Rachel Song SWMCF Scholarship Awardee
Lubango, Angola
1/28/2024 – 3/9/2024
I recently spent five and a half weeks in Lubango, Angola, at Centro Evangélico de Medicina do Lubango (CEML), a small clinic with approximately 50 beds; they also have a small maternity ward, 2 operating rooms, a 24/7 emergency department, and an outpatient clinic. Additionally, I spent a weekend in Kalukembe, a smaller town northeast of Lubango, with a larger hospital (~200 beds) but with significantly fewer resources and only 2 full-time physicians (in EM and Ob/Gyn). Both places were significantly resource-limited, and while I knew this going into the rotation, having to work through what the limitations looked like practically was a challenge but also an encouraging, eye-opening experience.
CEML recently started a PAACS (Pan-African Association of Christian Surgeons) residency program with their first two residents starting this past January! The hospital also has a 2-year medical internship program with 5 interns. Most of the hospital is run in Portuguese, which was a little overwhelming for the first couple of days, but thankfully, I was able to pick up a decent amount of understanding relatively quickly (being able to speak it is a different story!) Our days usually started with team rounds in the mornings, followed by education and a time of prayer before being sent to either the clinic or the OR with a “Bom dia e bom trabalho!”
Mondays and Thursdays were consult days – mostly outpatient visits; my time in Lubango was during the rainy season, so there were a LOT of malaria cases; most were simple and easily treated outpatient, but there were a handful of more serious, resistant cases that required admission and strong medications. Tuesdays, Wednesdays, and Fridays were more OR-heavy days. It was a lot of fun and so eye-opening to see the breadth of skills and knowledge of the surgeons and residents. They did everything from ortho cases – total hip replacements and SIGN nails, to Ob/Gyn – C-sections and obstetric fistula repairs, to general surgery – hernia repairs and colon cancer resections.
One unique part of CEML is its partnership with the Fistula Foundation; this allows women with obstetric fistula access to life-changing surgery and treatment. Just south of the clinic is the “Patient Village” where families can live, and where many pre-op and post-op fistula patients live. I was able to visit for a couple of hours during my first week, and it was so sweet to see the community that has been formed there with so many of the women!
Beyond the wide experience across many surgical specialties, there were a few cases that really stuck out to me. One was with a woman who came in with a massive, infected wound covering most of her foot and shin. She had originally had a small bug-bite-like injury that she had tried to treat with traditional medicine practices. Unfortunately, some of the traditional medicine she tried included covering her wound and foot with chemicals that ended up causing significant burns and further injury. By the time she got to us, there was significant tissue damage and she was becoming septic. In the OR we did an extensive debridement and we ended up having to take her back a couple more times over the following weeks for more debridement. It was both eye-opening and heartbreaking to see the clash of traditional medicine and modern medicine.
Another huge highlight from Angola was joining a small team to head out to Kalukembe for a marathon weekend of surgeries! We flew with MAF to the mighty Kalukembe airport (a dirt strip runway that also had a main road running through it) and made our way pretty quickly into the hospital and OR. Most of our cases there were general surgery or urology-based; the ob/gyn procedures were covered by the attending Ob/Gyn missionary doc at the hospital. We spent most of the days in the OR which was exciting to be a part of (even when the power occasionally cut out mid-surgery!)
While I could tell story after story of different OR experiences and patients with uncommon diseases that I would never see in the US, I think my favorite part of Angola was the people. The surgeons, residents, and interns were incredibly kind and knowledgeable – I learned so much from them about tropical disease management and operative techniques in
low-resource settings. But it was most encouraging to see how they integrated their faith into their practice through things like praying with patients on rounds and having all hospital staff worship and devotionals every week. It was truly such a blessing to be able to serve and learn at CEM, and to experience the beauty of creation in Angola. As I begin my general surgery residency with the goal of going into international medical/surgical missions, I am so thankful for this impactful experience that I know will continue to encourage me through my training and beyond!