Living in Cavango has opened my eyes to how life has been lived for most of history, including when Jesus walked on water, fabricated tables from trees, fermented wine, calmed storms, angered the powerful and physically touched so many seekers in the Middle East. As it was then, in Cavango there are no books, newspapers, television, internet, or world-wide communication, along with no electricity, plumbing, toilet paper, tooth brushes, etc. These rural folks have no idea of the crazy global development they have missed during their 30+ years of civil war. Lack of knowledge is ubiquitous and hunger to learn is also lacking, as they have little realization of all the ways that knowledge could benefit their health and lives.

I spoke this morning to our patients and their families about the value of knowledge and that they had so much to learn from the rest of the world and that the rest of the world had much to learn from them, such as how they survive, with contentment, in such harsh conditions. I shared with them that nowhere else in their country, and few places in the world, are daily “classes” open and freely available for the purpose of improving physical and spiritual health. I encouraged them to take the knowledge gained in Cavango during their hospital stay back to their communities and share with their friends and families what they learned…

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Betsy has been quite busy most days making masks for the people in Cavango, organizing construction of an apartment for our future home (we’ve had bricks, blocks, cement, rebar, steel roofing sheets, gypsum board, steel supports, gravel, sand, etc delivered this week in four trucks willing to tackle the mud and slop of the last 30km of a 5-6hr drive from a “nearby” city and the work will begin in earnest this week), packing up and preparing to move out of our house, transporting surgical patients an hour on dirt to the airstrip (our ambulance is down and driver suspended), and driving a pickup full of men who are loading and unloading rocks, adobe bricks, and sand for our hospital construction. She is faithful in embracing supporting roles without esteem and attention (like linemen on a football team) that will benefit many who will never recognize her efforts. Those of you who support our work here are similar, in that your impact is tremendous, but your sacrifices and efforts will remain unknown to those who benefit.

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Taking credit for healing an ill person is like a field-goal kicker taking credit for a victory after a successful final kick in a 43-41 game. So many factors were involved in the result of the three-hour-long game, only one of which was the final kick, which lasted a few seconds. Grieving a death hurts, but shouldering the blame is like seeing yourself responsible for the loss of the same game by missing the last kick. In Cavango, we have “saves” and losses, and I’m reminded often of the small and minimally significant role we play in each person’s life, but we are a part of a large and beautiful team of (unseen) people, “playing” their positions (here and from the other side of the world) and, in each case, we wrestle against many antagonistic “opponents” of good health. Malnutrition, disease and lack of resources, knowledge and access are formidable opponents and are difficult to overcome, but we consistently see the most amazing outcomes, along with our share of painful “defeats”.

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I saw thirty inpatients Monday morning and, without exception, all were improving. What a joy that I wish each of you who support our work could see and experience. Every day…

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A 8y/o child arrived in a near coma, minimally responsive with severe difficulty breathing. His inner eyelids and nails were white and we measured his hemoglobin as 2.1 (normal 12-13)! We transfused into him a unit of matching blood from his father the hard way. Because his IV line wouldn’t flow properly (after attempts in several veins), we had to draw 10ml from the blood bag and push it over several minutes into his IV catheter fifty times over four hours (normally it drips in from the bag quite easily). His hemoglobin the next day was 6.8! He was walking, eating, and ready to go home, accepting a sucker with a grin as he headed for the door. He tested negative for Sickle Cell Anemia (we’ve had two kids with this incurable death sentence in the past month) and the cause of his profound anemia remains unknown, though it was likely malaria, as his family said he’d had a fever for several days a week prior to his arrival. The Wind…

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I never thought I would spend so much time and effort diagnosing and treating Tuberculosis (TB). We see 1-2 new TB patients/day and treating these people is quite a pleasure, as they stay with us for their first two months of treatment and almost all improve dramatically during that time. We also get to share about Jesus with them every day and demonstrate His, and our, love for them. The results of seeking our Father’s touch on their behalf, combined with our evidence-based medications and care (mud and spit) almost always yield successful results in people who would have otherwise likely suffered early deaths.

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Artur (photo) is an example, as he arrived in Cavango acutely ill and unable to breathe (because of cost and distance, they never come until their symptoms are severe). Via physical and ultrasound exams, we were able to identify large pockets of fluid around his heart, restricting filling, and in both chest cavities, collapsing both lungs, secondary to TB. He endured painful draining of the fluid from all three spaces with large-bore needles over what was, for him, a couple of anxious hours. He has, however, progressed wonderfully over the past month and will recover completely.

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We still treat a fair amount of leprosy, with six active cases (down from fourteen a couple years ago) currently receiving life/limb-saving treatment over the course of a year. They arrive in various stages of deformity, which are permanent, though we can kill the cause and prevent further damage. We get to know them quite well, too, and have many opportunities to introduce them to Jesus and demonstrate to them His incredible and never-ending affection for them.

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We have seen so much Typhoid Fever in the last several months. The two children from the same family in the photo arrived with severe abdominal pain and vomiting, but responded to antibiotics over the course of a week, which involved daily exams to see if their intestinal wounds had perforated, necessitating surgery. Our most common emergent transport to Lubango for surgery involves these intestinal wounds from typhoid, which can perforate the intestinal wall, spilling stool into the sterile abdominal cavity and causing overwhelming and life-threatening inflammation. We’ve flown several this month, via MAF, to Lubango to undergo emergent surgery and we’ve seen perhaps a dozen who, like these two, arrived quite ill, but we were able to treat them with antibiotics and avoid perforation.

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Two beautiful children died in the last couple days. One fat and healthy six-month-old arrived because he had lost interest in nursing over 24hr and had a fever. I told the baby’s mom how perceptive she was and that this lost interest in nursing was considered a “mental status change” and warranted concern for meningitis. We immediately began aggressive treatment but, the following day, the child became comatose, completely unresponsive and began having unremitting seizures. Over a couple days, he showed no improvement and died. We had prayed and hoped with his mom for his recovery, and embraced her as she wept and grieved her loss, after she had done everything right… The Wind?

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The other death this week was an adorable 6y/o girl who arrived with severe malaria and appeared to be improving when I saw her on the morning of her death and she gladly grabbed my offered sucker . Her fever had dissipated and she was tolerating liquids without vomiting for the first time in three days. We switched her to oral meds and told her mom that we would see her the following morning, as it looked like she was out of the woods. Her mom then brought her to us in the afternoon when she became radically short of breath. She was breathing over 100x/minute, her oxygen level was 83% and my stethoscope revealed severe inflammation in her right lung. She soon became unresponsive as we began an IV line and I went to set up the oxygen concentrator, 110/220 transducer and generator. Malaria kills, but it also severely weakens the body, making it susceptible to secondary infections such as, in this case, pneumonia.

All was set, but our little portable generator wouldn’t start. Our backup generator had broken the previous week and, after hours spent taking it apart and seeking a fix, it remained dead. While perhaps a dozen patients waited to be seen in the late afternoon (having waited all day), I hurriedly took this generator apart and deduced that it was the sparkplug and went home to get a replacement, while one of our workers used some sand paper on the current plug. All I had at home was a used plug that I had cleaned. Neither worked. Soaked in sweat, after a frustrating hour of pulling the start cord so many times, I entered the clinic to check on the child and was told by one of our nurses that the child had just died. We get close to these families and patients in their time of need, imagine ourselves in their position, do everything we can to help… these young deaths are difficult and way too common here. We had gotten to know this little girl and her mom over three days of treating her severe malaria and hurt for her as she wept unconsolably. A spark plug… The Wind? If we acknowledge “the Wind” and His intervention in our successes, we must also acknowledge His purposes in our losses, but it doesn’t get any easier…

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As I was leaving yesterday, several deathly sick kids with very anxious families arrived, all traveling for hours to seek help. Jacinto is a toddler in a coma from cerebral malaria, who needed an intraosseous needle to establish IV access. Maria is six (photo) and has an intestinal perforation from typhoid (we drained a large amount of stool contents and air from her abdomen, which had leaked out of her intestines and into her abdominal cavity) and she will fly in the morning with MAF for urgent and, hopefully life-saving, surgery, while Domingas (photo) arrived with disseminated tetanus, with full-body rigidity but her mouth open and able to swallow a bit of sugar from a sucker, held by her grandmother. She will be hydrated with IV fluids, given muscle relaxants and pain medication and hopefully her respiratory muscles won’t lock up (the main cause of death for this hideous illness). This morning, Jacinto was awake, drinking liquids and nibbling on food, and he smiled and accepted a sucker from someone, Domingas was swallowing liquids, and Maria and her family left with Betsy for the rocky and sloppy ride to the airstrip. The Wind knows, is in control, and will move where He will… as He has… with love for these isolated people, in placing us here, on the wings of so many of you, who support our work.

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We previously shared with you about the costs that many patients and their families face in transportation and care when they arrive at our hospital needing urgent, life-saving surgery that we cannot provide. A couple months ago, we were unexpectedly informed by our partner mission surgical hospital, CEML, that we owed them nearly $60,000 for surgeries performed, and lives saved, from 2017-2019 (their billing staff is behind in their accounts), and our projected costs for 2020 and 2021 are $30,000 each year. This covers between 60-100 surgeries, annually.

So many of you have sacrificially responded with concern and a desire to help and, as of today, you have contributed $27,700 in the past two months to our “rural health” project account at SIM, specifically to help cover these costs. Others have contributed to our general ministry fund over the same time period, no doubt to help the same. A dear friend from Ohio, passionately concerned for these desperate needs, has contributed $30,000 to cover the costs for 2020 and has pledged another $30,000 for 2021. Our beautiful home church, VCDC, in Sunbury, Ohio, is also raising money this week to specifically help with these urgent surgical needs. Without these funds to cover the costs for surgery, historically about eight of ten would accept their “fate” and die in our hospital or at home, never knowing that a remedy was available (about 2/10 statistically would survive without surgery). One or two of ten cover their own costs, which we always encourage, prefer and seek, prior to offering to cover their expenses, which average about $500US per surgery. All of the patients contribute what little they can, as we ask from them a commitment to reimburse us after their care, whatever they are able. We typically see about 10% reimbursed.

With the excellent and available surgical care at CEML and MAF faithfully providing air transport, along with these contributions, so many people survive otherwise fatal illnesses and generations are impacted because all of these survivors will have further opportunities to meet Jesus and most will go on to have families. We are a small part of a crazy beautiful team of caring partners and this response of Jesus’ body, from the other side of the world, has been beautiful and humbling to behold! We are deeply honored by your trust and, on the behalf of these desperately needy, rural people, thank you!

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In these confusing times, we hope for you a renewing, restful and peace-filled Thanksgiving and Christmas season as you express your gratitude to the One who came to demonstrate, in so many ways, our crazy value in the eyes of our Father. We will be leaving Cavango in a week and traveling to the states for a month of dedicated time with our family. It will take us ten days to arrive in the US, with a 10-12 hour sloppy, rainy-season drive to Lubango, four days there for testing and meetings, then a 14 hour road trip to Luanda (no domestic flights because of CV19), where we will wait for three days for another CV19 test, prior to boarding our plane in Luanda, on to Ethiopia, then to Chicago, where our son Luke will pick us up and drive us to Toledo. I try to make decisions giving proper consideration to risks, costs and benefits. There are risks, costs and benefits involved in travel, CV19, our absence in Cavango, etc, and there are risks, costs and benefits in staying. In weighing them for this December… we are so looking forward to seeing our kids! Face Time, Skype, email and Zoom are nice to have, but nothing like real conversation and connecting.

We hope to make a trip to Sunbury, as well, to connect with our church family, many of whom are part of our beautiful “team” of supporters, who enable us to be in Angola to share the Good News of Jesus’ affection with the rural people here, and to “kick a few field goals”…