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




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