I can’t believe that the halfway point on my trip is already approaching. There is research that shows that the brain creates a sense of recollection of time based on plotting of events that are new/unique/noteworthy on a sort of neurological timeline of life and estimating the distance between them. As many of my days have been new and unique here it feels like it has been much longer than 3 weeks.
Yesterday some of the nurses in the operating room gave us some interesting insight about some common local beliefs. “Paludismo” and “malaria” (which are both words for malaria in Portuguese) are reportedly considered by many people around Lubango to refer to different things. “Paludismo” is thought to be mild malaria without CNS symptoms such as coma or convulsions. “Malaria” is basically used to refer to severe malaria or cerebral malaria. There are some frustrating half-truths here. It is true that many people who get malaria will not get cerebral malaria and that plasmodium falciparum is the main responsible etiology for this type but that does not mean that a child can be declared “safe” if their symptoms are initially mild. Parents must still be wary of the new onset of severe symptoms.
Another interesting misinterpretation of a term is “maligno” or malignant. Apparently maligno is also a term used to refer to “evil” or “cursed” in this part of Angola. Apparently many people have been interpreting a doctor saying “you have a malignant tumor” as meaning “you have an cursed tumor.” They may interpret this as a doctor reinforcing that someone has cursed them to cause their cancer and therefore believe that undoing the curse may be part of the treatment. Unfortunately there are very few alternate terms that we can use to help people with little education to understand this concept. I have heard other doctors describe malignant cancer to patients by saying “you have a horrible bug with is eating away at your insides until it eats you entirely.” This seems to make more sense to some patients with less education but then again this may potentially create false hope as many people are aware that “bugs” like worms and parasites can usually be killed with medicine.
It seems that many people who come in from the countryside are badly in need of education about different medical problems. I wish that my level of Portuguese was higher so that complicated discussions about the origins of common issues would be more feasible to me. I feel that my hands are tied. In the meantime I am going to look into the cost-effectiveness of making several print-outs for patients from the Where There is No Doctor series and giving them to patients who are waiting for consults or who have come to see us in consult. Perhaps this might be a way to start the conversation. Literacy levels among patients are reportedly about 40% so some of these pamphlets may be only a collection of pertinent pictures regarding a certain topic.