Blog posts from our friends

If you'd like to see better and more interesting pictures than what we've taken (with fun commentary), take a look at our friends' blog, http://pedrohispanoemangola.blogspot.com . Jorje and Marjerida are two fantastic general surgery residents from Portugal who visited CEML for 30 days in October/November. We really benefited from their companionship and help! Even if you have a hard time following their commentary in Portuguese, they posted lots of pictures that you can follow. They also included an extensive photo-diary of their weekend in Kalukembe. If you go back a little in the posts, you'll see pictures of the city's central hospital (and the 12 new ambulances still not in use) and life in and outside the hospital here.

Enjoy!

Ultravivid: a tour of Kalukembe

We just came from a week at Kalukembe and are back at CEML doing consults and operating. Our time at Kalukembe solidified our interest in returning long term (but still plan on going to Zambia in January to look at a few more options). We wanted to give you a little tour, since you'll be here with us (whether physically or spiritually) if we return. With the support you've been sending we were able to purchase a new camera (to replace the stolen one) and since Priscila didn't know how to turn off the "super vivid" setting... that's what you're getting! That is just fine: after the rains everything is intensely sweet and green and the images actually do a little justice to the scenery. Enjoy!

Walking from the living quarters to the hospital through a beautiful path under shady savannah trees. 

The patient family housing, many patients come from great distances, stay for months, and are required to feed themselves, hence a family member needs to come along to care for them. 

The banco de urgencia (emergency room) is a little bit of a joke for Daniel: it is a small room off the side of women's ward with a desk and a bed, really nothing else. On one door the sign actually says "gynecology" ... but Priscila has only ever walked passed it. 

Main hospital entrance/drive: in 1994 the hospital was ransacked by government forces, everything from meds to bedding and curtains were stolen, other things were destroyed. The government, however, has just committed $30million dollars to rehabilitating and expanding this 300+bed hospital, and they are looking for doctors to staff it. 

To your left as you walk towards the hospital: the operating theaters. Notice the defunct solar panels and water tank. The water pump was broken while we were there so the pre-op scrubbing was done with rainwater, murky with local red mud. 

Casting room, with a fresh white coat of paint.

Some of the operating theater staff: center is Paulo, head of the OR: a surgical tech of amazing skill, authority, and patience. When we aren't there is he pretty much it for major surgical interventions and does other minor surgical procedures. He does everything from cesarian hysterectomies to hernia repairs. We enjoy working with him and appreciate his tutelage.

This is a crying shame: can you help with this? This is the surgical library. Please let us know if you have any GOOD surgical books you'd be interested in donating. 

Priscila continuing her vaginal surgery work... here we actually had a lovely anterior/cystocele repair (refreshing to mix and mingle the fistulas and hysterectomies with these types of procedures). Notice the size 8 gloves. We don't have much options for glove sizes, you use whatcha got.  

If you were to exit the operating rooms, directly in front you'd see Maternity or ("L&D" for my obgyn friends). Family members are waiting outside for visiting hours.  

A cute baby wrapped in colorful winter clothing. Beatrice is one of the new senior nurses/midwives who I respect and really enjoy working with. She is competent, diligent and responsible. Awesome. 

Wondering what daniel is doing on maternity? Actually doing a consult on a labor bed - he is a prized consultant and so since the outpatient offices were closed he came up to do his consult and ultrasound on maternity. 

The nursing students at Kalukembe are one of our great joys. Here they are curiously peeking over to a police-reenactment of a stolen baby incident. During our time there the dreadful thing did actually happen: a desperate woman, pretending to be a young girl's relative took her newborn to "change the diaper" and never returned. There was a huge uproar, the culprit (unintelligently lived in the neighborhood) was actually nabbed by police within 24hrs. 

I came around later to maternity and found the young 15 year-old mother (one of our FIVE eclamptic ladies admitted over THREE days) reunited with her daughter but also confronting the thief. The police  had brought a professional photographer with them and forced the woman to reenact step-by-step the kidnapping. Once outside maternity such a huge crowd had gathered we were afraid the woman was going to be lynched. Thankfully she was taken away in a police vehicle.  

Exiting maternity and walking down past men's and women's ward you'll hit the outpatient consult area. Here patients start gathering at 7am and (on days that Dr. Steve Foster or Dr. Annelise Olson are around) will wait until 11pm. It was lunch time so folks were out looking for some nourishment.  

Once you register, pick up your outpatient file, make it through the nursing triage, you wait here for a medical consultation. 

This young lady is actually a friend of mine now: Delfina. Her first and only pregnancy was tragically complicated by a diagnosis of heart failure (EF of 10%), we followed her very carefully and were planning on inducing her at 32-34weeks (she was decompensating) but she disappeared for a few weeks and came back with a dead baby. I was surprised but delighted to find her at Kalukembe (she lives in Lubango). Her sister is that wonderful senior nurse Beatrice (on maternity) and so she was being taken care of by Beatrice's family.  

Between the pediatric ward and the HIV/physical therapy buildings are some more lovely trees and landscaping. I'm dreaming of doing more gardening around maternity. 

A typical afternoon for family members: three generations of ladies there to care for a sick child on the pediatric ward. Typical African dress is very practical: these beautiful skirts double up as a blanket, towel, sheet, cover for the rain, etc. 

Our super-boss and Clinical Director of the Kalukembe District Hospital Sr. Nelson. He is an amazing man: graduate of the nursing school here, works NON-stop doing outpatient consults, inpatient care, administrative work, translation and organizing/scheduling surgeries during our visits, follow up, applying for multi-million dollar grants to rehabilitate the hospital, teaching at the nursing school, AND just started doing his bachelors in psychology! We are all lazy bums next to him. I had to take this picture on the run - he never stops moving. 

Well, returning to to the living quarters, we again enjoy the (seasonally) verdant walkways. 

Here are some of the living quarters for the nursing students, notice the plethora of satellite dishes :) 

This is Zeke after a week in Kalukembe: tired but happy to have spent the days running after dogs, birds, chickens, ants, cicadas, lizards, and being shuttled around on the backs of ladies (including mommy who sometimes has to take him to maternity on her back to do consults and deliveries.... but only once into the operating room for an emergency procedure!).  

Alive and well!

Thank you to everyone who is praying, encouraging and supporting us these last few weeks! It has been difficult communicating, so please forgive us if we haven't replied to your emails. This is our first family picture in a long, long while (taken by some friends yesterday) to prove to you that the theft hasn't stolen our joie de vivre! God is good all the time, All the time God is good. We are heading out to Kalukembe District Hospital today after dropping off our new passports (horrah!) at the immigration department (to restart the visa application process), getting new tires (at least $220 a tire. . . yikes!) for all the off road driving, and getting our broken car window replaced with plexi-glass (more robbery-resistant, ha ha).

Follow up & cia

Here's a follow up photo of one of the gentlemen from our blog post back in May. He's responding well to anti-tuberculosis treatment :) Glad to see improvement! And following are a few pictures from the last few weeks. We will go next week to Chiulo hospital as a family; after being there alone earlier this month, Daniel is very excited about the prospect of going with Pri and Zeke.

probable TB rash, receiving medicines

TB rash, before the medicines

This girl from Chiulo hospital uses her mosquito net in a fashionable way

Overflow patients to the pediatric ward at Chiulo mission hospital. Daniel spent a week there at the beginning of the month as the sole medicine and pediatrics doctor; the under 5 Peds ward had over 130 children, Measles ward had 12-15, and another 80-90 medical patients were on Men's and Women's wards. Long days of rounding! 

Zeke digging the new high chair lent to him

Back at Kaluquembe

We spent a little over a week with our friends and colleagues at Kaluquembe earlier this month. This time, we walked away with a little more perspective on the work and challenges at the hospital. The clinical work kept us busy (hysterectomies, C-sections, fistula repairs, and a very sick antenatal population for Priscila; learning herniorrhaphies, head traumas, and treating a variety of medical conditions on men’s, women’s, TB and children’s wards for Daniel). And the beautiful evening walks rejuvenated us. But wow; the challenges for a place with such high infant mortality are daunting; so is the management of MDR-TB in a country that does not acknowledge it has such a problem (thus, there are no easy ways to test for it nor are medications made available for treatment . . . a scary situation that spells international crisis). In a country that has immense resources but where over 80% of the population still lives on less than US$2 a day, the barriers to good patient care are more than we yet know. Please keep praying for us (and for patients and health workers); we are trying to provide just and merciful care to our patients, but it feels that there aren’t many here who share that same desire. 

Femur fracture room on the men's ward. Note simple traction devices that patients remain in for weeks to months

Molar pregnancy as seen on our favorite piece of CEML equipment: the Sonosite Micromaxx. Treatment options are usually D and E or hysterectomy. Even getting methotrexate is a big hurdle here.

Priscila with nursing student and Dona Julia, the Chief midwife at Kaluquembe

Zeke, stewing something smelly

Our friend David

David is Zeke's friend here at the hospital, they love each other! They are the exact same age and he is the first and only child of his young mother who takes care of him with such sweetness. He contracted cerebral malaria and, despite being treated at the Central Hospital, became blind. He is a beautiful, joyful little boy who is struggling to maneuver in this dark new world.... please pray for him and his mother.

Chiulo

We are back after 3 weeks away from home in Lubango: 1 week in Chiulo, down south and almost 2 in Kaluquembe, 2 hours north of here.

Baobabs around Chiulo

Chiulo Mission Hospital is a rural Catholic hospital with government funding for most of its services, and physician staffing provided by an Italian NGO, CUAMM. There are a range of services that include public health initiatives, a TB sanitorium, antiretroviral clinic and a nursing school next door. We went down to help the doctors, as the surgical resident and general practitioner were carrying heavy workloads without breaks. With a radiology tech that only shows up once a week (Saturday or Sunday, depending on how he feels), a lab with only basic microscopic and blood tests (no creatinine checks here! Leucocytes? What are those?), and nursing students left to run the wards when staff nurses go absent, we are quite impressed with Marco and Bernadita; their bare-bones medicine and surgical skills and dedication to their patients are an inspiration. 

Many patients travel for days to arrive for care. On the pediatrics ward, the common diagnoses were malarial complications, malnutrion, diarrhea and measles; on the adult wards, many had TB and its complications and others were patients with AIDS-related complications who had stopped taking their antiretrovirals and 'relapsed'. On maternity, Priscila cared for a variety of prenatal conditions and encountered a high number of neonatal deaths. Daniel performed the one C-section of that week with Marco on a woman with anticholinergic syndrome (and Bernadita rescucitated the baby with Priscila’s help).

Marco and Daniel performing a tubal ligation (no, the bed does not go higher)

Daniel is relieved to know no pistols, grenades, machetes or AK-47s are allowed on the premises. . . the luxuries of occupational safety!

This lady has a leprosy flare. During the war, leprosy was neglected; it has persisted in rural parts of the country, though it supposedly has come under better control.

Priscila ultrasounding just before leaving Chiulo, with Tim Kubacki (left) and Marco (right). 

This lady tried to kill herself with a knife the night before coming in. She cut her throat and trachea above the thyroid membrane and missed all the frightening real estate that is located there (we even saw the pulsating carotid artery on her right side!); we opted for primary closure of the trachea (no ventilators and just one size 6 Shiley cannula), gave her dexamethasone and she did physically well post-op.

Birthing suite

Summer 2012 letter

Daniel at Dondi

Mother and child at Dondi Mission hospital

Steve Collins, operating on a patient with cataracts (over 100 operations in 2 weeks at Dondi)

Patient in bed, after her surgery

 A happy patient the morning after the operation, able to see her daughter again

AK-47 shells: remnants of the war in Huambo province

I visited Dondi Mission Hospital for two weeks last month. While i saw patients with general medical problems, Steve Collins cared for patients with eye complaints (the main reason for our trip). Until the mid-1970's, the mission maintained a seminary, agricultural school, leprosy mission, TB sanitorium, nursing and lab training schools, an international school, animal husbandry and a busy hospital servicing an area close to 2 million people. All this was destroyed during the civil war; now, a Bible school and girl's school are all that remain. 

It's a beautiful area, with even more beautiful people we met through our work there. And we pray that, with time, help for the people of the area will be restored.

Some of our medical work

Medical team to Kalukembe: the regional referral hospital for  1 million people, 180 beds and no doctor. We  come here once a month and are wondering if this might be a place for us long-term 

So this huge abdominal mass, thought to be a large ovarian tumor turned out to be a 10kg messenteric cyst!  

Nursing at Kalukembe: limited resources, lots of work. 

Priscila supervising the medical student Jody... they actually had fun!