Summer 2013 Letter

Spring 2013 Letter

Fall/Winter 2012 Letter

Chegada (arrival)

We're now back in the USA, and it's Independence Day! Hooray! After two months at Kalukembe (more pictures to follow this post), we packed our bags, left a few belongings in our friends' container and boarded the plane out of country (and then 3 more to get to Philly). Zeke had a great time watching 'avião' after 'avião' take off and running down long terminal corridors.

Thanks for your prayers. We will be in Philadelphia after visiting family from this fall at least until the end of 2014. Priscila will be taking her oral boards, we will be looking for organizations to return with and, God willing, will be going back in 2015 to Kalukembe. Daniel will be working in Delaware at Christiana and hoping to take some cataract surgery training towards the end of our time in the US; Priscila will be working part-time at Esperanza health clinic in North Philadelphia as well. Zeke will be playing with his cousins, living with two who are in Japan right now. He's already on cloud 9 with so many planes flying over our south Philly home.

Priscila giving a talk on cancers affecting women to over 1200 women in Benguela

Zeke and his favorite lady friends, our neighbors Bety (r) and Avidé (l)

Since the water pump/tank was not working our entire time there, water was a daily struggle for the hospital. Here, they are filling the tank to be used for the operating room (but without a gravity feeding system, the staff would use the faucet at the bottom to cart the water into the OR).

Priscila, with the vesicovaginal fistula ladies she operated on during her last week of operations. She has gotten to know these ladies well over the course of time together with them. We miss them and pray for their social, physical, emotional and spiritual healing

Towards the end of our time in Kalukembe, one of Zeke's favorite things to do was to walk around the house, mimicking the local ladies carrying loads on their heads

But don't think we are immune to the draws of materialism! Zeke was amazed at how many cars were in just one store at the airport in Johannesburg. "Bue! (a ton!)"

On the move

We are on the move! We'll be moving to Kalukembe tomorrow (Priscila's birthday) to spend our last 2 months in Angola there. We have plans to return and work long term at Kalukembe as well. Our time at CEML is now finished.

Since our last post, we went back to Chiulo together for two more one week stints and Priscila had more in-depth vesicovaginal fistula (VVF) training at CEML. We've been packing up as Pri's been fitting in a number of gyn surgeries. And yesterday, we celebrated Zeke's 2nd birthday! Don't have the camera with me to upload those pictures yet, but lots of balloons and Zeke going wild over more trucks to play with. Other pictures below.

One of our favorite things about Chiulo are the abundance of baobab trees. Such fun-looking trees, we also love the "popsicles" that people make out of the fruit.

Malnourished 7 month-old twins, A and E. The mother's breasts had been severely burned months before and they were faring poorly on milk from other sources (no, she did not have money to buy formula). Chiulo has a consistent flow of children 'failing to thrive,' as we say in medicine. Unfortunately, even in the rainy season with fruits available, there are always on average 20 children in the malnutrition program. The pediatric census stuck overall around 80-90, most with malaria as the admitting diagnosis.

Before heading to Chiulo in March, we flew to Huambo for Priscila to give a talk with Dr. Steve Foster to the Women's Organization of Angola (google image search "oma angola" and several lines down, you'll see a picture of zeke from our blog :) R to L: The Most Beautiful Presenter holding the Rascal That Kept His Papa From Hearing the Presentation; the event organizer (sorry, forgot his name);  Steve Foster; Esther Chin, OBGYN resident extraordinaire from Ontario who came for 2 months; Matthew Chen, her fiancee and family practice doc who also came and helped with everything from pulling teeth to operatively delivering babies to accompanying me on interminable rounds at Chiulo; our master pilot, Brent Mudde

Zeke loved walking to school in the mornings with Dr. Laura Marin (lovely public health doctor with CUAMM at Chiulo) and her two daughters (and friend)

Ladies from Kalukembe (and a few of their spouses) who were flown to Lubango for their fistula repairs. Priscila was instructed by Steve Arrowsmith (see if you can spot the white urologist in the picture), who came for two weeks. Around twenty fistula repairs were done. . . i better ask Pri how many. i know she was operating every day, but i lost count.

Not every surgery during those 2 weeks were fistula repairs. This was a a stone i removed with Steve Arrowsmith from the bladder of one of the ladies who had a fistula in the past. Yes, i forgot to clip my fingernails for the picture.

Zeke, sporting his new favorite truck clothes and his favorite sapatos; gifts sent from our friend Julie Carter! Thank you, Julie!

Esther, Rob and a week at Chiulo

Rob and Esther Reich, sogros

It's amazing enough when family comes from far away to visit! Solomon wrote, “Like cold water to a weary soul is good news from a distant land.” But Rob and Esther Reich did not just come to visit us last month; they came to see Kalukembe and dream with us about possibilities of working, living and serving together there. In the short week we had together, we worked on the wards, performed operations, consulted on patients in clinic (Rob provided key HIV insights), attended the big annual IESA service (lots of church chutzpah, very little gospel speech), and passed our free time with long walks and talks.  We hope they had ample time to observe, question and process and then repeat that cycle again. 

Rob is a physician assistant and Esther a nurse, both who work at Esperanza health center in North Philadelphia. They already have much experience in community health and ministry; speak fluent Spanish (just a small jump from Portuguese); love the Lord and love caring for others; are simpatico; and are family (we'd more likely have an 'iron sharpening iron' experience; or, they'd just tell us when we're off the deep end). Looks great! Sign them up! . . . well, we know there are things to still ponder and pray about for them. God knows the desire of our hearts is to serve together with them at Kalukembe; but wherever they are and will be, we feel blessed to know them and to see their life stories be played out. Thanks again for coming, and a big thanks to Elias and Sammy for letting your parents come visit!

On a walk in Kalukembe.

Same, sad tune. Very few medications at Kalukembe.

On another subject, Daniel went back to Chiulo hospital for a week to fill the void of no physicians last week. Zach Rossfeld, a 4th year medical student from Ohio State University came along to help and posted a really thoughtful blog entry, which you can access by clicking here. 

Zach Rossfeld, in front of the HIV/AIDS outpatient clinic/container at Chiulo

This upcoming week, we have plans to go north to Huambo for Priscila to give a fistula talk and then back south to Chiulo with Dr.s Chan and Chen to keep helping out there until the new doctors are to arrive on the 19th. More to follow!

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!).