The Power of Ultrasound

On top of every cool experience I have had here in Kalukembe, it would not be right without mention of the use of the portable ultrasound. Besides poor quality xray, there are no other imaging modalities available. The Doctors rely heavily on the use of the ultrasound – diagnosing abscesses, endocarditis, free fluid in the abdomen, checking fetal development and even informing a mother coming in for a delivery that she will be bringing home two babies! I have received so much experience with scanning people, which will be so beneficial for my residency training! I was even able to diagnose an ectopic pregnancy!!

Hospital Experiences:

– Common things are common: aka as a medical student I can feel pretty confident in guessing malaria, typhoid or TB for any person who presents wtih fever, fatigue, belly pain and occasionally a cough. This is something very drastic from the pathology in the States. After examining a woman who coughed in my face, her xray confirmed a whopping case of TB. Should be really fun getting my PPD test done upon my arrival to the States. I have seen many children sick with typhoid and malaria, and the success stories bring me such happiness!

– Motorcycle accidents are also common, and so are injuries. They range from road rash to broken bones to comas. The traction used for setting bones is very primative…beams of wood at the end of the bed and bags of sand/dirt used as weight.

– Angolan skin is tough!! I am developing some bicepts trying to suture abdomens closed.

– I am taking part in so many surgeries, which is pretty great. The docs are letting me do more and more, to the point where I was left alone to close up an abdomen the other day. I saw my first typhoid perforation in the OR. When rounding on the little girl the next day, she kept crying out in pain. It then hit me…there are no pain medications here. These children are being so brave. The nursing students are also finding it fun to try and pronounce my name. I usually settle with Emilia, which is easier for them to say.

– The children are adorable and they usually stare at me wide eyed when I examine them…which makes them even more adorable. They are so stoic as they lay in bed with infections and broken bones. Usually the mother is able to sooth the baby with breastfeeding. I am amazed as the family members stay close at all times.

The environment surrounding the hospital is drastically different than what I am used to. First, there are many separate buildings connected with dirt paths. The windows are kept open for air circulation so flies are everywhere. It makes my stomach churn seeing the flies land on infected wounds and fly around peoples faces. The hospital does not provide food or bedding, so family members bring it along. During the day, family members can be found doing laundry and drying them on the lines in the open air. Patients get up and walk around outside. People snoop through open windows and offer their two cents about treatment options. Men and women wards are separate, but consist of large rooms with beds about two feet apart from each other. Women trade holding babies during their examination. Very basic lab work can be done, but can take days to return. Lastly, modesty is not really a concept here. People often are naked in their beds and women breastfeed just about anywhere. I have yet to see a bottle or formula.

The hospital politics are a bit corrupt. The government mandates certain regulations for the hospital and medical care, but then there is lack of support, finances and supplies provided to the people. The sense of obligation and patient advocacy seems to be lacking from the nursing staff. I have been trying to figure if it stems from a cultural mentality or a lack of education. Either way, it is difficult to provide good quality care to the people.  And I thought American Politics were bad….

I had the experience of going to the local market midway through my second week in Kalukembe. It was about a 10 minute drive from the hospital, so I got to see more of the country. The market was a mad-house. Unstable wood structures held new and used clothes (imagine an African Goodwill), bread, plastic tubs for bathing, candies, soaps… you name it. Children followed us around trying to get us to purchase matches or batteries. I successfully purchased my very own pano, which is the fabric that women wrap around their waist and use for practical things such as carrying babies on their backs, wrapping up laundry or sitting on the ground. Look out Ohio, I am going to start a new fashion trend!

And the moment you all have been waiting for…..the thank-you present chicken has finally become a meal. I learned how to humanely kill it, pluck the feathers and prepare it for dinner Umbundu style (the local tribe). And I thought this trip was just going to be about learning new medical knowledge. Bonus!

I do not have much time left in Kalukembe, which makes me realize how quickly time is passing. By the next time I post I will be in Cavango with the Kubacki family, exploring even more rural Angola.

Think I will look like a complete fool wearing my panos to church this coming Sunday? Worth it.

Easter Weekend in Kalukembe

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The special 'thank you' from a patient

Spending time in Kalukembe for Holy Week has been incredibly special for me. Not only have I found the environment to be a nurturing place for reflection and meditation, I have also been able to hear choirs singing in the distance, people wearing their best clothes, and a general sense of community.

During my walks from the hospital to my home early in the morning and late at night, I have had plenty to reflect on. I will be honest in saying that I have felt insecure many of times and been frustrated with my inability to communicate, but I understand the universal language of joy and I am so thankful to share my time with the people of Kalukembe.

The Drs Cummings have three small children who are pretty adorable. Lucky for me, they like to play at all hours of the day. So, when I arrive at the Cummings` home after a full day of being at the hospital, I get to explore the Angolan nature in the yard, build Lego cars or read Curious George. One afternoon, we sat out on the grass talking about Typhoid while listening to the storm roll in. Pretty nerdy, no? On Saturday, I helped make cookies in bulk, because Priscila and Dan often bring some as treats for the sick children at the hospital. Eliel, one of the Cummings boys, was helping me stir in all of the ingredients. In reality, there was a 1:3 stir-to-taste-test ratio. I too could`t help but sneak a taste or two as we layed the dough on the cooking sheet. I am so appreciative of being reminded of what it means to have the energy and faith of a child.

Since I have officially been in Africa for a week and packed pretty darn light in order to bring over all the asked for supplies for the C.E.M.L. Hospital…..I have found myself hand scrubbing my clothes a few times already. #livinglikealocal One day I left my socks on the window sill to dry while I was gone for the day. When I arrived home that evening…they were gone. Lesson learned. I now dry my clothes at the Cummings. They get a better breaze anyway.

Remember the story I shared about the chicken as a gift (see previous post)? Well, at the end of the work week (which was Saturday, since the Cummings are the only doctors) Dan asked me to go see if it was still in the kitchen of the hospital. So, I walked over to the kitchen and managed to put together a sentence that the ladies understood. They disappeared, returning with the thing, handing it to me. If only you could have been there to see me struggle to put together another sentence to explain I was just checking on it and would pick it up later. The ladies laughed so hard. The chicken now sits quietly under the sink in the house, awaiting the fateful day…

The homes here in Kalukembe are made of adobe clay and a plaster-esk type of material. The red-orange earthy color is really beautiful in contrast to the splashes of color from the clothes on the line and the vibrant green plants growing from all the rain. You may or may not want to know that the concept of bathrooms do not really exist here. Latrines exist, but they are usually dark and infested with mosquitos. Instead, nature is the peoples bathrooms. I now find myself watching my step as I walk around.

Easter Sunday was very different from any Easter I have every experienced. There were no dyed eggs or baskets full of candy. Instead, I awoke to the sounds of music in the distance and people dressed in their Sunday best. I joined the Cummings for breakfast (pancakes!) and church service. Due to the production of getting three young children ready, we arrived almost an hour late to the service. Do not worry, it had yet to start. We tried to arrive incognito, but being pasteywhite was a dead give away. Many of the children stared and wanted to play. The service was outside under the trees, and the entire village was present! Just as we settled in the back (we had to bring our own chairs), the children and singers paraded in. The service ran a little over 3 hours, full of singing, scripture readings and homilies from the pastor.

In the afternoon, we sat on the porch eating goiabas (guavas) and cookies. I learned the story of how the Cummings became a missionary family and learned Angolan geography. Later, I burned off the cookie calories laughing as Zeke (the oldest Cummings boy) played (aka wrestled) with a neighborhood boy. To end the day, we walked to the local futbal field to watch a game. We stood behind rows and rows of people lining the field. Once again, for some people we became the thing to warch instead of the game. I should have challanged someone to a staring contest. Maybe next time…which will be any time I pass someone. When one team scored, many rushed the field and began to dance, flip and sing chants.

It was nice to spend the day off and really soak up the village culture. I am pretty sure I will never get sick of the sunsets here. I am amazed at the palate of colors that are cast into the sky as the sun falls behind the clouds.

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The beautiful nature surrounding the Cummings' home

Note to Self: Hands Make Great Bladder Blades

I am not sure really where to begin, but I can say that these past few days have been one experience after another that has left me in constant awe of God`s unfailing love. I am struggling a bit to process my emotions, mainly because I pendulum swing from empathy to heartache, sheer amazement to fear, uncertainty to clarity. How can the time in each day rapidly pass, yet I have only been in Angola for a week?

To start off the week, before I was actually in Kalukembe, I spent some time with Dr. Sarah (OBGYN) at the C.E.M.L. hospital in Lubango. While scrubbed into a hysterectomy case I asked Sarah a very personal, yet crucial, question: How did she decide to follow the call to mission work right out of residency? Why didn`t she wait a bit, get married and have children before giving her life to medical missionary work? Her answer was raw and thought provoking. Her reply: I would have loved to been married, start a family and feel more secure in who I am. Instead, I decided to dedicate myself to truly follow God`s will. I have been called to mission work from a very young age, and I know this is God`s plan. If I fully trust God, then I know that He will help provide in other ways – safety and support. I am so thankful for sharing that conversation with Sarah, as she is a wonderful role model. I cannot be naive to the sacrafice of medical mission work, and this trip has already smacked me in the face wtih that realization.

You may very well be curious to know how I got from Lubango to Kalukembe. Well, you know me…always up for a little bit of adventure. And this is how it all went down: At about 15:30 on Tuesday afternoon, Betsy and I greeted a man in the parking lot of C.E.M.L. Hospital who drove up in a Kalukembe ambulance. He wasn’t exactly on time. In fact, I was supposed to be in Kalukembe the day before but the car/ambulance was in the shop…. Where was I?… He shows up and Betsy informs him that my Portuguese is very poor. Emphasis on the poor. Turns out, Zachariah`s English is very poor. Just imagine: a 3 hour jeep ride, in silence, while I hold a flat of eggs for a family in Kalukembe on my lap. Was it commical? Absolutely. It was also a perfect time for me to see more of the Angolan landscape, laugh as Zachariah avoided the numerous pot holes that formed after the hard rain, and the painful attemps we had at trying to communicate. Do not worry mom and pops, I was totally safe and arrived at the doorstep of the Drs. Cummings right as the beautiful Angolan sunset cast a pink glow over the entire countryside.
My accommodations are modest. I am staying in the villiage in a simple home. No running water and electricity that is only on for a certain amount of the evening. I am coming to peace with the idea of showering every few days, bugs as my companions and unique nature sounds to lull me to sleep. Every morning I take a short, yet beautiful, walk to the Cummings’ house to share breakfast, passing the locals and offering my greetings of `Bon dai`!

Internet access is rare and weak at the Cummings’ home, so I will Spark Note my most memorable moments over the past few days. I am spending my days working alongside Drs Priscila and Dan. Although they are formally trained in OBGYN and ER respectively, they are the only doctors at the hospital, running all services.

– I have learned that every woman has lost at least one child, either in childbirth or at a young age due to a tropical disease or infection. They understand what it is to suffer. I can only imagine the heartache they feel as they recover feet from other women in the post partum floor with crying babies.

– I helped Dan (remember – originally ER trained!) with an emergent c-section. Scrubbing is really just washing your hands well. The only anesthesia is local for the incision and ketamine for the procedure. There is no caudery. My hands surved the purpose of being a bladder blade and then pitocine (aka manual uterine massage). Dr. Dan let me close fascia, so I was in medical student heaven!

– One morning, Dr. Priscila and I were greeted with a long line of patients waiting to be seen. In the front of the line was an elderly woman dancing for joy. What made her so happy? Her fistula surgery was a success. At the end of the exam, she pulls out a chicken to thank Dr. Priscila! I never thought I would get emotional over a chicken, but I was blown away with the woman’s generosity and realized the difference Dr. Priscila is making in their lives.

– A woman in labor had a uterine rupture, and instead of being able to rush her to the OR immediately, she sat on the delivery bed bleeding internally until her surgery. There are three main reasons why her surgery didn’t happen immediately. 1. Lack of resources. 2. Lack of personnel. 3. Not a clear understanding by the medical staff what is critical. Taking part in that c-section about brought me to my knees. My heart broke for the baby that passed and the women who would find out when she woke up from her Ketamine slumber. Unfortunately, this is not a rare occurance.

– On a happier note, I did my first colposcopy with just a headlamp and acetic acid! It was nifty!

Not to be obvious, but I stick out a bit here. No big suprise. Many do not try to hide their stares, while the neighborhood kids try to form their noses to match mine. People talk about me to my face, calling me a mulata which means I am half white and half black. My hair gets touched a lot too, because it is `original` and not a weave like many women.

More soon!

No Use Crying Over a Spilled Drink…..In Your Lap

I made it safe and sound to Lubango, Angola!! And it only took 48 hours.

If you know me at all, you know that I like to fly. I am totally fascinated by the concept. Like, I get the physics behind it, but I also don`t get it. How can that much weight really stay suspended in the air for so long?

Anyways, I wanted to share my travel stories that got me to the place that is already changing my heart.

Trip from Columbus -> Atlanta. Short and innocent, right? Wrong. I was sitting middle seat, of course, between a mother and her son. They wanted to sit next to each other, but neither one wanted the middle seat. So, that got us really far. Halfway into the trip I began to doze into that half-conscious but not sure about reality state. Then I felt something cold on my lap. It took a few full seconds to realize that the something cold was in fact a spilled cup of ginger ale (and ice cubes) on my lap. Turns out that while you sleep, a cup on the seatback tray slowly slides to the edge, and my lap happened to catch the fall. The kicker? The mother never woke up from her slumber and had no idea.

Luckily, I was wearing my quick-dry, breathable pants. Everything dried before I walked off the plane. #silverlinging.
Another fun fact: Joey Bosa (OSU Football player) was on the flight. The motherly figure sitting next to me (before the spill incident) goes `girl, if you are single I would try my hardest to find a seat closer to the front` (he was in first class). Maybe next time.

Atlanta -> Johannesburg: A quick 15 hour flight, made enjoyable by the little boy sitting next to me. His name was Sammy and he had a giant bag of snack size Snicker bars as his carry on. He was even nice enough to keep my seat warm for me when I got up to stretch my legs…by falling asleep laying down. He was too adorable to wake up, so I did a few extra laps to try and reduce the incidence of kankles. Yeah, didn`t really work.

Long story (and I really do mean long) short, I stayed the night in South Africa at a hotel that is literally almost on the runway. I felt very posh. My flights to Namibia and then finally to Angola went very smoothly, which is most definitly answered prayers.

Betsy, Meredith and Norm greeted me at the airport. Of course I gave them giant hugs!!! I am so excited to be here and really thankful to finally meet them. I feel like I practically know them already (due to the endless emails I bombarded them with). I really impressed them (and myself) with the fact that my checked luggage was checked all the way from Columbus to Angola. That literally never happens.

The afternoon was spent sharing fellowship with Betsy and Meredith, meeting some of the other missionaries, visiting a local park and eating a delicious meal.
I am staying the evening in Lubango at one of the missionary homes before I head off to Kalukumbe tomorrow. There, I get to spend some time with the Cummings. I hope to dabble in some OBGYN action with the Mrs Doctor Cummings and some ER action with the Mr. Doctor Cummings.

Testing. Is this thing on?

Testing… 1, 2, 3…

If you would have told me a year ago that I would be blogging about my experience on an international medical rotation, I would have called you cray-cray. Secretly, I would be hoping you were right about the international adventure part…but the blogging…naaahhh!

But here I am, five days from my departure, setting up a blog.

Stranger things have happened.

My hope is that with this blog, my family and friends can share along with me- in (semi)real time- my experiences of medicine in a developing country. This trip has been a long time in the making, and by the graces of God everything has fallen into place. Many prayers have been answered and many prayers are still being said.

This trip is a medical rotation, where I hope to add a few brain wrinkles by the end of the 5 weeks.  It also serves a greater purpose. I have been given this unique opportunity to grow in my faith and in my concept of self. I look forward to the meaningful conversations shared. I plan to pick the brains of the Kubacki family (my hosts and the village doc), discovering how they listened and obeyed the call for medical mission work. I am excited to embrace a new culture, learn a few new dance moves and see the stars without light pollution.

I am ready to blur the lines of my comfort zone.

Am I packed? Nope.

Is Toto’s song “Africa” playing on repeat in my head? Yes. Am I embarrassed? Not really.

Stay tuned.