Ben Cavilla’s Blog

Angola Week 1

Well today is bright sunny morning (really one of the few since I have been here) and I decided to get up early and do some writing.  So far I am still as white as a ghost so I have taken to sitting in the window (literally…I sit on the window sill with my feet hanging over the street below) and catching some morning rays from the African sun.  So far the weather has not been great.  Many days are overcast here and there are a few that are cold (I actually had to put on a coat!) which was pretty surprising.  Anyways, I am told it is the rainy season here.  I guess I should be thankful that I don’t have to work all day in suffocatingly hot conditions.  My days are pretty full as I am in the hospital from 7 am to 7 pm and I wouldn’t have anytime to enjoy it anyways….

Anyhow, things here are going well.  I was a bit of a rough start with “the boss” being gone for my first 48 hours in Angola. The hospital was a bit of a disaster, nobody was doing a damn thing and people were dying all over the place.  When the cats away…. but as of yesterday morning Dr. Foster was back and everyone was on their best behaviour again.  After starting the morning off with some very exuberant singing of strangely familiar hymns in Portuguese out in front of the hospital with all the would-be patients for the day, I headed off to the wards for morning rounds with my trusty translator in tow.  My translator is an 18 year old Canadian kid from Toronto who is very keen green medically speaking, but has passable Portuguese and as such is able to translate for me.  We get along quite well and he is more than happy to help in any way that he can.  Unfortunately I lost my first patient during rounds that morning (the nurses did not think it pertinent to tell me he wasn’t doing so well until his heart stopped).  He was an old man with a really bad heart so I guess he was on borrowed time…but still….it was frustrating.

My first afternoon in consults was full of interesting cases to say the least.  My first consult was a young woman who had brought in her 7 year old sister because of a lump she had “in between her legs”.  Expecting to find some sort of cyst or something equally as common I asked her to take her pants off and sure enough just beneath the sparse layer of hair there was a lump in her left labium.  The feel of it rolling between my finger and thumb was strangely familiar and reminiscent of my time spent in Pediatrics.  My mind raced back to the mundane embryology lectures during my years in medical school (I slept through most of them) and my eyes wandered up her to her little chest…no breast buds.  Very strange.  This was something I had never seen in any book before let alone encountered.  I excused myself for a moment and poked my head into the next room where Dr. Foster was seated with another patient and sheepishly said,  “Excuse me doctor…I feel a little silly even raising the possibility of this, but I think that the little girl in my room has a testicle in her labium…do you think you could give me a second opinion?”  He of course laughed at me as we wandered back into the other room, however his smile quickly faded as he examined the girl, finding one by one the clues that I too had seen.  The lump in the labium, the pubic hair, the lack of breast buds.  A less mocking smile crossed over his face….“I think you’re right…we’ll have to take that out!”  The little girl was indeed a hermaphrodite (she later produced a piece of paper detailing in English her XY genetic makeup)!  Prepared for the worst I began to explain to the woman that her younger sister was actually her younger brother, however much to my surprise her reaction was very subdued.  And when I had finished explaining the reproductive ramifications, the necessity of the operation to remove the aberrant testicle and the likely need for hormone therapy (which would undoubtedly be unaffordable), the woman calmly reported that she had had the very same operation as a child…. Que Raro!  A hermaphroditic family!!!  And from the there the weird and wonderful cases rolled on. Pott’s Disease (TB of the spine), a girl with fused toes, a woman with a giant worm coiled in her thigh, and a little girl with a severely narrowed heart valve and resultant heart failure.  I think I saw more strange cases on my first day here than I have seen in all my years combined!

Well I could keep writing all night about the crazy things that I see here, but I suppose that I should sleep.  Tomorrow is another day and given today’s stampede of zebras it will likely be a busy one.  As they say here “Boa noite e ate logo” ( Good night and until then).