Wind, Transfusion, Coma(s), Leprosy, Ants, Music…

 

We gave our first blood transfusion in Cavango.  Malaria had invaded and destroyed the blood of one-year-old, Martinho.  His fingernails and conjunctiva were snow-white, revealing a likely loss of more than two thirds of his red blood cells.  A finger stick revealed blood as thin as tea. We treated his malaria and his fever resolved, but his profound anemia did not.  He became weaker, barely able to lift his head and he stopped nursing.  We have blood transfusion kits bought in the US by Blake, a Canadian supporter of MAF, the aviation transport organization with whom we work so closely.  He read in my blog posts of our many malaria deaths from anemia and purchased kits (for several thousand dollars) which would allow us to transfuse blood safely, without the need for refrigeration or electricity.  Betsy suggested that our visiting friends could help me in working through the details and instructions, which I haven’t had the time to do.  They gladly worked with me in figuring out the steps of the process.  We typed the patient’s blood and found that one of our friends, Jocelyn, was a match. Her husband, Eduardo collected his wife’s blood in a specially designed blood bag, which prevents the blood from clotting.  I established an IV live in the baby’s neck.  Our visiting medical student, Sonja, did the calculations for rate and volume.  All of our local staff chipped in, gathering supplies.  Martinho’s parents helped hold him still for four hours, bent over the bed. All of our supporters enabled us to be here.  The baby’s nails turned pink.  The next day, the baby was nursing strongly and sitting up.  He was walking after three days, has improved steadily and will survive.  The Wind…

 

So many contributed to the survival of this child, from Betsy’s suggestion, to each worker in the clinic and each contributor to our work, to Jocelyn, to the parents…. Martinho’s parents were overwhelmed with gratitude and their vision of Jesus will never be the same. They listened to our morning messages about our Father’s love for a week and saw it demonstrated so profoundly throughout the course of their baby’s illness. This is such a beautiful illustration of the Kingdom of our Father.  One plants, one waters…  How will they know if they don’t hear (and see)…  How will they hear if they die of malaria in childhood or the grief of a lost child closes their ears…

 

Just last week, a child the same age had the same degree of anemia and died without a transfusion.  Without the presence of the team, I had no time to perform all the needed steps to provide the blood, even though the material needed to save this child was in my house.  Donations are necessary and helpful, but we need people who will abandon their lives for the sake of those hungry, naked and anemic.

 

A nice morning today… Saturday… We mainly see inpatients, and the most critical first. Yesterday, our student, Sonja, delivered a 3lb baby (photo) at 28 weeks gestation shrouded in amniotic membranes who, after we cut her free of the membranes, began crying and breathing, though working pretty hard at it.  We didn’t have much hope for her lung maturity, but she survived the night with no difficulty breathing and began nursing strongly a few hours after birth.  This baby is the grand-daughter of a mom who had given birth to a healthy son two days prior (see end of this post)!

 

We then visited two patients who had been unconscious for four days. The first was a 1y/o boy with cerebral malaria, severe anemia and hypoxia (low oxygen) from lung inflammation (ARDS), a common cause of death in malaria fatalities.  We treated his recurrent seizures and put him on oxygen for almost 48hr (an oxygen concentrator connected to a 110/220 transformer, connected through the window to a small generator outside). Though he hadn’t opened his eyes for several days, when we walked into his room today, he looked up at us and tracked us around the bedside (photo). His oxygen level was normal without supplementation and he swallowed liquid without difficulty and began nursing again, with no neurologic deficits. He will survive.

 

We then approached a 48y/o woman who had walked in with severe malaria and a urinary infection last week.  After improving over three days with us, having completed her malaria treatment, and with her fever resolving, she suddenly entered an unresponsive coma.  She is a puzzle.  She may have typhoid fever or meningitis, though she has atypical symptoms for both. When we approached her today, she looked over at me and said, “Bom dia.”  She hadn’t responded to us for four days and every time we stopped her IV fluid, she became hypoglycemic (low blood sugar).  We’ve considered some more unusual causes of coma, such as Addison’s and thyroid disease, but with common illnesses being common, we will begin treating her for TB, complete treatment for typhoid and bacterial meningitis, cover another parasite called schistosomiasis and see how she does.  I never expected to talk to her again.  The Wind…

 

We had two new Leprosy patients arrive this week (photos), a forty year old man who has lost much of his hands to the disease over the past couple years.  Because none of his continual infections hurt, he didn’t seek treatment.  A twenty year old woman came because of pain, as her radial nerve near her wrist became severely inflamed and she couldn’t use her hand because of the pain. She also had multiple white areas on her body, all sensitive to pain, and strange sensations in her nose. These are a couple of the different “faces” of leprosy, though both are manifestations of the more severe form, called, lepromatous, disseminated (full body) leprosy.  One came in because of the destruction of his body because of lack of pain sensation, and the other presented to us because of severe pain.  Pain really does have great value in our lives…

 

This past Sunday, several small rats scurried playfully in the rafters of the church building throughout the service, as we invaded their space for a couple hours.

 

We were able to watch a recorded college football bowl game on a relaxing Sunday afternoon a couple weeks ago.  It seemed like it might be a pleasant diversion.  The coaches (leaders, models, elders) were screaming at the refs, yelling and jumping around, throwing headsets, and acting like children.  The players (kids 18-22 years old) were worse, and the people in the stands…  We turned it off, as I realized again why I haven’t been interested in sporting events for 30+ years, and why we haven’t had a TV for more than twenty years.

 

No one here is ever alone.  Everything is done in a group, with consensus.  There is no such thing as privacy, ever.  Living in rural Angola challenges me daily as to my perception of “needs” and “wants”.

 

We enjoyed our visit with Dr Eduardo and Jocelyn (an NP) de Souza (SIM missionaries from Lubango), Jocelyn’s parents, Ralph and Charlotte (from Minnesota) and Detlef, from Berlin, Germany, who built a beautiful screen door for us, along with a shade screen along the side of our house which bakes in the afternoon sun. He and Ralph worked tirelessly for a week, while Eduardo and Jocelyn joined me in the clinic, with Sonja, our wonderful med student from Ohio, who is with us for the month.  Martinho is alive because they visited when he was dying.  The Wind…

 

Faithfulness… Faithful service is not rewarding for the one who serves, it is rewarding for those served!  For joy, Jesus came, lived and died.  For whose joy?  Faithful service is not a mountaintop experience.  Emotional highs are not a part of the package. The benefit of the other and surrender to a Master are the driving passions of a servant, not personal reward. Jesus, and His faithful followers since, have been passionate about God’s glory, pleasure and joy, and that of others – not their own.  

 

This is a culture without windows.  It’s not uncommon for someone in my car to speak to someone outside through a closed window, not understanding why the person on the other side of the clear window can’t hear them.

 

Intellectually honesty…  I look at a fifty-year-old tree and the saplings growing around it and they all scream of the glory of their Creator.  In all of our 2020 intelligence, we can’t create even a single cell, yet we are surrounded by the miracle of life’s complexity every moment.  The natural world reveals beautifully our Father’s power and creative wonder, while we don’t give it a thought and ascribe the “credit” to chance and time, something that fits nicely into our miniscule understanding and our profound arrogance and ignorance (a nasty human combination). We have no clue re all the miraculous and unified efforts of millions of individual and radically diverse cells that conspired together to enable the single breath we just took, yet we too often give it all, and its Creator, no thought.

 

Our satellite internet system from Belgium stopped suddenly about two weeks ago and we’ve been without.  Betsy and Eduardo (photo) drove about four miles from our house and hiked ten minutes to a place in the woods where there is cell signal (the only signal for miles), over an area of only several meters, to download some emails.  A week later, we just had to catch up on communication, so we drove to the closest city and downloaded emails and messages, stopped at the outdoor market for a few things, filled our fuel tank, exchanged the propane tank we use for hot water and returned home in less than six hours.

 

Yesterday, Brent, one of our two beautiful, servant, MAF pilots, spent his whole day and flew out and brought a replacement part for our satellite dish and the problem was resolved.

 

We had another invasion of army ants over two days.  There were about a half dozen streams entering our yard (photo), each pouring thousands in our direction. When they hit the house, they spread out and covered our front yard, looking just like moving coffee grounds throughout the grass.  I didn’t know they were there the first day, not looking down as I walked to the car.  At about one minute into my two minute drive to the clinic, I got my first bite around my mid-calf.  There is never any mistaking the cause once one is familiar with this bite.  It’s about half the intensity of a bee sting and there is no venom, so no itching, like the fire ants of the Amazon.  Then I experienced another, and another.  I was uncomfortably dancing by the time I parked at the clinic and danced all the way into the building.  I went to the bathroom and stripped and killed about twenty. Then I gave my morning talk and killed them repeatedly throughout.  I told the folks what was happening and they thought it all was quite funny. Personally, I think they enjoyed seeing the doctor in this state of unpleasantness a bit too much 😉  Always wanting to take advantage of a teaching moment, I compared the army ants to illness and the earlier we attack any illness with medication (poison), the easier it is to eradicate it.  They seemed to make the connection.

 

I called Betsy on the CB Radio that we use to communicate from house to clinic and she put a trail of diesel around the house to keep out the ants, which works quite nicely..  The next morning I hopped through them again, experiencing only a few bites.  Then they were gone.  They “march” through our place about twice/year, devouring any live or dead animal products, including termites (silver lining).  The numbers moving along the ground in unison, and in order, is remarkable, and far better than any group of thousands of humans could ever do.  They have scouts, flank protectors, and leaders who travel up and down the line, maintaining order.  They are quite fascinating, despite the irritation they cause.

 

We showered our staff with a nice New Year celebration, a bunch of soda, 20 chickens, rice, spaghetti and the local corn meal, called “funje” (and Betsy made cake). Everyone had a great time, and I spoke for a few minutes about what an honor it is for Betsy and me to work with each of them.  I emphasized the beauty of selfless service in Jesus’ Kingdom and how the world is full of talkers, but not many servants, and that they were all examples of Jesus’ encouragement to serve those hurting and in need.  It was a nice afternoon, much appreciated by our workers and their families.  Then…

 

A first-time mom came in after almost three days of labor.  I was pleasantly surprised when the ultrasound revealed a live baby boy.  After a few more hours and some serious assistance on our part, the boy was delivered, but blue, pulseless and not breathing.  For better than five minutes, I gave chest compressions and mouth-to-slimy-face breaths until, just when I was ready to quit, he gasped a breath and I felt his heart beating through his chest.  He continued to recover from his long delivery well and was discharged home with his mom the next day. The Wind…

 

I had a completely normal and uncomplicated delivery last week, my first in Cavango in 6+ years.  Most births occur at home and only the disasters come to the hospital, in Cavango about 1-2/week.  This was a wife of one of our nurses and they have experienced several dead births at home and desired me to deliver the baby to better ensure a safe delivery.  I really wasn’t needed, though the room filled with women (friends of mom) laughed hysterically at how rough I was with the baby to dry him and get him to breathe (scream his displeasure).  Often in the home, a baby is delivered and they just watch it, doing nothing, resulting in many “healthy” baby deaths.  One of the sayings our nurses hear from me often is that a screaming baby is beautiful music, because it most often signifies health, as our sickest babies lose the ability to cry…