Paolo is a tall mustachioed man who looks a score younger than his 52 years. In his teens, the realities of the Angolan civil war and the fear of being agarrado (a not-so-nice version of being drafted) kept his family on the move and prevented him from getting past 6th grade. In 1978, hoping to escape further calls to war, he thought to start a career in healthcare. So at age 18 – with no intentions to do surgery alone – he moved away from his family and started a ‘basic nursing’ course at Kalukembe Hospital.
Kalukembe Technical School for Health
In his nursing course, Paolo spent time learning to be a scrub-technician, memorizing basic pharmacology, and rotating with the eight or nine doctors that ran Kalukembe hospital. After finishing his three-year course, Paolo stayed on at Kalukembe. Initially, the nurses learned basic skills to help keep the doctors moving through busy caseloads – helping close skin, pull teeth, and assist in c-sections. However, as it became clear that the war would envelop Kalukembe, the doctors – knowing they would have to flee – started teaching the nurses to be more independent.
When we speak, my interactions with Paolo feel strained by a hierarchy that has been distorted and bent backwards upon itself. Paolo addresses me formally as ‘doutor’ and at moments he has me fleetingly convinced that I am in charge. (Naturally, my medical student ego is stroked by the d-word). In our interview I struggle to elicit more than five word answers and when the c-section interrupts us, he seems relieved (Something to the tune of “Sorry doutor – if it’s okay with you, we should start the case”). As he leads me through the c-section, his deferent language becomes even more ironic.
The Aseptic OR
The more I manage to cut through the humility of the technicos, the more remarkable I find this group of nurses that developed every skill they had to care for the most under-served of patients. While the harrowing realities of war merit a story of their own, what strikes me most about the technicos is their unending desire to learn. Antonio Salomão Franscisco – the head of pediatrics – explains, “If [we] had not had the curiosity – the interest in taking charge of the situation – we would never have had this hospital functioning today.” On my way out the door, he makes sure I note down that he wants me to find people to teach them more about ultrasound and neonatal resuscitation.
Salomão: “We need to read, but the books we have are not up to date”
… (part 3)