I’m writing from Jamba Luiana, in the SE corner of the country and a town of about 10,000 people with the closest hospital and physician 6hr away in Namibia to the south. My reception here was memorable. I just wrote my last post a couple days ago from Rivungo, but it’s 4a, dark and still and I thought I would record my ongoing thoughts during this trip. Rivungo was quite a trial. It was so hot (mid-nineties in the consultation room) and the people were in a widespread state of starvation. It was difficult to witness such hardship and see the dignity and courage with which these folks face such adversity. I never thought I could see rural Angolans thinner, but all of their clothes hang off of them and they look like pictures I’ve seen from concentration camps.
On my last day there, the vice administrator (vice mayor) came and shared with me that two kids under the age of five had arrived the previous day from an outlying village, flaccid and minimally responsive. They provided them with water and corn, which was flown in by Marijn/MAF from several churches in Menongue. Within 4hr, both kids were standing and walking. They had almost literally starved to death, having no other illness. I see the effects of malnutrition and illnesses that result from the vulnerability that it creates, but I have never seen anyone actually die of starvation. MAF is offering to transport food raised by Angolan churches in other parts of the country and many lives are being saved because of these efforts. Because it currently seems to be a normal rainy season, the famine and starvation will likely end in December, when the first corn plants of this year will be harvested. Rivungo has quite a corn crop which they wisely planted in the huge Cuando river bed a couple months ago, which is usually river and swamp (and nothing can be grown), but this year the fertile, damp land is producing beautiful and fast-growing corn.
Marijn and I arrived in Jamba in the MAF Caravan at 2p from Rivungo. We left Rivungo late because everyone left the hospital at lunch time, even though they knew I was leaving at noon and needed to pick up my nine boxes of meds to take with me. Everyone has phones, but no one has airtime, so one guy on a motor bike and the guy driving the car taking us to the airstrip both left to find the person with the key, without success. Eventually, after I removed the door knob and was still unable to gain entrance, a man entered through a broken window in the back (photo) and we removed all the 50lb boxes through that broken window. Marijn had flown for four hours with a plane full of corn (1000lb) and was waiting at the airstrip. We added my additional 500lb to the food and left for Jamba.
We arrived in Jamba to a pickup bed full of about 25 people to return with Marijn to Menongue. Marijn had spoken on the phone with the pastor and told him he had eight empty seats. This is why everything is broken in rural Angola. Every rare piece of modern equipment is pushed beyond its limit. If this transport was in a car that could hold eight people, they would have fit 25, so this was their mentality. In this highly relational culture, “There is always room for one more.” Marijn took eight and my boxes and luggage were transported 20km to the town in the back of a pickup with me and those who were unable to travel with Marijn. It was tight and hot. When I arrived, I was dropped off at a guest house (a double trailer) next to the hospital (another double trailer) (photo). About 30 village people were there to greet me and we sat together and I explained who I was, the purpose of our visit, and the vision for our work. During this meeting, it poured rain for an hour, the first measurable rainfall in almost two years. This is one of the hardest hit areas from the drought and famine and the people interrupted me and several remarked that I had brought the rain. It was their only explanation as, after two years of waiting and praying, rain arrived with this visiting doctor. I jokingly said that it was Marijn and the plane, who stirred up the clouds and caused them to “leak”. The hospital director said that they had spoken often of our previous visits (I came here regularly in the past, but haven’t returned for about 18 months) and they had prayed and hoped for my return and “today our prayers were answered”. He said, to much laughter, that both answers together were almost more than they could bear.
I hadn’t returned to this area because I had some very unpleasant experiences here in the past, with lack of cooperation from the leadership and an uncaring, lazy and arrogant hospital staff. This was to be a “last chance” visit because, as bad as the working relationships have been, I’ve learned to not let poor leadership ruin health care and Kingdom opportunities for the people they lead. This meeting was revealing a completely different attitude under all new leadership. The hospital director is a beautiful man, who said that he had heard about so many positive outcomes from our past work, he completely embraces my vision and he continually expressed gratitude for our return to their village. Humility and gratitude are such beautiful characteristics in a human being and so often found in Jesus people and so often lacking outside my Father’s Kingdom. Love covers a multitude of sins, according to Jesus-follower, Peter, who deeply experienced both the pain of a self-protecting, self-defensive focus and love’s beautiful redemption (1Pet 4). Their past “multitude of sins” were quickly forgotten…
I then went to meet with the administrator (mayor), following appropriate Angolan protocol for a visitor, and I encountered another beautiful man, about my age, who expressed the same humility and gratitude. As he shook my hand, smiling broadly, he said that, as Africans living in such harsh and dry conditions, they place great emphasis on the value of rain. He said that he believed it was no coincidence that the skies had opened with so much rain at my arrival and that he was so grateful that God sent me and the rain at the same time. He said that it was a clear indication to him, as a new leader, that my arrival was God-ordained and that he was honored by my much-needed presence. Those of you who read my posts will recognize that one of the reasons that Angola is in dire straits is that the leaders here typically do not have this attitude as they rather push help away while saying that everything is fine, when it is quite obvious otherwise. The administrator went on to say that he knows that I “left civilization” to serve them and, for that, he was very grateful. This is insight we also rarely see in this country, where our sacrifice isn’t appreciated/realized and we are viewed, rather, with suspicion of hidden motives and/or as “deep pockets” of which to take advantage.
It is now 24hr after I wrote the above, quite still and cool at 3a, and yesterday it rained all day. We saw 48 new patients and about a dozen previously seen patients. The hospital staff of eight people received well my training in registering the patients, taking vital signs and evaluating people desiring reading glasses, and they managed the flow well. They registered 90 people and left at least that number hoping to still be able to register for a consult. I have Sunday afternoon (today) and until 11a on Monday to see as many as I can. I told them that I normally see about 5 patients/hour and calculated 90 as my probable capability for the one full day and two half days. On Monday, Marijn will pick me up at noon and we will fly about two hours west to our next stop in Licua.
It is now Monday morning and yesterday was a blur. I saw 47 people after 1p after speaking at a small local church gathering and sharing about how Jesus (and Jesus-followers) responded to crisis. We looked at how Jesus responded to hunger in the desert (Mt 4). He was tempted to change His circumstances and relieve His hunger, but resisted and insisted that He would only follow His Father’s instructions, no matter what. I emphasized that Jesus was like no other man, and His followers must respond to crisis differently than the world. When hungry, the world cries out for food, and Jesus-people rather cry out to their Father, seeking His word and His instruction, to determine how they might respond. The world focuses on their pain and a Jesus-follower focuses on how their Father might turn darkness to light and how they might be His hands and feet in serving those hurt by the crisis. A non-Jesus-follower would ask God to turn a rock into bread (ask God to satisfy their desire/need), while a Jesus-follower would, even in his/her hunger/pain/grief, seek their Master’s word for them, in whatever circumstances they find themselves because, to a Jesus-person, there is no such thing as luck or coincidence. Every loss and every pain has eternal purpose, and we have the privilege of participating with our Father as He carries out His purposes. Trust in our Father’s purpose and wisdom, and yielding to His desires rather than ours, is our motivation (like Jesus in the garden). A Jesus-lover asks for his/her Father’s direction and does what He says, whether in crisis or in plenty. A Jesus-lover abandons pursuit of worldly success and comfort and lives out of an ongoing dialogue with their Father, centered on “Your will, not mine” and “He must increase and I must decrease.”
I encouraged this group that they could be completely set apart from the other people of their region by loving (prioritizing) and serving others within the crisis instead of complaining and begging God for a miracle to change their circumstances. Their Father knows they need rain without being told, and they can seek Him and His direction as to how they can be His hands and feet to bring water to the thirsty, food to the hungry, clothes to the naked and an embrace to the downtrodden. I reminded them from LK 22 who Jesus said is the greatest in His Kingdom – not those who perform miracles or preach great sermons or have positions of authority or success… In light of this Kingdom reality from Jesus, I shared that I’m concerned especially for the men in the Angolan church, who are all about holding leadership positions and who culturally receive service from women instead of serving them (you could have heard a pin hit the dirt floor). It was similar in Israel and Jesus specifically said that the one serving the meal (the woman) was greater than he who sits at the table and is served (Lk 22).
It’s 4:30a and the sun is up because it is summer and we are on the eastern edge of the time zone. There is a virtual parade of people walking by my trailer on their way to their fields (photos), ready to begin planting after the rains of Friday and Saturday. A woman has arrived to sweep my floors and another is filling up the water in my bathroom bucket (for a sponge bath). Work is done early here because of the heat.
Tuesday. I saw patients for a couple hours in the morning yesterday (about 20), including a man who has borne a dislocated shoulder for seven years. This is an injury I see rather often because no one here knows how to reduce it (put it back in place). They suffer a fall and lose virtually all use of the affected arm, seek help at health posts and receive Tylenol. Almost all I see are chronically dislocated and need surgery to relocate the head of the humerus back in its proper place, because over time it has scarred into its new position over the chest.
It’s pouring rain outside of the small hospital in Licua, my next stop for three days. Marijn flew me here yesterday (30min flight or 6-8hr drive). I arrived at the airstrip and was driven a half hour to the town, where we unloaded my nine boxes of meds with several additional boxes and sacks of meds that Betsy bought in Lubango and MAF brought to restock me. This is such a team effort, including every one of you who support our work. After organizing for the next day’s work I went to meet with the administrator, a beautiful, older woman (my age) who has lost children and raised a severely mentally deficient child (from malaria) to adulthood. It’s amazing to me how severe adversity can sometimes produce crazy beauty. Cristina was the administrator in Jamba Luiana (my previous stop) for years and where we became acquainted. It was good to see her and she loves our work and has seen its fruit over the years, first hand. Cristina said she announced our arrival over several days, so we will likely be full. I then came back to the hospital (trailer) and set up my tent, ate some tuna and crackers (perhaps the 6th or 7th time this trip) and laid down about 6p (this is why I awake at 2a, refreshed and ready to go). I’ve moved into my tent to type because I was being mauled by bugs attracted to the light on the computer. It appears that the rain has triggered a termite hatching and there are literally thousands now in the small building (they all arrived in about 15min through the open windows).
I’ve been outside of internet connection and cell service for almost a week and it feels almost lonely. I have contact with Marijn and Betsy via messages on a satellite tracker device that works slowly and with great delay. For example, I sent Betsy several messages last evening and will likely get her replies this morning. Weird in today’s world. I’ll be back in internet connection on Saturday when I return to Lubango. The trip has been quite a grind and I have four more days…
Wednesday. Yesterday was quite full and it rained stiffly most of the night. Today might not be as full, as the flow slowed toward the end of the day. I’m feeling pretty spent at this point and hope I can finish these last few days with a decent attitude. I’m told that one of the primary motives of the army’s “Boot Camp” experience is to continually push the participants beyond what they believe is their limit/capability. This twenty-day trip has felt that way with the crazy heat and the always-one-more, “last one” at the end of the day. I wondered if I could handle twenty days (I had been doing about ten) and I now know I can, but it sure hasn’t been pleasant. It reminds me of the night shifts I worked for years in the ED. Working at 3-4am is simply always unpleasant. You can diagnose and treat patients accurately, but you never feel good doing it. Working in the developing world is similar, in that there just isn’t much pleasure involved in seeing, day in and day out, people facing such difficulties with so few resources and remedies (I saw several more people yesterday in frank, starvation ketosis).
Thursday. I was hit with fever, chills and severe aches in the early morning yesterday (after writing the above paragraph) and the patients (thankfully) stopped coming at noon, so I thought I would take a “nap”. I hit my tent at 1p and woke up at 6p! Tylenol and ibuprofen help and malaria test was negative. I have no other symptoms and am at a loss for a diagnosis. I slept pretty well last night and this morning feel weak but with no fever. The perils of working with ill people all day! I became TB positive a couple years ago (and endured four months of treatment) and drove an HIV needle into my hand in Haiti in 1992 when we thought a needle stick carried more risk. At the time, HIV was a death sentence and there were some anxious moments of testing (all were negative) Such are the risks and the costs must be counted, but Kingdom Math is the motive, as the focus must remain on all who benefit. Today will likely be light in the morning and then Marijn will pick me up at noon and we will proceed to our last stop in Nancova, after a brief landing in Luengue to assess what we’ve been told are desperate needs.
Friday. Yesterday we wrapped up in Licua, where it rained without stopping for two straight days (after no rain for over a year) we and flew to Nancova, stopping on the way for an hour at the airstrip in Luengue. We met the administrator of Luengue, a woman in her 40s, who obviously cares for her people. While chatting on the airstrip (photo), she asked me to see her school director. He is a man about 50 and told of a feeling of sand in his eyes for 7-8 months and now cannot open his eye. He has trachoma, an infectious conjunctivitis, the same disease as in the woman written about previously in Rivungo. We treated him and he has a better likelihood of decent vision after recovery because it has “only” been 7-8 months. We will likely include Luengue in future visits.
We arrived to a nice reception in Nancova where there is a mature, caring administrator and a passionate hospital staff. We only have one day here and it will be full.
Sunday. Yesterday was not totally full and the hospital staff was a pleasure to work with and we were able to have an hour meeting in the afternoon to explore how we might best work together going forward. They are enthusiastic learners and care for their patients, but have little training and resources. I am now writing from Lubango, after my return with Marijn yesterday. It rained almost every day of this 20-day trip in a region that hadn’t experienced rain for almost two years. It was one of the most challenging 20 days of my life, and I’ll recap some thoughts in my next post, after a couple days of nothing!