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.