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!

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!