Helena, Frederico, Marcos, Progress, Salem, Truth…


A therapeutic and rich way for me to spend a few minutes with my Father is to ask Him to “take me where You would like me to go” in my thoughts and in our conversation. I also enjoy sitting down every couple weeks with my laptop and a blank page and writing about recent encounters on my journey. Thanks for reading!

It’s Sunday afternoon and the page is blank…

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Helena’s story is a pretty good portrayal of our work in Cavango and I wrote part of her story last time. Nothing comes easily, little goes as expected/desired, and frustration is common. Apart from our presence in this remote region, Cavango is a place devoid of the world’s health care progress since WWII. This means great effort is necessary to accomplish even the simplest tasks and few people have knowledge and training in how to use modern technology/medications, leading to abuse and harm caused by otherwise beautiful, health-giving products and services. All medication, material and technology we have in Cavango is imported from outside of Angola (India/US/China/Portugal), much of it purchased by those who support this work. We pay extravagant customs fees and, after import, everything is brought (at cost) to Cavango either via MAF (missionaries from Canada and Netherlands) or by road with us (missionaries from the US and Brazil).

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We failed to gain IV access in Helena with our outdated (but inexpensive) catheters, so we used special needles brought from the US to transfuse the blood into her bones, our last resort which always works, and these failed multiple times, for various reasons. She then developed “compartment syndrome” over several hours in one of her legs (pressure in a confined space of tissue, higher than blood pressure, that can compromise circulation), likely from one of our minimally trained techs improperly handling the needle during the (pressurized) infusion. We made a cut deeply into her muscles to relieve the pressure (causing blood loss), which was cutting off her foot circulation. She received, in all, about half the blood she needed during the course of a full day.

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The next day Helena had improved little, if at all. We decided to try an ancient procedure that I hadn’t done (once I tried it on a baby just before she died but didn’t know if we had succeeded), which transfuses the blood into her abdominal cavity, after which it seeps into her circulation. We typed her nursing mom to be a match and set her up as a donor, but the blood from her mom clotted in the line and we had to use two costly blood bags (from the US) instead of one. The blood entered her abdomen without incident and Helena was, again, minimally improved. But forty-eight hours after the procedure, she was greatly improved (the “seeping” took time) and we thought we were out of the woods. The next day, however, her parents brought her to us with a raging fever, having screamed all through the night. On examination, Helena had a large abscess in each buttock, where she had received injections in her village before coming to our hospital. These abscesses required us to make large, deep, painful incisions in order to remove perhaps a half-cup of cream-like pus from each side, and place a drain deep into the wound, to be removed three days later.

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Helena will never know the effort that went into her survival of this childhood illness, her parents were beautiful, patient, trusting and seemed grateful, having no clue, as well, as to all that our Father arranged for them and Helena, and she recovered nicely and went home yesterday, with soft, scarred, uninfected buttocks, a few healed puncture wounds in her legs, and pink nail beds. 

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Our nurses tell us that, in these remote villages, a needle will be used until it is too blunt to enter skin, perhaps twenty to thirty times, either on the same patient or on many. The villages don’t have alcohol, few have soap, and the only water is hauled from the river in buckets. So the needles are reused on multiple patients, in the buttocks, without cleansing the skin, in people who perhaps bathe once weekly, usually without soap, can’t afford underwear, and normally sit on the ground. Helena bore the consequences of this practice, like so many we see regularly in Cavango.

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Eduardo and I donated blood yesterday to Marcos, a blind, adult man with disseminated TB, who came to us with one buttock full of pus, surrounded by necrotic tissue and in circulatory shock, from both the infection and from profound anemia (Hb 3.3 before and 5.6 after), likely secondary to prolonged malnutrition. Blind, naked, hungry and very ill… the perfect person for which to be spent in the Kingdom of my Father. It is very likely that Marcos won’t survive, because of a simple injection administered by an ignorant someone, likely trying to help (good intentions are irrelevant), but without knowledge of the truth as to the potential risks associated with this behavior. It is estimated that millions (!) of cases of Hepatitis B are transmitted in this manner yearly, along with HIV and Hep C.

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Pedro, the other child who received Helena’s mother’s blood, strolled into our consultation room several days later, smiling and seeking his daily sucker (he couldn’t lift his head, speak or walk before his transfusion), and went home, likely with a hemoglobin less than 5, but his body will fabricate more blood in coming days/weeks, without the destructive influence of the malaria parasite, and he should recuperate fully.

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Little Frederico went home this morning with his very caring and heartbroken mother. He arrived yesterday extremely short of breath and with a blood oxygen level of 61% (normal > 93%). He had severe pneumonia, was unconscious, severely dehydrated (septic shock) and needed fluids, antibiotics and oxygen. We prayed, got an IV line after about five attempts, gave him the meds, began IV fluids, and started up our small, portable generator to provide electricity for the oxygen concentrator. The generator stopped after about thirty minutes. After examining the generator and finding no obvious correctible problem, we returned home to get our identical, backup generator, fired it up and left again for home. A couple hours later, we were called and told our backup generator had also failed. Another evaluation by two doctors and no clue as to why. Each little Yamaha generator came at a cost of about $1500US, both had relatively little use, and neither worked, likely because the only gasoline available in the bush is often old or contaminated. Hopefully we’ll be able to fix them.

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We then went over to our construction container in the late night and dragged over another, larger generator (brought from the US and donated by our beautiful AGA construction team three years ago) to supply energy to our little portable oxygen concentrator.  It worked well, but after about an hour, our $1000 oxygen concentrator failed!  Somehow, after a delay of about 15min trying to figure out the problem, the concentrator turned on and ran well all night and Frederico looked some better on our arrival the next morning at 7:30a, with an improved oxygen level and vital signs.  We walked in on his beautifully devoted mom pacing the floor of his room, praying.  I told her that he had survived the worst part of the illness and there was hope for his survival.  What a beautiful spirit in that woman and she was thrilled.  We left to go to the front of the building for our morning talk and couldn’t hear because the large, two-stroke generator was so loud.  I entered the building, turned off Frederico’s oxygen and turned off the generator for our thirty minute, outdoor talk.  Frederico died fifteen minutes later…

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If the US ceases to exist, which behavior of its people will be more embarrassing to our children and grandchildren?  Millions of “nonhuman” slaves, over 200 years, and their undeniable abuse and maltreatment, for another’s convenience and greed… or sixty million “nonhuman” Helenas, Pedros, and Fredericos legally and undeniably slaughtered before their birth, for another’s convenience and greed, over 50 years?  Human maltreatment and human slaughter, both hideous, “legal”, and supported by many church-goers…

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I gave our morning talk at our staff meeting this week on telling the truth and trust. I emphasized to our workers that our team must be built on trust in one another, and that trust cannot exist where people speak falsehoods to each another. Lying is so common in this culture and telling the truth is hardly relevant these days in the US culture, which is largely why real relational trust is a fantasy. There are solid reasons behind every commandment/guideline from our Father and many revolve around trust. If we want trust, speaking truthfully is foundational. “Spin”, bias and “people skills” have become more important than speaking the truth.

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Truth is also an essential element of progress, as today we cannot improve on yesterday unless the information yesterday was recorded accurately. There are many positives and negatives with “progress”, but the difference between Cavango and a similar-sized township/region anywhere in the US is crazy to ponder and there are severe cultural differences that have allowed the progress in the US, one of which is the historical value placed on recording events accurately and speaking/writing the truth. One of the reasons the younger generations have such difficulty in believing the written word today is that they have been exposed to so much inaccurate and biased recording of events, filled with ulterior motives. Spin, false optimism and people skills are in abundance in Cavango and the lack of “progress” in Cavango is as equally abundantly obvious…

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I also challenged everyone that when they translate for me (very few patients speak Portuguese), they must translate accurately what I am saying. This past week I was telling a young woman (42y/o) that she would die soon of bladder cancer (extremely common cancer here because of an untreated, very easily and cheaply treated, parasite), thinking through every word in order to be sensitive and accurate in encouraging her that we would all face what she is facing and that she has the opportunity in coming months to prepare for her departure… with God, with her family, and with her community. It’s a talk I sadly give frequently and see as an integral part of my service to these people, encouraging them, like Jesus did, to put one’s death/departure in perspective and see it as an opportunity to have an impact on their beloved. The translator did not communicate my words accurately or sensitively and this was discussed at the meeting and received well. One of our nurses, Eliseu, had his head down for almost the whole meeting. Afterward, he asked for a minute alone and shared emotionally that several years ago we had given him some lanterns to sell at reduced prices and, when he finished, he hadn’t been truthful and kept the equivalent of about $10 for himself. He said it’s been haunting him ever since and that whatever he had purchased with the money wasn’t worth the turmoil he has wrestled with since. He gave to me the money he had stolen and lied about. What evidence of our Father working in one’s heart….

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Salem, Angola…  Our worldview is foundational to how we explain what we don’t know and fear is often a major influence on our worldview, especially if we don’t embrace Jesus and His teachings.  A 60y/o man and three generations of his quite-solid family were literally run out of our village this week because of witchcraft.  Witchcraft that no one witnessed (no one!) but many believed and feared.  Witchcraft and curses are rumored to be rampant here but rarely witnessed.  Belief in interaction of the spirit world and the seen world is rampant.  The spirit world is almost universally seen as harmful and feared (vs adoration of, confidence in, and surrender to, our unseen Father who “so loved the world…”), gossip is never-ending and truth-telling isn’t valued – quite a combination! 

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The “evidence”… A few people had dreams about this man and they talked. “Why would I dream of him if he wasn’t soliciting entrance into my dreams via spirits?” Someone reportedly saw uneaten plates of food at his house and believed he was leaving food for spirits, and they talked. His adolescent son died, and people didn’t think he grieved appropriately, and they talked. Several children died unexpectedly in our village last year and rumors began about his involvement and perhaps his placing of a curse on the kids (they died of malaria after staying at home too long and their parents irresponsibly not seeking available treatment just up the road). Blame is comforting… More talk, opinions bolder, gaining momentum, more talk… Animated word reached the regional village chiefs, who convened a council and, because they (and he) couldn’t prove his innocence, he was deemed guilty of witchcraft and exiled from the region. No justice system is perfect, but this was crazy. I asked some of our workers about the decision and they unanimously said that the chiefs had the ability to “see” what they could not and their decisions were always right! Our “all-seeing” village chief, BTW, has fathered children with several women other than his wife in a village considered a “mission”, where polygamy is illegal…

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I’ve known this condemned man for eight years, he was one of few here who lived a Jesus-transformed life (he freely admitted to a youthful past of rebellion), spoke at our morning meetings, served people at our clinic humbly and was an enthusiastic kingdom learner, as was his adult son.  It’s a sad story and we are seeing the same played out (again) on a larger scale in the US as we culturally dance (within and outside of “the church”) on the ever-changing waves of opinion re truth, we listen to charismatic strangers/prophets rather than follow people we know and whose “fruit” we can observe.  The solid, reasoned principles of self-abandonment and surrender to the person of Jesus are disregarded in order to pursue our feelings/desires for temporal happiness and pleasure…  There is little more blinding than the pursuit of self-gain/pleasure.  Are there any today who abandon personal gain and pleasure to follow Jesus and serve others?

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Jesus said if we seek truth we will find Him, because He is truth.  Our culture is arrogantly abandoning seeking truth and Jesus for other pursuits, similar to the people 2000 years ago. John – Jesus-follower-and-eye-witness-of-Jesus-alive-after-His-crucifixion – profoundly defined these other pursuits as…

            the lust of the flesh (redefined today as romantic “love” and attraction),

            the lust of the eyes and greed (redefined today as “ambition” and “success”) and

the pride of life (redefined today as “self-esteem and “well-being”). (1Jn2)

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If we did in medicine what the US culture is doing, we would throw out everything we’ve learned in medicine over the past 200 years and began again, suffering just like those in the Cavango region!

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In the questioning of Jesus at His “trial” (a system of justice similar to that of Cavango), Pilate revealed himself as a frustrated “truth” seeker and cynically spoke words heard so frequently in today’s more “advanced” and “progressive” cultures, “What is truth?”. At some point in his life, it appears Pilate abandoned his pursuit of truth and caved to success, self-serving power, the state and, in Jesus’ case, the mob. In the US, we are reverting to Pilate, Cavango, Shamans and Salem… Jesus said if we seek truth, we will find Him, even telling Pilate that one of the principal reasons He came to earth was to “reveal the truth”, stating in another instance, “I am the Truth”. How different are we than the man who condemned Jesus to the cross?

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Over connecting with, and surrendering to, Jesus, we prioritize healing, well-being, success, inner peace, religious experiences, leisure, security, happiness, knowledge, societal betterment, tolerance, climate control, politics, and our understanding and bias (what we “feel” to be true). One of the most life-changing statements Jesus made, for those with ears to hear,

“These things dominate the thoughts of unbelievers, but your heavenly Father already knows all your needs. Seek the Kingdom of God above all else, and live righteously (which He defined as loving Him and others above oneself), and he will give you everything you need.” (Mt 6)

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Thank you for your emails of encouragement these past two weeks. We get few, but they are rich, read several times, and we are beautifully reminded, in them, that we are not alone… Thanks for praying, reading, writing, and for journeying with us, by whatever means you choose!

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One comment

  1. Praying for your hearts and bodies this morning. May the weariness and aches of too little sleep and too many losses be soothed by our living, loving Father. You words always challenge me and bring me to my knees. I am grateful for this, Tim & Betsy.

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