On alternate nights this week, my sleep was interrupted (always) when I was called in to see several people with life-threatening illnesses, demanding an urgent response.

.

On the first night, a 1yo baby boy, Manuel, had arrived and was unstable after we had drained a large abscess in his right buttocks the previous day, the result of having received an injection at a government health post with a used and dirty needle.  We see these almost daily, but Manuel was succumbing to the massive infection as, much of his one buttock had quickly became necrotic.  Our nursing staff, which has gained great expertise over the years, established challenging IV access and we hydrated Manuel to overcome his septic shock, gave him blood to replace his blood loss from malaria, administered additional antibiotics, and Manuel survived and will travel with MAF to our wonderful CEML colleagues for extensive surgery to, hopefully, save his leg and life.

.

Florinda had arrived two months pregnant and was hemorrhaging profusely.  A pregnancy test was positive, but an ultrasound exam revealed a uterus with a large tumor rather than an fetus, indicating a “molar pregnancy”.  This tumor will continue to grow, if not removed, and can transition to a deadly cancer that will take the mother’s life.  Florinda needed a blood transfusion to survive her hemorrhaging and we stabilized her over several days before she “aborted” her tumor.  She may need to travel to our faithful colleagues in Lubango for removal of any remnants of her tumor.  We’ll see over the next few days…

.

A severely malnourished 6mo arrived, as well, unconscious, with severe malaria, having battled at home with parents who had sought help from the local shaman.  Malnourishment at 6mo of life is the result of severe neglect as, at this age, a baby will survive well on breast milk alone.  We aggressively treated this child for two days and he did not survive.  Another arrived the same hour, in the same state, and survived the first few days to begin treatment for disseminated TB.

.

A 40yo man arrived with a severely distended abdomen and difficulty breathing.  We drained six liters of fluid from his abdomen, the result of severe cirrhosis from long-standing and neglected Hepatitis B, an illness completely preventable with a globally available childhood vaccine.  We see so many deaths of this completely preventable illness and this illness is rare in developed countries because of vaccinations, which are now popularly regarded as “dangerous” and avoided by so many in developed countries. 

.

We fought through a major measles epidemic this year, and saw dozens of children die from this illness just in our hospital, another completely avoidable death via vaccine prevention.  We have had several cases of pertussis, another life-threatening illness preventable via vaccinations.  We see tetanus and rabies deaths, also completely preventable and unseen in the vaccinated.

.

I was also called in to see Roberto, a 29yo man who had been vomiting with abdominal pain for several days.  He had an exam that pointed to a need for surgery but some aspects of his story and exam indicated that he might survive without surgery. Our nurse working the night shift wisely decided to call for help.  We arrived and our nurse’s challenge in making the call was confirmed.  We put a needle into the patient’s abdomen to examine the inflammation fluid present, discovered via an ultrasound exam, and aspirated pus, which indicated that surgery would be necessary for the Roberto’s recovery.  We stabilized and prepared Roberto to fly with MAF to Lubango for his life-saving surgery.

.

Lorenzo is 70yo and had been in an accident while riding as a passenger on a motorbike in November, went to the urban government hospital, received an x-ray, and was placed in a huge plaster cast over his pelvis and both legs for three months.  The hospital also put in a urinary catheter and left it there for the whole time.  When his cast was removed, Lorenzo had no use of his left leg due to continued, severe pain.  During his months in bed, Lorenzo had developed severe weakness in one arm, as well, from lack of use.  Lorenzo’s catheter was removed and he has had great difficulty urinating since. 

.

Lorenzo’s family had heard of Cavango and our care here and transported him five hours to seek further help.  We performed a simple x-ray, undoubtedly the same x-ray taken at the other hospital in November, and discovered that Lorenzo had suffered a complete dislocation of his left hip.  With ultrasound, we also found his bladder full of foreign material from a long-standing and neglected infection from his original indwelling urinary catheter.  We placed another catheter and, along with antibiotics, relieved his bladder of the infection.  Lorenzo will travel to CEML to have surgery on his hip, though his dislocation has been too long neglected to recover full function. 

.

An immediate repair or reduction of Lorenzo’s dislocation would have restored full function of his hip and his casting was actually the cause of what will be now a chronic and severe disability.  Via the civil justice system in another culture, Lorenzo would be awarded over a million dollars for the Disability-Adjusted Life Years (DALY) he lost via the blatant medical negligence he endured…

.

Her “heart” captured my heart…  Beautiful little Madalena arrived after suffering severe shortness of breath for weeks.  One could almost hear her heart murmur without a stethoscope.  She had severe heart failure from rheumatic heart disease, the result of destruction of her heart valves from the bacteria which causes strep throat, easily and inexpensively (anywhere) cured if Madalena was treated with basic medical care, rather than taken to the shaman for his “all-natural” “cure-all” herbs and roots. What we believe about truth and lies affects us and those we influence, sometimes in manners life-threatening…

.

Madalena survived our aggressive care and is now wandering our campus, infecting everyone with her contagious smile.  She was given a coloring book by some of our beautiful visitors and expertly colored a picture for her doctor, which will hang on my wall likely longer than she will live.  We may be able to extend her life for a few years when, in many parts of the world, she would have already received a valve-replacement surgery, she would have already been in and out of the hospital post-op, and she would go on to live a full life without any disability whatsoever…

.

A head-on motorbike accident brought to us an unconscious 23yo man with a laceration in his scalp measuring over 25cm which our nurse, Florindo, expertly closed with staples.  He regained consciousness uneventfully.  Another head-on motorcycle accident produced two unconscious victims, one with extensive and complex facial lacerations requiring 20+ expertly-placed sutures by our intern doctor, Adelaide, to repair his lips, forehead and cheek.  The scars of his wounds will remain (photo), though his lips will be fully functional.  Both regained consciousness and had no internal head injuries.  The other man also regained consciousness over the night and will recover.

.

Jorge arrived extremely short of breath and had been coughing for a month.  We drained over a gallon (!) of liquid from his left chest and the next day he beamed his gratitude as he sat in bed eating a simple breakfast, connected to his chest tube which was still draining liquid into a Cavango-style-medical-equipment, used, 2L water bottle with an “underwater seal”…  The cause of his illness, TB, along with his secondary bacterial infection, will be aggressively treated and he will likely survive well.

.

The precious life of thirteen year-old, Laura, was saved over several weeks of aggressive treatment for heart failure in May and was discharged home on several medications without which, as we had painstakingly explained to her parents, she would not survive. Unknown to us, Laura’s parents had taken her home without medications.  She returned last week unconscious and breathing over fifty times per minute.  She remained in a coma for several days but today was sitting in bed and eating.  Some people inexplicably survive the worst of neglect and abuse and we will have a couple weeks to, again, gain the trust of Laura’s parents to partner with us in extending her life…

.

Several children arrived the same night needing a blood transfusion to survive.  Little Emilia (photo), arrived unconscious and with a hemoglobin of 1.9 (normal 12-14), losing nearly 90% of her blood to the malaria parasite!  Emilia received an urgent transfusion and survived.  Over these two days, our excellent lab and nursing staff administered blood transfusions to twelve children, all who would have died without.  We average about two life-saving pediatric blood transfusions daily. 

.

The only way to avoid criticism is to do nothing, say nothing, and be nothing. – Aristotle 

Work like Cavango is valued little by many, including in Angola.  We receive much criticism… We have had people recently comment to us (for the hundredth time) that we should just close the hospital at times in order to “get away”.  “Anyone with minimal experience can manage such a little ‘bush hospital’ because it’s such a small work in a world with many needs” and, “You must care for yourself” and, “You can’t feel responsible for everyone in the world”… 

.

With the above type of activity in Cavango happening regularly, and nearly 100 current inpatients daily who need urgent help for acutely, life-threatening illnesses (one of many “Jericho roads” in Angola), what would you do? 

.

Angola is in its current state of minimal development for many reasons…  Instead of residency and mentoring programs for new medical school graduates, for example, Angola sends the same to remote (”bush”) hospitals for a two year commitment with no mentoring.  This is one of the best ways to stifle progress and the passing on of knowledge/experience…  Reinventing the same thing a thousand times will not lead to an improved product/service (evidenced in Angola), whereas learning, improving and passing on to another… 

.

We remember, of course, that, in Jesus’ well-known story/parable of the “Good Samaritan”, He told of two “religious authorities” who walked by the hurting man on the road to Jericho (they likely had “important” meetings and/or family events to attend or, perhaps, it was “Sabbath”…).  What was Jesus indicating that His followers would do?  On other occasions, Jesus told His disciples that, in order to follow Him and to serve, especially those hurting, they must die to themselves, their “dreams” and their desires/duties/obligations…

.

Living Jesus actually does advise us in Cavango… regularly… about not what we “should” do but, rather, about what He would have us do, which trumps (for us) any “wisdom” shared with us by those (many of whom label themselves as “Christian”) who have a very different worldview than the Jesus we know and serve in Cavango.  Jesus did not implore His followers to pursue a better life for themselves (as is preached in churches today around the world) but to, like Him, give away their lives so that others might live…  “Do you love me?  Feed my sheep…”  Knowing Jesus as He did, how did Peter then live… and die?

.

Thank you for partnering with Jesus so sacrificially in this endeavor in which so many (the above are just a few), who are considered as having little/no value (like the beaten man on the Jericho road), are rescued, served, valued, embraced and loved by our King, through all of us.  The value of our work will one day be made clear and, until then, we will entrust our efforts, time, rest, and resources to the Living One we follow…

.