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! 

   

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.