New Place, Staff, Why, Sobas, Raft, Bridge…

We have moved into our new facility. It was incredible today to see our eight critical patients in only two rooms, our Emergency Room with four beds and our ICU, with six beds, even though these areas are quite simple compared to those in the rest of the world, as there are no beeping machines. Any of these eight patients could have died during the night, but all greeted me as I entered their respective rooms. Francisca (photo) had been in a coma for four days with hepatic encephalopathy (liver failure) and sat up and spoke to me with a slight smile, verbalizing gratitude that she was alive. About a month ago, we found an old medicine in a city pharmacy which is normally not available in Angola and, because we have many such cases and almost none survive, we bought some of this medication (which helps the body remove ammonia, the cause of her “toxicity”) and she was the first to receive it and benefit. Without it she wouldn’t have survived. The Wind…

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A young man arrived a couple days ago with peritonitis, appearing to likely need transport with the next MAF flight for urgent surgery in Lubango, but he had stopped vomiting during the night, he said he had hunger for the first time in almost a week, his abdominal exam was now almost normal and he will recover over the next few days. A baby with severely low oxygen from pneumonia had survived the night on one of our oxygen concentrators and had begun to nurse. A man who hadn’t slept in weeks because of heart failure said he slept all night – in such a busy and noisy setting!

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In the other room, a 3-month-old baby had presented to us a couple days ago with fever and severe swelling about one eye, so tight that I could hardly open her eye lid to see her bulging and fixed eye. This morning her eye swelling was about 50% gone after 48hr of antibiotic treatment for her orbital cellulitis, which often blinds and/or kills its pediatric victims. She actually smiled, both eyes tracked my movements, and she will survive, with her vision intact, without surgery. Our little two-year old boy in traction (photo) smiled and reached for a sucker. He’s been in this position for three weeks and we were able to get an image of his femur with our new x-ray machine, which revealed a bone tumor rather than what we thought was a fracture. He was all too glad to have the traction removed and will go to Lubango this week for surgery of what may be either infectious or cancerous in origin.

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Another young adult with what could have been an intestinal perforation from typhoid or appendicitis was pain-free and smiled on my approach. A teen with a severe fever and low oxygen levels because of pneumonia greeted me with a smile and said he was “breathing fine” after not being able to breathe for a week.

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Later the same day, I saw several people return after surgery in Lubango with our severely talented surgical colleagues. A pregnant woman left in a coma with seizures secondary to eclampsia, received a Cesarean and survived. A woman left us in shock, with a tube in her abdomen draining pus, and had multiple intestinal perforations from Typhoid surgically repaired, and was eating, drinking and smiling. Her parents gushed joyful understanding and gratitude for all that had occurred to save her daughter’s life. A 60y/o woman walked in on crutches beaming. She had left us several weeks ago, on a stretcher in the back of our pickup truck with Betsy, enduring a 90min, dusty and bouncy drive to the dirt airstrip. Prior to that she had been in traction in our hospital for several days with her foot tied to a rope which extended up over a ceiling truss to a dangling cinder block. She had come to us on the back of a motorbike (!) fracturing her hip after falling from the back of the same motorbike on her way to see us for an unrelated illness. She was so grateful, as was her family.

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Those we send for surgery for life/limb-threatening illnesses sometimes don’t survive, but the majority return to us well, as did these, after overcoming illnesses that would have killed them without the services of local men and women, Cavango, MAF and CEML and all those who support these works from the other side of the world… Our Father’s Wind has chosen to heal, not miraculously as Jesus did, yet miraculously still, through the unity, love and collaboration of tangible, sweaty and flawed fingers, hands and elbows…

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We canceled our planned “inauguration” because of needing to prioritize funding for patient-care modifications, as we rush to have all patients and families under roof before the rains begin in a month or two.

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We have two teams of workers, each of whom work alternating weeks, as they all need time in their fields to grow their corn, the staple for this cashless, store-less, rural culture.  All of our revenue from consultation fees is paid out in salaries but, for our staff of about thirty, the salaries are small, averaging about $4/day.  Saturday mornings we gather both teams for a staff meeting and shift change.  We noted this week that our volume is down, typical for this time of year. We currently have only about 80 inpatients. 

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These meetings are a joy and give me the opportunity to praise work well done, offer corrections, listen, listen, listen and impart vision, which involves largely remembering why we do what we do.  We always try to discuss three basic questions, “What do we want to be doing?”  “How are we doing re what we want to be doing?” and “How can we improve how/what we are doing?”  The participation is always hearty, responses thoughtful and enthusiastic and there is a real sense that those on our Cavango team are each an essential and equally significant part of a very special Kingdom ministry/work, serving their hurting neighbors, who have no one else to trust to care for them and/or their sick kids. 

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This week’s meeting went for over two hours, as we discussed our ongoing renovations to improve our care, several key patient interactions that went well and a couple where we could have given better care.  There is great enthusiasm for the new space and it’s so good to see the pleasure experienced in the renovations, especially by those who do work that is not seen as so “honorable”.  Those who register patients were given a nice new space, the cleaning crew was honored with a new space and materials, the guards have a small house in which to sleep when able and, of course, the nursing areas are much improved.  The patients are appreciating the increased space, as well.  We will soon move the pharmacy out of what was the size of a closet to a larger, nicely ventilated and lighted space in the new building.  Their excitement around the changes is palpable.

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Next up will be a simple, large metal-roofed, wall-less “vila” (picture a “shelter house” at a North American park), where patient families can sleep dry during the upcoming 4-6 months of rain.  Also, we will block-in the exterior walls of our newly roofed area which will triple our inpatient space.  All are simple and functional changes, which our construction crew is accomplishing with excellence and at a very good pace.

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We invited the Sobas, or chiefs, from the surrounding villages (photo) within about a day’s walk, to a meeting today, which we hold several times/year, and by the time the meeting concluded, after almost three hours, we had over forty Sobas in the meeting/waiting room of one of our new hospital buildings.

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These stoic men who live and lead in the simplest of conditions spoke at length about the value of our work for their people.  I emphasized to them our commitment to serve the rural people of this region, those without access to the still-limited resources of the city, many hours away.  Most walked many hours to attend, some wore their uniform as chief, some did not.  Their words were heartening, as we face so much apathy and conflict from the government and/or the church denomination which owns the mission property.  The bond between all of us is always obvious and I emphasized that we could accomplish much if we remained united in the purpose of serving the people of their aldeias (villages).  It’s a great group of leaders, most of whom humbly serve their people well, and it’s always a joy to meet leaders with servant hearts who want to sweat with us in serving their people, rather than seek handouts.

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Our main agenda item this week was crossing the large Cubango River (50m-300m across in this area), which is hundreds of miles long and drains into the Okavango Delta in Botswana.  A couple years ago, we constructed a simple barrel raft, especially for those ill and seeking care at our clinic, which is used multiple times daily for crossing the river above the rapids.  We shared about the issue of frequent theft of cable, nuts/bolts from the raft and how we needed help in overseeing its maintenance and safe function.  When the water rises, September through April, the current is quite strong and raft stability becomes a factor.  We know of only one accident, when the raft was overloaded and two motorbikes ended up at the bottom of the river and several people got a bath.  Crocodiles are all around this part of the river, but no injuries were reported.

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The Sobas raved about the value of the simple raft, the likes many had never previously seen.  We shared about our desire/plan to construct a very basic bridge over the river and solicited their help.  We built a similar bridge over the Kutato River, about 15km from the hospital, and we are told over a thousand people cross that bridge weekly, many enroute to our hospital.  We will build this bridge in coming months, over the large boulders and rocks which create some beautiful white water rapids, about 150m across (photo).  We will use cement and rebar to construct pillars of rock on top of the boulders and place wooden bridge planks on the pillars.  We hope to begin construction in May, when the water recedes (it is currently low but we don’t have time this year to complete the project before it rises the normal two meters).  It will benefit literally thousands of people as they venture to the hospital in the high-water season over coming years. 

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We will reinforce and guard the raft and its pulley system during this rainy season and we made agreements as to choosing a leader for the bridge project and soliciting volunteer labor from all of the surrounding villages, represented by these men.  They were enthusiastic in their support and voiced gratitude for this project which will benefit so many.  We estimate the materials will cost about $10,000 (mainly for cement, wood planks and transport of the same) if you would like to contribute to this important work which will serve many.

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There are so many ways to help these people access the excellent medical care we offer in Cavango and transport to the hospital is perhaps the principal challenge for these rural folks, most of whom travel by foot and some via motorbikes which are hired with their driver for transport.  We are able to assist them to appropriate and often life-saving medical care with rafts, bridges, our ambulance and the transport of patients with urgent surgical needs (like those above) to our surgical colleagues in the city via weekly flights (or more) with our missionary-servant-colleagues from MAF, none of which would be possible without your help.  On behalf of them, “Thank you!”

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