Over several mornings, I asked our pre-clinic gatherings of patients and their families how many people had broken a bone in their lifetime.  Each time about three of those sitting in our circle raised their hands.  In the US, statistics reveal that about fifty percent of people have had a broken bone by age 65.  It could be that many people here don’t know they have broken a bone, didn’t know what I meant or didn’t want to raise their hand, but the difference is quite significant, nonetheless.  We only average 1-2 fractures/month at Cavango.  One of the “costs” of progress!

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A much loved little boy, Graciano, arrived in the company of three motorbikes with six men, in a coma and, per my obviously expert opinion (revealed below), he had no possibility of survival… He had three illnesses, each severe enough to kill its victim without any help from the other two. Graciano’s face and neck were extremely swollen (with difficulty breathing from swelling around his airway, eyes swollen shut) secondary to a spreading facial abscess which began in a tooth and reached from his neck to beyond his temple. Tooth infections kill where there are no dentists. He also had a critically low blood oxygen level and little remaining blood, with Hb < 4 (normal > 12), destroyed by malaria. The infection from Graciano’s mouth had been aspirated and caused severe pneumonia. We put Graciano on oxygen (from a concentrator which we simply “plugged in” to a wall outlet (!)), transfused into him his Mom’s blood and drained a large amount of pus from his neck and face three times over the course of a week and now his swelling is gone, he is without supplemental oxygen and his blood count is normal. Graciano will return home soon, with only a small, healing scar on his neck.

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Goiter is a common problem here (photo). Iodized salt is a great public health benefit…. The beautiful woman pictured, Salomé, arrived in heart failure and with full-body edema from an inflamed, nonfunctioning thyroid gland which had developed quickly over a month. She also had pneumonia with critically low oxygen levels and has responded well to our initial treatment.  She and her family are a delight and greet us warmly every morning.

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We have a major rat problem.  People are getting bit at night, food is missing and the varmints are seen running around the inpatient ward throughout the day and night.  One person estimated, “hundreds”!  They are living inside the walls of our inpatient ward.  The people are not at all upset about it, but I am!  We will seek to address the issue this week and cannot use poison because people eat rats, even dead ones…  and I’m told that people in this culture won’t tolerate the presence of cats…

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For the first time in Cavango since our arrival in 2013, the following are not “my” stats, but those of Eduardo, Jocelyn, Laurel, Florindo (local “apprentice”) and myself.  How cool is that!

In 2021, our little, rural work in Cavango saw approximately 8000 people arrive for a consultation (30-ish per day) and 64 patients of every 65 were treated here and the vast majority returned home well.  Approximately 14/15 of our 2000+ admitted patients, so many arriving critical with life-threatening illnesses, were treated here and the vast majority returned home well.

We transported approximately 1/65 of our consultations (1/15 of our admitted patients) to Lubango to receive urgent care for illnesses necessitating life/limb-saving surgery. Over the past year we have spent over $100,000 paying for these surgeries. We pay because the situation is urgent, the patients arrive in Cavango unaware of the seriousness of their illness and they would never know the cost for life-saving surgical care (surgery care averages about $1000/patient – so inexpensive globally). With reason, they don’t bring that amount of money with them to Cavango and the urgency prevents them from a return home to acquire the same. Because we are sensitive to the exhausting effort involved in recouping costs from patients in an impoverished culture, we never want our patients to add to the heavy financial burden at CEML, the mission hospital in Lubango providing the surgical care. Thus far, we have remained faithful over many years to pay all medical expenses for our patients needing emergent transfer to CEML, often making painful sacrifices in other areas to do so.

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Prior to transport, we sit with each anxious and concerned family and ask them to verbally commit to reimburse us after their surgical care (always giving a pretty close estimate of costs) and, after their return, we sit with each family again (now usually thrilled and grateful) and go over the CEML bill and explain the costs and our need for reimbursement in order to continue to help others with similar, urgent concerns.  Every family readily agrees, both prior and after, to pay for their care, but about 1-5% of our costs were reimbursed in 2021.  The remainder of our work in Cavango is self-sustaining (!), with the patient fees covering salaries and charges for medication covering the purchase of new meds, but these globally-low expenses for crazy-beautiful-and life-saving surgeries, for a radical minority of our patients, can be overwhelming. 

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These patients are also unknowingly blessed beyond measure in that their transport is provided by, and completely paid for (over $2000/flight), by Mission Aviation Fellowship (MAF), the Canadian “wing” of the beautiful international aviation ministry by the same name, and their always-ready-to-serve pilots in Angola.

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Many of you are involved in these efforts which save over 100 lives annually, but the disproportion of expenditures is burdensome, to say the least.  “If one of your 100 sheep…” “If someone asks for your coat…”

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I was asked recently if it is difficult to always be raising funds to do what we do.  It does, of course, require a fair amount of time and effort and many of you participate with us financially in this work and I am grateful for every sacrificial contribution to this work, which benefits so many!  I don’t see myself, however, as raising money but, rather, as gathering partners to provide care with us via…

• beds, blankets and sheets for those ill and staying in the hospital,
• simple buildings to house the above beds,
• employment for those doing the construction and those serving in so many other ways,
• food for those hungry and/or malnourished,
• clothes/shoes for those without,
• reading glasses for those older,
• real and proven remedies for those blind, lame and otherwise seriously ill,
• roofs over the above-mentioned beds during storms for those who seek our help and are too ill to return home (inpatients),
• light for those in darkness,
• clean water for those thirsty, from a spring 2km from the hospital,
• lab tests, an X-ray machine and portable ultrasound machines help greatly in providing, accurate diagnoses,
• surgeries for those who would die without,
• instruction about improving physical health,
• seeking our Father for help with those who can’t/won’t (praying with them),
• messages of freedom in Jesus to those held captive by the culture’s godless philosophies, promises and lies, and
• introduction to Jesus for those who don’t know they don’t have to live life alone…

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Cultures are very much like people, with different “personality traits”, strengths and weaknesses. Highly valued in this culture are “nice-ness” and avoiding offense. Also, little is accomplished because critical thinking, for the purpose of improvement, is rare, as critical thinking is, indeed, “critical” and might offend. If it might cause any discomfort or anxiety, speaking truth, even when obvious, is unknown. Telling lies is common because smooth waters are valued more than revealing what is true. One doesn’t correct the wall that is not plumb, remove the fallen tree in the path, address the rattle in the car, or call the doctor at 2a when the baby is breathing poorly – better to be “nice” and remain unflustered – and the child dies…

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There is little effort to improve anything because resources are scarce and to do so would be critical of the way things are…

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This provoked in me recently a desire to restudy Jesus’ interactions with people and I was surprised at how often He said or did something that could be considered “offensive”.  He was critical in order to bring those hearing Him to an improved relationship with His Father.  This implies, of course, that the relationship isn’t right and is, therefore, “critical”.  I don’t know His tone or how He called Peter, “Satan” or how He called some religious leaders “hypocrites” and “white-washed tombs”, full of death and wickedness, or how He called the same a “brood of vipers” who clean the outside of the cup while the inside is full of filth and self-indulgence, or how He explained His offensive dictates to be “born again”, eat His body, hate your mother… 

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Jesus compiled quite a number of interactions that many church people today would consider inappropriate for a “Christian”, criticizing people’s beliefs and insultingly wondering aloud how long He should put up with His chosen disciples. We know His motive was love and He will always be my primary example and model for what love looks/sounds like. He clearly reveals, however, that love is not, always “nice”, but must, at times, speak what is true, even when it might be difficult to hear and act in a way that might offend someone. He quoted Isaiah and told them they “honor me with their lips, but their hearts are far from me. Their worship is a farce, for they teach man-made ideas as commands from God.” And “You cancel the commands of God for your own traditions.”

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I wonder what He wrote in the sand to cause “certain” accusers to flee.  He caused offense when He healed on the Sabbath and when He reorganized the temple furniture.  Couldn’t He have just healed on other days and remain “respectful” in the temple?  I wonder what “offensive” behavior provoked leaders to call Him “a glutton” and “a drunk”?  Surely He could have “reigned it in” and changed His behavior in order to keep “peace among men”?

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Jesus told this story to some who had great confidence in their own righteousness: “Two men went to the Temple to pray. One was a Pharisee, and the other was a despised tax collector. The Pharisee stood by himself and prayed a prayer, justifying his choices in life: ‘I thank you, God, that I am not like other people—cheaters, sinners, adulterers. I’m certainly not like that tax collector.’ But the tax collector stood at a distance and dared not even lift his eyes to heaven as he prayed. Instead, he beat his chest in sorrow, saying, ‘O God, be merciful to me, for I am a sinner.’ I tell you, this sinner, not the Pharisee, returned home justified before God. For those who exalt themselves will be humbled, and those who humble themselves will be exalted.”

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Does criticism necessarily reveal lack of humility? Is there a difference between being “critical” and directly confronting destructive behavior?

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He said, “Beware of the leaders who like to walk around in long robes, and like respectful greetings in the market places, and chief seats in the religious services and places of honor at banquets, who devour widows’ houses, and for appearance’s sake offer long prayers; these will receive greater condemnation.” 

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“If God were your Father, you would love me, because I have come to you from God. I am not here on my own, but he sent me.  Why can’t you understand what I am saying? It’s because you can’t even hear me!  For you are the children of your father the devil, and you love to do the evil things he does. He was a murderer from the beginning. He has always hated the truth, because there is no truth in him. When he lies, it is consistent with his character; for he is a liar and the father of lies. So when I tell the truth, you just naturally don’t believe me! Which of you can truthfully accuse me of sin? And since I am telling you the truth, why don’t you believe me?  Anyone who belongs to God listens gladly to the words of God. But you don’t listen because you don’t belong to God.”  

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“Do not give dogs what is sacred; do not throw your pearls to pigs. If you do, they may trample them under their feet, and then turn and tear you to pieces.” 

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Jesus called the king a “fox” and said “it is not right to take the children’s bread and toss it to the dogs.” 

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He told His listeners in story form that they had killed the prophets He had sent to them and that they would kill Him.  He said He wanted to gather them, as chicks under his wing, but they would not oblige.  He told His followers that they would be killed because they were teaching the truth of the Kingdom of His Father.

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Jesus was seen by some in His day as critical, offensive, temple-wrecking, law-breaking and “a drunk”. I wonder how much this concerned Him? How much do the perceived or real opinions of others influence our behavior/perspective? Jesus called people Satan, devil’s children, pigs, dogs, tombs, snakes, murderers, costumed hypocrites and liars? Do we follow Jesus or have we crafted a “nice”, inoffensive, churchy (false) image of Him?

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Some of the messages of Jesus’ followers were equally harsh. Paul said to a man, “You are a child of the devil and an enemy of everything that is right!  You are full of all kinds of deceit and trickery. Will you never stop perverting the right ways of the Lord?  Now the hand of the Lord is against you. You are going to be blind, and for a time you will be unable to see the light of the sun.”  

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Peter said to the gathered crowd at Pentecost and following, “So let everyone in Israel know for certain that God has made this Jesus, whom you crucified, to be both Lord and Messiah.” And “You rejected this holy, righteous one and instead demanded the release of a murderer. You killed the author of life, but God raised him from the dead. And we are witnesses of this fact!”  Directly to leaders, he insultingly said, “Do you think God wants us to obey you rather than him?  We cannot stop telling about everything we have seen and heard.” And “We must obey God rather than any human authority. The God of our ancestors raised Jesus from the dead after you killed him by hanging him on a cross.”

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Criticism can be like virtually everything else in our Father’s created world.  It can be constructive and edifying or it can be destructive.  We can choose to be critical of virtually everything and lose humble gratitude and never extend grace and this is certainly unhealthy and not of our Father…

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Our motive must always be the prioritization of another (love) and, as Jesus demonstrated, this can involve criticism of those who live in a manner that is destructive or harmful to him, her or another . Instead of confronting error face to face, however, we often smile in another’s presence and criticize them behind their back (or on social media).  We have it backwards.  How much healthier for all involved to… directly (Mt 5.23)… “speak the truth in love”, like the One we follow, rather than speaking criticism “about” another. 

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Jesus’ emphasis on absolute “Truth” has influenced this world more than we might normally consider and as we, globally, foolishly and ignorantly refuse to acknowledge our Father’s profoundly beautiful and healthy design and instruction, I fear the consequences will be severe…  Ps 119 is a beautiful review of one needy, sinful and wise man’s marveling at the universal health of our Maker’s loving mandates for those He created with a Father’s love…

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My own beautiful culture is trending rapidly to embrace the same ways as the rural and godless Angolan culture, which has literally not changed since Jesus encouraged His followers to be as wise as serpents and as innocent as doves… 

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A fellow Jesus-follower recently told me that he is tired of conflict and wants no more. Me, too. Paul thought similarly about his “thorn”. Like the Angolan culture, we can certainly choose to live a life void of conflict, but in my understanding of Jesus’ perspectives and emphases, that is essentially abandoning allegiance to our King and prioritizing personal peace and “control” over the messy, painful and full-of-conflict-battle that we are invited to wage, with Him, to bring Light to those captive in the darkness…

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In Cavango, I try to follow the 10:1 rule re encouragement:criticism, but when someone treats another poorly, acts well apart from their ability/potential, or behaves in a manner that could cause harm, I am critical, directly and honestly.  I’ve been told recently by one of my local “disciples”, “We know you want what is best for us, but your words are sometimes not pretty or easy to hear. We always know where you stand. There is no guessing.”  I think this benefits them.

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Like the One we follow, we must always emphasize the Kingdom beauty of mercy and unmerited favor (“Forgive them, Father”), but we must also seek the very best in those with whom we interact (“Go and do this no more”), even if it means pointing out potentially destructive behavior as we seek, above all else, the pleasure of our Father…