Trials, Retreat, Support, The Greatest Untold Story…

 

This past couple of months in the US was not planned, as we have faced some recent trials, culminating in Betsy’s hip replacement surgery (Aug 17th).  I (Tim) had a life-threatening case of ARDS and malaria with subsequent placement of 3 stents in my coronary vessels, Luke had testicular cancer with successful surgery that likely removed it all, Betsy dealt with rapidly worsening hip pain necessitating somewhat urgent surgery, I broke my big toe on a motorcycle trip (below), and had some skin cancer removed (I think that’s everything…).

 

We realize that these trials are in no way exceptional or unique, and that many of you have faced similar and worse.  We remember in these circumstances that Jesus’ favor/affection must remain our focus, and is enough; that all trials (as well as this brief, brief life) will pass, and that only an eternal perspective, based on our love relationship with our living God, produces sustaining joy and peace.  My Father is faithful to provide whatever thorns are necessary to keep me dependent on Him and the eternal purpose of the thorns is far greater than the temporal pain. 

 

Betsy is beginning her recuperation and her pain will gradually decrease over the next few weeks, Lord-willing.  The cause of her rapidly progressing arthritis (the surgeon said her hip was awful) was discovered at surgery in a torn labrum that likely occurred a couple years ago, when her pain began, which then caused laxity in the joint that led to the unnaturally quick development of such severe arthritis and pain.  She is grateful for all of your prayer and concern and remains in good spirits as she painfully attacks physical therapy.  She will remain in the US until about October 1st, when she will join me in Cavango.

 

I took a five-day, 2000-mile retreat on the back of a rented motorcycle, wandering around the perimeter of Michigan.  It was a delightful week causing me to fall in love again with trees, being on a bike, and the incredibly varied wonder of my Father’s creation. The variety of both the foliage and it’s varied greens left me in awe of my Father’s radical creativity that, for the most part, goes quite unnoticed.  I wrenched my left big-toe on the first day beneath the back roll bar and the pain was only a minor distraction to the wonder I was experiencing, both in and around me (though it reminded me of its presence with every gear shift).  Now, two weeks later, the swelling and discoloration are beginning to decrease, though the tenderness remains.  No early morning walks for a while!  I don’t think there is anything I would have enjoyed more over a five day period and I am grateful for the opportunity for this refreshing in my Father’s warm affection before I head back to Angola Sept 5thConversation and solitude are a beautiful Kingdom combination!

 

I then flew out to Colorado to meet with seven people who are passionate about our work among the underserved in Cavango.  Three of those we stayed with lived in Cavango in the 1970s, two have visited several times, and one was interested in finding out how he might join us in our work.  The topic of conversation was Cavango past, present and future.  I learned much of the work there in the 50s and 60s as a leprosarium and hospital, before it was destroyed during the civil war in 1976.  I shared much about our growing health care and Kingdom work over the past three years and we brainstormed about future possibilities.  We talked for about 6hr on Monday, then I presented Cavango to about 20 adults, invited to an evening get together because of expressed interest in our work.  It was a beautiful, interactive group, several of whom will likely join our sending team in some way.  The next day we visited a missionary engineering firm (EMI) made up of over 100 men and women, living on sacrificial support from beautiful senders (as are we) and serving in various places all over the world, where needs for their services are greatest.  Kindred spirits!

 

Our discussions largely revolved around how to better the services that we provide the rural people of the Cavango region.  We discussed in-patient wards and energy options, people needs, financial needs, medical equipment needs (beds, surgical ward, etc), and each person was interested in exploring what role they might play.  The group, AGA (Advancing the Gospel in Angola), of which these beautiful folks are a part, has sent a container full of goods to Cavango and it is set to arrive this month.  Four of these men stocked this container (at great effort and cost) and will meet me in Cavango in mid-September to distribute the contents of the container.  The container holds the steel needed to begin construction on the first of five simple buildings that will renovate our hospital and make it more conducive to excellent care for those we serve.  I’ve also just received word that our mission, SIM, has located 100 donated hospital beds, so we will now begin to fill another container for shipment next year.

 

The enthusiasm expressed for our work in Cavango and serving the people of this region was deeply encouraging, and much needed, as getting things done in Angola is never easy!  These dear brothers and sisters are so interested in using their skills and resources to help the rural people, who have needs beyond description.   There is no earthly reward for these folks, and their faith deeply encouraged me.

 

A couple weeks ago, I traveled to North Carolina to visit some of our mission leaders at SIM, as well as leaders at Samaritan’s Purse, who have played an integral role in our work in Angola.  I also met with the family of a student who desires to visit us next year (they are missionaries with the aviation wing of Wycliffe), and leaders at Campbell University Medical School, who wish to partner with us in sending residents to learn from us and our work, which is so different than medical work in the US.  It was a rich trip, renewing and forming partnerships that will benefit the people we serve.

 

I also visited the leaders of our home church, VCDC, in Sunbury, Ohio, and their passion for partnering with us in serving the rural people of Angola also left me encouraged to continue to see Jesus’ affection demonstrated to those we serve through our work, words and lives.

 

I met several people in North Carolina who were instrumental in the effort to treat those with Ebola in west Africa in 2014, several of whom are featured in the film, “Facing Darkness” (worth seeing), but who most of the world will never know.  I was impacted by the beautiful, silent, exhausting and life-on-the-line sacrifice these folks made for those Jesus loves in Liberia.

 

Kent Brantley, a physician with Samaritan’s Purse and survivor of Ebola in 2014: “People have asked me if my faith saved me from Ebola, as in a physical healing,’’ Kent said. “In a very real way, it was my faith that got me Ebola. It was the living out of our faith that put us in a place that we were at very real risk of getting Ebola. And that changes my perspective on faith. It is not something that makes you safe. So, yes my faith put me at risk of Ebola, but it also is what I clung to at the most difficult times of my illness. Not faith that because I follow Jesus, I’m going to get well, I’m going to recover, but faith that says I got this disease by following Jesus, so whether I live or die, I’m OK with that. And that brought a tremendous amount of peace. It didn’t take away the fear or anxiety from the illness. But it brought tremendous peace during it.’’ (emphasis mine)

 

 

The above engineers, missionaries and most Jesus-lovers don’t self-promote (you won’t see us in Time magazine or on CNN).  Yet, the number of people helped/healed in Jesus’ name (at great cost and sacrifice) throughout recent history (2000 years) is incalculable and is the most beautiful untold story of all time.  The number of people who have found eternal life and peace through a relationship with Jesus will one day be known, but for now remains a mystery.  We hear about the human hypocrisy and abuse in the church (in Time and on CNN), but this pales in comparison to the ongoing, untold, beautiful sacrifice for people of every race, tribe, and ideology in Jesus’ name.  Mother Teresa was only one of so many loving Jesus (in response to His amazing love for them) by sacrificially going to the hard places to serve “the least” in this world.

 

Please don’t be deceived by the media’s disproportionate coverage!  Join the Kingdom army today and give your effort, dollars and time to feed the hungry, heal the broken-hearted, embrace the wounded, and advocate for those with needs.  As you become consumed by love for your Father and those with debilitating needs, the beauty of His kingdom will overwhelm you and you won’t have time to fret about all of the negative publicity.

 

All that the beautiful men and women of Samaritan’s Purse did in literally putting their lives on the line for the people of west Africa is already forgotten.  The efforts of all those in our home church, those in Colorado, those with SIM and those on our support team – for the people of Cavango – will never be known.  Yet…

 

seek them out

 

…the unnoticed, the lonely, the debilitated, the abused, the wounded…  No one will ever know of your sacrifice and effort, but you will join the great untold story of Jesus’ love for the hurting and broken through His (ever-flawed) followers/children and your Father will see and never forgetJesus literally left heaven to love, serve and rescue mankind, and we can give our lives for the same…

 

Curveballs, Should, Light, LW…

 

Can healthy hurt?  Is suffering from God?  No one likes to suffer, or see others face painful circumstances, yet these common, human questions, and all of the various ways we ask the same, are as much about expectations as theology.  If we expect pain, loss and difficulty, we have a very different resulting attitude than if we expect ease and pleasure.  Our response to life’s intrusions is different if our world view considers them good/healthy rather than bad/unhealthy.  Our response to pain and difficulty can be quite cultural and I would never have believed it had I not been confronted with the cultural response to suffering and loss of the rural Angolans (see below).  AW Tozer writes excellently about expectations in a brief message entitled “This World: Playground or Battleground” which you can read here.

 

It seems that few Jesus-followers today embrace Jesus’ primary emphasis of relationship with Him eternally and His prediction that this life would involve alienation, trouble and difficulty, using Himself as an example of what His followers would encounter.  There is much church emphasis today on temporal healing and self-fulfillment as we dismiss Jesus’ admonition (and example) to deny pursuit of self-pleasure, embrace crosses (pain and difficulty), seek Him and His kingdom (first) before any personal needs or wants, accept confusing “thorns”, and run toward difficulty, loss and suffering (and those encountering the same).  Jesus demonstrated (in how He lived and suffered), 1) that light is most useful and beautiful in darkness (confusion, pain, loss, etc) and, 2) how to selflessly serve and suffer well because He intimately knew His Father and He knew where He was going at His life’s end.

 

Are we willing to embrace Jesus in our loss and pain in order to bring far more attention to Him and His goodness than we could through earthly pleasure and success?  If you are suffering today, please know that your life can better point to your Father (and lead others to Him) by suffering well, and demonstrating the fruit (Gal 5.23) of His presence within you during your trial, than you can by (even miraculously) being healed of your calamity.  Intimacy with Jesus (and the fruit of this intimacy) in our suffering is other-worldly whether we are healed or not (Paul’s thorn).

 

Suffering is experienced by every single human being, and miraculous healing by few, which is why those who suffer with counter-intuitive peace, trust and joy cause observers to wonder about the source of these qualities (because the observers are accustomed to suffering with confusion, fear, anger, anxiety and frustration), about whether there might be purpose in suffering, and about even the possible reality of eternal life (good beyond the suffering). Although Jesus demonstrated that He will rarely miraculously end our suffering, He also communicated that there is so much in this life more important than our trial, however intense.  The pain of Jesus’ suffering and death, and of our Father’s loss through the same, were not comparable to the eternal joy that so many would experience as a result.

 

One of the most arrogant and destructive words in the English vocabulary is the word, “should”.  We would be wise to eliminate it, especially in the church.  If it is directed at another, we are expecting a free human being to behave in a manner that suits us, and we have a delusionary illusion of control over their behavior and the world around us.  A “should” attitude in any relationship (with oneself or with another) places a burden on the recipient impossible to bear. “You should” and “You should have”, for example, with their accompanying arrogance, have destroyed far more marriages than infidelity!

 

If “should” is directed at ourselves, we are expecting a singular result outside of life’s normal complexity and chaos.  If we combine “should” with the word “have”, it is especially destructive, because it lacks our Father’s grace and is spoken from hindsight, with it’s accompanying perfect vision, which was not present during the circumstance about which we speak.  If ever tempted to use the words, “should have”, we would be wise to stop and forgive before these seeds of control and judgment germinate into bitterness and destroy us from within.

 

The words “should” and “should have” are virtually never spoken among our rural Angolan friends, in fact I believe I’ve never heard them.  Rural Angolans live with daily hard labor, little sustenance, no options for improvement, much life-threatening disease, and death/loss as an always present reality.  And yet they also live in gratitude and with an easy smile and tangible humility, yielding a pervasive, attractive and sober joy which permeates every interactionThey also expect nothing from life and nothing from each other!

 

When used among the religious among us, “should” disregards our Father’s rule over the events of our lives and of the lives of the people with whom we interact.  It reveals a lack of trust in either our Father’s care, His goodness, or His ability to intervene in our circumstances.  The use of this word elevates us to god and judge and we would do well to recognize the destructiveness of using the word “should”, confess its every use as sin, and never use it again.

 

We would also be wise to apply to all we do the attitude of the early Jesus-lovers (Ph 2.19) – “Lord willing”, and that of Jesus in the Garden prior to His crucifixion, “This is my desire, Father, but I surrender to your will/desire/pleasure…”

 

I have been reminded these past few months of my short-sightedness, the destructiveness of expectations and the healthy kingdom perspective of, “Lord willing…”.  I had many (good) plans for these recent months in Angola, yet we have been thrown some “unexpected” (and expensive) curveballs that have required acute reorientation, sudden plan changes and a great deal of flexibility.  Firstly, in May I had a life-threatening case of malaria which damaged my lungs and threatened my pre-existing heart condition, taking me to South Africa for evaluation and (excellent) treatment of both my lungs and my heart vessels.

 

On the heels of this experience, our son, Luke, was diagnosed with testicular cancer and urgently returned to the US from Mozambique for surgery.  We are so grateful that it appears that his surgery entirely removed the cancer, but Luke now faces the disappointment of having been medically discharged from the Peace Corps while he endeavors to reorient his life/direction in light of these changing circumstances.

 

During these same months, we’ve seen Betsy endure a radical worsening of her arthritic hip pain, to the point of very limited activity, moving forward by several years (our “expectation”) her need for a hip replacement surgery (her x-ray change in one year, along with the rate of her pain increase, have both been quite remarkable).  She is now scheduled for the surgery in the next month or so (we find out this week), requiring both of us to remain in the US for her surgery and recovery.

 

None of this was even in our thoughts, let alone our plans, when we returned to Angola from the US in March, refreshed and ready to dive in to our work.  I have a new appreciation for my lack of control of life’s events, along with a new affection for, “Lord willing.”, and the heart condition necessary to sincerely speak this phrase.

 

I am reminded again that we far more “respond” to life’s circumstances than we “determine” the same.  It is certainly “Both… and” rather than “Either…or” – one of life’s many tensions between two extremes.  We also know that our Father graciously invites our participation in His activities in this world among those He loves, but we would be wise to participate humbly, acknowledging our short-sightedness, rather than with an arrogant and delusional attitude that involves “shoulds” and expectations.

 

So we will wait in the US for Betsy’s surgery, perhaps for two weeks and perhaps for a month.  We will try to emulate the rural Angolan people we so love and admire, who are never surprised by the unexpected because they expected nothing prior to the unexpected, who are never in a hurry and never frustrated by waiting (because they began with no expected time frame), and who are ever grateful for small and simple pleasures (because they didn’t expect them).

 

We will keep you posted and so appreciate your continued prayer and support for us and for our beloved rural Angolan friends, who we look forward to serving again soon.

 

Applause, 19, Walkers, Dirty Hands, Sheetch…

 

Betsy and I returned to Cavango after our three-week interruption to South Africa for treatment of my heart issue (which is doing well) and we drove up to our simple hospital at dusk (after a rough ten-hour drive) to greet the workers.  There were already 50-60 cooking fires scattered around the clinic (pretty normal scene), each with a family or two sitting near and preparing for their simple dinner.  Over about a minute, as we slowly approached on the dirt and parked, these simple, rural folks stood in unison and applauded.  150-200 people in rags, splints and bandages, previously sitting on the cold, hard ground (40s at night) around their small fires in the dimming light… standing, grinning and applauding as we exited our car!  Our nurse director told me later that he had told them of my illness and they were applauding both because I was better and because we had returned (the rumor among them was that my heart issue would cause me to permanently return to the US and no longer work in Cavango).  How can words ever express what I felt as I encountered this reception by people I admire, people I’ve so grown to love, and people who, without exception, live such difficult lives?  We are not here for such a reception, and we certainly would never have expected something so profound and spontaneous, but I hope I never forget that moment, especially on the tougher days…  We know why we are here and we daily sense our Father’s pleasure, but I have sometimes wondered if those we serve perceive real benefit to our presence and effort…

 

 

Every one of you who support this work please picture this setting and receive the pleasure and gratitude expressed by these people.  We are only the hands and each of you are a part of a beautiful body of people who care for the rural underserved in Angola as we do, and who enable what we do with your sacrificial financial contributions (you are exceptions to those in the church referred to below).  That applause was for the totality of our work, impossible without our self-sacrificing team who enable every treatment we render.  Please know today the pleasure of your Father, the gratitude of these people and the blessing you are to the hands that you send to touch these remarkable people!!!  Estamos juntos! (Portuguese – google it :-))

 

 

Over two days last week I saw four seriously ill 19-year-old young women.  The first was beautiful, tall, educated, quite healthy, spoke flawless Portuguese and came to us from a city several hours away.  She had been feverish for several days and tested positive for malaria, but also complained of severe pain in her left leg and arm and, when questioned further about this pain, confessed that all she could remember was that she had been bitten by a small street dog on her thigh about a month prior (dates are always questionable in this culture where time passage is rarely accounted for and time is measured by the location of the sun).  It was small and she dismissed it.  The bite was a small puncture wound which had healed nicely, with no evidence of infection.  When I asked about the dog, they said it was known to them, but that it had disappeared after the bite and had not been seen since.  The family couldn’t recall this dog previously disappearing in a similar manner.  I explained to the family after praying together that we would begin treatment for the malaria and observe her in the hospital, leaving my concern for rabies unspoken.

 

 

By the next day, the girl was highly agitated, the fever gone, and she was complaining of severe pain everywhere (can happen in malaria with fever).  Her mother was quite sharp and obviously concerned about her daughter’s “cerebral malaria” and said that she had never behaved like this before.  I took this distraught mom aside and broke to her the news that her beautiful daughter had rabies, that she would soon die and that there was no treatment anywhere in the world for this disease, once it manifested symptoms.  She asked about the vaccine and I sadly told her that at this point it had no value and I didn’t want her spending a lot of money needlessly (about $30US – a lot of money for these folks).  She tearfully and bravely accepted the news and thanked me for my honesty and care, admitting that the bite may have been two months prior (the typical incubation period for rabies).  The next morning found the girl highly agitated at any sound or movement, writhing on the floor and unintelligibly and constantly screaming.  She had been in this state since the previous evening (despite receiving a strongly sedating anti-psychotic medication that we stock for such cases) and the mother was obviously exhausted in her state of sleeplessness and profound grief.  She asked if she could take the girl home to die and the girl’s father bravely and tearfully tied his beautiful, inconsolable daughter to his back on a motor bike with his son behind the girl, trying to wrestle her still.  She died in her mother’s arms on a path about an hour from the hospital at a river crossing.

 

 

I’ve now seen (too) many cases of rabies, and each one provokes many emotions, including sadness, helplessness (an awful feeling for a doctor), and anger.  This disease should kill no one.  I drove from Cavango for 12hr three years ago (my first case there) to get a vaccine from the Angola government (only place in the country where it is available) for a woman with a minor bite from a rabid dog the previous day.  We found the vaccine in a larger city and brought back enough to give her the complete series over 28 days.  She died of rabies two months later.  Since then, we smuggle all of our known-good-quality rabies vaccines in from Namibia and have given the vaccine to about 30 people bitten by a rapid dog – without one fatality.  The vaccinated woman’s death was because the vaccine was not kept cold and became ineffective. This is quite a problem in a country where no one has consistent electricity and few are educated in the science of vaccines and the necessity of maintaining a “cold chain”.  An example of the lack of knowledge: The director of the vaccine department of a large health post (where we obtain for our clinic the standard vaccines from the government) told me once that they were out of a certain requested vaccine, but that I could substitute another (different vaccine), because they were the same thing!  We have rabies come through our region about twice/year and each time we see at our hospital about 5-6 people with bites, some in time for us to vaccinate, thus preventing the disease, and some we helplessly watch die, over 2-3 horrific days, from this incurable (but completely preventable) disease.

 

 

I try to take advantage of teachable moments, so the next morning at our daily gathering of all of our patients and their families, I taught them (over 100 people) and our nurses about rabies.  The discussion was animated and highly interactive and lasted for over an hour.  They had all witnessed the girl’s awful demise and no one forgets such a tragic spectacle.  They were quite interested and I was able to give them the basics of the disease (and the need for early, post-exposure vaccination) and instruct all of them to gather their communities together upon their return and share the information with everyone.  I believe that most of them likely will do so, based on the intensity of our discussion.  Few knew of the vaccine’s reliability because all of the people they knew who had been vaccinated had died (Angola vaccines).

 

 

This is one of our huge challenges here, because when people think of “modern medicine”, they associate us with other health posts that stock a few pills/injections and are staffed by caring people with little education.  To these rural folks, a pill is a pill and a shot is a shot (all the same and shot is always better).  They know nothing of specific treatments for specific illnesses (neither do many treating nurses) or that each medication is chemically different than the others (they all look the same).  They put all health posts in the same boat because we all have “the” pills and shots.  An example of treatment at gov’t health posts: I recently saw a 22-year-old man with an obvious STD who was treated by a doctor at a hospital with a basic antibiotic that doesn’t treat STDs.  He was treated for a urinary infection (because of the always contaminated urine specimen) that men almost never acquire, and will likely now be sterile for the rest of his life.  This was completely preventable with a correct (and easy) diagnosis and treatment.  I won’t touch the morality of his disease because virtually all men here will have one of this large group of diseases at one point in their lives because they don’t live by our Father’s recommendation of monogamy – which quite effectively prevents this group of diseases that has historically killed millions, and rendered many more men and women infertile.

 

 

Another of the 19-year-old women presented with a “swollen” and painful abdomen that she’d had for over a month, after she had delivered twins two months prior, both of which died at birth.  Her abdomen was distended and felt like a rock, unlike any abdomen I’ve examined (in 30+yrs).  It was different than the firm abdomen of peritonitis and this girl had been eating, drinking and pooping (medical term), ruling out this diagnosis.  Thankfully, I have an ultrasound machine which clarified this girl’s strange condition.  She had about an inch-thick layer of pus covering her entire abdomen, which I suspect occurred after she had a post-partum uterine infection that ruptured through her uterine wall and leaked into the muscular space of her abdomen (her uterus had an abnormal appearance, as well).  We prayed together and drained more than a liter of pus from this space and sent her to Lubango urgently via Marijn, our passionate Jesus/people-loving pilot with MAF for surgical treatment of her uterus by our wonderful servant-colleague, Rebecca (OB/GYN).

 

 

With any basic health care, this woman would be the smiling (and tired) mother of three-month-old twins, as most immediate delivery deaths (millions world-wide) are preventable with simple warming, drying, positioning, agitation, and basic airway management.  She wouldn’t have suffered infection in a clean hospital (she delivered at home on a dirt floor because of lack of access to a hospital delivery) and, in the (very) rare case that she did acquire an infection in a hospital, it would have been treated early and uneventfully, her uterus would not have ruptured, and she would be able to have more kids (unlikely at this point).  I’m grateful, however, that our Father used us to spare her life, so that she might have further opportunity to know Him.

 

 

The third 19-year-old woman presented with acute-onset (several days) of profound agitation, fever and “talking nonsense” according to her family.  Her diagnosis was pretty straightforward as her malaria test was negative (we see many cases of cerebral malaria with a similar presentation) and her neck was board-like stiff.  We prayed together and began aggressive treatment for meningitis and, within a few days, her fever resolved and she was walking, eating and drinking, though she was still confused at times and agitated during the night.  The family knows that she may have a long recovery but they are grateful for her progress.  This disease is also preventable by vaccine (at her age the likely culprit is meningococcal meningitis) and, in any country with decent access to health care, disturbing “acute” symptoms like hers would be addressed in hours rather than days.  Earlier treatment for meningitis (infection of the brain and spinal cord) is key to prevention of permanent nerve or brain damage.

 

 

The Wind…  The last of our 19-year-old women who came in during these couple of days was tall, weighed 35kg (<80lb), had been coughing for six months, had stopped having periods, had profound difficulty breathing especially supine (simply couldn’t lie down), and had an oxygen saturation level of 85%.  With ultrasound, we were able to determine that she had fluid around her heart (why she couldn’t tolerate the supine position) and that she was three months pregnant.  Auscultating her lungs with a stethoscope revealed marked inflammation in the upper lobe of her left lung, caused by tuberculosis. We prayed together and immediately began treatment for her TB, began anti-inflammatory medicine for the fluid around her heart, and started her on vitamins for her and for her baby (which appeared healthy).  Within just a few days, she had gained a kilogram, was coughing less, was sleeping at night (lying down), had less fluid around her heart, and greeted me one morning with a huge smile (she was literally too sick to smile when she arrived).  She will likely do well and, Wind willing, the world will greet another of our Father’s miraculous creations in just a few months.

 

 

Readers of this blog and supporters of our work know that these cases are, sadly, a small sample of what we see every day at our remote hospital (why I returned) and what set these women apart was simply their ages arriving in close proximity with each other, which made me take notice.  All had preventable and/or easily treated illnesses with access to decent evidence-based medical care, common in disproportionately wealthy North America and Europe, the main areas in the world with historical cultural deference to our Father’s guidelines and principles until greed, earthly success and comfort replaced our Father as the culture’s (and church’s) principle motivations.  How many “Christians” do you know who would turn down a million dollars because of Jesus’ warning about money?   Would you?  The loss of this deference to our Father’s pleasure (and Jesus’ words) is becoming more and more apparent as discontentment rules in global areas of prosperity far more than in the impoverished parts of the world.  Jesus advised us against the pursuit of that which money can buy because He knew how it would distract us from our relationship with Him, stealing the joy and contentment which can be found only in Him.  He also knows how sorry so many Americans will be when they realize that most of the resources HE gave to them to steward (to participate/partner with their Father in helping, serving others) was spent on themselves…

 

 

The church in the above mentioned prosperous parts of the world, claims with animated words and songs that it loves Jesus more than that which money can buy, but our lives speak otherwise.  The world (and the church) desperately need today more “walkers” and less “talkers”.   We follow pretty, animated public personas whose personal lives we are unable to evaluate (whether they walk the talk when off the stage, at home, unobserved) and we don’t hold in esteem and follow the man/woman that lives what they say.  In our church culture, the outgoing, entertaining and polished “talker” leads us and the sacrificial “walker” is irrelevant because he/she isn’t pretty, a good orator, highly skilled or famous.  Pretty images and rhetoric receive a lot more attention today than dirty hands.

 

 

As in Jesus’ day, today we have theologians with clean hands, soft feet, and hearts cold to their suffering global neighbor; fat on the law, full of trite answers, and deaf to the calling of the Spirit to follow the Wind to the hard and lonely places, where live the broken, the wounded, the hungry, the smelly, the dirty, the hurting… the least…

 

 

It happens every so often…  I pray with each person, recognizing the beauty and limitations of the care I offer, calling on my Father to have mercy on the patient, and to grant him/her healing and/or peace/intimacy with Him during their trial…  So many people are healed, but sometimes something unnaturally special transpires.  Last week, as I prayed for/with a woman about 30-years-old and from a city several hours away, she broke down and began weeping.  I asked her what was happening and she smiled at me through her tears and shook her head.  I was touched…  The Wind…

 

 

We also sometimes see things that are difficult to naturally explain.  A fifty-five-year-old woman arrived one afternoon last week suffering full-blown generalized seizures while we transferred her from her husband’s motorbike to an exam room.  She’d had these convulsions for almost 14 hours with barely a break, beginning when she was working in her field.  She was deeply comatose and had a recurrent seizure every few minutes as I checked a glucose, did a quick exam which revealed nothing obvious as to a cause, did a negative malaria test and confirmed that she had no sign of meningitis or a stroke (more common causes of a similar presentation).  We gave her some IV fluid and an IV medication (diazepam) to stop her seizures (a medication we purchase at a public, outdoor market in the city, without any regulatory controls) and her seizures promptly stopped.  We prayed with her and her family and hydrated her during the night and began treatment for a parasitic disease that can cause seizures (which needs days to begin to affect a cure, if that was the unlikely cause).  The next day she walked into the exam room to see me and denied any complaints.  She had eaten breakfast, slept well through the night, waking several times to walk out to the hospital yard to urinate, and said she felt fine, with no recollection of the events of the previous day.  She is staying at the hospital for a week (I left for the US) and, barring the unforeseen, will return home soon.  With many years of experience in treating people with seizures, I can’t explain it…  Thank you, Wind!

 

 

We also have a man in his 60s who arrived urinating only droplets for several weeks.  His bladder was hugely distended because of a large prostate and ultrasound revealed significant damage to both of his kidneys.  We put in a urinary catheter and emptied his bladder, but he also complained that his greatly swollen left eye was causing him intolerable pain (more than his bladder) and that he had lost vision about a month previously (when the swelling and pain began).  He’d had a severely swollen, painful and blind eye for a month before getting a motorbike ride of several hours to our hospital!  Lack of access to trusted care…  Ultrasound revealed marked swelling behind his protruding eye, but repeated attempts at draining his posterior orbit with a large-bore needle (which he tolerated stoically) failed to alleviate the inflammation.  After about a week of little response to antibiotics, I had to remove his eye to attempt to afford him some relief.  He tolerated the procedure well but continued to have intense pain for several days, which left me without further treatment options.  We prayed for him again, and he walked in the next day smiling and joking, saying he had slept pain-free for the first time in almost two months.  We have not because we ask not, but the Wind will do, what the Wind will do, how the Wind will do it, when the Wind will do it…

 

 

I left Cavango soon after hearing of our son Luke’s cancer diagnosis and need for urgent surgery (successfully performed yesterday while I was traveling), knowing it would take many days for me to arrive back in the US (I arrived without incident yesterday afternoon).  On my second day of driving (10hr on day one and 14hr on day two) I stopped at a gas station and, as the attendant (raised in Angola speaking Portuguese and studied in Namibia speaking English) was filling my car, he asked (in English) where I was going and why.  The typical pattern for conversation in Angola is that, after a kind greeting, one person will share how they are doing and what’s going on in his/her life (for example where a traveler is going and why) and the second will then do the same.  They hold to this pattern religiously, and all conversations begin thusly, whether with friends or strangers.  I’ve come to appreciate the formality and the relational benefits.  I told him where I was going and why, and he, quite compassionately, exclaimed, “Oh sheetch!” (how the English “word” shit would be pronounced in Portuguese 🙂   The combination of languages, his genuine compassion, and his entirely appropriate use of an expletive caught me pleasantly off guard!

 

 

In response to his diagnosis, Luke wrote from Mozambique (before he left for the US) a powerful blog post found here, which will challenge and encourage you.  Please take a look!  His posts are mercifully much shorter than mine…

 

 

Rumors, Credit, Privilege, Ignorance…

 

Rumors…  Every population, community, and individual must consistently deal with unsubstantiated information.  We must determine both the truth and significance of each message that we hear/see.  Most of what we hear doesn’t require a response or judgment on our part, while a small portion does.  In most conflicts and issues there is no reason for us to have an opinion or choose a side, as it is truly “none of our business”.  Some people think they must have an opinion about every matter and every person, and this is simply not true, though we often hear and repeat a matter without filtering it for truth and/or significance.

 

When we were in the US on Home Assignment, two things happened simultaneously that were potentially damaging to our work in Cavango.  Firstly, rumors circulated about the “high” and “unfair” prices at our clinic, some of which were propagated by a church pastor whom we had served multiple times at the clinic (resulting in healing each time) and he had previously voiced offense (to others and not to us) that he had to pay for his care.  Secondly, we didn’t have enough money in our clinic accounts to purchase meds (we have set up the clinic to operate financially with no outside help).  This is simply not possible because we sell our meds for the same prices that we are charged when we make our purchases at the pharmacy warehouses in the cities.  I considered the possibility of theft, but I’ve worked with few men anywhere with more integrity than our local head nurse/clinic director and he’s really the only one with access to the money.  The other issue that could contribute to account discrepancy and money loss, is giving out meds using “dividas” or credit (it is sadly a commonly exploited cultural norm).  Even though I had encouraged our staff over the years to issue credit only in dire circumstances, after a couple of staff meetings it became clear that we were giving medications more and more with a “promise to pay”.  As any five-year-old could predict, most of these “promises” went unfulfilled, and it soon became evident that this was clearly the source of our financial shortfall.  I had observed this practice over the years but didn’t realize its extent, until our books revealed the deficit in recent months.

 

I decided to confront both issues directly with the leaders of all of the communities that benefit from the services we provide.  I sent out notices to about twenty principal villages and towns within about 60km of our hospital, inviting the village leaders to a meeting at the clinic to discuss the hospital finances.  All of the leaders arrived the next afternoon (I don’t believe a single village was unrepresented and the presence of so many leaders on such short notice was quite encouraging as an indication of their interest in our work) and we discussed for three hours the work of the clinic, some of our challenges, and our prices and the reason behind them.  I explained that the consultation charge (about $5.00US) pays for salaries (our salaries are a fraction of those at the government hospitals) and the money collected for pharmaceuticals (each medication has a different price) is used only for the purchase of more medications.  They asked the question I am commonly asked (because we always charge a small fee for our services), “What do you do when someone arrives without money?”  I always respond similarly, by acknowledging that this situation is indeed difficult because the patient is ill, he/she cannot afford the care and the care cannot be given unless people pay for the service (workers) and for the product (meds).  I explained that our clinic is truly a community clinic in the sense that one person’s payment allows the purchase of medications for another.  If one doesn’t pay, then there isn’t money to purchase medication for the next…

 

I explained further that the workers who staff the clinic obviously cannot work in their fields when they are working at the clinic and, for this reason, must receive monetary compensation for their work (this culture lives and dies by how their fields produce), in order to buy food (that they cannot grow) for their families.  I also explained that the medications are not ours, but that we simply transport them from the city and pass them on to the person who uses them, at cost.  Straightforward, truthful, face to face conflict resolution is interpersonal and builds or destroys trust, whereas rumors cause harm outside of relationship with the subjects of the gossip.  This direct explanation at this meeting brought clarity, and these men arrived with questions and doubts (they are advocates for their people), we addressed them directly with honor and respect, and they left enthusiastic supporters of our work (most already had been, but they’d heard the rumors…).

 

I also told them that we refuse no one, but that we treat the sick person on the day of arrival and simply require payment before further treatment the following day.  This was an introduction of a new policy because of the money loss associated with credit, and they received it well.  I told them that we would have to close our doors within the next month or two if we continued to operate as we had been.  These leaders, many of whom own simple businesses, voiced understanding and supported this necessary policy.  Interestingly, one of these men collapsed on the road the next day and was brought to us in a coma, with cerebral malaria, and without money.  We followed our new policy and he walked home several days later healed, paying for his (inexpensive) services completely prior to discharge.

 

I asked these leaders for their opinion re our prices and our service, and several voiced passionately that they knew of no clinic anywhere with lower prices or better service.  They told many stories of amazement of people leaving their village near death and returning well.  Many of these seasoned men said they had never seen this happen in this region.  Several shared about experiences of traveling to the city and paying prices from three to ten times higher.  It was clear that these men were not behind the rumors, which is normally the case, as people without knowledge (or with an agenda) tend to spread lies.  My explanation was well received and the Q&A session lasted almost an hour, building trust and solidifying the important relationship between our clinic and the people we serve…

 

Two brothers brought in their 23-year-old brother with an acute mental status change.  A week prior, he had begun to speak “foolishly” and, at times, he didn’t make sense at all.   He hadn’t had a fever or trauma (no street drugs here) and had never experienced anything like this previously.  A patient with this presentation is a challenging work up anywhere, but in rural Angola (no testing, electricity, etc) more so.  We explained the situation to the family and that they would serve him best by taking him to a city hospital (CEML) where they could get some good testing because the history and exam were concerning, yet yielded little direction for me as to cause.  They said they wanted us to treat him and I explained that we would certainly do what we could in beginning to treat some possible causes. while considering others.  Among other things, psychosis, diabetes, toxin exposure (from the unknown ingredients of “traditional medicine”), and various types of infection and parasitic disease could cause his symptoms. We began treatment and after two days of little improvement (too little time to see if our treatments would have an effect), the family told us they were taking their brother to a traditional medicine doctor.  A traditional medicine “healer” is a man who mixes “all-natural” products (plant parts, animal parts/secretions, moth balls, etc) in a concoction and either injects it, gives it orally, rubs it on the skin, or gives it in the form of an enema (the more violating, foul (moth balls, enema) or painful a remedy, the more likely it will help, according to the typical rural Angolan mindset).  He/she will also create wounds on the skin in the area of the pain/problem (via burning and cutting) and chant or sing various incantations.  Of course, he/she has an untested mixture for any/every ailment.

 

Our enemy and many people in the world seek to harm another and/or seek personal gain by counterfeit and deception (lies that appear true, worthless products “dressed up” with bells and whistles, etc).  “Sales” can benefit the client, the seller, or both and counterfeit services or products usually benefit the seller.  I, of course, practice evidence-based medicine, which is tested and reproducible, I receive no compensation for my service, and I pray to the only hearing, responsive and all-powerful Author and Sustainer of life.  The counterfeit (traditional medicine) provides unmeasured and untested mixtures, makes a great profit for their service, promotes their products with anecdotal stories (vs tested evidence) and invokes help from the unseen world (which everyone here acknowledges), “praying” to unknown gods.

 

“There is nothing new under the sun”.  The selling points used by the Shamans are 1) the “all-natural” label (which is attractive in the US, as well, and is crackers because many all-natural products are deadly – hemlock, gasoline, ricin, botulinum, strychnine, tobacco, Black Mamba venom, etc), 2) anecdotal stories of improvement (secondary exclusively to the placebo effect), and 3) relational trust within a community (a salesman who is highly relational will always sell more product).  They also commonly malign evidence-based medicine (their highly effective competition).  We see the same scenario play out everywhere in the world, where unproven remedies (unknown benefit, unknown risk) compete in the health care market with those proven (known benefit, known risk).  Remember that, with the right sales person, the placebo effect is sufficient to generate a profit.  If one sells a product and 20-40% of the clients feel improved (as in massage therapy, which changes nothing but feels good) and are vocal advocates, and few clients feel worse, one has a profitable business.  We also see the western media, and those in the alternative health care market, highlight (ad nauseam) the apparent damage caused by medical errors and adverse reactions to medications, yet we never see publications about how many people are healed via evidence-based medicine, or even a comparison of the two.  This leads to the prevalent misperception that evidence-based medicine is dangerous and this misperception sadly kills more people than the actual errors themselves, because people who would benefit from evidence-based medicine fear the same and seek out the pretty, counterfeit, “safe” remedy at the “health store” (the modernized version of the potion-peddler).

 

I try to patiently explain the difference between the counterfeit remedies on the market (here and everywhere) and those we have at our disposal (tested, proven) and leave the decision to the patient and/or his/her family.  Evaluation of risk/cost/benefit must be the focus in these decisions as, with each proposed remedy, there is variability of the known vs unknown risks/benefits.  The issue really comes down to trust in the one giving counsel and offering the remedy, or trust in the remedy itself, whether misguided, informed or otherwise.

 

The sad addition in Angola is that the “all-natural” remedy often kills.  We have at least one or two people in our hospital every day with varying degrees of liver failure from “traditional medicine” and some recover and some die.  They receive traditional medicine for a “cold”, irregular periods, or another minor problem and suffer a long, painful death from liver failure.  Many people today pay for unknown and unstudied risk/benefit rather than that which is tested and proven.  I’ll never understand…

 

I faced this same trust issue this past month when confronted with personal health challenges.  I had a bad case of malaria that caused lung inflammation, diminishing the oxygen level in my system, and that stressed my heart to the point of causing frequent angina (heart pain) with little exertion.  After debating for over a week, I made the difficult decision to travel to South Africa for evaluation and the physicians there found (through evidence-based medicine) the inflammation in my lungs (on x-ray), the low oxygen level (86% sat, PaO2-60 mmHg), and narrowing of three arteries that serve my heart (via angiogram).  They, then, proposed and/or performed remedies for each.  I joked with each how unpleasantly differently the world looked from the other side of the stethoscope as I was faced with many decisions over the course of a week in the arena of trust, based on my impression of the doctor/hospital, his/her explanation of the tests and remedies, and their breaking down the cost/risk/benefit of each step.  The rural Angolan faces the same process (with less knowledge) when confronted with illness and it has been healthy for me, as a physician, to remember what these decisions look like from the perspective of the person ill.

 

My lungs should heal over the next month or two (ARDS from malaria) and my heart vessels are likely serving my heart better than they have been in years.  It was a wise decision to go and I’m grateful for the excellent care, for the results, for the encouragement and support of so many of you, and for all the lessons learned in the process.

 

I awoke the morning after the heart procedure experiencing a severe emotional heaviness and “saw” a scene from one of my favorite movies, the classic, “Chariots of Fire”.  This is my memory of the scene and may not be entirely accurate.  Harold Abrahams had just won the Olympic gold medal in the 100-yard dash, the fulfillment of his life-long pursuit.  His teammate, Aubrey, was about to burst into the locker room with enthusiastic congratulations when a perceptive colleague (Lord Andrew) stopped Aubrey and explained to him that Harold would best be left alone in this sober and quiet moment after his victory because, “though losing can be hard to bear, my dear Aubrey, winning can be quite difficult to process, as well.”  The “vision” identified perfectly the emotions I was experiencing and, I believe, was a gift from my Father to help me process the totality of my experience.

 

I felt myself in a similar place, having sober difficulty processing the incredible “miracle” that had just been performed on my heart.  Not one of my (many) heart patients in Cavango (hundreds of square miles and hundreds of towns and villages) would ever be in a position to receive the procedure that I had just received.  Well over half the people living on the earth today (including the entire population of Angola) and the great majority of those living throughout history (billions of people) would never have the “privilege” of experiencing three of their (life-threatening) obstructed coronary arteries mechanically opened, of enduring the pain of multiple needle sticks in the wrist for an ABG, of experiencing the discovery of low oxygen levels in their system, of suffering a grossly swollen and tender arm from a thrombosed vein (secondary to an IV catheter), and of “suffering” through the night hooked up to many wires and tubes and being pestered by too many (truly) concerned nurses to allow for rest.

 

Tragedy, loss, and pain are difficult to bear.  In a world filled with the same, their absence and/or the presence of privilege or undeserved favor is also difficult to process.   Jesus’ kingdom, however, readily acknowledges the former, while promising the latter, as His invitation is especially to those experiencing the former (the hurting, abused, undeserved, forsaken, forgotten, marginalized…) to live for eternity in the presence of the One who favored them so passionately that He left all of the privilege of His kingdom to experience all the indignities of human existence (not to mention the inhumane suffering), and to rescue them from the lies and deception of this present confusion and darkness.

 

During our 6 week stay in Cavango in May, I remember thinking one evening that our time seemed relatively light compared to some of the challenges of the past year.  And then (smile) I fell from a ladder and began to ache all over…

 

A phrase that has meant much to me during my recent uphill journey, “I will remember today, and trust in, both my Father’s goodness and my own ignorance.”

 

 

NG, Evidence, Ears, One More, Eternity…

 

We’ve had the unexpected pleasure of hanging out with an (English-speaking) team from National Geographic during our recent six weeks in Cavango.  They are a group of scientists, journalists and photographers exploring the major river systems of southern Angola, one of which is the Cubango River, which passes over some beautiful rapids about a mile from our house in Cavango.  They are in the midst of a trip from its source in the Angola highlands (140km from us) to its mouth in the Okavango Swamp of Botswana (1000mi).   Learn more about this river system here and follow their fascinating journey on FB here or on Instagram at #intotheokavango.   We’ve been able to sit by their evening fires near “our” rapids and listen to what they have been learning about this wilderness, described by them as “quite undisturbed by time and man”.  There are experts in plants, fish, birds, insects, reptiles, mammals, geography and so much more, from museums and universities around the world.  They showed us jars of specimens, photos from drones and videos of bee attacks and tiger fish underwater.  They traveled by small plane, helicopter, car, motorbike and dugout canoe.  We helped them through malaria and other illnesses, brought them cokes, tortillas and cookies (Betsy) and thoroughly enjoyed their company.  Many on the team will be traveling in the wilderness for several months.  They have endured the wrath of bees, mosquitoes, black flies and crocodiles and had to portage their boats around a sensitive and very protective mother hippo!  Their stated goal is environmental awareness and protection.  Both are hugely lacking in this part of the world.

 

 

I’m reminded of the tremendous effort that goes into environmental discovery, preservation and care.  I can appreciate the efforts of so many or I can be like many Americans regarding health care and take for granted the community of care involved in their healing (the lab tech, the developers of the ultrasound machine, the discoverer of the bacteria causing the infection, the night-cleaner of the surgical ward, the person at the information desk, the people who died during discovery of the illness and before treatment was found, the teacher at the doctor’s medical school, parents of the same teacher, the great-grandparent of our nurse who endured slavery for her offspring, the immigrant uncle of our doctor who worked on the docks so his kids would have options, the multiple inventors of various types of glassware, the developer of the syringes, the factory worker in China who makes perfect and sterile hollow needles, the pharmaceutical scientists…)

 

 

The majority of the world’s population live in areas without access to modern, accessible health care, where anyone can call EMS and get transported to the nearest hospital for physician evaluation within minutes (there is no EMS in this entire country and the majority of consultations are done in assembly-line-fashion by minimally-trained nurses).   And yet there is little gratitude in the US for the expert care received (if Americans could only experience the developing-world alternative).  Many parents outside the US would literally give their lives to see their sick child receive such health care, while most people in North America express no gratitude and voice criticism freely.  As an ED director of a small hospital in years gone by, I saw, out of the thousands of sick and injured people we treated successfully each year, perhaps one or two return to say thank you.

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We used to fight to get our patients in and out of the ED in less than two hours to improve patient-satisfaction.  In rural Angola I try to see everyone on the same day as their arrival (and often don’t succeed and they sleep outside on the ground until the next day’s clinic).  Yet there is far more gratitude here for far less service, far more patience, far fewer expectations, far more grace, and far fewer resources.  I’ve never once here heard a complaint about the wait and I won’t tell you how many complaints I (and my fellow ED directors) responded to (daily)…  Will you remember with me today that gratitude is always available, costs nothing, edifies those who hear it expressed, and is health for the soul, mind, heart and body…

 

 

Two of the most significant decisions facing each of us regularly are “To whom will I listen?” and “Whom will I believe?”  Jesus often prefaced what He said by, “For those with ears to hear” meaning, “For those who choose to hear”.  In humility, we can recognize our relative insignificance and ignorance and choose to be concerned with God’s perspective of us and our journey (and seek His counsel), or we can make decisions independently of Him… We’ve all done both, and have experienced the consequences (pleasant and unpleasant) of each attitude/decision.  Yet the choice remains daily before us, “To whom will I listen” and “Whom will I believe/follow/trust?”

 

 

When I arrived in Cavango, from a part of the world most had never heard of, I was unknown, of a different race and culture, and I had a completely different world view than those with whom I was now working (theirs could be labeled “fatalism” and mine, “personal responsibility”).  Imagine that the “nurses” I was instructing had never seen a modern hospital, had never heard beeping monitors, had never seen lights/power in the hospital (used candles at night), and could certainly never fathom an EMS.  Several had never been to a city.  Several wore no shoes.  They lived in a culture without books, toothbrushes, narcotics, toilet paper, electricity and running water.  They had never heard of scientific research, had no idea about the various chemistries within medications, had never seen an ultrasound machine…  And I arrived and practiced medicine in a way they had never seen.  I stocked the pharmacy with unfamiliar medications and practiced “evidence-based” medicine, that which had been studied and proven – a form of medicine based on accurate treatment for an precisely determined cause, and one based largely on that which is, to these rural people, unseen (bacteria, failed heart valves, inflammation, parasites, blood pressure, etc).  I did a lot of explaining, and mostly encountered blank stares in response.

 

 

The daily, exhausting and endless explanations continued and countless people were healed with basic, evidence-based medicine.  When I would return from clinic trips to other parts of Angola, however, I’d find that the nurses’ treatments hadn’t changed, as they had resorted to the familiar.  I challenged the staff personally and in meetings that they had to decide whom to believe – their antiquated and inadequate knowledge (and its poor results) or what I was demonstrating and teaching.  Over time, I began to see them implement my treatment strategies and, one day, the director of the clinic quietly approached me.  He had been treating patients for 40+ years, through the long civil war, and had seen so many deaths.  He said that he never imagined that so many people could come to a hospital sick and leave well.  Modern medicine, to him, had been little better than the traditional medicine practiced by the shamans, which involved incantations and soups of various parts of plants and animals.  Minor illnesses in both cases often resolved and serious illnesses in both cases ended in death.  Now he was seeing people near death consistently walk home a few days later.  This “nurse” (one year of training in the 70s) was simply seeing the results of evidence-based medicine and the results of generations of study and research…

 

 

Over time and observation (of healing after healing), the nurses at Cavango began to imitate my treatment and ask questions about arriving at an accurate diagnosis.  They’ve adopted my methods and have chosen to learn from me, based on what they’ve seen.  We each choose to whom we listen.  Like the nurses in Cavango, we must observe character and results, compare methods, make judgments about risk/benefit and recognize that there will always be differing opinions and the choice of whom we follow is ours to make (many times daily) individually.  None of us are born independently capable of wisdom.  We all must learn from someone how to act and respond (Jesus learned obedience) and from whom we receive is our choice and largely determines who we are…

 

 

There are those who say that Jesus has had a negative influence on the world, and those who say the opposite.  Some say Christianity is one of many religions, and others say it’s not a religion at all.  One says Jesus was a good teacher and another says He was deity.  Many say the bible is man-written, others God-breathed.  One says that we are the product of chance and time, while another says we each were purposely created.  Some say marriage is God-ordained, not because it’s easy, but because it is good.  Others say marriage is an antiquated societal dictate that must evolve with the changing culture.  Jesus called us to, like Him, abandon our lives/dreams/desires, focus on the benefit of others and “see” with an eternal perspective.  “Experts” today encourage pursuit of our dreams (desires), that life’s sole purpose is happiness, and that personal pleasure is our best pursuit.  “Look out for #1 because no one else will.”  We could make quite a list of the many choices before us, which are essentially boiled down to – to whom will we listen.  On our life’s journey we encounter many forks in the path and we can make wise and unwise choices, decisions that result in pleasant and unpleasant consequences, we can seek what is best for others or what is best for us, we can push into the uphill path less traveled or skip downhill with the majority, we can travel alone or choose our companions…  And we can believe (spoken by One who died and came back to life) that we have a Father who sees where (and who) we are and invites us to walk together with Him for the remainder of the journey, who will provide a light to our path, will direct our steps (if invited), and who will never abandon us…

 

 

Honest self-evaluation is one of the most challenging endeavors we can undertake. Our nurses compared their previous results with what they were now seeing and, in humility and honesty, changed course.  We can do the same.  Who/what is directing your steps?  Perceived security/longevity?  Laws? How you were raised? Comfort?  Your own wisdom?  Earthly success vs eternal rewards?  Popularity?  Peace?  Charismatic leadership vs your Father’s pleasure?  Is the Bible true and worth believing for directing your steps (it claims so)?  Have you read your Father’s letters to you recently or are you believing what others tell you about them?  Who is God and what are his attributes and how do you find out?  Can you really know Him?  We spend a lot of time in our lives on what doesn’t matter.  Is it time to reconsider whom you are following and listening to?

 

 

One of the most exhausting facets of our lives among the rural poor is “just one more”.  Late in the evening, after so many consultations throughout the day, “just one more” arrives in the darkness.  Our car is full and again overburdened for the day’s 10hr trip and “just one more” person arrives and asks for a ride, or a friend brings “just one more” 50kg sack of corn for us to take into town for his family.  “Just one more” loan, “just one more” favor, “just one more” question, etc. just when you think it’s time to rest.  As I write, this seems quite trivial, but it is one of the pebbles that can get in my shoe and cause me to become distracted from the purpose of my journey.

 

 

I drove around the whole city of Lubango (a million people) today from 4a-6a and found no diesel.  We have an outlying clinic scheduled for tomorrow and cannot travel without fuel.  The entire country system is broken (high inflation, no fuel, power grid weak, salaries by the fed govt unpaid, etc), and the rural people will suffer again…

 

 

It looks like the pastor of our mission will be fired.  In many ways, he is a typical Angolan man and a man who would be familiar anywhere in the world.  I’ve known men of many cultures and few are those who will converse and interact soberly on a personal level.  This pastor and the typical man speaks in clichés and always has a trite answer.  He dictates and commands.  He laughs a lot, especially at other people.  He is dramatic and always faithful to his mask (“tudo bem” or “everything is good”).  He doesn’t know how to read, or reveal to another, his inner struggles and joys.  Because he can’t hold a genuine conversation, he can’t build trust, and without trust, there is no following.  So, after a year at Cavango, the majority don’t want to follow a caricature (some do, especially the men who are like him), and I’m sure he doesn’t understand.  But I can’t talk to him about it (I’ve tried) because of his inability to connect relationally and his inability to even begin a process of self-evaluation…

 

 

We were visited by leaders of this pastor’s denomination as they sought to resolve the community conflict surrounding this pastor.  They asked questions, they listened, they conversed, they shared their dilemma, they were willing (and able) to process together to find solutions.  They were relational men, thoughtful men, caring men, Jesus men…

 

 

Could it be that every single event and interaction in your life has the purpose of revealing something to you about your Father?  Perhaps your life isn’t about survival, success or significance (most common responses given for life’s purpose), but more about revelation from your Maker (about you, about others, about life, about Him…) as He prepares you for eternity.  Your marriage isn’t only about you or your spouse, but that you might see your heavenly Spouse’s incredible, unconditional love for you (the church is the bride of Jesus).  You are a parent not only to raise your children, but to understand more of your Father’s parental heart toward you.  Last night’s storm was to reveal His protection during and after and His presence with you in your daily pain.  The oak tree in your backyard is to reveal your Father’s beautiful patience and long-suffering toward you.  That recent interpersonal conflict had purpose ordained by your Father, just for you, to see the wondrous and beyond-your-imagination grace that He continually extends toward you, as you are.   Your recent loss is helping you see each person with eternal eyes…

 

 

I considered this recently on my cool, misty, sunrise walk to the river, where I encountered the beautiful, passionate men and women from National Geographic and heard of the research they did the previous day in our “backyard”.  Their passion was contagious!  I was moved and encouraged by their hearts of wonder for my Father’s world.   I considered what I could learn from the sandy path on which I was walking, the footprints (and the lives of those who made them) on which I tread, the Black Mamba snake that saw me and slithered away, the small brush fire, the trail of ants stretched across the path, the gigantic termite hills, constructed over decades, the warmth of the rising sun on my return home…  Each had a message for me from my Father.  My stroll became an adventure of learning, about me, about life, about Him…  I was overwhelmed by the depth of my encounter with Jesus, just during a morning stroll, and wondered how much interaction with Him I daily miss in the midst of my superficial busy-ness and self-focus.

 

 

Have you ever wondered the value of the Kingdom message to those who live in stark poverty, those who see death almost daily and those whose calloused hands and feet demonstrate lives of unremitting lack and labor?  At a recent pre-clinic morning discussion with patients and their families (perhaps 80 adults), I asked them why we should follow Jesus.  My reading to follow the question was about Jesus’ resurrection and I was prefacing the discussion…  Perhaps 4-5 people responded and essentially quoted Peter without knowing it.  At a time when many disciples of Jesus were leaving (Jn 6.68)(Yes, Jesus’ ministry went through a season of decreasing numbers!), Jesus asked the twelve if they would leave also, and Peter said, “Lord, to whom shall we go?  You have the words of eternal life.”   Eternal life was his priority and Jesus’ central focus was always on eternity…

 

 

On that morning, when I asked the group why they might follow Jesus, they each said, in their own way, “Jesus has the words of eternal life.”  These beaten down, dirty and tired, beautiful rural people are understandably preoccupied about eternal life.  Death, to them, is a tangible reality and this life’s brevity is readily understood.  They are interested in eternal life.  We then discussed how Jesus’ words of eternal life were validated by His resurrection.  They implanted much more in me than I in them…

 

Tachypnea, Science, Origins, Delusions…

 

You’ve read on my posts a lot about malaria and the innumerable untimely deaths it causes.  Last week I saw a 54-year-old community leader from a village about 10km from us, who has likely had the disease 50+ times in his life, arrive in a coma and barely survive.  I was thinking of him these past few days…

 

I am still recovering today from my worst bout with the disease (update as of Tuesday: after resolving for a couple days, it has returned and I am beginning another round of meds), and it became severe because I didn’t make the diagnosis.  I had a week of gradually worsening muscle-aches, and for several days I attributed the muscle-aches to an awkward wrestling match with a battery and a ladder the previous weekend.  Another man and myself were putting a 70kg solar battery on top of a wall in the clinic (out of reach of the curious), each of us on a ladder.  When we neared the top of the ladder (about 3m), his ladder slipped out from under him and he fell to the floor onto his stomach, leaving me holding tightly to one corded handle of the battery and in an awkward, folded position on my ladder.  We were both somewhat bloodied and sore (but ok) and I was sure uncomfortable the next day, and thus the misinterpretation of the worsening pains in my muscles and joints (in hindsight, the aches from the malaria began the same day).

 

I certainly thought of malaria, but I’ve had malaria many times and never without an early fever, though I’ve seen delayed fever in locals, so when the fall became less likely as a cause for my pain, I began to attribute my generalized achiness to the TB meds I’ve been taking for about two months (I picked up this disease last year and it was discovered in the US), which can cause muscle pain in about 10% of patients.  And then the fever hit.  A further delay in treatment occurred when my initial malaria rapid-test was negative (I was forced to again consider that it might not be malaria), but the next day was positive, so I began treatment about 5 days after the onset of symptoms and almost 48hr after the onset of fever!  Smile.  Next time you are tempted to criticize (or sue) a human being called “doctor” for not catching something early and accurately, perhaps you will remember this story – it’s nothing personal, and not necessarily “negligent”!

 

One of the physical signs in low-resource settings of impending death from falciparum malaria is tachypnea, or rapid breathing.  Most of those who succumb to malaria in our hospital (about one/day this month) develop this sign, though not everyone with tachypnea dies (perhaps 50%).  There are many causes for the rapid, involuntary respiratory rate (severe anemia, renal failure, acidosis, lung injury, etc) and survival of the inflammation in the lungs often requires oxygen support and sometimes ventilator support, neither of which we have in our hospital (no electricity).  I simply could not get control of my breathing.  I was breathing more than 40x/minute and could not slow it down.  Knowing what it meant didn’t help and also knowing that I don’t have much cardiac reserve because of my heart disease didn’t help either.  Betsy and I talked about the pros/cons of transfer out but it wasn’t possible, because it was late afternoon and the earliest a plane could arrive an hour away was the following morning because the airstrip we use is dirt and has no lighting (Brent, our beautiful MAF pilot/servant, was waiting our word to alter his morning flight plans).  At some point that evening I fell asleep and, when I woke up a couple hours later, I was breathing somewhat slower and without a sense of suffocation for the first time in about twelve hours, and the next morning (after more sleep) I had turned the corner, and had passed my extended “cardiac stress test”.  Malaria has, once again, earned my utmost respect and hate…

 

Quite comforting, as well, was the care of our friends and family, and that of my Father through His kids.  In the middle of the respiratory distress, Betsy asked many of you to pray, and so many responded.  And within hours, the crisis abated.  I wouldn’t pretend to understand, as I’ve asked my Father to heal people and they have died.  I’ve asked Him to heal others, and they’ve survived.  I haven’t prayed and people have improved…  I rest on the words of Jesus, the One who beat death, that our Father hears, He does what He will (which is always best), He sometimes actually responds according to our desires, and we will all pass through earthly death relatively soon, one way or another…

 

It is healthy to again come face-to-face with my mortality and remember that my days are numbered, that this life is truly but a vapor in the setting of eternity, and that my Father is good, whether I live or die, whether I am sick or well, whether I choose to surrender to Him or walk independently of Him…  He is good.  In just a few years, each of us will see (more clearly) just how good He is…

 

An illness like this, like separation from our family and other challenges of serving cross-culturally, prompts again certain questions: “What are you willing to do for My sake, and for the sake of those I love?”  “Are you willing to endure this again to serve the rural people in Angola?” and “Are you willing to die from malaria?”  I never want to go there again… but am I willing?  My true beliefs (see below) will be expressed in what I do, much more so than in anything I say or write…

 

Foundational beliefs and biases are difficult to overcome.  Most people in rural Angola have a fatalistic world view, involving a relationally distant god who is aloof, self-focused, no respecter (or lover) of persons, and has little concern for our activities/joys/difficulties.  There is minimal understanding of cause and effect and the influences of the unseen on that which is seen (in both science and in the unseen Kingdom).  The biggest influencers of behavior are relationships and community.  This fatalistic world view appears to result in peace, but also a lack of motivation to change anything. “What will be, will be.” “It is what it is.” are culturally common attitudes and, because of this perspective, little ever changes.  Fatalism is close to how some people in the church view sovereignty. There are those who believe that the biblical God controls every moment/action/thought on the earth and the only difference between this and the fatalism of the people I serve is that one can trust in the sovereign “Controller’s” good purposes vs the randomness of chance.  In neither world view, however, does one partner with God in the improvement or modification of the world or the people in it, and in both views the “believer” is free of any responsibility regarding outcome.  Jesus’ invitations to us to partner with Him (in both the OT and NT), to have an impact on people and the world, support neither of these views and, in any question re doctrine or belief, I always try to understand and embrace Jesus’ philosophies and methods.  Jesus describes His Father as more of a “Ruler” than a “Controller” …

 

The patients often look at me dumfounded when I encourage them to take action re their illness, either in prevention or in treatment.  They really do not believe that anything they do can truly effect the outcome and they actually fear intervening, embracing the myth that there is less risk in doing nothing than in doing something.  My opposite (and often unhealthy) world view of illusionary control over all outcomes can cause frustration!

 

In some respects, our nurses are gaining understanding.  They have now seen so many malaria deaths (almost daily) when the sick child (sometimes adult) arrives after more than 4 or 5 days of fever and they’ve seen so few deaths when the child arrives within three days of onset.  They now appreciate that the time to treatment matters and that this is obviously the result of the parents’ decision.  They sometimes yell at the parents immediately after the death of a child, and tell them that if they had brought the child sooner, he/she wouldn’t have died.  Not the best “bedside manner” but theirs is already not the typical Angolan’s perspective and understanding is the first step to change.  The nurses believe because they have seen, and those who have seen are few.

 

Our newly hired hospital techs (do anything/everything) haven’t seen much health care and bring their unmodified-by-experience world view to work.  Our vital signs are all automated and simple and should be easy and accurate, yet they are consistently inaccurate and, even after demonstrating multiple times that the blood pressure cuff must be placed in this manner, or that the pulse-oximeter needs to be put thusly… they just don’t believe that anything they do (accurate placement of equipment) really makes a difference.  They also, of course, don’t understand the significance of abnormal vital signs.  I also find medication errors daily (I simply ask the inpatients how many shots/pills they received that morning and compare to my order) and I’m sure we’ve had deaths and harm caused from more or less medication given than ordered. Virtually every day I, graciously and respectfully, address the issue with the med-giver and make a little progress for a few days (only because they don’t want to disappoint me) and then it happens again, often in a critical patient.  It is, of course, a lack of understanding of the different potencies of the various chemicals in medications combined with the world view issue.

 

I gave a talk one morning to our staff lining up different substances on a shelf and explaining that if we inject soap, gasoline, alcohol, peroxide, ketamine, or penicillin into them, the effects on their bodies would be different and I explained that medications were similar in that each medicine can bring health or harm, depending on how it’s used. There were many, “Really?” looks and “Why” questions that became difficult to answer to their understanding.  The best analogies were eating poisonous plants/bugs (they all have) and putting water in the gas tank of a motorbike, concepts they understood but hadn’t projected to their work.  We all struggled to learn our basic biology and chemistry as kids, but it really helped give us an understanding of the makeup of the unseen, yet very real, material world.  Early scientists were motivated by humble adoration in learning and admiring the world as their God had designed it.  There is no science taught to kids here…

 

At least here the kids are not being indoctrinated by the religion of evolutionary origins which, with all of its knowledge gaps and non-answers requires more faith than I have.  Faith.  For starters: Science has a sound Law of Biogenesis that establishes that there is no such thing as spontaneous generation and yet “science” claims that something, everything in the material world, came from nothing – without a god or intelligent design!  Then they postulate that life originated from non-life (it’s never been observed), contradicting the solid scientific law. We marvel at our simplistic technology (in comparison to nature), yet in all of our 2017 scientific intelligence, we cannot even duplicate most of that which we say came about by unintelligent chance!  We are taught (everywhere) that humans are more complex than lesser-developed evolutionary creatures, yet we are continually finding examples of both incredible (beyond our understanding), and irreducible complexity in single cells!

 

Irreducible complexity is simply the most basic complexity necessary for function.  For example, a simple, conventional, spring-loaded mouse trap could not have developed into that same mouse trap and performed its function without five, pre-manufactured-to-scale, independent pieces (four of these pieces will never produce the same mouse trap) (adapted from Michael Behe).  Blood’s principal function involves transporting nutrients and waste from one part of the body to another and cannot provide this function without microscopic exposure of new molecular nutrients to the blood (a separate mechanism to break down food to these molecular nutrients), a separate pump mechanism, variably permeable plumbing for the blood and a mechanism for elimination of cellular waste…  Several independent, interdependent, complete and functional pieces, prepared to function both independently and synergistically with other already-fully-developed pieces, must join forces to create a function that, prior to these pieces fitting together, didn’t exist, but one that will now give this organism a selective advantage in evolutionary terms.

 

Irreducible complexity.  The minimal number of parts of a functioning, irreducibly complex machine or organism can’t “develop” or evolve over time, they must be already fully formed at the outset of function. The parts of the mouse trap must be pre-manufactured and exist independently, be brought together and assembled together just right (prior to destruction of any of the independent pieces), to function.  No single cell is nearly as simple as a conventional mouse trap and no one would claim that a functional mouse trap evolved via chance and time, but we simply accept and believe (faith), almost without question, that the radically complex cellular organism evolved (or even a multi-celled animal or plant, the complexity of which is still very much beyond our understanding).  We allow our ignorance, arrogance and imagination (it’s never been observed) to form world views supporting evolution of something exponentially more complex than a mouse trap.   The vast majority of the people who “believe” in evolution have never really studied or questioned it, and cannot begin to explain it except in the most rudimentary, passionate, opinionated (and incomplete) manner.  Our increasingly arrogant and godless culture passionately advocates putting our faith in the opinions of “unbiased” scientists re origins rather than “foolishly and ignorantly” placing our faith in a Designer for this world, which is still-way-beyond-our-understanding and our ability to even replicate!

 

The only way that the sciences, especially at the cellular level (of which Darwin was almost completely ignorant!) can be used to support a theory of evolutionary origins is by applying irrational and unscientific faith to data, forming a theory and calling it science.  A few of the foundational hallmarks of the integrity of science are its observability, reproducibility and predictability, and where these are not possible, we are discussing a matter of faith, not science (intellectual honesty is lacking in our discussions).  There is no more factual, scientific evidence for evolutionary origins than there is for creation, alien invasion, or Santa Claus.  All require faith and our primary decision is, therefore, “In whom/what will I place my faith and, ‘Why?’”  What we believe about whose we are and from where/whom we originated (created by God with purpose and love vs a product of random chance) affects greatly our self-esteem (the lack of which is a glaring problem in our US culture today) and how we see ourselves and others.  It was precisely this (Jn 13.3) that motivated Jesus to wash the feet of the disciples and embrace the cross…

 

Those who support an evolutionary and designer-less (godless) theory have no alternative but to label me as a delusional lunatic for daily conversing with, following, trusting and worshipping a figment of my imagination for the last 30+ years…  My bias (faith) is pretty clear and quite difficult to explain via all-natural, materialistic means.  No one in my family is doing cross-cultural work (genetics/nature) and no one in my medical school class is doing what I do (experience/nurture).

 

So many people advocating for cultural moral “choice” and equality actually support a world view that doesn’t support moral choice.  A designer-less, evolutionary-origins-world-view cannot support free and rational moral choice, because we are all simply a product of our primary genetic makeup (not within our moral control) and the life-experience (chemical reactions) on those genes (not within our moral control).

 

I have worked in science all my adult life and believe in it, love it and practice it for the benefit of many, but I have shared with so many people over the years that science is developed by (flawed, biased, passionate, lovely) human beings like you and me and its historical strength is the safeguards that have been developed over time and experience to promote research integrity and to protect against the influence of human passions.  This includes intelligent and appropriate analyses of the comparative value of research studies (not all conclusions are sound, nor all collected data worthwhile) and the development of controlled and appropriately blinded research that can be reproduced.  When biased people try to use science to label something a fact which is not a scientific “fact” (read the “facts” on the labels of animal origins at your local zoo), it tremendously compromises true science (the kind that saves the lives of the people I treat with scientifically developed problem-solving methods and products).

 

We incorrectly label faith issues as “science” (future eventualities referred to as factual rather than theoretical, events from the past that are not reproducible, and the opinions of scientists).  We are too proud to admit that we are ever learning and all of our conclusions are “in process” (a joke in scientific circles is that the one constant of scientific conclusions is change), too insecure in our (more opinionated than studied) beliefs to defend them (intellectual honesty is rare), too inattentive to anything longer than a sound bite to respectfully explore the beliefs of someone with a different perspective, and too tired of so much emotional rhetoric to care.  A major scourge of science today is its politicization.  Science cannot be influenced politically and remain science but, like in every other facet of American life, greed has entered the scientific world in the form of financial grants/support and the very integrity of the profession is at risk.  Many scientific studies are now sponsored financially by people desiring a specific political or financial outcome and the methodology and integrity of the research is sacrificed for political/financial leverage!

 

Seeking to understand how the world around us operates through solid, scientific research can be an impetus for worship of the Creator of this wondrous world, which is (still) far beyond our comprehension, and leave us grateful for the opportunity to learn, explore, participate, understand…

 

I am for freedom of thought and belief (all belief choices have consequences, both pleasant and unpleasant) and people can believe that the moon is made of cheese (plenty of people consider my life and beliefs foolish and that’s ok), but language quickly disintegrates to meaningless when definitions of words like fact, law, and theory are altered to promote a specific agenda.

 

Our foundational, always biased (bias is the core of what we believe, not what we say), system of beliefs is established via significant relationships, life-long input from the world around us, learned facts, unseen forces (our Father’s constant revelation of Himself to us through people, events, thoughts, nature, etc), wounds, circumstances, etc, and we all then align various, selective facts (data) to support what we believe.  Our culture largely believes the lie that those working in the scientific community are unbiased (delusional thinking – there is no scientific research to support this conclusion) and many delusional people (there has never lived an unbiased human being) follow and use science’s “unbiased” rhetoric to support their biased, and largely ignorant (but passionate) world-view…

 

I worked for a highly intelligent, skilled, and passionate biochemistry scientist in graduate school who insisted that he never used faith/bias of any kind in his life.  He bought the lie that he was completely objective and he was convinced (he had aligned much information to support his rationale) that only evidentiary science was factored into any/all of his decisions and he completely disregarded (any/all) faith as legitimate, because he was a pure materialist scientist (no god).  He was inconsistent, however, in that he saw his choices about belief as sound and mine as foolish.  And, of course, he found joy in mocking Jesus, Christians and any believers in God.  This is inconsistent if one has no moral control (all decisions and beliefs are the result of chemical reactions apart from moral choice) over their decision to believe in God (of course, he couldn’t help himself – his own chemistry caused him to ridicule!).  But he was so passionate about denying faith of any kind that he was delusional when defending his position, mocking christians, speaking of origins and denying faith as necessary for past, unwitnessed/undocumented events, etc.   It seems quite clear to me that, along with evidence, faith plays a significant role in all of our daily lives (so difficult to admit for the scientific materialist) and in our decisions about what is true (whether discussing God or otherwise).  “Will this chair hold me?”

 

Our primary decision is, therefore, “In whom/what do I place my faith (trust, bias) and, ‘Why?’”  I am grateful that it is so stimulating intellectually, physically, emotionally, relationally, and spiritually to place my trust/faith in my Father and that everything I learn about His world creates another platform on which I can bow before Him in joyful worship (this will continue for eternity).  Jesus indicated that following Him would require courage and be fraught with ridicule and misunderstanding from “the wise”.  His words, of course, have far more weight than those of any scientist because of what He did.  What a privilege to believe in, converse with, follow, and worship the risen Jesus!

 

Footprints, Seeing, Gossip, Grace…

 

On a recent morning walk after a storm, the majority of footprints on my muddy path (predawn walkers to the clinic) were shoeless.

 

Medicine can be such a humbling and human endeavor.  I am learning to better evaluate the heart with ultrasound (echocardiography) and a woman presented to our clinic with back pain and shortness of breath for several months (debilitating back pain is a common complaint in this high-labor culture).  Because of her breathing complaint, I evaluated her heart, which appeared to be fine.  I found nothing on her exam of concern and was ready to discharge her when I looked at the time and realized that I had a few minutes before lunch (not enough time to begin a new patient) so I thought I would re-look at her heart on ultrasound and practice some measurements.   I did the measurements, confirmed that her heart was fine and, just before shutting down the machine, I noticed a small something in the corner of the image.  On further investigation, I found that she had a small pocket of fluid in her chest cavity, which enabled me to make the diagnosis of pleural TB (TB in her chest, but outside of her lungs).  She has responded beautifully to treatment and if I hadn’t taken a second look, for academic purposes in looking at a healthy heart and not at her chest cavity, she would have gone home with TB and likely died without appropriate treatment…

 

Last week we made our regular trip to Huambo, leaving at 5a for our five hour trek on dirt to the closest city to purchase meds and supplies.  We had a delightful lunch with a Brazilian missionary couple, Ismael and Sibeli, who have become dear friends and who lead YWAM in Angola and surrounding countries, we had a flat tire, we burned out our clutch, and we broke the rack on the top of our car (put too much weight up there).  We didn’t, however, get stuck (many opportunities for the same) and made it back by 10p (the goal was 5p)!   We did find, though, that they are grading the “road” between Cachiungo and Chinhama (first time in 40 years), which will help us greatly for a few years.

 

We are nearing the end of malaria season, and had five kids die in our clinic this week, each within hours of arrival.  They each had been ill for close to a week and several hadn’t had fluid or food for several days.  We currently have several comatose kids, some of which won’t survive.  It is so costly for rural folks to come to the clinic (hours to days of walking) that they delay until the situation is grave.  It is a sad, and oh so common, consequence of inadequate access to basic care.  The number of deaths published around the world for malaria are grossly underestimated…  Sometimes we participate in healing (most of the time) and sometimes we participate in loving a child immediately before his/her death and loving the family through the first moments of profound loss.  Jesus demonstrated quite clearly that our perspective must be, and always remain, one based on eternity.  How will today’s tragedies appear to us in eternity?  In 1000 years, how important will it be, to the child dancing around her King’s feet, who died from malaria at age 7, that she didn’t have a few more years on this earth?  How important will it be in 100,000 years, as we joyfully bow before our King, that we were abused here, we were neglected here, we divorced here, we made unhealthy choices here, we were successful here…?

 

On a recent morning walk, I looked over the landscape and saw hills.  I looked again and saw plants of innumerable variety, size, shape and color, I noticed a dawn sky of billowing, pinkish clouds, I followed several birds dancing airborne in the early morning light, and I felt the warm breeze cool my sweaty brow, while the blossoming, fragrant autumn flowers swayed around me… and I was drawn into worship of the One who put all of this beauty together and Who opened my eyes to “see” it (five minutes prior, I didn’t “see” it)…  How often I don’t recognize the wonder He has put right in front of me, every moment of every day…

 

The folks with whom I work eat to live.  Eating is not a pleasure, but a necessary task in order to live.  Their food is simple and bland and little effort is made to improve a meal.  Three meals/day is not the norm.  They eat when it fits into their day (usually at the beginning and end) and they have little understanding of my “need” to break for lunch every day.

 

On our return to Cavango, we’ve been sought for counsel re gossip about several leaders.  Gossip spreads like wildfire among the immature and unwise (as to its potential destruction) and we’ve recently experienced wildfire in front of our house in Cavango.  I burned our trash, as I always do, in a hole dug for that purpose.  This time, however, the fire jumped into the dry autumn grass and burned up several acres in an hour.  What impressive power!  We tried to put it out and our efforts were futile, once it had taken off, and it burned until it reached a place where there was nothing more to feed it.  It was an interesting illustration of what had occurred while we were in the US re several leaders in our community.  So much destruction had occurred in such a short time.  We encouraged Jesus’ counsel in Mt 18, brought the accusers and the accused face-to-face, and saw much misunderstanding resolved.  There were the accusers, there were the accused and there were all those who helped spread the “fire”, who will hopefully see the reconciliation and stop feeding the flames.  I’ve thought about our enemy being called the “accuser” and how we must respond in the face of criticism and accusation.  I’ve been on the receiving end of suspicion and criticism over the years (as we all have) and some thoughts follow…

 

I’m reminded of Jesus before His crucifixion, standing before Pilate and his countrymen and hearing the false accusations, gossip and criticism that eventually lead to His death.  The newspaper-like account of this dialogue was enough to convince me, years ago, that Jesus was more than a man (Jn 18).  A Jesus-lover, like the One he/she follows, must humbly remember who she/he is and where he/she is going, must remain humbly unconcerned with negative/indifferent responses from others, must not judge or label, and must continue to humbly love, serve and share with others the good news of our Father’s grace, regardless of the response (because we can trust our Father’s oversight and ability to influence, as He will, the hearts and minds of those involved in any circumstance (like Jesus before Pilate). Jesus (humbly) washed Judas’ feet!  Trust…

 

We can judge actions and behavior as healthy or unhealthy, but we are completely incapable of accurately judging another’s motives (we struggle to accurately judge even our own), yet we do so frequently.  We must diligently guard against this because our conclusions about circumstances and people are always drawn from incomplete information.  Working cross-culturally, our perspectives on circumstances and people are even more cloudy.   There is no way I can understand the world view (that from which they make their decisions) of those I serve, shaped in an environment of which I am completely ignorant.   I have lived in a developing culture setting for more than a decade and yet I have never worked in a field every day, never gathered wood in order to eat, never carried water from a river in order to drink, never had a sick child with no access to treatment…  I simply cannot interpret their responses to life with any real understanding and I must, therefore, love and serve and remain unconcerned that their responses (toward God, toward me, toward life) might be different than mine.  My cross-cultural experience (as a minority) has made this more real to me, yet it applies to every person with whom we have contact, in every cultural settingWe never know the path that one has walked when we meet them on the way.

 

Judging applies to self, as well.  When we look back critically on a decision or response we made in the past, we are judging another person with the same name.  Judging in hindsight eliminates the mess and confusion of life at the time.  When I was sued as an ED physician, all of the discussion in the lawsuit was around one particular set of circumstances (one patient), pulled out of the normal ED chaos (many patients at one time) and set aside and examined, as if it occurred in isolation.  It’s ok to do that (good medicine is defensible), but we must not label our hindsight assessment as “reality”, and judgment must take into account the fact that the light on a situation changes when we look back.  We make our decisions with the light that we have at that moment (life’s chaos limits our ability to see anything with complete clarity) and there is nothing “wrong” with looking back on a situation with more light (hindsight knows what was unknown at the time) but we are wise to remember that judging someone (including ourselves) in different light can be unfair, inaccurate, and destructive.

 

I am often working in situations with less than perfect light because our clinic has no electricity (we use candles, flashlights and dim LED lights), and it is simply amazing how clearly a wound or situation looks when I shine bright light on it.  There is so much more guesswork when something isn’t clear!  Because of our human-ness, our life is lived in an arena of less-than-perfect light, and we must give ourselves and others grace, much grace, to err and/or to see things differently than we do…  Life often happens in darkness, fuzziness, and incomplete understanding.  We simply cannot judge by the light of day decisions made with the limited perspective of the “darkness” (incomplete understanding) in which we live. Because our very human perspective will always be quite limited, because this life is like walking through a minefield, and because only light gives clarity to darkness, Jesus, in a phenomenal demonstration of love, offers to walk with us every step (“I am with you always”) and He wrote to us many letters (He called both His letters to us and Himself, “light”) to help guide us on this challenging, foggy and wondrous journey…

 

Judging is like pulling one isolated frame out of a video, examining it in detail and evaluating the whole video based on that single frame.  We can evaluate a single frame, but we must acknowledge that one frame is not the video, just like one particular decision or aspect of our life (or that of another), past or present, doesn’t define who we (they) are. The only accurate judgment is all-knowing judgment, that which takes into account a whole life (all circumstances, thoughts, motives, wounds, influences, etc), which is why only God is in a position to judge.

 

We also must never receive/accept the judgments and labels of others, as they are made with the same ignorance and lack of clarity.  We might consider another’s opinion in a matter, but we must never simply accept labeling and judging about us, without taking the matter to our Father and/or to those who know us.  No one understands you or your motives at any given time.  Many hearts (in the church) have been significantly wounded by receiving/accepting another’s judgment of them.  Judgments about actions and decisions are, of course, necessary, yet must always be distinguished from judgment of a person. 

  

Grace (favor apart from performance) and mercy (favor despite poor behavior) are beautiful, indeed, and are rarely found outside of our Father’s Kingdom (unfortunately they are often absent within His church, as well).   Contrary to much church teaching, morality is not the key to our Father’s Kingdom, but grace and mercy are principal characteristics of the same and take into account life’s messiness, our lack of light at any given time, and our inherent humanness.  They are more beautiful to me in my later years than ever before, more beautiful than goodness, prosperity, happiness, success…

  

Judging…  On one of our long and brutal trips from Cavango to Lubango, we had a car full of patients needing surgery and we always buy soft drinks and lunch (usually dried bread) for our travelers on the way, knowing that traveling into the unknown of the city is a frightening experience for them.  During this trip with twelve people, much trash accumulated in the car, and a thoughtful lady took it upon herself to clean out the car.  She gathered all the trash and unceremoniously tossed it all out the window (littering is not illegal here as there is no trash pickup or trash receptacles).  Someone from a western culture could have observed this from outside the car and labeled her as thoughtless, lazy, and neglectful of the environment, etc when her only motivation was to keep the car of her “host” clean and to “do unto others…”.  Her motives were pure and beautiful, and she could have easily (and ignorantly) been judged quite negatively.

 

What biblical hero was without significant flaws, and how easily their hearts could have been mistakenly judged via their errors?  Moses appeared to be a spoiled rich kid with low self-esteem, no direction, and then he committed murder, David broke all of the ten commandments, Joseph had a prison record, Paul was a murderer, impulsive Peter walked around with his foot in his mouth, Noah had a drinking problem…  As I was investigating the claims of the bible as a young man, I was struck by the honesty, transparency and humanness of the main bible characters and this, in my mind, substantiated the accuracy of each account.  If I was trying to establish a movement of influence, I would never highlight the flaws of its leaders and, yet, this is exactly what our Father did in His profound letters to us.

 

I remember today that the kingdom of God is about Him and His profound love for flawed creatures.  It is the grace and mercy of God that make this messed up creature smile and worship, and it is this same grace and mercy (not my goodness or that of Moses, David, Paul, etc) shown to others that will open their eyes to see my Father’s beauty…

 

 

Repentance, Sabbath, Shack, Fondness…

 

We are back in Cavango after a week and a half in Lubango (it was to be a week and we had car issues and other delays).  We had a delightful week connecting with fellow missionaries and Angolan church leaders.  We are returning after a four month stay in the US, which consisted of rest, the celebration of Ellie’s marriage to David Steltz, connecting with our beautiful kids, our family and some of our faithful supporters, a Christian medical conference in Thailand, and a season of repentance.

 

I returned from Angola in November more exhausted than I realized and, through some sensitive and wise counseling with our beautiful SIM mission organization, I recognized that I had recently begun to place serving ahead of my first love and to identify in my work instead of as a beloved child of my Father.  The symptoms were loss of joy and peace and other characteristics of the fruit of His spirit (Gal 5:23).  I was able to see that I had arrogantly chosen to violate my Father’s loving command to rest one day a week and to live a life without the heavy yoke of shouldering all responsibility.  Arrogantly, because I had begun to see my work as so important that I couldn’t rest and the stress of bearing the burden of care that only God can bear was wearing on me.

 

As often happens in depression, my world became quite small and quite focused on me and my activity.  My time in the US helped me to step away and look at myself, my work, and the world from a different perspective, and appreciate again my insignificance.  In the grand scheme of things, we each (and our activity) are quite insignificant and humility embraces this reality, while arrogance disregards it.  Mental health requires a perspective centered on reality (vs the ideal) and one of the characteristics of poor mental health is hyper-focus on one’s self, work, growth, feelings, importance, etc.  Jesus addressed this often when He encouraged us to focus on our Father and on others.  A focus on our Father stimulates us obey Him (an audience of One), out of gratitude and appreciation for who He is, and one of His commands is to rest because it is healthy and because we cannot rest without trust.  It is said that the Jewish Sabbath begins at night because the first part of the Sabbath is spent in bed, trusting the world, our activity, our loved ones, etc to our Father.  We don’t work on the Sabbath, because we recognize that success or failure of any endeavor is our Father’s responsibility and is not dependent on our effort, skill, personality, etc.  Sabbath is about trust (as are all of the commandments), and I had abandoned trusting my Father for all outcomes, believing that some outcomes in my life were more dependent on me that on Him.

 

Repentance involves changing one’s mind, and our Home Assignment allowed me to see the direction I was headed and turn.  If there is one thing I have learned in my 30+ years of walking with Jesus, it is that living with my heart turned toward Him (in dependence) is life and walking in my own wisdom/desire/strength is destructive.  Because of my hard-headedness, repentance must happen often, as I have such a propensity to walk independently of my Father.  My natural bent is to not follow Him wholeheartedly but, when I do, I know the beautiful fruit that a surrendered heart can realize.  Every day I both wander from Him and follow Him.  I am seeing again that I need to monitor regularly whom I am following so as to stay dependent on Jesus and not on me.  There is no better way to do this that to read His letters to us, surrender to Him, talk often with Him, to read the writings of others who are following Him…  Though I now see better my need to trust in Jesus’ care and ability for running the world in which I live, I’ve obviously still not arrived as, yesterday, my first Sunday back in Cavango, found me in a church service for three hours (not rest) and making 5 trips to the clinic for emergency arrivals…  Please pray for me as I continue to process toward a place of healthy trust/rest.

 

This battle within is one of the reasons I write proverbs for my kids (see above under the photo).  To write my observations of life and to stimulate them to chew on what is healthy/true, to reject what is false, and to know the difference.  I need so much help in daily staying surrendered to God, health, wisdom, truth, etc.  I love reading others’ experience in the search for health/truth and I believe that sharing our experiences/perceptions about health/truth are beneficial.  These proverbs are written to share my observations and to stimulate thought and conversation, not to claim the corner on truth.  I believe that our Father’s letters to us were written to encourage relationship with Him (who has the answers), not to have all of life’s answers.   He invites us to reason with Him, to create with Him, to learn with/from Him and to work with Him in determining what is true, good, and healthy and these statements are written with this in mind.  Others have written and expressed their appreciation for how the proverbs have encouraged and challenged them, so I published them here.  I hope they draw you closer to the Truth (Jesus) .

 

I saw the movie, “The Shack” while in the US and, as the book did 10 years ago, it challenged me deeply.  Its message is honest, rich, hard, humbling… and packaged in a way to stimulate a response.  The realities of earthly pain and how our Father views us are especially addressed.  I constantly struggle with realizing His affection for me apart from what I do, which is the whole of Jesus’ message to mankind.  Like the main character in the movie, I can so easily become focused on me, my understanding, my performance, my pain, etc and lose my Father’s perspective, which is the core of the Gospel message.  The Kingdom of Heaven is centered on Him, His glory, His love, His abilities, etc and life is found in Him and not in me and my earthly understanding.  When I remember this and focus on my relationship with Him and His perspective toward me, I know life and peace and, when I forget, I know emptiness, confusion, frustration and fatigue.

 

I especially love the author’s depiction of the relationship of the members of the Trinity toward one another and I’m reminded that God has known love in the Trinity for all of eternity.  The message of the Kingdom is that this same Godhead has now included us in the love they know for One another.  Wow.  The radical significance of the Trinity is that love didn’t begin with creation, but that love for mankind was an extension of what God already knew and practiced in Himself.  Jesus says in Jn 17 that He loves us like He loves the Father, and we are loved like He is loved by the Father.  Wow.  Life with Jesus is not a religion, but a relationship with this loving God.  The movie challenges me because I have such a propensity to leave relationship for a system of commands and performance.  I encourage you to see this excellent movie, to read the book (again), and to reconsider this God who came to earth to clearly reveal and express His unfathomable love toward such flawed human beings.  The message will change you…

 

At the Christian Medical and Dental Association conference in Thailand, the writer of the book, “Insanity of God” spoke to us (about 300 English-speaking medical professionals serving in difficult places around the world) and during his message he stopped and said slowly and emphatically, “I am so proud of you!”  I got quite emotional (doesn’t happen much any more) and I realized how I long to hear those words from my Father.  That day will come soon when we all will have the opportunity to hear, “Well done, my faithful servant”.  The conference was the first time I was with so many serving around the world and Betsy and I will now try to go to this annual gathering as often as possible.  It renewed in me an eternal perspective, which I so desire to maintain.  I desire the things of this world to more increasingly “grow strangely dim” as I focus on Jesus and His heart for those He loves…  I had breakfast with someone serving in Iraq, lunch with someone serving in Afghanistan, dinner with someone in Nepal and every day was like this for 2 weeks.  We shared joys and struggles and had so much in common.  The body of Christ is beautiful, indeed.  I walked away from every encounter with such admiration for those I had just met…

 

Our time in Lubango was encouraging, especially my meetings with my fellow brothers/sisters in the Lord (missionary and Angolan), who work with me to serve those in the rural areas to express this Kingdom love to those who haven’t heard.  One missionary colleague, in particular, Steve Collins, so depicts the heart of my Father, as illustrated in “The Shack”.  The Father character in the movie (“Papa”) says repeatedly and joyfully about various flawed people, “I am especially fond of him/her”.  Steve Collins is a humble, energetic and joyful almost-80-years-old eye surgeon who has served thousands in his years in Angola, and everyone in his presence feels that Steve is especially fond of them.  This is such a beautiful demonstration of Jesus in Him and I want to be more like Steve when I grow up!

 

We had a meeting with Angolan leaders to discuss how we can best place our efforts to communicate to more people the incredible love of our Father.  68% of Angola’s population in 2015 was under 15 years of age.  Children are culturally neglected and we agreed that we, as Jesus’ body, need to place more of our energies and time in loving this beautiful part of the population.  If you would like to make an impact that would last for generations and for eternity, would you consider serving/loving these kids?  If so, please contact us and/or SIM (sim.org).  So many here could benefit from your love.  The laborers are few…

 

Our return to Cavango this week has been full.  We had perhaps a hundred people waiting to be seen, and many very ill (including many kids in coma from malaria and one beautiful 4-year-old who died in my arms immediately upon arrival at the hospital).  It has been a joy to be serving here again, but it has been equally joyful to see that the hospital had been run with excellence in my absence.  To see that all of our training over the past three years has been so fruitful is beyond encouraging!  Whenever we leave our work here, whether in one year or ten, our staff in Cavango has demonstrated that the work and service here will carry on in very good hands and hearts. Our colleagues here, with the Lubango MAF staff, with everyone at our parent hospital CEML in Lubango, and with our SIM and Angola church family, served the rural people with such selfless abandon during our time away…  So beautiful!

 

The child who died in my arms had had fever from malaria for six days.  We tell everyone that malaria rarely kills in the first three days, but kills many after that window.  If we could only get the message out…  We need people who will travel to villages and teach basic health and present the simple message of our Father’s affection for them.  If you would want to impact generations through simple instruction (no health training required), just in the Cavango area we could use perhaps four people willing to abandon their current earthly life to love these beautiful rural folks in this way.  The sacrifice would be steep and the eternal rewards for many even steeper…

 

I remember asking my Father when I moved here to give me His love for the people of Cavango.  As I sat in the church service this morning and looked around the room, I realized that He has done just that.  I have such love and respect for these folks, all flawed (like me) yet all so beautiful and living in some of the toughest circumstances.

 

Please pray for us and our work and refer to above and to the previous post about how you might be able to join us in this remarkable work…

 

Rest, Vision, Financials…

 

We have begun our four-month Home Assignment in the US (2yr in Angola, 4mo in US) and, upon entering the country, we were gifted with a colorful autumn in Charlotte and thick, fluffy snow in New York.  Over the course of a week, we were able to meet with our beautiful SIM organization, a passionate group with AGA (Advancing the Gospel in Angola), and leaders at Samaritan’s Purse who have worked in Angola.  We were so encouraged and loved at each stop.  We then picked up Meredith in New York and have been in Toledo with Tim’s parents since Thanksgiving.  I have battled a nasty facial infection that is resolving, a sprained lower back that is also improving and I’ve scheduled a total-knee renovation for December 15th (I’ve had continual pain since the surgery a couple years ago and I’m hopeful that this arthroscopic surgery will correct the cause).  I guess sometimes one must just rest!  We look forward to the Holidays with Tim’s family in Toledo, a family week away (just the six of us), and we then have the blessing of giving our beautiful daughter, Ellie, in marriage to a wonderful young man, David Steltz, in Rochester, NY on January 7th.

 

I would like to share with you briefly about our ministry, our vision and our current financials (we are committed to transparency and trust).

 

As many of you know, our vision is to take evidence-based health care and sound public health instruction to people who do not have access to the same.  We also desire to, like Jesus, address both physical health and spiritual health (a relationship with our Father).  Every person who survives a fatal disease through our work has more opportunities to meet Jesus…

 

We seek to assist especially those living remotely, removed from access to churches, hospitals, etc.  We live and work in Cavango, a remote former Leprosarium in central Angola, about 5hr by car to the nearest city, and about 10hr from the main city in the southwest part of the country, Lubango, where most of our missionary colleagues live and work.  I also travel with MAF (Mission Aviation Fellowship) to other remote areas, difficult to access by car, to hold clinics and to teach about the Good News of our Father’s affection for us.  My months are typically divided into two week periods, the first two weeks monthly in Cavango and the last two weeks traveling to various harsher areas in the country via MAF.

 

We seek to fulfill our vision by accurately diagnosing and treating the specific ailments of each patient (there are more patients than we can see at each location), teaching the general population (those waiting to be seen and their families) about achieving good physical and spiritual health, teaching the local health care workers in each location as they “shadow” me while I work, and leading a discussion before each clinic day about the good news of Jesus’ eternal grace and love.  We pray with each person we treat, encouraging them that only God gives life (and heals disease), and that He loves using tools to do His work, as Jesus did with mud and spit (and carpentry).  We also teach that our Father loves using people to help people (“…as I have loved you.”) and that He will often use doctors/nurses/parents/friends, instruction, wisdom and medications to assist in achieving health/healing.

 

We currently have a beautiful supporting team of between 80-100 individuals/families, each contributing a variable amount to our work throughout the year.  Some give annually, some monthly, some occasionally, from $10 to $1000 per month.  We are also supported by two churches, VCDC – our home church and Vineyard Toledo.  We cannot live and work in Angola apart from our financial contributors, and we are truly partners in this work, interdependently working together to see these forgotten people well physically and knowing Jesus personally.  We are a body – legs, arms, hands and fingers involved in touching each person.  The rural people of Angola that we serve would not have health care and many would never hear the good news without both your financial contribution and our presence among them.

 

My Father often stops me during the day to remind me of this fact, and that it isn’t my work that makes these folks better, but it is His work, through a beautiful body, all organized by Him.

 

I would like to invite you to join our team of contributors, and take part in the beautiful work in Cavango and the MAF clinics that, as you can see, I cannot do alone…  I can’t think of a better place to have a direct impact on “the least”, the hurting, the forgotten of this world (which is why we are here).  Please consider asking our Father if He would have you participate in this work with us.  You can most conveniently give through www.simusa.org to our name or to the Rural Health Care Project in Angola, where your hard-earned money will either support us or directly help individuals in some of the most remote regions receive appropriate medication and a word from our Father.

 

We would like to share our financials with you, our faithful team that has sent us here (through your giving) and that allows us to impact so many lives through health care and the word of Jesus’ grace.

 

Our personal salary will remain at $3,263/month and any additional money we receive goes to health insurance, rent, work-related travel, medications for patients, airplane fuel for the small planes that MAF uses to transport me to remote areas, etc.  The money given to the project mentioned above is separate and is spent only on expenses directly related to our ministry (medication, fuel for the airplane, hospital expenses at Cavango, transport for surgical patients, etc), and none of it is used for our personal expenses.

 

We are looking for new partners who desire to serve the rural people of Angola with us.  We would love to be able to raise additional funds for improving the conditions at our Cavango clinic/hospital – additional simple buildings, beds for our inpatients, etc.  Most of these folks currently sleep on the ground and we have no electricity and little running water.  Improved conditions will help in communicating and demonstrating the love of Jesus for these hurting and ill people.  We think that about $200,000 will provide the infrastructure necessary to care adequately for the high volume of patients we see presently see in Cavango, knowing the numbers seeking help will only increase.  Listed below are some (estimated) ways that you can contribute to these very basic needs.  For their sake, please consider:

 

20 small buildings (16ft x 24ft) – $5,000 each (this size is the most inexpensive size to build with block and steel)

150 Mattresses – $75 each

100 Beds – $50 each

Plumbing/Electricity – $10,000

Generator – $5000

Solar panels and solar batteries – $10,000

Operating room – $10,000

Surgery instruments – $5,000

Sterilizer – $5,000

Shipping – $30,000 (two containers)

 

 

Please contribute to one or more of these specific needs or you can give generally to our support account or to the project and we will spend your contribution according to need.

 

* If you know us or our history at all, you know that we take very seriously the trust placed in us to use all contributions for their intended purposes.  Thank you for your trust and for joining us in reaching these beautiful people of rural Angola.

 

The Ninety-nine or… the One…

 

While still dark this past Friday, 28-year-old Lussinga rose from the straw mat on the sand in her small stick house and gathered her three young children to begin her 10-mile trek through the deep and shifting sand to Fazenda Tchincombe, where that day we were holding our monthly clinic.

 

She arrived at about 10a and waited with the rest of the crowd to be seen.  I saw this young mother of four just before noon as she presented her “complaint” of intermittent vaginal bleeding for a month and increasing pelvic pain for the past week, denying pregnancy.  She admitted to intermittent fevers, as well, and no other symptoms.  She had a concerning exam, with significant lower abdominal tenderness and localized peritonitis.  A malaria test was negative and, though a diagnosis of a pelvic infection seemed certain (so common here), I wanted to do an ultrasound to make sure she didn’t have an abscess or another urgent concern.  The battery on our portable ultrasound, however, had already died that morning and we needed to set up a small generator for further use of the machine.

 

After pulling a tooth (actually, Meghan, the daughter of dear missionary friends and a high school student interested in medicine, expertly removed the broken tooth) and doing several other ultrasounds with generator power, we were able to see Lussinga again, near the end of the day.  The ultrasound exam revealed an empty uterus, cysts on both ovaries and a large heterogenic, “disorganized” mass near her left ovary.  Although seeing this mass confirmed for me that the likely cause of her pain was an infection (with an abscess), my experience in emergency medicine (neurotically concerned with “What is the worst thing this could be?” rather than “What is the most likely thing this could be?”) and my even greater experience in having an incorrect first impression, prompted me to collect some urine and do a pregnancy test, which came back positive.

 

This changed everything.  We now faced a diagnosis of a (ruptured and bleeding) tubal pregnancy (the mass that I had thought might be an abscess) and the need for urgent surgery (few survive this condition without surgery).  We were in a remote village, about two hours from pavement and then another two hours to Lubango.  We normally could call the small MAF plane in a situation like this, but the plane with larger tires to navigate the thick sand of this region was down for repairs (which is why I had driven in early that morning).  Our only remaining option involved wrapping up the clinic quickly and driving to Lubango.  We had some daylight left and this was good, as I prefer off-road driving in daylight.  First, we had to drive to Lussinga’s home, notify her family and prepare for her trip.

 

By the time we left the clinic area and drove about 30 minutes in the sand, we arrived at Lussinga’s house in the dark.  It was beyond simple and, even after many years in this type of work, I was taken aback.  It was set in a fenced-in area (sticks stuck upright in the sand) of about 1000 square feet, in which were three “houses”, each made of sticks (no clay) and a grass roof, enclosing one room of about 100 sq ft (about 10ft x10ft).  Those present began calling and yelling and soon a group of about 20 people (and the same number of laughing, playing kids running around in the dark) had gathered and I explained the situation to the family and friends.  The husband was beautifully responsive and prepared to accompany us and care for his wife, and Lussinga’s mom (see photos), three women and three children asked if they could be dropped off on the way (never is a car seat left empty on trips in the “bush”).

 

As we pulled away about 6p, the rain began, a torrential downpour that didn’t let up throughout our 5hr trip to CEML, our mission hospital in Lubango.  It was slow going on the now-sloppy dirt and then also on the pavement because of severely limited visibility, so many now unseen potholes (each a potential bent rim and flat tire), no edge lines on the road, and virtually all drivers coming from the other direction using their high beams.  When we arrived at the hospital, I handed Lussinga off to the capable staff, contacted our OB physician, Sarah Hudgins, about the need for a morning surgery, and headed to where we were staying and collapsed after a 22hr day (I had been called in to CEML at 2a the previous night for a couple of urgent concerns and then left at 4a for our clinic day at Tchincombe.

 

The next morning, Sarah, Esther (a visiting FP from Canada) and I removed a coin from the esophagus of a toddler (almost a daily “surgery” at CEML), did rounds, and took Lussinga to surgery (the pregnancy test at CEML came back negative!), where Sarah identified and expertly removed the bleeding Fallopian tube which contained the deadly ectopic pregnancy.  Lussinga is recovering in stable condition.

 

This is the work that you support.  Your prayers, encouragement and finances send us to the remote areas to find those like Lussinga, and either treat them or get them to where they can be appropriately treated.  Sometimes I am a doctor, sometimes a dentist, sometimes a teacher… and sometimes a driver…

 

I have friends who will say today’s election result is pleasant and friends who will say otherwise. Our Father allows both pleasant and unpleasant to further His kingdom. He allowed both Nero and Washington. Whether the election is better for our country and the world in the short-term remains to be seen. From His eternal perspective, the result IS better for the Kingdom (He has chosen/allowed this government authority for our country for this time). Will our response please and honor Him?

 

I’ve had a full and enjoyable three weeks doing consults and helping in surgery at CEML.  Too many stories to tell…  We will now be leaving Angola Thursday for the US and have a week of meetings in Missouri and North Carolina before arriving in Toledo the following week to spend time with our family.  We have plans to do little for a couple weeks and then hope to see everyone possible before our return in mid-March.  Please contact us to set up a time that we can get together (we will try to make most of our connections in January and February) to share with you about our work and perhaps find a way for you to be a part of our team that helps so many like Lussinga in rural Angola!