Bushbaby present

Last weekend, a bushbaby (galago) dropped down our chimney Santa Claus-style, and was a pleasant surprise to us and our guests! This nocturnal creature has an incredible leap, and Pri and Zeke even attest that its poop doesn't stink (i didn't care to find out). Although it was very entertaining to see it jump and hang out on our ceiling at night, we worried that it was ignoring our offerings of food and water. We thus released this delightfully unexpected guest back to its wild habitat, which he took in one leap. Merry Christmas and happy new (leap) year!

Our malnourished patients

A sad reality in Kalukembe, AO and other parts of the world is the persistent problem of malnutrition. When young children suffer, it affects me even more. Starvation in children has complex physical and social origins, including cultural beliefs about breastfeeding, interactions with other diseases, attitudes to certain foods, poverty, etc. But the end result is the same to me: it's sad, it sucks and it shouldn't exist. At Kalukembe, there historically was a program that helped mothers of children with malnutrition grow certain high-protein crops and taught them how to maintain healthy diets for their families using the local milieu. Then up till about 2 years ago, an international and government-supported program using pre-made supplements and formulas was in effect. Now, we are back to offering little to these children outside of medicines and advice about what to buy in the market. These children often need hospital stays of around a month, so this is a financial burden most families are unable or  unwilling to make.

Our "results," predictably, are poor. We are looking and praying for ways to restore health in these children, and we hope we will at least approach a lasting solution that would be a part of restoring the well-being of our entire community here in Kalukembe.

Here are two children's stories that bring me hope, and remind me of one of my favorite Psalms:

"[The Lord] raises the poor from the dust

and lifts the needy from the ash heap.

He seats them with princes,

with the princes of their people. " 

(from Psalm 113)

B. is 5 and arrived after months of weight loss and fevers. His mother died the year before; his father never met him; and so his uncle took responsibility and brought him to us for help. His underlying diagnosis was not difficult to make: tuberculosis that had spread through his whole body. But he struggled to eat or find anything that we recommended his uncle to try for several weeks. After losing even more weight, he finally stopped vomiting, started walking again and left our ward smiling and waving.

J is the baby boy on photo right. He is 4 months old here and came weeks earlier with his mother, who eventually died from suspect metastatic cancer. He struggled with sepsis and severe dehydration; then his new mother (also with an 8-month-old girl) came and like a mother hen began looking after him around the clock. Through mostly her care and love, he is feeding again and home in loving arms!

Beautiful Ladies

These beautiful ladies are all some of women we are helping or have helped with fistula - here a complication of childbirth that leaves a woman incontinent. There's lots of other work around the hospital, but taking care of these women is definitely a highlight! 

Often story starts out ugly and bloody.

But then we have a chance to help!

Some babies do survive (rarely) and they are so precious!

We sometimes diagnose them immediately postpartum: a difficult recovery.

Women of fortitude.

Some are so young - 15 years old. 

Sometimes our kids play together.

Awesome when loving husbands come - they've been together 17 years.

Summer 2015 letter

Water for life and health.

We are working on our hospital's water security. Currently, it is very insecure! The hospital has a daily need of around 65,000 liters and is barely receiving a fraction of that during 2 hours of running water from it's old bore hole. For example, maternity ward has one trash can for the entire antenatal and labor suite that is filled and a bathtub for the rest of the ward. 25 women who are rationed just that amount after the lovely mess of "giving light," as they say in Portuguese.

Part of the difficulty is with old, leaky and out-of-date water resevoirs; a weak pump from the one bore hole we have since 1976 does not manage to fill the tanks; and a spring water source off the property that is dry for at least 7 months of the year. In addition, the pipe system leaks like a colander. And we do not have bathing or latrine/toilet facilities for most patients.

Minne Prins, a Dutch businessman whose ministry is to develop Angolan businesses and infrastructure, has taken on the task to evaluate the current water system at Kalukembe and develop a proposal for renovation. He came to Kalukembe about 15 years ago to help with refugee camps and restoration of the hospital. The last time he was at our house, he tells us, cows were grazing between bookshelves! He's seen much change and is very experienced with customary practice, but gets things done with high quality.

If you are interested in participating in this water project, let us know and we should be able to get more information to you soon. 

Filing water tank for OR with well water - often empty anyway and buckets are carted into the building for hand washing and sterilization. 

Local laundry at Kalukembe 

water used for bathing and washing and irrigation just below hospital. Plenty of malaria breeding happening here!

Deluxe staff bathroom on Maternity ward. None exist on Mens or Womens wards, and the one for the ICU is at least a toilet. . . without a seat. No running water in either, note blue trashcan used for flushing.

Zeke, Eli, Naomi

Back in the saddle but still searching for the horse to leave the barn

It took us 2 years, but as of August 13th, we have been back in Kalukembe (Caluquembe with Portuguese spelling). We are sending a little update today from the provincial capital of Lubango. We are still without internet and are working on setting it up in Kalukembe through a vendor here today.

Some things gladly have not changed at Kalukembe: certain clinical colleagues are still here, persevering under increasingly difficult circumstances. For instance, government budget cuts fell hard on the health sector and procuring medicines and materials have gone from "very challenging" to "insanely challenging." We are quite inspired by the dedication of our nursing colleagues enduring with what little they have to work with. They work with the purpose of serving God and caring for the community. One of our colleagues is Gideon, a nurse clinician working in outpatient department. He laughed when i asked him how many years he's worked in the hospital. He answered with one word: "Muito"--"many."

Some things sadly have not changed: water for the hospital and home remains scarce. The most recent bore-hole is from 1976 and hits more mud than water. We still operate with barely any on the wards and in the operating room. Anyone like to guess nosocomial (hospital acquired) infection rates?

There are a number of things that have changed in the last two years and other things we just didn't know about when we were here in 2013, both nationally and locally as well as in church involvement in the hospital. But for the time being, we are glad to be settling into a spacious house and a big area to explore. We have a lot to be thankful for. People have been welcoming us generously with smiles and friendliness towards Zeke, Eli and Naomi. We hope they will have good friendships here and grow into wanting to serve God through serving others.

Like most parents, i hope our children will be better people than we are. i hope they love more, care more, laugh more, worry less, care less about financial security, and know more about fixing cars and incubators! The other day, Zeke asked if he could go into the maternity ward with Priscila because he wanted to help the ladies "push out their babies!" With so much obstetrical sadness (e.g., we cared for women with uterine rupture, eclampsia, hand presentation with internal extraction, placental acreta and a septic head entrapment that ended in maternal death on top of 3 infant deaths in the same day this week), we hope those babies come out--alive!

It's negative! And it's probably not what you're thinking! This is a rapid Malaria test for Eliel when he was febrile and with diarrhea and vomiting. 

Like some watermelon?

Church girls at our presentation ceremony

Getting interviewed by provincial TV at the presentation ceremony.  Do i really know enough Portuguese? Well, from what i gathered, i was asked if i thought it was wise to wear helmets when participating in the running of the bulls. i said yes.

Audrey Henderson reading and being a wonderful grandma to our boys. We are so thankful for Norm and Audrey in opening their home to us while we were in Lubango for a month!

Our home in Kalukembe

More beautiful than ever. 

The nursing school 3rd year students had exams this week. These chickens were breakfast for the examiners. Talk about "farm" to table service!

exploring the termite mounds in the forest

i suppose i won't be telling Eliel to stop making mountains out of ant hills

The fighting family visits Kalukembe

We visited today Kalukembe, met the new head of nursing, the new administrator and briefly looked at some of the changes at the hospital. We also were given a tour of our likely new home! After arriving, Zeke immediately wanted to know where his friends were and who would help him fight the "bad guys!" It was a good reminder to us 1) how outgoing Zeke is--he found local children to swing sticks together without any problem, and 2) the imagination of a 4-year-old is incredible: Priscila especially had been talking with Zeke about our return to Kalukembe these last 2 years and the "bad guys" we'd be fighting together. What we meant were the "bad guy" sicknesses, the "bad guy" injustices we saw against our patients, the "bad guy" poverty in our area, and other problems that don't nicely manifest as physical beings a child could shake a stick at. Zeke took them to be walking and talking and was ready to do battle after 2 years of mental preparation and take these guys down. Love his heart. 

Priscila sharing our new contact information with old friends 

Eli caught wanting to "share" someone else's lunch

Fazenda Tchincombe

One week tent living, washing diapers in a bucket, being encouraged by Dr. Joshua Bogunjoko and running around the fazenda with the kids. Here headed back to Lubango, awaiting meeting with IESA and housing preparations in Kalukembe. 

Ready...Set...

We are packing and arranging and packing some more. The day is set and we'll be leaving on June 29 for Angola. Barring circumstances we cannot predict, we will be there 2-3 years. It's been a lot of fun to see friends and family between storing books and packing our lives into luggage for the next several years. Keep praying for us. We don't have housing in Kalukembe and staff we knew  and respected from before have departed. If it didn't feel like a forest of unknowns before, our work in Angola certainly does now!

The health agents i followed around in Santa Rosa put on a surprise party for us at the end of our time. They made amazing munchies and doted on our kids. i learned quite a lot about the local culture and language with them. The New England Journal highlighted the community health agents program earlier in a June 4 article. You can read more by clicking here

Naomi and friend at the party

Eating so many munchies, Eliel's stomach suffered hyper-acute balloon expansion, so Opa took surgical matters into his own hands :) Zeke was surprised that Opa could pop a balloon with just a pencil

Saying good-bye to grandparents

Zeke with his friend, Marianna. 

Zeke with friends at preschool. His language grew over one month there

Difficult to see, but a double rainbow over the sitiu, where Pri's parents are growing their plants and dreams

Priscila with (L to R) Tia Filinha, Eliany, and Sandra Carvalho. The Carvalhos hosted us very generously while we were in Itajubá. Eliany amazingly tutored me multiple times until her dengue got the best of her

Back in Philly with Daniel's youngest brother, Luke, and his sweet girls.

Naomi with buddy Otis! 

Zeke and blood brother/mortal enemy Han sharing a rare tranquil moment with Tia Lisa

Eliel looking at the Atlantic from this side. Soon we'll be on the other side of the Atlantic!

The two jewels of the Cummings family

Eliel, already multi-tasking at 21 months: Computer, potty, Playstation, and (not seen in picture) cell phone

A few things we are up to in Itajubá, Brazil

Below are a few pictures or our time thus far in the south of Brazil, where cooler temperatures (50's to 70's F) have set in. i am getting tutoring and language immersion, with a great experience making home visits with community health workers (agentes de saude) several mornings a week. This was arranged through my mother-in-law, Adriana Ribeiro, who works as a doctor in Santa Rosa's public health post. This experience has been a wonderful opportunity not only practicing Portuguese but to be shown (mostly) working-class Brazilian culture. Zeke is going to school during week days, while Eliel and Naomi remain at home with Priscila. Priscila is doing the paperwork necessary for our move to Angola done--so so thankful she's doing this! We've caught up on several immunizations that the kids would not receive normally in the States, such as Yellow Fever and BCG.

Naomi and Eliel are getting much attention wherever we go, the former for her eyes and frequent smiles and the latter for his eyes and energy (bagunça). If we had more time here, i would try to get Zeke in a capoeira class with his hilarious, extemporaneous exercise dance routines to find some outlet.

Hair-cutting day in Itajubá. Eliel being left guessing what was happening, managed to get his first haircut without a tear shed. Oma Ribeiro was there to hold him.

Opa Ribeiro and Naomi Jacira enjoy conversations with each other, here at the salon. They have a  language i think only they share

Zeke getting a haircut: note his ubiquitous cowboy boots made it to the show

On Sunday after church, we came across a local parade of farmers, ranchers, horse-lovers riding bareback, saddleback, in buggies, on wagons, you name it. Big parade that i think had most of the city in it. Looked fantastic and relaxed: as it meandered through the city, some rested, some took shortcuts to join friends in other parts of the parade, others joined at later points, some played their favorite Brazilian country hits through speakers on wagons, some double fisted their beers and reins; there were entire families on horseback or in buggies, and others were in groups. Since we love horses, this was an awesome surprise

Twice a week, the community health workers arrange for a morning caminhada, or exercise walk, through the area for people with diabetes and/or hypertension. Towards the end of the one yesterday, a billy goat joined the ladies. But in a very un-Brazilian fashion, he failed to have bathed before hand and did not apply any pleasant perfume, either. Other things community health workers do include arranging doctor and nurse home visits, keep tabs on bed-ridden patients, visit peoples' homes, inform the community when influenza vaccines are available, etc.