Lubango, Africa; First 10 days
November 4th, 2015 by Laureen Knuteson
Greetings from Lubango, Africa on my first blog post ever! This city is home of a million people, located in the Huila province. I am here for a first hand insight into the life at a medical mission hospital and clinic. Where do I begin? This has been an exciting 10 days here in Lubango! It has been a time of many “firsts” for me here at Centro Evangelico de Medicina do Lubango (CEML). Today, especially, was my first time assisting on a C-section and it was awesome! All went well. Other firsts were assisting on a cleft palate repair (artwork!), repair of a few vesiculovaginal fistulas (these are sad), first eye surgery/lens implant, and my first ortho cases! They do many external fixations here for fractures, not the usual open internal fixations and rod placements. It is hard to get the internal hardware, and the external fixation system can be sterilized and re-used again after the patient is healed. Lubango has such a high incidence of trauma, due to vehicle and motorcycle accidents, that is well beyond the average statistics. Driving here is crazy, and common sense is rarely used. It is like there are no road rules! Safety prevention is key to changing this problem. Often a secondary issue to the initial fracture is the development of osteomyelitis requiring surgical debridement and possibly later bone and/or skin grafting. Malnutrition here plays a significant role in the outcome of your repair.
As mentioned above, they do vesiculovaginal and rectovaginal fistula repairs here. I personally had only read about them a few weeks prior to arrival. African women suffer from this in high numbers, and very few places provide surgical repair. Here in Angola, one other center is registered as a repair site, but I also read that there are 2 million women living in Africa with a fistula! This is likely an underestimate as many do not seek attention and do not know that there is a treatment. This is something I would love to learn to repair! This past weekend I was taken on a site seeing trip and we encountered a youth group whose teacher wished Dr. Collins (who concentrates on Ophthalmology) to speak about pregnancy and abstinence. He included information about fistulas and that childbirth at a young age does not allow your bodies pelvis to develop adequately, and more likely to have an obstructive labor, which after several hours of pressure may lead to tissue necrosis and fistula development.
Other things I have seen have been many with bladder cancer which Dr. Foster states is often contributed to former Schistosomiasis infections. I have also seen tetanus! I am not sure he will make it as he continues to have trismus and diffuse muscle spasms requiring frequent diazepam. I have never seen one receive so much. Of course I have also seen commonly hypertension and diabetes, which unfortunately they are not always able to get the medications for treatment. They sometimes go to more than one pharmacy before finding the right medication and may not be able to afford.
One thing for sure, the patients here are tough! Sometimes small procedures are done with no or very little anesthetic. The patients have been very willing to include me during their office visit at the clinic, and try to express to me their complaints despite me not knowing Portuguese. A few speak a little English. I have received assistance with interpreting from RN Audrey, and Dr. Foster has been kind to share with me their stories as well.
Oh, I must not forget. One other fun thing was that a visiting RN from a town several hours away came to teach CPR. I got to assist her on this, and I added on later to those most likely to use it, some training in using the defibrillator. We talked about what is a shockable rhythm and they really showed interest! Luckily, Jordan spoke Portuguese! It was great to see their interest and attentiveness. Now, I hope to expand later this week with some ECG reading class. I hope others will consider coming here as it is a great site to do primary care, and surgery. I will include some pictures once I learn how to load!