Good morning from a crisp, upper 40’s, clear and gorgeous autumn morning in Cavango. I’m sitting in front of a warm fire and thinking back over the past couple weeks with a blank page in front of me. We will see where this goes.

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We transfused over twenty patients last week, mostly children with malaria who arrived with blood concentrations that would not support life for long (Hb<5).  This radical anemia is the principal manner in which malaria causes death.  The microscopic parasites enter the body from the saliva of the mosquito during a bite, invade red blood cells, reproduce and divide, destroying the host cell in the process.  The number of circulating parasites resulting in cell destruction depends on whether a person is bitten by one or several malaria-infested mosquitoes.  Red cells are destroyed daily, by the thousands to millions, depending on the number of initial invaders.  If it wasn’t so humanly destructive, the whole life cycle process in which this “simple” organism can work in sync with others of its kind to overwhelm an exponentially larger host, reproduce and send its offspring, via mosquito transport, to invade other victims, would be considered wondrous.  As this invasion continues and expands within a human body, it causes significant host defense response to this “invader”, which is felt as “fever”.

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Small human bodies, with less circulating blood volume and the same number of parasites killing a greater concentration of red blood cells, die from this disease far more than adults.  In this rural, low-resource culture, one in three children will succumb to primarily this disease before the age of ten (in the US, for comparison, the childhood mortality is 1/2000).  At this writing, our ICU is full and our overflow room is full, with over twenty critical patients.  Many are under the age of ten.

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We are also battling a measles epidemic, one which is completely preventable with well-established, safe and globally available vaccines.  Measles weakens the bodies of children, increasing their vulnerability to the impact of other diseases, including malaria and pneumonia.  We have ten oxygen concentrators, which increase the concentration of inspired air to the lungs and blood of the patient, and all are in use, mostly to kids with this severe anemia from malaria combined with pneumonia following measles, both of which decrease the transport of oxygen to a patient’s vital organs.

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Two concentrators are serving older women with severe heart failure, resulting from years of untreated hypertension.  Two others are treating lack of oxygen in adults with severe tuberculosis, left untreated for too long.

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Our new hospital building was designed to be large enough for us to grow.  It appears we erred, as it has been maximally filled this week, a short time after opening the doors.  We over-amped our new solar system to make sure we had more than enough power for any needs.  The storage batteries were completely exhausted these past three nights but didn’t die.  They are maxed already.  The system had just enough stored energy from the previous day to handle the ten concentrators and other routine draws such as lights.  It appears we might need generator backup, which we had hoped we could avoid.

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Our beautiful new solar system was purchased by many of you and installed largely by our servant friends from MAF.  Marijn and his visiting father directed the installation of 70+ solar panels and the inverters and chargers.  A huge task that was done with excellence.  Brent and Marcel used expertise that few have anywhere to wire it all together and connect it all to the wiring of the building, completed prior by Messele.  The varied ways and number of people who contribute to this work is beyond description.

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We are thoroughly enjoying our relationship with a severe servant, Tomás Messele, who taxis (by motorbike for the last hour on dirt) to Cavango for three days weekly from Huambo, 3-4hr away.  He is a Jesus-loving pastor of a small church in Huambo and a trained electrician.  He was hired by another dear friend from the city several years ago, to help him build an apartment for Betsy and me so the DeSouzas could move to Cavango.  He was so inspired by the work he saw in Cavango that he returned often and then asked if he could be a regular hospital “handy man” and assist in any way possible.  Messele has been amazing.  About the same time he asked to participate, a beautiful supporter of our work from the US asked if he could pay the salary of someone who would do this exact type of work for the hospital.  Beyond blessing, Messele has repaired electronics, has helped to install and repair/maintain solar systems, has wired our new building and several others, has repaired generators and cars, receives and brings ordered meds to us from Huambo weekly, makes all kinds of needed purchases for us in the city and so much more.  What a beautiful partner he is for this work and we look forward to his presence with us every week.  He is like our Cavango son, as are many of those who work with us.  He even sometimes runs with me in the mornings!

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Three-year-old Maria arrived with malaria and also an acutely distended abdomen.  She needed a blood transfusion to save her from malaria and her abdomen was full of free fluid, resulting from an intestinal perforation from a duodenal ulcer (quite unusual at her age).  We put a tube into her abdomen and an IV line into her tibia.  We drained a large amount of pus from her abdominal cavity and washed her abdomen with fluid through a tube several times over several days.  She survived several days of treating her malaria and getting her stable enough to fly with our ever-ready, ever-serving MAF colleague, Marijn, who transported her to our wonderfully skilled surgical colleagues in Lubango for repair of the cause of her overwhelming abdominal infection.  The surgery was successful and Maria will survive what would have been certain death without the sacrificial contribution of so many of you.

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Two-year-old Graciana (photo) arrived in a coma for two days and her outside layer of skin peeling from her whole body.  She had recently recovered from measles, which also caused some skin flaking, but her resulting weakened condition from measles left her vulnerable to malaria and sepsis.  We have had perhaps a dozen of these cases, aptly named “Scalded Skin” Staph infections, over the past couple years and only two have survived.  On arrival, Graciana also was found to have malaria, no pulse and no response to pain.  We treated her and asked our Father for help (as we do with every arrival) and two days later Graciana woke up and has improved daily.  She will survive three deadly illnesses and have no clue.  In the next bed, a two-year-old boy arrived in a coma from “only” malaria, received aggressive treatment, a request from our Father for help, and he died within 48hr. 

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In the next bed, a little girl also arrived in a coma and needed blood due to losing over half of her circulating volume to malaria, she was put on oxygen supplementation for several days due to an oxygen saturation of 50-60% (normal > 93%) from pneumonia and she received only IV fluids until she woke up after three days.  She will recover completely.  A complicated ankle fracture/dislocation that needed reduced, several hideously large abscesses needed incised and drained, an asthmatic in respiratory failure, a man paralyzed from the waist down from TB, a child paralyzed from the waist down from a neuropathy… come to my mind as I write… Several other kids/adults have survived against all odds.  Blessing is as difficult to understand as is tragedy…

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Smile.  We had a large political contingent of 30+ men and women visit us from several cities to speak to our staff about their interests in upcoming elections.  We held a brief spontaneous meeting in one of our rooms that could accommodate such a group.  In the middle of an impassioned speech by one of the leaders, one of our beloved employees, a large, unnamed black cat which, for a little daily food, has worked quite well at keeping our rat population at bay for the past two years. entered from one door of the meeting room and sauntered lazily through the middle of the perimeter-filled room and exited the other door of the room.  No one from here batted an eye, as he does this all the time and has free reign of our hospital grounds, but it would have been nice to capture some of the looks on the faces of our urban visitors, a pretty good demonstration that they were not in a city hospital…

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Another smile. We put about a hundred pictures of our staff, taken over the past many years, in frames and displayed them on shelves in the hallway of our new building (photo).  What a hit.  Many have never seen themselves in a printed photo.  I never walk past the shelves without passing several people animatedly enjoying the photos.  We will bring back from the US about thirty posters containing nearly 1000 pictures of patients, along with more photos of our staff, which will all be permanently displayed on our hospital walls.  It is a beautiful way for us to tangibly demonstrate that the value of this hospital is its people, both those who serve and those served.  It is a small way to honor the people of this region who contribute so much to, and receive so much from, this little, simple, remote, Jesus-filled place.

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Along with so many recoveries, we had several deaths this week, of the many patients who arrived.  We have no more critical care beds.  All had borne their suffering in their homes for so long that our modern medical care had no merit.  Their fault?  It costs their savings just to get a consultation and meds.  The journey to the hospital takes hours or even a day or two.  There is little knowledge/appreciation of what good medical care can do to supercede the prevailing “belief” that one is a helpless victim to the unseen forces that cause illness…

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Watching people suffer and grieve takes its toll.  There is so much obvious pain here… so many physical scars/deformities where illnesses and wounds linger far longer than in places with accessible, decent health care.   So many young deaths accompanied by the lingering grief of their loved ones who survive them and will never forget.  Even after all these years, I walk from some patient encounters angry (at no one in particular) or just sad. I often retire early at night and voice to my Father that I’m not sure I can do this anymore.  Then I arrive to another “Maria” and “Graciana,” and remember so many of you supporting us in this endeavor, and the motivation to continue is rebirthed, for another day…

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Throughout history, until recently, Cavango was the global “norm”… without evidence-based diagnosis and treatment, without soft beds, without dietary options, without fans/heat/AC, without transportation, without access to water and waste disposal… Famines, floods, plagues and (mostly) now-treatable diseases, astronomical infant and maternal mortality, life expectancy of 40 years until the 1900s…

There is so much obvious and hidden pain here, and so much hopelessness and purposelessness in the developed world driving self-medicating addictions and crime… so many blind to “the Way, the Truth and the Life”…

There are many “Cavangos” in the world.  In Africa, an estimated 1/5 live hungry…  How does one process all of this in light of eternity?  How, then, does one choose to live? 

So many voices, religions, philosophies, “sciences” and superstitions, independent of Jesus, try to define purpose/meaning for our brief existence…

Today, the majority of people in the world live without gratitude to a Maker/Designer/Cause and without an overriding purpose or reason for life.  We choose to place our God-given faith in fables of a godless “big bang”, in evolutionary purposeless origins, in good/bad “luck,” and in prosperity and the pursuit of personal  “better,” all of which feed a global, ubiquitous purposelessness to life…  Life is not given and purposed by a benevolent Creator but is, rather, the result of chance occurrences…

Is another’s life of equal value to your own?  Another’s child, mother, or father of equal value to yours? Based on what?  Should personal pleasure, leisure, entertainment, fulfillment, and happiness be our pursuit?  Prioritizing ourselves and, especially, how we feel, is the essence of missing our Creator’s purpose for our lives.  The height of arrogance is believing that my life should be my central focus or that others and “this world” should serve me…  We’ve chosen to be our own “gods”…

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Peter, who knew Jesus before and after his death and resurrection, wrote that we will face mockers and scoffers, who follow their own desires…  Paul, who was one of the “scoffers” and was then an eyewitness to the risen Jesus just a few years after He rose from death, predicted to his disciple Timothy, that people will be lovers of self, lovers of money and what money can buy, boastful, arrogant, combative, disobedient to parents, ungrateful, unholy, unloving, irreconcilable, malicious gossips, without self-control, full of pride, loving pleasure rather than loving God; embracing a false spirituality/godliness, always learning and never coming to the knowledge of the truth…

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I am one of a minority “sect” of people who don’t see that life is to be lived “to its full,” or that life should “feel” pleasant, or that this life and others should be “for me”.  We realize that we were not made to determine what is good and each of us knows that we are incapable of the same.  Our purpose is not to “be good”, or to “enjoy,” improve, or “care for” our own lives.  Rather, we see life as an honored privilege (bestowed with complete freedom to accept or reject), filled with unending opportunities to participate with our Father, in gifting, planting, pouring out, multiplying and giving away our every effort, our every moment, to benefit another.  One’s life is completely transformed when we choose to abandon the pursuit of a better life, take our focus off of ourselves and unite with our Father/Creator/Designer and His “other” focus. 

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John Wesley suggested, “Do all the good you can, by all the means you can, in all the ways you can, in all the places you can, at all the times you can, to all the people you can, as long as ever you can.”

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The purpose of life for those who accept invitation into this “sect”….  Jesus is our leader and, his life, our model…  “Go”…  “Greater love has no one than this”…  Each of us have been given complete freedom to choose whom we serve, where we serve, and how we give away our resources, talent, effort and love.  As Jesus before us, our purpose is to be “spent” for our Father’s pleasure and another’s benefit.  He is available every moment, by invitation, to direct, encourage, and empower our every endeavor.  “I am with you always”… 

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Our lives, worldviews, perspectives, and activities are transformed when we choose Jesus as our Master and we, His slaves.  We are all slaves always, but we have been honored with the ability to choose whom we will serve.  When Jesus becomes more and more our “Master” (a learning/growth process), His “other” focus becomes our focus…  and our lives become easier, happier and more pleasant, rewarding, fulfilling?  No!  Rather, we lose our lives, but many others benefit…  Kingdom math: 1 – 1 = Many

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The cost…  As it is with the One we love, serve and follow and, as with Peter, Paul, Wesley and so many others whose lives indicate likely membership of this same “sect” (only the leader and the member know), the “me” psychology, philosophies and “wisdom” of this world (even within our own families) will not accept us and our choices and we will be mocked and isolated; we will be the brunt of gossip and slander; we will be labeled, mischaracterized, belittled, dismissed, unappreciated and rejected and there will be some who will be offended by our devotion to our King, the Truth and His narrow, “other” Way. 

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The beneficiaries… others…

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Many of you have chosen to join this sect with me…  I am so grateful to be united with you in serving the many beautiful sons, daughters, mothers and fathers of this small, remote Cavango region…

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