Yes, we're still here!

 Greetings! I just realized it's been a few months since our last post, so hope I can do some small justice to what has transpired since then. In May, we traveled to the US for a retreat for medical missionaries at Alongside in Michigan, then helped (along with others) Daniel's parents move from Philly to Pittsburgh. We are also preparing a big transition. . . moving to the States for a while: for kids' school, for Daniel to pursue a palliative care fellowship, and also be close to family. We also hope this time will let us catch our breath!

Yet we won't be completely leaving Kalukembe. Priscila will continue as director of our Maternity Health project and will help our Palliative Care team with intermittent visits, funding and communications. We have also been invited to contribute to formulating a rural medicine training program for our province, though where that goes remains unknown. We are still coordinating visitors for Kalukembe - including already planning a dental campaign for 2026. Dr. Emmanuel Ikwutah, a Nigerian general surgeon, has solid plans to come to Angola and work at Kalukembe. So the work and ministry will continue! This is a place we see filled with potential, purpose and, most importantly, with God's presence. 

Ok, let's share more through pictures below. As always, permissions granted.

At Alongside retreat in Michigan, we learned a number of things: strategies to thrive in our work, the challenges of finding and maintaining healthy boundaries in our lives, and all the fun things that dry ice can do (all thanks to Dr. Jim Ritchie! Pictured with Pri and Eliel)

Attending a Phillies game one last time before Dan's parents moved to Pittsburgh. Phillies won--they do well in the regular season. It's the post-season they need to figure out.

Amandio and Julia visiting a patient with gastrointestinal cancer on the ward. In addition to receiving surgical care from Dr. Sam Chen visiting from Canada, she also received spiritual care through encouragement, conversations and prayer from our palliative care team.

Friend and colleague Petra J. visited with other Votoka nurses in August, giving an impromptu talk on safe maternal delivery to women waiting to be seen outside Priscila's office

We also were hugely blessed and had lots of fun with Mike and Dr. Ruth Hennebery. Friends from our church in Wilmington, they came and helped in many ways: Ruth with OBGYN surgeries, consults, ultrasounds; Mike with homeschooling, games with kids, fixing shelving and other handy jobs!

Mike setting up bed nets in the maternal waiting home. More evidence of his working holiday!

Nurse Filipa sharing about maternal health with Julia and Naomi helping at Chituto clinic in September

The Mission Aviation Fellowship hospital maintenance and well-being team of  (R to L seated) Marcel, Andrew and Basilio; with Dr. Jake Pratt (standing, visiting from Samaritans Purse). They came and fixed the hospital's solar water pump and one of the steam sterilizers that had been broken for over a year. Without such a partnership from both organizations, the hospital would be with much, much less.

Dr. Jake Pratt visited from Samaritans Purse and brought together the chaplains from Kalukembe Hospital and CEML, a sister surgical hospital in Lubango, for a conference focussed on the heart of a chaplain. We were very excited to see mutual encouragement and affirmation of the importance of chaplaincy work in mission hospitals

In July, Anna Eberwein returned after her first year in medical school to do research in uterine ruptures and to help teach both neonatal resuscitation and care for preterm infants. Our staff got to refresh on their resuscitation skills and learn more ways to care for preterm infants. Thanks, Anna!

One of the all-hands-on-deck weekend crises. . . Dr. Andrew (visiting ER resident) performing USGIV for an epi infusion while looking for more blood in a woman with placenta accreta and imperceptible blood pressure at the start of the case. Transfused 7 units by the end, epi, calcium, antibiotics. Priscila and Dr Ruth did her emergency hysterectomy and she was sitting up in bed, breast-feeding the next morning.

Spring update

 Happy Easter and warming weather to our friends up north! Here in Angola, we are approaching the end of rainy season and planting our sweet potatoes! Since our last writing, a lot has happened, good and sad. One disappointment is that our rural medicine training program is paused because our partner hospital is unable send residents this year. However, we've still had opportunities to teach: Daniel giving classes on communicating danger signs, organizing clinical presentations and severe malaria and Priscila at local communities, sharing about healthy pregnancies and womens health. In March she spoke at the first national conference for religious and governmental partnerships in prevention of obstetric fistula. 

We are thankful that malaria season has not been as severe as in recent years, but likely due to a poor maize harvest, there have been increasing numbers of children with malnutrition admitted. It's often heartbreaking to see small severely malnourished children die within 24 hours. Since the municipal hospital across town has not had nutritional supplementation for quite some time, it was was a blessing to receive (from a partner mission hospital) "Manna Packs" (supplemental meals for malnourished kids). Please pray for family members to champion the 24 hour care these kids need and for communities to support the mothers of malnourished children. 

Let's show some pictures! As always, the people in these photos have given consent. The animals had no choice.

Pitanga fruits and their seeds. Naomi patiently labored, cutting the fruit off seeds, boiling it down and making yummy jam for us in March.

Celebrating the health of our colleague who suffered post-cesarean section complications and needed a perisplenic drain. After a bumpy postpartum course, we are glad she is home with her family and baby, happily recovering

This is also a celebration--Domingas is here with our patient, A, who had been dependent on oxygen for a month due to severe TB and malnutrition. He remained resilient throughout his time in our hospital, even checking how I was doing, asking about my own health and even family. It's such a delight to be able to witness at times the slow but gradual improvement in our patients. In A's case, it was seeing his breathing and weight improve over time. In addition to that, to see his curiosity and engagement in conversation grow. Thanks to your support, we were able to assist in his hospital fees.

Ok, I didn't see this one coming. A 13 year old girl complaining of chronic cough after having been admitted with a bout of malaria. As it turned out, she swallowed a coin (the bright round object on the X-ray image) on a dare 2 years ago and didn't tell anyone when she felt it get stuck. We transferred her to another mission hospital and after esophagoscopy and thoracotomy, it was removed from her esophagus without further complications.

Some things are no different, whether in Angola or the USA. Dr. Kirsten Ward, an EM/FM resident from the States, came and rotated in March and helped in the ER, the wards and even with procedures. Here, she is doing hallway/floor medicine on pediatrics ward, something she knows very well from working in busy ER's in Delaware. Thanks for your flexibility, Dr. Kirsten!

Priscila with nurse Avelina performing point of care ultrasound on the labor ward. With more ultrasounds available at our hospital, Priscila has been able to teach and emphasize with our OB nurses practice in making point of care decisions based on ultra sounding at the bedside. This is a growing skill for our nurses and has already improved the care they have provided. Basic but critical diagnoses such as placenta previa, baby's position, oligohydramnios, ectopics, among other things have been identified by our staff.

Dr. Kim and Mr. Rod, thanks for visiting! Kim helped with patient care and they both helped in Rod's project of taking physical photos for patients to keep. Kids, mothers and staff loved them! 

Just another outpatient consult day for Priscila: lots of women waiting to receive Priscila's care on her clinic day. Wednesdays end up quite long and tiring. However, I look forward to bringing her lunch and hoping to catch a few minutes together to pause and refresh together.

Dr. Kim joined Priscila in a community health outreach this past week, performing prenatal ultrasounds and consults. Thanks for your supporting in helping us with a portable ultrasound! 

Groundwork under way for maternity ward renovations at the hospital, through the support of several organizations. We are eager to see the improvements unfold which will include more space for triage and patient care 

Nurse Amandio with palliative care conference leaders in Lubango. Earlier this month, Amandio and our fistula program coordinator, Julia were invited to a palliative care conference day in Lubango. This really helped them both, and they have both brought more motivation and compassion towards our palliative care patients. I hope to share a post on this soon. It's been really encouraging to see our care for patients nearing the end of their lives grow and mature.

Camouflaged in the grass, 9 chicks are following their mother hen, Speckles. Our family enjoys our many chickens around the property. . . so long as they poop away from the veranda!

The first dentists in the history of Kalukembe Hospital!

 A breath of fresh air! Smiles to our faces! Set our teeth straight. . . no wait, maybe not exactly. But the latest visitors to Kalukembe Hospital came with skills not seen in the known history of the area. Drs Cesar and Shay, from Curitiba in Brazil, brought energy and skills for well over two busy weeks of dental care. As far as our colleagues at the hospital could tell, this was the first time that dentists provided restorations and root canals, not just extractions. Dr. Tito, our resident dentist, benefited greatly from their tutelage and the increased volume of patients to learn some new techniques. Not to mention, doing more extractions :) Over 500 extractions, 473 restorations, 387 teeth cleanings and a root canal rounded out their productive visit. They also took out time to give a lesson to our nursing school and perform a skit for our children's church. The main theme of the skit: keep your teeth clean!

Also in January, Dr. Emmanuel I., a surgeon, visited from Nigeria. He is very interested in coming to work full time with us here. He just graduated from a PAACS (Pan-African Academy of Christian Surgeons) program in Niger and is applying for a 5 year grant to come as a missionary surgeon here. We loved having him in the operating room, on the wards and playing games with our family at home; he even made amazingly delicious and spicy Nigerian cuisine for us! Please pray he will be accepted and we can help support his ministry here. 

Drs Cesar and Tito (L and R), working together on dental fillings during the dental outreach

  

(L to R) Tio Tito (nurse anesthetist), Dr. Emmanuel and Tio Pereira (surgical clinician) in the operating room. We respect Tio Tomas and Tio Pereira greatly, so it was an encouraging endorsement that they too appreciated Dr. Emmanuel's character and skills

Dr. Emmanuel with assistant on a laparotomy case

The Brazilian visitors with our dental/OR staff setting up before their first day of dental work.

Isn't it a joy to give? Our nurse, Joana, giving a doll that was knitted by supporters to a patient with Down Syndrome (permission granted by her loving grandma). These dolls, which came across the years from supporters in a community homeschooling group in Hamilton, Canada, have been a delightful gift to our pediatric patients. They never stop bringing smiles to girls and their families. . . even this girl smiled before the picture was taken :)

December update

 Greetings in the last month of 2024 to you! 

We have had an event-filled November and already December, highlights being a visit to Cavango hospital and a palliative care conference. 

Cavango, a village on the Cubango river, sits at the headwaters for the Okavango delta. Our friends work at a 70-bed mission hospital - recently rebuilt on the ruins of a mission hospital destroyed during the civil war. The site serves around 30,000 scattered in nearby villages, but sees patients from the cities of Huambo and Kuito as well. It was a joy to be and work with our friends the De Sousas and the Gouds, who serve the community there as medical care providers, pilot, children's ministry, maintenance and much more. Our kids loved playing games, fishing, making crafts and sharing a week with their kids. 

After getting back to Kalukembe, we hosted the palliative care team from CEML hospital in Lubango to help lead a one-day conference in palliative care. Given care at the end-of-life is multi-dimensional to address the many factors that come up for our patients, we were glad to have representation from all the sections in the hospital, including our chaplain and our psychologist. As much an introductory course as it was exposure to other colleagues doing palliative care elsewhere, I was greatly encouraged by the discussions with others I had even after the conference. We hope this will be seed spread for future growth of a multidisciplinary palliative care team here in Kalukembe!

Posing with most of our palliative care conference participants. As the photo was taken, we all shouted, "We shine!"

As part of the conference, participants practiced in small groups difficult conversations about prognosis and developing plans of care based on patient values

Guilhermina and Emmanuel, nurses from the CEML palliative care team, sharing case stories and their experiences since their program's inception in 2020

On the Cavango airstrip with our gear for the week!

Dr. Eduardo DeSousa giving the morning public health and devotional talk to patients and staff. Cavango mission hospital

Dr. Eduardo finishing up an LP on a patient with bacterial meningitis. Given lab limitations, the CSF fluid was tested for gross appearance (very purulent) and glycemic level (low)

A couple days later, the meningitis patient's father was happily cradling his son to feed him (photo permission granted!). This was really sweet, to see the patient improve gradually during our time in Cavango. It's a joy to help and see recovery! 

The beautiful Cuvango river. . . crocs don't like rapids!

Sorry that this is out of sequence--but just to show we are in the Christmas spirit here in Kalukembe! Priscila and Julia popping LOTS of popcorn for the children of 3 local churches who will be performing in the youth Christmas services this past Sunday.

Priscila and Daniel with Ester and Cecilia, nurses, and a patient (face blurred to protect identity) at Cavango Mission Hospital. Though not much OBGYN occurred during our time there, Priscila was able to help Dr. Eduardo and his team manage this patient who came in 1 week post partum suffering from infected retained products of conception. Even helping a few to restore their health was an encouragement for us and for our colleagues there. We are so thankful for the work they and the care they give to people in Cavango.

Training at Kalukembe in 2024

How can the work of the hospital continue to benefit the community for years to come? With few resources (both material and human), here is our focus: sustainable medical education. 

Rural medicine training is critical for Angolan physicians. After 7 years of preparing, we are almost at our one year anniversary: doctors have been arriving since January for 2-week rotations in rural medicine, with emphasis in obstetric and pediatric care. These doctors come from our sister hospital in Lubango, CEML. While rounding in the ICU and other wards, they do bedside ultrasound evaluations and improve their diagnostic skills. Being called to assess an obstetric and pediatric emergencies can be stressful - but it's rewarding to deliver a healthy baby or see a child recover. Even our surgical resident enjoyed her Rural Emergency Medicine work - and we loved having her!

Brining in other partners into this work has been important: Christiana Emergency Medicine residents helped Daniel develop the resuscitation curriculum. We have had a team from the central hospital in the provincial capital come teach a class on sedation and assessment of the critically ill patient. The director of the pediatric residency at the public hospital in Lubango has expressed interest in having residents come through for basic procedures and emergency management. We hope these partnerships can allow even more trainees rotate and learn here at Kalukembe. 

To keep this up we need teachers! Dr. Chance Williams, a family physician from Kansas, spent a month with us - even giving a mini-course on placement of intra-osseous needles. Dr. Mariana Vigiola, a general surgeon, jumped right as a teaching surgeon. Dr. Emmanuel K, 4th year surgical resident from Niger, is coming for a site visit in December. We are discussing with him the possibility of long-term commitment here. Would you consider coming to help teach? We may not be able to provide 1st class beachfront accommodations, but I can promise a cup of fresh-ground Kalukembe coffee!

Dr. Ilda (L) and Dr. Mariana (Rt) operating together on a patient 

Eliel helping Ms. Jasmine making yummy fried rice for dinner. . . note our pets waiting for any mistakes to fall to the floor!

Near the end of September, Pri and I were able to participate in teaching ultrasound at the 1st annual Southern Angolan Medical Congress. Priscila also presented the hospital's research on maternal hepatitis B prevalence. We hope such networking will bring attention to Kalukembe hospital's work in the community!

With Dr. Hermenegildo, at the end of his second rotation at Kalukembe hospital. He'll be starting surgical residency in just a few months!

Dr. Ana seeing children in the pediatric clinic. She's a natural around screaming kids!

Dr. Chance ultrasounding on maternity ward with his translator, Ludmila.

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