There are moments when i Forget

that I’m in a third world country. Angola is a funny place. There is a mall in my town and fancy restaurants. They just opened a new “Shoprite”, which is a modern grocery store chain from South Africa. I even have “The Hungry Lion” (think African McDonald’s).

I have patients that arrive at my hospital driving Mercedes and talking on iphones. Others fly to Namibia or Brazil to get a second opinion or just to do a little shopping. Then I have the patient who comes in leaking urine for 9 years after a difficult delivery. She was in labor for 2 days and finally delivered a dead baby, but ended up with a vesicovaginal fistula (a hole between the bladder and the vagina). I have other patients who are dying from tooth infections. There aren’t dentists and they come to see me when they have necrotizing fasciitis of their face and neck. I have albino patients with giant skin cancers that are eroding into their eye sockets and skull. I have a patient who dies because I can’t intubate him and there are no hospitals in the entire region that have a functioning ventilator. I have another patient who dies from a benign brain tumor because there aren’t any pediatric neurosurgeons in the country. I have another patient who will never get a chance to speak--he had cerebral malaria when he was young and now is deaf. The family brought him to me to see if I could give him a pill or operate on him so that he could speak. All he needs is someone to teach him sign language, but there are no deaf schools near his village. I have another little girl who lost her foot to gangrene--not because of the snake bite, but because of the local health post that treated her with a tight tourniquet around her ankle. I had 3 ladies come in during the same week with unresectable cervical cancer. There is no radiation treatment in Angola & only one hospital in the capital which has any chemotherapy. One patient walks into my office in a suit and tie and the next patient walks in with only a loincloth. The patient in the loincloth pays for his surgery with crisp $100 bills and the man in the suit and tie has traditional medication, which frequently involves dung and grass, in his wound. This is Angola.