I returned yesterday from our regular trip to the sparsely populated and harsh southeastern part of Angola and couldn’t sleep tonight even though I am likely more spent than I’ve been in a while.  I will share some of what we saw and experienced, as well as some of the thoughts that haunt me tonight.  It may not be an easy read…

 

Four-year-old Mateus came to the clinic in Rivungo in a coma after two weeks of bloody diarrhea and vomiting, one of many kids we saw in this region with a similar illness.  Diarrhea is the third leading cause of death in Angolan children and about 1/3 rural kids don’t reach age five.  Mateus and his family live a little less than a day’s walk from town and they waited at home, hoping that the waxing and waning illness would resolve.  Then they heard a doctor was visiting and they came. Mateus was unresponsive on arrival and in hypovolemic shock (severely dehydrated). We gave him fluids through a needle we placed in his tibia and he began to respond later in the day but died during the night.  His family was crushed after having some hope for his recovery after his minimally positive response to our initial fluid delivery.  They returned home mourning their loss.

 

The day I left Cavango two weeks ago, I spent the afternoon repairing the penis of a mentally ill twenty-three-year-old man who got a hold of a knife and tried to cut off his genitals (and was about 30% successful), and stabbed himself in the chest, abdomen, leg and hand.  His beautiful, barefoot family has cared for Tiago his whole life, after he was born healthy and contracted malaria at age five and never developed further mentally. He was clean, well fed and strong, a testimony to the sacrificial care he has received every day for so long.  They said they keep sharp objects from him (as anyone would from a five-year-old) but he found a knife and explored its capabilities.  He stabbed himself in the chest and had a sucking wound (he punctured his lung) and he violated his abdominal cavity (his peritoneum), along with his extensive and dirty genital wound and severe blood loss that had occurred over two hours of motorbike transport to the hospital.  I told the family he would never survive because all three of his major wounds were deadly, so we prayed together.  He didn’t just survive, but I received word yesterday on my return to cell coverage after our trip, that he has thrived.  This family has been mourning the loss of their son for all these years as they sacrificially and exhaustingly care for what is left of him… I’ve no words to express my admiration for this bush family who know more about sacrificial loving than I ever will…

 

That same day I said good-bye to a dear 23-year-young man who had contracted severe intestinal tuberculosis (TB), likely from drinking infected unpasteurized cow milk. He lived near us with his beautiful family and had come to see me two months prior with a surgical abdomen.  We transported Jacob to CEML and our skilled-surgical-colleague-friend, Annelise, operated on him and found his abdomen full of TB. His post-op course was stormy and unbearably painful.  He told me on his return to Cavango from Lubango several weeks after surgery (still with unremitting vomiting) that he had no desire to live, could take no more pain, and was longing to die.  He, his mom and dad, and I prayed together… and the following day together mourned his tremendous suffering and untimely death (their dearly loved first born).

 

Twenty-five-year-old Pedro carried very little flesh on his bony frame and I was asked to advise his family on his condition after his arrival in Rivungo. He’d had a bout with malaria 22 years ago and has since suffered multiple seizures weekly, was nonverbal, was wearing urine and stool-stained clothing, was covered in flies and was carried to the hospital in Rivungo by his family (trading off carrying him on their backs) after a prolonged seizure the previous night.  Apart from the miraculous, he and his family have no hope for his recovery in this world.  They will continue to mourn, and to care for him as best they are able.

 

Teresa arrived on our second morning in Rivungo with severe bleeding and pain after giving birth to her first child in her home during the night.  We were able to easily identify that her placenta hadn’t completely delivered and remove the remaining part without difficulty, revealing a complicated vaginal tear involving the rectal musculature. On any other day, she would have received no help in this rural hospital and would have lived out her days incontinent of stool if she survived the hemorrhage caused by her retained placenta. The hospital had a small tray of instruments and no suture or antiseptic.  Because we carry these “tools”, we were able to repair her complicated laceration and (hopefully) maintain her rectal sphincter tone.  Teresa won’t mourn but so many like her have no visiting medical team, hospital, sutures, etc and suffer the same, very common postpartum complications.

 

Three-year-old Margarida fell out of a wheel barrow two months ago and was brought to the hospital in Mavinga not bearing weight on her left leg.  Without the availability of x-ray, an untrained guess called her leg fractured and she was put in a circular cast for six weeks about her knee.  The cast had been removed and her leg/foot was flaccid below the knee.  She likely had peroneal nerve palsy because of prolonged compression on this nerve from a poorly placed, constricting cast on a leg that was not fractured.  A lengthy ultrasound exam of all leg bones revealed no fracture anywhere.  We prayed that her nerve would recover, but today Margarida’s family will mourn her lost leg function.  On our last visit, a young woman lost function of her hand, also because of a poorly placed cast (not because of the injury itself).  No x-ray capability in this municipality of over 30,000 people, combined with well-intentioned, poorly trained medical decision makers…

 

On our arrival to Mavinga, an “ambulance” met us at the airport carrying in the back a 30-year-old woman on a twin mattress.  It was her eighth pregnancy and her labor had stopped in the last couple hours after progressing during the day. We had departed from Menongue two hours prior in swirling and stormy 50+ knot winds and our pilot, Marijn, said during take-off that he was able to take off in those unpredictable winds but wouldn’t want to land our small plane in the same.  We examined Domingas in the ambulance and found her stable and not in pain but with a fully dilated cervix and the baby high in her uterus, we confirmed via ultrasound that her baby was healthy, and decided that it would likely be minimal risk to watch her overnight to make sure her labor was arrested (she might still deliver), and send her for a cesarean in the morning if necessary (in better weather).  There was risk in immediately transporting her and risk in waiting…  The problem was that Domingas had delivered without complication six times, but had a complicated delivery by cesarean in a rural hospital a year ago.  She had a full abdominal scar, indicating a complicated cesarean delivery/repair.  Our concern was that her scarred uterus had enough flexibility for the head to descend to her cervix, but not enough elasticity to allow the shoulders to pass through the lower part of her uterus, holding the head above the pelvis.  A repeat exam at 5a revealed no change and Marijn flew her two hours to Menongue for a successful cesarean and we heard the following day that mom and baby were well and spared from mourning.  Any other day and this baby, and perhaps the mother, would not have survived. Families mourn every day in these rural towns from deliveries fatal to mother and/or child (the vast majority of deliveries take place at home, on a hard dirt floor, surrounded by a group of well-intentioned, women “counselors” trying to help).  No one here has not lost to illness a young, beloved child.  No one…

 

A strange bright spot on a dreadfully dreary canvas…  Twenty-three-year-old Alice had an inflamed, 5mm spot on her eye, next to her iris for several months, that had begun spontaneously, and that made closing her eye and sleep almost impossible.  An exam with magnification revealed a clear, raised cyst over the medial white part of her eye near the iris containing a pork tapeworm larva.  I can’t imagine the discomfort she has endured, day and night.  Our treatment will take care of the problem, called ocular cysticercosis, not uncommon in the rural, developing world, where pigs and humans live together, and eggs are ingested on contaminated vegetables or in infected water.  This illness causes much debilitation and death from these larvae and their preference for neural tissue, especially the brain.

 

We transported our six awkward medical boxes, weighing between 40-60lb each, full of meds, instruments, tests, etc, from one place to another over thirty-five times during the week-long trip.  My 58-year-old back screamed every time.  Our Hollander MAF pilot, Marijn, instead of dropping us off and returning home, stayed and slugged it out with us all week.  He helped in so many ways, fitting reading glasses, praying for the patients, lugging equipment, refilling boxes, and saving the above baby and Mom by flying them to a surgery-capable hospital.  Our American NP missionary friend, “doutora”, Rachel, joined us on this trip for the second time and worked all week with her active one-year-old on her back or next to her in a play pen.  She virtually never took a break in the heat, always surrounded by clinic chaos, and she slept little, as do most nursing mothers. None of our stops had running water and our first two stops had solar power for outlets and lights, while the last stop had no power, though we were able to use a small generator for a couple hours to charge our ultrasound machines.  We had clouds much of the week so the days were warm instead of the usual stifling.

 

We had scheduled our arrival dates two months ago and confirmed two weeks ago, yet no one knew we were coming until the day before, so word didn’t get out to the population about the opportunity for consultations.  Those who came simply knew the small plane brought doctors, and there were still too many for us to see.  At our first stop in Mavinga, after we peeled ourselves away from Domingas in the ambulance, we were told that they had nowhere for us to sleep because the vice-governor of the province was visiting, with his entourage. We were then going to stay in a local person’s home, but they found a place for us while driving into town from the dirt airstrip.  We had to eat our simple meals (when they were available) after this delegation finished, slept several to a room (in tents on the floor because of the mosquitoes), we had a little water in buckets for bathing, and saw about 120 patients in the hospital over the two days, many complicated.  In Rivungo (our second stop), the same vice governor visited and held party “meetings” late into the night, accompanied with loud, chest-thumping music that ear plugs couldn’t silence.  Our sparse and late meals were supplemented by peanuts and crackers that we bought at the little town market store.

 

It was a difficult week for me and I hit a wall somewhere, not necessarily from anything in particular, as it was a pretty normal trip, but more from “pebbles in the sandal”.  Communication-in-advance never happens and everyone is late and moves incredibly slowly in Angola, making a scheduling anything (flight departure, arrival, meals, etc) next to impossible (while sick people wait all day).  Before lunch and at quitting time, there is always the request for “one more” patient.  My attitude was lousy as we turned people away during and at the end of each day.  I was spent by each midafternoon as I tried to sprint through every consultation in order to accommodate a few more.  Then we arrived in our last location on Friday and the local leaders wanted us to participate in a church service (to honor our visit) and then walk almost a mile to meet with the administrator (mayor) before we began our work.  We lost 2-3hr of patient care.  I hate religion and this scene in Licua was close to a perfect real-life illustration of the profound story told by Jesus to define the meaning of the word, “neighbor”, contrasting the actions of a despised Samaritan who stopped to care for a wounded man to two religious men, who were presumably importantly occupied by their religious priorities, and who walked by the wounded man, leaving him for dead.

 

I was haunted by our “alone-ness” as we sprinted through the crowds each day, slugging it out alone among the ill and wounded…  Where were my American brothers and sisters?  Do they know the about the suffering and helplessness here?  Do they care?  We have a supportive home church (click VCDC above) and a wonderful, small group of people sacrificially financially supporting this work.  Would you join them?  Passionate, Jesus-lovers can still make such a difference in this world, if they would go and/or sacrificially send others…

 

If the wounded man and the Samaritan in Jesus’ parable are neighbors, then the desperate and alone outside of our borders are our neighbors and Jesus encourages us to find them and serve them.  We are given resources to give away.  He doesn’t “bless” us materially, He distributes resources to those He loves to steward those resources to others He loves… We have been granted the radical privilege of participating with Jesus in the care of the wounded, confused, hungry and naked. He is calling you to have a radical impact on someone’s life today.  Go and find them, seek them out, enter their pain, gain their trust…  Who might that be?

 

I’m in Africa because Africa has been Africa forever and the American Church (me) can help Africans have their basic needs met, if we would go, love, embrace, serve… gain trust… then teach… about health and about our Father’s Kingdom.  Outside of life-threatening desperation, people and cultures will consider change only in an environment of love and care, where trust is gained and then risks (changes) are considered… Africa has received gazillions of monetary donations, and hasn’t changed.  Based what I’ve learned in my few years working with the impoverished, money and instruction don’t change people or cultures!  Money and instruction have a positive impact only in an environment of trust, which can only be gained in relationship, which can only develop when living daily life together, which is why Jesus told His followers to “go”…

 

The church has heard and ignored Jesus’ words for 2000 years (a very small percentage has ever left their own, familiar, people group to serve another) and Africa has remained largely unchanged…  The “gospel” here is religion and law (trying to earn God’s favor by what we do in contrast to recognizing that we have His favor because of what Jesus did), and religion is always the dead counterfeit that thrives in the absence of passionate Jesus-lovers.  Passionate Jesus-lovers are the world-changing witnesses of His life, love and power and this hasn’t changed since Thomas touched Jesus’ scarred hands.  This is why Jesus encouraged his followers to abandon their lives and go to be His witnesses, rather than gather in beautiful buildings, pray, sing and and learn principles…  and we have been building and gathering ever since…

 

How can passionate Jesus-lovers not go to people who don’t know Him?  How can screwed up people who have received undeserved and inexplicable acceptance and grace from an inexplicably merciful, loving, and forgiving Father, not tell every hungry person who hasn’t heard about His banquet invitation?  Can a caring man find the cure for cancer and keep it hidden from those with cancer?  Can a man with a bucket of cool water not offer a glass to one thirsty?

 

We formally saw about 350 people during the week and we were able to help most in some way, while others presented so late in their illnesses, because of no access to decent care, that their care was more palliative.  There were those with cancer, TB, Leprosy, heart disease, severe and incurable (in Angola) arthritis, blindness, crazy chronic high blood pressures (which will kill in time), deformed limbs, childhood deafness from chronic ear infections, and birth defects curable anywhere else… And we saw such a small percentage of those in these remote towns suffering from debilitating, chronic illnesses.  We were told that many didn’t seek a consultation because of inability to buy the medications from us (average of $3/person at cost), yet there were still too many.  We celebrate those few we could help and mourn those we could not.

 

We met with the leaders of these communities prior to leaving each location and asked them for suggestions as to how we could better serve them.  They all voiced the same desire for us to work more days and more frequently, as they are simply unable to meet especially the more complex health care needs.  Because of this, we will extend to two weeks our trips to Cuando Cubango (the southeast) in 2019.  This will enable us to work three days in Mavinga and Rivungo and two days each in Licua and Nancova.  The challenge, of course, is that more time on these trips means longer lines in Cavango upon our return…  We landed in Nancova on our way out of Cuando Cubango and we were met by about 20 community leaders who were thrilled that we were to include them next year on our trips (at the recommendation of the provincial authorities). They were humble and grateful to work with us to help those many with illnesses they currently cannot treat. The area was minimally inhabited and quite beautiful, located in some hills overlooking the Kuito River, and about 7-9hr in several directions from a larger city.

 

More time…  So many needs…  Our humble service is a pitiful drop in the bucket. Angola is rich in lack of basic nutrition, medical care, instruction and training. The US, for example has 28 times the number of physicians per 10,000 people than does Angola. How can this poor distribution of human resources be tolerated in a country (the US) where most would say they believe in “Doing unto others…” even as we ignore the cries and suffering of moms, dads, brothers and sisters just like us?  How many US physicians attend a church that claims to follow One who said He “didn’t have a place to lay His head”… because He had too much caring to do!  How can a doctor not go where there is severe need for his/her knowledge and ability?

 

In the US, we claim to have compassion for those suffering…  We demonstrate and shout about poor distribution of resources, yet church-goers give away an average of 3% of our income (same as the non-church-goers) and about one in four of us gives time as a volunteer to needs that we consider significant.  The one in four that volunteers, averages about 50hr/year in volunteer work – an hour/week.  There is a political movement gaining ground in the US calling for better distribution of resources to the poor.  I wonder how many espousing this philosophy are sacrificing their own resources and comfort to directly address the pain and lack instead of organizing campaigns to send others and others’ resources to address the problem?  We shout platitudes, beliefs, and opinions on social media and among our like-minded friends instead of living what we say we believe…  The American Dream has become an unashamed pursuit of personal happiness rather than the pursuit of what is good…

 

We build huge, beautiful government and church buildings, our sports stadiums, restaurants, theaters and golf courses are full, we vacation in peaceful beauty, we play with/on the latest technology, we eat better foods and know more information about our world than anyone in history… We pray/hope that our governments and churches will send more people and resources to help those with needs… We live in comfort never dreamed by those before us…

 

while millions lack water, food, medical care and knowledge of our Father’s affection for them.

 

I believe that I will one day be comforted, because Jesus said so.  This past week, however, I have returned to a familiar place… of mourning… for the hungry, the suffering and the neglected who I embrace every day… and for the greed, love of pleasure and comfort, and lack of a neighbor’s love… within Jesus’ church…