December update

 Greetings in the last month of 2024 to you! 

We have had an event-filled November and already December, highlights being a visit to Cavango hospital and a palliative care conference. 

Cavango, a village on the Cubango river, sits at the headwaters for the Okavango delta. Our friends work at a 70-bed mission hospital - recently rebuilt on the ruins of a mission hospital destroyed during the civil war. The site serves around 30,000 scattered in nearby villages, but sees patients from the cities of Huambo and Kuito as well. It was a joy to be and work with our friends the De Sousas and the Gouds, who serve the community there as medical care providers, pilot, children's ministry, maintenance and much more. Our kids loved playing games, fishing, making crafts and sharing a week with their kids. 

After getting back to Kalukembe, we hosted the palliative care team from CEML hospital in Lubango to help lead a one-day conference in palliative care. Given care at the end-of-life is multi-dimensional to address the many factors that come up for our patients, we were glad to have representation from all the sections in the hospital, including our chaplain and our psychologist. As much an introductory course as it was exposure to other colleagues doing palliative care elsewhere, I was greatly encouraged by the discussions with others I had even after the conference. We hope this will be seed spread for future growth of a multidisciplinary palliative care team here in Kalukembe!

Posing with most of our palliative care conference participants. As the photo was taken, we all shouted, "We shine!"

As part of the conference, participants practiced in small groups difficult conversations about prognosis and developing plans of care based on patient values

Guilhermina and Emmanuel, nurses from the CEML palliative care team, sharing case stories and their experiences since their program's inception in 2020

On the Cavango airstrip with our gear for the week!

Dr. Eduardo DeSousa giving the morning public health and devotional talk to patients and staff. Cavango mission hospital

Dr. Eduardo finishing up an LP on a patient with bacterial meningitis. Given lab limitations, the CSF fluid was tested for gross appearance (very purulent) and glycemic level (low)

A couple days later, the meningitis patient's father was happily cradling his son to feed him (photo permission granted!). This was really sweet, to see the patient improve gradually during our time in Cavango. It's a joy to help and see recovery! 

The beautiful Cuvango river. . . crocs don't like rapids!

Sorry that this is out of sequence--but just to show we are in the Christmas spirit here in Kalukembe! Priscila and Julia popping LOTS of popcorn for the children of 3 local churches who will be performing in the youth Christmas services this past Sunday.

Priscila and Daniel with Ester and Cecilia, nurses, and a patient (face blurred to protect identity) at Cavango Mission Hospital. Though not much OBGYN occurred during our time there, Priscila was able to help Dr. Eduardo and his team manage this patient who came in 1 week post partum suffering from infected retained products of conception. Even helping a few to restore their health was an encouragement for us and for our colleagues there. We are so thankful for the work they and the care they give to people in Cavango.

Training at Kalukembe in 2024

How can the work of the hospital continue to benefit the community for years to come? With few resources (both material and human), here is our focus: sustainable medical education. 

Rural medicine training is critical for Angolan physicians. After 7 years of preparing, we are almost at our one year anniversary: doctors have been arriving since January for 2-week rotations in rural medicine, with emphasis in obstetric and pediatric care. These doctors come from our sister hospital in Lubango, CEML. While rounding in the ICU and other wards, they do bedside ultrasound evaluations and improve their diagnostic skills. Being called to assess an obstetric and pediatric emergencies can be stressful - but it's rewarding to deliver a healthy baby or see a child recover. Even our surgical resident enjoyed her Rural Emergency Medicine work - and we loved having her!

Brining in other partners into this work has been important: Christiana Emergency Medicine residents helped Daniel develop the resuscitation curriculum. We have had a team from the central hospital in the provincial capital come teach a class on sedation and assessment of the critically ill patient. The director of the pediatric residency at the public hospital in Lubango has expressed interest in having residents come through for basic procedures and emergency management. We hope these partnerships can allow even more trainees rotate and learn here at Kalukembe. 

To keep this up we need teachers! Dr. Chance Williams, a family physician from Kansas, spent a month with us - even giving a mini-course on placement of intra-osseous needles. Dr. Mariana Vigiola, a general surgeon, jumped right as a teaching surgeon. Dr. Emmanuel K, 4th year surgical resident from Niger, is coming for a site visit in December. We are discussing with him the possibility of long-term commitment here. Would you consider coming to help teach? We may not be able to provide 1st class beachfront accommodations, but I can promise a cup of fresh-ground Kalukembe coffee!

Dr. Ilda (L) and Dr. Mariana (Rt) operating together on a patient 

Eliel helping Ms. Jasmine making yummy fried rice for dinner. . . note our pets waiting for any mistakes to fall to the floor!

Near the end of September, Pri and I were able to participate in teaching ultrasound at the 1st annual Southern Angolan Medical Congress. Priscila also presented the hospital's research on maternal hepatitis B prevalence. We hope such networking will bring attention to Kalukembe hospital's work in the community!

With Dr. Hermenegildo, at the end of his second rotation at Kalukembe hospital. He'll be starting surgical residency in just a few months!

Dr. Ana seeing children in the pediatric clinic. She's a natural around screaming kids!

Dr. Chance ultrasounding on maternity ward with his translator, Ludmila.

Hope in a House: Casa de Esperanca

Women in Kalukembe are resilent and strong... but often suffer devastating losses, especially in pregnancy. Our hospital is in a rural area and often women have many hours (if not days) before they are able to arrive for an obstetric emergency. Even yesterday afternoon a woman, who had a complicated delivery the night before and hemorrhaged from a cervical laceration, arrived in critical condition and died despite our interventions.

Our Maternal Health initiative has grown as a response to this heavy reality. Knowing that the causes are multi-factorial, but often involve delays because of distance, the Casa de Esperança (a Maternal Waiting Home) was built. It is a place for women who are high risk pregnancies or have already suffered traumatic deliveries and need surgical care, can stay. It needs some more work, but is already open and we have hosted over 20 patients (and many more family members). Because it is still fully booked with fistula patients--who’ve suffered through a traumatic birth and often lost a child--care has included trauma counseling and re-integration skills like sewing, cooking, etc. We have also loved organizing and working with a visiting team of nurses for health talks at local communities affected by maternal death, at health clinics, and  around the hospital and in the patient villa. 

 

 

 Julia, the house administrator, registering a patient.

Patients listening to a lesson on how our bodies and hearts need healing! 

 Family member cooking for a patient in the comunal cooking area.

 

Most recent group of patients and their family members!

Nurses Filipa and Amandio (nurses from our maternity responsible for patient and community health education) give a health class. 

There is always so much singing at the Casa de Esperanca! Here is one quick moment.

 

May, and we had visitors!

 Happy mid-May, friends! Dry season is already a month in and the cooler temperatures have brought a sense of fall in our Southern Hemisphere home. Below are some pictures of our work and lives from April and May. We are grateful that we can walk and see God's goodness around us in "the land of the living" (Psalm 116:9).

Priscila and I gave lectures and simulations to nurses from the municipality's public hospital and clinics on OB and neonatal care. It was a delight and an opportunity to build relationships with other health workers in the area. Maternal and infant mortality remain a severe problem in our area: we average 100 neonatal deaths yearly at our hospital. The national estimate is 57.2 deaths per 1000 births (global average 28/1000; US average 5.6)

Digital x-ray has arrived at Kalukembe! No viewing stations yet, aside from the technician's monitor; but still, it is a big upgrade to get digital images. Most patients do not have smart phones (or even brick phones!), so nurses usually oblige to take pictures and show them to me or whatsapp them. The system is still far from perfect--many patients have x-rays taken and then lost. The technology is fresh, and I hope to see improvement in our diagnosis and management of patient conditions. This image is of a little boy with sickle cell and osteomyelitis in his arm. Sickle cell complications remain common and hydroxyurea remains expensive and scarce.

Dr Lena Gamble visit! Dr. Gamble, who worked at Kalukembe with us and now lives in the States, was back in Angola for a Freedom course conference her friends in Lubango have taken over organizing. She kindly took time out of her schedule to visit us and our staff friends at the hospital. The kids got to play chess, sing, remember and make new memories with her during her weekend visit. Thank you, Dr. Lena!

Rare (for Kalukembe) large bird sighting! This southern ground hornbill has been sighted several times in the last month around the hospital campus. 

May is our busiest malaria month, which means pediatrics ward overflows to the corridors and other wards. Please pray for our patients. Please pray for our patience in caring for so many patients, too. The daily census on the ward has been over 90 recently, but our beds only accommodate for 60.

Kalukembe sunset in dry season

Maternity also is managing a census flux that is seeing higher numbers on the ward. 

Neonatal resuscitation practice with mannequins during the OB/neonatal care day. Fun to see so many get their hands involved in practicing chest compressions, positive pressure ventilation and grooving with the 3:1 rhythm!

Fistula women at the newly constructed waiting home! This space is envisioned to be for maternal waiting as well as fistula patient community. Visiting nurses from a project in Bié province have already stayed and helped with post-operative care and provided group counseling. Really great to see!

Samaritans Purse World Medical Mission visited with a team of 4: Electrician Dan Noel is pictured above with a translator and our electricians. The hospital got upgraded with more LED installations and OR equipment getting fixed. We also had an electrolyte machine installed in the lab with training sessions for the technicians there. Incredible how much was installed in the last week! Thank you for all your hard work!

The joy of living in Kalukembe

March 2024

 Do we still blog? Though it is an ancient form of communication, but yes! We still do! Do we still live in Kalukembe? Yes! And we would like to share a few updates in our ministry and work there. In January, we began receiving intern doctors from a partner hospital in Lubango for 2 week rotations each month. Pri and I have for a long time wanted to participate in educating colleagues here, so this has been a wonderful answer. Each of the interns who have come seem to have had positive experiences. The overarching goal is to help train physicians for general medical care in resource-limited settings. The focus for the brief rotation at Kalukembe is to experience pediatric and OBGYN care, but also to see patients through our emergency ward. Since it will be one intern at a time, we hope to tailor didactic training to their interests as time goes (EKG interpretation and cardiac ultrasounds, for example). But, well, 2 weeks has a lot of patient care that can make getting in "formal" didactics a challenge! 

As of December, construction for the maternal waiting home has been under way. With walls up and floors down, we are looking closer to completion. We are working out if and how solar power could be provided, and plumbing work is yet to be done, but the potential this place holds is quite exciting. Imagine first laboring at home far from anyone, then getting transported by motorcycle while in labor after a day or two of no progress to several clinics before finally arriving at our hospital; then imagine feeling labor begin and just walking from the womens waiting home right down the road to the hospital to safely have labor monitored and delivery assisted, whether vaginally or operatively without significant delays. There will be much to learn about what barriers might be to utilizing this service, but seeing how it's been done well in other places, we believe this is the right thing to do here to reduce mortality and increase safe and healthy deliveries in our community. 

At home, the kids have recently been busy with their snack restaurant business. They buy coal, oil and local food ingredients to then prepare and sell. Their menu usually includes fried potatoes, juice and now even guava paste. They also make hospital deliveries, which has been great for Pri, who often can't get back for lunch. I haven't heard if they're ready to expand to international deliveries yet, but I highly recommend the sweet potato fries! 

And below, a few pictures!

Visiting nurses dedicated to helping women who suffer obstetric fistula visited our hospital for almost 2 weeks in February. They came with women from the central area of the country whom Priscila cared for and operated on. Nurses Domingas, Elisa, and Mariana brought much compassionate care for these ladies. And in addition to sharing on the hospital veranda about healthy pregnancies, they also shared at the local womens church organization. We are very grateful for their visit and the work they continue to do in Huambo province!

Working out of our temporary ER space, Dr. Hermenegildo from CEML in Lubango did a fantastic job taking care of patients. Dr. Hermenegildo and Dr. Ana have both now rotated through Kalukembe and have been great ambassadors for physician trainees at our hospital. Our nurse colleagues have appreciated working with them and our patients have benefited from added doctor presence. Please keep praying as we develop this training experience so that doctors who pass through might learn quality care in austere environments

Man, I am impressed what these guys come up with. They built a tree house out of bamboo and scraps, and no injuries (that's where my ER mind goes)!

Most of the time, I am on children's ward where the largest number of patients and highest mortality lies. Occasionally, I will see patients on mens ward, especially ones who need to be transitioned to palliative care. It is a painful but important challenge to help staff and family transition with patients when they enter the active phase of dying. Having conversations about prognosis, treatments that can be accomplished and ones that should not be pursued, dying with peace in their hearts: peace with God, peace with themselves, peace with their loved ones. . . these are all issues requiring wisdom that I know i am far from having.  I see not only the difficult fragility and endings that face patients and their families in these moments, but my own limits to healing and restoration. It's painful, it's beautiful and it's a privilege to be with them in those times. Romans 12:15-16 is a beautiful reminder to make this a habit of living with others as we all experience the joys and setbacks of life. 

Julia (L) and Anna (R) here with one of our lovely fistula patients (all permissions given). Julia has been more involved this time in ancillary care of our obstetric fistula patients--purchasing food, checking on housing, helping them settle in to their often prolonged stays at our hospital. Both young women have been a delight to have with us since we returned to Kalukembe. We have benefited so much from their kindness to especially our children and our family. We are excited to learn that Anna has also been accepted to medical school!