Monday, August 06, 2007

Teaching, and Learning, Care

Thank you for journeying with us through what we hope was our introductory Angolan experience. Beth and I returned to the U.S. ten weeks ago and are now settled into our new home in Boston. These weeks have offered us some opportunity to reflect on our time in Lubango.

On our very first day in Angola, back in October 2006, we had the honor and pleasure of being welcomed by the American Ambassador Cynthia Efird. She had both a listening ear as well as many words of wisdom for us. Those that made the deepest impression came in the context of discussing the value of health care, current public health challenges in Angola, and how we and our colleagues would be stretched in delivering hospital services.

“Whatever you do,” she told us, “teach care.”

Over the next eight months we found that there were indeed many opportunities to teach care. We found even more opportunities to learn care. This blog entry is dedicated to a few of those who have been our teachers.

Dona Zefa
Dona Zefa finished her studies at a Catholic nursing school just prior to Angola’s civil war, and has essentially worked in the operating room her whole adult life. She is now “retired”. Which means she volunteers 4 days of work a week at CEML, she will not accept any pay, except for a Christmas bonus she received last December. Simply put, the CEML OR would not be functional without her. She quietly keeps things rolling all day long – instruments get cleaned and sterilized, operations gets started, all the staff get their lunch (this usually required some browbeating to get Robert to lunch), and at the end of the day everything is as tidy as when it started. All with a beautiful, gentle spirit.

Dona Zefa getting the work done... with a smile.

Kambali only has a fourth grade education and used to clean hospital floors. A number of years ago a couple of doctors recognized he was both a quick and eager learner and a humble partner in the work. He was then trained by Steve Collins to assist him in cataract surgery. Now, Uncle Steve is almost useless without him. And Kambali does a number of eye operations on his own. Because of his lack of credentialing, he is only paid $150 per month (compared with $250 for his nursing colleagues). We’ve never heard him complain. He cares for his aged patients with gentleness, respect, and humility. It’s inspiring.

Kambali and Uncle Steve operating in Huambo, Central Angola.

Amelia is the head nurse for CEML’s inpatient ward. Ultimately, all that happens in the ward is her responsibility and she functions in the equivalent capacity of a resident physician in the US. She was Beth’s closest and most valued ally at the hospital. Her task is enormous – managing patient care, ensuring bills are paid, and training the ward nurses, many of whom had never touched a patient prior to their first day of work at CEML. She was always steady, always able to translate our Portuguese to Portuguese, so that patients could understand, or to Umbundu or Nhanheca (the most common local languages). And she always defended the “doctora”.

Beth and Amelia (right) with Marcia, who has recovered from her rectal cancer surgery.

Israel is one of the Emergency Department nurses. He said of himself once that he is frustrated because he doesn’t know enough to do his job properly. Without a doubt he is one of the brightest nurses in our hospital. For years during the war time he was stationed in a rural health post by himself to manage an enormous range of pathologies with minimal resources and effectively no referral options. Now that he is in the city, he is taking advanced practice nursing courses to better himself while working full time and helping care for his family.

Israel and Beth in the "Banco de Urgénica"

Henriques works as the pharmacy nurse/technician at CEML. From the day we arrived he has been a friend to us. There is always a smile on his face we he sees you, laughter in his voice when he greets you, and a hug available if you’re close enough. Henriques was one of our best windows into Angolan culture and the Angolan experience of the last 30 years. We were often invited into their home, to share meals, to be with their children, to share life and understanding. He loves his family dearly, loves his work, and is loyal to his friends. He remains a dear companion.

Henriques and Beth with their children, Dalva and Terry

Beth (pronounce “Betty”) is a nurse on the ward, and is married to Henriques. Together they have two beautiful children – Dalva and Terry. Beth is singularly professional and competent in her care of sick patients on the ward. She is constantly wishing to learn more, asking questions, seeking answers, and always with a gentle and kind spirit. When she worked the night shift, we rested easy; we knew our patients were in good hands. When she called for help, we came quickly.

Lino works in the OR and has been a surgical assistant for 20 years. His understanding of surgical technique, appropriate instrumentation, and his ability to anticipate the surgeon's next move are top notch. These alone make him a pleasure to operate with. But what is most wonderful about Lino is his calm demeanor, and his caring for patients pre-, intra-, and post-op. Lino also taught me more about Angolan literature, politics, and religion than just about anybody else. A real breath of fresh air.

Lino, always dapper in and out of the Operating Room.

Pastor Moisés
Pastor Moisés took on the chaplaincy at CEML shortly after the hospital doors opened. Previously, he had been head of IESA (Igreja Evangélica Sinodal de Angola), a national evangelical denomination whose members number in the tens of thousands. Now, as the chaplain of a 40 bed hospital, he quietly makes daily rounds – visiting with patients and their families, offering ministries of presence, prayer, comfort, and spiritual guidance. He is the de facto palliative care consultant. In our mind, the greatest complements paid to him came from the dozen of patients, from various religious backgrounds, who refereed to him as “nosso pastor” – our pastor.

"Nosso Pastor"

Senhor Danny is the CEO of CEML. An administrator by training, he had never worked in healthcare prior to being recruited to CEML 5 years ago. Since then, he has worked tirelessly to get the hospital working, and, now that is has set sail, to keep it afloat. His passion is to provide holistic care for the people of the city and province. He has a servant’s heart and a wry sense of humor. I don’t think I’ll over forget seeing him drive back to work, without complaint, at 8:30 on a Friday night to shuttle the dayshift nurses home in a beaten-up old Landcruiser, after the hospital driver called in sick. 16 staff members piled in and off they drove to be distributed around town.

"O Chefe" - the Boss

There were many times that our experiences in Angola were hard and sometimes painful. These had a broad range of causes – the stress of conducting life in another language, adjusting to a new a culture where for us the rules were not clear, being subject to obstructionist bureaucracy related to visas, and being witness and companion to so many of our patients who died while under our care. Without a doubt, we still have much to reflect on, grow from, and even heal from. But we wish to express our gratitude to those mentioned above for caring not only for our patients, but also for us. Without their grace and kindness our experience would have been so much less rich. We also wish to thank so many others who have gone unmentioned, but who were vital to us this last year – our physician colleagues; hospital staff; the missionary community; family, friends, and colleagues in the U.S. and elsewhere who have loved us well.

As alluded to above, we hope to be back in Angola, Lord willing, in the years to come. And we hope that many of you will take us up on our offers to come visit, experience, share, and contribute.


Sunnygr said...

Dear Doctor Robert and Beth,
I am sure you will not remember my husband and I, you helped with my husbands kidney transplant in 2003,
but we will always remember you and be grateful for your kindness and sweetness.We want you to know how proud we are of both of you...we have just finished reading of your work in have always been in our prayers, as Steve Klintwort told us where you were.
Terry's kindey has failed due to polyoma virus and we are doing pd diaylis at home, he is doing ok and we take each day God gives us and try to do our best.
I think Terry's transplant was your first and we can never thank you enough for all the help you gave us ...Here's alittle hint that might jog your memory of us...we gave you some McDonald gift cards and we live in Laconia,Tn.
In closing ,please know that we are as proud of you as we can be and hope your new life in Boston is
all you ever wished for
Reba & James Terry Wright

Robert and Beth said...

Mr. and Mrs. Wright,

I don't think we'll ever forget you two. Beth still reminds me of the day we walked into your room on 10 South to introduce her to you, and the response was, "Look honey, it's Dr. Ravioli and his wife!" I am sorry to hear that Mr. Wright's kidney has succumbed to polioma virus. But I am encouraged to hear of your abiding faith and hope.

Life in Boston is going well, though it's bitter cold today (-10 with windchill). Thank you for this wonderful note, your encouraging words, and your faithful prayers. They are valuable beyond words. Have a wonderful new year.

Many Blessings,

Sunnygr said...

Dear Doctors Robert and Beth,
Terry and I were so excited to hear from you and happy you remembered us...
I am sending my e-mail so please stay in touch when you have time...Happy New year and God bless both of you....
Reba Wright
P.S. I still call you Dr. Ravioli LOL

Adelino Victorino said...

Hi Doctor Robert & Beth
My name is Adelino Victorino, am a young Angolan men, my province is Namibe and am from IESA church in Filadelfia (platou)at the moment am in South Africa continuing my studies i've got 2 years now in SA. I saw ur project on the internet & is such an amazing. I'd like to thanks u for all u've done and u're doing in Angola.I beleave that God will inspare u for new projects as the time goes by, is passed meny years now sense we lost the best hospital that we have ever had in Angola ( Kaluquembe) witch i have been there by the time i was alitle boy. your project show me that God send u to renew what was lost keep on doing all the best u can bcs the reward is coming from God.Please send to me ur email adress and ur cellphone number. My email adress is:
I would like to meet u. God bless u