Hope Present And Future – Angola Day 21

July 19th, 2014 by INMED | Comments Off

steve-foster-petra-kalukembeSteve Foster, left, has lived and served in Angola since 1978. A fully Board Certified Canadian surgeon, Foster and his classy wife Peggy over the last thirty-six years raised four children, save thousands from early death, and continue to inspire tomorrow’s healthcare personnel in this stark nation. Steve Foster was my mentor at Kalukembe Hospital when I first arrived in Angola in the 1990s. Today he and I are on site together back at Kalukembe, where Foster is mentoring Petra Schmid. A Swiss national, medical student, and earnest Christian, Petra possesses those rare, Foster-like qualities of vision, faith, endurance, and social graces that should reassure us all that, as Samwise Gamgee said to Frodo Baggins, “There’s still some good left in this world… and it’s worth fighting for!”

On Backup For Hell – Angola Day 19

July 17th, 2014 by INMED | Comments Off

annelise-olsenOn call for emergencies one evening, I cared for a elderly man with acute bleeding into his bladder. This caused obstruction of urine outflow, a huge bladder, and extreme pain. Simply placing a Foley catheter thru the penis or directly through the abdominal into the bladder was no solution, since the clots obstructed any hope of outflow. I was at the end of my expertise, and considered, “When it all goes to hell, who ya gonna call?” I called Annelise Olsen, Lubango Evangelical Medical Center’s newest surgeon extraordinaire. That evening Annelise walked me through my first transvesical postatectomy, and here’s my mentor showing off the 300 gram prostate we shelled out of his bladder neck. What’s this, a general surgeon performing urological surgery? Yes, and far more. Everyday Annelise performs grueling orthopedic, ENT, and gynecological procedures – utilizing Angola’s extremely limited resources – that would make any surgical sub-specialist have second thoughts. The field of general surgery in North American has become so compressed by surgical sub-specialists that there’s relatively little remaining for the generalist. But out here, a truly general surgeon can enjoy the entire spectrum. And when family physician like myself confronts a hellacious situation, I’m grateful that uniquely a talented surgeon like Annelise Olsen is on back up.

I’m In Stitches – Angola Day 17

July 15th, 2014 by INMED | Comments Off

iv-bag

Here’s a story that will make you smile… Steve Foster, my mentor and Angola’s surgeon extraordinaire, came home tonight describing how that he saw a dehydrated child in clinic this morning. “Give him Ringer’s Lactate, one liter each 5 hours,” instructed Foster, in his deep, declarative voice.

 

Ten hours latter Foster returned, and found the child looking much better. However, there was no IV line in the child’s arm. So Foster quizzed the staff, “Didn’t you give him the Ringer’s Lactate?”

 

The personnel replied immediately and with all sincerity, “Certainly! We just popped the top off of that clear plastic bag, poured the Ringer’s Lactate into a cup, and gave it to the child to drink. Just like you said, Dr. Foster.”

World’s Most Life Saving Drug – Angola Day 15

July 13th, 2014 by INMED | Comments Off

tb-drugsWhat is the world’s most life-saving drug? Penicillin against infections? Quinine against malaria? Furosemide against heart failure? Hydrochorothiazide against hypertension? My nomination I hold here in my hand. João Manuel has been coughing blood and loosing weight for six months. His chest X-ray shows white out of both lungs and he requires 5 liters of oxygen each minute to sustain his life. What was the leading cause of death in North America just 100 years ago? Tuberculosis. And TB remains among the top three kills in today’s most disadvantaged nations, attacking people like João Manuel. Anti-tuberculosis medications, taken correctly and in combination, are extremely effective. Here is João Manuel life-saving drug: a combination pill with isoniazid, rifampin, ethambutol and pyrazinamide.

Physician, Heal Yourself – Angola Day 13

July 11th, 2014 by INMED | Comments Off

malaria-test-positiveYesterday I cared for three young people with rapid onset coma and hemiplegia. They were also all malaria test positive. Malaria can cause a plethora of neurological signs, and no confirmatory brain imaging is available out here. So I started IV quinine and today – miraculously- all three patients resolved their deficits and woke up. Astounding! But next I was suddenly struck with extreme fatigue and chills. Sure enough, though it has not rained here in four months and I’ve seen not one mosquito, I too was malaria positive. Coartem is the first-line drug of choice. Tragically, our hospital Coartem supply has entirely run out. I drove to a private South African pharmacy and paid $13 for this drug, reflecting how few Angolans enjoy to such lifesaving privilege as I.

“Who Is My Neighbor?” – Angola Day 11

July 10th, 2014 by INMED | Comments Off

good-samaritanThis morning the staff of our small medical center met together as Pastor Moses opened his Bible to Luke chapter 10 and read, “On one occasion an expert in the law stood up to test Jesus. ‘Teacher,’ he asked, ‘what must I do to inherit eternal life?’ ‘What is written in the Law?’ replied Jesus. ‘How do you read it?’ The expert answered, ‘”Love the Lord your God with all your heart and with all your soul and with all your strength and with all your mind” and, “Love your neighbor as yourself.’” ‘You have answered correctly,’ Jesus replied. ‘Do this and you will live.’ But he wanted to justify himself, so he asked Jesus, ‘And who is my neighbor?’” Pastor Moses motioned just outside the door, where some 100 people awaited their medical consultations. He then pointed to the hospital ward and maternity, where 50 more were already receiving life-saving attention. “Today,” declared Pastor Moses, “we enjoy the privilege of compassionate care for these, our neighbors.”

Demography & Documents – Angola Day 9

July 8th, 2014 by INMED | Comments Off

angola-medical-recordLucia is just fourteen years young. Yesterday she suddenly lost ability to speak and also developed paralysis of her right arm and leg. Were she a lady in her sixties or seventies I would highly suspect a stroke. But a young woman in southern Africa with new neurological deficits? My provisional diagnosis is cerebral malaria infection. Now she has no fever and her first malaria smear is normal. But nevertheless, in this region of the world such syndromes are commonly caused by this ubiquitous protozoa. Above is her medical record from our tiny ER. Yes, paper. And notice how we don’t invest much time in documenting details when fifty more people are awaiting attention. How is Lucia today? After 24 hours of IV quinine she is beginning to speak and her paralysis almost entirely resolved.

 

Trauma & Hope – Angola Day 7

July 6th, 2014 by INMED | Comments Off

elbow-laterationFeliciano was struck by a truck as he tried crossing a road on the chaotic, crowded streets of urban Angola. Lacerated open at the elbow, the lateral ligaments were fragmented,  exposed the entire joint space to dirt and gravel, and left his forearm gangling helplessly. Feliciano was carried to a health post were some sutures were placed in a helpless attempt to cover the 5 by 10 inch area where his entire skin was ripped away. “You must take him to Hospital of Christ the King,” urged Feliciano’s friends. “Perhaps they can save your arm, and even your life.” Photoed above is the result of my first surgical procedure for Feliciano – to simply debride, irrigate, and pack the grossly infected wound.

 

elbow-lateration-castedFollowing the procedure Feliciano will wear this splint and receive daily dressing changes for the next week, along with an IV antibiotic. This will hopefully allow the infection to subside. Next week I’ll take him back to the OR with the objective of reattaching the lacerated tendons that may allow Feliciano the capability of extending his fingers once again. At the moment such motion is impossible. The greater surgical challenge will be to cover this gaping wound skin grafts and by suturing closed some of the defect. This morning Feliciano spoke with animation: “I will move my fingers once again!”

 

 

Where There Is No Dentist – Angola Day 5

July 4th, 2014 by INMED | Comments Off

no-dentistWhat is your diagnosis? Even without formal dental training you will likely identify severe gingivitis, broken and missing teeth, and dental destruction with exposed root structures. This Angolan lady came for assist today complaining of pain throughout her mouth. No only is dental disease disfiguring and uncomfortable, it can also be life threatening. Most every year I watch a patient die from complications of dental abscesses. A simple tooth or gum infection progresses to abscess draining puss and then to sepsis (infection of the blood stream). Extremely few Angolan have access to a dentist – and as a result many die. In North America we have many dentists, but dental care and dental insurance are largely viewed as a luxury, rather than as essential health care. This is a deceitful misconception. Dental care is not simply cosmetic. It is lifesaving.

Complicated Knee Fracture – Angola Day 3

July 2nd, 2014 by INMED | Comments Off

knee-fracture-x-rayOrthopedic trauma is a leading cause of admissions here to our Lubango Evangelical Medical Center. The post-war economic progress throughout this nation is expressed by a growing number of motorcycles on unusually rough roads. Eduardo, the man of 40 who’s X-ray appears above, was driving his moto on the dirt when he lost control and broke open his knee. This X-ray demonstrates what appears to be a typical platella  fracture.

 

knee-fracture-openBut this injury occurred a month ago. Today was Eduardo’s first presentation for medical care. Above is the open wound and the yellow object protruding through his skin is indeed the platella bone. Infected, necrotic, the first step in Eduardo’s care will be to provide general anesthesia, open the wound widely, and remove the infected tissue. Only after this heals – weeks from now – will we enjoy the possibility of reconstructing the platella and assuring his ability to walk again.