Monday, May 01, 2017

Extending care

One of our hopes in working in the Kalukembe area is that we would be able to help people who are helping people help people better! Visiting a couple clinics that the hospital oversees (the IESA denomination oversees around 25 clinics) monthly this year helps us help this way that much more. Hope this following small description helps give a picture (Have you ever noticed how much "help" shows up in our blog? i apologize; often, my self-editing skills fail).

Caconda is a town about 45km north of Kalukembe, has an established IESA clinic that has fallen on difficult times since the national financial crisis. In addition to fewer medicines in their pharmacy, the number of patients seen per day fell from 60-80 to 10-15. Our hope has been to see patients with them and help generate income to pay for more medicines and salaries. The needs from Caconda certainly never waned, as most of our cases at the hospital of uterine rupture come from the are from there, as well as liver failure by traditional medicines. Sitting and eating with staff after seeing patients together has brought great opportunities to learn about other workers' queries and knowledge levels. Augusto, the nurse clinician, has had a good list of questions each visit and a real heart to help the people of the area. Going into these visits i thought what the clinicians could learn would spread greater healthcare value than what i could do in seeing numbers of patients. But even in a place not too far from our hospital, there are people who cannot go farther to see a doctor, either financially or through other constrictions. So even if it was to diagnose terminal cancer and have heart-to-heart talks and prayers, I've been touched by the direct connections with patients there.

Chituto is another place with a new IESA clinic about 170km from Kalukembe to the southeast. This is the youngest clinic in the denomination, opened in 2016. The nearest government hospital has one nurse, barely any supplies and performs no procedures. Even though it qualifies to have doctors, none have ever been there. Most patients are among the poorest of the region and the nursing and lab staff rotate from Kalukembe hospital. Just getting there is exhausting enough, driving in rainy season through the lakes of mud; but fun to share time with the clinic's administrator who also is an outpatient nurse clinician at Kalukembe. In March, Dr. Steve Senichka accompanied us and made lighter work for ultrasound visits. About 80% of the ladies who've been seen for prenatal ultrasounds had no prior prenatal care until seeing me and over 90% were in their 3rd trimester. Though it's not what i usually do, i hope prenatal counseling even from this emergency medicine-trained doctor will translate into wiser decisions women and families will make about labor.

We hope we can continue to share positive developments through interactions with staff at these clinics and in the communities they serve. Concretely, several patients have been referred and operated on in our surgical weeks at the hospital. Likewise, several patients have been started on tuberculosis treatment; and chronic ailments probably continue to nag both patients and myself :) And we keep leaving advice for increased community outreach through the clinics. . . perhaps one day, there will be more public health offered through these places. But also relationally, we hope to share a growing bond with our staff who serve in limited and challenging circumstances--no easy online resources or CME conferences to attend. But they keep working with what they know and what they have. We're grateful to these hard-working servants.

Ok, time for a diary of pictures!

Patients lining up at Chituto clinic. Only 45 of the 110 registered were attended to that day. ...

"What? Another S3 heart sound?" Dr. Steve Senichka examining another patient with heart failure at Chituto clinic. It is common to see patients in advanced stages of heart failure. The most frequently seen causes of heart failure range from infections to pregnancy to untreated hypertension

With the team of lab technicians and clinicians at Caconda clinic. Augusto is at picture far  right
Zeke and his friend, Bruno, making charcoal to sell. It's a steep lesson in  supply-and-demand economics.  . .  Zeke's 400% mark-up price for a bag of charcoal hasn't captured many enthusiastic customers with so many other competitors underselling the same product. Keep at it, bud. You'll figure out a way to buy a bike some day.

The kids outside of our tent in the yard. For Zeke's 6th birthday, we had a boys-of-the-family sleepover in the tent. They outlasted me: i fell asleep reading Robin Hood in mid-sentence. 

And happy birthday to the most beautiful woman! i am so glad we can share life, work, and chickens together!

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