Day 7: Hour 168

I totally saw a lemur the other day. Unfortunately it didn’t break out into “I like to move it, move it” in an Indian accent. A little disappointing but I’ll get over it…

Anyway….

I thought this was just going to be a medical trip. But it’s turning into so much more than that. And I am simply delighted. I am definitely learning medicine. But this experience is hardly limited to that arena.

According to Dr. Kubacki, the two hardest things about venturing into the world of medical missions are:

1. Leaving the familiar. (I’m going to be honest, there is something so attractive about staying where I am comfortable. Never deviating from what I know.)
2. Learning the language. (This is such a huge struggle because it often takes years to get to any level of proficiency.)

He has spent a gracious number of hours simply conversing with Kyle and I. No deadlines. Nowhere to go. Just dialoging about medicine and life. Sometimes on his porch, other times on the dusty roads of Cavango. The counsel and wisdom he has given us is like a mine of sparkling diamonds. I feel so overwhelmingly blessed to be soaking up lessons that have taken him 50+ years to learn. Wisdom ranging from medicine to our walk with Jesus to marriage (and everything in between). I would write some of the things that he has shared — but I can’t. This would quickly leave the “blog” category and enter something more like the “Textbook on Life” category. Not gonna do that to you guys.

A few other missionaries: Gary (pilot), Jason (mechanic), and Ryan (Jason’s 9 year old boy) arrived at the Kubacki’s house the other day. They drove here with a bulldozer loaded on one of their trucks in order to begin working on an airstrip in Cavango. It took them 48 hours to drive here with all the equipment because they had to stop and bulldoze a few sections of the road that were impassable. As it stands, if a patient out here needs immediate surgical attention, Dr. Kubacki has to make the 10 hour trek to Lubango. Having an airstrip for one of the mission planes would give these precious villagers faster access to medical help.

The past couple of days I have been helping Dr. Kubacki in the clinic in the mornings and then traveling out to the airstrip to help the guys construct it during the afternoons. Some of the local villagers made large wooden stakes for us to use as we make the measurements for the project. Working out in the hot African sun is incredible. Not only am I able to look over my shoulder to a scene that looks like it came right out of “The Lion King”, but more importantly I am privileged to be able to be a small part of building something that will help countless of Angolans in the future. The guys constructing the airstrip are awesome. I’ve had some good talks with them and learned so much about various topics relating to mission work.

We joined Betsy and Meredith (Dr. Kubacki’s daughter) again yesterday for English class. It was a total blast! They let Kyle and I teach part of the lesson and it was quite the experience. So many laughs as we traded phrases like “I am hungry” and “I would like to eat” in Portuguese and English. I love the challenge of attempting communication in that setting! One of the Angolan men in the class was chuckling as he explained to me “If I have to learn English, you have to learn Portuguese.” I heartily agreed.

In the clinic, we continue to meet some incredible people. Yesterday morning, a former pastor of the local mission/church in Cavango heard that the Kubacki’s had visitors. He arrived early in the morning wearing his suit (think unwashed Goodwill) in order to meet and honor us. The fact that he has severe asthma didn’t deter him from making the walk to where we were staying.

He hugged us both.

And we hugged him back.

That’s just how they roll here. It is a culture founded on genuine respect and honor.

One of the patient’s we saw in clinic today was a government official with osteoarthritis who came to see us because a friend of his had been helped by a steroid injection that Dr. Kubacki had given him. He reported that anti-inflammatories had not improved his pain much so I injected his knee (under the watchful eye of our fearless leader).

Dr. Kubacki has been teaching us and giving us lots of practice using point-of-care ultrasound to help in diagnosis. Ultrasound is a beautiful tool that works perfectly in the missionary-medicine context. With no access to CT’s or MRI’s, he has developed into an ultrasound “jedi master.” Maybe one day, with practice, I will be as good as he is. Today is not that day.

We have seen plenty of malaria, rheumatic endocarditis, heart failure, tuberculosis, and the list goes on. Talk about a crash course in “majority-world” medicine. Dr. Kubacki is an incredibly proficient teacher. He really has gone out of his way to ensure we are receiving the best medical experience possible.

In his pre-clinic talk today, Dr. Kubacki gathered the 15-20 patients around in a circle and began telling them the story of when Jesus healed the blind man in John 9. He explained how everybody was asking Jesus “Why was this man born blind?”

The villagers quietly listened. Cultures differ in many ways but we all experience pain, loss, and suffering.

And we all ask the same question. In different ways, perhaps — but we are all looking for an answer.

Why do we suffer?

Why do our bodies get sick?

Why do our hearts get broken?

Why do we have to lose the ones we love so dearly?

Jesus answers. But He doesn’t explain fully. He says we suffer so that God can be revealed to us and others. Dr. Kubacki continued to teach. “Jesus rejects the notion that the blind man was born that way because he had done something wrong.” What did Jesus do right there?

He tells us that our suffering has purpose.

Now if Jesus had stopped there, it might seem cruel to simply say that we suffer in life to bring glory to God. But He didn’t. He bent over and spit in the ground. He spit on the ground and began making a pile of mud. To the shock of the crowd, he came up close to this blind man and began gently pressing the mud onto his eyes before telling him to go wash. The man did as he was told — and his eyes were opened. For the first time, he could see.

Dr. Kubacki had everyone’s quiet attention.

Including mine.

Jesus tells me that my suffering has meaning. He gently stoops down beside me if I allow Him to and joins me in my pain. The Son of God became a human like me in order to know me. In order to win back my heart.

You know, my American mind wants all the answers, right now. I really do. I want to understand everything — every tear I’ve cried, every pang of hurt I have felt. I want an explanation.

But Jesus wants me to trust. And to walk with Him. Content with the knowledge that He is beside me.

And once I go through the painful process of embracing that truth, He asks me to be the “dirt and spit” that He uses to alleviate the suffering of those around me. What an incredibly humbling thought. Sometimes the simplest truth, when grasped, can have the deepest impact.

All of this was pulled from a 7-minute conversation between one doctor and a group of villagers. Go figure.

The past year has been incredibly challenging for me. Maybe it has been for you too. This first week in Angola has reminded me of some things that had become clouded to my heart. Questions that I desperately needed answers to are slowly, slowly being surrendered. I’m learning that the secret to life is to take myself off of center stage and to simply trust and walk. But I know that I still have a long way to go.

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Day 5: Hour 120

And the learning continues here in Angola. Truly stepping out of your comfort zone is one of the healthiest things you can do. It’s the arena where accelerated growth occurs. Examples of ways that this trip has afforded me opportunities to do this include:

1. Experiencing life in a culture foreign to me! I have gained a fresh appreciation for what cultural minorities experience when they come to a place like Ohio. It’s exciting but can be difficult if you don’t have somebody (like the Kubacki’s) to walk you through cultural norms and practices.

2. Struggling through communication with a language barrier — let’s just be honest, my Portuguese isn’t that great. So creativity comes in handy. Yesterday we went to one of Betsy’s (Dr. Kubacki’s wife) English classes. She is teaching several of the local villagers English and it was incredible to watch and listen as they practiced forming words like “work” and “three”. The “r” and “th” sounds are incredibly difficult for them. We had lots of laughs as they practiced on us. It was so much fun and really made me realize that there are many ways to communicate besides speaking. A smile. A hand on the shoulder. A nod. Incredibly powerful! Most people have probably experienced moments where those non-verbals have proven to be far more life-giving than words.

3. Showering less. Honestly, the people in these rural villages don’t really ever shower at all. And their culture doesn’t have a problem with it. Clean water is not always available and many people walk around barefoot. The floors of their houses are dirt. As I have experienced this culture, I have come to realize that westerners truly are “germaphobes” in comparison with most of the world! I’m not saying that’s a bad thing, it’s just the conclusion I’ve drawn.

4. There really is no need for a cellphone out here because of the incredibly limited cell coverage. Back in the States, I surmise that my cellphone has become something akin to a “3rd arm.” Most of you know of what I speak. Just the thought of going anywhere without your phone might send some into a panic attack. Not that I don’t miss the extensive avenues of communication that it allows me to have…but it’s been so healthy for me to leave the phone in my bag.

5. The final way it’s pushed me to the edge of my comfort zone is in writing this very blog! It’s so not my personality to “put everything out there.” But as I sit here and type, it really does help me process and “chew over” the things I’ve experienced: the sights, the smells, the conversations, the culture.

Moving on to our clinic time…

We have seen some amazing people. It is so touching to hear their stories. Today, we interacted with a 61 year old woman who was such a beautiful person. She had walked 20 miles to see us. 20 miles.

20 miles.

That’s a far distance. But she wanted our help because she had ichthyosis, a skin disease likely caused by a parasite leading to “elephant-like” skin. We examined her and gave her some medicine that would alleviate some of her symptoms. She was grateful.

And had to make the 20 mile trek home.

Among the local villages, if a trip to the doctor takes less than a day’s walk, it’s considered a “short-distance.” Dr. Kubacki taught us a new phrase. He said that we should replace the term “third-world country” with “majority-world country.” The majority of the world lives a life that is far, far different than the western world. I am not decrying the material wealth that the we have received. I just think it’s important to realize that the majority of our human brothers and sisters live on far, far less than even the poor among us will ever experience.

One of the nurses that works at the clinic and serves to translate the Portuguese into the native dialect had a broken fibula that needed to be re-cast. He sat as Kyle, Dr. Kubacki, and I reinforced his plaster cast. We don’t have access to fiberglass casting materials out here (the standard of care in the U.S.) so we had no choice but to use old-school plaster casting materials. But as we were wrapping his leg he made the comment in Portuguese…”Look, I have a modern American cast!” And he grinned from ear to ear. He was grateful for such a “modern” treat.

Beautiful people.

Today before clinic began, Dr. Kubacki shared a brief story about Jesus with the patients who had gathered outside. We sat around and listened as he spoke about Jesus telling His disciples that He is “the Bread of Life.” The people listened, many hearing this strange teaching for the first time.

Afterward we asked him if the people understood. He said he wasn’t sure – but that it’s okay to allow people to wrestle with understanding. After all, Jesus did. More often than not, He would tell a story that would leave people scratching their heads. And then the people that were really searching would come to Him afterwards to ask questions to try to really understand. Many times people would approach Jesus saying: “I want to follow you” only to hear Jesus say (in so many words) “No, you really don’t.”

Truth sometimes stares you in the face and demands to be wrestled with. Questions like “who is this Jesus and what does He want with me today?” seem to be begging for a fight inside of our hearts. It doesn’t always come easily, wrapped in a pretty package. Often it requires struggling.

One last thing before I leave you — I have been saying repeatedly how “beautiful” the Angolan people are. Most of you reading this are westerners. Just like me. I just want you to know that:

You are beautiful people too.

So much about our culture is wonderful and the good things we have been given are not things that we necessarily need to feel guilty about. I just wanted you to know that.

Our Father looks down on all of us and desires for us to walk with Him today. Now that’s a thought to wrestle with.

Day 3: Hour 72

To be perfectly honest, I find writing blogs to be very daunting. Translating incredible, life-giving experiences onto a two-dimensional document seems to somehow diminish it’s magnitude. I have a deep respect for those moments that are never shoved into the public forum but are instead held close and quietly treasured by the ones who know them. I really wish everyone reading this blog could experience this journey first-hand, alongside of me. Plus it would save me the time of writing this 🙂 I don’t feel at all adequate to properly communicate my time in Angola.

The past several days have been full of adventures. We flew into Lubango and were picked up by Dr. Kubacki and shuttled to the home of a pilot missionary there in town. They were Canadian. So we got along just fine 🙂 Yesterday we made the 10 hour drive through some rugged terrain to Dr. Kubacki’s home in Cavango. During that bumpy car ride, we had some great conversations — learning about his heart for the people of Angola and his desire to enter their pain in order to show them God’s love and help alleviate their suffering. He challenged me in ways that I so needed. Honestly, if this entire trip had ended with that 10 hour conversation, it would have been more than worth the investment. We also discussed differences in Angolan vs. American culture. Absolutely fascinating. I think we as westerners tend to think that the whole world thinks like us. So not true.

Here are a few things I have learned so far:

1. Angolans are relationship driven — not task driven. They are perfectly okay with sitting and talking for hours. It doesn’t bother them if they haven’t “checked” things off their list. My first reaction to this was “Wow! That seems like a bad thing”…but I had to think again. The strength of relationships that bind many of these villages and families together is incredible. And they are so very friendly! I can only contrast that to my performance-driven culture, where relationships often seem shallow and people are suspicious of others who seem “overly-friendly”…

2. There are many diseases like TB, malaria, leprosy, etc. here. But there is virtually no anxiety or depression in Angola. Dr. Kubacki explained it’s largely due to the fact that their view of life tends to be fatalistic…meaning they acknowledge that we as humans have little to no control over what happens in life. That gives them some sense of peace and acceptance. Westerners believe the opposite – WE can dictate the terms of an outcome. As I recognized and processed this, I came to the conclusion that there is likely a balance. Recognizing that we can affect change is wonderful – it’s why we have hospitals and major scientific advancements. However, the illusion that we have complete control truly does lead to an unhealthy extreme. We are not the One running the universe. But we can get to know Him! I wonder how healthier we would be if we became a little more like the Angolans in realizing that we are not as “in control” as we think we are.

3. Here in Angola – character trumps charisma. Somebody can be the best public speaker, but if he or she doesn’t back it up with a life of respect and integrity, nobody is going to trust them. Also, marriage is seen from a practical/utilitarian view. Arranged marriages are the norm. Romantic love is not emphasized and really not important at all. Respect and honor are. Displays of affection are not seen as necessary. Girls are encouraged to find somebody who will treat them well and honor them rather than the guy they “fall in love with.” So different from the way individualistic westerners typically think and function.

4. Plenty of people out in the rural villages have never heard of the United States of America. They live in huts, most don’t have cars, no refrigerators, no microwaves, no electricity. But I promise, you will never see more ecstatic waves in your life as you will when you drive through these villages. Today we spent the day in the local clinic here in Cavango. We saw a young boy with TB, lots of malaria, a lady with CHF, and scabies, and a case of endometrial hyperplasia. I have learned more about tropical diseases in one clinic day here than I did during the 4 years I spent in medical school.

But here’s the best part…

Before clinic started, all of the patients were gathered around and Dr. Kubacki shared a story about Jesus feeding the 5,000 (Matthew 14:13-21). One of the nurses translated the Portuguese into the village’s native language. After telling the story, Dr. Kubacki asked if anybody knew why this story is important to our life. Silence. Finally, one man spoke up with a confused look on his face “We are very pleased to be hearing this story. But we do not know what it means.” Dr. Kubacki went on to explain that Jesus saw that the crowd needed food and cared about their hunger. In the same way, He cares about our needs too and loves us deeply. He further explained to them: “Our Father’s heart is to help us in our struggle and suffering”. It was a message that I needed to hear just as much as any one of the villagers sitting there. Separated by an ocean and a cultural chasm, both the rural Angolan villager and I need to know that our Creator cares about entering into our pain.

Dr. Kubacki said that at a previous clinic time, He asked the villagers if they believed that God exists. They all agreed — yes, He does! He then asked them if they know who God is and what He is like. His question was met with dead silence and empty stares.

Our Father’s heart for us is love. And when we enter into another’s pain, we are His reflections.

The scenery is beautiful here. The house we are staying in has a view over a deep African valley with a river flowing powerfully through it. Breathtaking is the only word I can think of to describe it. The people here are beautiful too, in their simplistic and friendly way of life. Absolutely beautiful.

Day one – Hour 20

I can’t believe I’m in Africa. Right now we are sitting in a lonely, semi-deserted airport in Johannesburg, South Africa. 2 flights away from our final destination in Angola. It doesn’t seem real that I am here. So far away from everything I have ever known. Do you ever get those eye-opening moments, when you are hit by the realization that this world is so much bigger than you are? Like experiencing the expansive vastness of the ocean for the first time. You can’t help but feel miniscule. Truthfully, I think it’s healthy. Healthy to see and experience that I am not the center of this universe. I know what you’re thinking: “this dude just got way too deep, way too fast.” Yeah, I guess so. But that’s just how I roll.

We left Chicago at 2 pm local time. Two flights and almost 20 hours later, we are here in South Africa. As delicious and satisfying as the 4 oz container of couscous on the airplane was, we needed just a little bit extra. So we got pizza. In Africa. I figured we’d go for the full cultural experience.

In preparation for our trip, we have tried to learn some Portuguese as well as study up on several tropical diseases that we will likely encounter while here. We really are so grateful for everyone who helped prepare us for this experience. A huge shout out to Heather Datsko for sharing her advice and resources from her trip last year! You’re the best!

A word of introduction…

Hi! I’m Nigel Hogan, a 4th year medical student at Ohio University Heritage College of Osteopathic Medicine. For one of my final rotations in med school, I decided to venture out on an international medicine experience (with my buddy and fellow med student, Kyle) in Angola, Africa. We will be working with Dr. Tim Kubacki – an OUHCOM grad who lives over there serving the needs of the Angolan people. In this blog, I will do my best to chronicle the experiences that I encounter along with the lessons I will inevitably learn during the next 720 hours. I’m quite excited – and I would welcome you to come along on this journey with me via my postings! Let’s get going!