Zé, Loss, Understanding, Grace, Sovereignty…


We were separated from one of our dearest friends this week and I know that many of you can relate to such a loss.  Zé (“Zay”) was an extremely sharp 46-year-old Jesus-lover who worked tirelessly and passionately at our clinic in Cavango over the past several years, doing whatever might be helpful to serve us and any/all arrivals.  He exemplified what Jesus encouraged in His followers – a child-like enthusiasm, gratitude, and humility and about everything, which impacted me greatly.  He was rewarded a couple years ago with the position of clinic “secretary” and Betsy taught him how to use a computer from scratch, his first lesson involving how to move the arrow on the screen with the mouse!  He learned slowly (but enthusiastically) and entered our clinic statistics into a laptop, showing up at our house almost every afternoon for data entry and his lesson with Betsy.


Zé began having severe headaches this year and we found him to have very high blood pressure, but we didn’t know when his hypertension had begun, as he had never previously sought a consultation or had his blood pressure measured.  We began medications, but nothing we threw at him reduced his pressure.  In typical Angolan fashion, he never complained and our follow up consultations were brief and inconsistent, with Zé always smiling and saying he was doing great. When conventional treatments failed to his lower his pressure, I did an ultrasound, curious about a possible secondary cause, never expecting to find both kidneys almost destroyed from inflammation.  There are many possible causes for this type of swelling, called hydronephrosis, including schistosomiasis (Bilharzia), a microscopic parasitic illness common in this part of Africa (fascinating life-cycle – click here), that can cause areas of chronic inflammation in the renal system which can block urine flow and cause such swelling.


We took him with us to Lubango to get a scope of his bladder with our colleagues at CEML to see directly if this might be the cause of Zé’s urinary obstruction. I was actually hoping that this was the cause, as it offered some hope of surgical correction as most causes of renal failure at his age offer no such hope.  Extensive bladder Bilharzia (schistosomiasis) was confirmed and, over the next couple of months, various nonsurgical remedies failed to resolve his pronounced renal failure.   Our surgical colleagues suggested performing a radical surgery to try to spare what kidney function remained, moving his ureters (tubes from kidneys to bladder) to a site in the bladder unaffected by the plaques of Bilharzia. I had a long, personal talk with Zé and he courageously and prayerfully consented, understanding that with, or without, surgery his pronounced renal failure indicated a likely terminal illness and that surgery was his only hope to diminish the kidney swelling, which could extend his life.  The delicate (and remarkable) surgery was successful as to the routing of urine into his bladder, but his kidney failure didn’t resolve (it worsened) and he developed a serious post-operative infection, along with a severe case of malaria during his recovery. Zé’s condition continued to deteriorate and in November his family asked if he could return to Cavango under my care.  After returning here, he failed every remedy, his infection never improved, he suffered greatly and he died this past weekend.


During this past month, Zé lived at the hospital, rarely leaving his bed, and there were days of minimal improvement which gave me hope and then he would worsen.  It was such a difficult month, watching my dear friend so suffer, with persistent vomiting, minimal ability to eat or drink, and unremitting pain.  Zé’s loss is a heavy one, and some days the weight is almost unbearable.  Those in the medical profession are familiar with the questions and doubting I face in hindsight re things I could have done differently (earlier ultrasound) to extend his life or reduce his suffering, but a little.  Zé’s passion, ever-present smile and encouragement are already dearly missed by everyone and I daily long for each as I arrive in the morning and proceed through my clinic work.  We made many long trips together and shared so many experiences over these past five years. Everything to him was worthy of a story, a laugh or a passionate discussion.  It hurts.


As his funeral came to a close in a drenching rain, Betsy and I were approached by an older woman (our age) who traveled from Luanda (two full days) to be there.  I recognized her as a Cavango clinic patient, but I didn’t know she was Zé’s distant relative.  She said she came all the way to Cavango every couple months to be treated in our clinic because she had found no one else to treat her condition (diabetes and heart failure) and she was enjoying good health for the first time in years. She spoke at length of her improvement and that of so many others she knows and gushed insightful gratitude for our care, our presence, our sacrifice and our excellent medical work.  She encouraged me to not feel badly about Zé’s death, that we did everything that could possibly be done to spare his life. Unknowingly or knowingly, she addressed exactly the pain I had been carrying this past month as I watched Zé deteriorate.  Her unexpected, grace-filled words were healing and some of the burden seemed to lift even as she spoke.  Zé’s father then approached, a man I’ve known since I’ve arrived, and with whom I’ve had some conflict because he wanted to work at the clinic and I didn’t hire him. He spoke at length of his appreciation for all we did and also emphasized that we should not carry sorrow re his death.  He also expressed gratitude for our presence here and that he was so grateful that it was us who cared for his beloved son.  Then his brother approached, a community teacher and a man I respect, and he verbalized the same. What balm for the sadness and heaviness!  These sensitive few so reflected their Father, as they expressed such healing honor and grace.  Father, please let me be a man of such sensitive grace to hurting people!


The local folks in Cavango, like many in the church today, want to believe that everything in a good God’s world should be pleasant and that all sickness, suffering and death are, therefore, caused by evil forces, oversimplifying the ways of our mysterious and holy God and His creation’s immense complexity into a readily understood, feel-good belief-system/philosophy/doctrine.  I cringe whenever I hear such oversimplification applied to a world filled with suffering and pain. The experiences of the One we follow, and the horrid circumstances confronted by His early followers (and so many since), are forgotten today as we “tickle our ears” and create a Jesus who would grant our wishes/desires, while losing sight of living Jesus’ primary emphasis on eternity.


God calls Himself “holy” and “I am that I am” indicating that He and His ways are completely unique, and that there is no adequate description that captures Him, beyond “I am”.  He is beyond even our imagination, yet we use our imaginations and understanding to characterize Him and His ways, and so miss the mark.


Grace and faith are Kingdom qualities for a reason, both highlighting our incomplete knowledge and our short-sighted perspective.  In unstudied arrogance, we describe with certainty God, the world and even ourselves, having an answer for every question.  We lack the humility to realize that questions re the same, and how our Father would have us live, have been pondered and discussed/argued since the first human words.  The first created man and woman, according to our remarkably preserved Jewish writings, doubted God’s character and wrestled with how to apply to their lives both His direct words and their perception of His will/desire/pleasure.  We see through thick glass dimly, and we always will…


The people here are much more spiritually minded that the naturalistic, materialistic (all that is real is matter) mindset in the west.  Even in the rural region of Cavango, where young deaths are so common, they are searching for an explanation, as the death of a loved one always provokes emotions and questions, if not curiosity, about the cause, purpose, etc.  Zé chose to tell no one close to him of his terminal illness, so there is much speculation (and blame) re his death and its “suddenness”.  Conversations have been passionate and framed in confusion and pain. We’ve had several hospital staff meetings (Zé’s closest friends) and today a meeting with the community leaders, where I’ve had the opportunity to address specific concerns and questions and share my perspective.  These have provided a great platform for me to passionately argue against the power accredited to evil and to speak (sometimes shout) about the comparative power of our incredible, eternal, and omnipotent Father, Jesus’ promises about Zé’s current home, and the relevance today of Jesus’ message re His eternal kingdom.


As Jesus faced death before Pilate, He stated that evil has no power beyond His Father’s rule and oversight, who causes no evil but has the beyond-our-imagination-ability to transform any evil deed into eternal good, the prime example Jesus’ brutal and innocent death, from which the entire human race eternally benefits.  Zé’s death, like all deaths, was a complex mixture of causes – parasites, urine blockage, Zé’s decisions, my decisions, God, and evil – and it’s brought into tangible focus for his friends and family (and for me) what is often a “theological” and theoretical discussion.  From palaces to shacks, death slaps the rich, poor, healthy and hurting with the reality of this life’s brevity and forces us to consider what we believe about eternity. We must embrace, aggressively at times, the Kingdom truths spoken by Jesus and not allow emotions, fear, and pain to steal the eternal hope for which He left His glorious throne to reveal.


Apart from any religion, I investigated Jesus and began to follow Him because he’s the only person recorded to live after death under His own power, making His crazy-radical words more significant than those of any other person. I have continued to follow Him because He has validated His presence, power and love so many times, often in unpleasant circumstances.  It seems clear to me from my study of Jesus, and what is recorded about what He believed, that God oversees and rules over every event in this world, but that He also universally allows sickness, suffering and death.  One who rules doesn’t control every person/event (like puppets), but always has the power to intervene in that which He rules. Perhaps what is unpleasant for us often has value to Him!  Other than Jesus, every single human being who has ever lived even a few years in our Father’s created world has experienced both sickness and death, and even He “learned obedience through His sufferings”.  Fire purifies gold, storm and drought force roots to grow deep, illness screams reminders of our mortality and death is the ordained doorway through which every one of us must pass to enter eternity.


My understanding ends there and I endeavor, sometimes with great effort, to live in trust of my Father’s character and that all He allows, including our suffering, has (good) purpose in light of eternity.  Humility is required to trust that which we don’t understand, while arrogance and pride won’t acknowledge our short-sidedness and limited perspective.  The people here understand nothing of science and explain everything spiritually, to their detriment.  In the west, we explain everything materially/scientifically and neglect the spiritual, to our detriment.  The profound mystery and complexity of life forces the wise to acknowledge both, and to maintain physical and spiritual realities in tension. Jesus confronted this tension directly with His emphasis on eternity, even as He directly and personally addressed earthly suffering.


Jesus spoke often of the reality of our minimal understanding and our need to follow Him, even referring to Himself as a shepherd and to us as sheep.  This was not a compliment!  He spoke of our deep need to follow Him rather than to pursue understanding, and to believe and trust Him rather than to exhaust ourselves trying to independently set right (and understand) the world and our circumstances.  He encouraged us to abandonthe pursuit of a “good life” and spoke of seeking Him above all, indicating repeatedly that our care would/could be His responsibility and that He would lead us to our eternal “best”, though emphasizing that “best” for His followers wouldn’t necessarily be pleasant.


My love for these people grows all the time, as likely does yours for the people you serve.  My hate for the illnesses that violate and steal from them grows, as well. Though mortality is still universally 100%, a doctor in modern cultures can always help in some manner, with a cure or with palliative care, but that ability is greatly limited here with our scarce resources (we hope to have electricity next year, which will provide ability for lab and x-ray).  Even today I shared with two beautiful, young people that they had illnesses that they wouldn’t survive for even a few months (though they would receive curative treatment in the US).  Zé’s circumstances are in no way unique in Angola.


We (I) can become distracted and frustrated by all of the confusion and pain around us, especially here, where there is so much lack, because of 30+ years of civil war. Yet I’m reminded today of the value of fire and storms and our inability to understand… and my need to trust the One in control…


I’m also more keenly aware during this painful season that I must continually and intentionally shift my efforts and focus from the forest (our world/culture at large) to the individual trees (Zé) before us.  We are called to serve, love, encourage, and embrace the “trees” around us, leaving the care of the forest (and understanding of fires and storms) to Him.  


Jesus didn’t call His followers to change or understand the world, but He did encourage His followers – to seek out and serve the wounded, to fish for, and free, those captive to the philosophies of men, to be light in the darkness, to lead other sheep to the Shepherd…


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