Safely home

I arrived safely back to the states yesterday afternoon. My dad picked me up from the airport. I will post some more pictures and details from my last week in Angola in the next few days. Thank you for your prayers and support!

Heading back to the states

I am heading back to the states tomorrow morning. I will again be going via Luanda, the capital of Angola. I have a 12 hour layover in Luanda, then I fly to Frankfurt. I only have a three hour layover there, and then I fly to Dallas. I should be arriving around 4:30 pm on Saturday, God willing.
I go home with many mixed emotions. It will probably take me some time to process everything I have experienced and seen during my 4 weeks back here. I will write more then. I would love to talk to you more about my trip so let me know if you would like to get together! I have lots of pictures and some videos as well. I am very grateful for the prayers and e-mails. The Lord has used you to encourage me and He has heard your cries for the Angolan people as well. Thank you for your support!

Urgent Prayer Request

Please pray for a 9-month old little boy. He came in with fevers, diarrhea, and vomiting for two weeks, and a bad cough for one week. The parents also mentioned a history of seizures. He has malaria and the chest x-ray shows pneumonia. I've started him on anti-malarials, antibiotics for pneumonia, and oxygen. Pray that he makes it through the night. His O2 sats are in the upper 80's. We do not have ventilators here to help him with breathing. Pray for wisdom for the overnight nurses taking care of him tonight.

Update #3

I want to share a few stories about some of my patients:

E.M. is an 18 year old who most likely was affected by tuberculosis at a young age but did not receive treatment until 6 months ago. Those who have tuberculosis here are sent to Tchamangala for 6 months of treatment. They stay there, so that the staff can directly observe them taking their medication each day (DOTS). The tuberculosis was treated, but it had already destroyed much of his right femur head and pelvic joint; so much in fact, that he has been using crutches and has not been able to put weight on his right leg. The only operation that can be done here in Angola for him is a fusion of the hip joint which would allow him to walk on it and bear weight. Sadly, this means he will not have any movement of the hip joint. We did the operation yesterday and he seems to be doing ok so far. He says he is in a lot of pain, and has "tenturas" (dizziness) from the pain medications he is on. Before the operation I had the opportunity to share a little about God and he wants to know more and would like to read the bible. You can pray for him as he recovers from surgery in these next few days. I have also asked the hospital's chaplain, Pastor Moises, to come with me next time I chat with him. Today he smiled as I placed a bible on the table next to his bed. He also shared with me that he would like to become a teacher.


P.K. is an 8-month old little girl who came in vomiting and not eating who turned out to have a WBC of 300,000. We think this is most likely leukemia. We started her on Prednisone and her count went down to 48,000 so we are hopeful. We sent her to the oncology hospital in Luanda, the capital of Angola for further treatment. Pray for this sweet little girl.


L.P. is a young girl, maybe 15-16 year old, who sustained trauma to her birth canal while giving birth earlier this year. This trauma caused an abnormal connection, a fistula, between her bladder and vagina. We fixed her fistula a few days ago. Please pray that the repair is successful! Also, pray for her life decisions and choices in school, marriage, and child-bearing. Pray for God to guard her mind, heart, and spirit. Pray for the young women of Angola, so much seems to be against them.

A.T. is the sweetest little boy ever. He sustained a femur fracture when a motorcycle hit him! He will likely be discharged this week, praise the Lord. He has a lion toy and a tiger toy that he plays with, and yesterday he was super excited because he received a toy guitar from his mom.

Thank you all for your prayers, e-mails, and support. I am really encouraged by your notes! The time in Kalukembe was really busy, we did 46 procedures/surgeries! Plus 100+ clinic visits AND saw the patients on the wards! I then got to take a day off on Monday and went to the beach which was super nice and relaxing. I went with Sheila (Dr. Foster's sister), Rebecca (an 18 year old who is here in Angola who will be studying to be a teacher next year and hopes to return to Africa to work with children), a Dutch family (he teaches at the seminary here), and four men from Holland (who were here building a house for pastors who will be attending the seminary). It was a sweet time to appreciate God's creation and for fellowship.

This is my last week here in Angola. Please pray for wisdom in taking care of critically ill patients and small children. Pray that I would use my time with the nurses working on the wards to teach and encourage. Also pray that I would be obedient as God calls me to pray for patients and share with them about His love and sacrifice. I am writing this by candlelight because we do not have electricity so I will have to end here before the computer battery dies!

I will be back in USA on Saturday afternoon.

With love in Christ,
Marcela.

Heading out to Kalukembe

Yesterday we had an older man come in after 4 seizures and with an altered mental state, no fevers. When he started to wake up, he was very combative and then informed me that he usually drank 6 beers a day but that yesterday he had not. I figured he was going through withdrawal symptoms. Dr. Foster then came by and recognized the man. This man has been a pastor for many years and though he may have drunk in his early years, there is no way he drinks currently. We started him on anti-malarials, and it turns out he had cerebral malaria. I have yet much to learn about how disease and what diseases manifest here in Angola!
I went by and saw him today and he told me about Jesus. He told me that He is the son of God, and that He has saved him. He is such a kind, sweet old gentleman. He laughed and laughed when I told him all the things he had told me the day before. I get excited about getting to worship our Saviour with men like him for all eternity!
Tomorrow I head out with Dr. Foster, Maryan (a medical student from Holland), and Chikukuma (our anesthesiologist) to Kalukembe, a 200-bed rural hospital that is run by nurses. They usually line up many surgeries and difficult cases for the few days we are there. I will be there until Saturday evening. I am excited because they have a maternity ward with lots of deliveries! :)
Thank you for your notes and support!
In Him,
Marcela.

Finding me a husband

Just kidding! But today, the women in the ward asked how old I was, and how come I wasn't married yet. When I answered that I was 25, one of them spoke up and said that she too was 25 and that she already had three children! They said that next time I come to Angola I must have 10 children...hahaha. One of the nurses today offered to introduce me to her 26-yo "doctor" brother.
They are calling from the ICU, later!

Update #2

Thank you so much for your support, prayers, and e-mails. Last week was very difficult for me because three of my patients passed away.
One was a 26 year old who took some traditional medicine that caused liver and renal failure. Another was the 11 YO girl I wrote about in my earlier post. I had given strict instructions to continue bagging her and checking her O2sats while I helped Dr. Foster in surgery. In the middle of the surgery I heard the mourning/yelling that occurs here in Angola when someone dies. The nurse told me it was time for her to go. I became very angry at this response. I need to ask forgiveness from this nurse when I see him. The last one, a 15 month old, died before I got to the hospital on Saturday morning, from amoebic dysentery and dehydration.
By Saturday night, my heart was very broken. I cried a lot.
Please pray for the people here, for physical, emotional, and spiritual healing. You can pray for strength for me and for His touch and love to be seen through the workers here.
Thank you Courtney for sending this Psalm. It reminds us that He is FOR the oppressed/sick/hurting/abandoned.
Your prayers are much needed and appreciated!

Psalm 146

Praise the Lord!
Praise the Lord, O my soul!
I will praise the Lord as long as I live;
I will sing praises to my God while I have my being.

Put not your trust in princes,
in a son of man, in whom there is no salvation.
When his breath departs, he returns to the earth;
on that very day his plans perish.

Blessed is he whose help is the God of Jacob,
whose hope is in the Lord his God,
who made heaven and earth,
the sea, and all that is in them,
who keeps faith forever;
who executes justice for the oppressed,
who gives food to the hungry.

The Lord sets the prisoners free;
the Lord opens the eyes of the blind.
The Lord lifts up those who are bowed down;
the Lord loves the righteous.
The Lord watches over the sojourners;
he upholds the widow and the fatherless,
but the way of the wicked he brings to ruin.

The Lord will reign forever,
your God, O Zion, to all generations.
Praise the Lord!

In Him who is ALWAYS faithful,
Marcela.

Urgent Request

Please pray for an 11-year old girl we have on the service. We are not sure what is wrong, probably a combination of aspiration pneumonia, anemia, ?neurocystecircosis (?sp), her o2 sats are now in the 70s (were in 20's!). I am not sure what else we can do, I've been giving her oxygen by manually bagging her for the past 2 hours or so. Her mom and brother are with her. Also, please pray that I would be patient and loving with the staff here. Pray for opportunities to teach and show compassionate patient care.

Travels to Angola

I left DFW on Saturday afternoon and landed in Frankfurt Sunday morning. I had a 12 hour layover so I headed to the city of Frankfurt for some sightseeing. I had fun visiting the churches there, they are very beautiful! Sadly, they are now mostly used as tourist spots, not so much to praise Jesus. I then headed out from Frankfurt to Luanda on Sunday night, and arrived in Luanda at 5 am. The international airport was very nice, looked just like a Western one. I waited for a while for someone to meet me but since I knew the flights to Lubango left around 7am, I asked a security guard officer to show me where the domestic airport was.
This security guard turned out to be my guardian angel :) He spoke English! He made sure I made it safely to the domestic airport and helped me buy my ticket. At this point, I assumed he would leave me to fend for myself, but he stayed by my side as the people at the ticket counter yelled (no English there) at me about my carry-on bag being too heavy (limit was 5 kg). Sadly, they made me pay $40 :( As I was going through security, my guardian angel told me that he was a pastor there in Luanda. What a blessing! I managed to get on the plane just in time!
So, I fell asleep as soon as I got on the plane, and when I landed, I grabbed my backpack and purse and headed out to the bus they had for us. At this point I noticed that we were at some sort of military training camp, but I figured, ha, must be another part of the Lubango airport. As I am going through customs here (just a hole in the wall of a small cement building) I was asked who I was staying with in Benguela. I said, no! I am going to Lubango, NOT Benguela!!! I had NO idea the plane had an ealier stop before Lubango. I rushed back out, and thankfully the plane was still there. But again, this was a military camp, so they all had guns and stuff, so I was little afraid to just run back to the plane. An older man helped me, and explained the situation to one of the high ranking officers there. This officer turns around, walks around the building and comes out with a motorcycle. He got on, turned it on, and motioned for me to get on! I must have been a sight, with my backpack and purse, seated behind this captain/general hurrying towards the plane!
Anyways, everyone on the plane got quite a laugh from all this, and I'll admit I did too. Definitely felt like a total foreigner!
I arrived safely in Lubango, Peggy (Dr. Foster's wife) was waiting for me :)
I've been very busy at the hospital, I will try to write again tomorrow!
Please pray for one of our patients, she is a 6 month old with leukemia, and we have started her on chemo.

I've arrived!

I've arrived in Lubango, Angola! Going through the Luanda airport was a little scary, I will write a post about that and another funny story (already!) as soon as I can. I am already at the hospital this afternoon, though I am expecting jet lag to hit me pretty soon. I will write again soon! Thank you for all your prayers and support.

Upcoming trip to Angola

Dear family and friends,

It has been a long time since I’ve written an update, and therefore I am so excited to get to write you! Three years ago in July 2006 I arrived back in the U.S. after spending five months in Angola. I started medical school here in Dallas at UT Southwestern that fall, and now I am in the process of applying to residency programs in Obstetrics and Gynecology. These past three years have been quite a challenge – two years of classroom time and a little over a year on the wards, rotating through each specialty. I am so thankful for the opportunity to study medicine and the privilege of taking care of patients. The Lord has granted much grace in the learning process!

Shortly after I left Angola, the new Centro Evangelico de Medicina de Lubango (Evangelical Medical Center in Lubango) opened, as a 40-bed urban tertiary referral hospital. Dr. Foster works most of the time there, with some time spent in the rural 180-bed district hospital run by nurses in Kalukembe. More about the hospital and mission can be found at: http://www.ceml.net/ceml/myweb.php?hls=10020.

An exciting opportunity has come up for me to return to Angola for a four-week elective in International Health. I will be leaving September 26^th and returning the 28^th of October – which means I leave in a week! I will again be working alongside Dr. Foster, seeing patients in clinic and assisting in surgery. I am also hoping I will get to visit the church where I taught English for two months.

Three years ago, I asked for you to join me in praying for Angola, the Angolan people, and what God is doing there through the workers. Would you join me in praying again? Please pray for the men, women, and children that will seek care at the hospital: pray for physical and also emotional and spiritual healing. Please pray for strength and compassion for the workers, as they seek to bring hope and healing to the people of Lubango and surrounding areas. Mostly, pray that God’s will be manifested in Angola. I will try to update my blog with prayer requests, stories, and learning experiences as often as I can: http://marcelainmedicalschool.blogspot.com/.

Also, my travel costs and living expenses during my time there will be a total of $3000 US which includes airfare, lodging, and food. I ask that you pray and consider helping me with the finances of this trip. Please e-mail me for more information on where to send support.

I am so thankful for each one of you! Please let me know how I can be praying for you as well.

In Him,

Marcela Castillo

marcelita_castillo06@yahoo.com

A frightening and sad realization

Ms. M came in to the Psychiatric ER on Wednesday evening after being found to be aggressive and hostile at her boarding house. When police arrived, they found Ms. M barely being held down by her mother. She was APOWWed from the boarding house to the Psychiatric ER. According to the history given from the boarding house, she had suffered from a serious case of meningitis two years ago which led to encephalitis, which led to her Psychosis NOS and Dementia NOS. Therefore, two years ago, she was a normal functioning member of society. I met her on Thursday morning when I came in at 8 am. According to the staff she had defecated on the floor in the room she was in and had not given urine as of yet. I tried to talk to her, but she would only stare at me and then laugh and walk away. At one point, she became aggressive and was put in seclusion. At this time, her urinalysis came back which showed a UTI and she started antibiotic treatment.

Friday morning I arrived at 8 am to find that Ms. M was still in the Psych ER, and that every hospital possible had been called and than no none was willing to take her in. When I went to talk to her on Friday, she commented on how she needed something to do, and soon thereafter began pounding on the door and screaming to get out. Again, she went into seclusion. This was the first time I had watched Ms. M being put in seclusion and kept there for a time. She screamed desperately for us to let her out. She knocked on the door repeatedly to try to get our attention. We could hear her clearly inside the Psych ER office. I couldn’t help but feel like we were robbing her of the dignity she had left. At one point, I went by the room, only to find her staring at me with deeply sad eyes. What did she think of me? Did she hate us for doing this to her? That afternoon, when Ms. M came out of seclusion, I approached her to check up on her. She smiled at me, and told me she was about to eat. As she ate her sandwich, she told me about what she liked to do, what her favorite food was, about missing her mom and then asked me what I liked to do for fun. Needless to say, I was stunned by the difference! Later that evening, Ms. M was admitted to 8N and I did not see her again.

Through Ms. M and other patients, I’ve come to realize a sad truth. Before this rotation started, I believed psychiatric patients lived a secluded life, away from society, or at Salvation Army. Yes, some of them do live this way. But at some point they didn’t. They had families, they had goals and aspirations, and then an illness affected their lives that for many of them changed their lives forever.

I think it was denial on my part that I chose to believe this, since I didn’t know how to approach patients with a psychiatric illness. In my mind I decided I might as well act as if they don’t really exist. What a frightening and sad realization! These patients are just like any other patient with an illness; they are in need of a compassionate, caring physician who can provide excellent and quality medical care. The difference is that our society ignores and looks down on psychiatry patients, as opposed to holding a 5K or a benefit dinner or sending get-well cards as is common with other patients.

The person sitting next to me in the pew at church who murmurs and stares at the wall, the lady jumping next to me in my kickbox class, the old man sitting next to a child in the public library, the young man sitting next to me on the DART, the young mother of two sitting in the OB/GYN office asking herself if she should mention that she has been depressed, these have all been part of the stories of each of my patients while on Psychiatry. Sad thing is, it is not just I that have forgotten and ignored them – it is our society as a whole.

For example, Texas used to have drop-in places where they could go for daily activities such as games, art therapy, etc. The programs have been taken out of the Mental Health Texas budget. What can I do? How can I help? I am most frustrated by my inability to answer those two questions. I cling to the hope that maybe with one patient, with one conversation, or with one phone call to a family member I can make a difference today.

Happy New Year!

It has been too long since I last wrote on here. Since August or so, I did my internal medicine rotation as well as my surgery rotation, hence why I have not had much time to write! Internal Medicine meant that we were on call every 5th day, staying up to 30 hours in the hospital at a time! And then during surgery, it was 4 weeks of on call schedule every 3rd day, so my priorities became: sleep, eat, study some, and taking care of patients...and oh yeah, not falling asleep during rounds. During Christmas break I went to Chile for 3 weeks, which was wonderful, I will posts pictures as soon as I actually get them here in the US of A. As per usual, I was getting all my stuff ready to come back to the US a little last minute, and I left the DVD with ALL my pictures, videos, etc. sitting on my aunt's piano in Chile, in South America, on the other side of the hemisphere. Luckily, my parents, sister and brother-in-law are heading there in about a week, and so they will get the DVD for me.

I am currently on Psychiatry, which has been very challenging. My patients are mostly people with schizophrenia or bipolar disorder, and a few with major depressive disorder. For the past two weeks I've been in the inpatient psychiatric ward, which is pretty much where the most sick patients, the ones no other hospitals in Dallas want to take, are admitted. Sadly, most of the patients do not get better, even when all the medicines out there for their illnesses have been tried. One of the attendings mentioned that psychiatry is behind other specialties when it comes to pharmacology and research. Many of the patients we discharge home or to other facilities are simply at their baseline functioning level, which may be pretty low. Sadly, they are one of the groups that is most scorned, abused, misunderstood, and mistreated by society. I pray that I would not lose sight of what God can and does do in these patients. I ask that He would give me compassion for them, and that I would learn to see them as He sees them.