From One To One Hundred – Angola Day 26

July 26th, 2017 by INMED
Posted in INMED Training Sites In Action|


Photoed here are some of the thirty-five nurse practitioners who staff the rural health centers surrounding Kalukembe Hospital. Twice each year they converge for two days of continuing education. I enjoyed the opportunity to lead eight hours of workshops on how to promote economic development and literacy, since these are so very essential to physical health. I also lead them through management of simulated cases of tropical fever, acute abdomen, orthopedic trauma, and postpartum bleeding.


When I first came to Angola in the 1990s my approach was to care for as many people myself as I reasonably could. That emphasis lasted about six months, when I finally realized in my heart that progress in this nation required hundreds of people like myself. So I changed my approach to multiplying skill capacity, to sharing my vision and skills with talented Angolans who themselves would carry on the mission. Now, this vision is not valued by myself alone. Insightful Angolans, like Antonio Salamão whom I described in my most recent post, also embrace this vision. What a joy to be part of this multiplication from one to one hundred.


Innovators Of Africa – Angola Day 24

July 24th, 2017 by INMED
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Innovative and vulnerable – these are the children of Africa. Walking from home to clinic today, I met these boys touting their homemade airplanes. One is a King Air, followed by a Cessna Caravan – fine replicas of the aircraft that land on our dirt runway. The models include even spinning propellers and wheels. Innovative indeed! Toys created by children with no tools other than keen minds and observant skills are a testimony to the inner character of these youth.


But vulnerable they are, as well. Angolan children have among the highest mortality in the world. About one quarter will die before starting primary school. Malaria, pneumonia, diarrhea, TB and measles are the killers in this nation that spends on average $70 per person each year on healthcare, vs $10,345 per person in the United States. What can be done to protect these Innovators of Africa?


Choosing A Career In The Bush – Angola Day 22

July 22nd, 2017 by INMED
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By Angolan standards, he was blessed indeed. While still a young man, Antonio mastered English and graduated from the Liverpool School of Tropical Medicine & Hygiene. But rather than succumb to the allure of privilege, Antonio Salamão chose to serve out his career at Kalukembe Hospital. This rural medical center provides care for some half-million extremely low-income people – mostly subsistence framers. Kalukembe has 130 inpatient beds, delivers 100 babies each month – and has no running water or functioning telephones.


I first met Antonio Salamão three decades ago when I arrived at Kalukembe for a six-month orientation to Angolan medical care. He walked me through the paces of African community health, of managing pediatric diseases amid very limited resources, and how to apply ultrasound technology to unique tropical syndromes. This week I enjoyed two days together with Antonio at Kalukembe, marveling at his continued bright spirit and virtuous persistence to serve out his career in the bush.


Surgeon With Style – Angola Day 20

July 20th, 2017 by INMED
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Annelise Olsen, CEML‘s youngest general surgeon, expresses an inspiring persona. She embraces style, whether in clothing, cooking or lively conversation. Annelise embodies medical excellence, devoting her judgment and procedures to our patient’s best welfare. And she advocates for the global health virtue of sustainability: giving our willing learners ample opportunity to develop their own skills under her keen supervision. I speak from experience. It was she who taught me the procedure for suprapublic prostatectomy.


I first met Annelise a few years back when she came to CEML as a resident physician. Like many considering a career serving disadvantaged people, this early experience was formative. Annelise’s skill in Portuguese and eager learning orientation were clear. Later, she returned as a Post-Residency Fellow with Samaritan’s Purse. And today, Annelise is an essential part of our career staff. I enjoy being on call, knowing I can summon her for assistance. As Dr. Olson likes to say, “I’m on back up for hell.”


Compassion In Action – Angola Day 18

July 18th, 2017 by INMED
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“Our child became ill 6 months ago. So, we visited the traditional healer. We lost our money and our child was no better, so we went to the closest clinic. They did tests and gave medicine, but our he didn’t recover.” Thus, begins an account we hear frequently. It continues like this: “Next we went to the hospital, but were told they would do nothing more. Finally, we traveled several hours or days to reach CEML Hospital. Can you help us?”


Photographed above are the kind of patients and families who most frequently recount such stories of health lost, assurance languishing, and hope of healing. CEML Hospital is often their last reasonable hope of assistance, especially for those suffering from eye disorders, orthopedic injuries, maternal fistula complications, and more recently, cancers too. Who is CEML? In short: a ministry of the Angola Association of Evangelicals – a collation of hundreds of churches pooling their influence to create care that none could provide alone. It’s an active expression of compassion on behalf of humble country men and women like these.


Life After Life – Angola Day 16

July 16th, 2017 by INMED
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Life span in Angola averages only thirty-eight – a fact painfully experienced by our patients and families. We at CEML Hospital are diligent to help people better these odds. But all life has limits. As I pondered this truth, Pastor Moses phoned again, asking me to prepare a mediation for chapel today. Pictured above are patients and family members gathered outside their cabins, with the hospital in the background, singing in harmony with leaders from Moses’ church, below.



For my message of hope, I selected Philippians 3:20-21, “Our citizenship is in heaven. And we eagerly await a Savior from there, the Lord Jesus Christ, who, by the power that enables him to bring everything under his control, will transform our lowly bodies so that they will be like his glorious body.” What a wonderful promise! Whether we succumb to malaria in Angola at age eight, or malignancy in American at age eighty, Christ – the only person in history to return from death to life – assures His followers of life after life.


Pyopericarditis – Angola Day 14

July 14th, 2017 by INMED
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Caution: This is a graphic description. In my post on July 2, Aberrant Abscesses – Angola Day 2, I described the plight of a seven-year old boy with pockets of pus erupting in his leg, shoulder and hip. Let’s call him “Lobito.” After drainage of the hip abscess on that date Lobito’s fever and appetite gradually improved. But this progress was unfortunately short lived. Over the weekend Lobito became short of breath and his chest X-ray revealed a new finding: an abnormally round heart size. Yesterday, ultrasound of his heart demonstrated the presence of thick pericardial fluid, represented by the blue line that measures 2 cm in depth where there should be no visible fluid at all.



Yesterday our esteemed surgeon, Annelise Olson, performed a pericardiocentesis – insertion of a needle into the pericardium. Immediately, yellow-green colored pus erupted from the puncture. A large bore catheter we inserted where the needed has been, and in the image above I’m aspirating 300 ml of pus, accumulating in this blue bowl. Almost immediately Lobito’s oxygen requirement predictably decreased as heart, which had been compressed by the pus, began beating freely.



But pyopericarditis is both a rare and a lethal infection. Individuals often die from the overwhelming sepsis and cardiac failure that accompanies the disease. This morning I approached Lobito’s bedside with trepidation. What did I discover? Please judge for yourself from the photo above.


Inadequate Fuel For Healthcare – Angola Day 12

July 12th, 2017 by INMED
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CEML Hospital‘s home city, Lubango, is facing a shortage of gasoline and diesel fuel. With a population of one million and some five thousand autos, the society seems to have literally come to a stop. This photo is illustrative. A line of car fifty cars is parked leading into a gas station, and the drivers mill around the pump awaiting the uncertain arrival of a fuel truck.


What does this have to do with healthcare? All social institutions are connected with one another. Without fuel, CEML employees cannot find transport to work. Without fuel, patients often cannot work their jobs and thus earn income to pay for healthcare. Without fuel, the often-needed backup electricity generators necessary for CEML surgeries and laboratory cannot function. And in cases of emergency transport, how can an ambulance running on empty deliver an injured person in time? Economic health is essential to life as a whole. Just ask these motorists.


Recovery With A Smile – Angola Day 10

July 10th, 2017 by INMED
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Elias is an eight-year old boy whom I met 10 days ago in the CEML Hospital Emergency Department. He was febrile, vomiting and complaining of marked abdominal pain. Fortunately, our laboratory capabilities are growing more mature, and Elias’ results documented malaria, hepatitis, pneumonia and profound anemia. Ill children in Angola often do not recover, so we were especially prudent in this boy’s care. He received malaria treatment, antibiotic and oxygen for lung infection, and attentive monitoring of the liver dysfunction. Through it all, his parents were constantly present.


The boy remained febrile and coughing for 3 days. But then his malaria test converted to negative, need for supplemental oxygen decreased, and Elias began to ask for food. On the 8th day, I gave him a discharge to the “patient village” next to CEML Hospital, where our non-critical patients often finish out their treatments close to assist should a relapse occur. Today, I fully cleared Elias to return home – and we all are smiling!


Digital Health Records – Angola Day 8

July 8th, 2017 by INMED
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How can we best coordinate health records over multiple consultations and by multiple providers? This essential and complex question is relevant the world over, whether in North America or Angola. In both locations, digital health information is priority – though the definitions are entirely different. Digital in Angola means the health record is literally created with one’s own fingers.


Above is a representative sample. I cared for a patient today suffering from new onset epilepsy associated with malaria infection. A small yellow notebook was given to her at registration, and here in each provider documents a brief record of each consult, including vital signs, history, examination, lab and imaging, diagnoses and treatments. And at the end of the consult, the patients themselves store their records digitally – guarding the notebook in their own fingers.