Our friend David

David is Zeke's friend here at the hospital, they love each other! They are the exact same age and he is the first and only child of his young mother who takes care of him with such sweetness. He contracted cerebral malaria and, despite being treated at the Central Hospital, became blind. He is a beautiful, joyful little boy who is struggling to maneuver in this dark new world.... please pray for him and his mother.

Chiulo

We are back after 3 weeks away from home in Lubango: 1 week in Chiulo, down south and almost 2 in Kaluquembe, 2 hours north of here.

Baobabs around Chiulo

Chiulo Mission Hospital is a rural Catholic hospital with government funding for most of its services, and physician staffing provided by an Italian NGO, CUAMM. There are a range of services that include public health initiatives, a TB sanitorium, antiretroviral clinic and a nursing school next door. We went down to help the doctors, as the surgical resident and general practitioner were carrying heavy workloads without breaks. With a radiology tech that only shows up once a week (Saturday or Sunday, depending on how he feels), a lab with only basic microscopic and blood tests (no creatinine checks here! Leucocytes? What are those?), and nursing students left to run the wards when staff nurses go absent, we are quite impressed with Marco and Bernadita; their bare-bones medicine and surgical skills and dedication to their patients are an inspiration. 

Many patients travel for days to arrive for care. On the pediatrics ward, the common diagnoses were malarial complications, malnutrion, diarrhea and measles; on the adult wards, many had TB and its complications and others were patients with AIDS-related complications who had stopped taking their antiretrovirals and 'relapsed'. On maternity, Priscila cared for a variety of prenatal conditions and encountered a high number of neonatal deaths. Daniel performed the one C-section of that week with Marco on a woman with anticholinergic syndrome (and Bernadita rescucitated the baby with Priscila’s help).

Marco and Daniel performing a tubal ligation (no, the bed does not go higher)

Daniel is relieved to know no pistols, grenades, machetes or AK-47s are allowed on the premises. . . the luxuries of occupational safety!

This lady has a leprosy flare. During the war, leprosy was neglected; it has persisted in rural parts of the country, though it supposedly has come under better control.

Priscila ultrasounding just before leaving Chiulo, with Tim Kubacki (left) and Marco (right). 

This lady tried to kill herself with a knife the night before coming in. She cut her throat and trachea above the thyroid membrane and missed all the frightening real estate that is located there (we even saw the pulsating carotid artery on her right side!); we opted for primary closure of the trachea (no ventilators and just one size 6 Shiley cannula), gave her dexamethasone and she did physically well post-op.

Birthing suite

Summer 2012 letter

Daniel at Dondi

Mother and child at Dondi Mission hospital

Steve Collins, operating on a patient with cataracts (over 100 operations in 2 weeks at Dondi)

Patient in bed, after her surgery

 A happy patient the morning after the operation, able to see her daughter again

AK-47 shells: remnants of the war in Huambo province

I visited Dondi Mission Hospital for two weeks last month. While i saw patients with general medical problems, Steve Collins cared for patients with eye complaints (the main reason for our trip). Until the mid-1970's, the mission maintained a seminary, agricultural school, leprosy mission, TB sanitorium, nursing and lab training schools, an international school, animal husbandry and a busy hospital servicing an area close to 2 million people. All this was destroyed during the civil war; now, a Bible school and girl's school are all that remain. 

It's a beautiful area, with even more beautiful people we met through our work there. And we pray that, with time, help for the people of the area will be restored.

Some of our medical work

Medical team to Kalukembe: the regional referral hospital for  1 million people, 180 beds and no doctor. We  come here once a month and are wondering if this might be a place for us long-term 

So this huge abdominal mass, thought to be a large ovarian tumor turned out to be a 10kg messenteric cyst!  

Nursing at Kalukembe: limited resources, lots of work. 

Priscila supervising the medical student Jody... they actually had fun! 

Zeke growing up: 15months

Zeke with his friend, Eva

We were trying to get a nice family picture.... Daniel had a temporary mohawk and Zeke was very distressed about our removing him from the fish pond he was swimming in. 

Catching up

We visited for our first time last month Kalukembe/Caluquembe hospital with the team from CEML. Just a 45 minute flight away (and now with paved roads only about 2 1/2 hours by car), this hospital was founded  over 100 years ago. It is a busy place with a wide reputation and without any permanent physician for over 10 years. It only shut down one day while it was being bombed by government forces during the civil war. Today, it is a church-administrated, government-funded hospital. The CEML staff go almost every month for a long weekend to perform surgeries on complicated cases (vesicovaginal fistulae, complex femur fractures, oromaxillofacial surgeries, and so forth), round with staff to see the difficult cases and discuss questions they have, and encourage everyone in the good work they do. While Annalise Olson performed surgeries all day and night, Priscila was busy repairing vaginas in the OR; Daniel taught a some ultrasound, saw medical patients and relocated a hip that was out for 2 weeks! and Zeke entertained the off-duty nursing students. We look forward to returning later this month, then hopefully extending our time to a few weeks in September with them. For more stories on Kalukembe, check out Dr. Tim Kubacki's blog at http://kubacki6.wordpress.com

 Daniel, Eduardo and Annalise with a sequestrum and the patient (from whence the rotten mandible came) at Kalukembe. For those with stomachs, we have pictures showing how far the infection spread. Feel free to ask. 

 Zeke and friends on the airstrip at Kalukembe

Priscila and Annalise at the weekly radio show on medicine and health. Yes, even an OBGYN and a surgeon have opened Harrison's. Priscila has been involved in the topics of sexually transmitted disease and endometrial cancer. Daniel volunteered to watch Zeke at home for these shows. He did try his hand at the motor vehicle accidents show and realized his Portuguese was still at an elementary level. He answered an open-ended question with "Sim! (yes)" The moderator wisely navigated the rest of the questions to others for the remainder of the show.

At Hospital CEML

Dermatology is not my strength, so skin diseases continue to keep me humble. I read in one manual that skin diseases make up 20% of outpatient visits in the developing world. That’s more than I see, but there isn’t a day that goes by without at least one patient with concerns regarding the body’s biggest organ. Here are three of many patients I have seen. . . .

This is a young lady who had lived further in the interior of the country for a couple years and came because she was having an itchy rash all over her body (except her head). These lesions were tight and were not fluid-filled.

She had a slide of her blood prepared and reported to have microfilaria whipping around. Diagnosis: Loiasis. Since we don’t have the first line treatment, DEC, available, the royal we prescribed a 3-week course of albendazole. She hasn’t returned, so we hope it worked.

This 45-year-old gentleman has a rash I’ve seen several people with. It started on his shins 10 years ago and gradually has spread up. He had a (successful?) ligature of his veins on the right leg that stopped the spread, but had an unsuccessful attempt on this left leg. He also went a 6-month treatment course for pulmonary TB but this rash continued to spread during that time. He is in the hospital for a skin graft of a part of the rash that had ulcerated; he was treating that area with cow dung—to no avail. He had a couple checks for lymphatic filariasis that were negative (and he’s HIV and VDRL non-reactive, too). Diagnosis: not sure, and we welcome your thoughts! Being a surgical hospital, his skin grafting will be prioritized.

The right leg (like his other side) had a saphenous vein ligation.

We frequently find this strange boy waddling around in our kitchen, getting his hands, feet and face into anything he can find. The lesions on his face tested positive for chocolate. Diagnosis: bagunça

Spring 2012 letter

At our new home: Lubango!

La Leba: a scary road

Young men singing on the edge of cliff.

We were praying the roads were de-mined.

Daniel and Zeke looking out at the expanse.

The valley bellow the plateau; during the war, victims were shot and thrown off the edge... until recently, bodies and skeletons could still be seen.

Zeke playing on our new porch.

Making bread with Berta, our friend and neighbor. 

Patients at the Rio de Huila Hospital: Zeke loved meeting them! 

Zeke's first birthday in Lubango with friends.

Moments with our family... en route to Angola.