Pyopericarditis – Angola Day 14

July 14th, 2017 by INMED
Posted in INMED Training Sites In Action|


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
Posted in INMED Training Sites In Action|


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
Posted in INMED Training Sites In Action|


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
Posted in INMED Training Sites In Action|


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.


Dr. Alberto Serving His People – Angola Day 6

July 6th, 2017 by INMED
Posted in INMED Training Sites In Action|


Healthcare professional in Angola face a plethora of obstacles that would bewilder and derail most North Americans. Let me introduce you to my Angolan physician colleague, Dr. Alberto Alfredo. Raised in the interior of this nation, he took advantage of the rare opportunity to study junior college level nursing at the famed Kalukembe Hospital about the same time I served there in the 1990s.


Dr. Alberto’s pursuit of higher training launched him on a ten-year journey through medical education, interrupted by civil war and economic catastrophe. For most of his study, books were not available. During clinical hospital experiences, both medications and faculty were frequently absent. Being from the interior, he faced racism and bigotry throughout the university. And all the while, Alberto was working as a teacher to support his wife and nine children.


When you come to CEML Hospital today, you’ll meet a man whose character has been tested in most every conceivable way; one who has continued developing excellent patient care skills; and a man who year-after-year continues serving the most disadvantaged of his people.


Multiplying Healthcare Capacity – Angola Day 4

July 4th, 2017 by INMED
Posted in INMED Training Sites In Action|


This gentleman on the left suffers from gangrene of his left lower leg. Note how the skin, subcutaneous tissue and even muscle has been killed by this ‘flesh eating’ bacteria, leaving behind only exposed bone and tendons. Pictured center is my colleague, Steve Foster, expounding on the management of this lethal disease to a cadre of eager learners from the UK.


Dr. Foster is passionate about multiplying his skills among future healthcare personnel. This capacity-building attitude is widely appreciated today. But it was not always so. When I first ventured into international medicine the popular emphasis was on provision of services, with much less attention to future service sustainability. But thirty years ago, Dr. Foster was already pioneering the equipping of both Angolans and Westerners with the vision of multiplying healthcare capacity. And he continues in this inspiring tract today.


Aberrant Abscesses – Angola Day 2

July 2nd, 2017 by INMED
Posted in INMED Training Sites In Action|


This seven-year old child arrived with an account of a fall and pain in his right leg. Steve Foster, CEML Medical Director and my esteemed mentor, discovered a deep pus-filled abscess that occupied most of his shin. This abscess Foster drained readily enough. But close examination revealed similar abscess on other locations on the boy’s arms and legs. X-ray of the pelvis suggested an abscess of the hip joint – another potential life-threatening complication – which I’m further probing with the aid of a portable ultrasound.


A deeper question worthy of probing is why a seven-year old child would develop abscesses throughout the body. This phenomenon is rather common in Angola, while almost unknown in North America. Could it be related to malnutrition, especially protein deficiency which is common in this region? Perhaps these abscesses are from Salmonella typhi, a bacteria frequently present in contaminated water? Does poor health literacy among the parents play a role, who unknowingly fail to recognize early signs of disease? Honestly, such questions are often more abundant than answers at CEML Hospital and throughout healthcare in this nation.


Once Visitor, Now Vision Caster – INMED Grad In Cameroon

June 29th, 2017 by INMED
Posted in INMED Grads In Action|


“I sometimes wonder whether all pleasures are a substitute for joy… But then joy is never in our power, and pleasure often is. Our best havings are wantings.” This profound statement by CS Lewis may be illustrated by the life of Mary Buckler-Cairns. In the summer of 2008, while a medical student at Medical College of Wisconsin, Mary completed the INMED Diploma in International Medicine & Public Health, which included two months of supervised service-learning at Banso Baptist Hospital in Cameroon. You may enjoy her graduation photo!


A two-month African experience may fall into CS Lewis’ group of pleasures. But to sustain a career-long commitment in this environment requires finding joy in the unique challenges of culture, low-resources, family life abroad. Today, Mary and her husband are living in Cameroon, serving at Mbingo and Banso Baptist Hospitals. What’s more, she’s mentoring INMED learners in their own Service-Learning experience in this nation. In addition to grasping the nuances of African healthcare, by Mary’s example I suspect these fortunate young people will also be rethinking their ideas of pleasure and deep joy.


15 Worst Countries For Kids

June 23rd, 2017 by INMED
Posted in International Public Health|


Two decades ago I was in search of a special challenge: To offer a piece of my life providing healthcare in a nation at war. Simultaneously, a coalition of church in the southern African nation of Angola put out a call for assist in launching a clinic ministry. Thus began a partnership that’s endured through today. Next week I depart for my sixteenth summer in Angola.


When I first arrived in 1989 the plight of children was paramount. Most schools had long since been shuttered – closed by the colonists who feared an educated public and evacuated by the armies who preferred child as soldiers. Diseases of poverty (measles, malaria, dysentery, malnutrition) abounded, cultivated by absent vaccinations, mosquito nets, safe drinking water, and a pervasive attitude the childhood death was normal.


Today’s Angola is much improved. Armed conflict has ceased. Roads are now traversable. Some school have the lights on. Nevertheless, the plight of Angolan children remains grave, among the 15 Worst Countries for Children to Grow Up In. What can you yourself do? This complex question may cause you, like myself, to go in search of a special challenge, a unique partnership, to offer a piece of your life on their behalf.


INMED At Age Fourteen

June 16th, 2017 by INMED
Posted in INMED Grads In Action|


This week INMED Board and Staff members invested two days in inspiration and strategic analysis of our mission to better equip healthcare professionals and students to serve the forgotten. Peter Greenspan, obstetrician and Messianic Hebrew, opened the event event with the account of a tragically isolated woman: Jesus with the Woman at the Well. Dr Greenspan emphasized the lengths to which Jesus went to cross over culture and religious biases to communicate compassion and salvation to this profoundly disadvantaged woman – a model for us all to emulate.


As we methodically stepped through each element of INMED’s structure and activity, I was impressed with the steady grow we have witnessed. Fourteen years ago I was INMED’s only staff person, joined shortly by Micah Flint’s dynamic teamwork. Now we’re six full-time staff, flanked by dozens of volunteer faculty in twenty-five nations. Fourteen years ago our budget was $5,500. Today it’s $550,000. But most significant of all is the 500 INMED Graduates emulating compassion and care, so eloquently prescribed by Dr. Greenspan, toward our world’s most isolated people.