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. :)
Showing posts with label Sickle Cell. Show all posts
Showing posts with label Sickle Cell. Show all posts
Sunday, December 16, 2012
Wednesday, October 24, 2012
New Assignment: Cabinda!
Ok, I kind of got behind on my intended weekly blog updates! Since my last post, there have been lots of changes to my work situation. Kelli, one of the other Global Health Corps docs assigned to Angola, and I move to the northernmost province of Cabinda.
That tiny piece floating by itself is still part of Angola - and my new home/work place!
It is closer to the equator than Luanda was, so it is more rainy, lush, tropical, and hot all year round. This also means lots of malaria, and coincidentally (we expect, at least) probably more sickle cell disease.
Over the last 2 weeks, Kelli and I have been busy meeting with local officials and doctors, working with the "maternidades" (maternity hospitals) training nurses and picking up our samples, and getting ready for a fast-growing clinic to get started soon! We already have 400+ samples just from the last 2 weeks, and statistically we should have found 6 or so babies with sickle cell disease, even though we don't even have our lab up and running quite yet.
We are amazed and excited at how quickly everything is already starting up here, and in the next 6 weeks or so, we should have a full and busy newborn clinic getting started as well. We will be able to provide the infants with prophylactic antibiotics to prevent the severe infections that they are at risk for, vaccines, and mosquito nets to prevent malaria.
Once the assessment/development phase winds down and the real action starts, I'll be sure to post another update!
The view from the window of our lab!
Ummm....what do we do now? ;)
First baby screened at Primeiro de Maio Maternidade
Lândana beach in Cacongo, Cabinda
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.
Thursday, August 23, 2012
Anemia Falciforme
This week, we started work. FOR REAL. Kind of. We don't actual have medical licenses yet, so we can't legally care for patients. We don't speak enough Portuguese yet to be that much help in the clinics. And, even though we are at *the* pediatric hospital for the entire country with the highest level of care, the practice of medicine here is incredibly different than what we are used to, and we have lots to learn still! However, it has felt great to start observing in the clinics, helping out with the flow of information in the lab, and meet with administrators at the Maternidades (birthing centers/hospitals) where babies are born and our screening samples collected.
Instructions in the sickle cell clinic to help prevent frequent sickle cell crises: drink lots of fluids, keep all scheduled clinic appointments, and take all medications correctly
Dr. Luis Bernadino, an Angolan pediatrician of Portuguese descent who directs the hospital, actually established a sickle cell clinic here in 1977 to care for kids as they became symptomatic and were tested. Today, this clinic sees at least 70 children per day for check ups every 3 months, along with sick visits and any new patients who come through the door. Adult doctors in Luanda do not see sickle cell patients; there aren't many who survive to adulthood, but there are actually still a few patients around that Dr. Bernadino has seen consistently since opening the clinic 35 years ago. Though we don't know much about the prevalence of sickle cell disease in Angola in older children, just looking through the waiting room shows most of the evidence you need - there are very few children over the age of 5 present. Because, sadly, most of them die early in life. Already this week I've seen numerous young children with dactylitis, a painful swelling of the hands that is often the first visible symptom of sickle cell; older children with evidence of strokes; and an incredibly pervasive level of severe anemia at baseline in all of the kids screened. Normal hemoglobin changes with age, and can be lower in young children than older kids and adults and still be considered safe; generally, it should be at least about 12 g/dl. Here, children walk into clinic with hemoglobins of 3 or 4 all of the time. It's amazing.
Illustrations of dactylitis, the painful swelling of hands and feet that are often the first signs of sickle cell disease in young babies.
Today, I was able to observe in Dr. Bernadino's personal clinic, and got to see him teach a family about the genetics of sickle cell. It's really cool to see such seemingly advanced science taught in this type of setting. Luckily for the family involved, though the mother had died of sickle cell disease, her 3 children were all found to have sickle cell trait, not the full disease. I am excited to keep working on my Portuguese, work with education intiatives in the maternity hospitals to increase our screening rates, and learn more about how we can help the children of Angola who were born with sickle cell disease to endure less suffering.
Dr. Bernadino's teaching charts documenting the genetics of sickle cell disease transmission
Dr. Luis Bernadino, an Angolan pediatrician of Portuguese descent who directs the hospital, actually established a sickle cell clinic here in 1977 to care for kids as they became symptomatic and were tested. Today, this clinic sees at least 70 children per day for check ups every 3 months, along with sick visits and any new patients who come through the door. Adult doctors in Luanda do not see sickle cell patients; there aren't many who survive to adulthood, but there are actually still a few patients around that Dr. Bernadino has seen consistently since opening the clinic 35 years ago. Though we don't know much about the prevalence of sickle cell disease in Angola in older children, just looking through the waiting room shows most of the evidence you need - there are very few children over the age of 5 present. Because, sadly, most of them die early in life. Already this week I've seen numerous young children with dactylitis, a painful swelling of the hands that is often the first visible symptom of sickle cell; older children with evidence of strokes; and an incredibly pervasive level of severe anemia at baseline in all of the kids screened. Normal hemoglobin changes with age, and can be lower in young children than older kids and adults and still be considered safe; generally, it should be at least about 12 g/dl. Here, children walk into clinic with hemoglobins of 3 or 4 all of the time. It's amazing.
Today, I was able to observe in Dr. Bernadino's personal clinic, and got to see him teach a family about the genetics of sickle cell. It's really cool to see such seemingly advanced science taught in this type of setting. Luckily for the family involved, though the mother had died of sickle cell disease, her 3 children were all found to have sickle cell trait, not the full disease. I am excited to keep working on my Portuguese, work with education intiatives in the maternity hospitals to increase our screening rates, and learn more about how we can help the children of Angola who were born with sickle cell disease to endure less suffering.
Thursday, August 16, 2012
First ever blog post! Bem-vindo a Angola!
Howdy from Luanda, Angola! It's been a crazy journey to get to this point in my life, and I couldn't be more excited. Since starting med school, I knew that I wanted to work with underserved populations; somewhere along the way, I decided Africa is where I needed to be. Nine years, 7 cities, and 2 graduate degrees later, I am an official Americano-Angolano. :)
I have always loved traveling, so getting the opportunity to move to a country where I can (hopefully!) have the opportunity to make a difference in the lives of children helps make me feel like all of those years spent in school were worth it! Angola has some of the highest childhood mortality rates in the world - 8 out of every 100 babies born alive here dies in the first year of life, and 16 out of 100 will die by age 5 years. For comparison, less than 1 child in 100 dies by in the first year of life, or by age 5, in the US. The numbers are staggering, and heartbreaking. Just yesterday we toured the Hospital Pediatrica David Bernadino, the national children's hospital here in Luanda, and were interrupted by the wails and cries of a family indicating that another child had died here. On average, 7-8 children die per day in the hospital; on my worst week ever during residency in the Pediatric Intensive Care Unit in Little Rock, Arkansas we had 8 children die in a whole week. Usually, not even that many die in a whole month in that children's hospital, yet here it is an every day occurrence.
Angola is a large country in southwestern Africa on the Atlantic coast, south of the equator, bordered by Democratic Republic of Congo, Zambia, and Namibia. It suffered through a long civil war for over 20 years which left the country destroyed and covered in land mines. Though there are no official numbers, more amputees are estimated to live in Angola than any other country in the world due to the extensive years of violence. However, there has been stability and relative peace since 2002, and the country's second ever presedential elections are to be held in 2 weeks.
Due to poverty, lack of access to medical care and vaccines, poor nutrition, and many other factors, children here in Angola die of many preventable causes. Organizations and campaigns addressing many of these are in progress currently; however, sickle cell disease is rarely tested for, very common, and often fatal before the 5th year of life. Through the Texas Children's Hospital and Baylor College of Medicine's Center for Global Health, we are beginning the first true sickle cell screening AND treatment/follow-up program in Africa. Children have been screened at some of the major maternity centers in Luanda for 1 year now, with follow up at the pediatric hospital where they receive life-saving vaccines and antibiotics. We will now be working to expand access to this care throughout the city and to the northern province of Cabinda.
Since the moment we landed at the spotless 4 de Feverero Airport, I've been surprised in many ways by the level of development here in Luanda. There are crosswalks on the main streets with functioning lights and signals in many areas; shops and vendors selling anything and everything you could ever need; all brand-new cars on the roads; and signs of new construction everywhere you look. The country is rich in oil and diamonds, and has had one of the fastest growing economies in the world in recent years. There is definitely the possibility and resources available to make a lasting change; I know that my work here will be challenging, but I look forward to sharing all that I see and learn here!
I have always loved traveling, so getting the opportunity to move to a country where I can (hopefully!) have the opportunity to make a difference in the lives of children helps make me feel like all of those years spent in school were worth it! Angola has some of the highest childhood mortality rates in the world - 8 out of every 100 babies born alive here dies in the first year of life, and 16 out of 100 will die by age 5 years. For comparison, less than 1 child in 100 dies by in the first year of life, or by age 5, in the US. The numbers are staggering, and heartbreaking. Just yesterday we toured the Hospital Pediatrica David Bernadino, the national children's hospital here in Luanda, and were interrupted by the wails and cries of a family indicating that another child had died here. On average, 7-8 children die per day in the hospital; on my worst week ever during residency in the Pediatric Intensive Care Unit in Little Rock, Arkansas we had 8 children die in a whole week. Usually, not even that many die in a whole month in that children's hospital, yet here it is an every day occurrence.
Angola is a large country in southwestern Africa on the Atlantic coast, south of the equator, bordered by Democratic Republic of Congo, Zambia, and Namibia. It suffered through a long civil war for over 20 years which left the country destroyed and covered in land mines. Though there are no official numbers, more amputees are estimated to live in Angola than any other country in the world due to the extensive years of violence. However, there has been stability and relative peace since 2002, and the country's second ever presedential elections are to be held in 2 weeks.
Due to poverty, lack of access to medical care and vaccines, poor nutrition, and many other factors, children here in Angola die of many preventable causes. Organizations and campaigns addressing many of these are in progress currently; however, sickle cell disease is rarely tested for, very common, and often fatal before the 5th year of life. Through the Texas Children's Hospital and Baylor College of Medicine's Center for Global Health, we are beginning the first true sickle cell screening AND treatment/follow-up program in Africa. Children have been screened at some of the major maternity centers in Luanda for 1 year now, with follow up at the pediatric hospital where they receive life-saving vaccines and antibiotics. We will now be working to expand access to this care throughout the city and to the northern province of Cabinda.
Since the moment we landed at the spotless 4 de Feverero Airport, I've been surprised in many ways by the level of development here in Luanda. There are crosswalks on the main streets with functioning lights and signals in many areas; shops and vendors selling anything and everything you could ever need; all brand-new cars on the roads; and signs of new construction everywhere you look. The country is rich in oil and diamonds, and has had one of the fastest growing economies in the world in recent years. There is definitely the possibility and resources available to make a lasting change; I know that my work here will be challenging, but I look forward to sharing all that I see and learn here!
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