Tuesday, April 30, 2013

Bothering surgeon Varela

Dr Carlos Gomez Varela, 37, is one of very few surgeons Malawi has. He has performed over 5000 surgeries including separating conjoined twins. He is the only surgeon government banks on to service the whole of the central region and as I found out, he is a jolly element Malawi should celebrate.

The wide battered door to the main theatre at Kamuzu Central Hospital swung open and there in front of me he stood.

Dressed in a black collarless top and a black and yellow bandanna atop his head, the towering doctor ushers me in to the office. His beard trimmed thin and to a pattern making a distinct “w” under his mouth.

The Portuguese name, Carlos Gomez Valeira, is just his name, he is a proper Malawian, his mother from Mzimba and father from Ntcheu, his ancestors came in from Mozambique of course.

“I am a very technical guy, I like fixing things. I wanted to be an orthopaedic surgeon but that dream never came true.”

Valeira did his primary school at Namiwawa, and then went to Phwezi Secondary School. He was elasticated from there while in form three and had to finish his form four at Liwaladzi in Nkhotakota from where he got selected to go to Chancellor College.

“My father was not happy and I wanted to make up for the shame I had brought my family so I told him that I would become a doctor.”

He did and his parents are now proud of him.

He left Chancellor College and joined College of Medicine. He salutes Dr. Arturo Muyco, his mentor and former head of the surgery department at KCH and his mother for inspiring him to go for further training, his mother actually offered to pay for his further training. So he did.

Apart from the seven years at COM, he did an extra 5 years at Groote-schuur which is under the University of Cape Town in South Africa, under the Fellowship of College of Surgeons South Africa.

His Malawian friends he trained with in South Africa picked up jobs abroad. Valeira returned and as of January 2012 assumed the mantle of head of surgery and is the consultant surgeon at KCH.

“I would have decided to stay where I was but I feel for poor people, that is why I am still stuck here. Poor people drive me; I decided that if there is no one for them, I would have to be the one. It is a calling.”

Valeira however does not rule out the possibility of flying out of Malawi, he says he works under serious challenges which might frustrate him.

“For example, I was supposed to operate on five people today but because we don’t have gauze, I will just do two. It’s not the financial part but the work dissatisfaction. We have no equipment such as patient monitors, sometimes we don’t have anaesthesia or antibiotics.”
Surgery is definitely an art

Valeria performs five or six operations per day and he works does the surgeries on Tuesdays, Thursdays and Fridays on the other week days, he does ward rounds and his job description does not stop there: He does administration and is a lecturer at College of Medicine.

“An am always on call that is I can be called at any hour of the day. I never really go on holiday, I cannot afford to be abroad for more than two weeks and even when am abroad, I have to keep my phone on sometimes so that I can advise on complications.”

The brain drain problem which sees fine doctors like him trek to the United Kingdom or anywhere but Malawi does not always involve air tickets, some doctors are lost to private practice right here in Malawi.

So far government boasts of two surgeons in Blantyre, Valeria in Lilongwe and on in Mzuzu and one wonders what the ratio of surgeon to Malawians would be in this case.

Not that Valeira is a boring workaholic. He still has his weekends off, his three children Caroline, Ashley and Hoollie still get to go to play grounds or visit their grandparents in Blantyre.

His wife, Amanda whom he met while he was in fifth year of college still goes to bed smiling because he sometimes cooks for her.

Valeira also plays basketball and now and then enjoys a cold one with friends. He is also a fan of action thriller movies and Malawi music, so relax, not all doctors are nerdy.

A catholic, he does not hide his respect for intelligent design.
Valera separated these twins who shared a liver

“Sometimes when I am about to operate on a complex case, I inwardly pray because I know that no matter how good a man can be there is need for divine guidance.”

Talking of Jesus. Comparing Valeira to Jesus, Valeira has made many people healthier but like Jesus not many come back to thank him, he says he gets an occasional whisky bottle or a tie as gifts…but then again, Jesus never lived to be thanked.

 Devine guidance aside, Valeria is good. I joined him in the theatre as he was performing a revision colostomy for an imperforated anus. Scratch that: a girl was born without an anus and before they can make one, she has to use a hole on her belly and the procedure was to repair something about that hole.

The theatre was crowded with about eight adults in masks, aprons and gloves. Machines flashing graphs and digits and beeping pulses. The patient covered in linen and the only exposed part was her belly.

Valeira did his magic in thirty minutes, using what I would swear was a soldering iron to cut her open, grab the intestine, clamp it with about ten silver scissors and them yank off about 15 centimetres which was thrown away.

The way he stitched the belly would make a seasoned tailor want to go back to school, working the thread with careful dexterity. Are surgeons born or made, was my constant query as I watched.

While the operation was underway, jokes were being cracked and the anaesthetist bringing in more news of cases that need the knife.

“We work as a team in here,” said Valeira introducing me to his team, as if I would know them in the masks.
As he worked, his assistant on the other side stands next to about a thousand tools, scissors, pincers and knives and thread and fluids, when Valeira demands a tool she fishes is instantly and hands it over and when the assistant needs a tool she barks the instruction to another assistant to the assistant who fetches it from the drug cabinet in the corner of the room.
Its teamwork

One guy sits on the head of the operating table with a stethoscope constantly in his ear, another minds the monitoring machine, I gasped when the machine stopped beeping, I didn’t want to witness anything apart from a surgery and I was lucky, he buried his hand under the linen, fumbled with something and soon the beep was back!

Valeria earlier told me that he has lost two people on the operating table, one was a case the maternity team failed to handle and he was called in too late, the other was a stab victim who also came to the table too late and both died due to lack of blood.

“Like I said, we try but things such as lack of blood supplies frustrate us sometimes,” complained Valeira.

The colostomy revision was over and another guy lowered a pipe hissing with air into the patient’s throat and in a flash the baby coughed, she was then instantly attached to the oxygen supply.

Asked to cite some of the interesting cases he has attended to, Valeira points to the case where he separated Siamese twins who had one liver. He said he can remove cancers and repair blood vessels but he said he enjoys trauma surgery.

“Surgery interested me because it gives you instant results, you bring in a patient, I work on him and instantly see them improve.”

Again he complained that even if he can do cancer surgery, it is not complete without radiation and chemotherapy machinery.

As Valeira took of his gloves and chattered with his team my mind was racing with questions, does the extravagant government know his real value? What if he gets frustrated and goes abroad? Will Malawians get surgeries on political podiums?
I was there to see Valera in action

I stepped out of the theatre and someone wondered how I managed to stand the sight of blood and cutting tools. Well, it was not that bad, my photographer Thoko Chikondi refused to join me and I knew why.

But at least I witnessed a minor one, Valeira showed me photos of someone whom he fixed by opening his chest, I asked him what he used to open him up and he said “hammer and chisel,” to which I replied by staying silent.

1 comment:

  1. Great article. I bet if this was about Cash Gate with no real resolve, you would have had 1 million posts. Thanks for shading light on this impressive journey of selflessness by DR Varela