Stories from Caluquembe

Those supporting this work in Angola are participants in these stories as much as  I am.  These are a but a few of the stories I remember as I sit to write.  I’ve been here two weeks and could write a book of incredible stories, most already forgotten because of the sheer numbers of illness and injury.

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A 13 month old little boy crawled into a well, thirty feet deep, and landed in water.  Ten minutes later he was pulled out unconscious, but breathing, and brought to the hospital.  We resuscitated him, gave him oxygen and antibiotics and watched him wake up and begin nursing the next day and go home, responding normally, two days later.

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In afternoon consults (those cases saved for “the doctor”), I saw a very strong-looking 65 year old man (photo uploading) who complained of chest discomfort.  He arrived with his wife and both were decked out in bracelets, necklaces and a skirt.  They each had their front teeth filed to a point, were bubbly and pleasant, and I understood not a word that they said.  They were from a small tribe on the coast and one of the people groups we are praying about working among (easily recognized by their teeth and “jewelry”.  They spoke a bit of Mbundu, the common language in the Caluquembe region, and we could communicate through a Portuguese-Mbundu translator (everyone working in the hospital speaks both languages fluently).  His discomfort was most certainly cardiac and all we could do was recommend treatment in the capital which will never happen.  We began some preventative treatment.

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A 23 year old woman had a vaginal-bladder fistula repaired two weeks earlier by Dr Foster and was told that the problem was fully corrected and she could go home.  No picture could capture her beaming smile as she gushed her thanks to everyone.  One surgery and generations changed. See previous post on devastation of these fistulas.

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A beautiful 3 year old little girl (photo uploading) had TB which had filled her left chest with pus and was near death on arrival.  I put in a chest tube to drain the fluid and she screamed (though barely able to breathe) and glared at me throughout the five minute procedure.  She did the same the several times that I’ve had to painfully adjust the pencil-sized tube.  She is doing wonderfully and will likely have the tube removed and go home to her remaining seven months of treatment this week.   There is so much TB, a disease so feared in the States that no medical personal goes near them in their isolated, specially vented room, without gloves, mask, and gown.  I’ve seen so many die already from it, many with permanent limps as teens from the TB destroying their hip, young and old hunched over from TB of the spine, large bellies filled with fluid from TB of the abdomen, comas and seizures for weeks (with permanent disability or death) from meningitis…

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Two women had labors of 3+ days and finally came to the hospital (in this culture, it’s always a last resort).  Brief exams revealed that the babies’ heads were in no way going to pass through the pelvis.  I performed on each a symphisiotomy, which is cutting the pubic bone (you can feel yours at the bottom of your abdomen) symphisis (and allowing the pelvis to fall open 2-3 cm).  This and an episiotomy allowed quick delivery of the still-alive babies.  The mothers will be on bed rest for about a week to allow the bone to begin healing.  One advantage to what seems a brutal, yet life-saving procedure, is that their pelvis will be a bit larger for their next 7-8 pregnancies and this same circumstance will likely not occur for them again.

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Nothing is as sterile here as one would prefer in the operating room, though I think they do wonderfully with what they have.  We wash our hands in a bucket of water, there are many flies, there is no suction, etc.  We had a 20 year old woman do very well after a life-saving Cesarean (she had arrived with seizures and eclampsia), only to go into a coma with endometritis several days later, an infection of the inner lining of the uterus.  It doesn’t look hopeful for her at this point but she is still alive, though not responding.

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An afternoon: I saw a three day old in maternity with a fever of 104 (my third newborn like this in a week), likely from congenital malaria, a huge killer in this part of the world.  I then spent an hour sewing up the face of a 5 year old with extensive lacerations from falling on a stick, and was called to maternity because a 23 year old woman who had hard labor for two days suddenly had her contractions cease.  Her uterus had ruptured and her baby had died.  Her pelvis was also too small for delivery but the baby’s head was quite low in the pelvis.  I performed a symphisiotomy (she bore it with barely a whimper), delivered the baby, and we resuscitated the mom in ICU.  She is still there today, one week later, and doing well.  Three spinal taps in that afternoon revealed meningitis.  I was then called to four victims of a motorcycle trauma just arriving to the hospital.  One man was unconscious and seizing with multiple lacerations, and open fractures of his tibia and foot.  He also had several broken fingers and a broken humerus.  We treated him aggressively for his head injury and, remarkably, he woke up the next day and is recovering well.  A 20 year old girl suffered a broken femur and shattered, open tibia fracture in the same leg.  On their return to Lubango, my family transferred her to to our mission hospital (CEML) where she will receive surgery and excellent care.  The two other victims suffered multiple broken bones but survived and went home several days later.  I was then called to the operating room to remove a bean from the nose of a 2 year old boy!

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Another afternoon: I began by performing a Cesarean on another girl with a pelvis too small for the baby.  The baby was still high in the pelvis, making this surgery the best option.  I then put a catheter in the bladder (through the abdomen) of a 70 year old man whose urethra was obstructed by his prostate.  All men, worldwide, will have prostate problems if given enough time and surgery is rarely available here so the few men who live long enough have the privilege of living their final years with a catheter.  Then, after wiring a jaw closed in a young man from, you guessed it, a motorcycle trauma, I was called to the Emergency room (it is a small room with a bench and a bed) and encountered a 17 year old girl clutching her throat with the complaint of not being able to breath.  I sent the nurse for some medicine and the girl promptly collapsed unconscious and not breathing.  Mouth to mouth provided no air movement as she had an upper airway obstruction, likely from aggressive infection.  I put a needle in her trachea but it was too small to provide any benefit. The nurse returned after about a minute, quickly gave the “adrenalin” and left again for a knife and the means to get a airway into her neck.  He returned after another two minutes and I quickly did a cricothyrotomy, establishing a good airway through the anterior neck and into the trachea.  I did mouth to tracheostomy resuscitation and chest compressions and ended up with a mouth, face, and clothes full of blood and secretions but no heartbeat.

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I’ve been asked how it feels when someone dies that surely would have survived with modern equipment and medicine.  This young, beautiful girl sure fit as she would have survived if we simply had the equipment/medicine in the room, like we would have in the States.  It is a confusing, awful, almost daily feeling, as there are several deaths here each day that fit.  I was then called to maternity for a woman who had three days of labor for this, her 7th pregnancy.  When I did her exam, I shook hands with the baby, never a good sign.  With an ultrasound, I was able to verify that the baby was still alive and we took her to the OR and did a Cesarean, without complication.  Today, the mother and baby are fine.  Without the Cesarean, neither would have likely survived.  It is a beautiful procedure, performed under local anesthetic with minimal risk to the mother, even in this environment.

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Yesterday afternoon (my afternoon off):  An eight month old boy arrived after seven days of vomiting and diarrhea and nothing by mouth for three days.  He was unconscious and had a heart rate over 200 and no peripheral pulses.  The nurses called because they couldn’t begin an IV so I found a spinal needle and started an IV in his tibia.  His malaria test came back (of course) positive and we now had access for fluids and IV meds.  A woman was attacked by her son (?) with a machete and the wound went through her Achilles tendon and ankle, shattering bones.  Over a couple hours, I cleaned and reconstructed her ankle and reapproximated her tendon in hopes of saving her foot.  We’ll see.  Then I was called to another motorcycle accident (there is almost one serious motorcycle accident/day, usually with multiple victims) with a jaw bone fracture in multiple places, lost front teeth, a cheek bone fracture, and a fracture of the orbit.  The young man was conscious and drunk (some things remain the same in any ER trauma, anywhere) and will likely survive.  I did several emergent ultrasounds for Maternity and made it home with Ben for dinner at six.  Ultrasound is an amazing tool in this setting and I’m enjoying thoroughly the information it can provide.

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I begin every day in the hospital wards doing “rounds” on the 200 or so adult and pediatric patients, most of whom are/were gravely ill.  The first two weeks, Luke joined me, and now it is Ben.  How very nice it is to share this experience with them.  I always approach rounds with a sense of excitement, as there is a daily sense of joy as I see many respond to their treatment and move away from death’s door.  There is also daily sadness as I again hear the word, “faleceu”, indicating that another has “passed away” during the night.

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This is a hospital in the developing world doing so much good for so many of our Father’s beloved.  It was begun by missionaries around 1900 and they would be so pleased to see the beautiful work that is still being done here, and the Jesus-like manner in which it is done.  So many lives are saved, and so many hurting people embraced, each and every day and it is a thrill to be a part.  The two leaders are remarkable men who are not doctors but do the work of ten doctors.  They have a great work ethic, care deeply for the people, lead well and practice excellent medicine in very simple conditions.  They have been doing this for many years and still approach each person with love and energy.  Please pray for Nelson and Solomon (photos uploading).  I greatly admire so many of the people here.

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I’m challenged daily as I serve and interact with the patients and families who are staring at death or have loved ones dying, who sometimes travel for hours or days for help, and whose smiles and kindness simply doesn’t fit the environment in which they find themselves.  These folks are ever kind, never angry, and always polite and respectful, even while in very emotionally trying circumstances.  This post-war, impoverished culture astounds and confuses me daily.  These beautiful people, created and loved by our gracious Father, demonstrate by their lives that they were clearly made in His image.

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These people believe that unseen forces are more powerful than seen forces.  Most are not “christian” but their faith in what is not seen is much more impressive than that of most christians.  We say that we believe in and trust that which we cannot see, but our lives demonstrate otherwise.  The attitudes and responses of these people to tragedy and affliction demonstrate faith rarely seen in our “christian’ culture.

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It has also become evident to me that these folks suffer greatly and don’t see it as “unfair”.  They do not expect otherwise.  Like us, they desire favorable circumstances but, unlike us, they don’t expect them.  In the West, we EXPECT life to go well (better than well) and live with fear of unseen difficulty and with disappointment in trial.  The people of the West think that they have much to offer people in the developing world.  It’s otherwise.  At least compared to the population of rural Angola, it is we who have so much to learn.  In the US, we have gained so much stuff and, in the process, lost life.  They have no stuff, and suffer greatly, yet know life as our Father meant it to be lived.  I am so blessed to be here and in position to learn from these beautiful people, who are so well acquainted with hardship and loss, yet so rich.

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These… are why we are here.  Their lives are worth any sacrifice, as demonstrated by the One we worship.

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Thank you for serving these folks with us.  You’re not supporting missionaries, you are touching and healing wounded, ill people through them, praying for people who don’t know Jesus through them, embracing broken people through them, sharing the Truth though them.  Jesus does the exact same through His body.  It’s the Kingdom.  Thank you for loving the Angolan people.   I hope these posts give you an idea of what you are a part of, or could be a part of.  Please pray for those mentioned in this post.  Photos are uploading and might take a day or two.

5 comments

  1. Thank you for sharing these stories Tim. They really help us to feel like we are a part of the work you are doing.
    These stories are heartbreaking but I really appreciated how you put hardship in perspective for westerners vs everyone else.

  2. You are doing an awesome work in kalukembe. Please great our brother Antonio Solomon from me. Twapandula chelwa

  3. Tim, it is really interesting to hear what’s going on there. I especially like the pics of you “in action”. Keep up the good work for our God, and loving His people. I love you.
    kelly

  4. Tim, it won’t be the same when we arrive in Altamira later this week. God bless in your work and know our prayers are with you. Rich and Vicki Schurter

  5. I don’t know what to say, other than God bless you brother. We are so blessed here in the states it’s unbelievable, and most don’t even know it. Deb and Ben went on short term mission earlier in the month in Honduras. Volunteered in orphanage for HIV positive kids. Build and repair roads. Eye opener for Ben I’m certain. I’m very much hoping Zach and I can visit you next June, Zach still talks of studying Medicine, he needs to see what you do. Blessings, love to your family.

    PS – I turn 50 tomorrow. Major blow-out party on Sat. My band playing, many friends coming wish you could be there. Pray I only drink to much, not way to much.

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