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! 

   

June 2020

Since last sharing, world events have challenged every country. With this i've been learning the significance of daily work and rhythm; letting our plans for the future remain unknown. i am sure it has been a wild ride for you too, adjusting to restrictions, limited interactions, and new routines. It's hard for all of us, and we know each struggle is real, no one greater than the other: your experience or mine.... But allow us to share about the last 3 months at Kalukembe. Like for you, we've seen and experienced ups and downs. But our God is steadfast, and we know this more deeply than before. 

At the hospital, in spite of travel restrictions and cancellation of the monthly surgical visit (for elective cases), work was busier. It's been months filled with preparing space and staff for COVID-19, managing a surge in malaria cases, navigating interactions with government authorities examining hospital malaria care, and preparing for the exit of staff who have taken jobs in other places. 

For our family, we have learned even more about living and making memories in Kalukembe! We eat more local food, enjoy walks nearby, and celebrated 2 birthdays we thought we'd be celebrating in Brazil with Priscila's parents. Due to local school closures, our neighborhood kids visit us regularly for book exchanges from our small Portuguese literature library. And this past week we welcomed Dr. Damião (our new Angolan colleague!) and his family as our neighbors. 

We hope the pictures and captions below to serve as a good flavor of our past 3 months.

One of our electricians, Toni, putting up lighting outside of Pediatrics ward. In May our container from Samaritans Purse arrived, and we've been able to put up more LED lighting around the hospital: improving care and safety. 

Lena, Naomi and Priscila, all wearing the ever-popular bouffant that ladies locally wear. Guess which color Naomi loves!

Nurse Rebecca taking a blood sample from a patient to confirm malaria. We had been without rapid tests most of this season, relying on microscopy and clinical suspicion for diagnosis. Adding to the complexity, most patients arrive having taken unknown medicines, been to other health posts, been treated for unknown durations, and arrive with relatives who know nothing about the patient's story. Talk about working in a fog (ah, the fog of war analogies hold all-too-well here)! These rapid tests, a donation from the government, have been extremely helpful to confirm malaria. 

More happy container arrivals! Solar panels have arrived, part of the process of setting up alternative energy at the hospital. As it is, the main campus generator exploded and the replacement ones are not able to give enough power for some operating room equipment, such as the electrocautery machine. Some day in the future, we hope these panels will be an alternative energy source.

More evidence of the benefits of light! The previous fluorescent light was not turning on with the smaller generators, but with this LED replacement, the path from physical therapy to outhouses and the morgue is well-lit!

Daily routine on pediatrics ward. At peak, we cared for over 100 children a day, over 20 daily admissions due to malaria and over 15 blood transfusions per day. 2-3 children from the same family occupying the same mattress were the norm. So thankful for these mattresses from a US-embassy employee-initiated donation in 2018. They provided flexible care space quickly. This past week was the first week we did not need to use them, one sign that malaria season is now slowing down.

Zeke making sweet guava paste (goiabada) from the guavas he and his friends collected in May. Guavas are Zeke's favorite local fruit. Now in the cold dry season, we are very fondly remembering the rainy season's abundant fruits 

Cold season means Zeke and Eliel get to build many fires to keep us all warm. Here, they are listening to "Wee Sir Gibbie of the Highlands," by George McDonald read by their grandfather.

One of the small groups from IESA health ministry's meeting in Lubango on Friday, June 19. Groups of pastoral and health leaders were formed to work through challenging questions posed by the health ministry's leadership. They then re-convened to propose and discuss solutions. We face many challenges in the health ministry, but are very encouraged by the tone of camaraderie this meeting set.

A month past

Coming in to Lubango is a great boon for internet use and communication. However, we don't often get to personal writings we'd like to do and we get sucked into other work-related communications and obligations. Sorry! We want to share the progress made in February individually, but will start with pictures and their stories for everyone. Along that vein, thanks so much to your generous giving, our nurse housing project is 90% funded! This next week, the work is expected to wrap up and handed over to our local workers and electricians to complete painting and electrical work, etc. We are incredibly thankful to be almost funded, almost done and with nurses ALMOST moved back in!

Below are a few photos of the February that passed.

(Dead) Centrifuge Central. I took some inventory of lab machines to let a potential visitor through Samaritans Purse know what machines were available and what were in need of servicing. All 6 of these centrifuges were sitting in our lab, not functioning for some reason or another. Two more were also broken. For lack of maintenance, we have quite a few machines like these sitting around. If you have mechanical abilities and are interested in fixing hospital machines, you are most welcome! We do have local workers who help fix our chronically breaking down hospital generators, but for smaller machines like these, it has been a challenge to find capable servicing. We hope that if we get a container coming (still in the process since December 2018), there would be visitors who could help install newer donations and fix some of these guys! 

Nurses Cecilia and Joaquina preparing 8pm medicines to hand out to around 70 kids on our children's ward. February was a busy month with ongoing malaria season and staff nursing shortages. Making sure patients received the correct medicines through the correct routes and doses was a big challenge we worked together to achieve. Especially these two nurses have done tremendous work in maintaining caring and kind attitudes towards our patients throughout. . . not easy when families are trying to use their charcoal cook stoves in patient rooms and sleeping entire families on the floor as nurses try to deliver the late night medications!

Home schooling continues! Or, doing our best to instill the joy of reading and learning with our kids.  I am glad our kids love stories and that is mostly to Priscila's credit. 

Reconnecting with patients over the years in Chituto is a delight. This mother's story I posted in 2017 had suffered the losses of 3 children around their births. This is now her second child to have survived, the first born through Cesarean section. Glad to celebrate health with her and this 5 month old (who did have malaria on the day I visited. . . but got the right care!). I was quite encouraged by the opportunity to keep caring periodically for people of the Chituto area and to bring Zeke and Dr. Lena Gamble along this time.  We included prenatal ultrasounds with general medicine consults. 

Our Children's ward has seen this every morning for the past 2 weeks: overflow admissions from the night before on mattresses in the hallways with even 3 siblings to a bed. There have been quite a few challenges to be encouraging and help the nurses not miss the sick kids hiding literally between the sheets. Keep praying! There were promised mosquito nets that perhaps got diverted to other places and we've run out of IV fluids. 

Naomi helping Zeke up to take a look at the nurse housing renovations. The project is nearing completion and we are almost there with the support. Thank you so much! It has been exciting to see our nurse colleagues are eager to move in! If interested in giving, please visit the website here.

Assorted images

Naomi and the Cayanje construction: both look beautiful!  

Home-made dog-drawn carts :) 

Rainy season obstacles.

Pediatrics ward painting event! Art therapy. 

Broken bone Award

We were in the OR when someone said the kids were outside waiting.... Eliel gave the executive summary that Zeke had fallen off the roof while swinging on a nearby tree branch (en route to show Naomi how she should get off the roof), fallen on his arm (which was now crooked) and was lying in bed. Daniel checked him out (I said I would probably just start crying), brought him to the OR where our wonderful friends Annelise, Jamba and the surgical team kindly set his bones, plastered him up and gave him a fresh start. First broken bones of the Ribeiro-Cummings family: this was an Award Zeke was very proud of. :) PS we do NOT, as a rule, climb roofs

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!