Faithful Servant, Meningitis, Customs, Dates…

The foundation on which was built the house in which we have lived for seven years (and where the DeSouzas now live) was the same that supported the house lived in by U.S. missionaries Darrell and Barb Hockersmith during the civil war in the 1970s, later destroyed in the same war after the Hockersmiths were evacuated. They are passionate supporters of our work in Cavango, they’ve visited us in Cavango and we, them, in Colorado and the credibility of their lives and their tireless love for those hurting and confused have greatly impacted me. Darrell met Jesus face-to-face this week and I am thrilled for Him, though sympathetic to Barb’s temporary loss and that of his family and friends (many in Angola). He abandoned his earthly life many years ago to follow Jesus and this week he heard directly from His Father, “Well done, good and faithful servant”. I look forward to bowing with Darrell before our Father one day soon!

We’ve had two cases of infant meningitis this week, neither with malaria (our most common reason for our many children arriving unresponsive). The first presented at the end of our day, in coma and with fever and unremitting seizures. We began treatment and I instructed the night nurse to call me if our initial treatment for seizures failed and his seizures continued. The next morning Eduardo and I talked about him on our way to the hospital and I boasted about our staff and that it was good that we weren’t called, as they would have called with any uncertainty or downward turn. We surmised that the initial meds must have been sufficient to stop the seizures. We arrived to find out that the baby had seized all night and had died near day break. When I arrived in Cavango eight years ago, this scenario was common and many hours of instruction have helped the nurses make consistently sound decisions as to when to call me. Not only had I not been called with a critical patient having life-threatening symptoms (on which I have taught ad nauseum), but specific, clear and simple instructions were disregarded and a child died, as a result. I was furious and it took maximum restraint to not respond in anger.

This culture is radically fatalistic and non-interventionalist and I’ve been battling this worldview since arrival, and it was in full evidence by the shoulder shrug of the nurse as he told me of the child’s death. Our staff has responded wonderfully over the years and have come a long way in recognizing when they need my assistance for any reason during the night, for the benefit of the patient. Then this! The child died and perhaps his death, like many every day in Cavango, could have been prevented. This doesn’t fit nicely into some people’s theology of God’s sovereignty, but much of our work among those who would otherwise die apart from our presence here doesn’t fit nicely into some people’s theology boxes! Our Father has given us the privilege of sharing responsibility for those around us. He said His followers would embrace this opportunity to partner with Him in clothing the naked, feeding the hungry and freeing the captives. Our Father rules and intervenes, but in no way controls all circumstances and people… I must decide how to (responsibly) approach this with the team and could use prayer for my Father’s wisdom.

The second child also arrived in a deep coma and has received IV fluids and meds through his tibia since, as we have been unable to establish a peripheral line. We saw no response for three days, but yesterday, Eliseo, the nurse I wrote about last time (not the one mentioned above), bounded toward me grinning as I exited my car and he excitedly told me that during the night the baby had begun nursing and responding to pain! We will continue to pray, seek our Father’s intervention, do everything we are able to do, and hope that this little boy recovers with no neurological damage.

A woman had never conceived after trying for many years. Infertility is a serious problem in this male-dominated culture where rural women have few options and find purpose in their influence on raising their children. I see many women unable to conceive, likely as a result of scarred Fallopian Tubes from adolescent pelvic infections, which are rampant in a culture without access to remedies and little knowledge of preventative measures. We pray with these women, emphasizing that only God gives life and enables conception, and take them through several steps of treatment (few potential remedies are available here) and have some successes and many who remain infertile. Juliana had concluded our last step several months ago, which is statistically low risk/cost, but also has low likely benefit. She arrived because she had several days of vomiting and, today with blood, so she traveled six hours on the back of a hired motorbike/driver to reach us. Ultrasound revealed a four-week pregnancy!

Access… Mariana could hardly walk for over a year because of severe back pain. She limped barefoot into our clinic bent over a stick for a cane after enduring several hours bouncing over roots and potholes on the back of a motorbike…

Little Joāo (photo) arrived in our clinic after suffering from the pictured, weeping scalp wound for over two years. He had an easily treated severe fungal infection of his scalp, called kerion, and will be a new person in just a couple weeks…

I was immediately critical of the family carrying into the exam room a young woman who had been suffering of severe abdominal pain and vomiting for over a week, so I questioned them (critically) about the delay. They said that it took several days to come up with the money for a consultation ($3US) and then walked for two days (mostly carrying her) to arrive in Cavango! I was quite humbled as I listened to their story and realized that, though I have lived among these rural folks for eight years, I still have no idea of the difficulty involved in living in this horribly impoverished region and trying to access the simple, solid medical care we offer. Can I even imagine facing such decisions that involve costs beyond what I have ever paid (just the consultation costs more than a day’s wages for a common laborer and most of our staff) and such travel effort to access help?

Ones… My new colleague, Dr Eduardo is learning rural medical practice and our drive to work is enlightening and enjoyable, as Eduardo chooses one patient from the day before, researches his/her illness for one hour and presents to me what he learns in one minute (about the length of our drive).

I love the fact that health care work is based on truth and trust. Credibility is the foundation for trust, and this combined with studied assessment of risk/benefit leads one to a decision that is true. Neither can be fudged if the best possible outcome is desired. If a patient has appendicitis, persuasive arguments and/or charisma cannot change the diagnosis. If a doctor with earned credibility makes the call and describes the comparative risks/benefits of illness vs treatment options, the patient knows his/her best interests are the focus, and will trust the credible judgment of the physician re costs/risks/benefits. One with credibility is believed/trusted in the same way that a pilot flying the plane is believed/trusted when declaring the plane flight-worthy. With credibility and evidence, a certain outcome is never guaranteed, but its likelihood is maximized. Without credibility and knowledge of evidence (based on experience and outcome studies of other patients who have faced the same), the risks/benefits are unknown and confidence in the decision is difficult to realize. Our modern cultures have emphasized evidence gathering and we have done well in this regard, but we all see physicians unknown to us (difficult to establish trust and credibility), which has brought us a radically scientifically advanced global health care system wrought with patient insecurity and doubt.

An example… Through us, you (those who support this work) are investing in six people who are attending training in the city and will return here (their home) to serve those hurting for many years. One of these students made a consultation with me during his last visit because of a chronic cough and I made the easy (and clear) clinical diagnosis of tuberculosis. He returned to school in the city and was recommended a course of treatment of shorter duration than that which is globally recommended (based on a myriad of studies). He has a choice to make, based on credibility and evidence, in whom to believe and which course to follow. His choice will likely have an impact on both his short-term and long-term health. He, and we, are constantly faced with many voices and counselors…

As to their health, people here face the choice of believing their own wisdom/experience, that of their family, that of the local “medicine man”, that of the poorly stocked and poorly staffed government health post or the foreigner at the mission hospital. Our American culture is also full of even more (always smiling and attractive) voices as to how to improve our health and well-being…

Making a decision to follow Jesus is similar. There are many “messiahs”, leaders, counselors, and “preachers of truth”. Jesus was one of many in those days claiming to be the “Messiah”. Paul and others, who knew Jesus personally and then gave their lives testifying that He was truly God, wrote often of “false teachers” who could lead one away from the truth of who Jesus is. There are today, and have always been, many voices clamoring for our attention. Honest evaluation of the credibility of the witness, based on life and experience, combined with a sober study of any/all relevant evidence will lead a seeker to Jesus. Jesus made the most profound unequivocal statement, “He who seeks will find”. The question is, “What are we seeking?” According to Jesus’ claim, if we are seeking to know God as He is, and emphasize credibility and evidence, we will find Him!

What and who we believe, as to health care, and as to which god we serve, will always be a choice. Jesus invites us to choose to follow Him, based on His crazy credibility and a lot of evidence, painstakingly and deliberately left for those who choose to “see”. He said that, in those who choose to surrender to Him, He would place a witness, who would testify of Him, and thus increase our faith/trust in Him. We choose to believe/trust Him, and our intimacy with Him increases our certainty to the point that we simply “know”, something those who don’t know Him will never understand…

There is no such thing in life as a decision that is all cost/risk or all benefit and with each action we undertake, reasoned maturity considers thoughtfully the potential consequences to all involved always, and humbly, understanding our human inability to predict all outcomes. Jesus suggested that there was great cost in following Him! Jesus also said to seek Him, not the fruit that results from intimacy with Him. I’ve found this to be a true cart and horse and I’ve tried both and have witnessed and experienced the difference. So many seek the fruit…

There is much derogatory talk these days of the ludicrousness of binary thinking, which I think is, for the most part, relevant. The complexity in our world is vastly underappreciated by the ignorant and arrogant who want to reduce everything to an “either, or” soundbite. What is fascinating to me is that those critical of binary thinking often use binary thinking to dismiss Jesus, as they repeatedly throw out the baby and bath water in order to continue to live their lives independently of the One who created the same and has made His creative genius abundantly clear to all “who have eyes to see”.

Those who have gone before us endured and learned much and are worthy of our respect. Though times and cultures must change and adapt, sometimes there are solid reasons for customs we don’t fully understand, and we would be wise to consider this before we abandon certain cultural “norms”. Years ago, I was critical of liturgical church services, where phrases and songs are repeated regularly and then, only years later, I learned that these services were designed for congregations of illiterate attenders. The repetition was helpful and necessary for learning key, revealed truths about God! In Cavango, for example, the services consist of much singing, where different groups (men, women, youth, children) learn biblical truths put to music. When they learn a new song every week in order to perform the same during the service, the truths put to music are more inclined to be remembered…

Another example… All of the people of a local tribe around Cavango file their two front teeth into an upside down “V”. Visitors have remarked about the strange custom, and question its purpose. I don’t know the history here, but ancient tribes around the world were accustomed to doing similarly or (painfully) removing a child’s two front teeth. No one today, even in the tribes where it is still practiced, know why it is done and the people here file their teeth because it traditionally “has always has been done this way”. Anthropological studies reveal that, in at least some of these tribes, similar customs began because in the past so many people died of tetanus and it was observed that people without front teeth could be given fluids through a reed while suffering from “lockjaw” and survive, as a common cause of death in tetanus, before the discovery and use of IV fluids, was dehydration from inability to remain hydrated through a mouth spasmed closed. A custom was wisely begun to prevent death and continues to this day in many rural parts of the world. It is no longer necessary in much of the world, but it increases further my respect for those who have gone before and endured/learned so much…

People here never drink plain water, but only drink Kissangua. Kissangua is made by boiling corn in water. No one knows why they grow up only drinking kissangua, but it is a custom that likely began because, long ago, wise and observant leaders recognized that those who drank this boiled drink didn’t suffer from the diarrheal illnesses suffered by those who drank water. Boiled water and corn…

Expiration dates… The manufacturer of medications is only required to post an “expiration date” on its product that verifies effectiveness, not a date for when the medication is no longer effective. Globally, people in low resource settings would benefit greatly if even a small portion of discarded medications were distributed to them. Most medications are effective for years past their “expiration date” but, in places like Angola, it is illegal to distribute medications past their labelled dates. CYA and greed is alive and well in today’s world! In the 90s, some dear friends and I operated a free medical in Columbus, OH and we kept a stock of donated expired meds. We offered these for free to our patients and also offered to write a prescription for those desiring to purchase their meds at a pharmacy. Invariably the expired meds were chosen and I recall no treatment failures over thousands of patient encounters.

On the surface, prosperity is pleasant and hardship unpleasant, so we have sprinted toward pleasure and prosperity and not considered potentially harmful long-term consequences. What might be below the surface? Do we consider what is not immediately evident? Do you think the following might be accurate?

Prosperity -> materialism -> self-importance -> self-gratification -> priority of rights and desires -> arrogance -> idealistic expectations -> ingratitude -> discontentment…

Hardship -> grief -> humility -> personal rights/desires in perspective -> reality-based expectations -> gratitude in simplicity -> contentment…

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