For Easter, four of the surrounding villages travelled to our village, Cavango, to celebrate from Thursday through Sunday. This is a HUGE deal to the people in this village. They spend days preparing: trimming the tall grasses along the roads for people to walk, preparing the first meal for when the visitors arrive, cleaning guest huts for them to stay in, and practicing skits and songs for entertainment.
As we drove back from our remote site visit in Camboli, we saw a group from a village traveling by foot along the side of the road, loaded down with baskets on top of their heads. These people were walking hours to days to get here. When we saw a few kids who were trimming grasses along the side of the road closer to the village, Rode (our translator and nurse) asked us to stop. She yelled out the window to the kids that the visitors are getting close. The kids’ faces immediately lit up, and they started clapping and jumping around. They anticipated seeing people they hadn’t seen since either Christmas or last Easter.
We asked why the surrounding villagers come to this location and not somewhere else. Rode told us that long ago before the civil war, the first missionaries to Cavango reached out to other communities and invited them to celebrate Easter here together. Ever since then, the tradition has continued despite the destruction of the physical portion of the mission during the war.
For Easter service Sunday morning, the Kubacki family and I packed into the truck to head to church. We stopped at the clinic to quickly check in with the nurses to make sure the inpatients were doing well. The nurse, Segundo, surprised us by telling us there was a man in very grave condition who just arrived. Dr. Kubacki and I went into the clinic while the rest of the family went on to church.
We walked into the exam room to find a 20-something year old man laying unresponsive on the bed with his eyes closed, eyelids twitching, and his breathing shaky but regular and deep. Rode was on shift and was hurriedly taking his vitals. I grabbed his wrist and felt a slow and steady radial pulse. Dr. Kubacki let out an “Oh..” in a light tone that immediately let me know that this was not urgent, and that he had an inkling about what was going on.
He began his normal precepting questions, “So what do you want to know about this guy?” I began looking at his vitals, asked what he was doing at the time he went unresponsive, when he was last seen normal, and if this has ever happened before. The man’s entire family: parents, uncles, aunts, cousins, were either in the room with us or looking in from the hallway. They seemed to agree that nothing out of the ordinary occurred (no strange food, no falls or accidents), and that he collapsed this morning after saying he felt feverish and had a stomach ache.
I noticed his ankles were crossed so I uncrossed them, and we began our physical exam. I pulled up his eyelid, and started speaking loudly to him in English to try to get a response. He glanced at me quickly and then his eyes rolled back up into his head. “Give him a sternal rub”, Dr. Kubacki added. I forcefully rubbed my knuckles on his chest, and he tensed up in response. I noticed that his feet were crossed at the ankles again. I asked Dr. Kubacki if he had crossed them for the patient, and he smiled with a “nope”. I lifted the patient’s arm up high above the bed and let it go. He held it in the air for a second, before letting it drop.
I chuckled a little, as from our physical tests, it appeared he was faking a coma. Dr. Kubacki told me how he handled this situation very often in the emergency room back when he worked in the United States. He would whisper into the patient’s ear to preserve their dignity in front of the their family: I know you are faking. You need to wake up now or we will have to do some very uncomfortable things to you. Very often, people would slowly open their eyes after this, and “miraculously” wake up. We tried this with this man, with Dr. Kubacki whispering in Portuguese to him. It didn’t work. We put a line in him, and strangely enough, he did not react to the pain of me having to double stick his arm to find a vein. He also did not awaken after Dr. Kubacki loudly mentioned multiple shots, IV lines, and pills for days. Dr. Kubacki decided to play it safe and treat him for cerebral malaria, as it can present with very odd neurologic symptoms. He used this as a teaching point to always give the patient the benefit of the doubt and to treat accordingly.
We left for church and found the Kubacki’s sitting amongst the 480+ people outside the church for the service. Mrs. Kubacki was curious to know what had happened at the clinic. We told her we are thinking that our patient is potentially faking a coma, and we would have to see how it played out. “Maybe he just didn’t want to come to church!” she proposed. That was a pretty funny thought.
Mrs. Kubacki filled us in that they had spent an hour at the river watching several people be dunked for baptism. She said they were in a shallow and stagnant area, and advised us to watch out for schisto diagnoses (schistosomiasis- a parasite that is transmitted in standing water) at the clinic. The service went on to include a few songs sung by the choir from each village’s church, a line dance performed by our Cavango teen’s choir, dedication of the babies, a message by Jeremias the Cavango pastor, offerings, messages from each of the village churches’ pastors, farewells, and communion. After all of this was said and done, the total time involved was 6 hours. 6 hours!!! At the end of the service, the pastor pointed at the sky and said in Portuguese, “Look at the sun here in the sky! The day is almost done!” (they use the sun to tell the time). This was all very cool stuff, but I could understand why someone might fake a coma to play hooky from church today.
On our way to the clinic after church to check on our guy, the nurse was leaving and said our patient woke up and wanted to go home. Because we were treating him for malaria, the nurse advised him to stay, and he did, so we decided to see him the next morning. We went home around 4:00pm, had a late, late lunch, and sang some hymns with Betsy playing piano and Ben playing violin. What a talented family! I shared with Ben that playing the violin is on my bucket list, and he gave me a lesson and let me try it out. Who knew I’d learn to play the violin in Africa! Everyday is truly an adventure.
Side note: If you have any questions, I’d be more than happy to answer. You just might inspire a blog post! Also, thanks for the comments. I thoroughly enjoy getting those! I will post an update on inpatients that I’ve mentioned soon.