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Wednesday, November 30, 2011

More about Rita and Other Things

Just want to say to everyone out there how much I love when you respond to our blogs. It takes some of the lonelyness away when I know I have a community out there thinking and praying. So thank you!
This blog is just a few random thoughts about life here and some follow-up on Rita. First of all has anyone seen this plant?

The people here call it tea, and I can only find the Umbundo name for the tea, but they take a wad of it like so:

 and boil it in water to drink, the tea honestly tastes like the flavor of Fruit Loops. So I call it Fruit Loop tea and drink it iced. But here they love it hot for breakfast. I was wondering if anyone out there knew what kind of tea I'm drinking? And does the flavor of Fruit Loops come from an exotic plant in Africa?
I also made a pumkin pie for Thanksgiving.

They pie was eaten before I thought to take a picture. Oh well.

Also I've had a few people ask about Rita, so here are a few more details that I've learned. Some were wondering what happend to her family, why did they all die. All of Rita's brothers died in the Angolan Civil war, and her parents and kids became sick and died, it is common here for people not to know why their family members die, they just become sick and die, when I first got here Rita had Maleria, and she thought she was going to die so with the little money that she has, whe went and got her hair and nails done. She looked beautiful! But she was actually preparing for her funeral. ha (Time has past enough for us to look back and laugh, Rita too)
But anyway, people here die of the saddest things because of lack of education and resources mainly, I don't think they know that there are treatments out there, or the symptoms seem mild enough at first, but then like Maleria, it get's bad fast, and when untreated people die.
 I found out that the cost of the labor for construction of her home will be about $1000, that doesn't include the plubming,  or a door or windows. Then there is of course the materiels that I mentioned before. So in the grand scheme of things, this house will not cost much, but for Rita, it is so much. I found out that she tries to save $100 every month! That means her and her children live on $100 dollars a month, and I live here, so I know that is not easy. That means no meat, just cornmeal, beans and greens.
I asked INMED if they would receive the donations for Rita, and they agreed to even waive the 8% that they usually take for maintaining the ministry, and they will wire the money with our next wire transfer. We are so thankful for INMED. If you are interested in helping Rita, e-mail me for details at
 Anyway, that is what is happening on this side of the world, here are a few more pitures:

Oliver turned 6 this month. Happy Birthday Oli!

Taking the missionary kids on a walk.

Close up of that beautiful flowering tree.

With Love from Angola,

Tuesday, November 22, 2011

First Angolan Cornea Transplant

I (John) saw this patient for the first time on friday after she had been struggling with her painful eye problems for over a year (I still get bad cases on friday afternoons , why does everyone in the world wait till friday to come to the doctor).  She is 18 years old and was facing the prospect of a life with painful, blind eyes.

Here you can see that her right eye is perforated. That brown lump is her iris (colored part of the eye) escaping through the large hole. This situation is very dangerous and she may lose the eye to infection or bleeding as there is fluid leaking from the eye.
 Her left eye is also involved and may experience a similar fate if I can't figure out how to stop the disease that is taking her vision.

                                  Thanks to my friends at Global Sight Network, I have glycerol preserved corneas to use for just such cases. I took her to the operating room and performed a corneal patch transplant, the first of its kind surgery in Angola. There may have been other transplants done in Angola, but nothing like this. Its purpose is to save the eye. It may restore some vision, but it is not a regular vision restoring transplant. Think of it like a patch to fix a flat tire.

 Here is a photo from the TV screen in our operating room. The glycerol corneas are much different than the normal fresh corneas I am used to using. It was much more swollen during the surgery and very stiff. The opaque nature of the graft may improve over time, but I'm not expecting perfect clarity.

 This is the appearance of the eye 1 day after surgery. With time the white color should fade and she may have more vision. On this day she was able to count my fingers across the room and she said her pain was gone.

So with the help of my friends (thank you Chris Croasdale for the donation of the materials, Trephines and cutting block and Global Sight Network for the cornea), This young woman has a new chance at having useful vision. With the help of my cornea consultants back in the USA, I think I have a good idea how to stop the process from coming back. We shall see.

I hope to be doing more of this type of surgery in the near future. I was really wondering if my training at Harvard in Corneal Transplantation would be useful here in Angola. This opportunity was a testament to the fact that it was not an accident that I ended up there for training. A special thanks goes out to my mentors at the Massachusetts Eye and Ear Infirmary and Loyola for their gift to me of a world class surgical education.

Saturday, November 19, 2011


Rita is our neighbors housekeeper. When they move in January, we will employee her so she won't lose her income. Rita and I are becoming good friends as she has begun to confide in me. Unfortunately her story is not unique in Angola, but I will tell it anyway. . .
 Rita is a 35-year-old widow who had 5 kids but two have died. Her parents are dead and all of her brothers are dead. One sister lives, whose 3 year-old daughter died this week. (She does have cousins that live.) Rita's kids are 16, 9, and 5 years old and she takes care of a 10-year-old who's mother died. When Rita's husband died, her in-laws turned their backs on her.
Rita is tired, she works very hard six days a week for only $200 a month, which is a standard paycheck in the city. Meanwhile, it is summer break here in Angola, and her kids just play in the streets while she works. I've taken pictures of the two room house that she rents for $20 a month. (it does not include a bathroom)

Front Door

She has a gas stove that was a gift from her employer, and no electricity, and no running water.

The fridge was also a gift from the boss, but acts simply as a cabinet.

This is her 5-year-old daughter, Belita
Rita's 9-year-old son sleeps on a foam pad on the floor.

Rita dreams, as many of us do, of owning a home. Her cousin actually gave her some land; and in the past year and a half she has saved enough money to lay the foundation. Her current house has no water, no batheroom, and no electricity.
I'd like put together a "Build Rita's House" project for Christmas. I don't think we should just throw money at people as a solution to the world, but in this case of a hard working widow with three kids plus one, I think the Lord called us to such a cause.
"Religion that God our Father accepts as pure and faultless is this: to look after orphans and widows in their distress and to keep oneself from being polluted by the world."
 Anyway, I'm collecting all the building details, so if there are any MOPS groups, community groups or churches that want to adopt Rita's family for Christmas please contact me and we can go further.

Here are pictures of the new building sight:

This is the neighborhood. Their is a plan to bring in running water in 2012.

Sisi, the 10-year-old living with them, And Belita, her daughter, we could find Rita's son for a picture, he plays in the streets until nightfall.

Building details, $1 per brick and $16 per bag of cement. I'm still looking into the cost of labor here, but her plans so far do not even include a bathroom. Since she will have running water, we are thinking we could put in a bathroom next to the kitchen.
If her story touches any of you, please contact me. We are hoping to bless her this Christmas with the money to complete her house. We have the benifit of being here to manage the money, that way we know it is being used the way it is intended.

Tuesday, November 15, 2011

A Day in the Life of Me

Many of you have been wondering what everyday life is like for us here in Angola. I will take you on a photo tour.
First things first, mosquito nets are a must. 

The boys room
Our room
Henry also helps with the mosquito problem. We are learning to love Henry.
Babies still take first steps in Africa.
The kids are going to a school right now. I was hoping it would help them get used to things and learn the language, but it's not so great. We are seriously considering good old fashion home schooling.
I'm hungry!
24 hours a day, we have a guard who also tends to our garden, and we share the fruits of his labor. The guards also teach us the local tribal language, Umbundo.

We live near a beautiful beach that we get to enjoy on some Saturdays.
Another Saturday trip exploring sea caves and boulders
I'm washing cloth diapers every day.

I'm learning how to wear Roman, African style. I still have some learning to do.

Another local friend

Babies still have first birthday celebrations in Africa.

And they get sleepy

Visiting friends in their home

Hungry again!

Sometimes John has non-patient visitors at work

makashishi- that is it's Umbundo name, John calls it the brain fruit, despite it's looks, it actually tastes good.

Produce Department

we have another "mosquito" problem here in Angola, this one is just as dangerous as the bugs, but doesn't cause malaria.

Another pic of the motorcycles. It get's much worse, but I didn't want to go seeking them out just for a good photo.

Thanks for coming on my tour. I'm trying to put some light content on the blog, so It doesn't get so heavy that I loose some of you. Please keep coming back, and keep praying! We love and miss you all.

Wednesday, November 9, 2011

Not every day is a day at the beach

Fair warning, there are graphic medical pictures shown here. If you don't like gross eyeballs you should probably stop reading this.

I wanted to give the reader an acurate snapshot of a typical week in the office here in Angola. These are just a few of the difficult cases I've had to deal with here (we see 80 patients daily, and I don't have time to take pictures of all of them). I'll give a brief summary of each case.

Case #1- 35 yr old woman has had this growth for the last 2 years. It appears to be squamous cell cancer of the conjunctiva. I elected to treat this with a topical chemotherapeutic agent (5-FU). I don't easily have access to pathology here in Angola and I don't have the standard equipment to treat these with surgery. So, I elect to treat these small tumors topically. I see at least one of these every day in clinic.

Case #2- This is what happens to the eye in case #1 in 10 years if left untreated. This eye was removed entirely and sent away to the capital for examination. If I'm lucky they will send me the results of the exam.

Case #3 - Cataract, lots and lots of cataracts. This man had a trauma to the left eye. I've done almost 100 surgeries at this point, and on review of my records 90% of the surgeries have been for patients that can only see shadows because their cataract is so dense. Really crazy, because in 4 years of surgical training in the USA I did maybe 6 of this type of cataract.

Case #4 - Many people suffer from trauma here. This man had a rock fly up and hit his eye causing a cut in the cornea and the sclera (white part). His iris (brown part) was sticking out of his eye. He came to me a week after his injury. I debated on what to do for him, the eye looked pretty good but his eye pressure was very low and on inspection there was fluid still leaking from the wound. I took him to the OR today and sutured the wound closed. I may not have done this surgery except for the child I had seen the day previously with the same story, except they waited 2 weeks to come and in that time he developed a terrible infection of the eye causing him to lose his eye.

Case #5- Cornea scars. These are all too frequent here. This man had a central infection, leaving a nasty scar. It is more than 50% deep so I need some good cornea tissue to do a transplant. Cornea transplants are complicated, first I need fresh tissue which I don't have here. Next I would need a patient who good get medication reliably for 1 year. Since most of the patients we see here are well below the poverty line, the chances of them paying for medicine for 1 year is low. If they stop taking medications the transplant will likely reject, now they have a blind AND painful eye. That being said, I took a picture of this man and took his cell phone number. Maybe one of my US collegues can lend me some fresh tissue one day...

Case # 6 - orbital cellulitis in children. While I don't love the over-use of antibiotics that exists in the Pediatric medicine culture of the US, it does prevent things like this from happening.  I was wanting to admit to the hospital, start IV antibiotics..... oh wait, I'm in Africa and I am the hospital and I don't have IV antibiotics to give the child. This child did very well with oral Amoxicillin only, made a full recovery. That is the benefit of people not having good access to health care, the bacteria have not seen antibiotics.

Case #7 - Presumed retinoblastoma. A deadly tumor. Sorry to disturb you with this one, but I see a couple of these a month. With a population of 20 million people all of whom have no access to easy eye care, I have a huge referral source and people take buses with their children; faces taped or wrapped to hide the gruesome sight of their bulging eye. The white on this childs face is actually adhesive from the tape used to hide the eye.
I  have no good solution for these tumors currently. I do not have general anesthesia for a 3 year old child. I do not have chemotherapy. In fact there is little access to this in the entire country. Sadly, even with a surgery this child is likely to die soon from the metastasis. I referred them to the children's oncology unit in the capital city 8 hours away at the Government hospital.

So, while there are some tragic cases here, I'm really enjoying the practice of medicine in Angola. I'm seeing things here in less than 2 months time that US physicians may go their entire careers and not see. Plus I'm at a place that shares the Gospel message of Jesus Christ to every patient that walks through our sacred doors. I don't get to choose who I can help physically. I wish to God that I could fix everyone's problems, but I simply can't. I don't know why God allows some people to suffer, and others to live in comfort. I don't have answers to many things. But I do know that for those patients I can't help physically, there is hope in Jesus Christ. To Him be the Glory, forever, Amen.

Friday, November 4, 2011

Witness to a Tragedy

A very common situation (This is not Elizabet)
Elizabet loaded up her vegitable bowl for the day, tied her one month old baby to her back and went to the market to earn a living for the family. Elizabeth married a blind man, so her husband, her three children and her husband's blind brother all depend on her and her mother-in-law for support. After she arrived at the plaza to sell veggitables, she laid her baby next to her. While he slept, she busily tended to customers; and the next thing she knew, her baby was gone.
I heard of her story at the blind mission. (A ministry that feeds the blind, and get's together weekly to talk) Through some very good connections, we were able to have the governers wife come with us to visit the family. Her and her husband are concerned about the people of Benguela and reach out to them like this frequently.
As we arrived at their house, we were devastated to find out the conditions of the homes. No electricity, no water, no furniture (except a lawn chair). I saw a chicken in the corner, and a tire in another room. Upon further investigation, we found out that the father of the stolen baby and his brother were blinded 20 years ago, when they were 5 and 6 years old (most likly from complications of the Measles). His brother is totally depressed and refuses to eat or speak, probably because ever day he sits in a dark "home" on the dirt floor, not being able to fend for himself. (pictures of his house follow)

 The brothers
I was wrong, they actually do have electricity

Oldest daughter
The families middle daughter
I know that the world is unjust, but in the United States, we don't have to see the problems. We only get to receive the blessings of being born in a rich county. We did nothing to deserve such a wonderful life, and this family did nothing to diserve such a hard life.
 The neighborhood kids
Another neighbor
Please pray for the Governed and his wife, as they attempt to make a difference. Only the Lord can lead people of influence like they have to change these kinds of problems. Pray that they can infuence other leaders in the country as well, to see what the Lord's people can do in Angola. Pray for this family, as they mourn a terrible loss, and may the Lord give them peace and comfort like only He can do.