The Rural Rounds

      Almost every patient I saw during my rotation tested positive for malaria - especially during the rainy season, when mostly every patient routinely gets a rapid malaria test. Here, malaria is as common as the flu or strep throat back in the States. What initially shocked me was just how normalized it is in daily clinical practice.      I was also stuck by how prevalent tuberculosis (TB) is in this region. Because of its high disease burden, TB is always on the differential - you simply can't afford to miss it or delay treatment. After a month of seeing it so regularly, I realized how desensitized I had become to something that once seemed rare and alarming. It's wild to think how quickly that shift in perspective happened.     Another surprise was seeing several children diagnosed with measles - something we rarely encounter in the U.S. due to routine vaccinations. But in many of these remote villages, access to vaccines is limited and lack ...

      A 50-year-old male came into the clinic with dyspnea, shortness of breath, and palpitations. On exam, his extremities were cool to touch, he had a very faint pulse, and noticeable edema. Since we are resource limited and do not have access to a 12-lead EKG machine, we performed a quick bedside ultrasound revealing a heart arrhythmia and tachycardia, which we initially suspected to be atrial fibrillation.     Fortunately, the hospital had recently acquired a cardiac monitor - something we don't take for granted in this setting - so we quickly connected him. The rhythm confirmed our suspicion: atrial fibrillation with rapid ventricular response (RVR), with his heart rate spiking between 200-250 bpm and occasionally jumping into supraventricular tachycardia (SVT).     With no access to cardioversion and extremely limited medication options, we had to rely on clinical judgment and resourcefulness. The only cardiac medications available were atenolol,...

 I wanted to share some of the unique cases I encountered during my time in Cavango over the next few posts!     One day, a 7-year-old boy came into the clinic with a complaint of a stiff neck. He had classic nuchal rigidity  - a textbook sign I had only read about until now, and it was incredible to see in person. Based on this, we initially suspected bacterial meningitis and admitted him to the ICU to begin treatment.     Later that evening during rounds, we conducted a more thorough exam and realized something important: all of his muscles were rigid - not just his neck. The rigidity in his abdominal muscles was the key finding that led Dr. Tim to shift his concern from meningitis toward a diagnosis of tetanus.     Back in the States, we would have quickly performed a lumbar puncture and run a CSF analysis to confirm or rule out meningitis. Unfortunately, we didn't have that kind of lab support available here. So, we moved forward based on clin...

     Every morning after rounds, everyone gathers outside for a one-hour palestra  - a vibrant and meaningful group discussion that brings together patients, their families, hospital staff, and community members. These gatherings begin with a few religious songs sung in local tribal languages, setting a reflective and unifying tone.     The first part of the palestra  focuses on spiritual well-being. A short teaching is shared, centered on a passage from the Bible, followed by open dialogue and questions. It's a powerful moment of connection and encouragement. Many of the people are grateful for this space, especially since opportunities for such engagement are rare in their remote villages.     Next comes the medical education segment. These discussions revolve around common illnesses in the region that affect both children and adults - ranging from preventable conditions to serious, life-threatening diseases. Topics we covered during my tim...

    As one can imagine, practicing medicine in the bush of Angola is quite different from what we're used to in the United States. It brings you back to the core of medicine - clinical reasoning, careful observation, and thoughtful decision-making. Here, you're constantly weighing the risks and benefits of every test and treatment. This is truly poverty medicine, where cost and burden on the patient and their family are always part of the equation. Some patients travel for days to reach the clinic, many of them on foot. They are incredibly resilient people, and the effort it takes for them to come means they are truly unwell. It's a humbling reminder of both their strength and the responsibility we have to care for them with purpose and respect.     There are several lab tests available in Cavango that we commonly use in the U.S. - such as CBC, BMP, LFTs, TSH, creatinine, and urea - but they are only ordered when absolutely necessary. In the States, these are often r...

      The hospital in Cavango was originally built to care for people with leprosy before 1976 before the civil war in Angola. Since then, it has been rebuilt and transformed. What began as a small clinic for outpatient consultations and emergency cases - with only 3 to 5 patients per week - remained open thanks to a loyal and dedicated staff. About 13 years ago, the Kubackis arrived in Cavango. Speaking with Dr. Tim, he shared that it took years to build trust within the community, which had previously relied on government hospitals or spiritual healers for care. Through consistent, compassionate treatment and word of mouth, more and more patients began to seek help at the clinic. As the demand for services grew, so did the need for larger space. Over time, the facility expanded into the hospital it is today.     Now, it's a 120-bed hospital with inpatient wards, an ICU, emergency area, maternity room, and four outpatient consultation offices. There's also an a...