Our statistics reveal that we had a pretty slow week, involving about 105 new consultations and 35 admissions.  We currently have 83 inpatients.  As I sit down in front of a blank page, though the vast majority of those we saw this week are markedly improved, three come immediately to mind.  We had three deaths this week, all somewhat unexpected – two young adults and a one-week-old baby.  The baby had been beautifully resuscitated at birth by our night nurse and survived several days of antibiotics and oxygen therapy for aspiration pneumonia acquired during the resuscitation. For several days, she was off of supplemental oxygen, nursing strongly and breathing normally and was discharged to her mom’s care, who is currently an inpatient in our TB program.  During her first night out of the hospital, the baby was found dead by her mom.  What did I miss?  What could I have done differently?  I teach our staff that we honor those who die by doing everything we can to learn from our interaction with them and soberly evaluate and reevaluate the care they received.

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A 23yo woman came to us several weeks ago with heart failure (caused by untreated strep throat) and was also improving greatly, then she suddenly worsened and died over a couple days.  A 30yo man came to us a couple months ago with back pain and we diagnosed him with Spinal TB.  His disease worsened while under our care, progressing over a month to paralysis of both legs, but we continued to encourage him, as we have seen so many arrive with paralysis from this illness and recover to walk home.  He suddenly became worse a couple days ago and died suddenly of a completely different illness.  How did this happen under our watch?  How can we prevent another from suffering similarly?

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Perhaps one issue that adds weight to these deaths is that each was surrounded by a beautiful, caring family who had put their trust in us to travel many rough hours to arrive and, then, worsen and die while under our care.  Another complexity is that unexpected deaths like these add fuel to the local perception voiced by the mother of the young man who died – that illness is of the spirit world and beyond our ability to overcome.

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We have endeavored to teach physical cause and effect and the benefit of early, accurate treatment for years.  We have shown microscopy images, pictures, x-rays and ultrasound images to illustrate and instruct about that which otherwise can’t be appreciated.  We have made accurate diagnoses and provided appropriate treatment thousands of times to validate our approach to health care. 

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Yet… the majority of those who work for us still go to the shaman (!) for “remedies” for whatever ails them (of course their costly potions treat anything/everything), as do most of our patients before arrival in Cavango (cultural norm/expectation), causing delay in legitimate diagnosis and treatment.  They still believe that illnesses and deaths, including these, occur because of curses and spiritual “powers”.  They believe that the hospital work and “believing in God” might help, but our power is not really enough to overcome the unseen powers of death and illness. 

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In a world in which mortality remains at 100%, we long to understand.  Especially within the church, we oversimplify…  Illness is of the devil and healing is of God.  Pain is bad and “feeling good” is healthy.  Death is the enemy…

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“Blame” for illness and death must be assigned so as to maintain some illusion/delusion of understanding. Blame, however, is falsely empowering and falsely absolves us of our responsibility for causes and outcomes. 

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In the west, we blame genetics, upbringing, circumstances, history, victimization, etc and we minimize the value of our choices in how we respond to the always-present challenges before us.

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It is perhaps more clear in Cavango than in the west that our battles are with principalities and philosophies which keep us from resigning ourselves to reality and responding in a healthy, “open-eyes” manner to what is true.  Today’s arrogant, “enlightened” majority don’t realize that “there is nothing new under the sun” as 2000 years ago Pilate summed up quite nicely today’s “modern” prominent world view before Jesus when he smirked, “What is truth?” 

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We see it in the developed and enlightened countries with the twisted, hands-over-eyes, modern, psychology-based, “I’m ok, you’re ok”, “Follow your heart”, “Shoot for the stars”, “You deserve the best”, “You can do anything”, and the anti-science, anti-reality, delusional LGBTQ and gender dysphoria pleasure/happiness-chasing philosophies/illusions which are no different than Hollywood’s antiquated “happy-ever-after” fantasies/fables and the serpent’s “You can be like God.”  In Cavango, we see blindness and deception blatantly influence virtually every activity. 

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Jesus sure put a twist in it all.  He indicated that both, what we see as “blessing” and what we call “illness”, including a lifelong blindness, involves His (unseen) purposes, ultimately to bring us into (eternal) relationship and surrender to Him.  He invites us to participate in the care of those ill (be His hands).  He indicated that death is not an end but a door into the next chapter…  that relationship with Him would continue in His “house” and those who did not know Him would also continue without Him in their next chapter.  He said connection with Him was the key to both this life and the next and that both could have purpose and significance, depending on our relationship with Him. 

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Instead of ridiculous, emotionally-laden, leader-enriching “healing” services/shows (where Jesus is magically “present” to heal), He encouraged His followers to hit the streets and go to those ill (where He is actually “present” in illness, sweat, vomit…) and embrace them (“wherever two or three…”), encourage them, care for them and love them “as they are”, pay for their legitimate care, develop relationship with them through their illness and after, tell them about our Father…

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Perhaps the major difference between the many philosophies of the world and Jesus’ message of redemption is revealed in our view of reality and our responses to the same.  In the world’s “group-think”, we are taught that we are largely hardwired and predetermined (via genetics) products/victims of millions of years of purposeless, random chemical encounters, we are basically well-intentioned and we bear little responsibility for our circumstances or even our actions – “What will be, will be”. 

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Jesus teaches, rather, that we are beautifully, thoughtfully and purposefully made and that our choices are significant in determining our course, but we are self-interested, rebellious and easily deceived. His message is that we can “turn” … from our self-focus and what we want… and surrender to our Maker and to His ways, which are based on reality and what is true… In His letters to us, He indicates that this is like putting our feet on rock-solid ground vs being tossed around by the fickle and ever-changing philosophies/fables/myths of godless “chasing after the wind”…

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At our always interactive, weekly, Saturday morning staff meeting (with 30+ staff) last week I shared from Heb 11 and emphasized that life is not about success, good outcomes or “happily ever after” and that the “fruit” of our devotion to Jesus might be to us pleasant or unpleasant.  We were created to a life of freely choosing to walk with our King, surrendering our lives to Him to serve and love others no matter the outcome… or not.  “For those who have eyes to see” is ever applicable in our work in such a lawless and godless culture, as we can “see” our Father’s hand in opportunity after opportunity to love those hurting or we can “see” only “victims” of unseen forces…

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Also this week, we cut open the neck of a two-year-old boy and that of an 85yo man, both arriving the same hour with marked difficulty breathing because of severe swelling from an infected tooth which had spread to the neck.  Both survived.  A little two-month-old arrived with severe abdominal swelling because she had picked up Hepatitis B from her mother.  Hepatitis B is a sexually transmitted disease which can cause liver failure and/or cancer and is greatly widespread in this culture.  Our number of AIDS patients is ever increasing and we diagnosed four more this week.

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Screams were heard from the woods behind our hospital early one morning.  Investigation revealed a woman, alone, lying in the dirt and in labor.  When questioned, she said she was caring for her child in the hospital and went into labor with her 8^th child.  We invited her in and told her we would pay for her hospital stay and she delivered a healthy baby boy an hour later in our maternity ward.

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This is the never-ending battle we face in serving the cashless poorest of the poor.  How many deaths occur in the homes in our region (or in the woods) because of lack of resources to receive care at our facility (cost for labor and delivery is $3.00US but is equivalent to almost two days wages)?

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Our new lithium solar batteries are functioning well and we need to use a generator for backup little.  Our new X-ray unit allowed us to make several diagnoses with certainty that would have not been possible even a year ago.

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We had a delightful visit last week from the entire MAF team as they begin the process of moving one of their pilots and his family (Marijn, Noortje and their two kids) to Cavango.  They began the moving process by putting up a 10,000L water tank/tower for their house (to be built this year), and making repairs to the house we had built this past year where they will live while they build.  They are Jesus-lovers and they look forward to serving and loving the people of this region in ways we never could.  They will be a beautiful addition to our Cavango team, bringing more Light to a very dark place.  The whole team brought smiles, a selfless work ethic and a few cigars…

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Then a few days later, we called them back to Cavango to transport to surgery 30y/o Teresa who came in during the night with abdominal pain for “a long time”.  In medicine, we are ever reminded that, “Reevaluation is your best friend” because initially the diagnosis is often unclear.  Medicine isn’t “cook book” algorithms that are always black and white.  Teresa said she had fever and vomiting and a tender belly like so many we see.  When asked, she mentioned she was on her normal period and last month was the same and she said that she knew she wasn’t pregnant, as it had been years since she had a child and her periods have been unchanged.  We admitted her and began a normal workup and later in the day (reevaluation), in between the many others waiting to be seen, just to be thorough, we performed an ultrasound, which surprised us by revealing free fluid in her abdomen (normally there is none). 

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The list of possible causes of abdominal pain with free fluid in her abdomen was considered and her treatment was begun, for an unknown cause.  Another “medicine-ism” is “Vital signs are vital” and, when abnormal, must be addressed and investigated.  Because one of her vital signs was still abnormal (fast heart rate) on another reexamination, we decided to draw off a little of her abdominal fluid to see if its appearance might help us better determine a cause.  The painful “tap” unexpectedly yielded frank blood.  A young healthy girl with frank blood free in her abdomen made the list of possible causes quite short, including a bleeding ectopic pregnancy. 

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No matter what the patient says about pregnancy possibilities, it always must be considered in women of child-bearing age and we had already seen an empty uterus on ultrasound, making an ectopic pregnancy possible.  When we were able to finally get some urine from her – delayed as she was quite dehydrated – the pregnancy test came back positive.  We checked her blood count in our new lab and it was dangerously low.  We immediately called our MAF colleagues (from the ICU), who were (always) willing to stop everything and come pick up Teresa and transport her to our ever-available surgical colleagues in Lubango, who arranged a night-time surgical team to try to save Teresa’s life.  While waiting for the flight, we transfused two units of blood into Teresa, one from her willing father and one from Tiago, Eduardo and Jocelyn’s son, who we called in from home because we knew his blood type was a match.  Teresa had a generalized, potentially dangerous, allergic reaction to the blood which we urgently treated and it, thankfully, responded to treatment before she left.  At surgery in Lubango, after a two-hour flight, half of Teresa’s blood volume was found in her abdomen!  She wouldn’t have survived even a few more hours without repair of the “leak” – a still-bleeding fallopian tube in which grew a young pregnancy outside her uterus, with no likelihood of survival. She survived the surgery.

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This all occurred in the middle of a busy clinic day, in which we admitted several more critical patients to our already-full ICU, which included two kids with seizures from cerebral malaria, a severe asthmatic who needed oxygen and a lot of attention to survive, a woman with severe heart failure, a woman with liver failure, a man with a crushed tibia and fibula, a severely dehydrated 4-day-old baby who hadn’t nursed (with likely meningitis), among others.

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Betsy and I had a Zoom call last night with a group of beautiful men from the US greatly invested in seeing us expand our services and care for these people who have virtually no one caring for them, giving them solid instruction, and valuing their lives.  It was quite encouraging and reminded me that many others are sacrificing their lives with us, in so many variable ways, to see a few benefit…

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After the meeting, I was called to the hospital to see a young woman who will lose her whole buttock to gangrene and maybe her leg/life because she received an unclean injection with a dirty needle from a “nurse” at a government “health post” a week ago; a six-month-old who needed a chest tube to survive for at least the night for untreated-for-too-long-at-home pneumonia; a two-week-old who hadn’t nursed for several days (!) and improved quickly with some simple fluid intake (but remains critical) and a young woman with the first symptoms of rabies, who was bitten by a “sick” dog two months ago and won’t survive, because her family had no knowledge of a vaccine because no one around (except us) has rabies vaccine…

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As described above, our challenges, frustrations, and sadness, mixed with pleasant life-extending outcomes are ever present but I can’t express adequately my gratitude this morning for all those involved in the care of these beautiful people.  Only a couple years ago, we didn’t have beautiful partners in this work (the DeSouzas), electricity, a lab, x-ray, blood transfusion capability (used almost daily in malaria season), and internet in the clinic to immediately contact MAF as needed (Teresa) and so much more…

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Though, of course, I can wander in some rabbit holes, my primary motive for writing, as always, is you.   Many of you, along with our ever-improving local staff (who admitted Teresa during the night instead of sending her home), and our colleagues at MAF and CEML, are the reason so many people are returning home well from our little outpost in rural Africa.  The vast majority of the moms, dads, sons and daughters, who arrive critical, will survive to have more opportunities to meet their Maker and King, and they will have children, who will have children… and your impact in this region will transform generations…