Since I left Kalukembe

 A few months ago, Dan and Priscilla (the other missionary docs at Kalukembe) and I left the Kalukembe (KK) Hospital because of living situations that weren't conducive to our staying there at the time. We weren't in any danger, but thought it best to leave while the ministry organization that manages the hospital worked out the problems we were having. I thought I'd let you guys know what I've been up to since then...

The first week during our time away I got to fly to Cavango to visit Dr. Tim and Betsy Kubacki. 

Mission Aviation Fellowship's (MAF) Wings of Hope plane. I and the patients I have been able to care for are grateful to be recipients of the MAF ministry here in Angola.

Dr. Tim runs the mission hospital in Cavango with a team of Angolan nurses and staff that he has been training for the last 7 years.

 I got to witness medical ministry in action as Dr. Tim gave his daily talk about a medical topic of interest, one of the staff expounded on a scripture verse, and we prayed together before starting our day. 

      

Dr. Tim caring for patients in clinic. 

I'm pretty sure I didn't help Dr. Tim nearly as much as he helped me! Learning to practice medicine in a place even more rural than KK requires a skillset that can only be developed over time and with experience. Thanks again Dr. Tim for sharing your skills and experience with me. I've nearly worn out the notes that I took but I still refer to the photos of those notes several times a week. 

I also got to work on my paper, relax, enjoy the outdoors, and sample Betsy's good cooking while in Cavango.

The Kubacki’s dog, Dexter, kept me company as I edited the paper I’ve been writing since March. 

I got to take long walks. 

I saw beautiful sunsets while out and about. 

I got a little homesick when I noticed that this stove had made it all the way here from Alabama, USA as had I.

My plans to learn to make brownies and pizza from Betsy were put on hold when Dr. Steve Foster called to ask me to help establish the COVID-19 ward at CEML Hospital in Lubango. So, I jumped on the next plane back to Lubango - with quite a bit of fear and trembling due to the magnitude of the job I was being asked to do. 

I remember being much more calm after Betsy prayed for me the evening before I left. I was being asked to do something I’d never done, with a team I wouldn’t get to choose, during unprecedented conditions...and in a foreign language. I was determined that despite what was to come, I would go in with a good attitude.

I decided before leaving Cavango - no matter what medicines, PPE, staff, etc were or were not available, our section would be bathed in prayer and positivity and our patients would know that they are loved and are receiving the absolute best care that I could offer them. 

While there was much need for caution as we began to establish our new COVID-19 section, there was no need for fear. I was received with open-arms by the staff and the administration gave me a green light to do whatever I thought was necessary. That was the easy part. The hard part was figuring out what I wanted to do and how it needed to be done in this context while simultaneously caring for critical patients in those first few days.  Whew! Vasco Kupua, one of the Angolan doctors at CEML was my right-hand man during those first few weeks and his assistance shaped the processes and protocols we were able to design and implement.  

I have to give credit to the staff who are like any other staff that I’ve encountered anywhere in the world - resistant to change. However, as we’ve installed new processes at the hospital with the goal of identifying and subsequently isolating suspected COVID-19 positive patients from the general population of those seeking medical care,  the staff has been very engaged and responsive. They have done what has been requested of them - even when the requests changed weekly (sometimes daily during those first few weeks).

The nursing staff in our section consists of 3 nurses who alternatively work 48 hour shifts then rest for four days. So there is only one nurse present on the ward at any given time. They are so kind that they let me call them girls for the entire first month without complaining!! 

Nouns in Portuguese can be male or female. Some nouns, however, end in (a) but don’t indicate a female, for example, 'analista' or 'electrista'. I (mistakenly) thought the word for nurse fit into the latter category. For the first 5 weeks I called these guys 'enfermeiras'!! They were so gracious that they responded every time! 

Despite all of the support from admin, there simply wasn't enough staff to cover our new ward during the times it was really busy. So...my roommate Irene, a missionary nurse from Holland who serves on another project associated with the hospital, volunteered to help on the COVID ward during those first few weeks. I'm so grateful to her for stepping in and using her gifts during crunch time!

Nurse Irene (aka the best roommate in the world) assisting in the COVID-19 Section on days when there was more work than our single nurse could handle.

Just this morning (11/30/20) as I walked onto our ward holding my stomach which had been aching terribly since breakfast, our lone patient was sitting up in her bed without oxygen and gave me the biggest smile. I had to smile through gritted teeth, but I wouldn’t deny her our morning ritual. She didn’t deny me her smile when she was tachypneic, anemic, had an O2 sat in the 80s while on oxygen, and was afraid for her life. I was determined to write her discharge orders before I found a place to lie down. Even as I went to receive good care myself (I suspect a blend of malaria and stress were causing the stomachache, bodyaches, chills, raging headache, etc.), I laid down with a contented heart, knowing that my job was done - not just writing the orders - but sending my patient home with a smile on her face. These are the little connections with patients that keep me going.

What else have I been doing at CEML Hospital?

When not caring for patients in our COVID-19 Section, I’ve had an opportunity to assist with educating the new interns.

We said goodbye to the interns who had been training at CEML for the past 18 months-2 years. They are taking their knowledge, skills, and hearts to serve God to other parts of the country.

We welcomed new interns who are passionate, excited, smart, and...oh so new! I am daily reminded of the challenges I must have given my attendings, especially during intern year ( a million times THANK YOU for the grace and patience extended to me throughout the medical education process!).

Now, I get to teach these brand-new doctors things I never learned in residency, like “go ahead and treat for schistosomiasis when there’s blood in the urine, but also schedule the cystoscopy because bladder cancer is very common as a result of these types of chronic infections.” However, there are many, many more common things that formed the foundation of my medical practice that I also get to pass along to them - things like 1) look up every single medicine every single time during the first year because it is possible to hurt someone with a medication error, 2) learn to take a focused history and physical exam, emphasis on “focused”, 3) only order labs that will affect patient management, etc.

It is hard to describe the joy I feel when I see them putting into practice today a lesson they learned yesterday. Knowing that they will one day take evidence-based medical practices to parts of Angola that I will never reach is one of the highlights of my time here. 

What have I been up to in my spare time?

Studying more and more about COVID-19. I’ve shelved the paper I’m writing until I can get home and access the necessary resources to finish it properly.

Reading, of course! I average about 2-3 books per week by signing into the free public library at home and listening to audiobooks on my daily walks! Shout out to my sister, Del, for allowing me to access her account as well! I’ll publish my reading list later to satisfy my curious friends! 🙂

'Hanging out' with these guys. 

By ‘hanging out’, I mean being ministered to and doing everyday ministry with them. I've been learning to reach the lost and disciple others in this context by simply joining in their daily routines as my schedule allows. How we have been ministering to one person in particular illustrates perfectly how we each are able to use our gifts, callings, and professions to show the love of Christ to one person at a time. 

Clockwise from the top: Carlos, Jeni, myself, and Irene (my roommate) having dinner at Irene's house. It's a blessing to do life with friends who love God and genuinely enjoy each others' company. We eat together, work together, worship together, and minister together. These friends have shown me how to minister to one person at a time here in Lubango. 

There was a lady who used to sit by the side of the road but then no one saw her for a long time. So Jení and Irene went to find her. She was sick, so Irene asked if I would go with them to check on her. She needed more care than I could offer during a home visit so she agreed to be treated at the hospital. We couldn’t drive up the narrow dirt road to her home and she was too weak to walk...so Carlos carried her to the car. 

What church do I attend? The simplest answer: I didn't come here to go to church. I came here to be the church. With that in mind, I've found God everywhere that a few of us have gathered in His name:

That same patient that we picked up in the bairro-we didn’t just drop her off at the hospital. Nurse Irene was (and still is) her personal nurse. She arranged for her to be fed everyday, brought her clothes home to wash them, bathed her, and taught her how to give herself insulin. Jení connected with her family and engaged them in her care. She also did the legwork to find out sustainable ways we could assist this family who said during one discussion “diabetes must be a disease for rich people. Poor people like us can’t afford these medicines.” I get to be her personal on call physician. As she transitioned out of the hospital I received daily texts at first about her blood sugar until we found a medication regimen that worked for her. Now I get updates a few times per week and make home-visits when an in-person evaluation is warranted.  On the day in the picture, someone suggested that we go and pray with her, instead of just praying for her like we always did. So Sunday morning, instead of going to church, we piled into the car and went to the hospital and had a sweet time of worship and prayer with her in her room at the Villa. 

In the villa, the housing complex near the hospital where families and patients stay. After ministering to our patient  in her room, we had a spontaneous worship service right in the middle of the villa.

Worship night with a few friends (at the Hall's House). Every single worship night is different. We soaked in the presence of God as we prayed over the sick, the country, our missionaries, etc.

When I’m not hanging out with those guys, I’m hanging out with these guys:

For some reason, these neighborhood kids think I’m cool. I have reinforced this idea by inviting them over for popcorn, jello, and homemade lemonade (thanks to Teija and Irene for kid-friendly snacks)! For my kindness, I get a group-hug from a gaggle of kids whenever I get home before sunset! 

Playing a little football with my little neighborhood friends. Fun times!

Here in the city, I’ve been busier both in and out of the hospital than I’d been in Caluquembe. I’ve gone to bed every night tired but happy! Thanks for all the prayers that have kept me going these past 10 weeks!!