Ben Cavilla’s Blog

Angola Week 2

Well it has been a few days at least since my last posting and needless to say a LOT happened here in Angola.  It was a tough week to tell you the truth.  The hospital was full of sick patients and we lost 3 more in the last day.  One patient with terminal AIDS at the age of 37, one elderly woman who came in with a rock-hard abdomen and a liter of puss in her belly, and a young guy with Typhoid Fever.  That was a hard one for me as I had been caring for him since admission.  Like happens all too often here, he presented with a fairly advanced infection.  He had been already feeling unwell for almost 10 days by the time I saw him and his eyes were a bright yellow color and his abdomen was full of gas and tight as a drum.  He also had Hepatitis B working against him but I was unable to tell if this was a new or chronic infection as we do not have the necessary lab tests here to tell the difference.  After initiating urgent IV antibiotics in our small Banco Urgencia (ER) I transferred him the 3 bed “reanimation” unit (ICU) which is really more of a holding cell where patients wait to die.  There are no automated ventilators and there are no vasopressors….just bags of saline and very attentive family members who will take shifts squeezing an Ambu bag around the clock if necessary.  Unfortunately 3 days after admission I received a call at 7:00 in the morning saying that things “were not going so well” and in a haze of adrenalin and grogginess, I rushed to the hospital in our rickety Land Rover (driving in Angola is another story that I will have to save for another time). By the time I reached the hospital, the boy was semi-conscious and there was blood spewing from his mouth and nose.  For almost two hours I yelled out broken Portuguese orders to the nurses while two wide-eyed premed students tried their best to do as they were told…. but after 3 liters of saline, one unit of blood (via a central line that was hard fought for) and one vial of dopamine that I manage to find in a drawer, I couldn’t keep up with the blood loss and his heart stopped beating.   He was 21 years old.   And as his family all looked on, I called off our efforts and covered his body with a sheet.  I could see the despair in their eyes and I could not stop the tears as I told them the news….truly one of the most difficult experiences that I have had in my short time as a doctor.  As I walked away, they began the wailing that is customary on such occasions here…it is a sound I will not forget.

Even as I write this recount, I have to fight back the tears.  So many times I feel so helpless.  The paradox of being a doctor but not being able to cure is something that I am struggling to deal with.  Fathers, mothers, sisters and brothers die here everyday… it is almost expected. They come to this “modern” hospital in a final act of desperation in the hope that we can save their loved ones…but for most it is too late.  I do my best to carry on and cling to the memory of those few I have helped.  But even now, I am thinking about the little 6 year old girl under my care who is quickly succumbing to Typhoid Fever and Malaria. I have just transfused her with a third unit of blood in as many days. We are running short of blood and I will donate my own O negative blood tomorrow if she makes it through the night…