The surgeon and his knives

Dr Carlos Gomez Varela, 37, is one of the few surgeons Malawi has. He has performed over 5 000 surgeries, including separating conjoined twins. He is the only surgeon government banks on to service the whole of the Central Region and as BRIGHT MHANGO writes, he is a jolly element Malawi should celebrate.

The wide, battered door to the main theatre at Kamuzu Central Hospital (KCH) 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 into the office. His beard was trimmed thin and to a pattern making a distinct “w” under his mouth.

The Portuguese name, Carlos Gomez Varela, is just his name; he is a Malawian: his mother from Mzimba and father from Ntcheu. His ancestors came 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,” he said.

Becoming a doctor

Varela did his primary education at Namiwawa Primary School in Blantyre before he went to Phwezi Secondary School in Rumphi. He was dismissed from the school while in form three and had to finish his form four at Liwaladzi in Nkhotakota from where he was selected 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 said.

He did and his parents are now proud of him.

Varela left Chancellor College and joined the College of Medicine (COM). He salutes Dr Arturo Muyco, his mentor and former head of the Department of Surgery at KCH, and his mother for inspiring him to go for further training.

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

The 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 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,” he said.

Working under serious challenges

Varela, however, does not rule out the possibility of flying out of Malawi. He said 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 work dissatisfaction. We have no equipment such as patient monitors. Sometimes we don’t have anaesthesia or antibiotics,” he said.

Varela performs five or six operations per day. He does surgeries on Tuesdays, Thursdays and Fridays. On other week days, he does ward rounds.

His job description does not stop there: He does administration and is a lecturer at COM.

“I 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,” said Varela.

The brain drain problem that sees fine doctors such as him trek to the United Kingdom and other countries 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, Varela in Lilongwe and one in Mzuzu. One wonders what the ratio of surgeons to Malawians would be in this case.

Not that Varela is a boring workaholic. He still has his weekends off. His three children, Caroline, Ashley and Hoollie, still 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.

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

Jolly good man

A Catholic, he does not hide his respect for the creator.

“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,” he said.

Varela is a jolly good man. 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.

Varela did his magic in 30 minutes, using what I would swear was a soldering iron to cut her open, grab the intestine, clamp it with about 10 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; he worked 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 Varela, introducing me to his team, as if I would know them in the masks.

As he works, his assistant on the other side stands next to about a thousand tools, scissors, pincers and knives and thread and fluids. When Varela demands a tool, she fishes it instantly and hands it over and when the assistant needs a tool she barks the instruction to another assistant who fetches it from the drug cabinet in the corner of the room.

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!

Losing two

Varela 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 while 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 Varela.

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, Varela 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 them and instantly see them improve,” he said.

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

As Varela took off his gloves and chattered with his team, my mind was racing with questions; does government know his real value? What if he gets frustrated and goes abroad?

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. Varela 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 responded by staying silent.