Nair’s Death

I have often asked myself about the cost of a human life in Angola. Nair’s death pained me, but it was the pain of someone who is powerless and not able to do anything about it.

In the last few days, I have been following the tragedy of a mother.   After Nair complained of headache and a backache, her mother took her to Samba Healthcare Center in Luanda. Tests were carried out and turned out positive for malaria. The staff at the clinic decided to give her a combined doze of Coartem and Paracetamol. She was also given two packets of serum “to drink at will” and folic acid.  After that, they sent her home.

The family concluded that the treatment was not sufficient and, on the same day, went to the David Bernardino Pediatric Hospital. Here the doctor ordered a test in the laboratory for sickle cell anemia. The doctor signed her name, Maria Batalha, and ordered the girl to return home.

The following morning, at 5.20 a.m., Nair’s mother took her once again to Samba clinic, which was near their house, because she had continued complaining of more pains. The staff at the clinic told off the mother saying they had already seen the girl the previous day and given her a prescription. However, the Coordination of Luanda Pediatric Assistance (COPAL) had issued a note transferring the case to the David Bernardino Pediatric Hospital as there was no doctor at Samba for “better medical observations.” Once they had been told that the girl had malaria, the family went to this hospital; the girl was then able to walk on her own.

According to the mother, the doctor at this hospital said she was already too tired to see Nair and advised the family to give her serum.  She pointed to a corridor with pots of serum and a cup with which patients could scoop the serum to give their children to drink. The unidentified doctor told the family to return home and continue with the combined medicine of Coartem and Paracetamol as prescribed by the Samba Healthcare Center.

To-ing and fro-ing

Still worried, the mother went to the Prenda Hospital, hoping that she would find some assistance there. The staff there said they did not have a Pediatric unit and advised her to go to the Cajueiros Hospital. This hospital was far and the family did not know its precise location; the family decided to return to David Bernardino Pediatric Hospital.

The family waited patiently. “A doctor turned up who wanted to see my daughter. Soon after, another female doctor turned up to discuss her salary and other personal matters,” the mother told me.

Meanwhile, a malaria test carried out at this hospital turned out negative. The doctor, whose signature is not legible on the document, signed the paper from the laboratory, and carried on with his conversation. The same test revealed that the level of hemoglobin of the child was low (7.4). A prescription for an injection of Diclofenac  ( anti-inflammatory, antipyretic, and an analgesic ) was prescribed as well as Coartem (for malaria) and oral serum.

“The doctor did not see us until 3 p.m. when the child was practically dead in my arms. Only then did they decide to put her on a bed next to a baby; they attached a serum drip to her as she was giving her last breaths,” the mother told me.

“Since we are common people from the lower class they chose to ignore us,” lamented the mother.

A doctor who chose to remain anonymous said, “with hemoglobin at 7 milligrams by millimeter it is mandatory that the patient should be admitted at once as this shows serious signs of anemia.” “The child in that condition needs to be observed in the hospital and not going from place to place,” said the doctor.

Nair’s mother was unaware of a system used at the hospital to deliver bribes to the staff unbeknown to the hospital management.

“As a mother, I did not know that there was a system at the hospital of putting money in the trash can which the doctors would pick up to attend the patient at once,” she revealed.

On the other hand, the record of treatment offered Nair at David Bernardino Pediatric Hospital does not leave any margin for doubts. All that was recorded was the date, case number 292, patient’s name, her weight of 20 kg, her age and the municipality in which she was living. Her temperature was not registered.  No signs of emergency were noted at the triage section of the hospital. In the last section about which department the patient was referred to, nothing was written about the general urgency of the Pediatric Hospital. The record was not even signed.

The only work the doctors did was to perform an autopsy and issue a death certificate citing meningitis as the cause of death.

We are not dealing here with the lack of resources, but with the absence of goodwill and humanity. “

A simple measure, such as using the ability to see and talk would have saved a  life and delighted a family,” said a doctor who chose to remain anonymous.

The Hospital’s Version

The Pediatric Hospital has a different version of the events. The clinical director, Elsa Barbosa, said she carried out an investigation whose results she shared with me after four days.

On the fatal day, “at 6 a.m. the doctor asked to carry out a controlled analgesia on the child. That is when the mother left the hospital.  We do not know what happened after that,” the doctor said.

After the toing and froing and the return of the family to the hospital, according to Elsa Barbosa, “Nair was admitted at once. The obvious symptoms were that we were dealing with meningitis.  We admitted her at once.  Just ask her mother.”

“Her death was a complete surprise,” lamented Elsa Barbosa.

Asked about whether Nair had to share a bed with a baby knowing the nature of the disease the clinical director said, “Meningitis does not pass on easily.” Elsa Barbosa added that a quick test was carried out in the emergency room.   She added that as for the test for sickle cell anemia, this was going to be carried out in healthcare center, after she had been discharged.  “This is not an illness that requires some urgency,” she said.

I also asked her whether the doctor who was on that shift had said she was not going to attend to Nair because she was tired. “The doctor told me that she did not say this to the mother; she added that the mother had thanked her for the treatment.”

The clinical director also explained the attempt by the family to make payments. “We have a for-profit ward where payments can be made. The mother initially went to this area and said she had an employer who would help her pay the bill.”

“The nurse took her to the emergency room.  She saw that the child was not well and needed to be in a place where doctors could take care of her.  At the time, the mother did not have money; she said she was going to ask her employer.” According to Elsa Barbosa, “The nurse said she was not there for the money and took the child to be attended in the emergency room.”

During my conversation with the clinical director, I gave the mother’s telephone number – so the director could also hear the mother’s side.

“Why has the hospital not called me? Is it that they lack courage? I am prepared to appear in court to testify on how I lost a precious life because the doctors were negligent in their care for my daughter, and because they humiliated me,” said the mother. “My sister-in-law, Mimi, who was always with us, was so traumatized by the experience that she has suddenly stopped talking” said the mother.  I visited Mimi, who is 23, who communicated with me through writing, as the shock has turned her mute.

Mimi has lost her voice, as she witnessed her niece’s slow death in front of the eyes of hospital staff.


Whose responsibility?

How can the medical personnel involved in this case be made to account for their deeds? At the funeral, a woman next to the family suggested that the mother should have been more aggressive. She stopped short of saying that the mother should have made an attempt at bribing the doctors. The mother in question is poor and could only have turned to public hospitals. We are dealing with a respectable citizen who defers to the authority of public officials. In moments of despair, she said she was ready to pay gasosa or “soft drink” – the term used by public servants who expect to be paid when rendering services to the common citizen.

“The doctor told us that the hospital has cameras and they could not be seen receiving money, and that I could have denounced her to the authorities,” said the mother. She did not know the system of putting the money in the trash basket.

The public has been hugely indifferent to the health sector. There is no collective call for the improvement of hospital services. It is now a matter of each looking out for his or her own.  The rich and those who can afford it take care of themselves and their families abroad.

In any case, it should be recognized there could be no collective demands for an improvement in the health sector without similar demands for the education sector. This is why we have to look at the key question of governance; after all, it is up to those who rule to decide on the strategies to ensure a viable health system. “

We doctors are cowards when it comes to denouncing our bosses yet we have the courage to move between life and death and to decide who lives and who gets to die. This is how we have been betraying the Hippocratic oath,” said the doctor.

The totalitarian example of Cuba

In Cuba, for instance, whose totalitarian regime is admired by Angola, the government has always invested in health to make it one of the major gains of the revolution and the pride of its people.

To achieve that, Cuba had first to invest in education – and then have it serve the rest of the society. The quality of these services have even been exported. Cuba has been sending doctors and teachers to various parts of the world and has been receiving students from various countries.

In Angola, the Cubans have been rendering invaluable and unequalled services to the health and education sectors for the benefit of the Angolan people. Recently, a contingent of Cuban doctors left the country because the Angolan government had not paid their salaries.

In the 80s, Fidel Castro had to come to the aid of Angola by sending medicine valued at 700 million American dollars to improve the disastrous conditions in the hospitals. According to an article by the American academic, Piero Gleijeses, the Angolan government of José Eduardo dos Santos said it did not have money and was refusing to sign a letter of credit. In “Moscow’s Pawn? Cuba in Africa 1974—1988” Gleijeses cites Fidel Castro as having told his cabinet, “We cannot let a man die in a hospital, or a child, or an old person, or a wounded person, or a soldier, or whoever it may be, because someone forgot to write a letter of credit or because someone didn’t sign it.”

José Eduardo dos Santos’s policy in Angola continues to be one of neglecting the population.

In Angola, the biggest achievement of the revolution are lies.

The health system is inhuman yet the propaganda says otherwise. I recently heard on the Angolan National Radio commercials about the deeds of the regime with someone affirming that “Yes, we have better health.”

Angola has the worst child mortality rate in the world – worse than Afghanistan and Iraq, which have been destroyed by ongoing wars. The national economy has grown solely to satisfy the desire for luxury by those who wield power and also to satisfy the opportunists. In the current economic crisis, the rich and powerful continue to take what they can get.

I was also recently struck by that impotent revulsion when I learnt that a most powerful smiling lady had donated expired medicine to a hospital for publicity. Her retinue promised the foreign businessman that the packages would be returned to him after the official ceremony of the donation. The medicine ended up in the black market and was used.  My source asked me to remain silent about the event. I felt I had connived with the monstrous deed by remaining silent.

This time, with Nair’s death, I refuse to be an accomplice with my silence. I have chosen as a citizen, to give vent to my sentiments of revulsion and powerlessness in this matter. This is my power as a citizen and I will have to use it for the common good.