Manuel went home today, after celebrating his 35^th birthday.  Previously a picture of health, he arrived two months ago with abdominal pain, back pain and fever.  After two days, he lost all strength in his legs and couldn’t even move his toes. The next day he lost ability to urinate and he was in severe pain because of a radically distended bladder. We put in a catheter to free his bladder, we began treatment for TB meningitis and several days later he began moving his toes.  His leg strength gradually progressed to where he could hobble around slowly with crutches.  Several weeks later we removed his catheter and he urinated on his own.  He went home today walking without crutches and urinating without difficulty!  He is a beautiful young man who never complained and hungrily devoured our morning messages about Jesus.  He will never forget his experience in Cavango and the love he encountered via Jesus’ hands and feet, including all of you who contribute to this work…

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As in Israel 2000 years ago, this culture counts days as calendar days and not 24-hour days. If Jesus died on Friday and rose on Sunday in this culture, He would be considered dead Friday, Saturday and Sunday, rising on the third day…

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A three month old boy was brought to us by his parents with fever for two days and nonstop crying and his father pointed out that the boy’s fontanelle (soft spot) was bulging. The baby demonstrated a common sign of meningitis and this sign was noted by her observant father! His son responded well to treatment, returning home fully recovered after a week of treatment…

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It is spring and mushroom season in Cavango. Mushrooms are springing up in virtually every color, shape and size. Many are harvested, dried, cooked and added to every meal during this season. There are highly nutritious and highly poisonous species, many resembling one another. Without generational knowledge passed on about the truth of what is harmful and healthy, many lives would be lost in continual experimentation but, even in rural Africa, virtually no one dies of mushroom poisoning because of the solid, accurate knowledge passed on generationally about the difference between healthy and dangerous mushroom eating practices. Lessons learned by those who went before us communicating what is true and healthy has tremendous value and prevents repeated pain and loss!

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Angola has a mask mandate. Everyone is preoccupied with avoiding this new disease and “biosafety” is the national buzzword. Ridiculously high fines (twenty times the daily wage!) are issued for people not wearing masks. Comparatively, how many people will die of malaria in Angola in 2019, 2020, and 2021 with no ‘biosafety” mandates or availability of “biosafe” nets, repellent, insecticide, etc? Exponentially more than CV! The government hasn’t had TB meds for years. How many people will die of TB during these years (and in coming years because of resistance), with no “biosafety” mandates or funding for prevention/education/treatment? Far more than CV! More will die in Angola of malnutrition, diarrhea, and typhoid fever with no biosafety mandates! The health posts have empty shelves and poorly trained, masked, workers… Inflation makes medication (and food) purchases for the common man impossible. The Angolan kwanza is globally worth six times less than it was when we arrived nine years ago but the local people have seen the devaluing of the kwanza demonstrated by price increases at almost the same rate with little change in wages.

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People buy a few antimalarial pills and Acetaminophen (cheap) for fever instead of full doses of effective malaria meds. Needles are re-used and meds are even prescribed by health care workers at partial-dosing, all without fines. People are encouraged to pay to see the “medicine-man” using all-natural, completely ineffective “traditional medicine” who works with no “biosafety” oversight and helps no one beyond placebo and kills many because of lack of standards. We have several in our hospital at any given time slowly and painfully dying from this “practice”. It is now required by law for every open store to have thermometers and hand-sanitizer at their entrance, in a country where neither was available for purchase two years ago. Awareness of disease transmission is a huge positive during this current season of propaganda, if only it came with some perspective…

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A hellish Saturday… One-year-old, feisty Helena arrived with a hemoglobin level of 2.6 (normal 12) after malaria had consumed her blood at home for over a week. Hemoglobin (Hb) is the remarkable substance in our red blood cells – that developed accidentally and purely by chance, over millions of years – that transports oxygen to/from our lungs to/from our tissues. Hb is one of the many ongoing miracles present in our body that we never think about, that in all our progress and knowledge we cannot reproduce, but without which we cannot live.

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Helena was breathing rapidly to compensate for her lack of ability to transport oxygen and was gravely ill. We began the tedious blood-matching and transfusion process (her blood on a finger stick looked like weak tea), and removed a unit of matching blood from Helena’s father, all of which which took a couple of hours. After several attempts, it was clear that placing an IV line in this plump, previously healthy, yet hypovolemic baby girl was impossible. We began an intraosseous infusion (needle in her bone), which ran for a few minutes and stopped. We tried applying pressure to the blood bag and infusing the blood in 10ml increments, both of which failed after a few minutes. Another puncture of another bone, with the same failure, occurred four times (!) through the afternoon, each time a technician pulling out the line or the blood failing to enter, and Helena communicating very clearly her displeasure with every attempt. She required several adults to hold her still throughout the day. Through it all, she received about half the volume she needed and her hemoglobin rose to 4.0. I was called to the hospital six times in six hours, each time returning home hoping the blood would finally enter Helena, only to be called back again and, by the end of the day, I was spent. One patient, so much effort, with no guarantee for success. Several other critical patients arrived and all recovered nicely, but they were whispers as I awoke this morning to the shouting of my “failure” in not “simply” getting blood into this little girl. There is no greater love than laying down one’s life… Even when the attempt fails? Even when no one benefits?

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I see people die almost every day who would survive if they lived with access to even basic modern health care. I’m so tired of hearing from the palace that God wants all people healed and prosperous. Jesus never communicated the same. We take an event from Jesus’ life and turn it into a religion. At the wedding in Cana, Mary asked Jesus to help and he responded. So now millions pray to Mary instead of the One who said “Seek Me”, “Follow Me”, “Ask Me”, “Abide in Me”, etc. He heals a blind man and we create a movement around “all people should be healed”! History, virtually all bible stories (see Heb 11) and current global conditions would indicate that our temporal happiness is not Jesus’ eternal priority. Our union/partnership with Him (see Jn 17) is His stated priority, over and over, especially in our inevitable difficulties! “In this world you will face tribulation, but… I have overcome the world”. Those who personally witnessed him alive after His death and his early followers were tortured and slaughtered, and yet rejoiced in this promise and remained faithful to Jesus and to each other without expectation for health and happiness! The religions bearing His name often bear little likeness to the One they claim to follow.

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Over half (!!!) of the world’s people live on less than $3/day! Eight of ten (!!!) of the world’s sons, daughters, moms and dads will try today to eke out a meal or two earning less than $10/day! And we continue to preach a message focused on my health, my desires, my dreams, my salvation… a “gospel” completely different from that of the One who died and came back to life, and who taught that our Father and others must take priority over anything we personally face! He said, in fact, that the key to life rests in an “other” focus! Our Father reveals Himself to us and asks us to leave the palace and follow Him to the eight of ten who are hungry, naked, captive… How are we doing? Eight out of ten… We claim to follow the One who “had no place to lay His head” as we fill our palace barns ever fuller while ignoring the wounded and hungry… We loathe “performance-orientation” but our problem isn’t performance-orientation, it’s our me-orientation!

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We spend so much effort in the palace seeking an encounter with Jesus who said, blessed “are those who haven’t seen”, who recognize the foolishness of the me-focused world, who “see” His obvious works (in His resurrection, His mushrooms, His Helenas, His hemoglobin…) and who follow Him and serve those in need, like those of you who sacrificially support this and similar works!

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But Helena survived the night, looked poorly, was breathing rapidly and her hemoglobin fell to 3.3. Our last attempt at getting blood into her was to take it from her mother and inject it into her abdomen and hope it would be absorbed intact into the many veins leaving the peritoneum. The peritoneum is what holds our intestines. If you picture a balloon holding ten meters of hose, the peritoneum is the balloon. The “balloon” has many veins and our hope was that this blood would be absorbed into her circulation through these veins. It was a common global practice in the 1950s and is rarely done in today’s medically advanced cultures. I wrote our medical leader, Steve Foster, who has more experience in poverty medicine than virtually anyone, and asked about the procedure, my last thought as to getting blood into this girl. He said they used the procedure commonly 50yr ago in the hospital in Angola where he was working, and he forwarded some pearls. We did the procedure yesterday (Monday) and she was only slightly better today. Please ask our Father to give me wisdom, for her sake.

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A few hours after Helena arrived, three-year-old Pedro arrived with a Hb of 2.7, also after a week of malaria at home. His breathing was fine but he was so weak that he couldn’t speak or lift his head. We typed him and his parents and neither parent was able to donate their blood to him. We found, however, that he was a perfect match for Helena’s mother! She was nursing and had given birth just a few weeks ago, which made her less than an ideal candidate for donation, but we counseled her as to intake and rest and removed a unit from her and divided it into two donation bags to give equally to the two children, which was actually the perfect dose of blood for each, according to their weight. Helena’s mom did fine and Pedro received his blood conventionally, intravenously, and slept through the procedure. His Hb today was “up to” 3.3. Please pray for wisdom!

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The poorest of the poor. Maria and her husband live in the “mata”, are in their mid-eighties and arrived barefoot (he had a shoe on one foot) after traveling most of the day over rough dirt paths on the back of motorbikes to get a consult. Maria has had this swelling in her neck (photo) for over twenty years. She did not arrive for a consultation for herself, but accompanied her husband. After our consultation with her husband, I told Maria that I knew a group of people who would want to send her for surgery to remove her “weight “ which is how she described this chronic mass she lives with. Those who support this ministry, you are sending Maria to have her burden relieved! She smiled and said “Thank you” several times (if only you could have seen her response) and acted like she couldn’t believe it. What a privilege to be in a position to offer such a life-changing remedy to someone who did not even seek care.

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How grateful I am for our partners at CEML. What joy I have in just being the “gatekeeper” as I couldn’t send Maria without the faithful and tireless work of our surgery friends at CEML. Without them and the regular transport via our servant MAF pilots (Brent, Marijn) and mechanic (Marcel) I likely couldn’t continue this work while watching patients needing surgery die.

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Maria will travel to CEML with her husband, who was shot in the head during the war, and had a superficial wound from shrapnel that healed without incident, only to open twenty years later and painlessly leak pus every day for the past two years (!). His surgery for an infection in his bone will be rather simple and Maria and her husband will care for each other after their respective surgeries. 

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Monday’s weekly staff meeting to begin the day revealed that we had more than 50 inpatients, many critical, as people wait so long to arrive.  We saw over forty new patients today (Monday), in addition to these, along with several procedures (including the transfusions), and it is becoming too much. I’m not sure how long I can keep this up, but who will help these people?