Cavango continues to be a place where the population of the region lives very much like the rural populations that Jesus encountered when He left His home, prosperity, power and position to reveal and demonstrate His care for those He created and, especially, for those rejected, suffering, or hurting. Our Father performs many miracles in this simple place so similar to those that Jesus did all those years ago. Those we witness in Cavango simply take a little time… A few examples follow:

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Maria is an eighteen and awoke one morning two weeks prior to her arrival in Cavango having no ability to feel or move her right arm or leg. Her family, of course, visited the local Shaman and waited for a response to his “treatment” but, after seeing no change for over a week, they made the difficult decision to pay a motorbike owner to transport her several hours to Cavango. We tested for malaria (a common cause of Maria’s radical symptoms), even though she had not experienced symptoms for the same, and she tested negative. Because we had seen similar cases like this, we began aggressive treatment for cerebral TB and, within 72 hours, Maria had some sensation and a little movement restored. She continued to progress remarkably and daily to the point that now, two weeks later, she is walking without a limp and has almost completely restored strength in both her right arm and right leg.

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Hilaria is thirty two and eight months pregnant (her ninth) and she felt the strength in both her legs diminish over several weeks, to the point that, when she arrived in Cavango, she couldn’t lift either leg or move her toes. I suspected spinal TB and told Hilaria and her family that I could recall over two dozen people over the years who arrived completely paralyzed from TB and returned home well. We began aggressive therapy for the same and today, less than a week in, Hilaria visited me and stood up out of her wheelchair, grinning, to show me how she has improved…

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We had what proved to be a nice teaching case for our staff as they learn to do initial consultations on arrivals. Giovana is nineteen and arrived because she had a fever for several days and, when asked, stated that she was on her normal period, with normal menstrual cramping, and she denied all other symptoms. Her malaria test returned positive and her ultrasound by our nurse was unremarkable (she had asked for one, as so many do, to “look inside” and verify good health) and, before discharging her home with malaria treatment, our ever-learning (and humble) consultant quickly reviewed the case with me.

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I explained to him that all women of reproductive age with (any) abdominal pain must be tested to be sure they aren’t pregnant, regardless of their stated menstrual history and other diagnoses. When there was hesitation, I explained how I had learned the hard way that severe diagnoses can be masked by other complaints and guidelines like this one might not apply in this situation but would help him at some future point.

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Sure enough, Giovana’s test was positive, so we repeated the ultrasound together and found that her uterus was indeed empty, but I also noted a 4cm mass on one side of her uterus that our consultant had discounted, thinking it was an ovarian cyst (similar appearance). We also saw some free fluid around the “cyst” that had gone previously unnoticed, which may have been blood. We tested her blood count and found it low as, she had bled, unnoticed, into her pelvis, for several days. We transfused Giovana and flew her urgently via our wonderful MAF colleagues to our skilled surgical colleagues in Lubango to remove her ectopic, tubal pregnancy. Giovana could have returned home where she would have died in her sleep from “malaria”…

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This week, during one of our morning talks, I noted three people walking among us and interacting normally, each with a remarkable (and similar) story from the last month. All three arrived in coma and all three were in a coma for more than a week. One was a 27yo many who we treated for spinal TB and meningitis who is now hardly using crutches to get around. Another is a 12yo boy who also had TB meningitis who I never thought would survive and when he came out of his coma, like Maria, could not move one side of his body and couldn’t speak. He is now walking around with no deficit and is left with only a small speaking difficulty which will likely also resolve. The third is a little, always grinning, 5yo girl who is running and playing and readily accepting a daily sucker. She is also learning to speak again but is making great progress and will likely completely recover. What a privilege to be a small part in our Father’s work in Cavango!

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I enjoy the challenge of the many varied illnesses that arrive daily in Cavango. One morning first thing, we had a successful, challenging labor and delivery of a beautiful little boy; next we evaluated one of our many children who arrive in coma; then we saw a woman with severe back pain for a week; then we evaluated a 2yo who arrived with severe measles who had severe eye infections that might cause her permanent blindness because of a delay of over a week by her caring father in seeking treatment. This delay in seeking treatment is so common here for reasons I will address below.

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This season in our region has been challenging for those who live here. We have seen our high hospital volume decrease somewhat this year and we have addressed the issue several times in our weekly staff meetings to see what we might be able to do about it. Our staff has families spread around the region and is far better in a position to speak as to the environment than am I. We talked about it again this morning. It seems there are several factors in play…

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Paved roads are an hour away to the north, three hours to the east, five hours away to the south and nothing to the west. The mostly isolated dirt roads, through fields and forests, leading to our hospital have seen a huge increase in robberies and even several robbery/murders in the last year. The people of the region simply don’t want to travel these roads because of the very real risk in doing so. Most who arrive pay motorbike owners to bring them and several motorbike owners have been implicated in some of the theft and violence. What is already a costly visit to the hospital now involves the risk that, unless one knows well the motorbike owner, it is unwise to place one’s trust in a driver to take them on an isolated road to the hospital. And the passenger is typically quite ill, as well, adding vulnerability, and the motorbike driver knows that the patient and his/her family will be carrying cash to pay for the hospital visit.

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This is combined with the fact that the charges for motorbike transport have increased ten-fold over the past ten years and wages have increased very little. This is largely a “disemployed” population where people work for days or weeks when work is available but mostly there is no work. The people here live by their fields, growing food and selling what they can to make some money. Mostly it is a cashless, store-less, culture where goods are exchanged more often than purchased. The commonest wage in the rural areas remains at the equivalent of $2US/day and this has changed little since our arrival more than thirteen years ago.

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At this morning’s staff meeting we discussed the differences between the two men in Jesus’ parable who passed by the wounded man on the side of the Jericho road, and the despised Samaritan who stopped and helped him. We can’t judge or assume motives, especially in characters in a story, but we agreed that the two who passed by demonstrated that they were more concerned about other issues than the wounded man and the Samaritan chose to abandon his own interests long enough to provide benefit to the wounded man. We discussed how every day we can be like those who passed by, more concerned about our own interests, comfort, fears, reputation, etc than about those who are hurting. We have been honored severely by our Father by His granting us complete freedom to choose whom/what we serve…

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I also enquired about the well-known hunger in our large rural region and our staff’s responses were quite sobering and difficult to hear. They said no one in this region has enough food to eat more than once/day and many families lack even this because last year’s heavy rains wiped out most people’s crops. This year’s harvest isn’t expected until May or June at the earliest.

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To help meet this awful, real, regional need (not all of Angola is facing this devastation) we have received several containers of rich food supplements, purchased and sent here by some of our beautiful ministry partners. We distribute this food daily to hospitalized patients and it has been beyond helpful and healthy for our (often malnourished) inpatients and their families.

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A few months ago we asked about thirty village chiefs for lists of families in their village hit the hardest with hunger so we could distribute food to them. Today, our team recounted these efforts, when we delivered a month’s supply of food to over 400 families, and they said that much of the food went to those most needy, but that some of the food also went to relatives and friends of the chiefs who were, comparably, not suffering. They communicated that distribution by the village leaders was unwise but that they were willing to travel to the villages to investigate who was truly hurting and get the food to the right people. They voiced great enthusiasm for participating in this beautiful, practical endeavor, during this uniquely awful year for the people of our region, in a way that would imitate the Samaritan in Jesus’ story.

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We are so grateful for all of you who have participated in sending this food. Few will ever know or be grateful to you for what you have done, yet so many have already benefited and many more will benefit until the next harvest and beyond!

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Regarding our volume, in addition to the risk and cost of transport and the lack of resources, our staff also said that, because the rains have begun this year, many families are “all hands on deck”, whether ill or healthy, to get the fields cultivated and seeds planted ASAP and this keeps people from considering medical care when they might otherwise.

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I was able to take advantage of the opportunity to share with them how pleased I am with the quality of our care and that I see evidence of their pursuit of excellence every day. I pointed out to them that we have more and more patients arriving from hundreds of miles away every week and that is evidence that people are referring people to us, not because of a single doctor, but because of the overall care in Cavango. I emphasized that our care was certainly not a reason that fewer people were coming and that we need to find ways to help people receive the excellent care that we offer. They agreed and shared that they, indeed, knew that our care was improving by the number of incredible healings they have been able to witness and participate in.

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Please pray for our Father to direct us and our efforts during these upcoming months to especially share your/our/His resources with those most hurting.

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