As I walked into our ICU this morning, I was confronted with a few of those we serve.  A partial list is compiled for you who partner with us in the successes detailed here and so many more who benefit from your contributions and sacrificial support every day in our little Cavango hospital outpost in the middle of Africa nowhere,

I met 17y/o Mariana on the way into the ICU as she was… walking out… with a huge smile.   She had arrived about a month ago short of breath after having a gaping hole draining pus from her chest under her arm – for over a month at home!.  She weighed about 80lb, could hardly lift her arms and hadn’t walked or been out of bed for three months!  Her lung was collapsed and she endured a chest tube and lavage and drainage through the tube for over a week.  She began to gain strength and just the other day began to stand by the bed and then walk a few steps with a walker.  Mariana had severe, disseminated TB and has responded remarkably well to treatment.  Her chest/lungs healed and she is walking everywhere, always grinning.  She has gained almost 20lb!  She was in the ICU visiting a family who had become her friends when she was there on oxygen for so long.

Another beautiful lady, 23y/o Alice, had given birth a month prior and began developing raging fever, a stiff neck and the worst headache of her life, accompanied by persistent vomiting.  She could hardly move her head or open her eyes.  We began treating her for bacterial meningitis and she still has a severe headache (though about 50% better than when she arrived) after two weeks in our ICU, but just left her bed a couple days ago and is eating without vomiting.  College campuses used to see this type of awful meningitis infect students in North America every fall/winter, but now there is a vaccine and it is rarely seen.  It was quite nice that Alice responded by coming to Cavango.  Another day or two delay and she wouldn’t have survived.

Maria is a 35y/o woman with hepatic encephalopathy and she emerged from 4d of coma yesterday and today is freely conversing and walking.  As you know, we are always assisting several people in our hospital prepare to die from liver failure after receiving toxic, “all-natural” remedies from shamans.  We lost a beautiful man this week to the same illness a couple days after we drained three gallons (!) of fluid from his abdomen.  Hopefully, this lovely woman’s liver will continue to respond positively to our treatment.

A 30y/o man, Bartolomeu, with a history of daily alcohol abuse, arrived with Korsakoff syndrome (severe vitamin deficiency) which resulted in his presenting in a near coma state and unable to converse. He hadn’t been able to use his legs for over a week. He is today much improved and is talking and walking.  Hopefully, he will leave to a sober life caring for his family free of the curse of addiction.  Alcohol abuse is common here.

A 2y/o little boy, Eduardo, arrived with generalized tetanus, screaming in constant pain and unable to move his head (held in extreme extension), open his mouth to drink/eat, bend his limbs, and experiencing consistent seizure-like activity commonly seen in tetanus.  Eduardo has been with us for two weeks of IV hydration and muscle relaxants and is eating and drinking and will survive this normally deadly illness.  Eduardo, like so many in this rural setting, was unvaccinated (parents have little understanding of the benefits), though a vaccination program is widespread and available to most in Angola.

A 1y/o, whose name escapes me, arrived with severe malaria, barely alive, and severely anemic – Hb 3 (normal 12).   He was immediately transfused and is nursing.  In a week, the malaria had destroyed ¾ of his blood (!).  The beautiful, torrential rains have begun in our area, everything has turned multiple beautiful shades of green, the mosquitoes (and flies) have returned and many children will arrive with similar symptoms daily.  Transfusing a little of, usually, mom or dad’s blood into these children is often all they need to survive, along with malaria treatment to kill the deadly culprit.

Feliciana is 50y/o and arrived with empyema (a chest cavity filled with pus) from a combination of a longstanding TB infection and an acute bacterial infection. She is tolerating a second chest tube and has needed constant oxygen supplementation for over 3wk but, is now, finally, improving every day, though still needing oxygen.  She is a beautiful, tough woman who is largely in this predicament because she tolerated pain and difficulty breathing for too long before seeking help.  Her toughness will now hopefully get her through the painful treatment she is enduring quite well.  Her daughter is 10y/o and helps us with her treatment and we call her one of our nurses and she offers us a beautiful smile every day on our arrival (her attitude has nothing to do with her daily treat, I’m sure).

Frederico is 65y/o with bleeding from his stomach and loss of 2/3 of his blood (Hb 4).  He was transfused, treated and has improved rapidly and is to go home soon.  Frederico has lived such a difficult life, losing an eye to a bullet in the war, yet he greets us warmly with gratitude every day.  He suffered severe stomach pain for months and lost weight he didn’t have to lose before seeking help and is so grateful for being able to eat again without pain.

Helena endured a prolonged labor at home and complicated delivery (vacuum extraction for cephalopelvic disproportion – baby’s head too big for the mother’s pelvis) in our hospital;  The baby was (remarkably) born alive and the mother lapsed into a malaria coma, suffered postpartum hemorrhage following delivery, had a Hb 5, and was transfused.  She awoke from her coma after just 24h while her baby had hungrily nursed the entire time.   Helena is improving and walking/eating.  This disproportion is a common problem here especially in tiny women and these tough women endure, often, days of labor before seeking help (usually the baby has died).  They just don’t know the value of experience in hospital deliveries, as availability of this type of experience is scarce.

65 y/o, Claria, arrived with cerebral malaria and acute dementia, but is now improving, walking and conversing normally. 

A 35 y/o mother of eight, Cristiana, endured a traumatic labor with vacuum extraction of a dead baby, and then developed a belly full of blood.  We removed the blood from her abdomen and she endured multiple lavages of her abdomen to clean out the blood (fluid in through a tube in her abdomen and draining out into a bag), as well as a blood transfusion to replace lost blood.  Cristiana will go to CEML for likely a hysterectomy to remove the source of bleeding (we think a tear in her uterus);

Graciana is 60y/o and arrived in shock from a bacterial intestinal infection which caused profuse diarrhea for days, but she is improved after 48h of IV hydration and antibiotics, and is tolerating fluids orally and walking.  Bacterial intestinal infection is so common here, as boiling river water requires collecting wood for an open fire and just doesn’t happen every day.

A 1 y/o little girl who arrived after four days of coma at home (!) from cerebral malaria and she is improving, is nursing, but regular seizures continue;

Two other children arrived in malaria coma with constant seizures.  Both are still in coma after four days.  The parents of one of these children wanted to leave and take their child to a shaman.  They just don’t know the value of excellent, evidence-based medicine vs the herbs and roots of the local “salesman”.  Most don’t know the difference between a doctor and a shaman…  A long discussion ensued and they stayed.  I hope the baby awakes soon!

Petra is a 16y/o girl who arrived with acute difficulty breathing due to heart failure from Rheumatic Heart Disease, which had destroyed her heart valves.  She is improved after aggressive medical therapy and oxygen therapy for a week and is sleeping without difficulty breathing and walking and will soon go home to, hopefully, years of life extension (no cure here) with medical therapy.  Her illness likely followed an untreated, “simple” strep infection…

Candida, a 54y/o woman, arrived with hemorrhagic cystitis (bladder infection and urinating blood) for a week, and in shock.  She improved quickly, but would have likely died with another day of no treatment.  Another “simple” infection that went untreated for too long.

8y/o little Xavier, arrived with malaria, resulting in severe lethargy and Hb 4.  He was transfused yesterday with blood from dad and is eating and walking and, today, smiled as he accepted my sucker;

A 20y/o young man arrived after a night-time motorbike accident w multiple lacs and a facial zygoma fracture.  He improved with sutures and antibiotics and will survive with just a bit of facial deformity but much “road rash” all over (abrasions).  As soon as he had his sutures removed, he left during the night without payment.  A common problem…  We had three people leave in a similar manner this week, one was a baby with hydrocephalus. We told his parents that he could likely be cured with “free” surgery at CEML.  The baby will die without surgery.

Adriana had malaria and arrived in shock with severe anemia and dehydration, and improved after transfusion.  She delivered a healthy baby girl with no complications soon after arrival in such a state!  “Normal” deliveries are uncommon here as most deliveries in this rural area still happen at home and we normally see only those with obvious complications.

Cecilia is a 40y/o woman and she arrived with severe difficulty breathing and had an empyema. We drained her chest twice over 4d, each time removing nearly 2L of thin pus (caused by TB) from one chest cavity.  She is greatly improved, walking and breathing easily.  Cecilia simply endured severe TB at home for too long.  We hope she won’t have severe, permanent lung scarring…

A 30y/o arrived with severe abdominal pain and fever for a week.  He had peritonitis, secondary to typhoid fever, causing an intestinal perforation.  He will fly with MAF to CEML for urgent surgery.  Contaminated water…

Daria, a 50y/o woman, arrived in severe heart failure and unable to breathe until she had both of her chest cavities drained of over a liter of fluid which had caused the partial collapse of both of her lungs.  She is markedly improved and walking.  Untreated high blood pressure is so common and this consequence of untreated elevated blood pressure is a daily presentation at our hospital…

Cristiano arrived with marked, full body edema from severe (right) heart failure, originally caused by TB and lung scarring, which caused sluggish circulation in his lungs which made it hard for his “pump” to push the blood through his chest.  He has lost 8kg of fluid over several days, diminishing the force against which his heart pumps, and is walking and sleeping without difficulty.  He gushes his gratitude daily but faces a likely fatal illness as this type of heart failure is largely irreversible.

One morning, one day, in our resource-challenged little Cavango hospital, where so many arrive near death to recover and return home…

I enjoy writing to you who are supporting this work and caring for these beautiful people, from afar, unseen, often unappreciated, and wholly significant!

—

Cost… has become a four letter word in today’s “church”.

We are so unfamiliar with the cost of following Jesus as we give out of our surplus, at little/no cost, and pat ourselves on the back for our “generosity”.  We give because it “feels good” and is “satisfying”.  We give because it may return to us “pressed down” and “multiplied”, rather than out of radical concern for those without (weep with those who weep), and an attitude of “care not” for ourselves…

The gospel preached today is about “gain”, “blessings” and our “rights” as “children of God”.  Forgotten is the painful cost that was ever-present for Jesus and all who chose to follow Him, and is still present today for those who choose to go to the darkness – for the benefit of those trapped in dark philosophies, beliefs and behaviors – and confront and speak of the destruction of the darkness and the beauty of the Light…

I admire those of you who sacrificially join us and shoulder the cost of going to the fire and fighting it, in taking Light to those wandering in the blinding darkness, healing to those suffering pain and loss, freedom to those helplessly captive…  Jesus spoke of His admiration of those like you when He compared sheep and goats, based on how they cared for those hurting and lost…  Their gain is your/our reward.  They will never know you or what you have done for them, yet Jesus knows all you are doing in Cavango (for Him) where so many benefit every day… 

—

“Calling” for the Jesus follower is much misunderstood.  We wait for an “experience”, a dream, a “prophesy”, a “vision”, a “sign”…

while…

Our Father  has  called those who are His…

To, first and foremost, fellowship with his Son… to know and be known…

To follow Him…

To go to the darkness; to the hard, hot, lonely places where so many struggle in pain…

To decrease, for His increase…

To be always on the lookout for rescue opportunities, as was Jesus…

To become less, that another might become more…

To become poor so another would become rich…

To be last, that another would be first…

To give thanks, to Him, in all things…

To a life of godliness, through knowing Him who… called us…

To “be my witnesses in Jerusalem and in all Judea and Samaria, and to the end of the earth.”

To “proclaim the excellencies of Him who called you out of darkness to His wonderful light”…

To be not ashamed of the testimony of our Lord…

To suffer, “because Christ also suffered for you, leaving you an example, so that you might follow in his steps”…

To be “the few” and to seek out “the few”…

To be witnesses that Jesus is alive…

To be hungry, that another might be filled…

To appear foolish to the wise…

To be wise as serpents, gentle as doves…

To hear His “voice” before all other “voices”…

To count the cost, then go into all the world and proclaim the Light to any/all creation…

To love God…

To be known by Him…

To love others…

To consider others before oneself

To follow instructions from Him before all others…

To be weak, that another might be strong…

To make disciples…

To proclaim Christ crucified, the power and wisdom of God…

To make known His deeds among all people…

To seek Him and call upon Him…

To serve all we can, wherever we are, with whatever means we can…

To be holy, set apart, different… as He is holy, set apart, different…

To repay evil with blessing…

To rise up against the wicked. To stand against evildoers…

To do good; seek justice, correct oppression; bring justice to the fatherless, plead the widow’s cause…

To “be transformed by the renewal of your mind, that by testing you may discern what is the will of God, what is good and acceptable and perfect”…

To proclaim good that which is good and evil that which is evil…

To be prepared to always give an answer for the hope in us…

To fix our eyes on Jesus and not on the things of this world…

To value the interests of others before our own…

To bear the burden of another…

To improve the lives of others, at the cost of our own…

To be weak that another might gain strength…

To defend the vulnerable…

To be merciful to the guilty…

To seek first His kingdom…

To father the fatherless…

To provide for the widow…

To honor and value the forgotten…

To give that another might receive…

To allegiance to Jesus before men…

To go to the darkness and bring light…

To go to the cold places and bring warmth…

To go to the hurting and bring healing…

To go to the naked with clothing…

To go to the hungry and bring food…

To go to the thirsty and bring drink…

To suffer that another finds healing…

To die that another lives…

To serve for the benefit of another…

To be spent for the gain of another…

To work so that another can rest…

To proclaim that He who died, lives…

To proclaim our weakness and our Father’s goodness…

To be poured out that another might be filled…

To abandon the pursuit of our well-being and become preoccupied with the well-being of others…

To proclaim the beauty, righteousness and success of our King, rather than pursue to improve our own beauty, righteousness, success…

To work for the success of another, rather than our own…

To set the captives free…

To protect from harm those abused…

To love those who others won’t love…

To pray for those who harm us…

To personally respond to His above callings and discover the radical adventure of daily following Jesus…

and…

To not judge the responses of other individuals to the same callings…