Same Names, Little Things, Arrogance, Development…

Two women recently arrived in Cavango within the same week and created a unique situation. With 30+ inpatients, it was several days before we noticed that they had identical first and last names (Victoria Mundabe – changed for privacy), and this caused some confusion. There are no “family” names here, so each member of the family has a unique first and last name. One of the women had liver failure caused by taking all-natural “jungle medicine” and was responding to our treatment well, while the other had terminal bladder cancer from chronic infestation of a parasite called Schistosomiasis. I had a long talk with the latter and her husband about the nature of her illness and that there was no hope for recovery. These conversations are not uncommon in our rural work where people wait so long to seek help (because of lack of access), and they present for this grateful, and rescued-from-the-superficial-philosophies-of-the-world, Jesus-lover an opportunity to present the reality of eternity with love, understanding and wisdom. In a world with the mortality rate still 100%, it’s a matter we all must soberly address frequently in order to be prepared for the inevitable.

I emphasized to this beautiful young couple (in their 40s) that each and every one of us will die and that what she was facing was not unique to her, though it always feels so to the person with a terminal illness surrounded by healthy people. This life is so brief, whether we die at 15 or 95, and the variables are simply when, how and whether we are prepared. I encouraged Victoria that many people don’t have the opportunity to prepare for their departure from this world and that she had several months to prepare herself, her family and her community for her departure, and that this preparation time was truly a blessing (though painful). I encouraged her to speak often with her heavenly Father and renew her relationship with Him, and I shared with her how much He cared for her, quite apart from any religion. She received my words graciously and courageously before we prayed together for our Father to touch her and give to her all she needed to prepare both to leave this world and to enter the next.

The other problem with these women’s names is that they were about the same age and bore a striking resemblance to each other, as did their husbands. Several days went by and I was working my way through our in-patients one busy morning when I was handed the chart for one of the women while addressing the other (same name). I didn’t know them well enough to tell them apart, and I recounted to the woman in front of me, whose illness was not terminal, our conversation about her terminal illness! She reacted with shock and confusion and she called her husband and they both asked what had happened that she was now dying! As of yet, I didn’t realize that we had two women with the same name, as I rarely use the name of the patient when addressing them (apart from using the name on the chart to call her into the exam room), as names are rarely used here in conversation. People call each other, “brother”, “sister”, “aunt”, “uncle”, “mother”, “father”, “friend”, etc and I do the same.

Almost all of my patient conversations occur through a translator, as few rural people speak Portuguese. I speak Portuguese to the nurse, who translates to the patient’s respective tribal language. We have three common tribal languages in the Cavango region, Nganguela, Mbundo, and Choquei. Having three commonly spoken languages has stolen my desire to begin learning them as they are significantly different and are not variations of the same (similar to the Latin-based languages – English, French, Italian, Spanish, Portuguese, etc – which have similarities, yet are quite different). At this point in the conversation with Victoria and her husband, they are becoming emotional over the fact that her illness is now terminal and I am becoming confused as I note their apprehension. Never thinking that we have two patients with the same name, I concluded that my nurse did not translate my words accurately, and I’m becoming concerned that the gravity of the situation was not communicated.

Another cultural norm is that bad news is typically not communicated accurately or directly. As a culture, these people are highly relational, conflict avoiders, and pleasers. When it comes to communicating about a terminal illness, they are typically content with not communicating the truth to the patient (relational peace and temporal contentment is more important than communicating the hard truth) and always offering, instead, empathy and hope. On the contrary, I believe in communicating the truth about such an illness gently but quite directly, so that all involved can better prepare. I began to assume that my nurse so compromised my words (with too much emphasis on empathy) that the patient and her husband didn’t understand that she was dying. I called in the nurse who translated the previous discussion and asked how this woman and her husband could not know the reality of their situation after our long and difficult conversation several days back? Our nurse looked confused, as well, and he asked me for the chart, looked it over and left the room, returning after only a few seconds with a second chart and an explanation re their (same) names. We sheepishly explained the situation and apologized to Victoria and her husband and confirmed that she was, in fact, improving. They responded graciously (and thankfully) and suddenly they had much to be grateful for, even though their situation hadn’t changed at all!

We had a team meeting later in the day and explained to everyone on our staff what had happened and that we must be diligent in making sure charts are matched with patients both in consultations and in medication dispensing. This situation was confusing and caused brief concern (trauma) for the patient but, thankfully, neither patient was given the wrong medications, which could have been disastrous. We don’t have electricity, so wristbands, bar codes and scanners are not viable options, but we took some measures to make sure a similar mix-up doesn’t happen again.

Grimacing, sixty-five-year-old Geraldo (Photo) limped into the exam room, dragging his right leg and leaning firmly on a (natural) cane, complaining of severe hip pain. He said his pain of many years had become unbearable over the past weeks and he had endured an eight-hour motorbike ride to arrive at our clinic. We began anti-inflammatory medications (prednisone) and he strode in without a cane and grinning a few days later, shocked and thrilled by his radically diminished pain and improved movement. He said he hadn’t slept so well in years. His hip joint has been pretty much destroyed by chronic arthritis and he needs a hip replacement surgery, which is not available in Angola, and we will begin injections into his joint next week, which will help temporarily. Not all we do here is life and death, and so often we have the ability to simply give a cool drink to someone who is thirsty. Joint injections and cool water are small things, but life, medicine and ministry are mostly about small things. Completed journeys are the result of many small steps. Mental health is sustained by many small, sound decisions. One’s security in a community is validated by many small, positive interactions. Love and intimacy grow through many small, personal affirmations…

We were surprised by a visit one afternoon last week from a delegation from our municipality, involving over 40 people transported in 6 vehicles. The delegation was led by the administradora of our municipality (Cachiungo), a middle-aged woman who approached me, with another woman with a microphone, and asked about the new construction, who we are and our vision for the future of Cavango. She is new in her position (our fourth administrator – the equivalent of mayor in the US – in five years) and this was a nice opportunity to share about our work. I spoke for about 10 minutes and shared about everything I could think of about who we are, our vision, and our motives, emphasizing the desperate need for these rural people to have access to sound medical care. She listened attentively, asked some good questions and the interaction was delightful. During a pause in this very positive conversation, a man spoke up and introduced himself as the physician director of the municipal hospital, and he asked if our nurses all had official state nursing certificates and if I had an Angolan medical license, stating that if our documents weren’t in order, none of us could work in this hospital and the hospital must cease any and all operation (almost his exact and formal wording).

I tried to count to ten and didn’t make it and the conversation that followed was not pleasant. I asked him if that was really what he wanted to discuss while standing on the dirt, outside of our new construction, during such a brief (surprise) visit, in front of a crowd of 50+ people (and growing). I invited him to come another time and really observe our work and see if, perhaps, we might be able to find ways to partner in serving the underserved (in his jurisdiction). There was some back-and-forth… Dealing with arrogant and critical people is exhausting and part of life everywhere!

Several people in the delegation praised our work and the quality of the new construction and the beautiful benefit it will be for our patients. One would have to travel many hours in each direction to find a building as beautifully constructed though, by US standards, the construction is quite simple. It will have a cement floor, cement-block interior walls, a steel roof, minimal electricity and plumbing and glass-less, rebar, screened windows (hopefully secure from both human and mosquito intruders). It will, however, be full of beds, shaded in the summer and dry during the rains, and it will be a comfortable haven for so many of our sickest patients.

This first hospital building is coming along nicely (Photos), after the departure of our wonderful construction team from the US. We took a day last week and made a trip to Huambo (closest city – 4-5hr) to purchase supplies and to order about 200 meters of steel bars, 100 sacks of cement and 3000 cement blocks, which were then delivered by several trucks. The exterior walls of metal studs, lath and plaster are going up beautifully as our team of six Angolans continue the project. It will take months until completion, but it is clear, at this point, that it will be well constructed and serve many people for years.

I traveled this week with our MAF colleagues to Lubango for a few days to speak at a conference for medical professionals (Photos). Although I am not at all skilled at public speaking (I didn’t complete my TB lecture in the time allotted and butchered several key Portuguese medical terms/phrases in my lecture on Neurocysticercosis), it was a joy to participate in an excellently run conference, attended by more than 100 enthusiastic health professionals, mostly nurses, who function as clinicians in their communities.

We are in a season of development in Cavango and you can help in a very real way to serve these beautiful, rural people. We have a list of smaller and larger projects that need funding, with costs ranging from $100 to several thousand dollars. In coming weeks, I will add to the below list of projects and anticipated costs and if you (or your family, church, small group, etc) would like to fund (or help fund) a particular project, please contact me @ tim.kubacki@sim.org and send your contribution to Rural Health Care – Angola, found here.

Many will benefit!

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Projects:

Protect water source, spring – $100

Raft over 9 empty barrels to assist people crossing Cubango river to get to our clinic – $500

Lay water line (labor) from spring to clinic (2km) – $250

Paint clinic – $500

Plaster new TB inpatient building – $300

Weld steel cover our trash pit – $100

Construction of several grass-roof shelters for patients’ families – $250 each

Burn tree trunks and clear land in preparation for next building – $100

Ongoing wages of construction crew (6 men) for new building – $400/month