"A Normal Life" in Kalukembe

We met Artur Gadja via phone through a mutual friend, Dr. Matthew Chan in 2019.  Several months later, he graciously donated his talents and time to visit us in Kalukembe and document a week in our lives there. Here is the link:

https://vimeo.com/582233768/9efec4048f

This was done so good, I struggle with the feeling that sharing the film is self-promotion. But I hope you might see instead of THAT cynical interpretation, Artur was documenting us trying like others to make sense of what it means to love God and love our neighbor. We are so far from loving both perfectly; but I think that's the point--we are flawed people putting our faith in a perfect Person (Jesus) and Kalukembe is where our love and trust in Him has taken us. Out of that, we are learning so much about God and others and ourselves and have been present to testify to renewal and re-creation in our community and in our lives. Toil won't end until Jesus returns for a final restoration, when somehow the "world will be even more beautiful for once having been so sad" (Sally Lloyd-Jones).

Our hope is this sharing will be an encouragement to you as you consider where you are and who you can neighbor! So much to see, so much to learn as we do this together--why not begin where you are? CS Lewis wrote in Learning in Wartime, "If men had postponed the search for knowledge and beauty until they were secure the search would never have begun. We are mistaken when we compare war with 'normal life'. Life has never been normal."

Thank you for your tremendous job, Artur!

Back to the States

Hello again! We are writing from, compared to Kalukembe, the chilly city of Philadelphia! Since our last post, a concern led to an early departure then a diagnosis and now opening a new chapter in our lives. In October, Priscila felt a mass in her axilla. So with the concern that trying to get a biopsy in Angola would take us too long, we decided to move our timetables up and leave early back to the States to see what it might be, all the while hoping we could still celebrate the end of the year as planned with Pri's family in Brazil. We tried our best in two weeks to wrap up what we could and day good-bye to our colleagues and friends: some things were what we had planned to do anyway--giving Bibles, oil and mosquito nets to all hospital workers; purchasing TB and other medicines; setting up a hypochlorous acid generator for wound care; arranging distribution for kids' pets. Other things were sped up--packing up the house; arranging support for a few friends and their families; arranging care for fistula ladies in another center. Other things were left unfinished but ongoing, like the construction of the new doctors' homes and other chronic patients' care plans. And some things were stopped, such as a Hepatitis B screening study, and follow up for patients we had no way to communicate with our premature departure. Considering the circumstances we were leaving under, we are overall thankful. i am sad to leave our friends and patients, but we are so thankful that our departure was already a conversation begun beforehand with everyone including our kids. And what an opportunity to thank 250+ hospital workers with practical gifts before we left! 

 It's been a fast process here, too! Less than 12 hours from arriving in country, Priscila had seen the surgeon and scheduled for biopsy on November 1. Since then, we learned that Priscila has metastatic breast cancer that does not look like it's spread to far-away organs, that Zeke loves playing basketball, that our kids are growing out of their old clothes rapidly, that my parents are very patient and playful in helping the kids with home school, that Naomi has taken to a bicycle like a fish to water, that Eliel is a brilliant cardboard castle builder, that our friends and supporters are even more incredibly supportive and kinder than we knew, that God has been steadfast and present with us every moment, every day. If we couldn't see the future well before, our sights down the road are even more unclear now. . . . 

For now, we are with Daniel's parents until the end of the year. Then we will transition to Wilmington, DE, where Daniel will begin work and the kids will go to school. Priscila had her first chemotherapy session this week and will continue every 3 weeks for five more cycles before her breast surgery. Then it sounds like radiation and more chemotherapy. 

Thank you for all your care and support! The kids have appreciated warm winter clothes, we've eaten yummy meals provided to us, and Priscila's parents and Daniel's sister's family will join us in Philly for almost a month together! The list of kindness is much more than that, too! It's only what i can remember in the moment. . . . 

 i am told that the William Bradford celebrated with the Pilgrims their first harvest (with the generous help of the Wampanoag) and Psalm 107 was what he reflected on. It begins, "Oh give thanks to the Lord, for he is good, for his steadfast love endures forever! Let the redeemed of the Lord say so, whom he has redeemed from trouble, and gathered in from the lands. . . " and it ends with "But he raises up the needy out of affliction and makes their families like flocks. The upright see it and are glad, and all wickedness shuts its mouth. Whoever is wise, let him attend to these things; let them consider the steadfast love of the LORD." So much to think about here, but suffice it for now to wish you all opportunity to consider God's steadfast love in both our lives and in the world. Happy American Thanksgiving/Feliz Dia de Graça!

On our way from Kalukembe to Lubango to Luanda to Lisbon to Newark to Philadelphia! Not bad! And the kids were still smiling when we arrived. . . well, not fully. We did cry about leaving our dog, Chibi-ko

Pri preparing Naomi's birthday on the 6th. Naomi's response to a day full of fun with cousins, grandparents, and presents was to say, "Thank you! This day was full of love!"

The boys enjoying legos and soldiers with their cousin, Søren

One last construction project for Zeke in Kalukembe: a cardboard house with lots of lights!

I'm gonna miss common sights like this. . . 

Wrestling with Tio Jim in Philly

Priscila's care is at the same hospital where she did her residency. It was fun to find her placard on the wall after one of her appointments.

Reading Bible stories with "Jiichan"

And of course, cozy reading times as family

In the beginning of October, we were able to offer one more week of free prenatal consults as part of seeking to encourage women to have healthy pregnancies and safe deliveries. To date, this year had been the worst year for maternal mortality that we had experienced (22 up to the beginning of October). Which made it all the more poignant to us to connect with pregnant women and talk about healthy pregnancies and delivery plans. Ultrasound is such a great tool to open up such conversations with women. We continue to pray for these women and our colleagues, who continue to provide good obstetric care to the women of the community. 

Our amazing friend, Dr. Bible, came and visited in September and left just days before we did in October. He's here doing one of his many injections for a patient with back and hip pain. He was an incredible help on the wards (who knew? an adult rheumatologist helping see pediatric patients!) and in the clinic. He even helped at home, building desperately needed shelves in the kitchen. Thank you soooo much, Dr. Bible! 

The treatment journey has begun! First chemotherapy session down, five to go!  So much else to say about this! I will keep it brief: we love you SO much, Priscila! May your body and spirit know healing and peace

Preparing for the rain

 Greetings again from Kalukembe! Onjovo (Spring) is here, with many trees shedding their leaves and the sweet scent of flowers in the air. Though the rains usually do not fall in earnest for another month, the world around is growing in anticipation. Even with a dusty covering on all surfaces, it's a fun time of year to look around and take notice of new life. Rather symbolic, eh? But I leave that to you to make connections.

For us in the hospital, we are in a slight lull on pediatrics ward with fewer malaria cases crowding the wards. However, maternity and the adult wards continue mostly above capacity. . . some of that is self-created by the hospital since when mens and women's wards were repainted and floors tiled, about 8 beds per ward were taken away. I don't recommend renovating that way, if you'd like to know. The hospital is used to making do with what's thrown at it, so for now, we will carry forth with patient beds on the floor. . .  again. Our friend once said about our Emergency Department in the States what I often think is the same for here: we often seem to be shuffling deck chairs around on the Titanic.

At times, discouragement can set in when we see the same cycle of problems reappearing: the disappearance of TB medicines nationally; lack of follow through in patient care resulting in worsened morbidity and, at times, lives lost; typhoid fever and perforations as prevalent now as 9 years ago; suspicious cases for COVID keep coming but still no tests provided. The list can go on, and the discouragement is valid (if I am the one validating). But just as real are the small improvements we see, and the cycles of beauty in the lives of our neighbors and in the world around. We witnessed the final metamorphosis of Naomi's tadpole into a frog this week. The trees we missed seeing bloom this time last year (due to no power and poor communication) are in their flowering glory now. Eliel and friend Luis celebrated another year of life! The latrine outside of pediatrics ward has finished and I am stepping in less poop coming to the hospital! And Jesus's promises give us joy--"Behold, I am making all things new."

Oxygen concentrators are needing maintenance, but we were able to get 8 more reserve bottles of oxygen for the hospital as part of a grant from Samaritans Purse. We are witnessing a higher need for oxygen therapy among patients--TB mostly, but also pneumonia (suspected COVID, included), malaria and heart failure patients. If you are wondering, we do not use ventilators at our hospital. In fact, only Central Hospital in Lubango has about 8 ventilators for a province of almost 3 million people.

Celebrating with friends on our Sunday afternoon "club" of soccer play, Bible stories, snacks and book swapping

Precious moments of Priscila with Eliel and Naomi!

Priscila with some fistula ladies, here showing donated Bibles.

Coral tree flowers; a sign the rains will come soon

Relay racing through hospital uniforms at Eliel's 8th birthday party. We did wash the uniforms before!

Celebrating Eliel's and Luis's birthdays!

"Where there is no barber..." Eliel pulling extra duties in hair cutting.

"Where there is no teacher..." Ok, don't blame Priscila for this one. It was my one day of the week helping with homeschool. The boys then did a science experiment with the hair to see if hair melts or burns with fire. I recommend to interested parties doing this further away from the house next time. 

Your generous donations at work. Zeke in front of the new latrine--well ventilated and improved lighting at night! May not become the new hangout spot for young hipsters to pose for selfies, but sure is nice!

Event(ually) July

July in Kalukembe: dry, cold, cloudless skies, eucalyptus flowers, the end of malaria season. The afternoon sunlight is warm and golden. The evening fires and hot cocoa warm us inside. And the kids cuddle under their blankets to listen to stories we share. These picture updates hold more stories than I can remember, but we hope you enjoy the snapshots.

In May, Dr. Lena said good-bye and returned to the States. She is here with our kids and shared dogs. We miss you, Dr. Lena!

In June, we harvested our beans. After a rainy season short on rain, it was a good reminder to be praying for our neighbors and have generous hands as they go through difficult times

Eliel working on portrait drawing of Priscila with machines.

We celebrated Julia's (our live-in helper and friend who is jumping in the foreground) birthday with a picnic cookout and games. Some of the local kids even contributed food to the special event. We are very thankful for  Julia's positive presence in our neighborhood childrens' lives.

On the first weekend of July, we hosted a one-day refresher course for clinicians in our municipality. Topics ranged from eye diseases to fistulas to neonatal resuscitation. Here, Dr. Steve shares from his wealth of experience in eye diseases.

The view from our back veranda at dusk.

Little boy with dactylitis who had been admitted for anemia. Though the predominant need for 400 transfusions last month was for malaria-induced anemia, this boy was a good reminder to look for other causes. It's estimated that over 10,000 children with sickle cell anemia are born each year in Angola. Most research and work in screening and treatment have been done in the capital of Luanda and the oil-rich province of Cabinda. We still do not have access to hydroxyurea (and haven't found any vendors interested in stocking any), but provide penicillin, vaccines (when available) and encourage appropriate bed net use (not in the garden; nor as a skirt; nor as a fishing net). Please pray with us as we look for partners to help us in screening and caring for this very needy population in Kalukembe!

A common sight here, not seen in the States: washing our sterile gloves for reuse. Glove shortages at the hospital translate to dangerous situations: rescucitating patients who arrive gravely ill with unknown illnesses without gloves is unfortunately pretty common.

Naomi continues to create lots of fun home scenes!

Zeke, Eliel and friends playing an "away" game with local children from Kalonyoha. Ages ranged from 6 to 16, though Priscila increased that when she made her super substitution!

Video tours of Kalukembe Hospital!

Hospital Tour: https://www.youtube.com/watch?v=ru6auYXF0TU

Our family interview: https://www.youtube.com/watch?v=HmkNcUXDzNE

Maternity tour from 2016: https://www.youtube.com/watch?v=hGv6EBCLN6I

Spring 2021 update

 

Innocent.

Note: some names changed to protect identity

Our friend Pedro and his brother Avozinho ("Little Grandfather") had been picking, as they often do, unripe guavas for several hours in our yard. It was still early, but he called out, a respectful distance from the front door, and asked to speak to me. It was unusual for Sunday morning, but I went out, and he shyly asked if he could have something to eat, "The Hunger" was too much he said.... explaining quietly that he and Little Grandfather hadn't eaten in three days. His mother was sick and couldn't sell fish and his pregnant 16yo sister was gambling away the money she earned, refusing to buy food. Breakfast in Angolan Portuguese is known as "Mata Bicho" : "kill the beast" ... and the beast of hunger was still strong in Pedro's belly. 

Pedro is 10yo and a full foot shorter than our Ezekiel (also 10yo), probably from malnutrition. His head is scarred and indented in a corner, and I've always wondered who beat him there as a child. The boys used to tease him for his funny shaped head. He lives in a small, crumbling, adobe house in the "Sanzala" neighborhood (in Brasil "slave's quarters"). He just started going to school (after many years of encouragement), though has a somewhat erratic attendance given his responsibility to feed his siblings. He usually is selling small piles of bananas or advocados for a profit of 5cents, which he mostly has to give to his parents. His home life is sad, dark, abusive, with a mother accused of witchcraft, being responsible for the death of a grandchild and selling poisoned fish. But Pedro is a kind, quiet child. There are often several other small children who usually follow him as they scavange for food, especially Avozinho, whom he cares for like a father.... Avozinho reaching for his hand and Pedro always clasping it with tender reassurance. 

Of course we prepared Pedro a good meal. After all, I've known Pedro for 5 years now. He is our friend. He's consistent, kind, honest and trustworthy. So I was surprised on Thursday when in the middle of work in the OR, doing a fistula repair, I hear a conversation behind me about a student's computer being stolen by one of "my" friends from the slums next to the hospital.  I can only imagine what hunger will drive a child to do, but it was surprising to hear that it was Pedro. Others accused him of stealing a computer last year, of regularly breaking and entering homes, and his father said the young men holding him hostage could do with him what they willed: he was a child who "messed around too much anyway." The young men beat him, trying for a confession and discovery of the computers location. He didn't know.

I confronted him yesterday morning, the self-righteous lady that I am (God forgive me). I asked in an almost accusatory tone, what he had done. He related the whole day, and ended asking me in a tired hoarse voice that seemed to have repeated the story over and over, "would I not have told them, as they beat me, if I had known?" I tried a different angle, reminding him I was his friend and didn't want to find out later. He stood his ground. I finally brought up God, as if He were my last card, saying we are people of Truth, and don't lie. That liars, as my father always said, are children of the Devil. He said he wasn't.... then he prayed, quietly saying "Jesus, where I walk you are, were I was you were too." 

And as he prayed, I confessed. Jesus, walk with me too. Pedro doesn't often go to church, unless he and Avozinho are wearing Zeke and Eliel's old clothes, but he walks The Walk. You can judge a man by what he says in the church, but as others have pointed out, it's what he does outside that matters more. 

Março Mulheres!

March was International Women's Month. To celebrate here in Kalukembe, the hospital offered 3 days of free prenatal consults and ultrasounds. We did in tandem a day focussing on obstetric fistula prevention, with a public health team coming to visit from Lubango to give talks at the hospital, in the patient villa and at the nursing school. This was funded in part by Hope for Our Sisters, a wonderful nonprofit out of the States that has partnered with us in fistula prevention over the years. Also, through the Fistula Foundation, Priscila has performed fistula repairs for 23 patients to date this year. Obstetric fistula care remains free here and we are still only one of four sites in the country that offer this care. Unfortunately, public awareness for healthy pregnancies and fistula care remain very low; so we are very happy to have welcomed this public health team. Fistula Foundation is an incredible organization that enables us to offer free care to women who suffer from fistulas and has supported us since 2015. And, of course, thank YOU, without whom we would not be here! Thank you for joining with us in bringing the character of Christ to the women of our community in Kalukembe!

First morning of free prenatal ultrasounds. Masks were worn. . . social distancing was difficult to enforce!

Fistula prevention group on right at the beginning of their talk with some of the pregnant mothers

The fistula prevention team came over for lunch before they continued their full day with a talk at the nursing school. Lots of education!

Zeke and Julio with their newest project--an old bathtub reappropriated to be a fish tank (and gets the added bonus to be a breeding ground for mosquito larvae! Fear not, Zeke tells us, the fish love to eat the larvae--and they have kept pace thus far).  

In gratitude to the woman of our family: Priscila. She is here with one of our neighbor's sons on one of the arts and crafts afternoons she organizes. Thank you for your amazing, generous heart! 

Just a reminder of what our hospital beds often look like. This is a "before" picture

Now this is an "after" picture, though this one is our re-finished surgical table mattress. It took a number of months, but after procuring the right type of material, the hospital is finally "re-covering" their mattresses. Perhaps not the most exciting thing to share about, but it's a huge moral, emotional and physical help to our patients that they can lie on a mattress not soaked in the urine, feces and blood of many others before them. Such a matter we probably take for granted where we are from. We hope some day the same thing will be said here!

Priscila teaching Tio Pereira, one of our surgical technicians, how to perform a fistula repair. It's great to multiply the blessing of fistula care with our teammates here!

Lots of love and Valentines (February 2021)

Valentine's is past and Carnaval ongoing, so we are well into 2021. Here are a few pictures from the last month we'd like to share!

The boys' latest construction--a 2-story hut. Proud construction project manager, Zeke, standing in foreground.

Sleepovers on the second story are so much fun!

Aftermath of a brushfire we fought off with the help of a little water truck and a few friendly neighbors with branches. In dry season, brushfires are a common site here and used mostly to clear ground for cultivation; but these are rare in rainy season. Our area has been unseasonably dry this year, and with strong winds, these fires are dangerous if they get out of control. 

Naomi marveling at a giant stick bug. She claimed it as her pet. Along with 5 tadpoles, 2 moths, and all the mosquitos in the house. We see many fascinating insects in our area all year round.

Enjoying the view at the "Pedreira" with our friends.

Mr. Jose Cabinda leading discussion in a seminar in hospital leadership. We look forward to facilitating more opportunities to help colleagues consider how to lead and how to help the culture of our hospital mature as we face challenges and opportunities together

Standing in what is usually a watering hole at this time of here. We are praying for rain, rain, rain!

An example of the dangers of traditional medicines. This unfortunate woman was receiving treatment for a motorcycle wound with a cow manure mixture by a traditional healer for a couple weeks and was suffering gangrene of this leg when by the time her family decided to come to the hospital. Sadly, her family did not accept amputation as a treatment option so we arranged for her transfer to the provincial hospital in Lubango. We face many challenges with patients who receive these types of traditional treatments. Please pray we will grow in wisdom to communicate compassionately with patients and understand their expectations and barriers to receiving therapy. To many who receive traditional care, a doctor is a purveyor of good AND evil treatment. 

Celebrating time together with another Brazilian-American family, the DeSouzas. They were on their way moving to a bush clinic in Cavango and stopped by for 2 nights of fun walks and games together. Having lived in Lubango the past 2 years, we share in their excitement to serve in a new place! After their visit, Zeke asked why we can't attract other families to join us in Kalukembe. You need not be Brazilian or American--there are many ways you can contribute to the amazing work we witness at Kalukembe! And recently, we've even been able to shower, too!