Friday, September 06, 2019

Biology, bigotry and the blood of Jesus.

 Last week we walked to church through the woods, passing a small cemetery covered by the graves of all the new borns who die at our hospital… and lastnight I wrote a review for a government epidemiologist of the 7 maternal deaths the hospital had in the first 6 months of the calendar year.When asked what our “numbers” for neonatal mortality, I reply grimly “I don’t know, a couple a week, I’ll have to go count.” Daniel is at the hospital right now preparing for a cesarian delivery and rationing out our magnesium sulfate to another eclamptic lady, this one just arrived from an outside hospital and has been seizing for 3 days.

Home deliveries gone awry, septic infants, premature babies, anemic, febrile, infected. Mothers seizing from eclampsia or malaria, febrile from disseminated TB or schistosomiasis, hemorrhaging from placenta previa or abruption, septic from their uterine rupture or concomitant typhoid perforation… this happens all the time. 

But it's not all heavy. We have fun moments where our odd homeschooling strategies and patient care sometimes work out well together! Let me tell you about one such case: 

Last week Monday I was carrying for a lady with a septic abortion who was anemic, with a Hgb < 4. We treated the infection, removed the retained placenta… but she still needed blood. I left family with the task of finding someone to donate blood, and went home, praying. Tuesday morning is a school day for me (meaning I magically become a kindergarten and 2nd grade teacher) but at breakfast I got the distressing news that the young woman, whose family is from “the bush,” only had elderly ladies with her and were unable to donate. So after our math assignment, I told the kids we were doing our science experiment early. We we walked over together (along with our dear friend Luis, who does school with us) to “Hemoterapia” (our “Blood Therapy” ward) where I donated blood. We then walked over together to maternity… everyone taking turns carrying the bag of fresh warm blood. The boys were interested; Naomi, seriously worried. “Are you going to die? How can Philadelphia blood mix with Kalukembe blood? Are you strong enough right now?” She scowled watching the blood being given to our young lady, worried for a bit, that this life-giving blood was going to take my life. But in the end I laughed, picked her up, and we skipped out of maternity together. On our walk home we all had a sweet talk about biology (how amazing our bodies are!), bigotry (how we are all the same inside), and the blood of Jesus.

And guess what? Just like that she got better! I showed the kids her smiling face on the day of discharge and we all celebrated, even Naomi. This week we also re-double our efforts to prevent maternal and infant mortality. We restarted our ultrasound outreach (funded by Hope for our Sisters), where we invite ladies to come for a free prenatal ultrasound (usually costs a day laborer a week’s wage). It is sweet to give surprise notices of twins… but it is also a time to counsel risks. In three days we did 47 ultrasounds… a small step, but worth celebrating too. 

II Corinthians 5:14-15

Wednesday, September 04, 2019

Scenario 1

Update from Kalukembe! We have been here for a month and a half; Priscila continues with multiple tasks including homeschooling, caring for guests, caring for patients including reinitiating care for women with vesicovaginal fistulae, thinking up new ideas for projects for the family and hospital and home. I continue in my moral support with occasional skeptical commentary. 

Imagine this coming out of the liquid that bathes your brain and spinal cord. I can't. The 9 year-old boy that I drew this fluid out of had been sick for roughly a month, getting various treatments, including an assortment of antibiotics (though none likely were properly prescribed or taken), traditional medicines and then in the last week, his condition worsened. Pus drained out of his ear, he mounted persistent high fevers, and his neck grew stiff. His father took him to the municipal hospital across town but they told him they could do nothing and sent the boy to us. That day when his father brought the boy to our hospital, he no longer could talk and could only moan, eyes wandering in separate directions. His father was clearly concerned, but it was already too late for us to save the child. Even with the right antibiotics, antimalarials and judicious IV fluids--for a malaria rapid test positive, smear negative result (and this LP test was just done out of curiosity how the lab would interpret the liquid), the boy died 2 days later in our ICU.
The story's like this boy's played out for at least 6 other babies and children this past week. . . treatments at home or in some nurse's clinic that don't show improvement and then the parents bring their child unconscious to our hospital. After expending their time, money and efforts elsewhere, I feel heartbroken to see the children succumb to intervenable and preventable diseases.
Government officials recently visited our hospital to look through the charts of malaria deaths recorded here year-to-date (almost 90). Apparently, only 2 deaths were recorded due to malaria last year--clearly something off with our statistics. It overall seemed to be a good learning experience, for the hospital to be reminded to maintain better records of what happened to patients and improve diagnostic clarity. We all have much to learn in caring for our sick. I should be the first to admit I miss the mark to be compassionate and competent with each and every patient. I pray God will give me and my colleagues the desire for whole healing of our patients and families. It's for His goodness sake we seek healing.

Saturday, August 17, 2019

Return to Kalukembe 2019

We are back home in Kalukembe and are so glad to be here as a family, caring for our neighbors, sharing our animals, cleaning up our house, and learning through so many venues God provides.

Animal Assisted Therapy: bringing our rabbits to the pediatrics ward!

Students from our most recent seminar, "Where there is no doctor" that Dr. Nick Comninellis taught. The course was very well received and the nurses from our remote clinics benefited most from this continuing medical education. We hope that another seminar can be arranged in December. If you have interest in teaching nurse clinicians, let us know!

Our kids and friends climbing the banks of our local creek with our friend Dr. Steve Collins visiting

We've re-started our Fistula Program... some ladies have been waiting patiently all year, others have come recently. 

Family and friends: kids are starting back in school, also joined by our dear friend Luis

Tuesday, May 28, 2019

Preparation and anticipation

Beautiful dolls prepared by a knitting circle in Waterdown, Ontario. They gave us almost 200 dolls to take back to our patients in Kalukembe! These dolls were so fun for our patients before. Such a great and creative idea; we are so glad to be a vehicle for these gifts

It's been a while since we put anything on here, but plenty has been happening this last year in the States! No, no baby announcement, but we are anticipating returning soon to Kalukembe. We have had some delays in applying for visas, but we hope to have everything in tomorrow. And next we hope it will just take a few weeks for our applications to be reviewed and approved. No hard and fast dates yet, but watch this space!

After Daniel finished working in Delaware in April, we went on a trip through western PA, Ohio, Michigan, Ontario and western New York to visit supporters, friends and family (and all three-in-one). Then we visited our organization's headquarters for a few days and Priscila's sister's family a few more days in Texas, returning a week ago. In all the travels, we've still had time to make special connections with people, go hiking as a family and even celebrate Zeke's birthday on the road multiple times. Thank you to everyone we saw, and we are sorry we missed others of you who's places we went through or were close to. We would love to see you, too! Hopefully next time.

We are eager to return to Angola. We hear a little from our colleagues there, but it's hard to picture how things are moving on the ground. . . are there enough medicines for the patients? How are our friends and colleagues doing? Anyways, we have heard of some changes but don't know what kind of impact those have had until we get back. Please remember Kalukembe and us in prayer as we anticipate a return soon!

Priscila between Tia Malita and Tio John Vanderkruk in Ontario, Canada.  
With friends, the Sytsmas and Theules, in Grand Rapids, MI. Our kids are the normal looking ones. Ha ha. 

The two lovely ladies of the Cummings family enjoying an intimate story together in Texas (spoiler: most likely one about princesses, horses or unicorns)

Kids hiking in Pennypack park, Philadelphia. Beautiful forest!

L to R: Eliel, Zeke and cousin Han: displaying their treasure haul from upstream. Funny, in Kalukembe we worry about diseases like schistosomiasis and amebas around the water; in Philadelphia, we worry about fish hooks, broken bottles and sharp objects inflicting injury in the water. There is no risk-free place, I guess, and each place also carries much joy and wonder for our kids.

Jiichan (Grandpa) Cummings cutting up the watermelon our kids and cousins broke up in "suica-wari" (a Japanese game using the watermelon like a piƱata) on Memorial Day.

Digging for fossils with Bella and Uncle Matt in Texas.

Monday, April 23, 2018

Travels that bring us back

It's nearing the end of April and we have already been back in the USA for 2 weeks. We began our travels saying good-bye to our Kalukembe family in March and embarked on a journey that took us through 3 weeks; 7 airports; both sets of parents and one pair of grandparents; innumerably inspiring colleagues in medical missions; 3 bottles of lice shampoo (for our 2 youngest--not easy to find time and place for a haircut--be careful with your airplane seats!); and delivered some travel-weary but sturdy children to a new home in Wilmington, DE.

We finished our time in Angola with encouraging farewells and hopes for returns. Then we passed 2 weeks in Greece, first at a medical missions conference and then a long weekend with Daniel's parents sightseeing Athens. The conference drew missionaries in the medical profession from all around the world, mostly Africa, the Middle East and Central Asia. . . quite inspiring and encouraging to hear others share their experiences and what they've learned in their service. Greece's ancient and rich history enthralled our family, and we had the privilege to see the beauty of the Adriatic Sea (though not quite warm to swim in beyond a few seconds; i write that, but we did see an elderly man taking a leisurely swim for what must have been an hour!). And in Holland, we spent few days with Priscila's parents and sister, who made a cozy cottage warm with many Dutch delicacies. Zeke loved going to a pancake restaurant with his great-grandparents and swimming in an indoor pool. . . Pri's Opa and Oma are an inspiration--they just returned from a return trip to Brazil for 5 weeks and Opa's 90 year-old eyes lit up as he told us about the many times he was able to preach and share the Word in his "native" Portuguese.

And we are now in a big house in Wilmington, where we are settling in to stay for the upcoming months. Daniel is preparing for a return to work in the emergency departments of hospitals in the Christiana system. Priscila is homeschooling Zeke and managing Eliel and Naomi's energies with mushroom hunts in the backyard and dissections at the dinner table. What a fascinating world we live in!
We would love to hear from you while we are back in the States and with fast internet connection! We hope to settle in to a routine here soon, figure out our travel plans, etc, though most of our travels won't occur till next spring around the time we hope to return to Angola. Please keep remembering and praying for Kalukembe, the workers who carry on and the patients who continue to need care and healing.

The day before we left Angola, an ambulance arrived from the government as a donation to the hospital. The hospital had been struggling with an old vehicle that was used for carrying water, construction materials, and transporting on call staff and had no longer been reliable to transfer patients to Lubango for more complex care. Though not equipped with what a standard American ambulance would carry (which would cover 1-2 pages in supply stock alone), it did at least come with a stretcher!

Our home church, Belem, is in the middle of the patient villa. Walking to and from church, Naomi would enjoy seeing how peoples' meal preparations were progressing. Most food is prepared over charcoal fires as seen in the foreground. Most church members come from this neighborhood. In their farewell song, they sang that we are all journeying to the New Jerusalem. We look forward to reunite with our brothers and sisters either there or back in Kalukembe!

Our miracle premie who's mom arrived at 27weeks gestation with ruptured membranes and delivered at 28weeks at 1.2kg. She was tenderly loved, fought for and kept vigilantly in kangaroo care (since we have no functional incubator anymore - the hospital has 5 broken ones) for 2 months. Every morning the first thing I'd ask was "How is our baby" and even with the 20 others on the floor, the nurses knew who I meant. She was always the last patient and I loved doing my "you've-gained-dance" on the good days.  We finally sent her home a "fat" smiling baby and mom grinning ear-to-ear. We all did our celebratory dance that day.   

Naomi at church, happily sitting by a little "ne-ne". 

Zeke and Eliel, swimming at the waterhole with their friends this rainy season.

The 3 matrons of "cuida de mulhere": Priscila (chief of everything OB and GYN) with Tia Julia (chief of maternity) and Marta (chief of women's ward). What a privilege to work with these beautiful, intelligent hearts and hands--Priscila, too!

Monday, March 05, 2018

Catching up in 2018

It's March and we've already had 2 visitors from the States this year--wow! We are now wrapping up our work at the hospital and putting in our good-byes; packing up the house; picking our last sweet potatoes from the garden; flying (and losing) our last kites; maybe squeezing in a last health talk or two; and planning for a discussion of our work with the hospital thus far with church leadership. We hope to return in 2019, even with another physician through Samaritans Purse, Dr. Lena Gamble. Thus, a time for reflection and a time to anticipate our returning.
We are anticipating going to a medical missions conference in Greece, stay a few days afterward with Daniel's parents; visit Priscila's parents and grandparents in the Netherlands; then touch down in Philadelphia in April. Daniel anticipates re-entering work at Christiana with his physician group, DFES (which has been generously supporting us while here in Angola) and Priscila with manage the homeschooling, new home arrangements in Wilmington, and be back with Esperanza clinic in September. As plans take shape, we hope to scatter visits to see you and other partners during our time back. 

Naomi enjoying a laugh with a now-cured vesicovaginal fistula patient and family. i am often impressed with how optimistic and positive women with fistulae are. Even those in very difficult social circumstances with very little materials to their names hold to a peace in their situation that puts me to shame. God continues to teach me much about my complaining and discontent through the contentment of others.
Workers of the warehouse posing with donation from US Embassy of mattresses! We will be working on vinyl or other waterproof covering for them, but given the desperate condition of our beds, some have already been distributed and the patients are sleeping better already.

Zeke at the end of his day translating for Dr. Lena Gamble at a rural health clinic. He has mastered questions related to prenatal screening, and can now place on his CV "medical translation" as a skill next to "cooking popcorn over an outdoor fire".

A delightful answer to prayer: J, one of Zeke's friends is here happily showing his scar. He had been sick since October with a necrotizing pulmonary infection, spitting up the same foul-smelling material that came out of his lung space. After an operation in December, he's been gaining weight, breathing better and smiling lots more. It's been a real joy to witness healing here in Kalukembe, especially in one of our friends.

District hospital reality. This baby with cleft lip and palate was born at our hospital. We usually evaluate about 2-3 babies like this a month. If they can maintain growth, then our visiting surgical team will close the cleft lip at the age of 6 months. We do not have means to close a cleft palate at our facility and patients in the provinces of Angola do not have access to any surgeons who perform cleft palate repair.

Dr. Joel Atwood with one of our nursing  seminar participants. Dr. Atwood visited during the month of January and hit the ground running with lectures on neonatal infections the day after he arrived in country. As ever, visitors who have contributed to seminars have helped greatly in educating nurses from area and rural health posts. We usually have a mix of government nurses, nurses from our hospital and ones from other clinics in the IESA denomination. As there is huge lack of medical information available to health workers in Angola, these seminars have been well received. We hope to supplement these seminars with further discussions and visits in the remote clinics in the future. Indeed, there is much work to be done for the health of Angola, and we feel privileged to be involved in a small part of that work.

Priscila explaining the daunting vaginal exam box with nurse Mariana preparing her extra-long glove at our January nurse education seminar. Audience participation was a must during Priscila's sessions!

Friday, November 10, 2017

Friends and visits

A couple weeks ago, our cousins, Abby and Elizabeth Cummings, came from Philadelphia to visit us in Kalukembe. . . for the second time! Impressive not just for their bravery in coming but for the fun they brought through their talents and gifts. Thanks, guys!

Sunday school at our local church. The kids were excited to have visitors from another continent. Strangers are often referred to as "Chinese," the largest population of foreigners in Angola. Amusing to be called such.

Abby reading to Eliel and Naomi. One of the many, many times Abby read to the kids. Their English skills  advanced quite rapidly during the visit!

Witnessing joy in our work. Abby and Elizabeth accompanied us most days on rounds. This was a follow-up visit from M., 2nd from right and with her husband, mother and baby. She was in a taxi accident with her baby in June and suffered severe traumatic brain injury, comatose in our hospital ICU for weeks. It took 3 months before she could talk, and she now can walk with the help of a walker. Nelson Andre, at far right, supervised her care during her long recovery on the physical therapy ward. In M's case, i cannot think of a better-named place where she recovered: the "Elavoko" ward means "Hope" in Umbundo

Sharing in education. Elizabeth, who is a nurse practitioner at Childrens Hospital of Philadelphia, brought 2 baby mannequins to help in several hands-on resuscitation sessions on Maternity.

Never in short supply. A mother on the ward kindly allowed her newborn to be borrowed for further demonstration and practice with the nursing students.

Onsen, Angolan style. We drove with Abby, Elizabeth, nurse Avelina and her girls to Kalepi area, about an hour and a half away, where hot water bubbles up in a marsh. Zeke and Eliel dipped themselves in water that locals also use for irrigation. 

Encouragement balloons. With balloons Abby and Elizabeth furnished, Zeke, Eliel and friends passed through the wards to hand out encouragement to patients. It was also an encouraging visit for us to have Abby and Elizabeth around, sharing in the beauty of Kalukembe and seeing the challenges people face in their lives here.

Visiting a remote place

Early last month, i (Daniel) visited Lumbala Nguimbo in the far eastern side of Angola, near Zambia. The church re-opened a medical clinic there, posting this lovely couple, pictured below, for two year service. It took 3 days by truck for others who helped open the clinic to arrive; i flew by plane with the couple and others in 3 hours. Neither of them are from the area originally; so we desire they will be encouraged in this new, isolated and challenging place of work. For instance, the nearest hospital with surgical services is in Huambo, about 2 days car ride away. 

Kochi and Flora, with their youngest son, Ululi. They were relocated in October to Lumbala Nguimbo. Kochi is a lab technician and Flora is a nurse. They will be responsible for diagnosis and treatment at the clinic, forming the core of the staff there. 

Highlighting the challenges facing people in the Lumbala Nguimbo area, this little boy had sudden onset stridor (difficulty breathing) about a month before we saw him in the clinic. He had been admitted to the local government hospital for treatment for "asthma," but by physical exam we suspect his problem is an upper airway obstruction (perhaps a coin or other object). However, no x-ray in the immediate area (and an ultrasound probe was too big to easily identify anything in his neck/upper chest), no likely laryngoscope or bronchoscope that could help for intervention for two days journey explains well the frustration of both the medical staff and the reluctance of the family to leave even when offered transport by truck.
Ladies and their family members from Lumbala Nguimbo who were taking the return flight to Kalukembe for fistula care. In a country of more than 25 million and high rates of birth complications, caring for women with vesicovaginal fistulas is a service with profound impact. Kalukembe is one of only two hospitals in Angola with care for fistulas offered yearlong.

Lumbala Nguimbo IESA medical clinic, foreground, with lab to picture left