick sand.
Also in the afternoon, a 60-year-old man was carried in by friends and had been suffering constant seizures for 24hr. He was unconscious, had no stroke-like deficits, his malaria test was negative and, at that age, TB meningitis is probable and we don’t carry TB meds, so we gave our recommendations for treatment, stopped his seizures with medication, and prayed for him, hoping for the best. We again had to turn away more than we saw and it takes mental/emotional discipline, and a lot of reminders from my Father and colleagues, to continually recognize that, in this environment of economic crisis and lack of laborers, a drop in the proverbial bucket is still a drop… and all any of us can do is a drop… Yet so many simple needs go unaddressed in so many areas in the world while much of the developed world runs hard serving themselves. Will it always be this way? The administrator (mayor) of Luiana said they haven’t had a doctor since our last visit in 2016, the closest hospital is six hours away in Namibia, and they’ve had a number of recent deaths with no idea as to the cause. Feeling vulnerable to potentially harmful environmental unknowns is not a typically felt insecurity in the US but here is a familiar sentiment.
One of the challenges we faced in Luiana was that each person voiced multiple health concerns. It was their only shot at health counsel and/or medications and they wanted to take full advantage of the opportunity, but it made my job impossible (and miserable). There couldn’t be more contrast in the perspectives of two people, neither right or wrong, than that which I encountered with each patient in Luiana. I was in a hurry to see as many as possible, to identify specific diagnoses and to treat well with limited resources, while the patient wanted to get as much as possible from this rare encounter with a physician. The health care poverty was extreme, and it’s difficult emotionally to see human beings so desperate and know that you can help so few. I left Luiana exhausted, frustrated and, perhaps depressed. I worked with a very difficult and arrogant nurse all day who had little training, questioned everything, knew it all, and kept sneaking patients in to be seen (the aggravating pebble in the sandal). At the end of the long day, I didn’t want to return, but the next morning my Father gently rebuked me in the predawn quiet and reminded me that He isn’t interested in sending me to places where there is light, but to darkness. Encounters with darkness are never easy and always draining (and the greater the darkness, the greater the needed effort, fortitude, courage, patience, etc), but it is our Father’s heart to confront darkness with light, as He did in Jesus and Luiana is a dark place and we will return.
When we arrived early the next day in Mavinga, ready to again address long lines of people desperate for some water in such a dry health care arena, we stopped by the administrator’s office (mayor) to greet him and introduce ourselves, usually a pleasant fifteen-minute diversion. We had met his assistant four days prior and everyone in these small towns hears the plane arrive, so we were certain he was aware of our presence. We told several receptionists of our purpose and hurry… and waited… and waited… and waited. We told more people. His assistant showed up after 3hr (!) and I expressed my frustration to her and she angrily stomped off to find out why we were treated with such disrespect. We then waited yet another hour! I’d had enough and walked out, deciding that we would find plenty of other places to work, but if we were treated this way initially by a new leader, there was no hope of support for our work in Mavinga. After another 30min or so, he sent people to get me. I returned, curious as to what his response might be, but not very enthusiastic about meeting him. He turned out to be a genuine, humble, apologetic leader, who sought my forgiveness for what had been a huge miscommunication. He has a long history with various missionaries in Angola (including MAF) and excitedly welcomed us to his municipality of 30,000+. He is a Jesus-lover and brother, who truly seems to be prioritizing the welfare of his community. It was an enjoyable interaction (after the first few minutes) and such an ashes-to-beauty story from my perspective. This man will be a passionate advocate for our work going forward. We missed a whole day at the hospital, but I think it will be a cry-now-smile-later story for Mavinga.
The following day the line at the hospital began to form at first light, the beautiful head nurse of the hospital (who normally functions as a clinician) began taking vital signs at 7a, and we began at 8a and worked until we had no more light (6:30p) and saw about 60 people and, once again, turned away more. I can’t imagine knowing that my child has a concerning illness, sitting all day and hoping for a consultation and then returning home with my sick child, with no remedies and no further hope for resolution. Please help these people, Father, please bring more laborers, and please show us what we can do, no matter the cost…
Each place had malaria tests and little malaria medication. Every person I saw with malaria symptoms (only a few in each place because of the availability of local treatment) had received exactly half of the appropriate medication dose. The country-wide logic is that treating more people with a little medication is better than treating fewer appropriately. This makes some sense intuitively (and politically) but is completely errant, as with this method the parasite is given the opportunity within each patient to survive resistant to the treating medication. The same is happening with tuberculosis and, because of this certain development of resistance to currently effective medications, the consequences in Angola for this season of health care neglect will be even more devastating in the future than they are presently!
We must reassess our work in Cuando Cubango. More time is necessary to serve so many. More workers are needed. So many are needlessly dying and sick, so many need water for their thirst, clothes for their nakedness, medication for their illness, an embrace in their distress, the Good News of Jesus’ affection for them… We will consider two-week trips and weigh the possibility of carrying enough meds, enough fuel, and enough energy and fortitude to work in such an environment for two weeks at a time… for the sake of those He loves… Please pray for us, for them…