Ben Cavilla’s Blog

Angola Week 5

Well my last and final week in Angola proved to be everything I had hoped for and truly made all the prior frustrations worth while.  After an early rise last Thursday morning we piled into a 1985 Cessna Caravan single-engine airplane and lifted off with a team consisting of myself, Dr. Foster, two “nurses”, an Angolan med student and the two Canadian pre-med students.  It was only about an hour flight and despite a clueless motorcyclist on the run way forcing an abrupt pull-up and fly around and a flock of birds who veered off the approach path just in time on our second attempt, we landed safely on the bumpy dirt runway in the small town of Kalukembe late Thursday morning, where we were met by hoards of children and other equally curious spectators.

Kalukembe Hospital is an ancient looking structure amidst the jungle of northern Angola scarred by years of civil war and turmoil.  Nonetheless, it stands defiantly bursting at the seams, supported day in and day out by the superb nursing staff that are particularly adept with a knife despite their lack of pathophysiologic knowledge.  Needless to say, our arrival at the hospital was greeted with much fervor and scurrying about which was somehow refreshing to see after the likes of the hospital in Lubango, and we were quickly escorted through ward after ward, each filled to capacity with patients and their attentive families who welcomed us cheerfully with the typical “Bom Dia Doutores!” that is seemingly appropriate for all mornings, regardless of the actual state of affairs.  The Angolan people have a way of glazing over everything from a poor nights sleep to a recently amputated limb with a simple “obrigado” (literally meaning thankyou, but probably translating to something more like “my amputated leg is fine…thanks for asking!”)

What ensued in the following days is difficult to articulate, but suffice to say that even my time spent in the cities of Angola did not prepare me what I was to experience in Kalukembe.  There are far too many stories to tell here, but some of the more interesting cases we encountered included a baby born the day we arrived with anencephaly who we could not help, a woman who arrived with her decapitated baby’s head still inside her womb (apparently the nurse who attempted the breech delivery thought this was the best option to save the mother after he was unable to deliver the after-coming head) and the little boy who came in with triangular puncture marks all over his body after escaping from the jaws of a crocodile!  These of course were all complete firsts for me, but were surprisingly not the most bizarre of my cases (incidentally, when you hear hooves in Africa you think of Zebras long before Horses…).  Taking first place in the long list of bizarre cases that I saw in ‘Disturbia’ was a woman who came in with a story of being pregnant for 10 months without any fetal movements for the past 4 months and black, foul liquid pouring out of her….not a good sign to be certain.  According the reports of the local ultrasound technician, we were led to believe that she had a bizarre thing called a molar pregnancy (really a malignant tumor of the womb) and we booked her for surgery.  However, things went from bad to worse on the operating table and with some urgency secondary to her continued bleeding and rapidly falling blood pressures, we removed her womb which much to our surprise (and disgust… this is one of the few times since I began medicine that I have actually gagged behind my mask) the womb contained a partially decomposed fetus that was unfortunately all too recognizable as such.  I will spare you the very graphic details of it all, but suffice to say the whole thing was horrendous.  Needless to say, this is not an experience I would ever choose to relive again, and despite being mislead by the report of a molar pregnancy, the hysterectomy  was probably life-saving in the end, as her septic shock and hemorrhage left her barely clinging to life as we closed her up.

Anyways, as always the lows are followed by highs and I was given the opportunity to perform three sequestrectomies on my own later that afternoon…. Despite it’s very typically complicated medical name, a sequestrectomy is quite a simple operation in which you use chisel out a trough in the bone in search of dead and infected chunks of bone in what used to be the marrow space.  As strange as it may sound, there is a triumphant feeling of satisfaction (those of you who have ever struggled with eating fresh crab out of the shell may relate) when you pull out a big chunk of dead bone all in one go and by the time we left late Saturday afternoon, I had successfully removed 3 such morsels and assisted Dr. Foster with 46 other surgeries in just over 36 hours… incredible.