Happy New Year (Boas Entradas)

Greetings from rainy Huila province in Angola! We celebrated a warm, wet Christmas with gifts sent through a visitor earlier in the month to supplement our local "plaça" purchases for each other. I received a nice, warm herbal bath that i almost drained away through the confusion of thinking my bath was in the usual bathing bucket. Priscila had a magical way of making our time quite special.

Since our last post, we welcomed the De Sousa family to Kalukembe for a week before Christmas. Dr. Eduardo and Jocelyn (FNP) both were a delightful help in patient care at the hospital and they also helped in our continuing medical education two-day seminar at the end of the week. They serve at a surgical hospital in Lubango, and we are very thankful for their loving hearts for both our patients and colleagues. Jocelyn's parents and her four children also kept our kids busy with crafts and cookie-making when they were not out playing.

The nursing housing renovation project is also underway! Hope you enjoy those and other pictures below!

Cerebral and other severe forms of malaria have been burdening the local population in recent months. It's one miraculous recover i never tire to see when a seizing and unconscious child one day will be sitting up and eating breakfast two days later. It's also a very heavy burden when one sibling dies and the family is torn whether to remain at the hospital for the other one's care or abandon the care to return to the village. It is not easy for parents (most of our patients with severe malaria are children), navigating decisions made with other relatives regarding financial and health priorities. Please pray for our patients and their families; for our colleagues to give treatment proactively and caringly in spite of poor overnight staffing; and for improved prevention efforts, including that mosquito nets will be available to everyone.

Mahulo is a burn patient who suffered contractures and an infection at an outside hospital, but survived a 25% body surface area burn. Thanks in part to your support, he received contracture release operation and some skin grafting! His right elbow had been stuck with his hand in the "Thinker" pose before operating. Since this photo, he's been discharged and getting outpatient dressing changes. We celebrate his progress!

Rain never slows Zeke's dancing down! So far this season, the rains have been good for southern Angola crops. For this, we are very thankful given the previous dry rainy season

Enjoying a sunset on the beach with Eliel. Happy new year!

A somewhat "before" picture of a room in the staff housing area. The walls were already done before this picture was taken.

New metal shutters are replacing the old ones. And there are other old windows that had been sealed off that are now opened up again and given new shutters, too. We don't know the progress of the funding to date, but we had 50% needed to begin last month. Thanks for your support! 

Dr. Eduardo De Sousa at the continuing education course. Our audience included doctors and nurses from area government hospitals and clinics as well as nurse clinicians from our hospital and some of IESA's remote outlying clinics. Dr. Eduardo, who used to work with poly-substance abuse patients on Ojibwe reservations in Minnesota, talked about domestic violence and pregnancy. It was very well received and we are really thankful for his experience and openness to bring culturally sensitive topics like this to the seminar. 

Priscila giving a talk on vesicovaginal fistulas at the same seminar. Most of the seminar was focused on Maternal and neonatal health and care. Audience participation was as high as ever. . . especially because almost everyone acted out different patient scenarios Priscila provided. We are thankful to the Fistula Foundation and individuals who support ongoing education efforts!

Children of hospital staff sharing their approval at the building progress in their neighborhood. Thanks for making a difference in their lives!

Photos by Art

Amidst all his camera equipment, Artur used doll "stuffings" that have been given to our patients on the Children's ward. Hurray for early Christmas presents!

We had the pleasure of two visitors last week: Dr. Laura Smelter from Christian Health Service Corps and Artur Gajda, a cinematographer from Canada. Though the focus of Artur's trip was capturing videos of Kalukembe's story and our experience there, he did take a few stills. These are just a few to share with you now. I am amazed how with an artist's eye, these pictures tell the story of our community and its beautiful people in ways our words struggle to describe. His website is found by clicking here. 

Men in traction treatment for their long bone fractures on Men's ward

Zeke and Priscila walking in the patient villa

Antonio Chijenge, the leprosy program nurse. 

Daniel Pascal, one of our OR instrumentists/casting techs/minor proceduralists/etc. 

Children looking in on the nursing, lab and Bible school graduation that was celebrated last Sunday 

Neonate with skin infection on Maternity ward.

Priscila with fistula patients and family members on Women's ward. 

Priscila with EF, celebrating together a successful recovery from surgery 

Nurses Daniel, Rosie and Fedi in our ICU and preparing the "paozitos," which are cotton rolled onto sticks that are then sterilized and used for cleaning wounds or preparing skin for procedures.

Thanks, Artur! 

Kalukembe Staff Housing

Are you looking for an early Holiday present? We are! Some of our staff at Kalukembe live in these crumbling adobe homes, often without latrines or cooking spaces. We are looking to raise $90,000 for repair of 18 homes, latrines, and kitchen structures. If you would like to join us in celebrating early, you can support by going to this: Kalukembe Housing Project  ! Please write HOUSING PROJECT

Fall 2019 Letter

Coping with loss, living with hope.

We gain lots of things coming here, including the experience of loss. Eliel, just days before his 6th birthday, had fallen in love with his sweet Bunny. He tenderly cared for him, hunted for green leaves even in dry season, and would share stories and draw pictures of his friend every day. Suddenly Bunny took ill, and in a matter of hours we watched Bunny die, helpless and disbelieving. After local fashion, we buried him on the same day, surrounded by friends, there to help carry Elie's grief. It's been several weeks now, and Eliel still talks about Bunny, his memories. Death, very real to us, continues to be ever present. But today, as I sit here listening to the deafening pounding of first rains and the shouts of joyful children, I'm hopeful. We are thirsty: He is the Living Water.

Our neighbors and neighborhood.

 Gentlemen waiting outside their brother's room on men's ward. We love meeting our neighbors!

Sunset at Rio Kukala (our local creek). 

Biology, bigotry and the blood of Jesus.

 Last week we walked to church through the woods, passing a small cemetery covered by the graves of all the new borns who die at our hospital… and lastnight I wrote a review for a government epidemiologist of the 7 maternal deaths the hospital had in the first 6 months of the calendar year.When asked what our “numbers” for neonatal mortality, I reply grimly “I don’t know, a couple a week, I’ll have to go count.” Daniel is at the hospital right now preparing for a cesarian delivery and rationing out our magnesium sulfate to another eclamptic lady, this one just arrived from an outside hospital and has been seizing for 3 days.

Home deliveries gone awry, septic infants, premature babies, anemic, febrile, infected. Mothers seizing from eclampsia or malaria, febrile from disseminated TB or schistosomiasis, hemorrhaging from placenta previa or abruption, septic from their uterine rupture or concomitant typhoid perforation… this happens all the time. 

But it's not all heavy. We have fun moments where our odd homeschooling strategies and patient care sometimes work out well together! Let me tell you about one such case: 

Last week Monday I was carrying for a lady with a septic abortion who was anemic, with a Hgb < 4. We treated the infection, removed the retained placenta… but she still needed blood. I left family with the task of finding someone to donate blood, and went home, praying. Tuesday morning is a school day for me (meaning I magically become a kindergarten and 2nd grade teacher) but at breakfast I got the distressing news that the young woman, whose family is from “the bush,” only had elderly ladies with her and were unable to donate. So after our math assignment, I told the kids we were doing our science experiment early. We we walked over together (along with our dear friend Luis, who does school with us) to “Hemoterapia” (our “Blood Therapy” ward) where I donated blood. We then walked over together to maternity… everyone taking turns carrying the bag of fresh warm blood. The boys were interested; Naomi, seriously worried. “Are you going to die? How can Philadelphia blood mix with Kalukembe blood? Are you strong enough right now?” She scowled watching the blood being given to our young lady, worried for a bit, that this life-giving blood was going to take my life. But in the end I laughed, picked her up, and we skipped out of maternity together. On our walk home we all had a sweet talk about biology (how amazing our bodies are!), bigotry (how we are all the same inside), and the blood of Jesus.

And guess what? Just like that she got better! I showed the kids her smiling face on the day of discharge and we all celebrated, even Naomi. This week we also re-double our efforts to prevent maternal and infant mortality. We restarted our ultrasound outreach (funded by Hope for our Sisters), where we invite ladies to come for a free prenatal ultrasound (usually costs a day laborer a week’s wage). It is sweet to give surprise notices of twins… but it is also a time to counsel risks. In three days we did 47 ultrasounds… a small step, but worth celebrating too. 

II Corinthians 5:14-15

For Christ’s love compels us, because we are convinced that one died for all, and therefore all died. And he died for all, that those who live should no longer live for themselves but for him who died for them and was raised again.

Scenario 1

Update from Kalukembe! We have been here for a month and a half; Priscila continues with multiple tasks including homeschooling, caring for guests, caring for patients including reinitiating care for women with vesicovaginal fistulae, thinking up new ideas for projects for the family and hospital and home. I continue in my moral support with occasional skeptical commentary. 

Imagine this coming out of the liquid that bathes your brain and spinal cord. I can't. The 9 year-old boy that I drew this fluid out of had been sick for roughly a month, getting various treatments, including an assortment of antibiotics (though none likely were properly prescribed or taken), traditional medicines and then in the last week, his condition worsened. Pus drained out of his ear, he mounted persistent high fevers, and his neck grew stiff. His father took him to the municipal hospital across town but they told him they could do nothing and sent the boy to us. That day when his father brought the boy to our hospital, he no longer could talk and could only moan, eyes wandering in separate directions. His father was clearly concerned, but it was already too late for us to save the child. Even with the right antibiotics, antimalarials and judicious IV fluids--for a malaria rapid test positive, smear negative result (and this LP test was just done out of curiosity how the lab would interpret the liquid), the boy died 2 days later in our ICU.
The story's like this boy's played out for at least 6 other babies and children this past week. . . treatments at home or in some nurse's clinic that don't show improvement and then the parents bring their child unconscious to our hospital. After expending their time, money and efforts elsewhere, I feel heartbroken to see the children succumb to intervenable and preventable diseases.
Government officials recently visited our hospital to look through the charts of malaria deaths recorded here year-to-date (almost 90). Apparently, only 2 deaths were recorded due to malaria last year--clearly something off with our statistics. It overall seemed to be a good learning experience, for the hospital to be reminded to maintain better records of what happened to patients and improve diagnostic clarity. We all have much to learn in caring for our sick. I should be the first to admit I miss the mark to be compassionate and competent with each and every patient. I pray God will give me and my colleagues the desire for whole healing of our patients and families. It's for His goodness sake we seek healing.

Return to Kalukembe 2019

We are back home in Kalukembe and are so glad to be here as a family, caring for our neighbors, sharing our animals, cleaning up our house, and learning through so many venues God provides.

Animal Assisted Therapy: bringing our rabbits to the pediatrics ward!

Students from our most recent seminar, "Where there is no doctor" that Dr. Nick Comninellis taught. The course was very well received and the nurses from our remote clinics benefited most from this continuing medical education. We hope that another seminar can be arranged in December. If you have interest in teaching nurse clinicians, let us know!

Our kids and friends climbing the banks of our local creek with our friend Dr. Steve Collins visiting

We've re-started our Fistula Program... some ladies have been waiting patiently all year, others have come recently. 

Family and friends: kids are starting back in school, also joined by our dear friend Luis