this is how we do it

It has been seven days since last having Internet access.  Upon reconnecting, I need to get shout-outs to mom and dad for missing each of their birthdays.  Also, what happened against Wisconsin!?

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Hey team, I imagine it's apropos to summarize an average day at the hospital.  My other aim here is to touch upon CEML’sbackground and operations.

06:30 – My alarm goes off.

07:00 – I actually get out of bed.

07:05 – Breakfast.  

Weall have our favorite foods and, from time to time, suffer from specificcravings.  While my favorite is certainlyMexican, I proclaim toast to be a close second. That’s right, toast.  Peanutbutter, with or without bananas, or hummus happento be my preferred preparations.  Toastis even more legit here thanks to homemade Angolan bread.  

07:45 – Catch a ride up the mountain to the hospital.  

I had heard that the hospital was referred to as the, "clinic on the hill."  This is an understatement.  The view along the road to the hospital is rather impressive.

The hospital is on the promontory to the right with the city of Lubango sprawled below.  Further down the road on the terminal cliff in the distance is the local version of Cristo Rei overlooking the city.

08:00 – Arrive at CEML. 

These green-roofed, one-story buildings are the hospital.  There are six of them, each serving a dedicated purpose: outpatient visits, inpatient wards, emergency room, operating room, cafeteria/offices, and storage/cleaning.

The buildings are connected by covered walkways whose shade is home to the patients' families.

Also part of CEML are, "the villas."  A one hundred yard walk or so behind the six-pack of hospital buildings is a small, permanent encampment.  For one tenth the price of being admitted, patients are able to stay at the villas and return for such things as dressing changes and medication administration.  The hospital provides a small amount of electricity and running water to those in the villas.

Once at the hospital, the day gets going.  Putting the, "E," in Centro Evangélico de Medicinia do Lubango, Mondays and Thursdays are chapelmornings.  The service is in concert withpatients on Mondays and reserved for the hospital staff on Thursdays.  For twenty minutes or so, we sing songs and heara brief message as a way of starting the day. The other three days of the week, rounds get going.

08:30 – Rounds.  

We are equipped with a men's ward, women's ward, children's ward, and ICU.  Smirking at the thought of private and semi-private rooms in Columbus, here is a typical early morning shot of the men's ward.

The doctors divide the workload and normally see two groups of patients each.  Much of the daily work on rounds is medication management.  Even in the ICU, we have no ability to place patients on a ventilator or to dialyze!  Being an esteemed surgery site, we also take care of many post-operative patients and their associated drains and dressing changes.  

As an example, the patient below had a wound that became infected and required debridement in the OR.  The relatively pathognomonic green color of his bandage suggests a notoriously nasty bacterium, Pseudomonas.  A minority of antibiotics in the U.S. can touch this guy.  Ideally, we would be able to sprinkle his wound with a gentamicin powder.  The problem, however, is that there is no gentamicin (or any anti-pseudomonal medication) in the city!  Our alternative is diluted bleach and daily bandage changes.  Your guess is as good as mine as to whether or not the limb will survive.  Daily, though, I am impressed by how healthy the unaffected area of the foot looks...

With new orders placed, notes written, and all the patients seen, rounds come to an end.

11:00 – Procedures and pertinent orders.

Most bedside procedures and other time-sinks that can be deferred to the end of the rounds are done so. As soon as we wrap up, we then double back to take care of pressing matters.

Pictures below are from one of the patients I am most closely following.  This gentleman came in with what we in the biz call, "altered mental status."  It means that his mental status was altered.  Essentially, he was a walking, talking, loving, working husband three weeks ago and now we are lucky if he is able to coherently form words.  The possible causes include such things as malaria (super common here), meningitis, stroke, sepsis, and a complication of his HIV/AIDS.  Only one day in the last nine has he known his wife's name.  His fevers continue, without pattern, even on antimalrial and antibiotic therapies.  The lumbar puncture was to rule out meningitis after having neck rigidity on physical exam. Oh, oh, I almost forgot!  Angolans are tough.  Local anesthetic is rare and valuable and so is not used for an LP like in the States.

11:30 – Either head to the operating room or see outpatients.

Mondays and Thursdays are, "non-surgical," days with only the most emergent one to three surgical cases going.  These afternoons are mostly spent seeing the scores of outpatients that fill the hall.  Every morning a throng of people patiently await their consult visit for as many as nine hours.  Constipation, cough, bloody urine or feces, and effects of high blood pressure are some of the most common complaints.

Dr. Steve Collins, my homeboy, has his ophthalmologic surgeries going throughout the week.  Since 1996, he has performed more than 15,000 cataract surgeries.  Literally curing the blind, Dr. Collins has a system.  Pay attention to the next patient already in the room (and fully conscious)!

Our other chief surgeon, and patriarch of CEML, is Dr. Steve Foster (more about he and his family later).  The son of a missionary surgeon, Canadian-trained Dr. Foster is one of the most veteran general surgeons on the planet.  With more than thirty-five years of experience in an environment that requires maximum adaptability, he is a living, breathing paragon of a man.  Pictures included here are Dr. Foster prepping a surgical site (while randomly wearing an OSU Medical Center scrub top from our recycled cache) and our post-operative pathology conference on bended knee following a cystectomy (palliative operation for bladder cancer).

13:30 – Lunch.

I am used to a world where the ideal diet is one of meal variety.  In this culture, they rather seek out meal consistency.  The name of the game is funge ("phoon-j").  There is nothing fun about funge.  It is a tasteless cornmeal mush with an unappetizing consistency that is somehow always the temperature of a last-period school lunch (much love for lunch ladies, sorry about that one).  This is a typical lunch at CEML: dried fish, greens, and a hefty helping of funge.

17:30 – Home.

I hope that suffices as a, "day in the life of," CEML.  My ten or so hour days are not dull.

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Just a bit about the hospital's history.  CEML was built in 2006 for about $4.5 million USD.  Those funds are a combination of a $1 million gift to Dr. Foster's father, some $800,000 from USAID, and other corporate and private monies.  The hospital is committed to using pledged money only for the sake of capital expenses.  All operating costs and salaries (doctors do not take a salary) are paid out of patient billings.  Care here is relatively expensive and is not accessible to the lowest wage-earners in Angola.  Patients, however, can be sure they are receiving high-quality care without the hassle of a government facility.

As Americans, thanks for paying your taxes and be proud of your country.

As world citizens, please know of the much needed good being done at the, "clinic on the hill."