Medicine never existed in her career path. Her childhood passion was fashion; she wanted to be a beauty model when she grew up.
Today, the hardworking and industrious Dr Hilma Shipanga is a [Namibia’s first female] neurologist and enjoys every minute of it.
As a neurologist, she treats patients who suffer from central nervous system breakdowns that affect the brain, the spinal cord, the nerves and the muscles.
She says most of the neurological cases she often deals with are complications of systemic disorders whose root causes come from central nervous infections like Meningo-Encephalitis and TB-Meningitis, which disrupt the normal functioning of the nervous system. These may cause an inflammation in the brain or on the spinal cord. While mailgnant processes like cancer may metastate to the brain and the rest of the nerves system, trauma can also affect the brain and the spinal cord.
According to Dr Shipanga, neurology is neuro-imaging. You need specialised investigation and clinical findings. It is not like other disciplines of medicine. It is this interdependence upon which a successful neurological diagnosis is based. As such, neurologists must work with physiotherapists, neurophysiologist, occupational and speech therapists, to name but a few, to ensure a patient’s successful recovery and rehabilitation.
Neurological breakdown is caused by a number of factors, Dr Shipanga points out. However, one has to localise the pathology to diagnose the problem according to the signs a patient presents. If, say, a patient suffers from right hemi-paralysis, then a neurologist would know it comes from the left side of the brain. If the patient presents difficulty in muscle movement, then one would know the problem is with the part of the brain that controls movement.
But can such a condition be reversed? Yes and no, Dr Shipanga says. Some cases are reversible while others are not. Hereditary congenital diseases, for instance, are irreversible (some acquired diseases cannot be changed). A patient may suffer from meningitis, resulting to a brain damage from which they may lose their memory and other perceptional functions. That cannot be reversed.
But how can one take precautionary measures? Dr Shipanga says this usually depends on what stage of the disease a patient consults treatment.
“If a patient consults treatment late, nothing could be done for the complications already exist. One may suppress the symptoms of the disease but not reverse the condition. As a result, such patients may become epileptic following a meningitis attack,” she explains.
According to her, neurological conditions are a serious concern in Namibia: “The biggest problem is neurocysticercosis, which is transmitted by parasites from pigs. In the North, almost every village family owns a pig with no proper toilets. So they help themselves in the bush from where their pigs eat, hence contract the disease after eating the pork. Another way is when viallagers fetch river water from where their pigs also drink, resulting into a lot of neurocysticercosis cases.”
She adds, “It is a cycle. Sometimes it may not be a pig; after doing their businesses in the bush, some people do not wash their hands, touch their pigs and then finger feed without washing their hands. This cycle of the parasite may reach the brain. That is the main cause of epilepsy in the majority of the patients.”
The good doctor currently attends to the five most populated regions including Oshana, Ohangwena, Oshikoto, Omusati and Kunene in this regard.
“I am on-call 24 hours a day. Even when there is a medical officer covering a region for an emergency, they will still have to to consult,” she submits, adding, “We have engaged Government to tackle neurocysticercosis. It is, however, difficult to solve the problem since most people depend on their pigs for a living.”
In the mean time, all Dr Shipanga and her team can do is educate the public on how to take care of itself by regularly washing hands, boiling drinking water and building toilets. This way, when it rains, the water does not collect all the feces in the bush and then flow to the same rivers from where villagers fetch water for general consumption.
Dr Shipanga’s interest in neurology as a disciple grew after completing her degree in 1994 to become a general practitioner. She would be confronted with related cases in her routine, including malformations. People would become paralysed from neurological attacks while others would suffer strokes because of their high blood pressure attacks.
“General practitioners are limited in their experiences, so we had no clear knowledge of how to manage those cases. That is why I decided to study neurology at Wits University, South Africa. It was tough but I made it because I had passion,” she submits.
Seeing as she is one of the two public neurologists in the country, Dr Shipanga admits the job is very challenging: “It is a very big and stressful responsibility but there is no escape from it. If you want to give back to the community, you have to do it yourself because nobody will.”
The other challenge she faces is lacking the courage to notify parents whose children suffer from congenital malformations. These are often kids born with undeveloped brains; most of them soon start experiencing fits and then become paralysed.
“You really have to think twice before standing in front of a mother to tell her there’s nothing you can do for her malformed child,” she says, adding, it is also difficult to tell a couple they will never have another child [in cases of hereditary diseases].
“Because conventional families believe a woman must bear children, most couples ignore doctors’ warning to bear another child. So when they eventually have another malformed child, we have no choice but to counsel them. Either way, it is not easy,” she laments.
Despite these ups and downs, Dr Shipanga highlights the recovery of some of her patients who, say, were once on breathalysers or were wheelchair-bound as her best moments.
That they are only two public neurologists in the country does not dampen Dr Shipanga’s spirit. She acknowledges she is privileged to work in both the State and private hospitals. This exposure gives her the opportunity to mingle with people at different intellectual levels and with diverse educational backgrounds.
“If a tree does not want to break, you have to learn to bend with the wind. In other words, you have to learn from every experience. Private patients act like they own you because they pay for the medical services they receive while public patients depend on you because they do not understand most things. The problem, however, comes when you try to make them understand the depth of the problem, only for them to take their sick child to a traditional healer,” she says.
She is grateful to her late mother for being her main source of inspiration in life and death because she taught her about the three important virtues in life that one should never lose - hope, peace and honesty. She also taught her about the three principles one should never waste; time, words and opportunities because once they are lost, they can never be regained.
“That is why I grab every opportunity that knocks on my door because once it is gone, I will never be able to retrieve it,” she quips.
She considers her two children her heroes: “While studying, I could not take good care of them but they understood me. Sometimes I would come home crying out of frustration but they would encourage me saying, ‘Mummy, just hang in there, you will make it’.”
Namibia lacks local specialised expertise. Dr Shipanga thus calls on policymakers to send young people out to study for specialised skills that are scarce in Namibia.
But how does she unwind? “I grab every opportunity to spend quality time with friends and family to learn new things about life that have nothing to do with injections and medicine - even if it is just for a while,” she enthuses, adding in conclusion; “I also like to travel.” PF