Costs, Sand, Good, Pain, Indifference…

The average price in the US for a fifteen minute abdominal ultrasound exam is $745. In Cavango, we charge the equivalent of $8 for a full ultrasound screening exam (which takes about five minutes) of the chest, heart, abdomen and pelvis, only if the patient orders the exam on arrival. Some order this exam because they have heard that the machine can “see” inside and accurately identify their illness. If the physician (me) chooses to perform any ultrasound exam to aid in arriving at an accurate diagnosis, we charge the equivalent of $1.50.

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A fifty-five year old man arrived in Cavango on a Sunday night by motorbike, walking and talking, with normal vital signs, and complaining of abdominal pain. He was welcomed by our night nurse and told our consultation prices. If the consultation was done after-hours (when he arrived), the price would be the equivalent of $6 and if the consultation was done the following morning, the price would be $3. He chose to wait until morning and died during the night. We are short-staffed, especially after hours, so we offer different pricing options to encourage people to seek consultations during regular hours so that we are fully staffed and can more adequately serve them. With limited resources, we are always seeking to maximize our ability to serve with excellence, and to provide adequate time off for our small staff. We leave the decision to the patient, but we are willing to see anyone at any time.

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A couple arrived on a Sunday afternoon in a flatbed truck after a five-hour (!) drive from a large city. Because of the nonurgent reason for the consultation, they were told by the on-call nurse to wait until the following morning, and that he wouldn’t call the doctor for a concern about a chronic problem. Bernardo then drove his truck to our house and asked for a consultation and, without asking his concern, I told him to see the nurse at the clinic. He returned to the clinic and continued to push. The nurse called us on our CB radio (our method of communication between the house and the hospital), saying that the couple continued to politely request a consultation that day and would pay the weekend price.

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Interestingly, we had determined the previous day that we needed a truck to haul sand for some of our ever-ongoing construction and renovation, and we discussed the challenge of finding a truck driver willing to bring his vehicle over these roads to do the work.  So, after connecting a few dots, I went to the clinic and offered our work on a Sunday in exchange for Bernardo hauling sand the following day. When I asked what brought them to Cavango, he said that he had spoken to several “infertile” couples in his city who had conceived and given birth after coming to Cavango for a consultation, and that he and his “wife” had been unable to conceive for several years.  We agreed on an exchange of services and he paid for the consultation and accepted a fair, market price for transporting the sand the following day.  On Monday, he hauled five truckloads of sand to our construction site, all shoveled in and out by the guys from our village who are currently working on our construction projects.

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Bernardo’s “woman”, Alice, had been infertile for three years, after giving birth to a son.  He had five children with his “other women”, the most recent six months ago, so he knew he wasn’t the cause of the infertility. 

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We see women for infertility all the time in Cavango and I can’t remember the last time I encountered a monogamous relationship.  In the US, we are rejecting the Judeo-Christian influence on the nuclear family, of one mother and one father, as we revert to the historical “norm” of men and women producing off-spring with no parental, family commitments.  At dinner last night in our hotel, we had a conversation with several people from Angola, and they shared about their family experiences, all typical of “families” in this culture, which has never progressed beyond tribal, sustenance living.  One woman had been raised by two men and several women, each with multiple children from different men, and the other woman’s father had multiple women all over the country raising his (many) children without him.  He is 70+ and one of his current women recently gave birth to her first son.  Our dinner companion’s mother gave birth to others who died, but raised six children from several men. 

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As a culture and, as individuals, we have some decisions to make as to whether it is good to have children and, if so, what is healthy for those we have. The question settles around whether human lives have inherent value and are created with purpose. Are fewer children, raised in affluence, better than more raised with less? Does a life of difficulty and hardship have value or is such a life better unlived? Is each human life a treasure and do more children equate to more treasure? Is it better for the children to be raised and nurtured by a devoted mother and father, by one parent, by two fathers/mothers, or by multiple “parents”? Is it better for the “village” or a nuclear family to raise a child? How do we combine the two in a manner healthy for all? Does parenting, upbringing and modeling matter to a child’s physical, emotional, mental, and spiritual health and development? In Angola, we live in a tribal culture similar to those throughout history and in contrast to the historically recent Judeo-Christian values which are now being rejected by “modern” cultures. Which is healthier, short-term and long-term, for the individual/community/culture?

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The woman’s ultrasound revealed scarring in her fallopian tubes, almost always the consequence of previous inflammation secondary to sexually-transmitted-diseases (STDs), usually resulting from exposure to many partners by either the man, the woman or both.  We treated the causative infections, hoping that the inflammation is acute and will diminish but, after three years, her scarring is likely permanent and beyond remedy.  They agreed to pray with me as I shared with them that our Father is the author of life and would hear, and consider, our request.  

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STDs are rampant in this culture, and have been throughout history, rarely occurring in a monogamous couple. The resulting short-term and long-term illnesses and disabilities have been a human scourge throughout history and common, and increasingly prevalent, manifestations today are Gonorrhea, Chlamydia, HIV, Hepatitis, Herpes, Syphilis, Scabies, Human Papilloma Virus, Genital Warts, among others, all causing potential disability (including infertility) and/or death. Many are treatable today, diminishing some of the fear of the consequences of our promiscuous and self-gratifying behavior, but millions suffer around the world (in developed and undeveloped cultures) from these completely preventable diseases.

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We scoff at “antiquated” moral “restrictions” such as the monogamous, committed, lifetime marriage of a man and a woman and a family with a devoted mother and father, as we embrace our new morality – whatever “consenting adults” choose… Because we abhor the study of history and the wisdom we can gain from previous generations, we will face remarkable and devastating consequences… again

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I’m grateful that moral perfection isn’t required to walk with Jesus, and that His forgiveness and redemption are real. I’m also grateful that He has given us guidelines, restrictions and historic and current models to help us make wise choices that will benefit all involved and that we are less likely to regret in hindsight. Because I understand the ability of fire to cause hideous and permanent burns/scars, I treat it with great respect when benefitting from its light or heat. I mocked seatbelt laws until I worked in emergency medicine. I mocked monogamy in my youth and then I, and so many people I know, struggled to experience intimacy and friendship within their marriage after “playing the field” and “sowing oats”. Objectifying people for personal satisfaction is a difficult pattern to change…

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We are now abandoning marital commitment in our pursuit of relational intimacy in the same way that we abandon surrender to the Author of life in our pursuit of life’s “meaning”. We’ve pushed trillions of dollars at poverty, live in the most prosperous culture in history, and discontentment reigns… When will we examine our methods and have the insight and courage to surrender to the wisdom of Jesus and His ways?

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As I’ve aged, I’ve become more and more impressed with Jesus and His ways. I now have years of experience watching people live “my way” or in surrender to Him and His ways. I’ve observed and experienced the healthy and poisonous fruit borne along these various paths and the decisions I regret in my own life are those I made independently of Jesus. My respect and awe for Him has grown with time. I recognized in my twenties that His ways were uniquely “good” and I wanted to know Him and His ways intimately. Not easy, and even costly, but good. Time, experience and observation have further validated the “not easy”, the “costly” and the “good”.

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I’ve been meditating on the words attributed to God after His initial work of creation. “It is good”. Remaining faithful to Betsy in a monogamous marriage for thirty years has been good. Raising and knowing my children has been “good”. Not always pleasant, positive, rewarding, or satisfying, but definitely “good”, from so many perspectives. Not easy, and even costly, but good…

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We each, daily, have the opportunity to evaluate our lives as to whether we are “spending” ourselves on what is pleasant, easy, rewarding, satisfying, fun… or “good”…

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Since antiquity, we have been creating, serving and worshipping gods that we can understand, that make us feel comparatively adequate, and that allow us to personally live as we please. We give names to our gods that agree with us– success, peace, religion, good fortune, security, acceptance, equality, prosperity, atheism, agnosticism, contentment, tolerance, enjoyment, well-being, health, love, pride, satisfaction… and we validate our “faith” with the Bible, science, laws, rules, traditions, experts, celebrities, intuition (“It feels right”), pastors, forefathers… Is there one God that is “true” and worthy of our devotion? If so, who is He? In accounts recorded by eye-witnesses, Jesus, before Pilate on the eve of His condemnation, shaming and crucifixion, indicated that He (not our religion, tradition, feelings, or understanding) is “truth”, and then He came back to life after His death to validate His words, which have been further validated in my personal experience and observation…

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Geraldo arrived after several months with a persistent cough.  His TB diagnosis was straightforward in the midst of a hectic and full day and I wrote his orders, explained his treatment regimen and directed him to the pharmacy to begin his eight months of treatment.  He sat in his chair and leaned forward.  I told him he could go.  He looked at me confused and asked if I wasn’t going to pray for him…

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Joaquina is beaming as I approach the clinic (in Photos from April). She has returned from Lubango after having a large Keloid (abnormal scar) removed from her neck. She has a large crater in the space previously occupied by the keloid. Most people would be horrified by her current wound and the months of rehab and injections that she now faces, but she is deeply and demonstrably grateful and expresses the same every chance she gets. Her body is still full of unsightly keloid scars, but the most painful and burdensome scar has been removed and, to her, life is new and she is grateful. Perspective…

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We’ve been averaging almost a death per day in Cavango this past month. Some are expected, some are not. Each person is devotedly cared for, prayed for, and we get to know them and their families. There is great cost in caring and the pain associated with these deaths has not diminished over time. There is a daily temptation to stop caring, to place self-care in priority, to quit, and many succumb. Few enter the arena of caring for the hungry, hurting and forgotten and fewer continue to care through the pain of so much loss. Thank you for your part in serving these beautiful people!

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It is said in missionary medicine that, in cultures unfamiliar with the benefits of modern health care, frequent hospital death is expected and normal, because the basic, yet adequate, missionary hospital is the last resort. The families wait and wait, they pay for a shaman’s “remedy”, they wait some more, they visit the wholly inadequate “free” government health post, they wait some more, and then they go to the hospital. In the case of almost every death at our hospital, we know that if they had arrived and begun appropriate treatment sooner, they would likely have survived.

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Trust is such an integral part of health care and it takes years for a culture to trust in a “new” method of care. Demonstration and testimonial word of mouth are the only methods of increasing trust/confidence and in this culture, as in every culture, bad outcomes are discussed and critiqued more than gratitude expressed for good outcomes. The physician’s years of education are irrelevant because the only “education” they are familiar with is the local, dirt-floored school house infrequently visited by a teacher. Cause and effect are not their world view. They know nothing of technology or solid, reproducible medical studies/research. Our visits in Cavango have increased greatly over the years, showing a transition of trust but we are, still, rarely the family’s first health care consideration…

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Thank you for joining us in caring for these beautiful people. Please stay the course with us, as we will not succumb to indifference!

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I’ve just completed an excellent novel by Charles Martin, called Water from my Heart. I’d highly recommend it and I look forward to reading more by this author.

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Betsy and I are away at a remote, Angolan beach for a two-week get-away. We will then be in Lubango for two weeks of meetings before returning to Cavango August 1st.

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2 comments

  1. Thank you for sharing your ministry. My husband and I spent 3 years in Luanda (2014-2017). Recently I stumbled across your blog and it is always an encouragement to me as well as a reminder to pray for the people of the country.

  2. We love to hear of your work in Angola and are so blessed we can share in it with you.
    May the Lord bless your time away and fill you with renewed strength for this godly task.

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