Hippos, Opioids, Expiration Dates, Heroes, Snails…


On one of my morning runs to the river in Cavango, I came across many hippo prints along one section of the river bank.  There is no way to know the age of the prints, but I haven’t yet seen the hippos during my runs.  These animals are reputed to be more dangerous than lions in an unexpected encounter, so I now run somewhat cautiously during this part of my route.


The normal work routine in health clinics and other areas of employment in Angola is one week on and one week off.  This is to accommodate people working away from home without having to relocate and it gives them time to work in their fields – their only source of food.  Many people from the bush travel to cities for a week at a time and many travel from the cities to the bush for the same.  Our clinic developed the same routine because we wanted to hire workers from outside our immediate village.  We have several workers who walk 5-6 hours to our clinic for work and stay for a week at a time, sleeping at the clinic.  On Monday mornings we switch teams and usually have a meeting with the complete staff to discuss “operations”.


Medical privacy…  The government requires us to fill out a document for every person who flies to Lubango with MAF because the government must be aware of all of the movement of its citizens.  On this document it is required for us to write the diagnosis of the patient.  This document will pass through many hands before being filed, as everyone is curious about the people’s movement and the reason for the same.  The patients really don’t seem to care.  They are thick-skinned and don’t care that the government knows their health issues.  They also are willing, out of fear, to give the government anything it asks for, and they see this as good government by “papa”.  More government intrusion in their lives is often seen as papa “caring” for them.  They tend to trust that the government has their interest at heart because, after so many years of war and seeing people killed for standing up to authorities, it is too dangerous to even think thoughts that would be in conflict with the governmental authorities.


A woman presented to our clinic weeping as she described the severe full-body pain she’s had for months, after a “traditional medicine” (untrained, self-proclaimed “healer”) practitioner drained her swollen knee and, in a non sterile setting, injected it with an unknown, “natural” substance.  These people make the most money of anyone in their village and take full advantage of the fact that this culture is completely unfamiliar with evidence-based medicine.  The patients have no options, the practitioners have few inhibitions as to risk, and the remedies often maim and/or kill.  Another woman presented this past week telling us that she had much fluid in her abdomen (because of liver failure from ingesting toxic herbs from a traditionalist) and the traditional “healer” drained her abdomen through a non-sterile incision and her pain was now intolerable (she had peritonitis – infection of her whole abdominal cavity).  These unscrupulous, untrained “healers” treat with their “magic” herbs absolutely anything (and, of course, promise healing) for profit, with complete ignorance as to risk to patient.  There is fault in the ignorance and lack of inhibition as to risk, but the real fault lies in our poor global distribution of resources and the local corruption that keeps from its people access to good health care.


There is no opioid crisis here.  This is a country without without these pain medications and also without their abuse.  Surgeries are performed, limbs broken, and cancers encountered and no one receives opioids for pain.  No one dies from too much temporary pain and there are no addicts or the societal effects of addiction.  Of course, opioids are useful in certain situations, but a cultural comparison of risk/cost/benefit reveals that no opioids are far better than what we are seeing in the US.


We finished construction of a new, simple, adobe, TB building that will house 12 TB in-patients, increasing our capacity for TB patients to 36.  We hired a team from a nearby village and they formed the adobe blocks from clay (about the size of a cement block), dried the blocks in the sun for about two weeks, and used them to build the building walls with clay mortar.  It came out nicely and will last for years if we keep it dry with adequate roofing.  The building was built on the foundation ruins of a hospital building that was destroyed during the war in 1976.


I traveled the past two weeks to do rural clinics and I found out that, when we were gone from Cavango, we were visited by a delegation from our municipality (our governing authority).  They have visited us about a dozen times in my five years in Cavango and never when I’ve been present.  They scoured our pharmacy and found a (very) few expired meds and issued us a fine of $1000US.  Our hospital doesn’t have that kind of money (everything that comes in goes out to salaries and med purchases) and I refuse to pay with supporters’ contributions.  There will be quite a confrontation sometime over the next couple weeks and I would appreciate prayer for wisdom in how to graciously and firmly respond.  They would never issue this size of fine to one of their own clinics because they would know they couldn’t pay.  We don’t sell expired meds unless a critical patient comes in and we don’t have the appropriate medication, which virtually never happens.  These were on our pharmacy shelves and not yet thrown away.  Study after study has shown that medications are effective for years beyond their expiration dates (the US discards millions of dollars of good meds because of these arbitrarily – not scientifically – determined “expiration” dates).  These cowards from the municipality always arrive in my absence (they know) because every time I visit them (about 3-4hr drive), they are confronted about keeping TB and Leprosy meds from our patients (they consistently tell me they have nothing to give us but I open their closets to find meds every time.  I always leave with more meds than they say they have because I confront them.  If I don’t advocate for the rural people I serve, who will?  They don’t like me at all, even though all of our discussions are tactful and respectful.  Their health posts have had empty shelves for four years, their vaccines are almost all ineffective (because they don’t keep them cold), and they issue laborious unfunded reporting mandates while they do nothing with the information they are provided.


A few years ago, I drove 5hr (at the time) one way to this municipality to procure a rabies vaccine for a beautiful woman who was bitten by a dog while protecting a group of children from the obviously sick animal.  This same municipality gave me several ampules of rabies vaccine for the woman, which we administered by proven, effective protocol.  She died of rabies two months later, indicating that the vaccine was bad because it hadn’t been kept cold (it was not expired).  We now get all of our rabies vaccines from Namibia.


You may also recall that three years ago, the national authorities suspended our simple, dirt runway project after initially granting us permission, and fined us extravagantly as they lied on paper about us already using the partially constructed airstrip (not even close to possible).  At that time, they also issued a fine that could only be paid with outside funds.  We must not continue to enable this type of behavior by unscrupulous authorities who use the law for their personal gain.


Joining me on my quarterly trip to the very poor and neglected southeastern province of Cuando Cubango were Rachel Hoyme, a Nurse Practitioner from the US and missionary in Angola with Overland Missions (with her hefty, one-year-old strapped to her back most of the day), 80 y/o Steve Collins, an ophthalmologist from Canada who did eye exams and treated eye disease, and Jean Pierre Brechet, from Switzerland who has been practicing surgery in Angola for 40+ years and now heads the nation’s Leprosy program.  One of the radical advantages of missionary life is the incredible privilege it is to work along side those I so greatly admire.  There is much publicity today about church hypocrisy (some of it deserved), but we never hear much about those genuine Jesus-lovers who literally give their lives to serve hurting people.  Many of the missionaries in Angola, including the two men above, served people here while death or imprisonment was a daily threat, during the 30+ year civil war (in these civil wars, the armies are radically unpredictable and follow no rules as to capture or killing).  Not only do these missionaries abandon families and material comforts, but they serve with their very lives at risk.  They are pleasant, joyful, passionate and completely human.


Our celebrity mentality often has difficulty admiring people who are obviously flawed and completely human (everyone).  But is it possible for a flawed human being to do great things?  Should we follow “images” who we don’t know or flawed people whose weaknesses we know and still admire?  We are disillusioned when we trust someone we don’t know (an image) to lead us and they end up being less than perfect.  The reality is that this is harmful in both respects.  It harms the person who is the unrealistic “image” as they try to satisfy the unrealistic expectations of those following them and it harms the follower who has no opportunity to connect relationally with the one he follows.  Have you ever wondered why we listen to and follow good speakers/performers rather than those whose lives are remarkable for their service?  One would think that those who follow Jesus (based on what He said) would value more highly those whose lives are dedicated to sacrificial service rather than entertaining speakers.  But who leads our churches?  When was the last time you heard admiration for a church leader for his/her radically simple life, dedicated to serving the “least”?  We would much rather be entertained than listen to someone who is boring, hates the spotlight and reeks of the love of Jesus every day…


What an honor for me to actually know these heroes (who exemplify simplicity and service) and to appreciate both their human-ness and their incredible attitudes and passion for the “least”.  To travel with them for even a week will “sharpen” me and push me toward more and more service and sacrifice, for the sake of those Jesus loves…


During the week we saw perhaps 500 people, 400 medical consults and over 100 eye consults with Steve.  So many people in each location waiting 1-2 days for a ten-minute consult and not a complaint.  The areas we visited have a combined population of about 60,000 people and no doctors or meds.  We were treated with such honor and appreciation, exactly opposite of the contempt we receive from our own municipality, cited above.


Bladder cancer is so common here because of a parasite (called Schistosomiasis – you’d be amazed by its crazy and complex life cycle which involves snails – see here) that is contracted usually as kids in standing water.  The larval form enters through the legs and lives for years in the bladder.  The almost-always-untreated chronic inflammation caused by this microscopic worm in the bladder wall commonly leads to bladder cancer at the age of fifty and beyond.  We brought a 46-year-old dear friend from Cavango to Lubango last week with an early form of this cancer causing obstructive renal failure because his early bladder tumor was blocking urine outflow.  On this trip we saw three small, early bladder tumors that can likely be cured with surgery.  This is exciting because the most common form of this cancer that I see is advanced and terminal.  We saw a woman with severe and deforming leprosy who had received two months of treatment from the government two years ago before the government health post ran out and the disease progressed aggressively (Photo).  Dr Brechet was able to leave a full course of treatment for her.  It is thoroughly disgusting that the globally free medicine isn’t available for this woman and so many like her.  Dr Brechet also left enough medicine for me to complete treatment on the 15 active cases we have in Cavango.  So beautiful.


We were able to arrange surgery for a 65-year-old man blind from double cataracts who had walked with, and was carried by, his grandson for two full days from the bush to see us, only to arrive after we closed the clinic for the night.  He saw us the next morning on our way to the airstrip and we were able to arrange for him to have surgery at a location three-days-travel-on-the-back-of-a-flatbed-truck where Steve will be doing surgeries in December.


Where there is no health care…  We saw a man who had been treating his hemorrhoids for months with black shoe polish.  They hadn’t improved.


The local government representative in Rivungo, one of the towns we visited midweek and have visited for several years, was seriously drunk for our evening arrival with MAF.  He was a pleasant drunk but it was frustrating talking to him and explaining our vision because he kept asking the same questions over and over.  He was the same the next two nights, but stayed out of our way and didn’t impede the work as do some sober, drunk-on-power, micro-managing administrators.  I hope we can get some (sober) time with him in the next months and have the opportunity to introduce him to our Father.


The last town we visited was Licua – our first time there, with a population of about 3000 people and about as simple as it gets.  The town had two vehicles – a rattle-trap dump truck which they used to transport us 15km from the airstrip to the town, a small barely-running pickup, two motorbikes and a four-wheeler.  The main form of transportation is by foot (three days travel by foot to the closest larger town), but there are many ox-carts (Photo) which haul cargo and people.  The houses are stick, mud and grass, there is no electricity and no running water.  No stores and virtually no modern products.  They have a pretty nice, mobile-home-like, 10-bed hospital with beds (no mattresses), and functioning windows and doors.  They haven’t seen a doctor for 10+ years, they’ve had no meds for 4 years and operate under the direction of two beautiful, volunteer nurses who were extremely helpful in translating and they expressed their gratitude for our presence many times.


We return to Cavango today and will have a confrontation with the municipality’s authorities this week.  We also have a  meeting with the provincial governor on the 13th to procure his authorization for the construction of our airstrip and new hospital.  We have a beautiful team visiting us through AGA this month to begin the new hospital construction and train local men to complete the work.  Please ask our Father to give us wisdom and energy so that our work will serve many, will serve with excellence, and will point people to Him.  Thank you for reading and supporting and praying.  These beautiful people are worth it!



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