We had a meeting with many of the village chiefs (Sobas) from the area (photo) who traveled here (some, many hours by foot) to explain their decision to exile our faithful hospital guard for witchcraft. They explained that, as a “mission”, we couldn’t employ someone who is believed to be practicing witchcraft. These men are not Jesus-followers and rationalized that they were protecting us from evil forces, having no clue that we have no concerns about evil forces harming us when connected to Jesus. John, one of Jesus’ close followers, wrote to early Jesus-people, each of whom truly put their lives on the line to be considered a Jesus-follower, that Jesus’ spirit in us is far greater than the spirit in the world, and that we need not fear this spirit, or others (1Jn 4). This lack of fear of spiritual forces is rarely in evidence today because so few people abandon their lives and live continually connected to their King. Many “Christians” credit good and bad “luck” for outcomes, “knock on wood”, play the odds, buy lottery tickets, etc! The village chiefs meant well, abused their power, shattered a man’s life, and no one in the church defended this man because of fear of spirits, fear of bad “luck”/“fortune” and fear of the power of the Sobas…

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Blind and cachectic Marcos, from our last post, who received a transfusion and aggressive treatment for his disseminated infection from a dirty needle, is thriving! He’s walking pain-free, eating, gaining weight and enduring painful dressing changes and debridement but is better every time we see him. I predicted perhaps a 10%-20% likelihood of survival when we transfused him!

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This culture treats women as property.  The way women are referred to and spoken of/to is without honor and respect and quite different than the way women are treated in the US.  To local men women serve a function, like a cow or a tool.  Actually many functions, as they raise the children, provide whatever pleasure the man desires, whenever he desires, prepare all the meals (grind the corn, fetch the water, collect dead wood for the open fire which will boil the water to cook the powdered corn, work in the fields (most often alone or with the children), etc, etc, etc.  The men do little and the women do literally everything, with virtually no appreciation/recognition.  I’ve heard men say, “It’s what they enjoy.” “It’s the way they are wired.”  “It’s their purpose.”  Most men here have at least three wives/servants.  Women have few rights, and this region and its tribes are accurate illustrations of how women have been treated throughout most of history, which is very much in contrast to how Jesus treated women and what He taught.

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The Judeo-Christian tradition of monogamy, for example, and the honor it bestows on each wife (in contrast to one wife of two, one of three, one of four, etc), is a radical contrast to the way most cultures have treated women, including this one. Monogamy, of course, only provides opportunity for a man to cherish one wife. He still must choose to partner with, and to “love His wife, as Christ loves the church, and gave his life for her.” This sets Jesus and His teachings so apart from the historical norm (polygamy/property/servitude…) and has radically influenced the improved treatment of women in modern, western cultures. A law, of course, provides a formal guide but changes no one’s heart, so the objectification of women continues in other ways, via sequential polygamy (marriage, divorce, marriage…), pornography, prostitution, the sex trade, and harassment, as well as in every day interactions and behavior by both men and women.

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I highlighted this to one of our morning groups this week, of more than one hundred people (different group every day), and emphasized that I fear for the men of this culture, who see leadership and pride as honorable, but will face a King one day who sees serving and humility as worthy of praise and honor. One day soon, people from every tribe and tongue will worship the Alpha and Omega and, of those speaking Nganguela and Mbundu and put in leadership positions, most will likely be women.

But those who are the greatest now will be least important then, and those who seem least important now will be the greatest then… whoever would be great among you must be your servant, and whoever would be first among you must be your slave. – Jesus

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We have three babies under the age of three months in our hospital today who arrived in critical condition with tight ascites (free liquid in the abdominal cavity) from severe liver failure caused by “all-natural”, herbal treatments given, usually rectally (more drama), by local shamans. I get so angry, but what would I do if I thought my child was ill and I knew of no other options? The motto in medicine of “First, do no harm.” was established in an environment similar to this one, where self-appointed “healers” with little knowledge, but with excellent “salesmenship” and “people-skills”, profit from risky experimentation on sick people. After some aggressive, knowledgeable treatment, these babies all look like they will survive, but so many people have died historically from such treatment in virtually every culture. Jesus spoke of millstones and these people will face Him for recklessly taking so many lives, no matter their intentions.

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We have similar, well-intentioned foolishness occurring all over the world today as people denigrate and minimize simple, Good Samaritan-like service and the crazy advances in medicine and, using words like “prayer”, “in Jesus’ name”, “movement of the Holy Spirit”, etc, advocate and pursue “miraculous” healing over drama-less serving, “mud and spit” and a giving a “cup of water”.  Jesus encouraged serving the naked, hungry and hurting, responding as the “good Samaritan” and giving a cup of water to one needy, but we think it’s better to “pray for healing”.  Sweat, service and giving whatever is needed (our time/effort, a cup of water, a meal, a home, a car, a job…) is as rare today as when Jesus advocated the same, as we “lay hands on” the sick and say, “Bless you” and give nothing of ourselves for their well-being. One of the most significant requests we can pray is, “Father, what would you have me do to help this situation/person?”. We heard similar in the garden, from Jesus, before He freely offered His life…

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A culture without stores, pharmacies…  We see beautiful, smiling, grateful, 65 y/o Evaristo every month or two (photo).  I understand he lives alone in a shack near the river and lives off the land, working for every bite of food.  He arrives with his sweaty, smelly, and blistered bare-feet in knee-high, tattered rubber boots, dressed in rags and asking for more “pain medicine”.  He receives his “prescription” and buys our ibuprofen at cost for his chronic and severe arthritis and always takes a few minutes to emphasize how effective the medicine is for him and to express his gratitude to God for our presence here and the availability of such a remedy.  A grateful heart, especially in this setting, is beautiful to behold, and is contagious!  As someone with two replaced knees and having experienced the awful, unremitting pain of severe arthritis, this man impacts and challenges me every visit.

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Mariana (photo) came to see us several months ago after suffering from seizures for ten years (!).  Without diagnostics, we asked some questions and determined that she might be a candidate for treatment of a common pork tapeworm that can form cysts anywhere in the body, including the brain, and can be a cause of epilepsy.  We treated her and she returned three months later with no further seizures for the first time since she could remember.  We see people with seizures all the time, they are virtually all “spiritualized” and considered demonic, and we can help many of them with a good diagnosis and solid treatment.

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Samuel is 21 y/o and arrived last week in a coma after several days of fever. His malaria test was negative and his neck was as stiff as a board. At his age, the most likely diagnosis was meningococcal meningitis (for which we have a vaccine in the US) and we began aggressive treatment for the same. He opened his eyes the next day, was speaking the following day, and returned home completely recovered after a week. He is alive today and will soon have children, who will have children, who will have children, and generations will be different because our Father sent us here and because you are faithful to support this work!

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Little 2y/o Madalena arrived quite ill, breathing rapidly, severely anemic (Hb 5), and with malaria.  She hadn’t urinated for several days, though she was not vomiting and was drinking fluids.  She worsened over a week, not urinating once though she was given IV and oral fluids.  Ultrasound revealed injured kidneys, prompting an evaluation for Sickle Cell Anemia, a congenital illness causing the “sickling” of red blood cells (instead of a normal oval shape, they take on a “C” shape) which become ineffective and can clog small arteries and cause pain and/or organ damage by cutting off the blood supply to an affected area.  Her test was positive, revealing the cause of her kidney injury.  We gave her therapy for her kidneys, helping only a little, and she died a week after arrival.  This illness is readily treated in much of the world outside of Sub-Saharan Africa, with medication and stem-cell transplants and, though the transplants are years away in a setting like rural Angola, there is no excuse for an entire country to be without the very effective medicine (hydroxyurea) to help the kids with this almost universally fatal and very common illness.

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Twenty-two-year-old Alice arrived last week, very thin and unable to walk, having had intermittent fevers for a month. The rest of her exam was unremarkable, including an ultrasound, so we began treatment for suspected TB meningitis or spinal TB. Last night she developed severe shortness of breath and her ultrasound revealed a ruptured papillary muscle in the mitral valve of the left ventricle of her heart (medical people will enjoy the unique, short video clip). I realized then, too late, that the cause of her illness was not TB, but bacterial endocarditis (heart infection), which caused the weakening and rupture of this tiny, essential muscle. Our bodies have thousands of small, essential parts, without which we cannot live even for a few hours. Alice died several hours later, needing a valve transplant, curative and available in much of the rest of the world, but unavailable here. I diagnosed her inaccurately. If I would have begun appropriate treatment last week…

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These few are mixed in with so many “normal” cases of severely malnourished kids, malaria, abscesses, liver failure from shaman “remedies”, rheumatic fever and its consequences, parasitic illnesses, food poisonings, heart failure from untreated hypertension, asthma, deliveries, TB, and others, both familiar and unfamiliar to the non-impoverished-rest-of-the-world, common and uncommon, simple and complex…

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We battle illnesses as well as principalities, philosophies, and powers that produce deeply ingrained helplessness, apathy, fatalism, neglect, corruption of power and horrendous abuse in this land filled with beautiful people who need help.

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We have a hospital director who has great difficulty in being second fiddle, who knows virtually nothing, but pretends to have all the answers and loves his position but actually does very little managing.  We have theft of medication and money that we can’t trace.  I ordered about $2000US of meds this week and our pharmacy didn’t have the money for the purchase (we charge what we pay and should always have enough to restock).  People don’t show up for work, others regularly lie as a normal course of conversation, making it difficult to trust anyone.   Our ambulance driver abused and quite destroyed the car. Meetings are scheduled and nobody arrives.  Instructions are followed for a couple days and forgotten.  Medication doses are missed and/or given errantly. Organization is not understood in a culture where people have at home virtually no possessions to organize…

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And yet… Every day at promptly 7:30a, benches are put out in the front of the clinic, our morning gathering is announced and the patients and their families gather. Our Emergency “Room” is far more organized than even a couple years ago (photo), the floors are kept clean, we now often have running water and some dim lighting, we have enough beds, mattresses and blankets, we virtually never run out of medication, errors are less frequent, hospital construction is continuing… Progress is crazy slow, yet we are making progress in serving these rural people more excellently…

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My heart is so often broken from seeing every day so many beautiful human beings engaged in such pain and need, but this morning I am full of gratitude for being in a position to help, a broken vessel with enough light to make a small difference in a dark place, even with missed diagnoses. I could be in a million different places today, with a million different perspectives, but I’m glad I’m here, and only Jesus’ influence could take such a self-focused man and put him in a place like this and mold him over time to honestly write such words of gratitude.  And I am so grateful for each of you who choose to join us in serving these remote people.