Back to work for a new year in Angola

I was lucky to be able to spend 2 weeks at home in Texas over the Christmas/New Year's break, and even though it was difficult to leave my family again, it felt great to return to work excited and energized! Lately, the main projects that the other Global Health Corps docs and I have been working on include strategic planning, developing a monitoring and evaluation plan, quality control projects for our laboratory, and developing our follow-up clinic from the ground up. Our program in Cabinda is moving along pretty well - we have collected over 2700 samples from the 2 maternity centers in the city of Cabinda, and have identified 38 babies with sickle cell disease at this point.  We are also building up our clinic - we saw 3 babies this past week - which makes the work so much more satisfying day-to-day.  Now, we are figuring out ways to keep the nurses motivated to keep testing at the maternity centers (they are paid very little, so we try to express our appreciation as frequently as possible!  In Angola, it is VERY possible, even necessary, to "buy" people's work ethic); how to spread the word within the community so that parents understand the importance of actually bringing their baby to our clinic whenever we first call to let them know that a child has been identified with sickle cell disease; and what the best next step in spreading our screening to other parts of the province would be.  Lots of work to keep us busy!

We are also trying to work with other big groups who run health programs in the country to make sure that our program works with all of theirs since we overlap in some areas.  For example, we currently purchase and administer a vaccine called pneumococcal conjugate vaccine (PCV13) to give to the babies with SCD here.  It is a vaccine that all children have been receiving in the US since the year 2000, but here in Angola it can mean the difference between life and death for our patients because pneumococcal infections are one of the common causes of death for children with sickle cell disease.  Luckily, the country is planning to introduce this vaccine for all children this year!

In our clinic, we have a fun nurse named Ruth (pronounced like "root" in Portuguese) who we have started training to help educate the parents, administer vaccines, and perform heel-sticks for our blood samples.  In between patients, we get to sit around and practice our Portuguese by having interesting conversations with her regarding the differences in the practice of medicine and resources available between the US and Angola.  This past week, she was shocked to hear about the availability of vaccines in the US for varicella (chicken pox) and rotavirus ("stomach virus"); she told me about how the clinic nurses know the importance of measuring and plotting growth parameters like height and weight in children on growth charts, but they are unable to do it in the clinics because no one has any measuring tapes.  It's always a little disheartening to realize just how much the intellectual resources are available here, but far outreach the supplies, like medications or even measuring tapes.  It just makes me even more motivated to find other ways to help improve the ability of the health care workers here to provide the best care possible for their patients.

On a completely unrelated note - I have started a website/blog just for my photography here, because the number of pictures I take has gotten a little bit out of control!  If you are interested, you can check out http://sarahlabuda.zenfolio.com/blog to see and hear about the most recent travels or experiences outside of work. :)

Worst. Blogger. EVER.

Ok, it turns out that I'm not that good at blogging regularly.  I shouldn't be surprised by this, as I am reasonably sure that I have undiagnosed ADHD and get very easily distracted.  ANYWAY.  We have been super-busy here in Angola but it hasn't seemed all that exciting to motivate me to want to write anything about it.  Now that I will be leaving for Texas to spend Christmas with my family in 48 hours (YAY!!!), I figured it was time to update the old blog-er-oo.

In Cabinda, we have been very busy keeping up with developing our sickle cell newborn screening and clinic program.  Each week, we are busy supervising our laboratory's operations (we have 1 lab tech working right now, Lanzi, who is HILARIOUS); visiting the maternity hospitals to update nurses, bring supplies, and pick up the dried blood spot samples that the nurses collect for us; meet with local doctors and officials; and develop more plans for the program.  Recently, we restarted Portuguese lessons with our teacher, Sao, in Houston via Skype for 90 minutes twice weekly.  We have administrative conference calls to attend, MANY spreadsheets to update, emails to respond to, etc etc.  This is the first desk-based job that I've ever had!

Luckily, over the last 2 weeks our babies were finally getting old enough to come into clinic and start taking our vaccines and medications, so we were able to start our "real" doctor-work in addition to all of the public health/program development work that we have already been doing.  Because the children with sickle cell disease are at high risk of death in the first year of life, but are protected by the presence of fetal hemoglobin and maternal antibodies for the first few months of life, we bring the little ones in for their first visit at 6-8 weeks of life.  We are learning as we go what works to convince parents to come bring in their babies, which seem healthy to their parents at this time, to our clinic.  So far we have seen 4 babies and spent lots of time educating the moms about sickle cell disease, giving penicillin (to be given every single day), folic acid (once weekly), an insecticide-treated mosquito net to prevent malaria, and a pneumococcal vaccine.  We also repeat the blood test for sickle cell disease, just to make sure that we are treating the right patient.  Of our 4 patients, only 1 of the moms had even heard of sickle cell disease, so we have a huge job ahead of us in trying to educate the community and advocate for this "invisible" patient group.

At this point, I am basically emotionally and physically exhausted and can't wait to go home for some of my momma's chicken and dumplings.  Oh, and maybe see some family and friends, too.

So...feliz natal, boas festas, and prospero ano novo!

See you all back here next year!  One of my new year's resolutions will be to try to be a better, more consistent blogger. :)