sábado, 30 de janeiro de 2010

Your Comments

Thank you very much to all, who were so kind to write me a comment. It makes me extremely happy to know that you appreciate my stories and my motivation to write them... It is definitely an inspiration to keep on writing to read your feedback....

Some forget to sign....So, please sign so I can see who wrote me. By telling this stories, my goal is to spread all over the world the sad situation that those people in Congo live, and thats why I write in English, even though it would be easier to express my feelings in Portuguese.... That is also why you are all free to show to everybody, who might be interested in reading this stories... Many people don't care.... I don't judge anybody, but maybe if we open their eyes....bit by bit this huge problems all around the world will get better....


Please, do care, do try to make things better.... And remember that its not what we do, is how we do it ….


Once again thank you very much for giving me the power and the energy to continue my “fight”...


Gustavo Carona

quarta-feira, 27 de janeiro de 2010

Zone Rouge (Red Zone) - part 2

Continuing …..

There I was inside the car, living a dream....with a mixure of fear and excitement for crossing some borders that not many people cross.... Phillipe made me smile and relax, but looking outside the window million things crossed my mind ! The beginning of that second part of the trip was through a very thick jungle, where you can easily understand how difficult it is to control a war there.... It was wet and muddy the ground like always, and many times we couldn't see anything besides big, green leafs that were moving away while we advance …. The jungle was like a natural barrier for the zone after where the rebels were....For many Kms we couldn't see anybody....witch was a very strange and empty feeling.....There were many tiny rivers that sometimes we had problems to go through even with this huge 4x4 …. so we had to leave the car in order to improvise a pile of rocks and trees so the car could carry on ...It was again weird, to be outside the car and look around knowing that for sure there were many conflicts in between those trees all around....I could feel the war.....just by knowing the stories....of what happened in the last 15 years....

After a long while and the jungle was a bit more opened to the sky, and we started to see very few people walking on the side of this “road”....Its hard to call it a road as the tracks were covered by long grass, because it was so rare for a car to pass there …. This people where already the “others”.... the “rebels” …. they are not worst , they are not more guilty for the war....they were just fighting for what they believed in …. and not trying to get political if you understand their motivation probably you would conclude as I did that maybe the “bad” guys....are the Congolese army that are helped by the UN and the international community ...but who are responsible for many more war crimes and atrocities than the so called “rebels”....And most of the people of course are not involved in the conflicts that are just there trying to live their lives, with no where else to go ….Just living in the area and villages where the “enemy” was living!

Most of the people all around these lost places on Earth, were happy to see us....kids would wave and scream of joy and grown ups would just smile with shinning eyes, for our presence …. But here was different …. Everybody was so amazed and surprised of our presence that there was no time for showing a warm welcome..... Even kids that are always honest with their attitudes, so shocked by seeing us, would only freeze and stare, like their body could not move as a reaction of these site of white people in cars ….apparently to help them....

I will never forget the look on these people´s faces..... What I could read in their eyes was, before the natural “Thank you for being here” ….their eyes were asking us:
“ What are you doing here?”
“Why are you here?”
“Don't you know that there is a war here?”
That was the first reaction that I could read from their look....and after a while I started to read hope on their look :
“There are some people that didn't forget about us!”
“Maybe not everybody forgot that we exist!”
You are probably thinking that I was taking to many conclusions of some eye contacts ….But you cant imagine how intense it was the way that they looked at us.... Surprise and Hope ! I don't feel special, but in those moments I really felt special by causing these strong emotions on these unfortunate people.....whose feelings were so strong that you don't need to talk to them to listen to what there are saying ….

We passed by some empty villages ….. It was one of the saddest feelings I ever had in my life ! To see a whole village with nice huts completely abandoned where the grass was growing all over the place …. Everybody was scared being so close to No Man´s Land, so they left that village ….and somebody´s work, somebody´s home, somebody´s life was just left behind running away from the war....

The trip continues, my driver who was one of the best drivers and that had been there couple of times before in the past, stop the car in front of some guys with Kalashnikovs, and after talking for a while in Swahili gave them few packs of cigarettes.....”Doctor, this is one of the Generals of APCLS ((Alliance des Patriotes pour un Congo Libre et Souverain), an armed group who wants to give the richness of Congo to the Congolese)....and we have to give them something! We never know what can happen one day!” …. I could understand that very easy ….one never knows when can be caught in the middle of the war, and you better have some friends....

It was not easy for MSF to be able to go to that area, as I herd my boss few days before arguing with one important guy from the Congolese army, accusing us to be helping the enemy ….witch my boss replied with no hesitation.... “ We treat everybody or we treat no one!” ….No matter where MSF can be it is always very important to treat injured from both sides of the conflict, to make sure that everybody understands that we don't take sides....we just care about people ! Not looking at color of the skin, religion or political beliefs....

So finally after 3 hours after we left Masisi (to do no more than 40 Kms), we arrived to Likueti !

Likueti was a small village, but in these places you never know when these groups of huts will end … I could see very high and steep mountains from where I was, the beauty of the landscape couldn't stop to amaze me....but the most impressive was the bridge! The village was right on the river side, something like the villages of the Indians that we see in the movies, and the river was quite wide, with a bridge connecting the two sides....but this bridge that was easily 50 mts long was built by men, and no machines, made of ropes and wood, it felt like I was living in an Indiana Jones movie ...

We stop the car....just in front of the village, we leave the car and many people start to surround us, its never nice to see many men with Kalashnikovs....but I felt safe, they seemed friendly to us....Phillipe started talking with the leader who was a Colonel of APCLS.... and then introduces him to me ! He shows us the first reason why we came all the way there....A woman that had 3 twins 2 days ago, she was very weak , and 3 other women were holding her 3 very very small babies that were doing fine but needed medical care for a fews days to be sure that they would survive ! While I was evaluating my patients ! I herd Phillipe asking the Colonel....
“Witch one of the 3 is yours?”
“None Phillipe!” with a naive smile....
“What!?!? You have 3 twin babies in your village and not any of them is yours !!!” Some laughed a lot from Phillipe´s amazing sense of humor and many more didn't understand French....
And that was Phillipe once again in the middle of this heavy environment making me smile...

I continued to evaluate and treat all my 4 patients and Phillipe went walking to find the 2nd reason why I did the longest 40 kms of my life ….

Young man, with a gun shot wound of the lower thorax, besides the fact that he was part of the small group of the lucky ones that reach the hospital he was not doing so good, and all my attentions went to him ...He was FRDC ( Forces Democratiques de Liberation du Rwanda), part of the group (the Hutus) that was responsible for the genocide in Rwanda, that had to fled to Congo after the Tutsi got back to power in Rwanda....and whose cause is one day give Rwanda back to the Hutus that are 90% of the population and that have always been oppressed by the Tutsi.... Its not an easy issue to understand the genocide in Rwanda.....but the fact is that Rwanda, is a very safe and developed country thanks to the huge international help when they felt guilty about what happened in 1994.....and now that is one of the reasons why Eastern Congo is suffering this horrible war for so many years...

In the middle of nowhere....Antibiotics, painkillers, a lot of fluids.....cleaning and assessing the wound, evaluated the thorax and the abdomen …..and put him in the back of the 4x4....where I went! And the woman with the 3 twins went in the other car ….

Before we left Phillipe came to me and told me !
The Coronel was telling me that he has Hemorrhoids, do you have something to give him!”
No, I font have anything, he needs to change his food habits and if it doesn't work, we needs surgery.”
Find some cream to give him”
Phillipe, I don't have!”
You have to give him something, even if it´s just psychological!!! “
Phillipe had no medical knowledge but I guess he knew much better than me what was the placebo effect after being in Africa for so long ….

So I got Sulfadiazine (witch is a cream for burns) and went with it to talk with the Colonel ...after explaining what he should and should not eat, I gave him the cream....The Colonel was very happy and said “Thank you Phillipe you are so so kind”....and once again I was laughing (inside) thanks to Phillipe.... And this important so MSF could continue to reach this population that nobody else could....


Going back ….its like exiting a prison ….we go out ….they stay!.... with no escape ! Horrible feeling …I cant stop myself from looking back, where you have all these innocent people (most of them)...I can feel that they try to tell me:
Please come back!”
Don't forget about us!” …..This is my way of keeping my promise that I will NOT forget about you! And I trying to make the world to know what is going on in this forgotten places....

If the way there was bumpy...the way back was even worst, for 3 hours I had to go in the back of the car making sure that the wounded wouldn't jump to much in the most difficult obstacles, controlling the infusions and holding myself....it was not a pleasant ride ….maybe the good think was that I had not so much time to think !

Just passing by Nyabiomdo again..... their it was !!! For the 3rd time since I arrived Congo ! In the middle of the Red Zone of one of the worst wars of modern times..... Somebody with a t-shirt of FC Porto!!! I cant stop myself of putting my head out of the window and screamed “PPPOOOORRTTTOOOOOOOO!!” I think that he didn't understand and he had no idea where that t-shirt was from but it sure made me smile again …. Do I have the right to feel happy after all the misery that I just saw.... I really don't know, but the fact is that this small stupid things make me feel alive and of course.... Will I be proud to tell this story when I get back home to my friends that share the same love for FC Porto as I do ?!?

The 3 twins were a reason of joy for everybody in the hospital.....In Africa, its not common for 3 to survive, but they did !

The Rwandese Hutu went home with the bullet inside him after a few days, because we don't know where the bullet was (no X-ray)....and he was doing fine....so there is no reason to go and search for the lost bullet....He escaped the hospital, when we told him that he could go, so the army wouldn't find him ….

So this could be a story with an happy ending ….but its not ….at least for me...

The day after I went to the Red Zone, there were huge conflicts in many of the villages that I passed by, including helicopters attack.... It breaks my heart to know that many of the ones that I saw were shot at, running from war....and with their houses bombed.... Who knows how many died!?!? …. It would have been “just another” horrible attack in “just another” place that nobody knows..... But this time I was there …. and I saw their faces.....and it hurts me so much !!!.....that sometimes when I think about it its hard to breath.....




quarta-feira, 20 de janeiro de 2010

Zone Rouge (Red Zone)


Zone Rouge (1st Part)

(Congo, Masisi -- 2009)

My daily life in Masisi was, almost everyday, between our base and the hospital, which was a distance of 300 mts, so many times I felt trapped between those 300 mts, we couldn't go anywhere almost and even if we could go to town during the day where there was nothing, and I almost never had time because of work.

I couldn't say that I saw anything about Congo or even the region where I was, even though Masisi was right on these amazingly beautiful mountains.... it was still a strange feeling not to be able to go anywhere.... Security reasons, lack of time, kept me within those very short 300mts... Many of my colleagues where telling stories about other places, beautiful sites and views... and I needed to see a bit more of that great part of Africa that many people compare to the beauty of the Alps... Many times I was asking my boss, the field coordinator, to go somewhere, to get patients from others places to our hospital... But the answer was always the same “Gustavo, you have to stay in the hospital in case you are necessary in the operation room for an emergency!” Of course I understood that he was right.... but I wanted to go!

Masisi was in theory under control of the Congolese Army and the United Nations, even though sometimes we had conflicts right in town.... but apart from those days that were not that often, the Red Zone would start something like 10 kms away from Masisi, and from that line on it was officially consider war zone! Where the conflicts were almost daily and unpredictable!

My boss was about 50 years old, with many years of experience in Congo, and not many people knew what he knows about that complex conflict in eastern Congo... He is kind of a legend and a hero for that people as in 2007, when that project started thanks to him, war was IN Masisi, and while everybody was trying to escape that “apocalypse now scenario”, he arrived there and decide not to go anywhere and to help that population that was in desperate need of help.... No one else would be helping those innocents suffering from that war, if it was not for Doctors Without Borders and his decision of starting something with a small group when bullets were flying from everywhere and nobody was safe anywhere....

It was a Saturday night and I was having a glass of the very bad Rwandan wine (but that was all we had), and talking at night with my colleagues in one of the few moments that we had to relax and feel normal, when my boss came to me and ask me : “I will pick up 2 patients in Likueti tomorrow, do you want to come?“ It was the Red Zone of the Red Zone… villages where the rebels were in total control and where the Congolese Army or the United Nations were consider the enemy and would never go … With no hesitation I said Yes … “Be ready at 6.00!” That was all he said before continuing the cheerful conversation that we were all having.... I was pretending that I was hearing the conversation, but mind my was 100% occupied about my expectations of the next day! Nobody of the my colleagues expats was ever there, and at that moment the 2 other doctors that were there were women.... Maybe they were tougher and more experienced than me, but for my boss considering that it was necessary to go with a doctor, if he was taking any of us to that dangerous place where anything could happen.... it was better to take a man!! Being attacked, arrested, lost, sexual violence.... everything is possible there if you are in the wrong place at the wrong time!

So, finally I was going somewhere … I was happy for that, and for going into the most difficult places to reach and to help those that deserved the most....

When I realize it …. one after the other, many of my dreams were becoming true...

The wine just started to taste better, as my heart was also beating a bit faster, and after I finished another glass I went to bed before 22.00... I was sure that I was not going to sleep, but I was in a mood to think and talk to myself....

Before I left Porto, many of my favorite places of the city, I looked at, with the feeling that it could be the last time that I was looking at them.... many people that I love, I stared at, to take their faces very lively in my memory..... and all that was passing in my mind, one place after the other, slowly with no hurry, I was playing with my memories, thinking about the ones that make my world, and make me feel so happy to be alive …. I am not sure if I slept that night... for many hours I was really entertained, no Tv, no Internet, no one else, just me and my world built by memories..... I laughed and I cried.... for the same reasons.... All that I love, that makes me happy.... was also the reason to make me cry......”Saudades !!”.... and the strange feeling, that I was going right in the middle of the war zone!

When I stood up few minutes passed 5.00, my trip in my thoughts was over and now was time for the real thing! Like most of the other days, there was no running water (a cold shower was good news for me), so I had to have a bucket bath, but because it was too early there was not hot water (that was heated by one of the guards).... so it couldn't be worst a cold bucket shower to awake up.... there was no breakfast because it was too early and cold leftovers from dinner didn't seem like a good option for a very long bumpy ride in the worst roads you can imagine. So I was sure that for many hours I would have nothing to eat, but still I was ready and excited to go....

Two 4 by 4s, two Congolese drivers and me, and Phillipe (my boss) that was going to do the first part of the trip by motorbike in order to came back faster, as he still had to go to Goma on that same day, so there was Phillipe and his bike and another driver from the national staff driving another motorbike. About 1,5 hours took us to arrive to Nyabiondo, a town just passed the line of the Red Zone.... Its really sad to see the rhythm of this town, it used to be an important town, but now surrounded by war, it doesn't look like a very nice place to live, but many people still do, sleeping on the hills around and coming down from the mountains during the day to trade goods and make their business, and at night they hide again on the mountains not to be an easy target for the military or the rebels, who ever wants to rob them, kill them or rape their women.... The camp of the MONUC (Mission of the UN in Congo) is also impressive... a scary building, bombed in many parts of the walls that were surrounded by many layers of wire and where you could see many soldiers on the walls with machine guns aiming outside permanently....

(Sorry but no pictures from this moments as it was strictly forbidden and if somebody would see me with a camera I could put myself and all the others in risk of life....)

From this moment on, Phillipe jumped in to the other car as their were basically no proper roads.. ....just 4x4s cutting through this thick jungle where we had to stop many times because we were stuck or to repair some small bridges with rocks and trees.... big adventure ….the real thing…. and its never to much to say it ….beautiful landscape with mountains all around, huts and cabanas everywhere, and everything is green with almost nothing built by men ruining the landscape....

Few minutes after we left Nyabiondo, and as I said we were moving towards to Red Zone of the Red Zone, I started to hear the radio of the car ….:

“Gustavo pour Phillipe “ “Gustavo, Gustavo pour Phillipe” It was really cool to communicate by this big radios that the cars had and to learn this radio language that we are suppose to use just for important matters .

“Phillipe pour Gustavo” “Oui Phillipe Je t´ecoute .” I replied.

“Ça va Gustavo?” We hardly talked in the morning, because when I left by car he was already working in his office and then he came by bike and jumped to the other car with no time to waste!

“Trés bien, pas de problem”

“J´ai besoin de parler avec toi!” What could be important, to tell me when we where driving towards No Man’s Land , before we would reach the zone controlled by the rebels? For one second I was even more nervous...

“Oui Phillipe”

“Standart a gagné, hier!” Me and Phillipe share something in common, our unconditional love for our home football club!! We had many times great conversations arguing about which one was the best club in the world!!! And if Porto had its moments of glory like in 1987 or 2004, Standart de Liege cant say the same.... but I loved to hear him saying with no doubts that Standart was the best club in the world.... That’s football when its used for the best reasons, makes people talking and sharing their silly loves, as it was for him and for me …. the football club, the city, the people.... were all in the same group of things that we loved and missed from home...

“Et Porto?” Phillipe continued

“On a gangné aussi!” I just read the message in the morning that my mother sent me with the good news...

“Mon ami...., La vie est Belle!!!”.... And for something so stupid as football.... I was happy and smiling thanks to Phillipe when I was about to take the biggest risk of my life!

Thank you Phillipe....the heart and soul of our project....always in a good mood, and very professional.....a hero !
After 12 years of work for Doctors Without Borders (Medecins Sans Frontiers, MSF), and being in every place in this planet where bombs have explode he would proudly tell us all:


“ I don't work for MSF, MSF is my life!”



( This story will continue )


segunda-feira, 18 de janeiro de 2010

Guerras que não passam na televisão

Escrevo-vos porque vi de muito perto aquilo que muito pouca gente sabe se quer que existe. Sou médico e estive a trabalhar durante 4 meses para os médicos sem fronteiras, delegação belga, na República Democrática do Congo, na província de Norte Kivu, perto da fronteira com o Ruanda. Também eu pouco ou nada sabia antes de lá chegar, e ao aperceber-me da realidade que me envolvia, vezes sem conta a mesma pergunta ocupava-me o pensamento: “Porque é que ninguém sabe o que se passa aqui?” - Será a guerra mais mortífera dos últimos tempos, naquela zona cerca de 5 milhões de pessoas terão morrido nos últimos 15 anos anos, a violência sexual tem proporções incomparáveis com qualquer outra zona do planeta, com relatórios a apontar para 70% o número de mulheres que já terá sido violada e onde todos os direitos do homem são diariamente negligenciados por todas as facções do conflito. Disputas importadas do Ruanda, desde o genocídio de 1994, motivos politicos e terratoriais, um exército rebelde e criminoso assim como obviamente motivos económicos, ou não fosse tão rico o solo deste pais em minerais e outros, alimentam esta guerra terrível que não tem fim à vista! Compreendo que a natureza humana, nos leve a empatizar mais com o que se passa no nosso país ou nos com os quais nos identificamos como semelhantes...Mas porque é que todas as bombas no Afeganistão, Iraque ou Paquistão abrem os telejornais? Cerca de 3.000 terão morrido no 11 de Setembro, como retaliação não mais de 15 mil terão morrido no Afeganistão.....e 5 milhões não fazem história? Porque será que há guerras que não são notícia? Doi-me na alma ter visto tanto sofrimento de tão perto e sentir que aquela gente não está sequer no pensamento de ninguém....Vamos abrir mais os olhos para o que se passa em África...


Gustavo Carona

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 ….

sexta-feira, 15 de janeiro de 2010

2 Sweet Girls

It was a Sunday afternoon…. very few times I had a free Sunday to relax.... it´s the way it was.... no one else to do our job.... we had to be ready when ever is was necessary...
I was called by radio to go to the hospital with the information that there where some wounded by gun shots …. It was common on Sundays... Too many Kalashnikovs…. The military would get drunk and for any stupid reasons would use it.....
When I arrived to the hospital, the local nurses told me that there were children involved !! Shit !! What ever it is ...its very bad already... My heart starts beating faster....before I get to the room where they were …
And there they were, 2 sweet little girls ….very scared, screaming in pain....a lot of blood everywhere ….
Noemie, is 10 years old, she was shot in the upper part of her arm, causing a very extensive wound, and fracture of the bone (umerus)...






Tuliza, is 4 years old, she was shot in her foot, causing an explosion of many of the bones of her foot, with a huge hole that you could see right through it ….











Why??? How is it possible that one can do this to these sweet little girls? How can somebody be so cruel ?
Noemie and Tuliza are sisters, their mother works in one local bar in town, and this 2 drunk military, from the Congolese army, started arguing with each other where they were, and decided to use their guns to solve whatever issues they had....But for some reason the only ones who took the bullets were this 2 innocent girls... Life is just not fair for some...
The Kalashnikovs are high energy guns, once the bullets enter the body they start spinning on random directions and cause unbelievable destruction of the tissues of the human body...I will spare you from seeing the pictures of the wounds but believe me....they are really impressive....
We had to go with one after the other to the operation room, they lost a lot of blood, manage to go through the surgery with no big complications. Tuliza went first, very scared not wanting to let go of her mother that stood by her side until she was under anesthesia, it was a very complicated case, with no X-ray, its difficult to know exactly how bad are the fractures of the bones of the foot.... Cleaning , disinfecting, removing the dead and dirty tissue, and trying to immobilize the foot in a position that the fracture would consolidate in a way that she could use that foot again to be able to walk....she is 4 !!! Noemie went afterwards, the hole that she had was as big as her skinny arm, with total fracture of the bone of the arm, with something like 10 cms of the bone missing that explode way from the warm....Horrible scenario, even for somebody that already saw a lot . She had no destruction of the main arteries or nerves, meaning that she could probably use the arm in the future if everything went well ! But can u use the arm if you have the upper part of the bone of the arm missing? I cant answer this question, or we couldn't answer this question with the means that we had... She cant hold her arm, despite being able to use her hand... Maybe one day in an handicapped program somebody will be able to improve her mobility one day...Always think positive !! We do what we can, step by step...but sometimes is not enough...



For many days that had to stay in the hospital, as for this kind of injury, they needed to go, many times to the operation room for surgery, to change the dressing, cleaning the wound, as the biggest killers for these type of patients are the infections that are very common, so all the care was necessary to avoid that....and yes we did avoid the infections for these 2 sweet girls...
Everyday I was with them, not speaking their language but communicating somehow ….I played with them many times and got famous among these kids and others for giving them balloons made of plastic gloves! I was really happy to still have a way to make them smile...
Noemie, was wise and quiet, never saw her sad or complaining, she had this beautiful shy smile, with deep, big, very black eyes....Pure, humble and genuine... The most amazing thing about children in general is the fact that they are so pure and innocent, but these African kids take that idea to the maximum ... They are so full of life and desire to live....
Tuliza as you can see is a bit chubby...and one day she was very grumpy, trying to beat her mother and her sister... I was surprised, it was not normal... I was trying to ask her mother with few words and signs, about what was going on!! Her mother pointed to the sign your you had written in French and Swahili “ No eating or drinking as its surgery day”... it was very difficult to explain the patients that they could not eat or drink before surgery for the safety of anesthesia, and this mother many times couldn't resist the temptation of giving food to her kids even when I explained many times, with the locals help to translate those rules, causing us to postpone and delay the treatment of those kids…..... And then I understood :) !! Ahhhh !! Tuliza was not in a bad mood because she had to go to the operation room that day, because she did it many times before and she could go with me on my lap very calm and accepting her difficult treatment very well......She was beating every body because she was hungry !!! And for that I couldn't do anything about it !! Or make her smile !!
And that was the only moment when I ever saw Tuliza without her beautiful smile, that gave me a lesson for life! Her smile was naughty, full of energy, telling how much she loved life even when she was in a very complicated situation ... She made me promise myself, that I would never be sad again! It´s unreal of course …. but how can we be sad? For what reasons can we be sad? When this 4 year old girl that was shot in her foot by a Kalashnikov of a drunk military for no reason, who will be lucky if she will ever walk normally again....and still has that smile !! How can we have the right to be sad ???? I will always “use” her to get my smile back whenever I will be sad....
I did my best to help them in their treatment but I can honestly tell you that they “gave” me much more than I “gave” them....  For me it´s priceless this lesson of life ….
I will never be able to thank them, but with these simple words, I am able to dedicate them and many other kids that suffer because of that stupid war, this story...



Thank you Noemie and Tuliza I will love you forever !












quinta-feira, 14 de janeiro de 2010

O aperto de mão







Começo aqui a contar-vos a primeira historia de muitas que poderiam ser contadas sobre a minha estadia no Congo, em que trabalhei como médico anestesista para os Médicos Sem Fronteiras, numa região chamada Norte Kivu, na cidade de Masisi, perto da fronteira com o Ruanda, região esta muito complicada, pois tem sido inocentemente castigada por uma guerra terrível, que teima em não parar e que terá já morto nos últimos 15 anos cerca de 5 milhões de pessoas... E como sempre quem mais sofre nestes tristes cenários, são os civis inocentes, mulheres, crianças....cuja sorte quis que nascessem numa das piores zonas do planeta para se viver. Mas a vontade de viver, sorrir, amar, ter filhos e tudo mais que caracteriza a magia do ser humano está bem presente nesta gente que tem muita vontade de viver e dar vida!





E aqui vai uma historia que para mim prova isso mesmo...





No local onde eu estava a trabalhar como muitos outros em Africa, uma das cirurgias que realizavamos mais frequentemente é a Cesariana, dado a taxa de natalidade ser muito elevada e como tal por variadíssimas indicações muitas vezes eramos então chamados a intervir para que pudéssemos quer para salvar a mãe, a criança ou ambos . Como tantas outras vezes fui chamado ao bloco operatório de urgência a meio da noite, cansado de muitos dias de trabalho àrduo, quase sem intervalos.... Fiz uma raquianestia, ou bloqueio subaracnoideu para os entendidos ou para os desentedidos uma picada nas costas que anestesia todo a zona inferior ao umbigo, querendo com isto dizer que a futura mãe estava acordada e a ver e ouvir aquilo que podia.... Por falta de monitorização do feto, aconteceu aquilo que também muitas vezes me aconteceu neste hospital, que foi ter de fazer a reanimação neonatal....Mais uma vez trocado por miudos, o feto estaria já a sofrer dentro do útero e a cesariana já veio tarde....por sorte ou por azar estava lá eu... Com alguma formação sobre o assunto, mas pouco práctica pois nos nossos hospitais do mundo desenvolvido tal suceder é muito mais raro.... Mas este já então recém-nascido precisava de reanimação activa dado o sofrimento intra-uterino, para ajudar nesta fase que para uns é tão dificil ou mesmo fatal, que é a primeira vez que respiramos.... Normalmente uma simples estimulação táctil é suficiente para dar este empurrãozinho ao bébé, para alguns é necessário a ventilação através de uma máscara, e quando esta se mostra insuficiente....e temos sinais de que a oxigenação não está a ser adequada.... a frequência cardiaca teima em baixar, o faz com que o cerébro deste novo ser possa ter danos irremediáveis por falta de oxigénio das células cerebrais....e muito rápidamente , sim porque tudo isto são segundos ou poucos minutos de actuações e decisões dificeis, há que partir para a uma forma de oxigenção mais eficaz com a colocação de um tubo através da boca na traqueia, actuacção esta que tanto caracteriza o médico anestesista....


O que vocês vêem nesta fotografia é então já o final destes momentos de stress que felizmente têm um final feliz como se pode ver pelo tom rosadinho da pele e lábios deste bébé....a minha mão que parece gigante ao pé deste mais recente congolês....um estetoscópio...que me serviu para avaliar a ventilação deste pequenino , que é de tamanho adulto, pois não havia pediátrico ….e mais grave ainda para quem está minimamente ligado ao meio é o tamanho da lâmina do laringoscópio (mas foi esta que tive de usar, adaptando me ao que tinha)....esse aparelho metálico que vêm no canto superior da fotografia e que serve para a visualização directa da laringe e da traqueia, para posteriormente eu introduzir o tubo na traqueia que permitindo uma ventilação e oxigenção muito mais eficaz terá salvado a vida a este bébé.... Como disse toda esta hisória acaba bem ….o recém-nascido respira já sem a minha ajuda , sem ajuda de tudos e cheio de força espero eu para um dia contribuir para um Congo melhor ….talvez estarei a sonhar demais.... mas uma das lições que aprendi e reforcei todos os dias é que há sempre que pensar positivo com muita força.





Calma , esta historia não acaba aqui... Todos estes poucos minutos de reanimação do recém nascido ao que a importância da velocidade da minha actuação, deixa facilmente transparecer algum stress pelo qual eu passei para que tudo corresse bem, e em que a mãe (que estava acordada) viu toda a minha vontade para que este bébé acabasse por ter um choro bem vigoroso como todos gostamos de ouvir naqueles a quem se acabou de cortar o cordão umbilical...


Imagino o que pensará uma mãe que deitada numa maca com metade do corpo imobilizado, com um lençol que a impede de ver a cirurgia propriamente dita, mas que ao flectir o seu pescoço para a esquerda vê durante escassos, mas provavelmente eternos minutos, este estranho branco vindo sabe-se lá de onde às tantas da madrugada dedicar tanto do seu esforço para que o seu filho nasça saudável neste zona do planeta que parece ter sido esquecida pelo mundo.... Infelizemente a barreira linguistica impede-me de saber o que se passa por a cabeça desta mulher que sem instrução nenhuma, dentro do azar tenha a sorte de que exista um hospital dos médicos sem fronteiras naquela zona de guerra aberta....





Quando já tenho a certeza de que o bébé está são e salvo, volto as minhas atenções para a mãe, e como a comunicação verbal era impossivel (por eu não falar Swahili) como muitas outras vezes tinha de utilizar outra forma de comunicar com os pacientes e então passei a minha mão pela testa e cabelo sorrindo a passando a mensagem que estava tudo bem, e o perigo estava longe do seu bébézinho....foi aí que ela me disse algumas palavras que eu não percebi ! Esticou-me o braço , e eu continuei sem perceber! Até que um enfermeiro congolês (servindo de interprete Francês-Swahili) me disse : “Ela quer apertar-lhe a mão Doutor!” E assim foi, apertando-me a mão olhando-me nos olhos com verdade e transparência, neste olhar negro e tão profundo que ela me disse “Asante Sana! “ – “Muito Obrigado!”





E este Aperto de Mão é o motivo pelo qual corri riscos que não precisava de correr, atravessei o mundo por que quis, e mais grave do que tudo fiz sofrer muitos de quem gosto muito, que deixei com o coração a bater , sofrendo sem ter de sofrer....





A todos esses, desculpem, mas esta é a minha forma de vos agradecer e de vos explicar porquê....

sábado, 2 de janeiro de 2010

I have a dream.....

I don't like fiction, I like reality ....Many times its sad and strong..... What can we do when we deal with these situations? Close our eyes or do something about it .... I cant close my eyes.....I don't want to close my eyes....I want to see more and more.... And by some simple photos with no art what so ever and some honest words I want to tell some stories and by doing that I will try to do something about it and drag people with me to do something about it . I will try to touch your heart the same way my heart as been touched....in a good way ! My heart and effort goes to all that where born in the wrong part of the world in our days .....
Ocorreu um erro neste dispositivo