The last few weeks have already changed my view on my work here in Angola. Even though I've seen pleny of people, including children and babies, die before, the statistics I studied before coming here were shocking. If 1 in 5 children here dies before the age of 5, then I knew that I had to be ready for lots more severe illness and death than I had ever experienced before. And I've definitely seen it already - and seeing children suffer, mothers mourn, and families try their best to care for a dying little one are daily occurrences. I wrote a whole description of those experiences earlier this week that I am still deciding whether or not to post, so I may do some further editing and put it up at some point.
It turns out that I had done a "good" enough job of preparing that I wasn't particularly emotionally overwhelmed by any of these situations - it was very sad, yet still what I'd expected. But today, as I watched a 6 year old child who has been in the hospital for over 50 days with tetanus start to take some shaky, wobbling steps with the help of a physical therapist, my eyes immediately teared up. As it turns out, I was prepared for the disease and death, but completely caught off-guard by recovery and hope. I know now that, after witnessing his recovery, I will keep that moment in mind as I continue to face so many obstacles here in the future.
Friday, September 14, 2012
Sunday, September 9, 2012
Week 4 - DONE!
"You will have amazing days, and you will have devastating days, but you will never have an 'ok' day in Angola" -Eunice Carvalho, Chevron Chefe (quotation approximated...as I remember it from a month ago!)
How have we already been here a month?? It seems crazy, but it makes sense - I succeeded in accidentally rinsing my toothbrush under the sink instead of with my bottled water this week, so I guess things have settled a bit and formed a routine of sorts and life in Luanda is feeling kinda normal.
This week, I got some experience with the Pneumologia (Pulmonary) service, which included patients with tuberculosis, pulmonary hypertension, and heart abnormalities, in addition to the tons of empyemas I described in the last post. Rounds are quite different here - they consist of the attending presenting each patient to the student/intern/resident team, and having them record the plan for each. This took less than an hour for 30+ patients, about 30 of whom had chest tubes draining their empyemas. Then, the rest of the day was spent with the intern/resident team writing orders, following up on labs, recording the history and physical for each new patient, and trying to help me figure out what was going on! My Portuguese is continuing to improve, and we have all found this great Portuguese/English dictionary and verb conjugating app for our iPhones, but once people talk at normal speed, I still get lost very easily!
Friday was a tougher day, because several of the children who had been doing ok throughout the week seemed to suddenly worsen at once. With (what I consider to be) advanced diagnostic capabilities but limited treatment options available, many of these children who could have easily been prevented from becoming ill in the first place or at least survived with treatments in the US do not have much hope of improvement or recovery here. The doctors are able to discern that a child has Ebstein's anomaly, a cardiac defect, or pulmonary hypertension, which damages the blood vessels of the lungs, but have very few interventions available with which to treat these conditions. Instead of IVs, many children receive IM injections (separate shots) for each of their antibiotics. They also, like any other child, get upset when they have dressing changes or have to have their chest tubes adjusted. I had to leave the floor early on Friday afternoon because the sounds of so many children screaming in pain was just more than I could handle. With limited pain medication available - usually, only paracetamol (a form of tylenol) is given, if anything - medical treatment here can seem a bit brutal at times. I also had the privelege of seeing many of the kids who had completely recovered come back for follow-up visits, so that helped to temper my unease at seeing so many sick kids and their slow progress each day.
Fortunately, we have had some fun this week as well. One of our lab workers invited us to a party she was throwing; being the silly Americans that we are, we showed up at 8pm as advised, only to find the DJ setting up and a few teenaged girls and boys sitting on opposite sides of the room from each other. It turns out that this was her daughter's 15th birthday party, and 15 is apparently a big deal here! At about 9pm, food was prepared and we filled our plates with traditional Angolan wonders - funge, a paste-like, flavorless corn meal porridge with an alarming consistency; some sort of fish/cheese/potato dish that was delicious; beans; cakes; and assorted grilled meats. I decided to try what I falsely hoped to be a piece of chicken breast. When I sat down at the table and looked more closely at my plate, I saw a fish head looking back at me. It turned out to still have some very flavorful meat attached, so I survived the experience! I did have a bit of a battle scar from an ill-advised attempt to copy someone's impressive maneuver of opening a beer bottle with a fork handle. Not a great idea for a person as uncoordinated as me. Entire families with the most adorable young children were present, and were encouraged to sit on a couch and watch cartoons in a corner of the patio provided. Parents, relatives, and teenagers alike enjoyed each others' company, ate, and danced the evening away. We got to see some awesome street dancers perform (Teresa, our co-worker at the lab, grabbed my hand and pushed me to the front of the dance floor; I would have taken pictures, but I was too busy avoiding getting kicked in the face by break dancers!); watch the birthday girl and her friends take a bunch of pictures with their best Blue Steel facial expressions; and then sample some of the 5 cakes that were provided. Great fun!
This week, I look forward to learning more by observing on the inpatient wards with a different team (this time, probably malaria/meningitis/maybe tetanus or malnutrition?), and then having another 3-day weekend since September 17 is a national holiday! As Eunice told us when we first arrived, there will be days where we work the hardest we've ever worked, and days where we encounter the most frustrating obstacles we've ever seen, and then amazing days where we love every second - but we will never have just an average day here in Angola.
How have we already been here a month?? It seems crazy, but it makes sense - I succeeded in accidentally rinsing my toothbrush under the sink instead of with my bottled water this week, so I guess things have settled a bit and formed a routine of sorts and life in Luanda is feeling kinda normal.
This week, I got some experience with the Pneumologia (Pulmonary) service, which included patients with tuberculosis, pulmonary hypertension, and heart abnormalities, in addition to the tons of empyemas I described in the last post. Rounds are quite different here - they consist of the attending presenting each patient to the student/intern/resident team, and having them record the plan for each. This took less than an hour for 30+ patients, about 30 of whom had chest tubes draining their empyemas. Then, the rest of the day was spent with the intern/resident team writing orders, following up on labs, recording the history and physical for each new patient, and trying to help me figure out what was going on! My Portuguese is continuing to improve, and we have all found this great Portuguese/English dictionary and verb conjugating app for our iPhones, but once people talk at normal speed, I still get lost very easily!
Friday was a tougher day, because several of the children who had been doing ok throughout the week seemed to suddenly worsen at once. With (what I consider to be) advanced diagnostic capabilities but limited treatment options available, many of these children who could have easily been prevented from becoming ill in the first place or at least survived with treatments in the US do not have much hope of improvement or recovery here. The doctors are able to discern that a child has Ebstein's anomaly, a cardiac defect, or pulmonary hypertension, which damages the blood vessels of the lungs, but have very few interventions available with which to treat these conditions. Instead of IVs, many children receive IM injections (separate shots) for each of their antibiotics. They also, like any other child, get upset when they have dressing changes or have to have their chest tubes adjusted. I had to leave the floor early on Friday afternoon because the sounds of so many children screaming in pain was just more than I could handle. With limited pain medication available - usually, only paracetamol (a form of tylenol) is given, if anything - medical treatment here can seem a bit brutal at times. I also had the privelege of seeing many of the kids who had completely recovered come back for follow-up visits, so that helped to temper my unease at seeing so many sick kids and their slow progress each day.
Fortunately, we have had some fun this week as well. One of our lab workers invited us to a party she was throwing; being the silly Americans that we are, we showed up at 8pm as advised, only to find the DJ setting up and a few teenaged girls and boys sitting on opposite sides of the room from each other. It turns out that this was her daughter's 15th birthday party, and 15 is apparently a big deal here! At about 9pm, food was prepared and we filled our plates with traditional Angolan wonders - funge, a paste-like, flavorless corn meal porridge with an alarming consistency; some sort of fish/cheese/potato dish that was delicious; beans; cakes; and assorted grilled meats. I decided to try what I falsely hoped to be a piece of chicken breast. When I sat down at the table and looked more closely at my plate, I saw a fish head looking back at me. It turned out to still have some very flavorful meat attached, so I survived the experience! I did have a bit of a battle scar from an ill-advised attempt to copy someone's impressive maneuver of opening a beer bottle with a fork handle. Not a great idea for a person as uncoordinated as me. Entire families with the most adorable young children were present, and were encouraged to sit on a couch and watch cartoons in a corner of the patio provided. Parents, relatives, and teenagers alike enjoyed each others' company, ate, and danced the evening away. We got to see some awesome street dancers perform (Teresa, our co-worker at the lab, grabbed my hand and pushed me to the front of the dance floor; I would have taken pictures, but I was too busy avoiding getting kicked in the face by break dancers!); watch the birthday girl and her friends take a bunch of pictures with their best Blue Steel facial expressions; and then sample some of the 5 cakes that were provided. Great fun!
This week, I look forward to learning more by observing on the inpatient wards with a different team (this time, probably malaria/meningitis/maybe tetanus or malnutrition?), and then having another 3-day weekend since September 17 is a national holiday! As Eunice told us when we first arrived, there will be days where we work the hardest we've ever worked, and days where we encounter the most frustrating obstacles we've ever seen, and then amazing days where we love every second - but we will never have just an average day here in Angola.
Cuca, the national beer of Angola - more difficult to open than I had anticipated!
Why, hello there
Owie - teaches me to never try using a fork handle to open a bottle again!
Lots of party-goers, having a good time
Younger sister of the birthday girl, enjoying some cake!
Do you think 4 cakes is enough?? How about 5?
CUTE kiddos!
Birthday girl in the middle, with her younger sister, and friends - posing like their life depends on it!
Monday, September 3, 2012
Time flies when you're having...fun?
Time has started to speed up here, it feels like - how is this already our 4th week in Angola? It seems crazy that we have somehow been here almost a month, I'm making plans to go home for Christmas, and that life here is starting to feel almost, almost normal. For the last 2 weeks, I was rotating in the outpatient sickle cell clinics, seeing newborns and older kids; the sickle cell screening lab; and doing outreach with the "maternidades". This week, I've started observing rounds with the inpatient empyema ward. Yes, there are enough kids with chest tubes due to severe pneumonia and pus collections in their lungs to warrant having their own ward and service. It's nuts. Empyema happens in the US - but it would be extremely unusual to have 30 kids in the hospital at the same time with this condition. Here, every single morning during the presenation of overnight admissions, 2-3 new cases have been put in the hospital. We have a suspicion that a good percentage of these kiddos might have Sickle Cell Disease and just have never been tested. SCD causes susceptibility to what we call "invasive bacterial infections", especially by certain bacteria that cause these bad pneumonias, meningitis, and blood stream infections. Our main goal in the newborn screening project that we are starting here is to give these children prophylactic medications and vaccines that can prevent these infections. I am hoping to get a closer look how these kids are treated while in the hospital, and how we can intervene to help prevent these kinds of infections from happening in the first place! It is unfortunate to have to see so many sick kids, but knowing that I am working on ways to help aleviate this kind of suffering in the future really gives me some hope about what our project can some day accomplish.
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