Mariana arrived unresponsive and in respiratory failure.  She was moving no air and had a thready, weak pulse and little respiratory effort.  We rarely get such extremely acute events in Cavango because it usually takes hours of travel for the patient to arrive.  The person transporting Mariana was her uncle, who had picked her up and put her on his motorbike an hour earlier when he noted her severe breathing difficulty, which had significantly worsened over several hours.  We immediately diagnosed Mariana with acute bronchospasm when we saw her breathing effort with no air movement and she had a blood oxygen level of <50%.  We injected her with epinephrine, supplemented oxygen and gave her several nebulized breathing treatments and other meds.  Mariana began moving a little air.  Over the next hour, we saw some improvement and by the next day, she was sitting up in bed and breathing easily and she went on to recover completely.  Mariana’s case also highlighted a continuing real problem in this culture.

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As Mariana’s condition worsened in her village, she was taken by her father to the “kimbandeiro”, the shaman.  He characteristically “diagnosed” her with a “curse” and gave her a mix of cure-all herbs and roots.  He told her father that medical care would not help her because the cause was “spiritual,” and nothing could be done.  The Soba, or village chief, entered the picture and actually forbid the father from taking the little girl to Cavango, after the girl’s uncle suggested this response.  Mariana worsened overnight.  In the morning, Mariana’s uncle hurriedly loaded her on his motorbike and left for Cavango.  Another few minutes in her village would have left the unconscious girl dead.  A courageous, counter-cultural act by this uncle saved this girl’s life.  The father arrived the next day to Mariana sitting up in bed and breathing easily.

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Our beautiful MAF colleagues picked up essential malaria meds in Huambo that we couldn’t do another day without and transported a young man for surgery with a severe head/face infection to Lubango for life-saving surgery. Our ambulance transported a man in renal failure to Huambo to begin life-saving dialysis along with a young woman who needs an emergency, life-saving cesarean. Another baby death first thing (so many recently who arrive so late in their illness). Critical beds full. So many recovering from life-threatening illness…. “The Wind” blowing on many irons in the fire in our little outpost…  Sometimes in Cavango we are simply “gate-keepers”…

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The woman needing a Cesarean, Emilia, arrived seven months into her ninth pregnancy.  Emilia had severe abdominal pain and was feeling severely fatigued.  Her blood count was dangerously low and she had malaria.  We could have considered malaria as the cause for her anemia, but her abdominal pain didn’t fit.  We ordered some labs to evaluate her liver function and platelet count and discovered that she had a form of “toxemia” known by the acronym, HELLP syndrome (liver inflammation, anemia from destroyed red blood cells and dangerously low platelets – which increase the threat of hemorrhage), a form of preeclampsia that threatens the life of both the mother and baby.  The definitive treatment is delivery, usually by Cesarean.  We measured Emilia’s gestational age via ultrasound and discovered that her gestational age was older than she thought and that the baby might be developed enough to survive an immediate Cesarean.  We transfused several units of blood into her and her anemia resolved but her platelets continued to be life-threateningly low, constituting a bleeding risk.  

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I’ve only seen this condition several times over many years and I was grateful that we had the ability to make Emilia’s diagnosis via our excellent, simple lab (so many people were involved in this new development in Cavango) and that we were able to transfuse her with several units of blood to keep her alive prior to transport.  Both Emilia and her baby survived the multiple transfusions and timely transport by MAF and the excellent work of our surgical colleagues in Lubango…

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You may have been one of so many involved in saving these two lives!  On behalf of Emilia and her newborn, “Thank you!” for the sacrificial contributions of your effort and resources which are impacting generations in this remote region of the world. 

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Saturday night was one of many calls from the hospital (via internet connection) about a 2y/o who had been hanging on for three days with severe malaria and pneumonia.  Deaths typically occur from both diseases in kids with weakened bodies.  This little girl’s glucose dropped in the morning, which is often a terminal event.  We treated the same but the cause was the severity of disease.  On my arrival, she arrested and we tried to resuscitate her without success.  Tasting her vomit from mouth-to-mouth resuscitation efforts was a sober way to begin my “day off”.  Sunday rounds were unremarkable but the rest of the day was full of calls about new critical arrivals.  Most with severe malaria, a teen with measles and pneumonia, and a baby with the same.  An 8y/o arrived, who had a history of rheumatic heart disease and heart failure, arrived unconscious with malaria.  He stopped breathing soon after arrival and we were able to resuscitate him with epinephrine, stimulation and oxygen therapy.  He stopped breathing and lost his pulse multiple times over fifteen minutes and we got him back each time.  When I left for the evening he was breathing easily but still unconscious.  We will see how he does through the night. Later – Marcus survived and was sitting up and breathing easily the following morning.

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Too often, the family waits to bring the child until they enter into a comatose state, when the malaria, pneumonia or other illnesses are too advanced to treat.  We have had so many remarkable recoveries combined with so many child deaths over the past month.  The causes of illness and their ability to advance and destroy tissue over time, is not appreciated in the population we serve.  This “simple” understanding will occur in this population only when evidence-based instruction is given and trusted/received.  For this we need people… who will stay and build trust…  Trust, in any culture, can only be established in relationship over time as all of us accept/believe information we choose to trust…

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Five-year-old Mateus arrived in a coma, with malaria, and the loss of ¾ of his blood to the disease.  On arrival, Mateus needed and intraosseous line inserted into his tibia to receive blood.  His father’s skepticism and fear re our treatment was clear.  We gave Mateus blood four times (!) over several days to finally see his blood loss stabilize.  He woke up on the third day and fully recovered.  One of our visitors, Scott, graciously donated his matching blood to help Mateus survive.  Mateus would never have survived his illness if his parents had chosen to seek care elsewhere in this region.  His caring, beaming father took Mateus home after two weeks, grateful for all the care he witnessed over his time in Cavango. He brought Mateus back after a week and Mateus sauntered in with his hand reaching for a sucker.  He got to know our routine well!  Mateus will grow, have children, who will have children…

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Funny cultural anecdote. Our hospital director was joking one day when I told him he looked great after shaving his head the previous day. He thought it was funny that ten years ago in Angola a shaved head was only seen on rebels and criminals and he said today the same type of person sports a large afro. After a subject change in our meeting, another man made the profound cultural statement:  “In Angola, saying ‘yes’ is common and easy, but doing ‘yes’ is different.”  Perspectives are changing in Cavango!

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We enjoyed a wonderful visit by a group of serious servants from Ohio this past month.  They never stopped, doing so many jobs around our hospital that will benefit many for years to come.  We received a container from our serious servants with AGA full of used hospital equipment, food supplements and the steel for our next, severely needed inpatient ward.  One long-time friend is considering relocating to Cavango with his family.  We had an initial interview last week with two current missionary physicians, now giving their lives away elsewhere in the world (one for 12+ years), who will visit us in October to see if Cavango might be a fit for them.  We also have multiple visitors over the next two weeks, many seeing Cavango for the first time.  All are interested in serving those hurting and neglected by the rest of the world.  Cavango’s potential to serve more, with excellence, is growing…

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All of these remind me of the following truth, forgotten in this age of social media (imperfectly paraphrased from memory):  We need less conversation, chats and consideration about what we “believe” and what we “would do,” “should do” or “want to do” and more conversation about how we are living and why we live the way we live as, our lives, and what we actually do, display our beliefs more than our words or intentions…

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Truth and lies… I am more convinced today than ever that Jesus’ words/stories/passages are true, about the world, human nature, our Father, etc. as they have proven their trustworthiness in me over time in relationship with Him, observation and trials.  What is true is also expressed in all cultures, in many different ways.  Many of you know that we (I) need to be reminded often of what we (I) already know to be true (see “Tim’s proverbs”). For example, I recently have been encouraged by these timeless truths, expressed in other cultures at other times,

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“A fool prays for an easier road; a wise man prays for stronger legs.”  – Chinese proverb. 

Another (one of my favorites that is motivation often): “It is not the critic who counts; not the man who points out how the strong man stumbles, or where the doer of deeds could have done them better. The credit belongs to the man who is actually in the arena, whose face is marred by dust and sweat and blood; who strives valiantly; who errs, who comes short again and again, because there is no effort without error and shortcoming; but who does actually strive to do the deeds; who knows great enthusiasms, the great devotions; who spends himself in a worthy cause; who at the best knows in the end the triumph of high achievement, and who at the worst, if he fails, at least fails while daring greatly, so that his place shall never be with those cold and timid souls who neither know victory nor defeat.” – Teddy Roosevelt

And… “We are wise to make every effort to base our beliefs (lives) on what is true and not what we “wish” were true.” – Anonymous

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Beauty and Beholder…

Of course, we have much competition for these missionary physicians. The many LGBTQ+ hospitals in surrounding villages, which were established at the beginning of their world-wide movement centuries ago to foster pride and self-esteem in those hurting, while offering free surgical care, makeup, clothes and a new name for those interested in an identity alteration. The local Muslim hospital also has a large list of men-only applicants from Northern Africa who seek better health and eternal life for the rural infidels. Around the corner the brand new minimally-stocked government hospital is turning away applicants who want to leave the city and serve their Angolan brothers in remote areas and receive their promised monthly salaries a couple times per year.  This is near the packed, shiny, well-equipped (except for water, meds and electricity), socialist Russian hospital promoting free care to all; down the block from the Hindu temple clinic along the fence-less pasture offering attractive, ever-varied, all-natural, dosha care to any/all remote “untouchables”; across the dirt path from the Buddhist clinic, staffed by barefoot, robed, enlightened monks who offer no medications with their fully self/focused nirvana-seeking meditation courses/offerings.  There are, of course, so many other non-Christian healthcare works in rural Africa serving those with little means, making the choices of these selfless Christian physicians difficult…

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We know, of course, that the above don’t exist and that, comparatively, people of no other philosophy, religion or “belief system”  through the centuries have, admirably, sacrificially and courageously, given their one life and their “dreams” of personal “betterment” (like the One they follow), to serve those with real hurts and needs, as have those in some way associated with Jesus… like our visitors, these physicians, and those of you who choose to partner with us in serving so many here – for no earthly reward, but for the benefit of many…

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Our King’s pleasure in all we do today is our most worthy pursuit…

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