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Cisamba,
Nov. 14, 1926.

Dear Friends and Fellow-Workers at Home;-

Today is the last day of my visit in Cisamba.  Tomorrow I expect to go back to Ocileso.  This is the third surgical clinic at Cisamba Hospital in which I have participated.  Ten days ago Sapunga and I came over.  The first stage of the journey was made by automobile.  Mr. Neipp took us from Ocileso to the railroad station at Vouga, 100 kilometers.  We started at eight o’clock in the morning and arrived at half past ten.  The train was due about one o’clock but arrived after three.  It is not a big affair.  A wood-burning engine, with a small, shrill whistle, draws a few freight cars, a first-class coach with fairly luxurious appointments; a second-class coach, comfortable enough, and a third-class conveyance for the natives, which does not appeal to me as either luxurious or comfortable.  Fortunately a native who wears shoes and has money enough to buy a ticket can ride either second or first class, so Sapunga and I took our places together in a very dusty, leather-upholstered second class compartment which we had to ourselves.  We passed two stations, one of them Bela Vista, and got out at the third, Ketavola, about five o’clock.  We were met by Mr. Steed and his automobile.  Mr. Lloyd was there too, with his greeting.  It is a good hour’s walk from the station to Cisamba, but the automobile covered the distance in a very short time.

A visit to Cisamba is always a great pleasure.  The welcome is so cordial and the ladies’ home, where I am always entertained, is so delightful in every way.  I was put in the room that Miss Maggie Melville used to occupy and later Miss Campbell.  Miss Helen Melville is the housekeeper and a notable one setting a most delicious table and serving the family and guests with every comfort and in such a loving spirit.

The first two days were days of getting ready.  Miss Hosking and her helper, and Sapunga and I folded sheets, gowns and towels, and made up bundles of surgical dressings, cotton “wipes” etc.  Patients were coming in.  Not all who had promised to come.  I was disappointed first, but later was glad no more had come.

Then Communion Sunday came with its sacred rest.  In the afternoon I had a little service with some of the waiting patients.

One medical incident I have omitted.  Friday, the sixth, a telegram was brought to me from one our Ocileso boys, a Dondi graduate, saying another of these boys critically ill in Kamakoupa.  Mr. Steed took us over in his automobile at once.  The round trip was 35 miles I believe.  We found a very sick boy.  He was in a grass hut in a native encampment of workers, as he had been delirious and so noisy at night they would not allow him to stay in the town.  Of course the hospital was the place for him and we brought him back with us.  It was not altogether easy as the boy could not sit up and the automobile is not arranged as an ambulance.  But we arrived safely and soon had Cinjenge in bed.  He is still quite sick.  We do not like the findings in his right lung, but he is having every care and we hope he will get better.  He does not have to be tied in bed at night now as at first, but the sweats are bad; he runs quite an afternoon temperature and cough hard.

Monday evening Dr. Hollenbeck arrived in the Kumundongo automobile.  Tuesday we operated all day; finishing up about seven P. M. by the aid of a flash-light.  Wednesday we began early and worked well on into the afternoon.  Later we made an examination under chloroform.  This completed the operations, as Dr. Hollenbeck did not think best to do a cataract case, or to operate on the woman examined, reserving these for some later date.

There was not a single easy operation.  Everything was complicated.  Sometimes instruments were lacking.  Always the operation presented some hard feature that made the work slow and difficult.  Sometimes Dr. Hollenbeck was discouraged and said it was impossible to go on with the operation.  But he always did go on and finish up.

Sapunga was the anaesthetist for all the cases.  He gave the chloroform very well indeed.  In all but one of the cases a hypodermic injection of a little morphine, before giving the injection, was a great help.

Dr. Hollenbeck left Friday morning.  Since then Miss Hosking and I with our helpers have been caring for the cases; doing dressings etc.  I have tried to help a little with some of the medical cases.  Now I must go back to Ocileso.  I hear some very sick patient has been carried there since I went away.  I hope nothing too difficult has come up for my helpers to handle.

Come with me as I go to say good bye to the patients.  The little afternoon service is just over.  Miss Hosking’s head assistant and Sapunga led.  The meeting was held in the long surgical building as more patients were there in bed than in other buildings.  The ambulatory patients came over to share the meeting.  There were hymns, Bible reading and explanation and prayer.  The walk over from the ladies’ house is a pleasant one.  The rains have come and everything is green and fresh.  The birds are singing and nesting.  The insects hum.  The flowers are beautiful and often a waft of fragrance comes deliciously to one’s nostrils.  The late afternoon sunlight glorifies the fresh green of the trees.  We are walking into the west, where a bank of dark purple-black clouds makes a background for the vivid greens.  A delicate rainbow lies upon the cloud; for a thunder storm has just passed over.   It was not severe today like the one yesterday that took a toll of three lives in this neighborhood.  Already I know of fourteen deaths this rainy season, from lightning.  One was a most promising teacher in one of our Ocileso outstations.  May the Lord preserve from further fatalities.

Here is the woman examined under chloroform but not operated on.  She is walking around and smiling as usual, though always a great sufferer.  As you are the ladies who want especially to help the women of this land I will tell you a little about this woman.  She is a Christian and lives a consistent life.  Her husband sometimes has gone wrong but she has been faithful to him, and he is doing better I am told.  She is the mother of two children, the youngest is a boy probably ten or twelve years old, for he is as tall as to his mother’s shoulder.  She had no medical attendance when these children were born, and after the last one came she had trouble which has never left her.  Six months ago she came to the hospital and has been under daily treatment ever since.  At first there was a dreadful discharge, so offensive that no other patient could be put in the same room.  Miss Hosking’s patient care has cleared all that up.  But the pain persists.  I found on examination that the uterus was inside out and has probably been so ever since the birth of that child.  Of course it bleeds a great deal and when neglected gets to discharging that offensive pus.  The drag on the ovaries and ligaments must be distressing.  Attempts to replace the organ were unsuccessful, for it was swollen and the neck was tightly contracted about it.  I hope further treatment can reduce the swelling and then by cutting the restricting band it ought to be reducable.  The cut would have to be sewed up again after the organ is replaced.  What a life of suffering, all for want of a doctor when her child was born.

The group of patients sitting about here I have not had much to do with.  One boy had a toe amputated at our second surgical clinic.  He is under treatment now for a bad syphilitic sore.  He is a mulato and this is his sorrowful inheritance from the sins of his father.

Just step into the medical building a moment.  Here in the women’s ward is the latest arrival, a young girl in a very critical condition with fever and pneumonia.  She is pitifully wasted, and so weak.  Just now only partly conscious.  Miss Hosking has given her such tender care; bathing her repeatedly and feeding her with her own hands.  This other woman was fully as bad off a week ago.   I thought she was dying when I first saw here.  Now she is well on the road to recovery.  This morning she was allowed to sit out of doors in the sunshine, and she tried to run away and go home.  She said her baby was crying for her in her village.  We sent a stretcher after her and brought her back and have locked up her clothes so she will have to stay a little longer until she is really able to go.

In the men’s ward is Cinjenge.  He moistens his dry lips to answer my questions.  Beads of perspiration stand on his forehead.  His temperature chart is a little better today, but not good yet.  He has taken more nourishment, but is still pitifully weak.  His cough is painful.  We will hope for improvement soon.

Now the surgical building.  Here on the men’s side is my big hernia man.  As he knows I am going away tomorrow, he wants to do a great deal of talking.  He tells how long ago he heard and accepted the word of God, but was sent by the government as a laborer to the coast.  There he gave up all thought of Christianity.  His work was severe and brought on the rupture for which he came to me.  It was a bad one.  He had nearly died from strangulation of the hernia at one time.  He says he thinks God guided him to find help for his physical trouble so he might come back to the word of salvation.  That operation was such as I never saw in our own land.  Somehow all the hernia cases here have nothing in common with our hernia cases at home.  There is remarkable proliferation of tissue.  Layer after layer of fibrous membranes, all stoutly adherent, and nothing recognizable.  After struggling long to separate the hernial sac, Dr. Hollenbeck said, “The rest of my hernia cases I shall treat with trusses only.”  Such a great hole into the abdominal cavity to be closed.  The Doctor did his best to make everything secure.  There has been no pain since the operation and only moderate swelling.  We hope for good results and a spiritual blessing.

The first case in the women’s ward was sent here by Dr. Hollenbeck.  The young woman has had a bad leg for more than a year.  The shin bone was diseased.  As hard as stone, as black as coal and offensive beyond description, almost the whole length of the bone was exposed.  We had a hard time with this case.  The patient was weak from long suffering and her heart did not behave well under the anaesthetic.  The bleeding from the bone was excessive in spite of tourniquet above the knee.  At one time I had to hold the femoral artery with all my might to control the blood.  We did the first dressing today.  Poor child, she suffers much.  The dressing was very painful, but we did not find anything bad.  The bone left after the diseased bone was removed seems clean and promising.  It will be a long time before that leg can be well.  This woman is a believer.

The woman in the next bed is not a Christian.  Her case is one of many similar cases in this country.  Married as a child to a man who had other wives.  When her first child was born she had trouble.  Just what was the matter of course I can not be sure, but I judge it was a face presentation.  For one whole week she was in labour.  The child died of course, and at last she got rid of it.  But the head had been so long wedged against the bones of the pelvis that the flesh sloughed away, making a hole into the bladder.  You can imagine the condition resulting.  Of course her husband did not want her any longer and turned her off.  She has wandered around, and has not kept straight herself.  Do you wonder at that?  She was very eager for operation.  Last season she ran all the way from the fort to Ocileso (20 kilometers) because a motor cycle had passed through and she thought it was Dr. Hollenbeck and he might be coming for operations.  But it was not he.  Her operation was very difficult, the hole being hard to reach.  But it seems to be completely successful.  Poor child, she is very happy and promises to remember the Lord’s goodness in letting her find help.

Next to Nalongue, (that is her name) is Mbunda.  She comes from one of the Bailundu outstations.  That pleasant-faced man is her husband.  Both are members of the church and such nice people.  Mbunda has a goitre, but she came for the same trouble as Nalongue.  Her story is the same.  A week’s hard labour; a dead baby; a large hole, partly torn and partly sloughed, into the bladder.  Of course she could not have any more children, but because they are Christians her husband has been true to her and kind.  She has been in this deplorable condition for several years.  Dr. Hollenbeck tried to operate on her at Ocileso not long ago, but her heart did not stand the chloroform and we had hard work to save her life, so abandoned our attempt.  This time there was no trouble with the anaesthetic, though the operation was very prolonged and desperately difficult.  We did not feel sure at all that it would be successful, but so far there seems to be no leakage of urine.  I can not tell you how thankful I am.  Mbunda and Cimuku her husband are too happy for words.  They say “We can not thank with our words.  We can not thank one day only.  Our hearts will thank all the days.”  They give me a thank-offering, some money, not much but a good deal for them, to help buy medicine for other sick people.  It is nice to see these happy people helping everybody they can.  Cimuku runs errands, empties dishes, washes sheets and cheers up other sick ones.  Even Mbunda who has to lie flat on her back still, talks soothingly to the baby in the end bed to keep it quiet while its mother is gone.

That baby is the last case to look at.  Poor little thing.  Its mother had fits, probably epileptic.  As is usual in such cases she carries many scars from falling into the fire.  She has lost all the fingers on her right hand that way.  When her baby was a tiny thing I suppose she had a fit and fell into the fire with it on her back.  It was dreadfully burned.  The scars on the right leg contracted so the knee was bent sharply up against the thigh and bound there.  The foot was turned back on the leg, the little toe entirely buried in the scar on the side of the leg and the ankle almost dislocated.  Of course walking is impossible.  The mother has carried little Vihemba (her name means medicine) on her back.  She must be between three and four years old and is beginning to talk a little.  Here was our last operation.  The chloroform was difficult.  As soon as enough was given to relax the muscles, the pulse would fade away.  We would take off the mask and let the child come out of the chloroform till it began to cry.  Then a few drops more and repeating the whole performance.  Dr. Hollenbeck operated only on the knee, leaving the foot for later operation if the knee is successful.  It was hard to cover in the raw surface left when the scar was cut loose.  We did not have the right kind of suture material.  Of course the leg had to be splinted.  The little one is very good about the dressings.  It cries but little if the mother stands by holding the little hand.  You have to love the patient child.  Oh I do hope it can soon begin to walk.  This family comes from a heathen village.  I believe the mother is an unmarried woman.  Epileptics have no chance for marriage.  In fact I am told the discovery that a wife is epileptic nullifies a marriage according to the native customs.

Dear Friends, I want you to share with me the joy of this blessed work which you make possible by your interest, gifts and prayers.  Will it not be possible for the medical and surgical department to grow into greater efficiency?  A hospital in Ocileso we hope to begin next dry season, if the mission will let us have Mr. Dart to put up the Catherine Newton Memorial building, more complete equipment will come I feel sure.  Such a clinic as this involves considerable expense, but it is well worth it all.  Miss Hosking is such a splendid helper.  Do not forget to pray for the Ocileso nurse, that God will send her to us soon, if possible before my furlough is due.

I will close with a God bless you all and the Umbundu farewell;- “Lalapo ciwa” which means “Stay well”.

Your loving friend, 
Mary F. Cushman

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1.
Mary Floyd Cushman has a Wikipedia article, which says she wrote a book called Missionary Doctor: The Story of Twenty Years In Africa.  A used hardcover copy currently costs $58, so I'm not likely to read it anytime soon.  But I should check Google Books!

Dr. Cushman was 56 years old at the time she wrote this letter, and she had been in Angola for four years.

You can find Dr. Cushman, Mr. Lloyd, the Misses Melville, Dr. Hollenbeck, and Mr. Dart in the Non-family page for mission folks on this website.

​2.
Here is the woman examined under chloroform but not operated on.  She is walking around and smiling as usual, though always a great sufferer.
​I wonder if this is the woman that Sibyl is talking about here:There is a very dear woman at the hospital now waiting for a doctor’s help.
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