We just finished a three day trip to Caluquembe, where we saw patients from about 8:00a to 11:00p each day. The purpose of the trip is primarily surgical, as Steve Foster operates on those cases beyond the abilities of the local hospital staff. I did patient visits in the hospital, assisted in a few surgeries and saw patients in the outpatient clinic. I’m still learning so much.
One of the keys to accurate diagnosis and treatment is having a complete differential diagnosis. This is the list of possible causes for each presenting symptom. Unless a clinician’s differential is complete, he/she is likely to misdiagnose and, therefore, treat people inappropriately.
So, not only am I learning how to recognize and treat illnesses that I’ve seen little in my 20+ year medical career (toxic hepatitis, typhoid fever, falciparum malaria, tuberculosis, etc), how to effectively use a portable ultrasound machine, and how to perform some basic surgeries, I must also modify my differential diagnosis for each presenting symptom. It will take some time to think of these common, unfamiliar (to me) illnesses appropriately. The learning will go on for some time and I’m observing, working and studying diligently to be able to serve each patient well. It is clear to me now that I was previously competent in a very small niche of medicine (Emergency Medicine in a US community hospital) and then another very small niche of medicine (outpatient village visits in the Amazon). Both of these prepared me some for what I’m facing in Angola, but so incompletely. They provided, however, a foundation on which to learn, and learning I am. The other docs here have been gracious and patient with where I am. It’s been such a model of Jesus’ love – accepted as we are and empowered to move from where we are. When other docs arrive I must remember how precious that grace and tolerance was to receive.
We then traveled by car about 12 hr from Caluquembe to Cavango, the last 4-5 hr on never maintained dirt roads. On this dirt road, there are more than a dozen small villages of 20-60 grass-roof houses and we hope to visit these and the other 20 or so villages in this region over the next couple years. Cavango was a large mission hospital complex with separate housing for people with Leprosy and TB. During the war in the 1990s, 100+ leprosy patients were herded into a house and burned while the entire mission hospital complex was taken apart, brick by brick. Samaritan’s purse has rebuilt a small clinic building and Peter and Shelley Duplantis are missionaries living in this area, rebuilding the health care and Kingdom ministry. This will be one of the regions that I visit on my monthly ministry trips, likely beginning in January of 2013. I will hopefully return in October and December of this year, on the way to and from Luena (see below).
We had a young woman arrive at our clinic today in Cavango (where it is about 6 hrs by 4×4 to the nearest doctor). After four months without a period, yesterday she began having severe abdominal pain and hemorrhaging to the point that she couldn’t sit down. Her pulse was 120 and her abdomen was firm. We had no labs but our portable ultrasound machine showed an empty uterus. What do you think? She had a ruptured ectopic (tubal) pregnancy and we recommended for her to make the 6 hr drive immediately for emergency surgery. We prayed for her asking God to allow her to survive the trip and the surgery. It will be so nice when we can do a surgery like this in Cavango. We had a 40 y/o lady with undiagnosed liver cancer, a 15 year old “woman” who had lost three pregnancies, each at 6 mos gestation, a lady with a huge tumor around and in her jaw, a man in complete heart block with a heart rate of 32, a 42 y/o woman with undiagnosed endometrial cancer… All would have been able to receive treatment in the West, and we were able to help some of those we saw. We saw about 25 people in the morning and there was no chance to announce our visit beforehand because of the upcoming elections. It will be interesting to see how many we see when we come regularly and our visits are known in the communities. There are 30,000 people in this area with no doctor and virtually no health care. One woman walked 60+ km one way (more than a marathon) to be seen at the clinic and several others walked nearly as far.
I went to morning prayer where 20+ local people gathered in the chilly 40 degree clinic for an hour @ 6:30a. They usually meet at the church but because the doctors were holding clinic, they prayed there. Several people prayed about how grateful they were to their Father that the clinic was open today and that people would be helped. There was such a humble expression of gratitude and it left me humbled to hear what they shared with our Father. It was quite motivating for me to be there and to help people in this kind of need and this so represents what I’m here to do.
I will work for two weeks in September at a rural Catholic hospital in the mountains of southern Angola. They are desperate for physician help and it is located in a region that I would like to visit regularly in 2013. We would work in the region 100-600 km or so west of this hospital (where there is no health care and virtually no gospel witness), but my visit there will help me get a feel for the region, as well as meet these beautiful people with similar visions of ministering to the rural and desperate. Then, in October, I will travel two days by 4×4 to eastern Angola and work for about 7 weeks, filling in for a missionary physician going on furlough. Two fellow SIM docs work in a remote clinic in Luena, which is one of the poorer regions of this very poor country. One of the docs will be on furlough and my presence there will allow the other to take a long overdue vacation. It will also allow me to continue to learn in a high volume, low resource setting. I hope to be back before Christmas and we hope that Bets, Ben, Ellie, and Mer will be able to join me for at least part of the time in Luena.
Also during this next few months, we hope to solidify which regions we will regularly visit in 2013. We hope to begin with 4-5 places for monthly visits by small plane. There is a large, mostly unreached people group, living SW of Lubango, the Mucabal, that we hope to include also, and we hope to squeeze in an introduction visit soon.
This team of nine from Toronto and New York has been a delight. They consulted so many cardiac patients, put in two pacemakers and provided counsel to many. There were several bright, mature young adults on the team who were a joy to get to know. We thoroughly enjoyed hosting two young men and will look forward to how God will use them all in the future. It is always an encouragement to meet young men and women who take life and God seriously and who want to make an impact more than to live for fun, comfort, success, etc.
Please continue to pray for our Father to be specific in where He wants us. We want what He wants, not what looks good to us, what will produce the best results, what would be the toughest or the easiest, what would feel good, etc. What He wants… whether humble or grand, whether easy or difficult, whether costly or comfortable, whether fruitful now or fruitful later…
Tim, you communicate so well without mincing words or hiding your feelings. After reading your blog posts, I feel like I understand a little bit about your new mission and the struggles it presents. I am praying for all of you to hear clearly what the Father is saying, and to lean on Him for understanding. As I am able, I will be sending a little financial support. Love you Kubackis!! Patty