Here at Lubango Evangelical Medical Center it is the nurse practitioners that first attend to those coming for care. Paulo and Miguel are skilled, thoughtful, and can manage most individuals just fine. For me, they save the more complicated cases. Today, first, these included a four-year old girl who was growing normally until struck with cerebral malaria. She suffered a stroke and has been quadriplegic ever since. Second, they sent me an eight-year old girl with sudden liver failure, jaundice and ascites – all of unknown origin. Next, a two-month old with imperforate anus who was passing stool via his urethra. And finally, I received this eight-month old with hydrocephalus. Just a typical day of complicated pediatrics!