One of my most beautiful months saw my son, Luke, join our work in Cavango for a month as he completes his medical school education.  He will return to residency in Pediatrics in Chicago for the next three years, during which he will decide on his long-term plans.  He was joined by his beautiful fiancé, Rachel, for a week and it was nice for Rachel to see, first hand, the work she has heard about for years.  They will be married in May and then live in Chicago for the next three years as Rachel continues her career in Urban Planning and Luke completes his residency.  What a special time for a dad to get a whole month with his beautiful son and a week with his delightful, soon-to-be daughter-in-law.  Every conversation and moment together was special and cherished.

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Jesus spoke about the cost of obeying Him, of following Him and doing what He did.  Luke and our kids have been involved in the cost of our chosen path, growing up as “third culture kids” with all of the advantages and disadvantages.  On this trip, perhaps more than others, Luke was able to see, first hand, from a health care perspective, the many who benefit from our long-term “displacement” from our home culture. 

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I think of those Jesus-followers who have endured torture, stoning, crucifixion, rejection, exile and so many other forms of suffering.  Those who have seen their families murdered, kidnapped and abused by people and cultures who rejected surrendering to the one and only King and His narrow way of dying to self and the pleasures/ambitions of this world.  Our cost has been comparatively light but, nonetheless, real.

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We moved into our simple, new hospital building this month and we are making adjustments to more space and 24/7 electricity with our new solar system and clean water from our newly drilled well.  This new place is quite simple, yet it will allow improved service for those who arrive ill.  This building was constructed at great cost to many of you and… many will certainly benefit!

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Thirteen year old, Manuel, arrived in a coma, after passing out at home a couple hours previously.  He responded to nothing, including pain.  His exam and lab work revealed no clue as to cause.  The family said he had been minimally complaining of a headache and leg pain that morning.  We began empiric treatment for malaria and meningitis, though all labs that would indicate either were normal.  The next day he was the same, though he was breathing without difficulty.  Over the next several days, nothing changed.  He appeared to simply be asleep.  He had no fever, no breathing issues and his limbs were flaccid.

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Somewhere around day five, we began treatment for TB meningitis, though he had no indication of the same.  Two days later, his ever-faithful mom, who never left the bedside, said she had detected movement, but we could not elicit the same with verbal or painful stimuli.  Some definitive sporadic movement followed and he began opening his eyes.  On his thirteenth day in the same bed with little movement, I passed by on rounds and I spoke to him, as I had each day, and he responded, “Bom dia”.  I was floored. 

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His limbs still didn’t move purposefully and had developed contractures (fixed positions).  His devoted mom had observed swelling in his legs a couple days earlier and we noted the same and suspected infection, but he was already on strong antibiotics, so we looked with ultrasound and detected large amounts of free fluid in both limbs.  Because I saw little hope in his survival and I didn’t want to further traumatize Manuel or his mom, I decided to simply observe his legs.  When Manuel responded and it appeared his brain was not beyond recovery, Luke and our doctor colleague, Vianne, opened both legs and took out large amounts of pus from each.  Since then, over two weeks, Manuel has shown steady, slow improvement. 

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Manuel’s recovery is beyond my understanding and I still don’t know the cause.  He is now eating, drinking, speaking and smiles at our appearance (and a sucker) every day.  He still has profound weaknesses in all limbs, though his contractures have resolved.  He may not recover completely, but his slow, steady, daily progress indicates it may be possible.   

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Maria is seventeen and also arrived in a coma, after several days of fever.  She had delivered her first child at home without complications a couple weeks prior and had bleeding and pelvic pain for several days after, which had then resolved.  Then she passed out.  She was not responsive, her blood pressure was undetectable, her malaria test was positive and her blood count (hemoglobin) was three (normal 12).  She had lost ¾ of her blood.  She had massive swelling in her legs and her labs indicated severe kidney failure.  We gave her many units of blood from our staff, treated her malaria and kidneys and she woke two days later but was severely lethargic and complained of (intolerable) pelvic and back pain. 

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I must mention our staff and blood.  We need blood donated almost every day, as so many people arrive with severe anemia, mainly because of malaria.  We never lack for volunteers to give blood.  Virtually everyone on our staff of more than thirty give a unit of blood every month or two, with pleasure, when we cannot obtain the same from a family member.  Every time we ask, we have several more volunteers than we need.  It is a beautiful characteristic of our Cavango hospital culture.

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We began transfusions about five years ago, after seeing so many die from a treatable lack of blood.  No one here had ever donated and everyone was, of course, concerned about the concept and consequences.  In Cavango, we teach about cost and benefit in all we do and that love always involves cost for another’s benefit.  We explained over and over that the unique feature about donating blood is that the cost and risk to the donor are real, but minimal, and the benefit to the recipient is life because we only transfuse in life/death situations.  We also had a steady stream of outside visitors and every person visiting donated willingly.  Jocelyn DeSouza was our first volunteer. She, Eduardo and their kids, I and all of our visitors donated regularly.  The minimal cost and life-saving benefit was witnessed repeatedly.  We asked for volunteers every time, with no obligation, and the number of people accepting the invitation began to grow and now we never lack.  It’s beautiful. 

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Maria was touch and go, finally showing improvement in her mental status and blood pressure after several days.  Several more days and her kidneys finally showed improvement, but she couldn’t walk.  Slowly she graduated to sitting up and taking steps with a walker and now, two weeks later, she is smiling and walking everywhere, with healthy kidneys and a healthy baby boy.

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Frederico was 23y/o and arrived unable to swallow his own saliva and unable to speak, with much difficulty breathing.  We began treatment for what is, here, a relatively common and devastating illness called epiglottitis. It is rarely seen in the developed world because the two most common causes of this type of swelling are prevented by vaccinations against the primary cause (HIB) and by accessible and prompt dental care, which prevents the spread of swelling from dental infections.  We heard Frederico’s labored breathing from outside the room. 

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As we considered putting a tube through Frederico’s neck into his airway (below the obstruction), he seemed to improve over the first day, so we waited.  Somewhere around day three, he indicated worsened breathing, so we placed the airway.  In checking some routine lab work on the first day, we found that Frederico was also in severe renal failure.  We hoped it was because he was severely dehydrated and that his kidneys would respond to hydration and medications, which were provided.  After Luke expertly placed the airway through his neck, Frederico breathed more easily, his breathing rate slowed, he was calm and he slept well.  The following morning, however, Frederico died from his severe kidney failure.

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Another young man of 21 years died of the same illness in his airway two weeks earlier.  A third, Tomás (photos), arrived just a few days before Frederico and survived without the placement of an airway, but with repeated incisions in his neck to remove pockets of pus causing the obstruction.  He had arrived unable to swallow, breathe or speak, almost dead from his spreading dental abscess and yet, two weeks later, he returned home.

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Bernadina arrived in labor for over a day with her first child.  She progressed slowly and steadily over two days until she was ready to push.  Many ultrasound checks on the baby revealed that he was tolerating the long labor well.  But he wouldn’t descend.  We intervened with the placement of vacuum traction on the baby’s head and pulling… for over an hour.  Rachel Hoyme, our visiting clinician missionary friend from Lubango, had faithfully and tirelessly stayed with Bernadina throughout her labor.  Every time we (I) had decided it had been enough, we noted some progress.

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Finally, I said we absolutely needed to cut the pubic bone to provide space for the baby to descend and, as if Bernadina (or the baby) heard, Rachel delivered the baby’s head with a final pull.  She wrestled the baby’s shoulders out and found that he wasn’t breathing.  Rachel and Luke took turns providing mouth-to-slimy-face breathing and, after several minutes, he finally breathed.  His heart beat was strong and he opened his eyes and moved all extremities.  We checked Bernadina and she was all smiles and relief, after the longest several days of her life.  She and the baby improved over three days of recovery and she went home. 

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Several days later, however, Bernadina returned with her healthy baby doing well, but with stool in her vagina.  She had torn into her rectum (undetected after delivery) and we sent her to our faithful surgical colleagues in Lubango for repair of her vaginal laceration and possible fistula (traumatic connection of vagina to rectum) repair.   What a beautiful relationship we have with our colleagues, who can do so much of what we cannot.

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Our volume at the hospital has been about half normal for over a month.  The rains this year have been heavier than seen in many years and several rivers between us and large regions of people are impassable.  People are waiting even longer to travel and we’ve seen so many tragic, preventable deaths because of delayed treatment, including the two young men with neck swelling.  The rainy season is ending and our volume will increase again soon as the rivers return to normal levels.  We’ve heard many stories of sick patients carried through shoulder-high, rushing white water to get to the hospital (!).

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Another consequence of the amount of rainfall is that most of the corn fields have been washed away.  There is now resulting great hunger in this region.  We have solicited help from our beautiful colleagues with AGA (Advancing the Gospel in Angola) in the states and we will distribute food supplements from “Feed my Starving Children” to over 300 of the neediest families in over fifteen villages, many already having gone days without food.  We have enough food for these families for about a month and these families will face another crisis when planting season arrives and they will have no seed.  If you would contribute to help this hunger crisis, please see “Contributions” above and give to AGA and it will be a tax deductible contribution.  Many will benefit!  AGA plans on sending another container soon. 

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So many beautiful and tragic stories remain untold.  So many people in this region benefit from our, and your, care and concern.  Far too many young still die.

Cost… benefit.  What cost are we willing to pay for their benefit?  The world, and much of the global church, believe that the purpose of sacrifice is to gain personal  benefit.  The message of Jesus is otherwise: that we give/care/sacrifice for the benefit of another.  Much of Jesus’ life, suffering, message and death, as well as the same of His followers throughout history, have been forgotten and/or ignored.  Today, we prioritize many things that Jesus did not: where we live, our occupation/career, our financial security, our retirement, our status, our personal fulfillment, our weekends off, our leisure, our reputation, our own culture, our church, what we eat, our understanding, our success, our comfort, longer lives, etc.  Jesus called us to live and to die… for the benefit of another.  His message is like no other in history.  It is an everyday, often painful, battle to follow Jesus but so many might benefit from our attention and sweaty service… 

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Yesterday, I asked our large staff at our weekly staff meeting what “love” means.  They agreed there are many definitions, but that Kingdom love is valuing another before oneself.  Always with cost to the one loving.  Not a sentiment or a feeling/emotion…  “Greater love has no one than this…”  They are getting it.  Cavango is a very different place…

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Please continue to partner with us to care for these especially dear to our Father…