I have thoroughly enjoyed the presence of the DeSouza family (photo) and their five kids this past month, as they have brought life to these old and tired bones and renewed my desire to continue learning and serving.  The kids never fail to bring a smile to my heart several times/day and the passion of both Eduardo and Jocelyn to serve has been a great encouragement.  Eduardo’s humble thirst to learn has been refreshing, his sense of wonder and amazement re the work in rural Cavango has inspired the whole team, and his fresh eyes are enlightening us as to how we might improve our service.  

Betsy and I are thrilled for our daughter, Ellie, and her husband, David, on the birth of their healthy daughter, Eden Willow Steltz on the 10th. Ellie and Eden are recuperating well and David is feeling no pain. Betsy is quite enjoying being close to all three for a season. We are grateful for this crazy miracle of our Father’s creation and so pleased to be related to this new family…

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It’s been quite a stretch since my return to Cavango after Christmas in the US, as the volume has been stiff but, remarkably, we have seen only one death, that of a ten-year-old girl who arrived with severe heart failure that was beyond treatment. Following are a few of the people we’ve seen…

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Several children under two have arrived in respiratory distress from supraglottitis (photo), an inflammation of the upper airway above the larynx.  Though this illness is quite anxiety-provoking, and the cause of many childhood deaths in globally underserved areas (we’ve lost several over the years), these all responded to treatment and went home well after improving over a few days.  

We also treated a three-week-old boy (photo) whose nasal passages were completely obstructed since birth and he struggled for every breath, as newborns must learn to breathe through their mouths as that “skill” doesn’t begin naturally at birth. We lost a baby girl to the same a few months ago. This little guy’s parents said his condition radically worsened in the two days prior to arrival, he had an oxygen level of 83% and only inhaled when he cried and breathed through his mouth. He was exhausted from this battle of several days and we prayed and tried to find the obstruction to no avail (it was quite posterior) and he had few secretions so suction didn’t help. Our only hope was that the obstruction was inflammatory in nature and might respond to medication, though I seriously considered putting an airway into his neck, having little experience in doing this on a child so young. We also considered using small dilators to traumatically and forcefully open his posterior nasal passages, which I had never done. He survived the first night on oxygen and seemed to improve a bit the second day of antibiotics, oxygen and strong anti-inflammatory medication, though he remained in severe distress and still was not nursing because he couldn’t breathe while doing so. The third day he was breathing a small bit through his nose and nursing a few drops at a time (this gave us some hope). We arrived on the fourth day and went straight to his room and found him sleeping peacefully with his mouth closed and breathing without difficulty! He had begun nursing hungrily during the night and was quite a beautiful sight to behold. He has recovered completely…

Otherwise quite healthy, thirty-ish Manuel (photo) arrived with back and bladder pain and couldn’t urinate. We prayed and put a catheter in to relieve his bladder distention and he felt better, but the next day we found him using a wheelchair, completely paralyzed from the waist down! We suspected a Spinal TB or TB Meningitis cause and began TB treatment, along with some powerful medication to diminish inflammation. It took a couple days, but we were thrilled when we arrived one day and showed us that he could move a toe or two. Over the next several days, he began moving his feet and legs. Over the course of another week, he was standing and he is now walking with a single crutch. Crazy cool Wind…

We’ve seen five cases of frank peritonitis resolve without surgery, including a stoic little eight-year-old boy (photo), and several have demonstrated, via ultrasound, obvious free fluid in their abdomens, resulting from an intestinal perforation. We’ve also had a few critically ill, with the same diagnosis, that would not have survived had we not been able to send them to our colleagues at CEML via MAF for life-saving surgery – made possible by your life-saving contributions in recent months..

A young woman had given birth without incident in her home several weeks prior to arrival, and presented with severe fever, mastitis and peritonitis. She also had fluid in her abdomen, which we drained and discovered frank pus. Essentially her whole abdomen had become an abscess. We questioned her and her husband as to the progression of the illness and it didn’t fit an intestinal perforation from typhoid, so we asked if, perhaps, they had visited a shaman in the week or two following the birth. They confessed that they had and we determined that she’d likely developed the commonly seen liver inflammation (toxic hepatitis) from the shaman’s costly, all-natural “treatment”, causing the accumulation of fluid in her abdomen, which then became infected. She tolerated the draining of 1-2 liters of pus from her abdomen several times, yet one night awoke to pus leaking out of her umbilicus! We drained and flushed her abdomen again to further clear remaining pus and she has improved steadily over the course of the last week, without fever and tolerating an advancing diet.

Matilda (photo), a 55-y/o woman, arrived with an oxygen level of 45% (normal > 93%!), short of breath, coughing and unable to speak a complete sentence.  We discovered with bedside echocardiography that she had a rare type of heart failure caused by greatly thickened walls in her left ventricle, which was unable to fill a sufficient volume of blood with each beat, causing resulting high pressure in her lung circulation.  We began aggressive treatment, along with oxygen, and her difficulty breathing has resolved, though her oxygen level remains less than normal (last measure 85% without oxygen), indicating that she has likely suffered from this chronically (perhaps to some degree since childhood), recently decompensating. I think at this point she will make it.

We are in the heart of malaria season, treating many cases daily.  One great encouragement this year is the small number of life-threatening cases and deaths compared to other years and the rare number arriving with symptoms lasting longer than three days. This is the fruit of years of public health instruction, the population recognizing the prompt recovery for those who seek treatment, and the trust that has developed in our care.   

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As I looked out at the somber crowd of about a hundred adult patients and family members gathered outside our clinic last Tuesday morning, I saw several supported by crutches or sticks limping in to find a seat and several sporting large bandages over their eyes, jaws and various other parts of their bodies, following invasive procedures the day before. Most accompanying family members had slept on the ground by an open fire, as had some of the patients. Many also had slept on beds/mattresses that weren’t here a couple years ago.  The hospital fires were abandoned as everyone arrived at the designated area for the daily morning talk about improving our physical and spiritual health.  There were questions after the talk on mouth/throat maladies and serious engagement as I followed a bible teaching from one of the local men with my perspective on why we serve in the clinic in Cavango and how my Father has put such a burden on my heart for each of them.  I walked around the group and described the various illnesses which brought them to our hospital (no HIPPA/privacy concerns among these people) and how much joy I had in seeing them recover.  I put my hand on the shoulder of several mentioned above (photos) and shared my excitement at seeing each of them when I arrived each morning.  The Wind… 

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One of the many risks of living in prosperity is that one is tempted to believe that the ideal is possible, though thousands of years of history and the current state most of the world, including Angola, communicate otherwise. We see nothing of the sort here in rural Africa. When a patient comes to the hospital, they are seeking honest help for a problem they know they cannot resolve (often the village shaman has already been given opportunity). They do not come expecting to be “fixed” as do patients in the US, where anything less than an ideal outcome is a disappointment. Extreme arrogance, ignorance of history, and/or serious faith in fantasy accompany the attitude of many “idealists” in our modern American culture. 

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We currently have over thirty inpatients and I try to see most of them early in the day, immediately following our gathering. I write on the chart the subsequent day they will need to be seen. For example, a less ill person may be examined every other day and a sicker person will be seen daily. I was handed the chart of a 23 y/o woman who looked familiar but I didn’t specifically remember much about her. I looked at my notes and remembered that she had arrived quite sick a couple weeks ago, could barely walk because of profound edema, and was six months pregnant. She had severe preeclampsia and I had seen her last Friday and wrote on her chart for her to be seen the following day. I didn’t see her Saturday even though she was on the list for that day (I follow the list as I can’t remember each person). Then, a couple days later, her medication orders stopped and she received no medication for four days. Her blood pressure was dangerously high, though the few days of meds she did receive had reduced her edema and she was walking easily.

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Eliseo, the nurse translating for me is one of our most beautiful, and is humble and passionately caring. After recognizing the error, and confirming with the patient and her family that she had taken no meds for several days, I just couldn’t believe this had happened. Mistakes like this were common eight years ago, but nothing like this had occurred for some time. I ranted to Eliseo how this can never happen in any hospital and that this woman came to us to care for her and she could have died because of our negligence. I told him that we would address this with the whole team (where the responsibility lies, including the doctor) and that this type of error was unacceptable.

We continued to see patients through the morning and spoke no more of it. After our last patient, I privately asked Eliseo for forgiveness for my response, as it wasn’t his fault, and he didn’t deserve to be on the receiving end of my “wrath”, but it was the fault of someone’s severe negligence in taking her vital signs every day and letting her continue to remain in the hospital without treatment and never mentioning it to me. I told him that we would get to the bottom of it at our staff meeting on Monday and make sure it never happened again in our hospital.

Thirty five year old Eliseo immediately broke down and unconsolably wept for several minutes. I was at a complete loss as I let him regain control. When he lifted his eyes, he stammered that it was all his fault and that he had misread the chart and he was to blame and could have killed that woman. With Eduardo, I spent several minutes consoling him, emphasizing that he was forgiven, but that this was an important lesson to learn about approaching me when an inpatient was not receiving meds and whether it was with purpose or a system (or doctor) error. He responded maturely and said he had learned from it and it would never happen again. It was an important lesson for me, as well, in making sure I am always and easily approachable!

I was astounded by his response for several reasons. Firstly, Eliseo is one of our most responsible nurses and is always asking questions and seeking to learn. He knows well my mantra with the team that “All questions are good questions”. No one on our staff is a more enthusiastic learner. Secondly, he was profoundly and humbly distraught by his mistake. The men in this culture, characteristically, do not take responsibility for their actions. Bad outcomes happen “to” them, not as a consequence of something they do. Apologies are never spoken/heard. Like people in most cultures, vulnerability is rare, especially among the men, and they will laugh, lie and blame another or fate for a bad outcome long before bearing responsibility. Eliseo immediately admitted his error, took responsibility and profusely apologized. It was beautiful to behold.

Thirdly, he was profoundly hurt. He wept spontaneously, bitterly and uncontrollably, revealing how much he cares about the people and the quality of his tireless service for the patients in Cavango.

This is the type of local people that are part of our team in Cavango and they have learned much over eight years about both medical care and the responsibility that accompanies Jesus-like, sacrificial caring. Mistakes will continue to happen, but I left for the day encouraged that a valuable lesson was learned, that a beautiful man was wounded and healed from a failure, and that my Father has us here (still) to, with Jesus, impart passionate, wise and responsible care to the naked, malnourished (hungry) and captive to their cultural and human tendencies and desires.

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Confrontation and conflict are an ever-present necessity in addressing cultural norms and attitudes that foster abuse, apathy and neglect.  Jesus made this clear in His teaching about darkness and light, and He demonstrated this by His life, which was laced with direct and, sometimes angry, confrontation, motivated by care for those caught in darkness.  Hurt from confrontation is at times inevitable, but it does not necessarily cause lasting harm and, depending on how the conflict/confrontation is resolved, can produce valuable and edifying fruit. Eliseo was obviously hurt, not as much by my anger, but rather by his error and the potential harm to this woman under his care, and this is healthy fruit of loving, respectful and direct confrontation.

Darkness without confrontation by light remains darkness.  Confrontation done poorly promotes darkness, as well, because the “light” is appropriately rejected.  Confrontation is never easy, it is always fraught with human error and requires humility, apology and reconciliation, yet confrontation is a must in communicating and demonstrating light in a dark world filled with people suffering from the painful consequences of living apart from the Light.