by Damien Brown
And then of course there’s Sergio. Belligerent, moody, at times unpredictable, although I’m beginning to suspect he’s all bluster. He’s without doubt a capable health worker, and for the moment anyway we’re getting along well enough.
And really, as I sit here and look around, it strikes me what a disparate group we are. Ten enfermeiras, seven clinicos, four midwives, myself and the dispensary clerk—just this morning’s shift. Together we range in age from late twenties to early sixties, and possess work habits varying from remarkably competent to frankly dangerous, motivated to profoundly lazy, compassionate to disinterested, and irreproachably virtuous to almost certainly alcoholic. (The dispensary clerk is looking a little too red-eyed these mornings.) Hard to tell at times whether treating patients or managing the staff is the more challenging aspect of work.
Kassoma continues. Half the room is by now snoozing but like an experienced school teacher he knows how to get his audience back; ‘Então!’ he calls—So!—and bangs his diary on the desk. A dozen bodies jolt suddenly and he smiles dryly. ‘Enough statistics, colegas! Let us change the topic.’
Throats clear and bums shuffle.
‘Finalmente, our Coordenador told me of MSF activities this last month. If I may share this with you.’ He stands tall and turns the page of his journal, his shirt pocket sagging under the weight of a half-dozen pens. ‘Last week, colegas, the cholera outbreak along our coast came to an end. This is good news for Angolans, you will agree. Twenty-six thousand people were treated—’
‘Eh’s!’ fill the room,
‘—but MSF are now closing treatment centres.’
Nods of approval circulate. The outbreak was the largest in recent years, with an estimated five hundred new cases occurring each day during the peak. Two thousand people had died.
‘Next,’ says Kassoma, ‘Coordenador informed us that MSF are increasing their response in Ha . . .’ He stops. He apologises and squints at the page, adjusts his too-big glasses. ‘H. A. I. T. I.,’ he spells out. ‘Novo Doctor?’
I nod. ‘Sim, Senhor. Haiti.’
‘Obrigado.’—Thank you. ‘In Haiti, MSF have treated thousands this past month. They were victims of violence. MSF hope that—’
‘Because of what?’ interrupts Therese, the slim, stern-faced head nurse. ‘Why the fighting? Is there a war?’
Kassoma’s not sure. He looks to me and I try to explain what little I know, adding that there’s a UN mission in the country. The Angolans know well of the UN—a peacekeeping force had monitored the failed elections here following a short-lived ceasefire agreement during the 1990s.
‘Obrigado, Novo Doctor,’ says Kassoma. He tells us next of a malnutrition crisis in Niger where MSF have admitted two thousand children for treatment in the past week, but he’s not sure the figure’s right. ‘Verdade?’ he asks me. True?
I nod. I’ve been following the field reports via email.
‘Two thousand!’ he exclaims, shaking his head. Others around the room express their disbelief, too, clicking tongues and muttering softly. ‘Please,’ says Kassoma, ‘we must all pray for the people in Niger. This is a sad thing. Too sad.’
He pauses for a moment and turns the page. ‘Next, MSF are worried about casualties in Leb . . . L. E. B. A. N. O. N. Novo Doctor?’
I pronounce the name for him, and he goes on to list the half-dozen countries in which projects are scaling up this month, his demeanour that of a pastor delivering an important sermon. He’s the oldest of our staff, clearly the patriarch of the hospital, and people listen intently. But I find this surprising given the topic—could they even know where any of these countries are? Surely not. Kassoma, by far one of the more educated in town, can’t even pronounce most of them! Yet everyone seems genuinely interested, far more than with the housekeeping issues regarding our own hospital—some are now even taking notes! Like Senhor Calvino, to my right, the jovial, obese clinico from Outpatients—he’s actually writing this down! So too is Roberto, and Nene, the regal head of Maternity—both are jotting this in their journals! But for whom? For what conceivable reason? Why should they care about these unpronounceable countries? Yet they genuinely seem to. They express their collective disapproval, shake their heads empathetically . . . which, as I sit in this bitter cold, bathed in the smell of body odour and burned skin, I find quietly touching. Do they not know that others are reading about Angolans and their difficulties, shaking their heads? That when I send my group emails home, watered down as they are, they prompt a flood of pity and disbelief aimed their way? Or that MSF have serious concerns regarding their pulling out of here?
I’m not so sure that they do. And I may be mistaken, but what I suspect is this: they don’t perceive themselves as victims. Before, there was a war. Now the war is over. To whom or what else can they compare themselves? No travellers pass through, and no TVs project images of Hollywood lifestyles into their crumbling huts. No one here receives phone calls from overseas relatives (there are no phones) and the only accessible media is Angolan radio. Many haven’t seen a city since before the war, if ever, and we volunteers are their only regular contact with an outside world. And if MSF are confident enough to soon leave them, yet are rushing headlong into these other countries, then surely things here must be okay?
I’m making assumptions. Although really, whatever their reasons may be, I’m not sure if any group could empathise more with people in need than those I see huddled around me. Because more than anyone, they must know true hardship. The kind it takes to make a child stoop to eat sand.
Kassoma comes to the final item on his agenda, the antifungal trial. Today is just over two weeks since we started. Decision time. So now I brace myself, because if the results don’t go my way, then I may well be forced to browse Kassoma’s list for another posting.
Kassoma calls Carlos to the front. He’s the younger of the health workers, a good-looking, charismatic man with an affinity for aftershave, and he’s been charged with keeping the results. He pulls crumpled sheets from his pocket and reaches for a calculator. ‘Wait!’ he calls over chatter. ‘Okay, in total, eighty-two children were watched.’ He goes through the numbers slowly, then raises his eyebrows. ‘Eh! Okay, in the end it looks like the children were the same! Almost all were good in three days. So I cannot say I saw a difference.’
Murmurs ripple through the room. Sergio jumps up to fetch the calculator from the desk, scrutinising the papers as Kassoma watches keenly over his shoulder.
‘I am not so sure,’ says Kassoma. ‘Maybe Novo Doctor did not record his numbers clearly?’
‘Carlos recorded everything,’ I say. ‘Not me,’ although I had kept a close eye on the patients as well, and it’s been obvious no one was worsening.
‘But two weeks is not enough, Novo Doctor,’ protests Sergio. ‘And we have been treating our patients like this for a while in Mavinga. For some it may be helping.’
‘Fair enough, Sergio. If someone gets worse we can consider it,’ I say, ‘but otherwise we’re just wasting money. These bottles are flown from France.’
Sergio’s not happy. Andrea’s sitting just behind me and offering to help translate, but—for the first time since I arrived!—I seem to be understanding most of the conversation. Sergio argues the point until Kassoma finally cuts him off, unable to find a mistake with Carlos’s maths. ‘A deal is a deal,’ says the older man, looking more resigned than convinced. ‘Novo Doctor has made his point. Let us agree to stop using it, and we will watch closely what happens. But if things begin to change, Novo Doctor,’ (out comes the pointed finger again), ‘or if any of our children get sicker, we will talk about this again.’
‘I’m happy with that, Senhor,’ I reply.
‘Because we will not tolerate our people getting worse,’ he cautions.
‘Of course not, Senhor.’
‘In that case we have an agreement,’ he declares. And with that, Mavinga General Hospital—where surgical instruments are boiled on the fire, and kids with swoll
en bellies and no shoes want high fives; and where staff worry more about the Haitians than the drugs stolen from our last major delivery—reaches out and hugs me. Not necessarily a big hug, but a hug nonetheless. And I relish it. And as the morning sun beams through the doorway, the world outside ablaze in warm orange light, I bask in the first small promise that I may actually last the months here.
• • •
Carlos is the man to stay beside on the rounds. His cologne creates a haze of impenetrable scent as we enter the kids’ ward, although we’re running late and people are already up, the windows open and fresh air flowing, and it’s quite the sight, too—part breast-feeding centre, part hairdressing salon, it seems. Mothers and older sisters have gathered on beds to work on each other’s hairstyles, fashioning cornrows, plaits, braids, tufts, dreadlocks, and twists from thick hair, with bright plastic beads often tied in for added effect. The breastfeeding continues as an aside. The mood is buoyant and almost all children improving, so we move quickly through the ward.
The adults present more difficulties in terms of medical treatment. The infections that dominate younger patients’ admissions (gastroenteritis, malaria and pneumonia) are less common, and the consequences of war more evident, both physically and psychologically. Many bear the scars of old injuries, often only incidental to their current presentations, or else symptoms that I suspect are related to stress. The variety of conditions seen is far larger, too.
We enter the women’s ward. Eight patients lie in here this morning: seven women, and a man who’s snuck in because the men’s ward is too crowded, he says. As we begin, an interesting distraction is provided by the husband of the woman in bed six.
‘Desculpa!’ he says. Excuse me.
‘How is your wife?’ we ask. She’s currently being treated for abdominal pain.
‘Very good,’ he replies. ‘Muito melhor.’ Much better. ‘But my knee is the problem. It is hurting too much.’
Sergio points him out the door. ‘You can see Outpatients. We only see hospital patients here. Female hospital patients. And you too, my friend,’ he adds, pointing to the man who’d snuck in.
The man with the knee pain asks again. He is too old, he says, and he cannot wait on those benches all day. He rolls his trouser leg up and climbs up beside his wife. ‘Come. Please, you are already here. Just look quickly for me.’
Sabino obliges and asks him when the pain started, although before the man answers I know that we’re already talking years here, maybe even decades, because intricate patterns of fine cuts form a tapestry of scars around his knee. He’s been visiting traditional healers. ‘It began a while ago,’ he shrugs.
‘When, more or less?’
‘During the war—since the Cubans shelled us!’ he replies, which catches me off guard. I’m more conditioned to hearing things like ‘since I slipped in the supermarket’.
‘In Cuito,’ he adds. ‘Cuito Cuanavale,’ which sparks immediate interest across the room.
‘You were in Cuito?’ asks the man who snuck in, who himself is suffering back pain as a consequence of a shrapnel injury. ‘I was there too,’ he says, sitting up. ‘When were you there? Were you with the South Africans?’—and suddenly knees and backs and requests for consultations are forgotten entirely as the two swap stories across the room. I’ve read about Cuito—it was reportedly the largest tank battle on the continent since World War II—and their comments are loaded with history. Why indeed were the Cubans fighting, and in such large numbers, on the opposite side of the Atlantic? Or the South Africans, for that matter?
I try to get my head around it as they chat. So I tune out from the wards, suspend disbelief, and visualise this little corner of earth on an online map. Then scroll out, hover high over the Atlantic and veer just a little to the left, pausing when Angola is on my right, South America on the left and Europe above, and go back in time a little while . . .
Sometime between two to three thousand years ago, these men’s Bantu ancestors began a series of migrations across the continent, fanning out from our north to populate much of sub-Saharan Africa. Not until the late 1400s was there any contact between Europeans and Africans this far south, but that changed when a Portuguese caravel chanced upon the Congo River at what is now the north of the country. At around the same time, directly west across the Atlantic, the Portuguese landed in Brazil, and by the end of the century had colonised both regions. Trade grew, and in particular large sugarcane plantations were set up in Brazil and the Caribbean, requiring intense labour to maintain: the trans-Atlantic slave trade was born. And it boomed; by the early nineteenth century, between three and four million Africans had been taken from what’s now Angola and shipped west, many of them ending up in Cuba—a fact that becomes relevant to the Angolan war, when heritage, not just the socialist ideologies shared with Angola’s MPLA forces, is a large part of the reason Castro sends his troops here.
But what then of South Africans? What was a white apartheid government doing here, at The Edge of the World, fighting alongside black people for this dusty outpost?
Back to the map. Angola’s long southern border is shared with Namibia, where the South Africans were involved in a separate war in the 1970s. By this time most colonial powers had divested themselves of their African interests, but the South Africans, who’d taken Namibia from the Germans, refused to grant the protectorate independence. A Namibian resistance movement sprang up and the South Africans fought back hard, chasing them north into Angola, where the group received support from the MPLA. This, and the prospect of Angola becoming a Marxist country, was unacceptable to the South African government, who consequently invaded Angola. In aid of this they also provided support to UNITA, who were already fighting the MPLA from bases in the south-eastern regions—which is where our little town comes in.
For over a decade the fighting drew on, and by the late 1980s UNITA were pinned down in Mavinga, on the brink of defeat. A huge battle ensued. South Africa sent more troops to help them (landings were made at night on the town’s airstrip, alongside which UNITA soldiers would stand with kerosene lamps and candles to guide the pilots), and together they chased the MPLA north along our dusty road to the town of Cuito Cuanavale, a couple of hundred kilometres away. There, both sides dug in. Cuba sent fifteen thousand extra troops to help their MPLA comrades, and Russian jets bombed UNITA. For months the city was battered, and after all of this the battle was a stalemate. There were no clear victors, but there were consequences. South Africa and Cuba began withdrawing from Angola, and peace talks led to a ceasefire and elections in 1993. But UNITA lost; their increasingly belligerent leader, Savimbi, refused to accept this; and another decade of war followed until his death.
‘So what can you do for my knee?’ asks the old man, smiling a mostly toothless smile. ‘Can you fix this pain?’
And from across the room: ‘What about my back? What can you do about this shrapnel?’
Probably not much, although someone’s gone to call Roberto. For now, funge and feijão, the Angolan staple of maize and beans, is being ladled into tin lunch bowls from the kitchen window, so we need to finish up. And there could be no better place than our last stop, the nutrition ward.
The twelve-bed unit has come to epitomise the value of our presence in Mavinga for me. I’m still wary of it, but I’ve now witnessed the recovery of the first cohort of children admitted since my arrival. Their physical transformation is impressive, the change in their disposition simply mesmerising; within weeks, once gaunt, lethargic children roam excitedly around the compound, chasing each other and livening up the hospital atmosphere. Rehabilitating them is like adding water to wilted flowers, then watching them bloom back to life.
We enter, and a young girl in a bright pink dress makes a beeline for us. She’d please like a hug. Valeriano’s her name, and the little beard of high energy biscuit crumbs around her mouth suggests that her appetite is very much back to normal. It’s an extremely good sign; a cruel irony of malnutrition is tha
t a loss of appetite occurs in late stages, necessitating the use of nasogastric tubes in some children to facilitate the gentle process of initial re-feeding—as is currently the case with Alberto Kakuhi, this morning’s new admission.
‘One year old,’ says Sabino, who saw him earlier.
‘Any recent illnesses?’ I ask.
‘Just a little diarrhoea for the last two weeks,’ he says. ‘But otherwise okay.’
‘What’s their food situation?’
He chats with mum in Nganguela. What follows is a common story in here; she fishes out a thin, leathery bag of a breast and squeezes it (no milk), then points to her three other children and says that she has all of them to feed as well. I’d ask why she doesn’t just buy milk from the market, but I know the answer—usually there is none, and when there is it’s too expensive.
So they’ll all stay with us for a few weeks. Alberto will be given antibiotics, vitamins and de-worming tablets. He’ll mewl irritatedly when the enfermeira syringes the low-calorie milk into his tube, but he’ll receive this every three hours anyway, nights included. In a couple of days we’ll likely remove the tube and wean him slowly to richer milk, then solids, and within two weeks he should be playing with his siblings. In three to four weeks he’ll go home, returning for weekly follow-up and a ration of food to get the family through the next three months. It’s an immensely satisfying process, albeit a time-consuming one for staff. Imagine then when MSF first arrived here: forty-four emergency feeding centres needed to be set up across Angola, requiring almost two hundred expat volunteers and two thousand Angolans to run them. In Mavinga, over three hundred patients were being treated for severe malnutrition in the one centre, with seven thousand others receiving emergency food rations in town. All of which makes our little unit, poignant as the sight of skinny children is, a comparatively reassuring picture.