Wednesday, September 26, 2012

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

Saturday, September 22, 2012

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.

Wednesday, September 19, 2012

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