What’s The Neonatal Dose For Quinine? - Angola Day 19

July 9th, 2010 Posted in 2010 Angola | No Comments »

Angola NeonateThis is a question very few, if any, neonatologist ever faces in wealthier communities. Today I met this mother and her three-week old infant, who stopped nursing yesterday. Malaria is so very common here, even in the dry season, that the standard thick smear blood test is part of the work up of anyone with a fever - even a neonate. His blood smear demonstrated the parasites, and I went scrambling to find the proper infant dose of IV quinine. It’s not in any of our pediatrics or infectious disease text books, certainly not in Epocrates - that fancy medical info program I carry in my PDA. Alas, I finally found the dose in Handbook of Medical Care In Developing Countries. But this was only the beginning of the obstacles. Our pharmacy only has adult IV sets, and the wards have no infusion pumps, and no means for cardiac monitoring… Gotta love these challenges!

Pre-1960’s Medical Practice - Angola Day 17

July 7th, 2010 Posted in 2010 Angola | No Comments »

Angola Patient With NG TubeThis morning I arrived to find this man, who arrived with a history of weight loss (check out the cheek bones), abdominal pain, and cough for three months. One of the greatest challenges of ‘practicing medicine’ in this setting is the lack of testing available. In North America, he would immediately have a CT scan, abdominal ultrasound, chemistry 100, and a host of bacterial cultures. But out here, where most people earn in the range of $50-100 per month, such special exams are unaffordable and non-existent except for the rich who live in cities. So we virtually rely on history and physical exam, which is quite limited, but just the way medicine was practiced before the 1960s. One of the greatest challenges for healthcare professionals who come out to such low-resource communities is learning to work with very little!

Not All Work - Angola Day 15

July 6th, 2010 Posted in 2010 Angola | No Comments »

Angola BeachSeveral of you have written questioning whether we ever take any time off. Angola’s health crisis is a chronic one, and I totally resonate with the wisdom of enjoying some creative breaks from the action. On July 4th, while most American’s were igniting explosive devices, I took off with a group of Canadians and Angolans to visit “O Arco” - an oasis in the midst of the Namib Desert. Imagine my delight to discover this natural spring-fed lake in the midst of sand dunes, complete with lilies,  ducks, and flamingos! And then off to the beach in just south of Angola’s port city of Namibe, where we surfed the waves and tamed this dragon inte

Trauma: A Forgotten ‘Disease Of Poverty’ – Angola Day 13

July 5th, 2010 Posted in 2010 Angola | No Comments »

Forearm Fracture AngolaThis lady, Cicilia, was riding along on the back of a Mosquito – these ubiquitous 50 cc motorbikes that scurry around the pot holes that make up Angola’s roadways. Her husband was driving, carrying their son on the handlebars. With one stout, unexpected jolt the lady was thrown to the rocks, lacerating her thigh and fracturing her forearm. Scholarly analyses of health problems in low resource communities rarely mention the roles played by trauma, yet falls and burns are plentiful, leading to long-term disability and frequent death. Cicilia’s laceration is infected and her fracture is open, making in all likelihood for a recovery of some months.

The End Of Poverty - Angola Day 11

July 2nd, 2010 Posted in 2010 Angola | No Comments »

The End Of PovertyEarly death is an inconsolable fact of life. In the world’s poorest nations, like Angola from where I’m writing now, a quarter of children die before reaching school age, and adults can hardly expect to live much beyond age forty. Such disturbing truths motivate many healthcare professionals to do something bold on behalf of the world’s most disadvantaged people. Yet so many of our efforts fail to address the most fundamental issue: poverty itself. If healthcare is so difficult to sustain for those who are most poor, why not direct our effort toward alleviating poverty? In his provocative book The End Of Poverty, Columbia University professor Jeffrey D. Sachs brilliantly illustrates how economic growth in the poorest nations – those where people live on less than one dollar per day – has brought with it unprecedented progress in physical health. How does economic growth foster physical health? Through improvements in housing, nutrition, vector control, water and sanitation, general education, industrial safety, medical care, and incentives to reduce fertility.

Vesicovaginal Fistula - Angola Day 9

July 1st, 2010 Posted in 2010 Angola | No Comments »

Huila WomanOne of the saddest health problems in all the developing world is vesicovaginal fistula (VVF). It’s a hole created between a woman’s bladder and her vagina, resulting in a constant, uncontrollable flow of urine out the vagina. As a result, many these women - and often children under their care - are outcast by their husbands and their communities. Here at Lubango Evangelica Medical Center Dr. Steve Foster is performing the necessary, but often complicated surgical repair for a large number of women. But how about prevention? VVF is caused by complications of the normal birthing process. When the baby descends too slowly, undue pressure is placed on the mother’s bladder by the baby’s head, resulting in death of that tissue, and a subsequent hole. The solution? In short, provision of modern obstetrical care, where failure of the natural birth process is diagnosed and treated immediately.

Itunda Baptist Mission - Angola Day 7

June 30th, 2010 Posted in 2010 Angola | No Comments »

Itunda Baptist Mission, Huambo, AngolaIn contrast to the behavior of Angola’s colonial rulers, some individuals made genuine investments into the lives of the Angolan people themselves. In 1929 a family moved to the village of Itunda, just outside the city of Huambo (formerly Nova Lisboa). They started a school for local children, taught about Jesus, and initiated a church. In this photo is Caesar Sapolo, Angolan nurse, and myself in front of the marker for the Itunda Baptist Mission. The founders would no doubt be thrilled to know that decades later Caesar and I held many clinics on this piece of land they dedicated on behalf of Angola’s native people!

We Will Now Take Your Question - Angola Day 5

June 30th, 2010 Posted in 2010 Angola | No Comments »

Angola Public Radio AppearanceAngola was colonized by the Portuguese during the 1400s. Though the Portuguese invested little into Angola’s infrastructure, even after the colonial rule ended in 1975 the Portuguese language remains both the official and the common language. I was quite privileged to live in Lisbon for a year studying the language. One of the language highlights of my life was the first time I even gave a message at church in Lisbon. Another was last night, when Steve Foster (left), Iria Almeirão (center), Sozinho (right) and I appeared on Angolan National Radio. The theme of the night was malaria - one of the leading causes of death and disability. Later in the program we started taking phone calls. One guy called in and asked, “I have heart burn every time I drink a Coke. Could this be due to malaria?” At first I thought I misunderstood his language. Then I concluded that he was indeed serious!

This Child Should Never Have Died! - Angola Day 3

June 29th, 2010 Posted in 2010 Angola | No Comments »

Nigombe With PneumoniaDirectly from the airport in Angola I drove to the Lubango Evangelical Medical Center and made hospital rounds. Almost immediately I was summoned to the ER, where I met little Nibombe. Coughing and less than alert, it was clear that Nibombe was suffering from pneumonia that encased his entire left lung. On closer inspection, I was also alarmed to find that his condition was complicated by heart failure. I treated him with ampicillin IV, which is about the only highly active antibiotic we have at the med center, as well as furosemide for his cardiac insufficiency. Nibombe initially improved and I was feeling such relief. What a sad encounter the following morning to discover that Nigombe died suddenly during the night. Working out here, we face so very many unknowns. Unknown languages. Unknown behaviors. Unknown diseases. I keep thinking of what else from which this kid may have been suffering that I totally missed.

Cross-Cultural Shock - Angola Day 1

June 29th, 2010 Posted in 2010 Angola | No Comments »

Angola MarketStraight after reception for the INMED Intensive Course students I left for the Kansas City International airport. Three days and some 14,000 miles later I landed back in Lubango, Angola, southern Africa. This nation is noteworthy for being home to the shortest life expectancy on earth - just 38 years! Though I lived in Angola for two years straight and come back for at least a month each year, I still feel such shock re-entering the nation. Shock from language (only Portuguese and tribal languages spoken here), from unusual diseases (malaria, HIV, typhoid fever), from new professional demands (rounding each day on 45 hospital patients), and shock from a culture that is both familiar and still quite foreign to me.

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