Severe infections and addressing the resulting accumulations of pus are a common part of our work because of lack of access to medical care causing delayed treatment for infections that otherwise would be treated simply and painlessly much earlier. Lately, it seems every day we are draining pus from various body cavities in multiple people… from the heart, the muscles, the skin, the abdomen, chest cavities, the neck… Some examples follow…

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Adorable, little 2y/o Jacinta (photos) arrived in severe respiratory distress and ultrasound revealed a large amount of liquid in the space surrounding her heart and in one chest cavity. We drained several cups of thin pus, likely from TB, the consistency of motor oil, from her chest cavity, which had collapsed her lung, and about two cups (!) of thick, “creamy” pus from her heart cavity (pericardium) with no anesthesia – she was terribly frightened (see photo) but held still throughout the 30min procedure). Imagine a 4-inch needle sliding up under your xyphoid process! We subsequently three times drained the same amount of thick pus from around her heart and more fluid from her chest cavity (with anesthesia) over four days and will likely do so again, to try to avoid scarring and constriction of her heart cavity and further lung collapse, both of which could be devastating for her, long-term. We are thrilled that she has survived to this point (this morning she had no fever and was breathing easily, a combination we haven’t seen in her for a week), but concerned that our resources and abilities are limited and she yet may not survive the ordeal or she may face severe long-term consequences. Jacinta’s caring mother is a joy, full of questions and interested in everything we do, crying during her daughter’s procedures but looking on in amazement as she sees all of the pus removed from around her tiny heart.

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Maria is 25y/o and arrived in severe distress, nursing a toddler in her arms. She had both chest cavities full of pus, which we promptly drained (both with close to 2L), and she realized immediate relief and is recovering well.

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Thirty-three year-old Alberto also arrived in distress, breathing at a rate of 50 breaths/minute at rest, having suffered fever and cough for two weeks. He had one chest cavity full of thick pus and endured needle drainage and a tube in his chest for two days and a night to fully drain all of the pus. The tube was connected to a 2L water bottle, and the end immersed in water in the bottle to prevent air from entering his chest cavity from the outside during inspiration. He did remarkably well and was quite a sight as he carried his plastic “buddy” around the hospital grounds and coughed all of the remaining pus through the tube and into the bottle (2-3L in total).

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Julieta endured the draining of pus from her abdomen six times, each time with a saline “lavage” (introduction of several liters of saline into the abdomen and aspiration of the same) to dilute and thin the pus to help its removal and assist the body’s absorption of the pus. When Julieta was quite improved and doing well, she and her mother left during the night without payment.

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Carina arrived with a tight abdomen, severe pain and fevers for several weeks following the uneventful delivery of her first newborn at home. We drained almost 6L of oily pus from her abdomen and needed to do so eight times over about two weeks before she began to improve. She was deathly sick multiple times, but each time recovered for one more day. She also arrived with severe bilateral mastitis with necrosis of most of one breast, which required cleansing and dressing changes daily for two months. Her abdomen dried up and her breast wounds healed, though she lost much of one breast. Her attitude throughout was remarkable and without complaint, and both she and her husband expressed profound gratitude prior to their return home this week after almost four months (!) in our hospital.

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Marcos, the blind man from the last post who received transfusions, suffered full body sepsis, endured drainage of large amounts of pus from his buttock and leg, and essentially lost one buttock to necrosis from a dirty needle, was walking, eating and thriving… before he and his family snuck away in the night without payment.

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Little three-month-old Jaime arrived with a tight abdomen, incessant crying for days and not nursing. We drained her abdomen of milky, white fluid (chyle, not pus) and she began to nurse hungrily. We questioned her parents as to any possible exposure to relatives with a chronic cough, perhaps secondary to TB, as the fluid from her abdomen was likely lymphatic, and TB can cause lymphatic obstruction anywhere in the body, including in the abdomen. Her grandmother has recently been treated for TB and we began TB treatment in this happy little person and she is now thriving.

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Daniel is 43y/o and was carried into our clinic by his son, in severe respiratory distress and, like Jacinta, had a heart surrounded by constricting pus. We drained his pericardium, as well as a large amount of liquid from one of his chest cavities (photo). He has responded well and is walking without difficulty breathing and will fully recover.

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Florinda arrived after two days of labor with her 13^th child and her contractions had become weak and she had no remaining strength to push out the baby. After about an hour of trying various maneuvers and position changes to facilitate delivery, Eduardo used a vacuum device to assist in the descent of the baby and successfully delivered a large, beautiful little girl with a severely misshapen head from the traumatic passage (caput succedaneum). The baby, however, was delivered pulseless and apneic (not breathing). Basic resuscitation maneuvers, including agitating the baby, drying her, positioning her head to facilitate breathing, and cutting the cord resulted in no response. We began chest compressions and slimy mouth-to-face-respirations and, after about a minute or so, the baby took a breath and her heart responded. Another minute passed and she was crying and angry at the world! Within hours she was nursing and the next day her misshapen head was beautifully normal. Florinda named her baby Elizabet, after the doctor’s wife!

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These are but a few of those we see daily in Cavango. Our days are pretty much a sprint, with over thirty inpatients to review daily, many of whom would be in an ICU in developed countries, and more than that number of new consultations. We are so thankful for the arrival of the DeSouzas and that we will be able to share the patient workload in just a matter of months. The full days are a reasonable pace until someone requires time for procedures, similar to the above, which can then make for a long day. Our staff is stepping up and handling well the increased volume, seeing their efforts result in more and more healthy people returning home with their illnesses resolved. Your contributions to this work and prayer for our Father’s direction and wisdom are resulting in such beautiful fruit in physical healing and so many hearing of Jesus’ call to walk with Him as they navigate this very difficult and challenging life in the African bush. Often more than 100 people, a different group each day, hear about how they can walk with the One and only Creator-with-purpose, Ruler, Way, Truth, Life and Lover of our flawed souls, learn who He is, and learn how they can live healthier lives in their homes and communities.

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Our work can also often be emotionally overwhelming. We recently had a stretch of eight deaths in ten days, for example. Even though we see so many recover, those who died we held, embraced, prayed for/with, and devoted much effort and hope into seeing them recover. We see their families hurting and concerned on arrival, hopeful as we begin treatment and then grieve their loss. There is a special intimacy in the health care partnership between a physician and patient, and each loss is felt by this physician, some more than others. One child with an overwhelming staph infection called “Scalded Skin Syndrome” initially had no likelihood of survival, then he began to improve and I dared hope, then his kidneys failed and he died after we cared for him and hoped with his mother for almost two weeks… Because of the critical condition of so many, I am often awakened during the night, thinking of what I might do to help them. I seek my Father for ideas and long to see them improve, sometimes leery of what I might find on arrival to the hospital each morning. Often, my simple morning greeting of “How was the night?” is voiced with trepidation as I listen to the response of the night nurse.

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I’ve become deeply impressed, over many years, by how little real impact our words have on those around us. Yet our Father chose to build his kingdom through ever-flawed witnesses, people who would testify as to their relationship with the Living Jesus and whose transformed lives would lend credibility to their words, credibility being a relevant factor with any witness, legal or otherwise. We have come through a season in the global church where words became more important than credibility, and now we are realizing the importance of integrity.  We are celebrity followers, whose credibility we cannot verify and we become disillusioned when the celebrity behaves in a manner inconsistent with their words.  We listen to those who speak, sing or perform well and whose life we don’t know.  How much weightier are the words of someone real, whose life is consistent and resembles the One he/she follows?   We are also influenced by, and listen to, people who we sense care for us, as our journeys are so often lonely and confusing.  We each can be, today, people who care and whose words are consistent with their lives… by fixing our eyes on Jesus, seeking His direction and humbly serving those around us, one at a time…

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There is hunger before one’s third meal of the day and painful hunger after several days without food.  The painfully hungry soul is drawn to the Bread of Life; the hungry, distracted, satiated – not so.  We must seek the hungry of soul, the unmasked, the ripe fruit, the plowed soil, the broken jar… and invest in them… while letting the others go…

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Mornings in Cavango are clear, crisp and chilly, with temps in the 40s outside and 50s inside.  Layers…