An Update on the Healthcare Situation in Kibungo

So, we’ve been in Rwanda almost two weeks now, and I finally feel like we’ve got a routine down. My circumstances have improved a little bit since the last time I wrote about them. Most of my week is still spent working at the hospital. I go in at around 8:30 and meet up with whichever pediatrician is doing rounds for the day. There are several of them, and they never communicate which one is doing what. Lately, there’s a new Rwandan pediatrician who has been beating Dr. Bao, the Chinese doctor, to the pediatric ward. Dr. Bao usually shows up, then storms off to the neonatology area after seeing the new doctor is already there. I still don’t think I could do rounds on my own, as there are so many things in the chart that I don’t understand. Just viewing the lab results gives me a headache, as they’re neither written in English or French, like the rest of the chart.

It’s often frustrating doing rounds, as several of the children every day need to be sent to Kigali to see a specialist that we don’t have here. Unfortunately, the government health insurance that most of the people have does not cover ambulances, and we frequently walk away from a bed with a crying mother who can’t afford a transfer. Some things that would be fairly simple back home may end up being fatal for some of the children here. Also, I’ve started to come across several kids with developmental problems. There aren’t early intervention programs here in Rwanda, so we often have to tell the moms that we can treat what brought the child to the hospital, not the long-term problem. I almost got choked up the other day when I told a nursing student that a 4y/o boy who had not walked yet would probably never walk.

One of the other points of frustration I’ve had is concerning hygiene. There’s no sink to wash your hands in the entire pediatric building. Tom says they put one in at one point, but it was never hooked up and has since been taken out. I bring some hand sanitizer with me, and everyone there looks at me like I’m crazy when I wash my hands between touching patients. Also, there aren’t many gloves or masks. They’re all contained in locked storage places, and only the doctors seem to have access. I frequently walk into a room with 6-10 patients, and there’s a coughing child in the corner who I’m told has tuberculosis. I’m definitely going to be tested once I get back to the US. The hospital is filling up too. Forget having multiple patients to a room, there are now multiple patients to a bed here. I know it’s cliché to say this, but we really need to appreciate what we have back in the US.

Rounds usually take up most of the morning, including a trip to neonatology, which is always heart wrenching. The neonatology rounds consist of a line-up of mothers holding their premature infants as we walk down the line and look over each of the charts. There are a few incubators present, but they’re not used much, and I’ve even seen roaches crawling in the babies’ beds. One mother refuses to let us put a feeding tube into a set of twins, and she doesn’t have enough money for formula. She doesn’t have enough breastmilk for the twins, and I fear we’re slowly watching them starve to death.

Despite all of these issues, I'm really enjoying my time at the hospital. The Rwandan doctors are very friendly and eager to discuss the cases with me. Dr. Bao is very good and has been practicing pediatrics for 30 years. I'm learning alot from her, and she seems to be opening up to the fact that I'm here. She actually said, "Bonjour" to me once! The rest of the Chinese doctors speak more English, and they're definitely characters. The head of the group is very friendly and funny, and I enjoy talking with him. However, he does tend to whip out a camera and take a picture of me whenever I'm standing next to Dr. Bao and appearing to work with her. The nursing staff, mostly consisting of students, all pay very close attention to anything I say. There's even one nursing student who writes everything I say down. I'll have to be careful not to talk about anything ridiculous....

So that’s my time in the hospital. Usually we finish at around noon, so I have much of the rest of the day to read, go to the market, or start cooking dinner. I’ve learned how to make a pretty satisfying meal with only a few vegetables and some potatoes. The rule of thumb has been that cayenne pepper is your friend.

Aside from working in the hospital, I’ve also started working in the local public health center. There aren’t any other doctors there, and it’s generally run by nurses, dieticians, and other miscellaneous staff members. My first day there I had to arrive early for a staff meeting. This was ok, except that my translator couldn’t be there until after the meeting. I sat there for about 40 minutes, not understanding a single word that was being said. Finally, one of the other staff members sat next to me and explained what was going on. They had been talking for the whole time about the importance of wearing the correct uniform and remembering to wear an ID badge. I’m not sure I would have paid any more attention if the meeting had been in English.

Anyway, they’ve set me up in the consultation area of the clinic. I work with one of the nurses who is used to working on his/her own. The first 3 patients I saw on the first day had rashes that looked like nothing I had ever seen before. Everyone there gives me a confused look when I ask questions. They think that I’m a doctor, so I automatically know more than they do about what is wrong with the child. It doesn’t matter how much explaining I do, I can’t seem to get the message across that much of what I’m seeing is not present in Arizona. Despite these problems, I’ve had a good experience at the clinic. I’ve seen parasites, worms, chicken pox, malnutrition, and even easy things like colds. I get a funny look when I tell people that they don’t need any antibiotics, so I make sure to tell them to return immediately if they don’t get better soon or if they worsen, just in case there’s some rare tropical illness that I’m not familiar with.

The final medical thing I’ll be doing is a public health day next Thursday. We’ll be traveling to a rural medical clinic where it will be advertised that there will be an American doctor. We’ll have a public health nurse, a dietician, interpreters, and several other volunteer staffers. People from the rural area who usually have to walk over an hour for health care will be able to come see me for free. I’ll have very few options for treatment, but at least I should be able to point them in the right direction if further help is needed. It’s definitely intimidating, but I think my days at the clinic in town will be very good practice. I’m told one of the biggest things is dental problems, which I won’t be able to help with much, but if you’re reading this, and you’re a dentist, I know a ton of people in need of your assistance.

I’ll keep you updated on how the next week goes. Also, stay tuned for the story of our turkey roast planned for tomorrow. Currently, the bird, named “Indestructible” by the guy who brought it to the house, is living in our backyard. Jean Claude, our night guard, is letting it sleep in his room. I’m sure the roast will be interesting, as we still need to butcher, de-feather, and cook the thing. It was almost going to be a goat, but Tom wanted practice before Thanksgiving. I’m sure we’ll have some good stories after tomorrow.