To offer others comfort, we sometimes have to leave our own behind

One of the closing sentences of my daily reflection while in Angola read: ‘To enter the mystery [of Easter] means going beyond our own comfort zone, beyond the laziness and indifference which holds us back and going out in search of truth, beauty and love. To offer others comfort, we sometimes have to leave our own behind.’ – Fr. James Sullivan, O.P.

I was blown away with the reality of these powerful sentences. So many times over these past six weeks I have found myself a tad uncomfortable or insecure because I was experiencing the crumbling walls of my comfort zone. It was in these moments that I was able to share in the beauty of being human with another person. Yes…cultures are very different from country to country, sometimes drastically different, but we are all human being in the search for our meaningful, God-given purpose.

Since being back in Ohio, I have had time to share my experiences. At times, I have been fairly frustrated with my inability to clearly articulate what I saw while in Angola. Even as I struggle to share, I know how much of a blessing it is to have had this experience and to share it with others. This trip has changed me, made me more aware of who I am and what I am being called to be. I met some of the most beautiful people and have gained great wisdom.

I am making time for silence and reflection, ingraining the sights, smells and sounds of Angola into my memory.   

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Dr. Tim Kubacki and Alfredo in front of the Tchincombe Health Post.

 

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The Doctor is In

My last few days in Angola were spent in Tchincombe conducting clinics with Tim. Even though ‘The Ranch’ is about an hour flight to the SE of Lubango, the climate is sandy and hot. The mission of the Ranch is to teach the villagers sustainable business (cattle!) and to help spread the word of God. When we arrived early Monday morning, we were greeted by about a hundred people waiting to see the doctor. As we began to set up, tractors full of people arrived from neighboring villages.

Tim started the morning by gathering the villagers and sharing in a conversation about physical and spiritual health. The people asked insightful questions about malaria, giardia and the worms that so many believe live inside them.

My most memorable moment was after Tim read aloud the Gospel of Luke – the story of Martha and Mary (Luke 10:38-42). He was trying to emphasize that a relationship with our Lord is very personable and requires time to sit at the feet of Jesus and be fully present to Him speaking. One of the elderly women raised her voice and asked how that could be possible, since she could neither read nor write, lacking access to a bible. Tim paused, then sat on the sandy ground next to the man who was interpreting Portuguese to their tribal language. Tim emphasized that the most critical part of forming a relationship with Jesus Christ does not require the gospel (although it helps!), but it does require an open heart, not being distracted by the busy tasks of life. Just as he sat at the feet of the interpreter, so can everyone sit at the feet of Jesus, listening and talking to our Creator.

41 “Martha, Martha,” the Lord answered, “you are worried and upset about many things, 42 but few things are needed—or indeed only one. Mary has chosen what is better, and it will not be taken away from her.”

By far, the majority of the men, women and children were sick with malaria. Others had viral colds, gastritis and sinusitis. I was able to perform ultrasounds on pregnant patients, getting better and better at finding fetal gender. It is tricky to do! Many patients did not even know their age. A few of the women presenting to the clinic were wearing their traditional tribal apparel, which was incredibly interesting to witness. Lots of beads in their hair and draped around their chest. Some cloth covered their waist.

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I worked alongside Tim for the first two days, but then had to travel back to Lubango to catch my flight back to America. Tim decided to extend his time in Tchincombe by an additional day in order to see everyone. Tim informed me that in total he had seen over 260 patients in those two and a half days. I am continuously amazed at the his gracious heart. He embodies what it means to fully embrace the work of the Lord.

Random side note:  Brent, the MAF pilot, taught me how to fly the plane on our way back to Lubango. Such an adrenaline rush!
It was tough saying goodbye to Tim before leaving Tchincomeb and then Betsy and Meredith the following day. They have been instrumental in making my time in Angola incredibly insightful and life changing. The almost six weeks spent in various parts of a developing culture changed my life perspectives a great deal. Reflecting on the strengths and weaknesses of the the Angolan culture has allowed me to examine my own culture with a more critical eye.

Last Day of Medical School

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There is a baby in there!

This past Friday marked my last day of my medical school career. As cliché as it sounds, I cannot believe how quickly time has passed. I distinctly remember my first day in Athens, walking into Irvine Hall and meeting my classmates. Together we endured sleepless nights studying for exams, spent countless hours in the anatomy lab, and learned to properly conduct a physical exam. We also enjoyed a few nights on the town celebrating the little victories of life. In just two short weeks, I will be back in Athens with all my classmates sharing in the bittersweet joys of graduation. Oh, how much we have matured and have glimpsed the reality of the art of practicing medicine.

Thank you to all who helped me along this journey. I am forever indepted to your love and support. With a lot of sweat and hard work, dreams do become a reality.

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My last day of medical school in Rivungo, Angola!

Flight Medicine Week

Part of Tim’s medical ministry is to fly (with the Mission Aviation Fellowship) two weeks out of the month to places in the furthest southeast part of Angola to minister to incredibly remote villlages that lack accessability to quality health care. Part of the ministry is finding the  villages with greatest need and building a relationship with the nurses who staff the underfunded health posts. This requires an exponential amount of patience, because in typical Angolan culture there seems to lack a passion for change or advancement. Instead of valueing truth seeking, most people value being people pleasers. Many empty promises are made – with the best of intentions – which leads to lots of uncertainty and often many plans are never seen through.

This week brought lots of uncertainty, which was a perfect time for me to excersise virtues of flexibility and humility.

We left from the Lubango airport in a Cessna – 182 early Sunday morning, being delayed only by an hour because of a difficult police man and documentation. With that past us, we loaded into the plane full of medication boxes and flew to Menongue airport to refuel. There, we met up with some people from the I.E.C.A. church to chat over a refreshing Coca-Cola. We then flew another two hours to Mavinga and then another hour to finally land at the small military camp of Jamba. Guess what? Even though Tim had many conversations with numerous people, the church leaders where still unprepared for our arrival. We sat on the runway swatting some rather agressive flies for about two hours before we saw the dust stirred up from a car.

The military commander drove us to the small village of Luiana where the villagers scrambled to set up lodging for us. After about an hour or two, we found ourselves settled in a sturdy structure with a mattress and a bottle of water. After pitching my pop-up mosquito net tent, I fell asleep to the African night sounds of insects and music.

Monday: Spent at the health post of Luiana. There was an incredible number of people sick with malaria, along with back pain, infections, and gastritis. We even saw a lady with Cutaneous Larva Migrans, a worm that moves around under the skin and causes severe itching. In total, we saw 67 patients, working well past dark. I rather enjoyed the practice of medcine by lantern light.

Tuesday: By 6am we were back in the plane and flying to Rivungo, a village so far southeast that we were only a few kilometers from Zambia. Here, we were welcomed by dozens of children gathered at the landing strip. Unlike Jamba, we were quickly brought into the village and set up for a clinic at the health post. People came in with many chronic complaints and vision trouble. People take advantage of the presence of a physician, unloading numerous complaints, as this often may be the first time they see an actual doctor. Again, I am consistantly amazed at the amount of malaria. This time, however as the sun set I understood completely why that is the case – so many mosquitos! Rivungo is located near a canal that connects the village to Zambia. After clinic Tim and I walked down the street to the local store to buy water. We were constantly swatting mosquitos in the breif five minute walk. I was impressed.

Wednesday: A second day of clinic in Rivungo, as the ambulance that usually takes Tim to the remote villages is broken (as is the case for many of the health post ambulances). Today was slower paced, as patients came when they had down time. I was kept amused by watching the lizards sneak in a sunbath inbetween us getting up to use the ultrasound machine. I continued to learn about the culture through the types of complaints and the way illnesses were described. Many believe they have worms in their belly, so they say they feel a ‘bug’ move around in their abdomen. People rarely get specific about location of pain or how long they have had the discomfort. A few times Tim and I have laughed at eachother as we continue to ask the same questions expecting to get differing results- the definition of insanity, right?! Our running joke has been to whisper ‘insanity’ when we hold a high hope of getting more specific answers… but it never happens.

Thursday: A perfect example of Angolan philosophy. Some promises are actually kept, but on African time. The night before the Administrator of Rivungo promised to find us a functioning car to take us to Chifuoco. At breakfast we learned a car was set up and ready to make the three hour journey to the village. A few hours later the car had not yet materialized. Late morning, just when Tim was about to waive the white flag and stay in Rivungo for the day, a police car appeared infront of our door. We loaded the medicines, stopped at the praça to grab snacks (aka more bread) and turned on the four wheel drive. The driving here in Angola is difficult to accurately describe. Here in the Southeast corner everything is deep sand. You know the sensation you get when purposefully driving a bit wreckless in a snowy parking lot when no other cars are around? You slip and glide, half gaining control of the car. Substitute the cold for 100 degree weather and that is what I experienced as I was wedged in the front seat between the driver and Tim. Only a few times did I see my life flash before my eyes as we wove in and out of trees.

We arrived at the village early afternoon. Due to the timining, the village was near empty because everyone was out at their field harvesting. After sitting for awhile, the head nurse of the health post came up and engaged us in conversation. Once again, this was a great moment for community relationship building. Our originial intent was to spent the full day in clinic, but instead we gained a better understanding of how to send word further in advance so the villagers would know what day to stay home if they had a medical complaint.

We stayed long enough to see a few consults, making the trip worth it. The children loved the suckers (bon bons), we showed women their babies on ultrasound and gave malaria treatment.

The village was a beautiful site, stratigically places on the banks of a river and under some trees for much needed relief from the sun. Every one room home was made of a stick frame and a sand/rock material for walls. All roofs were grass. I was able to experience a latrine and now totally understand why Angolans prefer to use the bush. I shall spare you the details, but you can use your imagination.

The drive home had an added sense of adventure because we popped a tire and the jack was missing some pieces. As I sat watching the police man (our driver) and the two teens  (who hitched a ride from the village to go to the ‘city’ -aka Rivungo) change the tire by cell phone flashlight….I chuckled. It reminded me of the start of a terrible joke: a policeman, physician, med student, nurse and villagers stranded in the African outback…
By the endless graces of God, we made it back safe and sound.

Late Thursday night we received word that the people of the village we were supposed to drive to on Friday were not able to pay for the consults, so we decided to stay a third day in Rivungo. Tim explained that as much as he would love to bring medicine to the most in need, there has to be a willingness to pay. He does not gather the money for self gain, but to purchase the medications he so freely gives. In reality, the 500 kwanzas (which is about a days wage, equivalent to $1.50 USD) he asks for covers only about half of the total costs of medicines he uses during his flight medicine weeks. The rest is funded by generous outside donors from the States.

Friday: Day 3 of clinic in Rivungo. Very slow pace day, with a variety of complaints. I was able to debride an few abscesses (way fun!) and reveal to a woman she was pregnant with twins!

Saturday: We snuck in a few medical consults before flying back to Lubango. One woman, who we have been treating her infections all week, came for a sugar check. She had fasted all night so the reading would be accurate. When we checked her sugar level, it was critically low so we threw a few lolly pops and water her way. During this time she had altered mental status changes and began to sing on the top of her lungs. Thankfully, she returned to normal rather quickly, but it made for an exciting morning.

The food I ate this week was simple, yet delicious. Every morning was pão (bread) with some margarine and a cup of tea. Lunch was funge (imagine something similar to a corn version of mashed potatoes) and some meat. Dinner was rice and meat. I was able to experience the taste of goat, which didn’t taste like chicken but was rather tasty.

This week lent itself to time for real, meaningful conversation between Tim and I. We shared about building a deeper relationship with God through faith. We talked about the spiritual dimension of the Angolan culture. Tim shared further insight into his journey and lessons learned through medical mission work.

Each night I fell asleep to the (not so) distant sounds of lively music. One night there was a rally for the group that is opposing the current government power. The other nights looked and sounded like giant dance parties. I was so tempted to strap on my dancing shoes (aka barefeet) and join, but I already had enough stares tallied up for the day.

Vamos fazer uma oração (Let us pray)

As I sat on the simple wood bench on the women’s side of church this past Sunday, I was overwhelmed with the sense of gratitude. I have been in Angola a month now, and have been trying my best to be absorbed into the culture. I have learned to put extra emphasis into my greetings, being truly present in the moment as I share a handshake or kisses on the cheek. I have shared in the great joys of good health and shed tears as patients suffer from painful ailments. I am constantly reminded that just being human is the best way to embrace the community of a village.

The worship service was delightful. Men on one side, women on the other and children roaming between. It started with the youth and adult choirs marching in, singing beautiful hymns. Their harmonies gave me goose bumps. As I looked around, every person was singing along. The village is not that large, but if I closed my eyese I would have thought there were hundreds of people by the volume of their worship. Amazing. During the announcements, Betsy introduced me to everyone. I was welcomed with smiles and a round of applause. Although most of the service was in Ngangala, the sermon was translated to Portuguese. Not exactly sure what was said, but I read the 1 Corinthians passage and enjoyed the corn stalks used as props. All in all service was about two hours long. A wonderful time to be in a prayerful community.

The most beautiful part of the service was during the collection of gifts. The people of the Cavango village are incredibly poor, so their 10% tithe of their income was presented in corn. One at a time families placed corn into a community basket. What is collected is used to help feed the elderly and guests to the village. Grace at it’s finest.

A few times during the weekend, I was able to take walks to the river that is a few kilometers from the village. I would sit on a rock listening to the rushing water. The time in silence was a time to be refreshed. The variety in landscapes in Angola is enough to leave you in constant awe.

I cannot express enough how valuable my time spent in the clinic has been. Almost every moment I am learning from both Tim and the patients, expanding my critical thinking skills as I develop a differential of diagnoses. We have been seeing 40+ patients each day, with a vast span of health problems. No complaints here, as I really think my ultrasound proficiency and clinical skills are improving greatly. It has been a real joy to see the children improving from malaria as the medication works it’s magic. We end each consult in prayer, raising our hearts to God asking for His healing and mercy. Such a beautiful way to humble ourselves, being reminded that all healing comes from God.

I have joked with Tim a few times that my ability to come up with a list of disease possibilities in residency (starting in July) may be a bit skewed since I have spent the last month dealing with tropical diseases. I wish I would have started from day one, but I have now begun to compile a list of pathology we have seen, both in Kalukembe and Cavango. The diversity and complexity of some of patients is really neat. When we sneak home for lunch every day, both Tim and I try to look up information about diagnosis and treatment options of the complex cases. Medical detective work at its finest, especially with minimal resources.

One day this week involved another road trip. Before you get all excited about another solid story, let me stop you right there. It has not rained since our trip to Huambo, so the roads where much driers and more easy to manuever. Rest assured, there were still plenty of bumps but there was not the constant fear of getting stuck. I rather enjoyed it, as we set off just as the sun was rising. We passed numerous villages and plenty of people. The children were out playing with tires and sticks, make-shift cars and chasing eachother around. People waived as we passed.

We set off to Cachiungo on a quest to obtain TB and leprasy medications from the government. Theoretically, they are to provide them as needed and free of charge. In reality, there is no prediction as to what will happen every time Time drives the 4 hours north. This time, we were not succesfull in gathering the TB medications because there was no supply, but we got some leprasy meds and spent hours meeting with the Health Department personel. Tim left feeling upbeat about the relationship building, hoping to lead to better communication and access to medications in the future. 

To finish the week, I traveled with the Kubacki family from Cavango back to Lubango. It was a total days journey, half on dirt roads and the other half on pavement. The trip showed me another glimps of more Angolan landscape. I also learned to better check my surroundings when using the natural ‘water closet’ – I got some throns and burrs in very uncomforatable places. Made for a good laugh when we all gathered back into the car. We passed the time with good old fashion conversation, deepening my sense of community and fellowship with the Kubacki’s. I am really learning what it takes to be a medical missionary.

When I decided to embark on this international medical, it was my hope to embrace the culture and the identity of Angola to my best ability. Little did I expect to also share in one of the common diseases…malaria. A mosquito (or two) was nice enough to pass along the wretched disease. Experiencing the illness has given me a greater sense of emphathy with the patients we see each day. I know first hand what it is like to be rocked with a fever, vomiting, diarrhea and fatigue…. and I was able to sleep on a bed and have a flushing toilet. I literally cannot imagine being sick, sleeping on the dirt floor. I am incredibly thankful for medications and good health. I am now back to full strength!

For my last week and a half, Tim and I are off to even more remote Angola to reach people who are in great need of medical accessability. I am told we will be living even more simply and eating like the locals.

I am going armed with an open mind and heart.

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My favorite couple. The woman was a patient for three months at the clinic. She is the living proof of a miracle.

What Is Life Without Risk?

This morning I witnessed the drastic difference between life and death.

During the ususal busy morning routine, a man in a coma was brought in by concerned family members. The story was nothing dramatic, he had fallen when he got up early that morning. In this culture, the concept of a medical history is non-existant. When he arrived he was cold, taking raspy breaths and unresponsive. All efforts were done to resusitate him, but unfortunately he did not make it. He met his Creator mid morning as the daily routine of life continued around him. I stood in prayerful silence holding back tears as I watched the family members sandwhich the body between themselves, riding back to their village on a motorcycle. Can you imagine the heartache they must feel? How precious life is.

Later in the morning as we were examining the inpatients, a little boy walked into the room with a wide grin. This little boy, just about five days prior, was in a cerebral malaria coma. His smile melted my heavy heart. How much gratitude I felt for the wellbeing of this child. Graças a Deus!  Tim has said many times, seeing people overcome their illness is what keeps the motivation of a servant heart.

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The little boy came to the clinic in a malarial coma, he walked out of the clinic today

Later, a woman stuck her paperwork through the open window. When Tim invited her into the room, I immediately recognized her as the fistula patient who we flew back to Cavango. She ran to me, embracing me with a gigantic hug and a double cheek kiss. She is completely symptom free and is back to living her life as normal as possible. The Fistula Foundation is making such an impact on the lives of many women!

Earlier in the week, Tim, two of the nurses and I went on a road trip to a big city called Huambo which is about 4 hours north of Cavango. Getting to Huambo is an adventure all in itself. The roads are bumpy and a tad hazardous. We set out before dawn to make good time. The drive was enjoyable, with a colorful sunrise and every turn revealing more beautiful landscape. I am now very efficient of using nature as my toilet. The drive went smoothly until we got stuck. You see, the day before it poured, leaving the roads incredibly muddy and slick. We reached a stretch of the road that is notorious (meaning Tim has been stuck there before) for being rather tricky. I joked that Tim wanted to give me the full African experience. He said ‘What is life with no risk?’

We tried just about everything: Sticks under the tires, using a jack and rocking the car. I was not really much help, but I felt rather tough with all the mud caked on my shoes and clothes. Just as we were running out of ideas, we decided to jack up the back of the car and hope to push the car over it. Guess who got to drive the car? Yours truly. After a lot of man power (literally) and a great driver (not really), we were able to back out of the rut. Definitly answered prayers.

On the way into the city, we passed a lake. Becuase appearance plays a large role in Angolan culture, we stopped to get the car washed before entering Huambo. We did not want to appear as if we came from ‘the bush.’ We just hoped no one looked at our clothes.

Humabo is a large city, similar to Lubango. I experienced another market (called the ‘praça’) to buy some produce and eggs. We sampled the local street meat (fried chicken and maybe the organs too?) bread, and coca-cola. The reason we made the trip was to buy medications for the clinic. The Farmacia had cases of medication that were available on display. While Tim made the purchases, I spent the time looking at all the medication labels. The best way I can describe them is that they looked like knock-off brand lables. I chuckled as the ibuprofen was labed ‘pain release’ and sitting next to the malaria tests was the Vizzgra (aka Viagra).  Unfortunately, the price of medications has increased and the good malaria medications were not available. We were able to make some good purchases though, making the trip absolutely worth it.

The drive back was uneventful, but slow because it had rained all day. I am incredibly thankful for the grace of safe travels.

Doi? (Does it hurt?)

As promised, my trip from Kalukembe back to Lubango was a memorable one. After saying goodbye to the Cummings and the hospital staff, I found myself riding shot-gun (because I am ‘o dotora’) in a four door pick up truck with a total of five passengers, six if you count the rooster in the flat of the truck. I welcomed the company, because that meant the driver and I were not sitting in silence for the entire drive. Instead, I listened to them chat away, switching from Portuguese to Umbundu, as I looked out the window at the beautiful sights. We passed women washing clothes in the rivers and public taxi’s carrying people packed like sardines. One even had about a dozen of live chickens strapped to the roof. Increadible. Unlike the road trips I am used to – packing the car with snacks and stopping only for bathroom breaks – we made plenty of pit stops on the way. We picked up a variety of fruits at a street side market getting swarmed by the children trying to sell their products and we stopped for water at a random spicket. Just as the sun was setting, I was dropped off at Sheila’s home (a missionary who teaches at the Theology school in Lubango) where I was pampered with running water! The evening came to a close sharing homemade pizza with many of the missionary families living in Lubango.

Usually, it takes about 10 hours by car to travel from Lubango to Cavango where the Kubacki’s live. Because I was in Kalukembe when they made the drive back, I had the exciting opportunity to fly in a 4-seater puddle jumper plane with Bret (the MAF pilot) and a fistula patient. The views of Angola from 9,000ft were exceptional. We flew over many villages surrounded by crop fields and rivers snaked through the landscape. During the flight, I kept thinking about the experience from the perspective of the patient and her mother. They struggled to use the escalator at the airport and now they were flying. How fortunate are we?!

The Kubacki’s home has an incredible view, and a short walk down the path leads to the river where there are rumors of crocodiles and hippos. We are officially in The Bush, so the homes are made out of mud and sticks surrounded by fields of corn. As we drove in from the landing strip, we passed waiving children and baby goats. 

There is no rest for the weary here in Cavango. Tim (Family Medicine and ER trained) and I spent time at the clinic on both Saturday and Sunday, tending to some very sick individuals. The clinic/hospital here is drastically different from Kalukmbe. It is run by three very talented male nurses, with no lab tests or imaging. Medicines are running low and the government is not making it easy to obtain more. The patients roam the clinic grounds, receiving their medications daily from the nurses. Only the deathly ill stay on beds in the one room Ward. Here in The Bush, the gender dynamic is very apparent. The women often remain quiet and do not make eye contact, with the men speaking for them. Children use the bathroom anywhere. One boy peed during his exam, leaving a rather large puddle.

The nurses (who have about a year’s experience in medical training) work more than 100 hour work weeks, dedicating their lives to the people. Tim and I often talk about some of the frustrations with medical mission work, especially in trying to get the nurses to trust and know that our medical knowledge is based on evidence and years of education. Because of the war that happened in Angola, the people are very skeptical of people who claim to be bringing aid.  We realized that these men work tirelessly because they know what it is like to lose a child to a tropical disease, and they are trying their best to make sure the same does not happen to the families who travel hours by motorcycle to seek medical attention.

Medical missionary work means thinking long term, not coming temporarily with all the fancy equipment. Being a constant learner and working with the medical staff is key, building up the trust in the medical system that is already in place.

Monday was filled with consults from early morning until late evening. Many of the patients are malaria positive, but we saw other patients with TB, pelvic tumors, joint pain and pregnancy check-ups. Most patients say ‘Doi na minha barriga’ (Pain in the belly). Tim is being incredibly patient with me as I learn to use the ultrasound with even more precision. I have successfully put in an IV, aspirated an abscess and determined the sex of a baby using the ultrasound. 

Tim ends every consult with a prayer over the patient. He emphasises the importance of showing the patient that we are asking God to bring healing and to reveal Himself, even after their treatments are over. Many Angolans do not live past the ages of 40 or 50, making this life very short lived. By revealing the loving God through prayer, we are showing that faith offers eternal life which is much greater than this temporary one.

I am humbled every time I am reminded that God is using Tim and me as His is tools to bring about relief from disease and ailments….

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The jango outside the Kubacki home