For Paolo, already a nurse and de facto surgeon, continuing education does not mean an MPH or a PhD. In recent years, he attended night school and last year he finally finished the 10th grade. Of course, this is not where he would stop. Having finished escola secondaria, Paolo plans to start the newly offered ‘advanced nursing’ course next month. (Admittedly, I am initially confused if Paolo will teach or take the course). In February, Paolo will continue his duty as chief of surgery while also sneaking out for courses on physiology, pharmacology, and ironically enough, anatomy.
While I sing the praises of all that the technicos have accomplished, I should also note, however, that their work is not free of all problems. To my naïve eye, I think Paolo should wash out some of the open fractures with saline or water instead of simply removing the dead skin. Non-union of fractures (improperly healed bones), albeit rare, does occur. Maternal deaths – often due to the incredibly late stage of labor at which women present – are a near-monthly event. Undoubtedly, formal surgical education on the limited care that the technicos provide would go a long way.
Traction devices for fractured femurs
But the technicos themselves are not cavalier about the extent of their skills. Salomão reminds me that they are not there to set about on medical or surgical (mis)adventures; Paolo will be the first to sing the praises of Dr. Stephen Foster. With resolution of the war and increased freedom of movement, Dr. Foster – a surgeon based in the provincial capital -now makes monthly trips to Kalukembe to do complicated cases and give general recommendations on what the technicos should (and shouldn’t) do. Nevertheless, Paolo and his colleagues are the ones who perform the cesareans, the fracture repairs, the emergency surgeries, and the temporizing measures that have saved hundreds if not thousands of lives.
ICU beds in Kalukembe
The technicos at Kalukembe are in many ways the inspiration of our project. In all our effort to share what we know, this is the lesson they teach us: their development of raw skill, their resolve to work when they were expected to flee, and their desire to keep learning remind us that talent and determination and ingenuity can emerge from many places. This is true in Angola, in India, in Haiti, and in the U.S. Those of us interested in development would be wise not to stand in the way.