Kalene mission, Zambia. 1.17-2.1.2013

Kalene Assembly, where the Brethren Christians of the area worship. Way in the far northwest corner of the country, close to both Angola and the Congo, Kalene is a mission with a hospital that has been serving the area since 1908. This was our second place we visited while in Zambia for the month.

Kalene mission hospital, front. The hospital houses around 200 beds, with currently mostly pediatric patients. A nursing school is attached to the hospital. Roger Holland, an American family practice-trained doctor is the only full time physician there. The number of Western visitors to the hospital is comparatively much less than Chitokoloki.

Some of what we did. Here, Priscila is operating with an OBGYN who came for a week from Ohio. Daniel lost track of the number of hysterectomies and BTL's, but it was somewhere around "a lot." Daniel often did the anesthesia (spinals and ketamine, baby) as well as other procedures in the OR, and saw patients on the wards and in the clinic.

Priscila with the family of one of the patients, in the surgical waiting area. Almost all the patients come from the Lunda tribe, whose territory spans Angola, Congo and Zambia. In fact, two provinces in eastern Angola are named after the tribe. There are sad stories about how heavily these people suffered through the slave trade. . . . We could speak in Portuguese to most of the patients who came from Angola (though the flip-side of speaking French to the Congolese didn't hold as often). This certainly helped when we couldn't find a translator. Nasekelele!

At the headwaters of the Zambezi river. No crocs here! Just lots of fun exploring the rocks and nearby hydro-electric plant (spear-headed by an orthopedic surgeon from Northern Ireland, Peter Gill). Zeke especially loved the natural water slide. And the water. And the rocks. And the bugs.

Our cousin, Abigail, came to visit us! She was with us the entire time at Kalene. She came with us to the hospital, played with Zeke and was a great companion. We discovered berries in our back yard and engorged as many as our bellies could hold.

Zeke displaying the giant grapefruits of the area. Kalene is most famous for pineapples that grow for all but 9 weeks out of the year. Aside from pineapples, the area is full of fruitful goodness. Coming from Angola, where everything seems to be imported and very little fresh fruit exists, we were floored by the delicious bounty!

Seen on a local grocery store wall. Glad to know our lives are secure at Kabs Best.

Delayed Post

It’s been too long! We can use the excuse of being blocked from blogging, but only for the last two weeks of January did that one work. Then Esther and Rob (sister and brother-in-law to Daniel) came a-visiting . . . excuses, excuses; I’ll just get on with letting you know a little of what’s happened in the last 2 months. Let’s see, December was a month spent working at CEML and staying in Lubango. We also had some challenges in getting our visas in time for leaving to Zambia the beginning of January, but thankfully our exit and entry back into Angola went without hassle (and our luggage did not disappear this time, either!). With your financial support, we were able to visit 2 mission hospital sites in rural Zambia. The first place we visited was Chitokoloki. After flying in to Lusaka,  David and Ruth Gordon (hospital administrator) drove us the 10 hours it took to Chitokoloki, up in Northwest Province. The road varied from tarmac to bush path to crossing a river on a pontoon, and all went smoothly. Below are some pictures of our time at Chitokoloki, which was from the 5^th to the 16^th. The place looked like a garden, and the Zambezi a deceptively tranquil river (there are lots of crocodiles, we’re told; even while there, a dog and cow were snatched by the crocs . . . if a cow can ever be snatched). Rainy season is a very beautiful time of year in so many places in southern Africa!

The mighty Zambezi, 4^th longest in the continent, great crocodile waters. And I’m told is rife bottom-feeding fishing to be had. And croc hunting, so long as your boat doesn’t have a hole in the bottom of it. This is an activity Priscila would disapprove of.

Dr. David McAdams and patient.  Dr. McAdams has been at Chitokoloki for over a decade, after working in DR of Congo for another decade. Full of experience and stories, we wished we had more time to be with him. He left 4 days into our stay for his father’s funeral in N. Ireland. 

Priscila, performing another flawless vaginal hysterectomy, assisted by very capable hands. The OR staff at Chitokoloki were kind, caring and very impressive. It was a delight to work and serve with them. They even doubled as translators for our outpatient consults.

Rounding on Children’s ward. About 50 patients with a mix of respiratory illness, malaria and malnutrition, with the occasional extrapulmonary TB child in there, too. Here, Julie Rachel is with us. She is a nurse/jack of all trades, doing anesthesia, some surgery, midwifery and, while Dr McAdams and another RN are away, covering all the wards.

TOA team! A young lady presented with acute abdominal pain, an ugly ultrasound, and in the OR, we confirmed a tubo-ovarian abscess. Since medical care is free at Chit, she went from presentation to lab to OR all within 2 hours. At our hospital in Lubango,(where it is fee for service) this type of operation would have been delayed longer.

Solar Panels that power the hospital. Solar power allows the compound and hospital to only need diesel-generated power 2-3 hours a day

 

Blog posts from our friends

If you'd like to see better and more interesting pictures than what we've taken (with fun commentary), take a look at our friends' blog, http://pedrohispanoemangola.blogspot.com . Jorje and Marjerida are two fantastic general surgery residents from Portugal who visited CEML for 30 days in October/November. We really benefited from their companionship and help! Even if you have a hard time following their commentary in Portuguese, they posted lots of pictures that you can follow. They also included an extensive photo-diary of their weekend in Kalukembe. If you go back a little in the posts, you'll see pictures of the city's central hospital (and the 12 new ambulances still not in use) and life in and outside the hospital here.

Enjoy!

Ultravivid: a tour of Kalukembe

We just came from a week at Kalukembe and are back at CEML doing consults and operating. Our time at Kalukembe solidified our interest in returning long term (but still plan on going to Zambia in January to look at a few more options). We wanted to give you a little tour, since you'll be here with us (whether physically or spiritually) if we return. With the support you've been sending we were able to purchase a new camera (to replace the stolen one) and since Priscila didn't know how to turn off the "super vivid" setting... that's what you're getting! That is just fine: after the rains everything is intensely sweet and green and the images actually do a little justice to the scenery. Enjoy!

Walking from the living quarters to the hospital through a beautiful path under shady savannah trees. 

The patient family housing, many patients come from great distances, stay for months, and are required to feed themselves, hence a family member needs to come along to care for them. 

The banco de urgencia (emergency room) is a little bit of a joke for Daniel: it is a small room off the side of women's ward with a desk and a bed, really nothing else. On one door the sign actually says "gynecology" ... but Priscila has only ever walked passed it. 

Main hospital entrance/drive: in 1994 the hospital was ransacked by government forces, everything from meds to bedding and curtains were stolen, other things were destroyed. The government, however, has just committed $30million dollars to rehabilitating and expanding this 300+bed hospital, and they are looking for doctors to staff it. 

To your left as you walk towards the hospital: the operating theaters. Notice the defunct solar panels and water tank. The water pump was broken while we were there so the pre-op scrubbing was done with rainwater, murky with local red mud. 

Casting room, with a fresh white coat of paint.

Some of the operating theater staff: center is Paulo, head of the OR: a surgical tech of amazing skill, authority, and patience. When we aren't there is he pretty much it for major surgical interventions and does other minor surgical procedures. He does everything from cesarian hysterectomies to hernia repairs. We enjoy working with him and appreciate his tutelage.

This is a crying shame: can you help with this? This is the surgical library. Please let us know if you have any GOOD surgical books you'd be interested in donating. 

Priscila continuing her vaginal surgery work... here we actually had a lovely anterior/cystocele repair (refreshing to mix and mingle the fistulas and hysterectomies with these types of procedures). Notice the size 8 gloves. We don't have much options for glove sizes, you use whatcha got.  

If you were to exit the operating rooms, directly in front you'd see Maternity or ("L&D" for my obgyn friends). Family members are waiting outside for visiting hours.  

A cute baby wrapped in colorful winter clothing. Beatrice is one of the new senior nurses/midwives who I respect and really enjoy working with. She is competent, diligent and responsible. Awesome. 

Wondering what daniel is doing on maternity? Actually doing a consult on a labor bed - he is a prized consultant and so since the outpatient offices were closed he came up to do his consult and ultrasound on maternity. 

The nursing students at Kalukembe are one of our great joys. Here they are curiously peeking over to a police-reenactment of a stolen baby incident. During our time there the dreadful thing did actually happen: a desperate woman, pretending to be a young girl's relative took her newborn to "change the diaper" and never returned. There was a huge uproar, the culprit (unintelligently lived in the neighborhood) was actually nabbed by police within 24hrs. 

I came around later to maternity and found the young 15 year-old mother (one of our FIVE eclamptic ladies admitted over THREE days) reunited with her daughter but also confronting the thief. The police  had brought a professional photographer with them and forced the woman to reenact step-by-step the kidnapping. Once outside maternity such a huge crowd had gathered we were afraid the woman was going to be lynched. Thankfully she was taken away in a police vehicle.  

Exiting maternity and walking down past men's and women's ward you'll hit the outpatient consult area. Here patients start gathering at 7am and (on days that Dr. Steve Foster or Dr. Annelise Olson are around) will wait until 11pm. It was lunch time so folks were out looking for some nourishment.  

Once you register, pick up your outpatient file, make it through the nursing triage, you wait here for a medical consultation. 

This young lady is actually a friend of mine now: Delfina. Her first and only pregnancy was tragically complicated by a diagnosis of heart failure (EF of 10%), we followed her very carefully and were planning on inducing her at 32-34weeks (she was decompensating) but she disappeared for a few weeks and came back with a dead baby. I was surprised but delighted to find her at Kalukembe (she lives in Lubango). Her sister is that wonderful senior nurse Beatrice (on maternity) and so she was being taken care of by Beatrice's family.  

Between the pediatric ward and the HIV/physical therapy buildings are some more lovely trees and landscaping. I'm dreaming of doing more gardening around maternity. 

A typical afternoon for family members: three generations of ladies there to care for a sick child on the pediatric ward. Typical African dress is very practical: these beautiful skirts double up as a blanket, towel, sheet, cover for the rain, etc. 

Our super-boss and Clinical Director of the Kalukembe District Hospital Sr. Nelson. He is an amazing man: graduate of the nursing school here, works NON-stop doing outpatient consults, inpatient care, administrative work, translation and organizing/scheduling surgeries during our visits, follow up, applying for multi-million dollar grants to rehabilitate the hospital, teaching at the nursing school, AND just started doing his bachelors in psychology! We are all lazy bums next to him. I had to take this picture on the run - he never stops moving. 

Well, returning to to the living quarters, we again enjoy the (seasonally) verdant walkways. 

Here are some of the living quarters for the nursing students, notice the plethora of satellite dishes :) 

This is Zeke after a week in Kalukembe: tired but happy to have spent the days running after dogs, birds, chickens, ants, cicadas, lizards, and being shuttled around on the backs of ladies (including mommy who sometimes has to take him to maternity on her back to do consults and deliveries.... but only once into the operating room for an emergency procedure!).  

Alive and well!

Thank you to everyone who is praying, encouraging and supporting us these last few weeks! It has been difficult communicating, so please forgive us if we haven't replied to your emails. This is our first family picture in a long, long while (taken by some friends yesterday) to prove to you that the theft hasn't stolen our joie de vivre! God is good all the time, All the time God is good. We are heading out to Kalukembe District Hospital today after dropping off our new passports (horrah!) at the immigration department (to restart the visa application process), getting new tires (at least $220 a tire. . . yikes!) for all the off road driving, and getting our broken car window replaced with plexi-glass (more robbery-resistant, ha ha).

Follow up & cia

Here's a follow up photo of one of the gentlemen from our blog post back in May. He's responding well to anti-tuberculosis treatment :) Glad to see improvement! And following are a few pictures from the last few weeks. We will go next week to Chiulo hospital as a family; after being there alone earlier this month, Daniel is very excited about the prospect of going with Pri and Zeke.

probable TB rash, receiving medicines

TB rash, before the medicines

This girl from Chiulo hospital uses her mosquito net in a fashionable way

Overflow patients to the pediatric ward at Chiulo mission hospital. Daniel spent a week there at the beginning of the month as the sole medicine and pediatrics doctor; the under 5 Peds ward had over 130 children, Measles ward had 12-15, and another 80-90 medical patients were on Men's and Women's wards. Long days of rounding! 

Zeke digging the new high chair lent to him

Back at Kaluquembe

We spent a little over a week with our friends and colleagues at Kaluquembe earlier this month. This time, we walked away with a little more perspective on the work and challenges at the hospital. The clinical work kept us busy (hysterectomies, C-sections, fistula repairs, and a very sick antenatal population for Priscila; learning herniorrhaphies, head traumas, and treating a variety of medical conditions on men’s, women’s, TB and children’s wards for Daniel). And the beautiful evening walks rejuvenated us. But wow; the challenges for a place with such high infant mortality are daunting; so is the management of MDR-TB in a country that does not acknowledge it has such a problem (thus, there are no easy ways to test for it nor are medications made available for treatment . . . a scary situation that spells international crisis). In a country that has immense resources but where over 80% of the population still lives on less than US$2 a day, the barriers to good patient care are more than we yet know. Please keep praying for us (and for patients and health workers); we are trying to provide just and merciful care to our patients, but it feels that there aren’t many here who share that same desire. 

Femur fracture room on the men's ward. Note simple traction devices that patients remain in for weeks to months

Molar pregnancy as seen on our favorite piece of CEML equipment: the Sonosite Micromaxx. Treatment options are usually D and E or hysterectomy. Even getting methotrexate is a big hurdle here.

Priscila with nursing student and Dona Julia, the Chief midwife at Kaluquembe

Zeke, stewing something smelly

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.