Episode: "The Choice"

ANGOLA | BOLIVIA

In this episode, nurse Els Adams finds too many malnourished people to transport back to the MSF feeding center. Why does Els only have one truck?

Els was on a preliminary assessment visit to the quartering area – at this stage in the crisis, there were large populations appearing out of the bush spontaneously and unannounced, so it was difficult to know when and where more trucks would be needed. Even if Els had had another truck on this day, the people she brought back to MSF’s therapeutic feeding center (TFC) would have exceeded its capacity, leaving no room for patients from the surrounding areas who were even more in need of help. In successive days and weeks, MSF greatly increased its presence and its effectiveness in the country by sending more volunteers and building more feeding centers.

In this episode, there is no suggestion that the Angolan government or the United Nations are responding to the nutritional crisis in Angola…where are they?

The response of the Angolan government and the United Nations to the Angolan nutritional crisis was much later than MSF would have liked. Initially, there was an inexplicable hesitance to acknowledge the severity of the crisis by both parties. When this episode was filmed, the UN and the Angolan government had started to address the situation, but remained bogged down in bureaucratic negotiations concerning how best to respond. Eventually, both did, but only after thousands of lives were lost unnecessarily.

In this episode, a young boy named Dino dies at a district hospital in Angola while under the care of MSF medical aid workers. What is the cause of Dino’s death, and why was MSF unable to prevent it?

Dino was anemic – his malnutrition had resulted in a lack of hemoglobin. There is a possibility that a blood transfusion would have saved his life temporarily, but severe malnutrition compromises the immune system, and there is no guarantee that he would have continued to live. Dino didn’t get the transfusion he needed because the Angolan government health workers who staffed the provincial hospital in Malanje had gone home for the night and locked up the blood bank and the laboratory equipment necessary to type Dino’s blood.

At this early stage of the crisis, as the scale of the needs were just starting to become evident, MSF was relying on the Angolan Ministry of Health (MOH) for intensive care medical procedures such as blood transfusions. In response to cases like Dino’s, MSF met with the director of the MOH regarding the best way to coordinate a combined response to the emergency and quickly assigned personnel to assist the hospital’s staff. Later in the episode we see MSF doctor Jacqui Mukoyogo working alongside Angolan government health workers to coordinate emergency transfusions.

What happened to Inez, the girl who Els carries on her lap to the Therapeutic Feeding Center?

According to Els, Inez recovered very well; “After a few weeks, she was unrecognizable – she became a very pretty girl, with full cheeks and shining skin. The staff in our feeding center took very good care of her, and some of the cooking ladies bought some clothes and shoes for her. One day an aunt of her appeared, and took her with her to live in Luanda.”

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