Second Week At CEML, Reflection On Spirit and Culture

November 8th, 2015 by Laureen Knuteson
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What a blessing it has been to meet the many people associated with the function and support of CEML here in Lubango.  The CEML clinic is mainly run by Dr. Steven Foster, who is a well known and respected physician throughout this large city.  Not only does he show that he loves his work, but he also easily expresses his love of God.  He has much patience and doesn’t miss an opportunity to teach, whether it be a medical point or a social/cultural aspect when reviewing patients.  The patients here also show much patience and acceptance for their condition, and often do not outwardly show their emotions when given a poor diagnosis.  They are even stoic when dealing with physical pain.  The patients also can wait for several hours just to see him, and at times have to be told they need to come back the next day as the hours of operation have run out.  It is not uncommon to have someone’s  surgery rescheduled,  as he tries to not keep staff past 6 PM on surgical days. Some people’s surgeries have been delayed even up to even three days.


During my stay, the volume has been high for a single staff surgeon plus a current additional Angolan surgeon who continues to gain confidence in surgery.  There are two additional Surgeons that will be here early next year, and have been here before with commitments of long term stay.  Dr. Foster has been the force here for many years, and with these two other Surgeons, hopefully this Mission will remain strong.  I even got the pleasure of meeting a potential Angolan physician from Luanda that wishes to gain surgical training here in near future, and made a site visit.  I feel he will make a great addition.  Dr. Foster’s wish is that CEML would be a training site for surgical interns.  This past week a visiting Surgeon from Canada arrived and an Orthopedic Surgeon from Luanda worked here a few days.


My experience here has not only been made from what I have seen at the clinic but also from my experiences within the community.  My Hosts Norm and Audrey Henderson have been so gracious to take me site seeing to the near by natural wonders of this area like Serra da Leba and the Tundavala cliffs and gorge, and they have taken me to meet other people associated with the organization.  One happy family.  I also had the pleasure to experience twice an Angolan church service, and there sure are some amazing voices in the congregation.   I was introduced at the start and was greeted warmly.  One Sunday a few young men initiated trying to speak English with me, and I was so pleased at the gesture.  My Portuguese is pretty poor.  This is something that I would have to work on in order to make the type of impact I would like to make if I repeat my service here.


This week the country will celebrate the 40th Anniversary of the end of control by Portugal.  The report is that the clinic will be closed on Wednesday so one can celebrate.  I will wait and see what events may occur to help celebrate.  I was told most will be played out in the capital Luanda which is several hours away.   Despite this country having rich natural resources, it continues to have limited health care services and  basic standard of living.  Only a special subset of people have gained from this benefit of its oil and diamonds.  I hope the next 40 years brings progress towards equality, and may the example set forth by these Missionaries help spread desire of Angolans to serve their fellow Man.

Lubango, Africa; First 10 days

November 4th, 2015 by Laureen Knuteson
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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!

Introducing Myself

October 18th, 2015 by INMED
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knuteson-laureenHello! My name is Laureen Knuteson. I am a physician assistant (PA) and I’m starting my INMED service-learning experience at Lubango Evangelical Medical Center in Angola, Africa, beginning in October 2015.