Twenty-year-old Amanda arrived in the dark of night with her family and a bundle held closely to her chest.  Her young husband said they came from the local health post where they had returned for three consecutive days and, when no improvement was noted after receiving amoxicillin and oral rehydration drink for their one-week old, prematurely born, 2kg little girl, they decided to make the two hour trek to Cavango.  They said the baby developed a fever and cough after just two days of life, had stopped nursing and they had been frequenting the largely empty health post since.  They said the baby nursed little, cried never and was limp. 

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Amanda shared that she had delivered three babies prior to this one and they had all died during their first days of life, so common in rural Angola, where 1/3 children don’t live to age five.  Amanda was obviously distraught.

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Our night nurses had been unable to reach me on our walkie-talkies (dead batteries), which are used for such purposes, as there is no phone service here.  They had then driven by motorbike to Laurel’s house and she and Jordan, a visiting missionary friend and NP from the US and living in Huambo (the closest city, 3-4hr away), had arrived a few minutes before me.  They had messaged me about a very sick baby, using WhatsApp, before they left for the hospital and I received their message and hurried in.  On my arrival, they recounted the story to me and I asked to see the baby.  Amanda unwrapped the bundle, which Laurel said had nursed briefly on their arrival a few minutes prior.  As Amanda unwrapped her “bundle”, I was unable to detect any respiratory movement.  There was no muscle tone… and no pulse. 

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We hurriedly put the baby on the bed and began chest compressions, hoping she hadn’t been dead too long.  I began mouth-to-face respirations and continued to pump her chest.  Jordan and Laurel joined in without hesitation.  After several minutes, I detected a heartbeat.  The baby vomited.  Jordan wiped away the vomit and continued mouth-to-face respirations.  We gave her epinephrine subcutaneously as we had no IV access.  Our nurses all energetically responded to our commands, as they have now seen several successful pediatric resuscitations.  We continued our chest compressions, while giving the tiny girl oxygen via mask and Laurel ran to our supply area and grabbed an interosseous (IO) needle, which we placed in her femur, giving her several syringes of much-needed fluids, as well as some antibiotics.  She breathed a couple times and stopped.  She had a heart beat, but very slow.  We continued.  After about ten minutes, when we again stopped to reassess, and her pulse was stronger and faster and respirations were coming regularly and fast. 

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Amada’s little girl survived the night on oxygen, while continuing to receive fluids via our IO line, had urinated multiple times (our high-tech evidence of good hydration) and had begun to cry, though very little.  We had instructed Amanda to pump milk into a cup and give the baby drops by syringe when she cried.  The baby was swallowing the milk hungrily and even sucking on the syringe, while breathing over 100x/min.  Observing this, our night nurse had removed the oxygen periodically to see if the baby would nurse, and she had sucked briefly several times, having to stop because of difficulty breathing.  We removed the IO and removed her oxygen mask and replaced it with a nasal cannula.  Her blood oxygen levels were adequate while on supplemental oxygen and inadequate while off, so we continued to supplement her oxygen, using one of our portable oxygen concentrators, hooked up to an outside generator.  This morning, Amanda’s baby was nursing, crying energetically and definitely improving from her severe pneumonia, likely contracted during her home birth, while showing no signs of brain injury!  She will survive, reproduce and generations will be impacted by our Father’s care through your contributions and our basic, simple care in this remote place…

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In the next bed, 14y/o Mariana developed fever and also went to a “health post” where she was diagnosed with malaria and given “treatment”.  One never knows what treatment she might have received.  She went home and developed seizures and became comatose and the family brought her, finally, to Cavango.  She had cerebral malaria, which had likely progressed from “normal” malaria after inadequate treatment.  Because of the remarkable modern medications available to us, almost all malaria responds positively within 48hr with appropriate treatment.  Because of inadequate supplies from the “free”, socialized, government health system, well-intentioned but minimally trained workers in the health posts commonly give half and quarter dosages so that they can treat more people (!).  Because most people, especially adults, survive malaria, the workers mistakenly think their less-than-adequate treatment helps when it is, actually, setting up Angola for severe malaria resistance in coming years while today many (children) needlessly die.

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On examination, Mariana’s left side was flaccid when she barely responded to painful stimuli. Her right pupil was large and nonreactive, indicating severe brain injury. She didn’t improve over five days of excellent treatment and succumbed to the illness. Malaria invades red blood cells and causes them to stiffen and they can’t pass through blood vessels, causing tissue injury wherever this ischemia (“blockage”) occurs. The damage can be in any part of the body, as we’ve seen kids lose fingers and toes, suffer kidney failure, lose their hearing/sight, become developmentally delayed, suffer lung and brain damage and other complications, which are commonly preventable and, often even reversible, if treated in time. For Mariana, this process caused irreversible damage in a large part of her brain, similar to one who suffers a large ischemic stroke from a blood clot.

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Two women arrived the same day with severe heart failure.  They both were barely alive, needing oxygen and several medications to get through the night and, only after several days “circling the drain” in critical condition, slowly began to show signs of improvement.  They both needed medicine juggling for almost two weeks before improving enough to walk outside without oxygen.  Heart disease is one illness I didn’t anticipate seeing much in a poverty setting like Cavango, but it is so common.  Feliciana is in her forties and has severe valvular disease, likely secondary to untreated strep throat, causing years of blood flow inefficiency followed by pump failure.  Laurinda is 65 and, after years of untreated hypertension, her pump failed due to continually pushing against the high pressure.  Two very different illnesses leading to a weakened heart. 

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Both are showing signs of remarkable recoveries and they are beautiful examples of both the joy of working in medicine with tools in one’s belt that make a life-and-death difference and working in Cavango, where neither would be alive today without our presence here and your partnership with us, all made possible by the Maestro’s invitation to all of us to bring our scarred and broken instruments to participate, in greatly varied ways, in his traveling orchestra to make some crazy-beautiful music in places where His music is largely unheard. What a great reason to wake up each day!

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We are enjoying a visit by seven beautiful Jesus-lovers from a church in Columbus Ohio, the church where I met Betsy in 1990, and where we served and learned for years with our young and growing family.  The team is exploring ways to supplement nutrition via agriculture for the people we serve and many will benefit from their presence, efforts and hearts to partner with us in Cavango.  What a daily encouragement they are!  This morning they prayed for every patient (!) at our morning, pre-clinic meeting.

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This week, some drunk men and women arrived at the hospital while we were away at lunch and dragged one of our sweetest workers away, tied Eliza up like a goat and took her away to the center of our village, where a mob surrounded her, accusing her of placing a curse on a child who had recently died. The baby had an illness for five months, (finally) came to our hospital and still went home improved. After leaving our hospital, his parents (the main accusers) took the child to the local Shaman to receive who-knows-what toxins in his concoctions – and he immediately died – in the Shaman’s arms!

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Something similar has happened several times in the last year, most recently to an elderly, uniquely godly woman with a beautiful, large family and mother to two of our dear friends.  While her husband of 30+ years was away, the mob came for her in the night and attacked her with knives, also accusing her of killing a baby with a curse, but she was able to get away and hide in her house, with her family protecting her.  For her safety, she has moved a one-day journey away – a great loss for this small community.

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Eliza is faithful, quiet and stellar.  She is a single mom as her husband died several years ago.  Eduardo heard about Eliza’s assault after our return to the clinic in the afternoon and he and I drove five minutes to the “proceedings” in our local village and confronted the mob and, especially, its leaders, as they surrounded Eliza.  Eliza was seated in the dirt, barely covered in her torn and shredded clothing, head down, in the midst of about 50-60 fired-up adults.  She appeared physically unharmed.  They were holding a spontaneously arranged “trial”, hearing all the unsubstantiated and wild accusations against her (and not allowing her to speak).  

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After a “colorful” exchange with the leaders of the mob, Eduardo and I ushered Eliza away in our car and put her in a private room at the hospital, which she can lock, for her safety.  She recounted her story to us, of hearing about the accusations the day before and then being dragged away and tied up, first to a tree and then in the center of the mob.  To say she was traumatized would be an understatement, but she handled it all quite well.  We will further address her assault in coming days with community leaders from around our region, as accusations of witchcraft are common and quite difficult to defend, especially to a mob (there is no law-enforcement here). 

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As you know, my posts have been removed from public distribution because I can be critical of the culture in which we live and work.  Eliza’s experience of abuse is one of so many we see regularly among people who I have come to love dearly and consider, as a whole, beautiful, vulnerable and full of potential.

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To say I was angry at the behavior of those in our village would be putting it mildly.  I was also angry at those on our staff who watched while Eliza was dragged away, with no one raising a voice or a finger in her defense.  People who attend “church” in the village were part of the mob…

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At our full, weekly staff meeting today, for over an hour our thirty hospital staff members discussed loyalty, offenses, conflict and how we will defend each other. I shared Jesus’ perspective on offense and that we were to never accept an accusation against those in our hospital family without first hearing their side of the story.  It was an excellent learning experience for our team.  Discipleship isn’t “teaching” and bible study, though both might be involved.  Discipleship is living together – sweating together, failing together, rejoicing together, crying together…

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People question our Father’s “wrath” depicted, especially, in Old Testament stories. If one is tempted to think that wrath and confrontation are never justified, he/she needs to come and live with us for a season in this radically godless culture, full of beautiful and confused people who believe so many lies and/or are victims of those who do. The abusers wield power and control and the abused are held in bondage via fear and see themselves as “subjects” to those with power. We see the fruit of abuse and neglect daily… hating that which destroys someone loved is consistent… sometimes anger is justified and confrontation is necessary…

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I can’t describe how beautiful Eliza is as she faithfully does her cleaning work every day at the hospital.  For several years, she has been a truly precious part of our clinic family and who can stand by while someone one holds dear is molested in such a manner?

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These posts are written to those who partner with us in our remote work among the rural people of the Cavango region. I realize they are, at times, somewhat raw in their honest depiction of people and events.  They are written to communicate reality, in all its beauty and ugliness, as best I am able, and to give you, our faithful and caring partners, an accurate depiction of the work and people you support.

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I so appreciate the many notes of encouragement I’ve received over these past weeks from those of you who understand.

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