Where is Angola again?
The Republic of Angola is a country of nearly 20 million people located on the west coast of southern Africa. Angola has spent 27 of its 36 years since independence from Portugal mired in a civil war, much of which was a proxy-war for the US and USSR/Cuba. Since 2002 the conflict has abated and large oil reserves helped create a 15% growth rate. While the resolution of outright conflict has been a turning point in this resource rich country, years of war left a devastated infrastructure and a lost generation: more than half a million died in fighting and an uncounted generation of mutilados – ‘mutilated’ mine victims – remain. Currently, Angola also suffers the world’s highest infant mortality rate and the world’s lowest average life expectancy at birth (less than 40 years. Can you imagine that? I would have missed my midlife crisis already). While I have not found any data on the burden of surgical disease, it is no doubt high in a country where access to doctors is poor, maternal mortality is high, and land-mines continue to cover much of the country-side.
OK… so why did I go there?
As part of a capstone project for my masters, a fellow student and I looked into the potential of expanding “surgical task-shifting” in Angola to increase access to surgery. Task-shifting is a strategy to increase the health workforce – one that many countries (including the US) employ – in which nurses, midwifes, or other mid-level providers are tasked to carryout some of the responsibilities traditionally assigned to physicians. In surgery, Mozambique, most notably, has trained dozens of nurses to perform basic trauma surgery, cesarean sections, hysterectomies and hernia repairs. We are hoping to facilitate south-south collaboration and perhaps lay the ground work for Angolan technicos de cirurgia (surgical technicians).
Of course, this was not my own idea. Dr. Steve Foster, a Canadian Missionary Surgeon, has lived in Angola for decades and serves as medical director to a mission hospital in the south of the country. When there was a flare of violence in the 1980s, Dr. Foster and many of the country’s expatriates fled the country. Before doing so, however, Dr. Foster, his father, and a few other surgeons trained a group of advanced nurses at a district hospital to perform basic surgical procedures. Since then, a group of nurses have been handling much of the operative burden that this hospital faces. Dr. Foster is interested in making the case to the Ministry of Health that task-shifting is an idea worth exploring.
So what came of it?
A whole lot of life experience. In Angola I met nurses and doctors with the ingenuity and courage to care for patients even if their model did not fit a traditional mold. I also encountered a political system that was stubborn and lacked transperency. Nevertheless, the project got me interested in the creative ways people work beyond their resource constraints and the beautiful stories that underlie them. While much of my so-called research is currently on hold, my brief time in Angola has inspired me to look for inspiration and ideas where i hadn’t previously and to find ways to share these stories.