Nyereka aho ivuriro riri. (Show me where the hospital is.)

On Monday morning, Ryan and Mitch took off to go gorilla trekking up a volcano while I put on my white coat and walked over to the regional hospital in Ruhengeri with a couple of American doctors I had met in the hotel restaurant the week before.  At 7am we met with all of the doctors of the hospital to discuss all of the deaths that occurred over the weekend.  I missed most of what was said – I’m not sure if it was in French or Kinyarwandan, but I don’t speak either… All I know is that it was very nonchalant and matter-of-fact.  Too many deaths occur on a daily basis.

The hospitals in Rwanda aren’t large buildings with several floors.  Instead they are several one story buildings sprawled over a large plot of land.  Each building houses a different specialty – pediatrics, internal medicine, surgery, emergency, maternity, the pharmacy, etc.

I set off with one of the American doctors to find out what department was understaffed for the day.  That day it was the acute pediatrics ward. 

I was warned that the acute pediatric ward has the worst smell.  As soon as I walked through the door it hit me like a brick wall.  I have never smelled anything like it before, and 5 days later I can still smell it as though I was still there.  It wasn’t the smell of body odor or dirty diapers.  It was the smell of sickness and I will never forget it. 

There were 3 rooms with 8-12 beds in each room.  Each bed had 2 patients and 2 mothers, and maybe another child or two if a mother didn’t have anywhere else to take them.  So at least 4, but up to 6 people per bed.  Babies were crying, everybody was coughing, and there was no way to isolate the very contagious.  It was loud, it was smelly, and it was time to get busy.  We started at one end of the first room and went down the line, one patient at a time.  By the time we were at the last bed, I turned around and saw that all of the beds were full again with new patients.  I wanted to cry.  There was no winning.  There was a flood of sick babies and we could barely keep our head above water.

I forced myself to focus on the patient in front of me with all that I had so that I wouldn’t vomit or run out crying.   If I let my mind wander to the possible (and probable) germs floating around the non-ventilated room for one second it was over and I had to go outside, breathe, and regroup.  That happened a couple of times.

I worked side by side with an American doctor and a Rwandan resident doctor.  I wrote in the charts, examined the kids, and tossed in my two cents on differentials.  I mostly asked questions when it came to ordering labs and prescriptions.   The American doctor had 5 weeks of internalizing what he was seeing and hearing, but empathized with me as I scribbled the African treatment plans the resident was telling me into the charts.   

Every child is started on gentamycin and ampicillin on arrival to the hospital regardless of their chief complaint.  Once the doctor sees them (which can take up to a few days) they may be switched to amoxicillin, ceftriaxone, or taken off antibiotics altogether.  Almost all babies are given aspirin.  Everyone is tested for HIV and malaria.  Chest x-rays are unreliable and urine dipsticks don’t exist.

I left after 5 hours and didn’t know what to think.  I walked back to our hotel in the rain reflecting on what I had just experienced.  Being a muganga is a dirty, thankless job.

I was struggling with 2 opposing thoughts: 

1.)  My God, I never ever want to go in there again.

2.)    I have to go back.

Popcorn & Friendships

There are a few things that I instantly think of when I think of my dad.  One of them is popcorn.  For as long as I can remember, my dad has loved popcorn - and for as long as I can remember, I have been sneaking handfuls of popcorn from his bowls.

On Wednesday we took my dad to the isoko (market).  He seemed to have a great time watching Pierre and I pick out fresh fruits and vegetables and haggle for the honest price, rather than the Muzungu price.  I bet it is entertaining to watch.  I’ll point to a pineapple and say “ngahe amafaranga?” which means “how many francs?”  The seller will respond in Kinyarwandan.  I probably should have learned my numbers first because it does me no good to ask how much and not understand the answer.  So that’s where Pierre comes in.  He then types the amount onto his cell phone so I can read it.  If everyone agrees the deal goes down and off we go with a pineapple (…or 2 if the seller can’t make change).

As we were walking around the market my dad pointed out a huge spread of popcorn kernels on the ground.  I asked Pierre if we got some, could he could make us some homemade African popcorn at home.  Either he didn’t know how or he had no idea what I was asking him.  Regardless, we didn’t get any.

On Thursday as we packed up my dad’s stuff and got him set to go, Pierre moped around the house a bit.  When you can’t communicate with words, you learn to read body language – and Pierre was definitely sad to see my dad go.  Pierre makes few requests but in his best English he said, “I want photo Mzee.”  (Mzee is the Kinyarwandan word for “Old Man” and it is a title of absolute respect and honor.  That was my dad’s name for the 2 weeks he was here – we never introduced him as Eldon; always as our Mzee).  So we took some pictures, my dad gave Pierre a nice new Columbia shirt, and there were lots of hugs. 

When Ryan and I returned to the house from dropping my dad off at the airport, Pierre quietly walked over to us and gave us a big hug followed by an even bigger sigh.  That perfectly summed up all of our feelings. 

Last night (Friday) Pierre came in and handed me a gift.  He bought me a little bag of popped popcorn.  The 3 of us shared it and it was a sweet moment that touched me deeply.

Mutware (Chief)

Ryan, my dad, & I have spent the last week at Akagera National Park.  We did a 3-day safari and this is a list of what we saw and experienced:

Zebras.  Lake Ihema.  Palapa huts.  Warthogs.  Refering to warthogs as “Pumbas.”  Pumbas grazing outside our room.  Baboons fighting outside our room.  Tennis matches on clay courts.  Baboons watching us play tennis.  Impalas.  Giraffes.  Chasing giraffes across grasslands.  Pictures with giraffes.  Good food.  French fries with ketchup.  Baboons running into the dining room for breakfast.  Baboons sneaking into the dining room for lunch.  Swimming in Africa.  Swimming in a pool that overlooks Tanzania.  Watching baboons drink from said pool.  Water bucks.  Hippos.  Safari boat ride.  Finding an elephant swimming in the lake on the boat ride.  Circling the elephant for 30 minutes in the boat.  Bald eagle.  12’ crocodiles.  Cape buffalo.  Those little white birds that live on the buffalo.  Velvet monkeys.  Flat tire.  Ryan changing flat tire in the bush.  Repairing flat tire in a big town for $2.50.  Finding tire flat the next morning.  Repairing flat tire in a village barnyard for $3.00 + a bunch of bananas.  Topis.  Oribis.  Incredible tour guide named Cecile.  Laughing with Cecile.  Crying with Cecile.  Becoming friends with Cecile.  Cape elands.  Red buck.  Buying 50cents worth of the best little red peanuts from a kid in the village.  Free Kinyarwanda language lessons.  Monitor lizard.  Biting horseflies.  Thousands of biting horseflies in the car.  Thousands of dead biting horseflies on the floorboard (thanks Dad). 

There just isn’t a way for me to write about our every detail from our safari trip.  It was an incredible experience and I wouldn’t have changed a single minute of it.  We were even lucky enough to encounter Mutware, the nationally known 42 year old elephant who was separated from his herd and lost his tusks to poachers.  We heard a guy say that in his 70 game drives, he has only seen an elephant twice.  Yeah…we were excited.  Still are.

Tomorrow we will head north to Ruhengeri.  Monday morning, Dad & I are going to climb a volcano in search of silverback gorillas, and then the next day, the 3 of us will trek back up the volcano to see golden monkeys.  

Kurira (to cry)

The students here are sponges for information.  They are so hungry for it that they believe everything that they hear.  Unfortunately, they have come to believe the he said she saids that have been passed around their community.   

Fortunately, I was able to provide them with some medical truths that I am optimistic will also be passed along.

I met with the secondary school girls again on Thursday.  We had some serious woman to woman discussions.  In fact, I’m blushing just thinking about some of the words that came out of my mouth.  My presentation included puberty, feminine hygiene, conception, abstinence, and what it means to be in healthy Godly relationships with men.  They had questions on anatomy, abortion, and if you could lose your virginity riding a bicycle or wearing thong underwear.  The day before I promised them I would bring a tampon for them to see and so I did.  None of them had ever seen one – or heard of them.  It was a huge hit.  Lots of giggling and questions. 

(I’m sorry to the men reading this – but Ryan gave fair warning as to the possible content of my blog!)

Then yesterday, Friday, I went back to the school and was available for the girls to meet with me one on one.  Most of them have never met with a doctor before.  Ever.  I spent a couple of hours and met with 10.  Most had similar questions about their anatomy and concerned that they might be sick.  They are actually quite healthy and their problems are all very normal (and not problems at all), but they have never had anyone give them that information.  I think a few were bummed that I couldn’t make it go away.  Oh well, they will have to accept the “joys” of being a woman.

I had a few really tough cases.  One girl really touched my heart.  She was a translator for several of the other girls that came to me, so I was already familiar with her.  Her English is fantastic.  She is so bright.  I’m pretty sure she is the one that answered my question about germs a few days back.  As she told me her story, I just sat across from her and wept with her.  This is the girl that has it all together.  Top of her class.  Beautiful.  Funny.  Strong.  And yet a victim of a string of terrible events.  She has held these haunting memories inside for over 16 years, never having told anyone – until now.  I gave her the medical information she needed to know, promised her I would do some research on local resources for her to use, and gave her my phone number.  I told her I wasn’t trained to do any counseling like she needs, but I would be happy to sit, listen, and cry with her (for the next 2 months anyways…)

Her story is devastating.  In fact, it’s your worst nightmare.  Unfortunately, there are millions with very similar stories.  Our friend Pierre who lives with us has a heartbreaking story behind the singing and whistling he does while he happily serves our helpless selves.  (Hopefully we can learn his story soon.  Right now I can only communicate short sentences like “I can’t unlock the door” and “we go buy water.”)

I wish I could heal their brokenness and make their pains go away.  But I know I can’t, so I will be grateful for the opportunity to cry with them.

On a super happy note – my dad is currently on the flight from Brussels to Kigali.  He will get in late tonight.  Monday we will be heading off to Akagera for a 4-day safari adventure followed by a few days in Ruhegeri to see silverback gorillas and golden monkeys.  Yee-haw.

Inika mu mazi & isabune (soak it in water & soap)

I know I said in my previous post that I was going to be spending some time at the hospital this week.  Well, this is Africa and you have to be able to go with the flow when the flow isn’t going where you thought it was.  Instead of being at the hospital I have been spending some time at the Star School doing public health talks with the secondary school girls. 

Yesterday I met with about 50 girls ages 14-24.  We covered topics such as germs, proper hygiene, and safe drinking water.  These girls are bright.  They are getting one heck of an education.  I started off my talk asking if anyone knew what a germ was.  “A small living organism that can cause harm to your body.”  Said in English.  Just like that.  I couldn’t have answered it better myself – in fact, I wouldn’t have. I then moved to how to bathe, the importance of soap, how to wash clothes (again emphasizing soap), the consequences of not being clean (body odor, infections, disease), and why they should wait for the cooks to boil any water for them to drink rather than the immediate satisfaction of the cold water from the taps outside. 

I’ve learned that you can’t say “don’t drink that water, it will make you sick” unless you have a reasonable alternative ready.  All the girls seemed to fully understand the water bit.  They’ve either heard that advice before or have each personally experienced the consequences of the water – or both.  They all laughed and nodded as I rolled around on the floor in the fetal position holding my stomach.  (I had to get pretty silly to get them to come to life.  Rwandans are very reserved – Good thing I’m a goofball.)

Once I had made a big enough fool of myself to get them to open up – they really opened up!  There were tons of great questions.  Tons that made me laugh.  And tons that broke my heart…

Great questions: “What are some of the symptoms of a urinary tract infection?” and “What would happen if you didn’t get it treated?”  “Why is it okay to shower and wash my clothes with the bad water but not okay to drink it?”

Funny questions: “How come when she (points to the girl sitting next to her) takes a shower she still smells bad even right afterwards?”   Talk about a candid group of people!  Could you point to your colleague in a business meeting and announce to everyone that they had terrible body odor?   There were a lot of fingers pointed and names mentioned but no one was hurt by it.  They are a close-knit group and they were looking for answers for each other’s problems.  Still…I couldn’t help but crack up at their frankness.

Many of their questions were so basic that I really had to think about my answers.  I can quickly spout off the major infecting organisms that are found in their tap water, their unique symptoms, and 1^st, 2^nd, 3^rd line treatments for each one…. But that’s not what they want/need to know. 

They wanted to know 1. What temperature the water is supposed to be for their shower. 2. Is it okay to use soap on all body parts when showering.

3. What the yellow stains under the arms of their white shirts are, 4. Why certain parts of your body smell differently than others, and 5. Is it okay to use dish soap to shower with.

1. It doesn’t matter.  2. Yes of course.  3. Sweat stains.  4. They just do.  & 5. No, use Irish Spring, Dial, or Dove. – are the American answers to those questions.  We take for granted a ton of information that we don’t even know that we know.  (And no, they don’t have any of those fancy soaps I just mentioned.  They have one type of body soap.  It’s an odorless brown block of wax and lard.)

In a couple of hours I’m going back to the Star School (rain permitting) and I’m going to have a much more sensitive conversation with these young women.  That’s right.  Yours truly is doing the sex ed, this-is-whats-going-on-with-your-body lecture. 

So hang tight- an even more interesting blog is headed your way soon…