Hope in a House: Casa de Esperanca

Women in Kalukembe are resilent and strong... but often suffer devastating losses, especially in pregnancy. Our hospital is in a rural area and often women have many hours (if not days) before they are able to arrive for an obstetric emergency. Even yesterday afternoon a woman, who had a complicated delivery the night before and hemorrhaged from a cervical laceration, arrived in critical condition and died despite our interventions.

Our Maternal Health initiative has grown as a response to this heavy reality. Knowing that the causes are multi-factorial, but often involve delays because of distance, the Casa de Esperança (a Maternal Waiting Home) was built. It is a place for women who are high risk pregnancies or have already suffered traumatic deliveries and need surgical care, can stay. It needs some more work, but is already open and we have hosted over 20 patients (and many more family members). Because it is still fully booked with fistula patients--who’ve suffered through a traumatic birth and often lost a child--care has included trauma counseling and re-integration skills like sewing, cooking, etc. We have also loved organizing and working with a visiting team of nurses for health talks at local communities affected by maternal death, at health clinics, and  around the hospital and in the patient villa. 

 

 

 Julia, the house administrator, registering a patient.

Patients listening to a lesson on how our bodies and hearts need healing! 

 Family member cooking for a patient in the comunal cooking area.

 

Most recent group of patients and their family members!

Nurses Filipa and Amandio (nurses from our maternity responsible for patient and community health education) give a health class. 

There is always so much singing at the Casa de Esperanca! Here is one quick moment.

 

May, and we had visitors!

 Happy mid-May, friends! Dry season is already a month in and the cooler temperatures have brought a sense of fall in our Southern Hemisphere home. Below are some pictures of our work and lives from April and May. We are grateful that we can walk and see God's goodness around us in "the land of the living" (Psalm 116:9).

Priscila and I gave lectures and simulations to nurses from the municipality's public hospital and clinics on OB and neonatal care. It was a delight and an opportunity to build relationships with other health workers in the area. Maternal and infant mortality remain a severe problem in our area: we average 100 neonatal deaths yearly at our hospital. The national estimate is 57.2 deaths per 1000 births (global average 28/1000; US average 5.6)

Digital x-ray has arrived at Kalukembe! No viewing stations yet, aside from the technician's monitor; but still, it is a big upgrade to get digital images. Most patients do not have smart phones (or even brick phones!), so nurses usually oblige to take pictures and show them to me or whatsapp them. The system is still far from perfect--many patients have x-rays taken and then lost. The technology is fresh, and I hope to see improvement in our diagnosis and management of patient conditions. This image is of a little boy with sickle cell and osteomyelitis in his arm. Sickle cell complications remain common and hydroxyurea remains expensive and scarce.

Dr Lena Gamble visit! Dr. Gamble, who worked at Kalukembe with us and now lives in the States, was back in Angola for a Freedom course conference her friends in Lubango have taken over organizing. She kindly took time out of her schedule to visit us and our staff friends at the hospital. The kids got to play chess, sing, remember and make new memories with her during her weekend visit. Thank you, Dr. Lena!

Rare (for Kalukembe) large bird sighting! This southern ground hornbill has been sighted several times in the last month around the hospital campus. 

May is our busiest malaria month, which means pediatrics ward overflows to the corridors and other wards. Please pray for our patients. Please pray for our patience in caring for so many patients, too. The daily census on the ward has been over 90 recently, but our beds only accommodate for 60.

Kalukembe sunset in dry season

Maternity also is managing a census flux that is seeing higher numbers on the ward. 

Neonatal resuscitation practice with mannequins during the OB/neonatal care day. Fun to see so many get their hands involved in practicing chest compressions, positive pressure ventilation and grooving with the 3:1 rhythm!

Fistula women at the newly constructed waiting home! This space is envisioned to be for maternal waiting as well as fistula patient community. Visiting nurses from a project in Bié province have already stayed and helped with post-operative care and provided group counseling. Really great to see!

Samaritans Purse World Medical Mission visited with a team of 4: Electrician Dan Noel is pictured above with a translator and our electricians. The hospital got upgraded with more LED installations and OR equipment getting fixed. We also had an electrolyte machine installed in the lab with training sessions for the technicians there. Incredible how much was installed in the last week! Thank you for all your hard work!

The joy of living in Kalukembe

March 2024

 Do we still blog? Though it is an ancient form of communication, but yes! We still do! Do we still live in Kalukembe? Yes! And we would like to share a few updates in our ministry and work there. In January, we began receiving intern doctors from a partner hospital in Lubango for 2 week rotations each month. Pri and I have for a long time wanted to participate in educating colleagues here, so this has been a wonderful answer. Each of the interns who have come seem to have had positive experiences. The overarching goal is to help train physicians for general medical care in resource-limited settings. The focus for the brief rotation at Kalukembe is to experience pediatric and OBGYN care, but also to see patients through our emergency ward. Since it will be one intern at a time, we hope to tailor didactic training to their interests as time goes (EKG interpretation and cardiac ultrasounds, for example). But, well, 2 weeks has a lot of patient care that can make getting in "formal" didactics a challenge! 

As of December, construction for the maternal waiting home has been under way. With walls up and floors down, we are looking closer to completion. We are working out if and how solar power could be provided, and plumbing work is yet to be done, but the potential this place holds is quite exciting. Imagine first laboring at home far from anyone, then getting transported by motorcycle while in labor after a day or two of no progress to several clinics before finally arriving at our hospital; then imagine feeling labor begin and just walking from the womens waiting home right down the road to the hospital to safely have labor monitored and delivery assisted, whether vaginally or operatively without significant delays. There will be much to learn about what barriers might be to utilizing this service, but seeing how it's been done well in other places, we believe this is the right thing to do here to reduce mortality and increase safe and healthy deliveries in our community. 

At home, the kids have recently been busy with their snack restaurant business. They buy coal, oil and local food ingredients to then prepare and sell. Their menu usually includes fried potatoes, juice and now even guava paste. They also make hospital deliveries, which has been great for Pri, who often can't get back for lunch. I haven't heard if they're ready to expand to international deliveries yet, but I highly recommend the sweet potato fries! 

And below, a few pictures!

Visiting nurses dedicated to helping women who suffer obstetric fistula visited our hospital for almost 2 weeks in February. They came with women from the central area of the country whom Priscila cared for and operated on. Nurses Domingas, Elisa, and Mariana brought much compassionate care for these ladies. And in addition to sharing on the hospital veranda about healthy pregnancies, they also shared at the local womens church organization. We are very grateful for their visit and the work they continue to do in Huambo province!

Working out of our temporary ER space, Dr. Hermenegildo from CEML in Lubango did a fantastic job taking care of patients. Dr. Hermenegildo and Dr. Ana have both now rotated through Kalukembe and have been great ambassadors for physician trainees at our hospital. Our nurse colleagues have appreciated working with them and our patients have benefited from added doctor presence. Please keep praying as we develop this training experience so that doctors who pass through might learn quality care in austere environments

Man, I am impressed what these guys come up with. They built a tree house out of bamboo and scraps, and no injuries (that's where my ER mind goes)!

Most of the time, I am on children's ward where the largest number of patients and highest mortality lies. Occasionally, I will see patients on mens ward, especially ones who need to be transitioned to palliative care. It is a painful but important challenge to help staff and family transition with patients when they enter the active phase of dying. Having conversations about prognosis, treatments that can be accomplished and ones that should not be pursued, dying with peace in their hearts: peace with God, peace with themselves, peace with their loved ones. . . these are all issues requiring wisdom that I know i am far from having.  I see not only the difficult fragility and endings that face patients and their families in these moments, but my own limits to healing and restoration. It's painful, it's beautiful and it's a privilege to be with them in those times. Romans 12:15-16 is a beautiful reminder to make this a habit of living with others as we all experience the joys and setbacks of life. 

Julia (L) and Anna (R) here with one of our lovely fistula patients (all permissions given). Julia has been more involved this time in ancillary care of our obstetric fistula patients--purchasing food, checking on housing, helping them settle in to their often prolonged stays at our hospital. Both young women have been a delight to have with us since we returned to Kalukembe. We have benefited so much from their kindness to especially our children and our family. We are excited to learn that Anna has also been accepted to medical school!

Return to Kalukembe 2023

 As 2023 draws to a close, we gladly bring a new update to our blog friends! We have arrived in Angola and, though still in process of unpacking and fixing our home, we are back at work in the hospital and with projects. As our local colleagues say, we are on our feet! We'd like to share some images with you below to celebrate with us the opportunity we have to be back and rejoin the work at Kalukembe mission hospital. 

A public health education visitor came to Kalukembe for almost 2 months. Ms. Lia Vega challenged our local colleagues to consider and act in ways to holistically improve their communities through Community Health Evangelism (CHE) program. L to R at the ceremony for their departure: Daniel, Priscila, Dr. Damião (medical director of hospital), Lia Vega (CHE program leader for Lusophone countries), Rebecca Bontrager (community health missionary and colleague from Rio da Huila). 

Moving back to work, some changes have been made. Plans to expand the small Emergency room triage are underway; my office has been removed in order to grow much needed triage and resuscitation space. Space is now tight on Children's ward--yet another reason to pray malaria does not hit our communities heavily this year! 

I am always encouraged after being away if there is a small project which we participated in before still ongoing after returning. In the case above, our sterilization team is still producing hypochlorous acid for the hospital for use in wound care. We don't quite have the capacity for use as disinfectant replacing bleach, but already this has been a big return on investment. The less dependent we are on fickle medical material supplies, the better! Even Americans know the value of this (remember our radiation contrast shortage last year?)! 

We are very blessed by the presence of Anna E. at both our home and hospital. Anna is applying to medical school and helping us part time with tutoring our kids and the rest of the time working on not just a Hepatitis B seroprevalence study but also looking at our hospital's practice of maternal and prenatal screening as well as neonatal vaccination. There is much we are learning and we are eager to implement changes to our practices at the hospital. I need to remember that change requires buy-in and good supportive evidence provided in ways to build others up! Ok, if that's vague enough, watch this space. Just to give you a sense of the importance of this investigation, though, is that no one knows Hep B seroprevalence in Angola, but estimates are that greater than 10% have this chronic, preventable infection. Our preliminary data is bearing this out, too.

At home, we are reuniting with friends; playing soccer and introducing baseball; chasing lizards; bringing in more pets; starting Zeke's a chicken/egg business venture; and celebrating Naomi's 9th birthday! She made her own birthday cake, even the icing! She loves celebrations and takes initiative in organizing them. Happy birthday to our beautiful young lady!

2022 in Review

In the end, it seems it was yesterday that we started on this journey. Thank you for walking with us. My treatment is done and my chemotherapy port has been removed. I spoke with my oncologist and he kindly gave me some recommendations and said we could do our next follow-up as a telehealth visit. There is still lots of unknowns. Questions like will this cancer recur? What complications will come up later? How long should our next term in Angola be? But oh how I am glad to be able to play basketball with the boys and not be out of breath. To have Naomi brush my own hair. To start thinking about how I can actively participate in community - here and in Angola. It's not just spring out there... its in my heart too. 

So we are planning to be returning to Angola this year, focusing on a medical education and maternal health project. The kids are celebrating the end of a wonderful school year and looking forward to family reunions this summer and being reunited with friends and our beloved Chibi (our dog) shortly thereafter. We will share some of that news soon. 

Neo adjuvant chemotherapy countdown.

Loving family with Opa and Oma.

At the school Mathmagician show!

Spring Update

 

"A Normal Life" in Kalukembe

We met Artur Gadja via phone through a mutual friend, Dr. Matthew Chan in 2019.  Several months later, he graciously donated his talents and time to visit us in Kalukembe and document a week in our lives there. Here is the link:

https://vimeo.com/582233768/9efec4048f

This was done so good, I struggle with the feeling that sharing the film is self-promotion. But I hope you might see instead of THAT cynical interpretation, Artur was documenting us trying like others to make sense of what it means to love God and love our neighbor. We are so far from loving both perfectly; but I think that's the point--we are flawed people putting our faith in a perfect Person (Jesus) and Kalukembe is where our love and trust in Him has taken us. Out of that, we are learning so much about God and others and ourselves and have been present to testify to renewal and re-creation in our community and in our lives. Toil won't end until Jesus returns for a final restoration, when somehow the "world will be even more beautiful for once having been so sad" (Sally Lloyd-Jones).

Our hope is this sharing will be an encouragement to you as you consider where you are and who you can neighbor! So much to see, so much to learn as we do this together--why not begin where you are? CS Lewis wrote in Learning in Wartime, "If men had postponed the search for knowledge and beauty until they were secure the search would never have begun. We are mistaken when we compare war with 'normal life'. Life has never been normal."

Thank you for your tremendous job, Artur!

Back to the States

Hello again! We are writing from, compared to Kalukembe, the chilly city of Philadelphia! Since our last post, a concern led to an early departure then a diagnosis and now opening a new chapter in our lives. In October, Priscila felt a mass in her axilla. So with the concern that trying to get a biopsy in Angola would take us too long, we decided to move our timetables up and leave early back to the States to see what it might be, all the while hoping we could still celebrate the end of the year as planned with Pri's family in Brazil. We tried our best in two weeks to wrap up what we could and day good-bye to our colleagues and friends: some things were what we had planned to do anyway--giving Bibles, oil and mosquito nets to all hospital workers; purchasing TB and other medicines; setting up a hypochlorous acid generator for wound care; arranging distribution for kids' pets. Other things were sped up--packing up the house; arranging support for a few friends and their families; arranging care for fistula ladies in another center. Other things were left unfinished but ongoing, like the construction of the new doctors' homes and other chronic patients' care plans. And some things were stopped, such as a Hepatitis B screening study, and follow up for patients we had no way to communicate with our premature departure. Considering the circumstances we were leaving under, we are overall thankful. i am sad to leave our friends and patients, but we are so thankful that our departure was already a conversation begun beforehand with everyone including our kids. And what an opportunity to thank 250+ hospital workers with practical gifts before we left! 

 It's been a fast process here, too! Less than 12 hours from arriving in country, Priscila had seen the surgeon and scheduled for biopsy on November 1. Since then, we learned that Priscila has metastatic breast cancer that does not look like it's spread to far-away organs, that Zeke loves playing basketball, that our kids are growing out of their old clothes rapidly, that my parents are very patient and playful in helping the kids with home school, that Naomi has taken to a bicycle like a fish to water, that Eliel is a brilliant cardboard castle builder, that our friends and supporters are even more incredibly supportive and kinder than we knew, that God has been steadfast and present with us every moment, every day. If we couldn't see the future well before, our sights down the road are even more unclear now. . . . 

For now, we are with Daniel's parents until the end of the year. Then we will transition to Wilmington, DE, where Daniel will begin work and the kids will go to school. Priscila had her first chemotherapy session this week and will continue every 3 weeks for five more cycles before her breast surgery. Then it sounds like radiation and more chemotherapy. 

Thank you for all your care and support! The kids have appreciated warm winter clothes, we've eaten yummy meals provided to us, and Priscila's parents and Daniel's sister's family will join us in Philly for almost a month together! The list of kindness is much more than that, too! It's only what i can remember in the moment. . . . 

 i am told that the William Bradford celebrated with the Pilgrims their first harvest (with the generous help of the Wampanoag) and Psalm 107 was what he reflected on. It begins, "Oh give thanks to the Lord, for he is good, for his steadfast love endures forever! Let the redeemed of the Lord say so, whom he has redeemed from trouble, and gathered in from the lands. . . " and it ends with "But he raises up the needy out of affliction and makes their families like flocks. The upright see it and are glad, and all wickedness shuts its mouth. Whoever is wise, let him attend to these things; let them consider the steadfast love of the LORD." So much to think about here, but suffice it for now to wish you all opportunity to consider God's steadfast love in both our lives and in the world. Happy American Thanksgiving/Feliz Dia de Graça!

On our way from Kalukembe to Lubango to Luanda to Lisbon to Newark to Philadelphia! Not bad! And the kids were still smiling when we arrived. . . well, not fully. We did cry about leaving our dog, Chibi-ko

Pri preparing Naomi's birthday on the 6th. Naomi's response to a day full of fun with cousins, grandparents, and presents was to say, "Thank you! This day was full of love!"

The boys enjoying legos and soldiers with their cousin, Søren

One last construction project for Zeke in Kalukembe: a cardboard house with lots of lights!

I'm gonna miss common sights like this. . . 

Wrestling with Tio Jim in Philly

Priscila's care is at the same hospital where she did her residency. It was fun to find her placard on the wall after one of her appointments.

Reading Bible stories with "Jiichan"

And of course, cozy reading times as family

In the beginning of October, we were able to offer one more week of free prenatal consults as part of seeking to encourage women to have healthy pregnancies and safe deliveries. To date, this year had been the worst year for maternal mortality that we had experienced (22 up to the beginning of October). Which made it all the more poignant to us to connect with pregnant women and talk about healthy pregnancies and delivery plans. Ultrasound is such a great tool to open up such conversations with women. We continue to pray for these women and our colleagues, who continue to provide good obstetric care to the women of the community. 

Our amazing friend, Dr. Bible, came and visited in September and left just days before we did in October. He's here doing one of his many injections for a patient with back and hip pain. He was an incredible help on the wards (who knew? an adult rheumatologist helping see pediatric patients!) and in the clinic. He even helped at home, building desperately needed shelves in the kitchen. Thank you soooo much, Dr. Bible! 

The treatment journey has begun! First chemotherapy session down, five to go!  So much else to say about this! I will keep it brief: we love you SO much, Priscila! May your body and spirit know healing and peace

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!