A twenty-five-year-old woman presented in severe heart failure and full-body edema and when I picked up her chart I saw that we had treated her as an inpatient for TB nine months ago and, at that time, she’d had no heart failure. Right-sided heart failure is a common result for severe pulmonary TB because the scarring produced in the lung causes pulmonary hypertension, secondary to the compromised circulation through the lungs. Right-sided heart failure then causes edema in the body because the circulation returning to the heart is slowed, allowing fluid to seep out of the vessels into the tissues. This woman had abandoned treatment eight months ago and now suffered severe consequences from the resulting scarring and cell death in her lungs.
I asked her why she had abandoned treatment and she said that she couldn’t get a ride to the hospital. She had arrived the previous evening, after walking slowly and alone for a day and a half to get here, hiring a man in a canoe at each of two rivers to take her across, and hiking barefoot over several small mountains, carrying a six-month-old baby on her back. She’d finally returned after becoming more concerned recently because of her worsening cough, difficulty breathing and severe edema (I could cause a 2cm dent in her shin with my finger). She recounted how she had significantly improved during her stay with us and, though she sought a ride back, she was consumed with caring for her newborn and didn’t become afraid until about two months ago when her symptoms worsened (took two months for her to embark on a journey back to us). It is now unlikely she will survive long, though she improved dramatically over the first week as she lost about 6kg of fluid from diuresis. She is a genuinely bright girl with no reasonable access to decent medical care, whose life was so full with her newborn and other kids that she simply waited too long to pay the dear cost in time, travel and money to return to us for the treatment that would have killed the TB and allowed her to live. Often it isn’t evil that keeps us from making wise decisions, but wisdom is demonstrated in giving the many demands on each of us appropriate priority, and avoiding the tyranny of the urgent, people-pleasing and other distractions that interfere with wise choices. We must weigh cost/benefit for both short and long term as we make our seemingly mundane little choices, because a successful journey is made of many little steps in the right direction. Consideration and prayer (because of so many poor choices, most of my decisions are now made in conversation with my Father) not only yield choices that will please us later, but also peace in both knowing that our Father knows and that we are at peace with Him in what we choose…
On the same day, a 24-year-old man and a 22-year-old woman arrived in a coma with bright yellow eyes. Both had been in comas for several days before their families decided to travel for hours on motorbikes to seek treatment (with the comatose person squeezed between two people on the bike). They both had sought “healing” in previous weeks for minor problems through all-natural, jungle medicine and they each survived about 48hr with us before dying. Evidence-based medicine is unknown here and I would hate to see the statistics in Angola of preventable deaths if decent medicine and care-givers were accessible. The cultural history must be compelling, because our nurse director, who has seen countless people healed at our clinic over the years, had been struggling with “tennis elbow” for months before he mentioned it to me and I told him that an injection was often curable. He readily accepted and I pulled up his shirt to give him the injection on the outside of his elbow and his arm was covered in the scars produced by the “jungle medicine”. One method of the “healers” is to cause multiple superficial lacerations, about a centimeter in length, and rub a mixture over and in the wounds that contains plants that cause severe burning and inflammation, and leave scars. The more it hurts, the more they think it’s working (we do the same with “heat” creams for sore muscles – they do nothing but produce a sensation of heat). Of course, this treatment is not a remedy, but enough people get better because of placebo, as in acupuncture and other unproven, hocus pocus, “all-natural” treatments, that these guys stay in business. Then they give potions orally, rectally and even via injections, and kill many people who seek their treatment for minor, self-limiting problems. These two kids died and we have about 6 people currently in our hospital with liver failure from these unscrupulous peddlers. In any culture, who we trust can be a matter of life and death and who we follow, listen to, etc, a matter of eternal significance.
Because of my frequent absence from Cavango while doing clinics with MAF, our nurses often do consultations and follow-up visits. I had two patients return this week in critical condition because last month when I was traveling, during a follow-up visit, our nurses errantly copied their meds from their previous (successful) treatment and the errors almost killed these patients with delicate illnesses. Despite so much instruction, these nurses are careless as to details and still have no concept of the power in these meds and the gravity of some of these illnesses, like heart failure. In both patients, a medication was left off the list to take to our pharmacy and their heart failure returned in dramatic fashion. The minimally trained nurses (who do most consultations in this country) and the uneducated patients see a clinic as a place to go to get “the medicine”. When one goes to most health posts here, he/she is given the same medicine (or a prescription for the same) as the previous and the next, regardless of the causes of their respective illnesses. All patients receive Tylenol, an anti-parasitic, an anti-malarial, an antibiotic, and a vitamin. Some get better and many don’t. It is a shotgun approach in a country with so little education and training and none of the medicines prescribed cause acute harm, but the health posts don’t typically treat some of the delicate illnesses that we do at our hospital in Cavango, or they treat them with the same, five-medication “cocktail” and the person dies. There is no concept among rural health care personnel or among those receiving care, that there are specific causes that require specific treatments, and that there is a wealth of reproducible scientific evidence behind every remedy.
An eighteen-year-old boy came to us this week with a dog bite wound on his leg. He was in his field working when a storm came through (our first real storm since April) and he and his three dogs were struck by lightning. Two dogs died instantly, while he and another dog were knocked unconscious. He and the living dog regained consciousness quickly and, when he tried to restrain the confused dog, he was bitten on the leg. It was a minor wound, but we have had some recent cases of rabies and one of our nurses live in this village and recommended a consultation. The dog was unlikely rabid, but it was sure quite a story and it gave me the opportunity to share with this boy our Father’s affection for Him and that he had survived for a purpose. I’m not sure how much registered but I was grateful for the opportunity to sow some Kingdom seeds in this young man’s garden. For most of us, there are seasons in our lives, usually brought about by difficult and stormy circumstances, that prepare/soften our “soil” and ready it to receive from the Gardner. The world’s ways, philosophies, and distractions harden our hearts (as fallow ground), and we can’t receive from our Father until we, like the cultivated field, become broken and and turned over, via painful plowing tools, and fertilized with unpleasant and foul-smelling manure (our ever-working Gardner/Father often uses the foulest encounters to produce something beautiful). All preparation for seed is unpleasant for the soil and, for us, all preparation can be temporarily painful and confusing, yet each and every circumstance is purposefully designed to produce rich, life-giving soil which will yield eternal fruit and open our eyes to the glory of His otherwise unseen Kingdom and its indescribable Ruler.
We really get to meet the cream of the crop in this line of work. Our recent construction team was from all over the US and they worked nonstop for two weeks on the steel frame and roofing for our first new hospital building. It will be a simple, very well-constructed shell and we are planning on three or four more like it over the next couple years (Please consider bringing or joining a team!) and these “tools” will transform our patient care and treat every patient with the dignity they deserve.
To give you some examples of the people who chose to serve the rural Angolan people this past two weeks… They came with an organization called AGA, which has been instrumental in our work here for many years, and has benefitted so many rural people in this region. Paul is the passionate-for-the-rural-Angolan-people leader and was raised on the mission field, a few of those years in Cavango in the 70s, and he has led six teams here to work for these beautiful people. He has built his own construction company in the US and devotes much time and effort to our work in Cavango in preparation for the trips, organizing and sending the containers and paying for much of the product. This building went up without a hitch, largely because of all of his preparation, experience and thought (before the trip). Scott made his second trip here, was also raised as a missionary in Africa, has adopted several abandoned children, provides foster care for many others, recruited many of the team members on this trip, and kept us all smiling. He led evening devotions, during which each person shared their life story and Scott reminded us (repeatedly) that it is an honor, not a sacrifice, to give our lives and sweat for our King.
Alex grew up in Rwanda, where he lost his family in their brutal civil war in the nineties and was adopted by a beautiful family in the US, was impacted as a child through the shoe box ministry of Samaritan’s Purse, and continues to work for them in the US. He contributed in so many ways and always seemed like he was having a blast. Roger is 80 years old, was a missionary in Zambia and Botswana with SIM for 30+ years and continues to passionately support kingdom work in the hard places. Roger, like all of these guys, exemplified the missionary needed today, as he did anything and everything to serve and contribute to the work for over 30yr, behind the scenes. He had so many stories about his years overseas and kept us entertained and smiling with the telling of his many adventures.
Stephen grew up a missionary in the Brazil Amazon, is a pilot and airline mechanic in the US and contributed in so many ways, including spending hours (after the work day!) over our multi-purpose Bobcat mini-dump-truck, fixing the engine. This vehicle will haul sand and rocks for years to come in our future building projects. Stephen’s heart is in missions and I look forward to how our Father directs the remaining chapters of his story. Kevin is a construction manager in the US, was never without a smile, though sick much of the time, has adopted several abandoned children, and energetically and joyfully managed much of the construction when Paul had to leave for several days to deal with the Angolan bureaucracy re the shipping container. Jared has adopted five (!) abandoned children, is also a construction manager in the US, contributed in so many ways, loved working with our local Angola team, and had the energy, with Alex, to jog with me many mornings at dawn to the river and back. Bob is 90 years old, has made over 20 trips overseas and this was his 6thtrip to Angola (several at high risk during the war). He never stopped serving during the trip (except for a regular 15min afternoon nap) and worked tirelessly with Stephen on making over 200 roofing panels. He’s amazing and will never be forgotten in Cavango for his effort and generosity. Brian is a pastor in the US and brought his tremendous effort (though he confessed that he joined me in my utter lack of construction knowledge) and incredible and gift of encouragement and wisdom, building up each of us in so many ways each day. He led evening devotions and reminded us of the beauty of the psalms and sent us to bed every night, though exhausted, with songs of praise and joy to our King. This trip was but one, small step in their journey with our Shepherd and I look forward to continued relationship with each of them as our eternal stories unfold…
These guys drove out to Cavango and back to Lubango several times over 15hrs to haul equipment and trucks, enduring flat tires and getting stuck, in our first seasonal rains, worked long days while overcoming altitude sickness and “intestinal issues” in the Angolan sun, donated all their time and significant expense (along with their wives and families at home) to see a roof over every sick patient for years to come. They donated all of their clothes and tools, coming with three suitcases each and leaving with a carry-on! They were so “light”, doing all the dishes, keeping our crowded house immaculate, and leaving our house and the yard (which was a bagunsa (mess) most of the time) cleaner and neater than when they arrived. Their effort will be multiplied in serving literally thousands of sick and hurting people for many years. Kingdom principle: The reward for their work will be realized by others!
Betsy was amazing. She so enjoys hosting, and it was evident every day. What a delight to see her using all of her warmth and gifting in a setting of somewhat-organized chaos, as she lived with ten men in a small house for two weeks. I think everyone gained weight while here, even while working all day in the 90+ degree African sun, because of all of Betsy’s energetic preparation and crazy-delicious meals…
The team leader, Paul Hockersmith, visited us last year and noted some things we “lack” in our house. It is quite a nice place in the middle of nowhere, and was so-well-built by him and a team from his church about ten years ago. It is, however, a work in progress and yet incomplete. The unpainted house rests on an uneven and crumbling cement floor, we have virtually no molding around the windows and floor, our “cupboards” have no doors, we have a broken combination of 110V and 220V wiring that drains our solar batteries, our window coverings and furniture are like that of a college dorm room (over-used and without decor), etc. I am joyously married to a woman who is not concerned with such triviality, yet maintains a beautiful and warm home (we both like living here). Paul repaired some of our energy-draining wiring and put in the building container a vinyl floor for the whole house that looks just like wood. It will require a little prep work to smooth out the cement floor and install, but it will be beautiful, Betsy will love it and it will add significant resale value to the home 😉