Author: Kubacki’s I Angola

About Kubacki’s I Angola

Missionary Physician in rural Angola

CV, Dana, Value, Change…

Coronavirus infected Eduardo, our neighbor and colleague, and he’s been recuperating for about two weeks after needing oxygen at home for several days for difficulty breathing and hypoxia.  Eduardo has had some rough turns since arriving in Cavango, encountering a bout of severe malaria, kidney stones and now CV-19.  I admire his commitment to serving these rural people. Because we have no tests, Eduardo worked for a week with a fever, prior to the onset of difficulty breathing and our diagnosis (by flying in a single test with MAF), but we’ve seen no other cases in Cavango and we are grateful, both for Eduardo’s return and that his is an isolated case of CV.

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Dana is such a good example of how so many beautiful, unseen and unknown people, from around the world, work together to value/save/extend a life. Dana was brought to us (instead of to a Shaman or health post) by her caring and wise sister on the back of a (hired) motorbike from 5hr away, after she found Dana passed out in the front of their house. Dana was awake on arrival and said that she suspected she was two months pregnant and that she had suffered from three days of severe pain and vaginal bleeding. She didn’t recall passing out at home. Her pulse was rapid and faint, her blood hemoglobin was 3 (she had lost ¾ of her blood), her pregnancy test was positive and ultrasound (purchased by perhaps 200 people in the US) revealed an empty uterus, an abdomen full of fluid and a mass in her pelvis. Aspiration of fluid from her abdomen revealed frank blood and her diagnosis of a ruptured tubal pregnancy was certain.

We typed her blood (with a system developed by a company in the US for places without electricity and refrigeration) and called on two of our nurses to donate a unit of blood each. After the first unit was transfused, their donated blood continued to clot in our delivery system, so it took six people, over four hours, to inject the blood into Dana’s veins with syringes. We contacted MAF (supported by hundreds of people worldwide) and our MAF missionary pilot from Holland, Marijn, arrived early the following morning to transport Dana to CEML in Lubango (built by Samaritan’s Purse, USAID and hundreds of donors) for surgical repair of her ruptured fallopian tube and removal of the doomed pregnancy by missionary surgeons, who are here because of the financial support of hundreds of individuals and families. Betsy drove Dana ninety horribly painful minutes on a mattress in the back of our pickup truck to the dirt airstrip, as Dana groaned at every bump (thousands) on the dirt “road”. MAF flew her to Lubango, where she was picked up in CEML’s ambulance (purchased by hundreds of donations) and driven to the hospital for emergent surgery. She is due back in Cavango today via MAF, with three other patients from Cavango who also received urgent surgery at CEML, and will be transported by Betsy again, this time with our ambulance, purchased by our home church in Ohio with funds contributed by so many from our local church family. I love thinking of the voluntary and sacrificial contributions of so many, unseen and unknown, except by our Father, who is behind it all, for the sake of a young woman very dear to Him.

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It is now near 40d outside and 50d inside on these cold, winter, Cavango mornings.  The winter days are clear, cloudless, breezy and in the 70s.

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There may be people in this world as needy as those we serve in the Cavango region, but none more so, and many of you are instrumental, every day, in giving life to so many like Dana. Some examples of the difficult lives of these beautiful people follow:

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The rural people eat corn or millet powder (ground by hand) mixed with water once or twice daily. They so rarely have anything to eat with it that they have a name, “conduto”, for anything added, such as vegetables, beans, goat, pork, chicken, crackers, rice, pasta. One of the wealthiest leaders of the community, who has regular work, bought a single sleeve of crackers for each of his kids this past Christmas. They are thrilled when they have “conduto”. All consumed food is grown/raised in their small, fence-less fields, as anything else costs money, and this is largely a cashless culture where products are traded rather than purchased, and the nearest store is many hours away by foot.

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We are currently experiencing the results of a drought this past rainy/growing season and corn (and conduto) prices are more than 4x what they were last year (supply and demand). Everyone is concerned that they will not have enough corn to last the season and that when planting season begins in Oct/Nov, they won’t have enough for seed for this year’s crop, next year’s harvest.  Betsy and I are trying to think of ways we can help.  Please let us know if you would help us in this effort over the next few months.

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Malnutrition, especially protein malnutrition, is rampant, and we see several life-threatening cases daily (photos). They arrive looking exactly like the pictures of starving African children you see on TV commercials for World Hunger or in National Geographic. We treat them, mostly young children commonly affected during the first year or two after weaning, with an egg and two cups of powdered milk daily, and those who seek care at our hospital typically recover well and thrive. So many die at home without seeking care because of lack of resources. We educate constantly about the need for dietary protein, but this part of their diet (conduto) is difficult to afford and/or raise.

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We’ve had four people bitten by rabid dogs in the past month.  Cases of rabies are seen in our area’s people and animals about twice yearly and the country has no rabies vaccines and we cannot legally import them.  All four of these people recently bitten will die in two months, and they know it.

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The primary “health care” for the common man, from their perspective, is the same as it was when Jesus called forth Lazarus, touched lepers, walked on water and calmed storms – that of the local Shaman, who mixes herbs and roots to treat all maladies. They inject their concoctions, give them rectally, orally or make multiple cuts on the skin over the affected area and rub it in. Beginning at a very early age, all people (including all of our hospital workers) carry scars on various parts of their body from this treatment. We have several people dying in our hospital from this concoction every day secondary to liver failure from the plants used in the treatments. The actual benefit of the treatment is, of course, equal to that of placebo but this is “health care” to them.

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The only “modern medicine” they know is that of the “free”, government-run “health posts”, where the workers are minimally trained and the shelves are empty.  There are virtually no adequately trained physicians in this country and those few working in urban hospitals are typically from Cuba, China or Russia, the primary global allies of Angola.  The health care workers in the health posts know nothing of disease transmission and reuse needles for weeks with no cleansing and without alcohol to sterilize the injection site, resulting in horrendous infections and sometimes loss of limbs and lives.

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Our prices at Cavango are as low as we can possibly make them to operate the hospital, and a consultation costs each patient the equivalent of three days wages for the common laborer ($1/day is the common wage).  The consultation costs pay for the very small salaries of our hospital workers (average $3/day).  Our limited selection of generic, imported, Indian medicines are good quality, inexpensive, and sold at the same price for which we purchase them in the city at bulk warehouses, and they typically cost the patient about the same as that of a consultation.  So a visit to our hospital, the most inexpensive modern medical treatment within hundreds of miles, typically will cost about a week’s wages.  We try to lower prices more, using some of our outside resources, but we believe that it is healthy for costs to be assumed by the patient as much as possible, for the long-term social health of the population.

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We make plenty of exceptions. All patient costs for those transferred out for surgery, for example, are covered by your contributions to this work, usually about $30,000 – $50,000US annually, at an average cost of about $500/patient which is, of course, globally, radically inexpensive for the quality, life-saving, tertiary care they receive at CEML. 

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They dress in used, imported clothing and rags, and most own no manufactured products, such as underwear, toilet paper, towels, tooth brushes, shoes, etc, which require cash that they don’t have.

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Often patients undress for exams and have an assortment of insects crawling on their bodies underneath their clothing.

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We drain chests, abdomens, hearts and limbs into open buckets and deposit the medical waste into a septic hole underground.

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Soap is a luxury, so we use the same towels for weeks at a time, rinsing with water when able.  Our water comes from a spring, 2km away, which supplies the village and the clinic and about 50% of the time that we open our faucets, there is no water. The people are always covered in flies as, because of lack of soap and available water, everyone reeks of stool and urine. 

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No one has electricity or indoor plumbing in their homes and water is carried in buckets or jugs from a water source – a well, spring or, more commonly, a river/stream. Our hospital has no electricity, but we have a dim 12V LED light in each room for night exams, powered by a couple solar panels and batteries. It was only a few years ago that we used candles when our headlamps needed batteries. Headlamps and flashlights are quite a luxury here, as are the batteries which they require.

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Keeping a hospital stocked with medicines and instruments, let alone cleansers, disinfectants, soap, brooms, etc, is a challenge when the closest city is three hours away.

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No children have diapers or underwear, so babies urinate and defecate on their mothers’ laps and/or on the floor, where it is spread around with a mop to dry.  We have very little disinfectant and can’t keep up with the need for bleach, the most inexpensive disinfectant.  No one has cement floors in their homes, so they typically let the ground, both inside and outside of their home, absorb the waste.  Our hospital wards commonly have stool and urine on the floor in the mornings even though we have built fly-infested latrines around the campus, but the use of these is minimal, for lack of knowing their community/public health benefit. 

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They sleep on the ground, sometimes on a grass mat, inside or outside of their grass-roofed, mud-floored, mosquito-infested homes. It is now winter here and 30-40(F) degrees at night and sufficient blankets are rare.

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They cook over an open fire, spend hours daily gathering dry wood, and have few, if any, durable cooking utensils.

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Via MAF, we fly surgery patients to our mother-hospital in Lubango, transporting them over dirt by car, the first time most have ever been in a car, to a dirt airstrip an hour away. Almost everyone that I ask has never been to a city.

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In our morning talks about public health, I try to explain modern manufacturing, technology, medical studies, pill-making, etc to them and can tell that they have no understanding of what I’m speaking about. Imagine trying to explain “unseen” bacteria, seen in a microscope by all children in the west, as a cause of illness… It’s like trying to describe a mountain or snow to one who has never seen/experienced the same.

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No one knows math and they own few purchased goods to develop a comparative sense of monetary value, so when we discuss prices for treatment, our rationale makes no sense to them. I will tell someone that transport in the ambulance might cost 5,000 kwanzas (kz), about $7US, and they will be shocked at the number and indicate they can’t afford it, but when I ask them to reimburse us for paying for a 200,000kz surgery ($300US), they promise that they will and never do.

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There are no banks in rural areas.  Any extra money earned from selling surplus corn is used to purchase a cow, which is how the more educated save and invest their money.  The cows graze for free, are hearty, are easily sold to city butchers for much more than the purchase price of a young calf, and the investment is potentially doubled every year or two.  When drought or illness causes the death of a cow, you can imagine how devastating that is to a family.

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These people view themselves as subjects, to the government, to nature, to unseen spirits, to illness, to people in power, etc and, as to the influences from any one of these, they see themselves as helpless to intervene and/or change the outcome.  Their world view is one of fatalism and victimization.  “The gods have forsaken us.” would be an accurate self-perception.  They blame no one for tragedy and hardship, but rather blame impersonal unseen forces, spirits and gods, chance, luck, etc and take no responsibility for their actions or those of others for, to do so, would place responsibility on themselves for outcomes, inducing guilt and shame, which they choose to avoid.  They see themselves as unworthy of esteem, blessing, value…

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Speaking truthfully is not valued if it might be personally detrimental, theft is the norm, justice depends on who you know, planning for tomorrow is uncommon, nothing happens punctually because no one has watches or clocks, leading to radically inefficient time-management, people regularly don’t show up for work, expectations for task excellence are low, interpersonal interactions are kind and extremely superficial, meaningful communication and vulnerability is unknown, and analysis and critical thinking for the purpose of improvement of circumstances is nonexistent.  There are no books or contact with the outside (other than government-produced, propagandized “public” radio), so gleaning from what has been learned elsewhere is impossible.

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There are modern social scientists who think that people like us should not intervene in these impoverished cultures because we would be altering “normal”. These beautiful, capable, neglected and forgotten people ought to be left alone to continue to drown in their fly-infested, painful and life-shortening circumstances…  But…

We are here to challenge these local world views, which have been foundational to these tribal cultures forever. We strive to teach and demonstrate the value of these people to our Father, the purpose for which they were created, and their beauty in His eyes. We strive to reveal the very real capability in them to partner with our Father in intervening in, and stewarding, this world to make healthy changes that will benefit them and their communities. We strive to demonstrate and teach that there is no higher calling than to serve one’s neighbor. We strive to model that intimacy and partnership with our Father is the key to this life and that Jesus is alive, approachable and worthy of our devotion. Our goal is that in 20-30 years, no one will remember us and the culture will maintain its own identity and uniqueness, but also be aware of, and connected to, the rest of the world in such a way as to benefit from global “best practices” and the sense of inferior personal and cultural value will have been transformed from “subject” to intervener, developer, learner, and steward of all the gifts and resources that have been granted to them by their Creator.

Thank you for joining us!

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