Thankful to be home.

Rainy season is full of life, but we are full of reminders of its brevity. When our sons Ezekiel and Eliel went to say good-bye to Lourenço last week, we weren't sure how long it would be for him. He died yesterday. He was a joyful young man, a nurse we loved working with, 29 years old and newly married. He had presented with blood in his abdomen (hemoperitoneum) a few weeks ago from a ruptured retroperitoneal sarcoma. After a transfer to our sister hospital and a major laparotomy, he came home to receive palliative care at Kalukembe hospital; our boys brought music, Priscila read to him and he died without pain and hopeful for complete healing. Having witnessed many sad and painful deaths, I am so glad Lourenço's dying process was peaceful. 

This month we are also left grieving the loss of the chief financial administrator. Mr. Canivete's death due to the coronavirus was sudden and has left a void in our hearts and in the leadership of the ministry. We depended on him for most administrative issues and directing funds for purchases for the hospital. It has been a struggle planning the future in his absence. 

 On the 1st of November, we returned to Kalukembe after 2 months in Lubango. When we left Kalukembe in September, we thought it would be just for participating in an online emergency medicine conference for a few days. But then electrical power was cut to our home, and without clear plans for when it would be restored, we decided to remain in Lubango while the hospital sorted out what they would do. Living week-to-week in uncertainty during an already foggy year was not on our calendars--but who HASN'T had their plans change many times this year?

Our 2 months in Lubango were still filled, though with a different rhythm. We continued with home-schooling the kids; we helped at our sister hospital CEML part-time; the kids literally improved their swimming skills in big strokes; we completed a treatment guide for Kalukembe Hospital; and we met with health leadership to discuss the status of our partnership at the hospital. 

But not all these past months have been filled with grief and uncertainty about return to Kalukembe. Even in the weeks since we've returned, we have seen improvements in the life of the hospital! A few things we have lobbied to have for several years actually took shape: such as improved work schedules for the nurses and the assignment of Dr. Damião Cacuti to Clinical Director at the hospital. Another colleague,  Dr. Vasco, also joined us after 2 years training at CEML and has brought a new energy to clinical care. Priscila is benefiting from a dedicated full day for scheduled operations, including more fistula repairs and other gynecologic procedures (hysterectomies, slings, etc. . . ask her! If you are a resident suffering from fewer cases during COVID times, contact us!). At home, Naomi celebrated her 6th birthday in November and this week was busy decorating our home with colorings and cuttings for Christmas. The boys are glad to be back with friends in Kalukembe, riding bikes, swimming in the creek, hunting frogs, gardening and, uh, playing coronavirus tag. 

Preparations with church looks different from last year with no children yet allowed in church and smaller numbers at services, but the content remains the same as we celebrate Advent. I am thankful to celebrate with the worldwide church family what we have for thousands of years--the joy and hope that the birth and arrival of Jesus Christ has brought for all the earth. It's because of this hope we gladly join with you in continuing to care for our patients and our community in Kalukembe. Merry Christmas!

Good-bye to sweet friends in Lubango. 

Back to schooling at home with good teachers, including Dr. Lena Gamble! 

Nature walks are easier at Kalukembe: in our neighbors' yard. 

Naomi turns 6 with her friend Princessa! Special girls pretty in pink! 

Lunch with our neighbors, Dr. Damião and his family

Mission Aviation Fellowship colleagues generously flew in for a day to install solar panels on our roof. One more step towards improving stable electricity (still sorting out the battery system!)

Enjoying movie night outside our house for nursing students and our young friends! 

Joys of city livin'

Two months in Lubango was unexpected (no electricity at home in Kalukembe), but lovely. 

Here are some reasons why!

Catching up with old friends, learning to swim, hot water, good internet and chances to talk to family and friends, rest and time to write (Daniel writing the Treatment Guidelines for Kalukembe Mission Hospital). But this one of my favorite memories. Love to share it with you.  

Staff Housing Project: completed!

 Kalukembe Staff Housing Project: before, during, and AFTER! Thank so much to those who've participated in this beautiful transformation! Yes, the Cayanje neighborhood kids and we we are celebrating the project's completion! The project was done in time for the rainy season (heaviest in 30years, many other homes collapsed) and for our COVID-19 restrictions.

People, projects, and personal.

 

About people: Our Maternal Fund, provided by Hope for Our Sisters, has been a huge blessing to the women in our community. Here is a sweet lady, whose family had struggled to pay what they could for her surgery and extended stay at the hospital... but could still not complete the costs... she just heard her debt was forgiven by the Maternal Fund. I wonder how I will dance before Him who paid my debts? 

Psalm 103:10-12. He does not punish us for all our sins; he does not deal harshly with us, as we deserve. For his unfailing love toward those who fear him is as great as the height of the heavens above the earth. He has removed our sins as far from us as the east is from the west.

Projects in progress: We've completed our Staff Housing Project! And now have welcomed a container of medical equipment from Samaritan's Purse. Included in the container are solar panels for our Electrical Project and here is Daniel and colleagues unloading the stands for the panels. We are waiting for the borders to open up - so the electrical team can come!   

On a personal note: Homeschooling is something I didn't plan on... still struggle with... but moments like this are sweet and make me hopeful! I know so many others are in this same challenge! 

   

June 2020

Since last sharing, world events have challenged every country. With this i've been learning the significance of daily work and rhythm; letting our plans for the future remain unknown. i am sure it has been a wild ride for you too, adjusting to restrictions, limited interactions, and new routines. It's hard for all of us, and we know each struggle is real, no one greater than the other: your experience or mine.... But allow us to share about the last 3 months at Kalukembe. Like for you, we've seen and experienced ups and downs. But our God is steadfast, and we know this more deeply than before. 

At the hospital, in spite of travel restrictions and cancellation of the monthly surgical visit (for elective cases), work was busier. It's been months filled with preparing space and staff for COVID-19, managing a surge in malaria cases, navigating interactions with government authorities examining hospital malaria care, and preparing for the exit of staff who have taken jobs in other places. 

For our family, we have learned even more about living and making memories in Kalukembe! We eat more local food, enjoy walks nearby, and celebrated 2 birthdays we thought we'd be celebrating in Brazil with Priscila's parents. Due to local school closures, our neighborhood kids visit us regularly for book exchanges from our small Portuguese literature library. And this past week we welcomed Dr. Damião (our new Angolan colleague!) and his family as our neighbors. 

We hope the pictures and captions below to serve as a good flavor of our past 3 months.

One of our electricians, Toni, putting up lighting outside of Pediatrics ward. In May our container from Samaritans Purse arrived, and we've been able to put up more LED lighting around the hospital: improving care and safety. 

Lena, Naomi and Priscila, all wearing the ever-popular bouffant that ladies locally wear. Guess which color Naomi loves!

Nurse Rebecca taking a blood sample from a patient to confirm malaria. We had been without rapid tests most of this season, relying on microscopy and clinical suspicion for diagnosis. Adding to the complexity, most patients arrive having taken unknown medicines, been to other health posts, been treated for unknown durations, and arrive with relatives who know nothing about the patient's story. Talk about working in a fog (ah, the fog of war analogies hold all-too-well here)! These rapid tests, a donation from the government, have been extremely helpful to confirm malaria. 

More happy container arrivals! Solar panels have arrived, part of the process of setting up alternative energy at the hospital. As it is, the main campus generator exploded and the replacement ones are not able to give enough power for some operating room equipment, such as the electrocautery machine. Some day in the future, we hope these panels will be an alternative energy source.

More evidence of the benefits of light! The previous fluorescent light was not turning on with the smaller generators, but with this LED replacement, the path from physical therapy to outhouses and the morgue is well-lit!

Daily routine on pediatrics ward. At peak, we cared for over 100 children a day, over 20 daily admissions due to malaria and over 15 blood transfusions per day. 2-3 children from the same family occupying the same mattress were the norm. So thankful for these mattresses from a US-embassy employee-initiated donation in 2018. They provided flexible care space quickly. This past week was the first week we did not need to use them, one sign that malaria season is now slowing down.

Zeke making sweet guava paste (goiabada) from the guavas he and his friends collected in May. Guavas are Zeke's favorite local fruit. Now in the cold dry season, we are very fondly remembering the rainy season's abundant fruits 

Cold season means Zeke and Eliel get to build many fires to keep us all warm. Here, they are listening to "Wee Sir Gibbie of the Highlands," by George McDonald read by their grandfather.

One of the small groups from IESA health ministry's meeting in Lubango on Friday, June 19. Groups of pastoral and health leaders were formed to work through challenging questions posed by the health ministry's leadership. They then re-convened to propose and discuss solutions. We face many challenges in the health ministry, but are very encouraged by the tone of camaraderie this meeting set.

A month past

Coming in to Lubango is a great boon for internet use and communication. However, we don't often get to personal writings we'd like to do and we get sucked into other work-related communications and obligations. Sorry! We want to share the progress made in February individually, but will start with pictures and their stories for everyone. Along that vein, thanks so much to your generous giving, our nurse housing project is 90% funded! This next week, the work is expected to wrap up and handed over to our local workers and electricians to complete painting and electrical work, etc. We are incredibly thankful to be almost funded, almost done and with nurses ALMOST moved back in!

Below are a few photos of the February that passed.

(Dead) Centrifuge Central. I took some inventory of lab machines to let a potential visitor through Samaritans Purse know what machines were available and what were in need of servicing. All 6 of these centrifuges were sitting in our lab, not functioning for some reason or another. Two more were also broken. For lack of maintenance, we have quite a few machines like these sitting around. If you have mechanical abilities and are interested in fixing hospital machines, you are most welcome! We do have local workers who help fix our chronically breaking down hospital generators, but for smaller machines like these, it has been a challenge to find capable servicing. We hope that if we get a container coming (still in the process since December 2018), there would be visitors who could help install newer donations and fix some of these guys! 

Nurses Cecilia and Joaquina preparing 8pm medicines to hand out to around 70 kids on our children's ward. February was a busy month with ongoing malaria season and staff nursing shortages. Making sure patients received the correct medicines through the correct routes and doses was a big challenge we worked together to achieve. Especially these two nurses have done tremendous work in maintaining caring and kind attitudes towards our patients throughout. . . not easy when families are trying to use their charcoal cook stoves in patient rooms and sleeping entire families on the floor as nurses try to deliver the late night medications!

Home schooling continues! Or, doing our best to instill the joy of reading and learning with our kids.  I am glad our kids love stories and that is mostly to Priscila's credit. 

Reconnecting with patients over the years in Chituto is a delight. This mother's story I posted in 2017 had suffered the losses of 3 children around their births. This is now her second child to have survived, the first born through Cesarean section. Glad to celebrate health with her and this 5 month old (who did have malaria on the day I visited. . . but got the right care!). I was quite encouraged by the opportunity to keep caring periodically for people of the Chituto area and to bring Zeke and Dr. Lena Gamble along this time.  We included prenatal ultrasounds with general medicine consults. 

Our Children's ward has seen this every morning for the past 2 weeks: overflow admissions from the night before on mattresses in the hallways with even 3 siblings to a bed. There have been quite a few challenges to be encouraging and help the nurses not miss the sick kids hiding literally between the sheets. Keep praying! There were promised mosquito nets that perhaps got diverted to other places and we've run out of IV fluids. 

Naomi helping Zeke up to take a look at the nurse housing renovations. The project is nearing completion and we are almost there with the support. Thank you so much! It has been exciting to see our nurse colleagues are eager to move in! If interested in giving, please visit the website here.

Assorted images

Naomi and the Cayanje construction: both look beautiful!  

Home-made dog-drawn carts :) 

Rainy season obstacles.

Pediatrics ward painting event! Art therapy. 

Broken bone Award

We were in the OR when someone said the kids were outside waiting.... Eliel gave the executive summary that Zeke had fallen off the roof while swinging on a nearby tree branch (en route to show Naomi how she should get off the roof), fallen on his arm (which was now crooked) and was lying in bed. Daniel checked him out (I said I would probably just start crying), brought him to the OR where our wonderful friends Annelise, Jamba and the surgical team kindly set his bones, plastered him up and gave him a fresh start. First broken bones of the Ribeiro-Cummings family: this was an Award Zeke was very proud of. :) PS we do NOT, as a rule, climb roofs

Happy New Year (Boas Entradas)

Greetings from rainy Huila province in Angola! We celebrated a warm, wet Christmas with gifts sent through a visitor earlier in the month to supplement our local "plaça" purchases for each other. I received a nice, warm herbal bath that i almost drained away through the confusion of thinking my bath was in the usual bathing bucket. Priscila had a magical way of making our time quite special.

Since our last post, we welcomed the De Sousa family to Kalukembe for a week before Christmas. Dr. Eduardo and Jocelyn (FNP) both were a delightful help in patient care at the hospital and they also helped in our continuing medical education two-day seminar at the end of the week. They serve at a surgical hospital in Lubango, and we are very thankful for their loving hearts for both our patients and colleagues. Jocelyn's parents and her four children also kept our kids busy with crafts and cookie-making when they were not out playing.

The nursing housing renovation project is also underway! Hope you enjoy those and other pictures below!

Cerebral and other severe forms of malaria have been burdening the local population in recent months. It's one miraculous recover i never tire to see when a seizing and unconscious child one day will be sitting up and eating breakfast two days later. It's also a very heavy burden when one sibling dies and the family is torn whether to remain at the hospital for the other one's care or abandon the care to return to the village. It is not easy for parents (most of our patients with severe malaria are children), navigating decisions made with other relatives regarding financial and health priorities. Please pray for our patients and their families; for our colleagues to give treatment proactively and caringly in spite of poor overnight staffing; and for improved prevention efforts, including that mosquito nets will be available to everyone.

Mahulo is a burn patient who suffered contractures and an infection at an outside hospital, but survived a 25% body surface area burn. Thanks in part to your support, he received contracture release operation and some skin grafting! His right elbow had been stuck with his hand in the "Thinker" pose before operating. Since this photo, he's been discharged and getting outpatient dressing changes. We celebrate his progress!

Rain never slows Zeke's dancing down! So far this season, the rains have been good for southern Angola crops. For this, we are very thankful given the previous dry rainy season

Enjoying a sunset on the beach with Eliel. Happy new year!

A somewhat "before" picture of a room in the staff housing area. The walls were already done before this picture was taken.

New metal shutters are replacing the old ones. And there are other old windows that had been sealed off that are now opened up again and given new shutters, too. We don't know the progress of the funding to date, but we had 50% needed to begin last month. Thanks for your support! 

Dr. Eduardo De Sousa at the continuing education course. Our audience included doctors and nurses from area government hospitals and clinics as well as nurse clinicians from our hospital and some of IESA's remote outlying clinics. Dr. Eduardo, who used to work with poly-substance abuse patients on Ojibwe reservations in Minnesota, talked about domestic violence and pregnancy. It was very well received and we are really thankful for his experience and openness to bring culturally sensitive topics like this to the seminar. 

Priscila giving a talk on vesicovaginal fistulas at the same seminar. Most of the seminar was focused on Maternal and neonatal health and care. Audience participation was as high as ever. . . especially because almost everyone acted out different patient scenarios Priscila provided. We are thankful to the Fistula Foundation and individuals who support ongoing education efforts!

Children of hospital staff sharing their approval at the building progress in their neighborhood. Thanks for making a difference in their lives!