segunda-feira, 18 de janeiro de 2010

O Aperto de Mão (english version) - The Hand Shake

Here I start, telling you my first story of many, that could be told about my mission in Congo, where I worked as a doctor anesthesiologist, for the Doctors Without Borders (Medecins Sans Frontiers), in a region called North Kivu, in a town called Masisi, close to the border of Rwanda, a very complicated region, that it has been innocently punished by a horrible war, that insists on going on, and it has murdered in the last 15 years about 5 million people... And as always the ones who suffer the most are the innocent civilians, women, children… whose destiny wanted them to be born in one of the worst zones of the planet to live in. But the will to live, to smile, to love, to have children and all that characterizes the magic of the human being is present in these people that have a lot of will to live and give life!

And here it goes a story, that for me proves that very well....

In the place where I was working, as many others in Africa, one of the most common surgeries that we performed was the C-section, given the high natality rate, for many different indications many times we were called to operate so we could save the mother, the baby or both. As many other times I was called to the operation room in the middle of the night, tired of many days of hard work almost with no breaks.... I made a spinal anesthesia, or for the ones not in the medical field, I stuck a needle in the patient’s back in order to anesthetize all the inferior part of the body below the umbilicus, meaning that the future mother was awake seeing and listening all she could.... Because of the lack of monitorization of the fetus, it happened what happened many times in that hospital..... I had to do reanimation of the newborn.... Once again explaining the non-medical, the fetus was suffering inside the uterus, and the C-section came already late …. lucky or not I was there.... With some training about these issues, but not so much practice because it’s quite rare to be necessary in our hospitals in the developed world...
This newborn needed active reanimation, due to the intra-uterus suffering, to help him in this period that for some is so difficult or even fatal, that is the first time we breath.... Normally a simple tactile stimulation is enough to give that little push to the baby, but for some it’s necessary bag-mask ventilation, and when it’s not effective, we have sings that the oxygenation is not enough, the heart rate keeps on going down, which can cause permanent damage of the brain of the newborn caused by the lack of oxygen that reach the brain cells…. and very fast.... because all this is made in seconds or few minutes of tough decisions and actions, its necessary to improve the oxygenation by placing a tube through the mouth to the trachea.... performing the act that characterizes the Anesthesiologist so much …

What you see in this picture is the end of those stressful moments, that fortunately had an happy ending which you can see by the pink color of the skin and lips of this baby.... my hand seems to be giant next the this very new Congolese... a stethoscope... that I used to evaluate the ventilation of this little fellow, it’s for an adult, but there was not a pediatric one.... but even worst to whom is somehow aware of the medical world, is the size of the blade of the laryngoscope (but it was this one that I had to use adapting to what it was available).... this metallic device that you see in the right upper corner of the picture that is used for the direct visualization of the larynx and the trachea, to introduce the tube in the trachea, allowing a much more effective ventilation and oxygenation that might have saved the life of this baby..... As I said this story as an happy ending.....the newborn breaths without my help or any tube and full of energy to contribute one day for a better Congo, I hope ….maybe I am dreaming to much....but one of the lessons that I have learned and reinforced every day is that we always need to think positive as hard as we can!!

Calm down, this is not the end of this story.... All of these minutes of reanimation of the newborn, where the speed of my performance, easily shows some stress that I went through, so everything would go well, and where the mother (that was awake) saw all my will to make this baby to cry out loud, as we all like to hear in those where you just cut the umbilical cord....

I can only imagine, what a mother thinks lying down in a stretcher, with half the body paralyzed, with a sheet preventing her from seeing the surgery, but she could but flexing her neck to the left watch during few but probably long minutes, this strange white man coming god knows from where, during the night putting so much effort so that her son would be born healthy in this zone of the planet that seems to be forgotten by the rest of the world.... Unfortunately the language barrier prevents me from knowing what was passing by this woman’s mind, that unlucky for some reasons was lucky enough to have a hospital of the doctors without borders in that area of an ugly war....

When I am sure that the baby is far from danger, I turn my attention back to the mother, and because the verbal communication was impossible (because I didn't speak Swahili), as many other times I had to use other ways of communicating with my patients and so I passed my hand by the hair and forehead smiling and passing the message that everything was alright, and danger was far from her sweet little baby.... it was in that moment that she said to me some words that I didn’t understand! She stretched her arm towards me and I still didn’t understand!! Until a Congolese nurse (translating Swahili to French) told me: “She wants to shake your hand, Doctor!” And so it was, shaking my hand and staring at me with truth and honesty, in this deep black look, that she told me: “Asante Sana!” – “ Thank you very much!”

And this Hand Shake is one of the reasons why I took risks that I didn’t need to take, crossed the world because I wanted to, and much worst I made suffer many that I like that I left behind with the heart beating fast, suffering with no need to suffer….

For all of those, I am sorry, this is my way of saying thank you and explaining you why ….

1 comentário:

  1. Imagino o que os teus familiares sentiram durante a tua ausência!

    Como teu Amigo, depois do que já li neste teu excelente blogue, sou eu que tenho vontade de te apertar a mão (uma vez mais) e dizer-te em bom Português "Asante Sana”!


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