Last year, Betsy bought some simple wind chimes for my birthday.  They chime beautifully nonstop during this breezy, Spring season in Cavango and they are observed, studied and admired several times a day (sometimes at length) by everyone who visits our house, as no one here has ever seen or heard anything like wind chimes.

 

We just said good-bye to two lovely Angolan couples from Lubango, who stayed with us a couple days and come here quarterly to give nursing instruction to our staff. They are a delight to have with us. They are excellent leaders of “Obra Medica”, the health care wing of the denomination, UIEA, owner of our Cavango Mission.

 

We also enjoyed a visit from Donna and Stirling Foster, who have been missionaries in Angola for thirty years and run a UIEA mission ranch in the desert-southern part of the country where we visit monthly as one of our MAF clinics.  We sat by a fire near the river one evening and saw a crocodile cross the river and, judging by the size of the head, it was at least two meters in length.  The croc was also in a part of the river where we never see them and right where many people cross in a canoe to come to our clinic.

 

We also enjoyed the company of a student from Toronto, Jesse Maretzki, for a week.  He enjoyed the beautiful landscape, hiked many miles, and did some fishing in “our” Cubango river.  Jesse was able to see a few unique medical cases and especially these next few come to mind.

 

Fernanda is sixty and presented to us in little discomfort, but with her right hand burned black and hardened to the bones and her left hand with a few second-degree burns (Photo).  The rest of her was body completely spared.  These folks sleep in one-room, grass-roofed, stick-and-clay-walled houses, usually with a fire in the center of the room for a little warmth.  The smoke from the fire rises through the grass roof.  One of my favorite sights is a village at dawn, with smoke permeating the grass roofs through the beams of light as the sun crests the horizon. The colder the evening, the nearer to the fire they sleep. Apparently, this woman’s hands somehow caught fire and her right hand burnt so long that it became painless and kept burning.  Her left hand was only burned on the top surface and might have been from the blanket catching fire.  We contacted our wonderful colleagues at CEML and they agreed that she could wait for the next MAF flight for a forearm amputation.  Not only was this the most remarkable burn I had ever seen on someone alive, but the story became quite strange when, the morning after arrival, Fernanda and her family completely denied that burning had anything to do with the wounds and they said that she went to sleep fine (without a fire) and woke up with her hand like that, unrelated to any burn.  I have no idea what prompted them to change their story from the obvious to the impossible-to-believe, but they stuck to the second explanation until her transport to CEML several days later.

 

Cristina is twenty and arrived from a city 3hr away by motorbike barely able to move her right leg, describing pain from her buttocks down her leg to her foot since receiving an injection at a city “health post” several weeks ago.  They related the pain to an injection, but her vertebral spine was tender to tapping, indicating likely spinal TB with inflammation in the area affecting her right sciatic nerve.  We began TB medication and ani-inflammatory medication and, after a week, she has only minimally improved, still walking with her ”cane”, a stick to take some stress off of her right leg (photo).  She may or may not improve, depending on the nerve damage, but it’s truly up to our Father and we will know more in the next month of her eight months of TB treatment.

 

Madelena arrived at two years old and had been sick for a month.  Her nostrils flared with each grunting breath, her respiratory rate was almost 100/min, the skin between her ribs was sucked in with each inspiration (all important signs to observe for respiratory distress) and she looked quite tired, like she might not last much longer, which is why her parents finally drove her six hours by motorbike to our little hospital.  Via stethoscope, her right chest lung sounds were diminished and ultrasound confirmed that the reason for this and her distress was a right chest cavity full of fluid, outside of her collapsed lung. Because of the duration of the illness, I suspected the fluid might be pus, so I inserted a large bore needle between her ribs and into the pocket of fluid observed by ultrasound.  More than 300ml of frank, thick pus (color of dark butter and thickness of melted ice cream) was aspirated (Photo) from her little chest cavity and the child began coughing as her lung expanded and her respiratory rate decreased.  She gradually improved over the next few days, without fever, and she began eating and nursing and returning to health.  At this writing, she will likely return home in the next couple days.

 

Domingas lay on the examining table after several days of fever with her markedly pregnant abdomen protruding upward.  She was nine months pregnant and had begun to have mild, intermittent labor pain along with severe fever over several days.  It was her 7^thpregnancy and she knew the score.  By the remarkable size of her abdomen, it was clearly a multiple-pregnancy that she had bourn well to full term.  We turned on the ultrasound wondering only how many babies we would see.  We found two healthy boys, both active and large, but each with his head high in her abdomen.  It would be two breech deliveries.  We recommended that she remain at the hospital because it could be a challenging delivery.  It was. The next day, her labor pain became severe and her cervix began dilating.  When she was completely dilated, I ruptured her membranes (“broke her water”), and immediately the cord delivered.  This is not ideal because as the body or head passes the bony pelvis, it can compress the protruding cord and cut off the baby’s blood supply.  If the head or body require several minutes to pass through the mother’s pelvis, the lack of blood flow to the baby can result in its hasty death, though a protruding cord is more common in breech deliveries.  I was able to replace the cord above her pelvis and a moment later a foot greeted me outside of the vagina.  I reached in and found the other foot and encouraged them both outward and the body and head delivered rather easily after some manipulating and rotational maneuvers.  The little boy was a chunk and I felt grateful that it hadn’t been more difficult to get him out.  He cried within a minute and appeared healthy.  The challenges were to come.

 

The second twin also required manual rupture of the membranes and Pitocin to stimulate labor, which had stopped and, after two hours of further labor, the baby’s buttocks presented at the vaginal opening and the battle began.  He was rotated opposite of ideal, so I rotated him and wrestled for several minutes with various learned techniques, to get both his shoulders and head out.  He was larger than the first (!) but cried immediately and also appeared healthy. Then the placenta came out easily and mom’s severe hemorrhaging began.  Against much resistance, screaming and squirming (it is quite painful, especially after a long labor), I roughly massaged her soft uterus, which was refusing to clamp down and firm up, necessary to stop the bleeding.  We added more oxytocin and her tired and overly stretched uterus finally responded after about five minutes and much blood loss.  Our nurse, Rodé, turned to me and said “Three miracles at once!” She emphasized that these were three certain deaths in the village, where most deliveries still occur in this remote setting. Most breech births with any delay result in baby death and hemorrhaging is only observed until death, because they don’t know how to respond.  When we weighed the twins, one was just below 4kg and the other just above!  In this rural setting of undernutrition and thin moms, 4kg is heavy for a single gestation…  Mom and babies recovered well and went home after five days of malaria therapy for the babies because it was malaria that caused Domingas’ fever and prompted her trip to the hospital, subsequently saving three lives.  It’s the first time I’ve ever been grateful for malaria and/or mosquitoes!

 

Celestina is 14-years-old and her father began noticing swelling in her feet and her belly about a month before arrival in Cavango.  She arrived after walking for almost two days with her caring father, sometimes carried, sometimes walking slowly.  On arrival, she had edema everywhere, her abdomen was huge and her eyes were swollen shut.  She couldn’t remember any prior illnesses, she had no other symptoms, and her father denied visiting the traditionalist.  As you know, we see many people with liver toxicity from visiting the traditionalist or “jungle doctor”.  On exam and ultrasound, her heart and liver were fine and her kidneys were inflamed and she had large amounts of protein in her urine.   She has nephrotic syndrome, likely from a serious case of post-streptococcal glomerulonephritis, essentially kidney damage after untreated strep throat.  Strep throat is virtually never treated in the rural areas here and a majority get better with no untoward effects.  A minority, however, perhaps 5% go on to more severe forms of the disease, involving the heart, joints and/or kidneys.  She has been with us for over a week, with little improvement and yesterday, we removed about 4L of liquid from her distended abdomen (Photo), which helped improve her ability to breathe.  Many of these cases do recover over time with large doses of anti-inflammatory medication and we hope to see her turn around this week.

 

Ana is 14-years-old and arrived on a weekend in a nice pickup truck with her anxious parents.  They had driven from Huambo, a major city to our north, perhaps 5hr in the significant morning rain.  She had been fainting for the past year, unexpectedly each time, always upon arising, and felt completely fine otherwise.  Her caring parents had taken her to several hospitals and they had run many tests and had no answers.  We don’t have much in Cavango, but we have simple ultrasound (our better machine is in the US getting repaired).  With some simple maneuvers and with only one view of the heart, the reason for this girl’s fainting became clear, as the walls of her left ventricle were perhaps twice their normal thickness.  She had Hypertrophic Cardiomyopathy, likely since birth, and commonly found at autopsy after the sudden death of a young athlete. We gave her some meds which likely will help diminish her relatively minor symptomatology, advised wisdom when arising to a standing position, and drew some pictures so that this bright family could understand was happening.  I explained that Ana’s heart chamber wasn’t filling with the volume necessary to accommodate the increased pressure to the head needed with a quick position change against gravity.  I think they understood.  I also advised regular follow up to make sure that the disease wasn’t progressing, though there is nothing more available in Angola than conservative, medical therapy. In many cases, this is sufficient and helpful.  Ana’s mother said she was going to drive home and fetch her 72-year-old mother who has severe congestive heart failure and was out of meds.  She returned two days later with her mom struggling to breathe, and she recovered nicely to medication.  She was encouraged again to never let her meds run out!  Sometimes it takes all of us several times to learn a valuable lesson!

 

Please pray for our upcoming trip to the southeast province of Cuando Cubango, where they are experiencing severe drought and hunger.  It will be my longest yet and will be a challenge.  Please ask our Father to use us as his hands and mouth, that eyes and ears may be opened to see and hear Him…

 

In the below link video, Francis Chan’s analogy re fishermen is perfect and his reasoning is the same that motivated us to leave our lives in the US fifteen years ago. The above people and so many others have benefited from our presence here (and the prayerful and financial support of every person partnering with us), simply because it made no sense to continue to fish where there were plenty of fishermen and a paucity of hungry fish, while the world is full of other lakes full of hungry fish…

 

If you haven’t seen it already, Chan’s following message is worth watching for 30min as he describes his motivation to leave the US to serve those in impoverished Asia who haven’t heard the Good News.

https://www.youtube.com/watch?v=bnxdk9SZUqw