Hello from Butaro! I have been back in Rwanda two weeks today. In a moment of planning frenzy reflecting my true inability to sit still, I somehow managed to finish work, gallivant off to the Dominican Republic for 5 days only fly back to Boston, drive 6 hours home to upstate New York the next day, fly back to Boston again the next morning, run a million errands and pack for Africa, host a dinner, and fly to Rwanda the day after that.
This time the flight was unremarkable. After paying a hundred dollars for overweight and extra luggage, my luggage arrived – underwear and all (yeah!). I went up to Butaro – my home in the hills – the next evening and threw a mini party with the other expats in the new hospital/construction site. The next morning I joined in on the hike to an island just across the Ugandan border. We went up a hill, down a hill, up a bigger hill, down a hill, maybe up another hill... I can't recall... and then took a boat (that initially wasn't there provoking some irritation and then almost ran out of gas) and 6.5 hours later finally arrived on the island. The island was beautful. We had tents with lovely beds (particularly after the hike!) and thick blankets, a private outhouse, and lanterns. We swam in the lake – and probably contracted schistosomiasis – and swung on the rope swing – though I violated the first rule (land in water, not on land.) and gave myself a bit of whiplash before not-so-gracefully face-planting into the lake. And then, two of us hiked back to be back for work on Monday morning and made it home in 4 hours and 20 minutes. Thank goodness for ibuprofen.
Butaro has been busy. My first morning was a bit of a reunion saying hello to everyone again –and learning that you give three kisses and then shake hands when greeting people here. The hospital hired 4 new doctors – but all of the old doctors jumped at the opportunity to take a vacation it seems, so we’re still staffed at about the same level which means people occasionally dash off from rounds to help in a C-section or have to be in two places at the same time (which is just as impossible in Rwanda as it is in the US). Cases that would dazzle us in the US seem to be the norm here: an infant with a horrific facial rash the likes of which I’ve never seen, a teenager with vitiligo (the skin turns white in patches) in addition to a large pericardial effusion (fluid in the sac around the heart), and enormous parotid glands (the glands in the cheeks that make saliva), a 4 year old with heart failure, an infant with maddening jaundice… Unfortunately, we are still incredibly limited by our few labs and radiology studies in diagnosing problems and therefore in treating them. We did, however, manage to carry off some fancy medicine running a dopamine drip (counting drops per minute to calculate the dose) on a patient in heart failure for 4 days while diuresing her (for the non-medical folks, don’t try that at home).
There are still moments of utter frustration where my inner self wants to throw itself on the ground and scream. For example, the child who was treated for heart failure when she almost certainly has advanced tuberculosis (and no heart failure whatsoever) and then was transferred without so much a word to me to another hospital this morning. But, in general – and having picked my inner self of the floor and given her a pep talk this morning – people are trying to do the best they can with the knowledge and tools they have available. And, when I went for a run the other day I ended up with a constant crew of barefoot children running alongside of me cheering. It made a short jog feel like I was winning the Boston marathon.
As for things outside of the hospital, they are much the same. It is the short rainy season and the daily rain – sometimes a sprinkle, sometimes a monsoon – has damped down the red dust so my black shoes still look black and when I wash my hair it doesn’t run mud color now. The bucket showers are still bucket showers – but it’s warmer in Butaro now so at least I do not have to get dressed halfway between washing my body and washing my hair for fear of freezing. We have not had running water for over a week making it bucket everything: bucket flush, bucket hand wash, bucket dish wash. More irritatingly (since we have a ready supply of water buckets) is that the internet has been out for a week as well – something about an Israeli sattelite that switched positions. I have been bumming an iPhone off a friend once a day to check my e-mail. My French is still dreadful but I can get by on it. Today I admitted a patient by speaking French to the nurse who translated to Kinyarwandan and I wrote my note in English. Next up: learning Kinyarwandan. It turns out there are 16 noun classes which somehow means there are 16 ways to say any number, 16 ways to say “pretty”, and so on. Wish me luck.
Anyway, the satellite for the TV still works, so we’re going to go watch CNN on the flat screen TV. Yup, we’ve got a flat screen TV!
Lots of love from Butaro!
Thursday, November 18, 2010
Friday, July 30, 2010
Muzungus on Motos!
Miriwhe!
I've learned about 10 words of Kinyarwandan - which most people have told me is completely impossible to learn, so I've decided to stick to useful phrases such as 'good night' (Miriwhe), 'thank you' (murakoze), "I'm a doctor" (don't ask me to spell that one), and 'hey!' ('Umva!"). I can now get by greeting someone on the path to the hospital and it turns out that any word I say in Kinyarwandan provokes a fair amount of laughter from those standing around me. Learning French is also proving to be a challenge - I'm attempting to get by on the same 50 or so words that I repeat over and over again in a variety of orders to get my point across and then throw in some hand movements, Spanish with a French accent, a drawing or two, and the occasional English word for good measure. Everyone around me ends up resorting to a various means of communication as well. For example, communicating that a child was stung by a bee today was done by making a fair amount of buzzing sounds and ordering a sputum culture has now become a cough-spitting-into-a-cup action with sound effects and all (no sputum involved in the charade, though, that would just be gross.)
My housing arrangement continues to be amusing with a variety of people coming and going at all times - the American oncologist, the Haitian ObGyn, the Harvard medical and MPH students, two other Haitians who were friends of the ObGyn who stayed with us for a few days, and then all of the staff that is in and out morning and night. There is no TV in the house so we end up watching television series on our computers and spent this past weekend playing Connect 4 (not just for kids, it turns out) and ping pong. Last weekend, my housemates and I piled into our car (piled being the operative term) and went to Gisenyi for the weekend. It's a pretty little town on the shore of Lake Kivu in western Rwanda about 2 hours from here with a nice park, fancy hotels, and warmer weather (it's really cold in Butaro!) and is about 100 meters from madness of Goma (in the Congo). We had lunch and dinner with the extended the Haitian family (they work for the UN) and ended up randomly hanging out with the Indian Air Force - they fly the UN helicopters in Goma - and hitched a ride back to our hotel in UN jeeps (though got a bit lost first and ended up at the border of the Congo by accident). I then travelled pretty much clear across the country - by car, public bus, and then on the back of a motorcycle for about a half an hour with my backpack on my back and my laptop tucked between me in the driver - to another Partners in Health site in eastern Rwanda. It turns out riding on a motorbike with a backpack is a pretty good workout for your abdominal muscles and good entertainment for all the local children (there were two other PIH folks on motos in front of me prompting cries of "muzungu!" (which translates to some blend of foreigner or white person) from adults and children alike).
The hospital has kept me busy - 12 hour days the past few days including an hour in the middle of the night last night when the on-call doctor slept through his phone and the nurses callled another doctor (who lives down the hill) who called me (since I live at the hospital) to go see the child in respiratory distress at 2 am. (She did okay and I was back in bed by 3 am.) The pediatric ward is incredibly busy - two kids and two parents per twin bed. It makes infection control a bit challenging. We have one pulse oximeter for the hospital (with a few more on the way tonight, hopefully!), one glucometer for the hospital, and a limited number of oxygen tanks that seem to be perpetually going on empty. Our x-ray machine has been broken for months and though we are promised another one soon... soon keeps becoming later. I walked onto the ward on Saturday night to reexamine a 7 year old boy who is inexplicably paralyzed from the neck down and happened upon a 6 year old girl who had been seizing for hours after a week of diarrhea and a dose of traditional medicine (I'm not sure what is in traditional medicine - but in my experience to date it seems to do more harm then good). We treated her for everything - meningitis, malaria, typhoid fever, antibiotics for other causes of diarrhea, seizure medications... but she died this afternoon at the same time as we were treating another seizing, apneic (not breathing) 1 month old who may or may not survive the night.
On a good note - there are kids who get better and go home. We discharged a baby with severe malnutrition today, another severely malnourished baby who likely has HIV is finally gaining weight (after 26 days in the hospital!) on antiretrovirals (we are waiting for the confirmatory studies still) and we sent home another kiddo with typhoid fever yesterday who looked like crud when she showed up last week and was drawing on an etch-a-sketch before she left. We had an excellent neonatology course last week - taught be a neonatologist and a neonatology nurse practitioner from Boston - and serendipitously ended up with 32 week twins weighing in at 1.5 kg and 1.7 kg (just over 3 lbs each) on Friday morning so that everyone could put the class into action. It took us a few hours to settle them in - they were freezing by the time someone told us about them - and at one point I ended up with a baby and a hot water bottle inside my sweatshirt trying to get the kid warm. In the end, after attempting to warm them by placing one on mom's chest and dropping another into grandma's blouse (she was a bit surprised with that - since I couldn't explain what exactly I was doing when I pulled open her blouse and dropped in a naked baby - I haven't learned the term, "kangaroo care" in Kinyarwandan yet) we ended up with a washbucket, some hot water bottles, and a warming light (that has to be reset every 15 minutes) and we now have two ridiculously cute (and nice and warm!) babies. They've done wonderfully all weekend and should be on full feeds by tonight (that's medical talk to say that they are rock stars). The internal medicine wards are just as challenging with cases of head trauma, metastatic melanoma, advanced HIV, and literally half a dozen patients with mental health problems ranging from severe depression to psychosis and there seems to be very little we can actually do for them here..
And, on that note, I'm off to figure out some maddening warfarin and heparin doses and adjust cardiac medications before dinner...
Lots of love from Butaro,
Alex
I've learned about 10 words of Kinyarwandan - which most people have told me is completely impossible to learn, so I've decided to stick to useful phrases such as 'good night' (Miriwhe), 'thank you' (murakoze), "I'm a doctor" (don't ask me to spell that one), and 'hey!' ('Umva!"). I can now get by greeting someone on the path to the hospital and it turns out that any word I say in Kinyarwandan provokes a fair amount of laughter from those standing around me. Learning French is also proving to be a challenge - I'm attempting to get by on the same 50 or so words that I repeat over and over again in a variety of orders to get my point across and then throw in some hand movements, Spanish with a French accent, a drawing or two, and the occasional English word for good measure. Everyone around me ends up resorting to a various means of communication as well. For example, communicating that a child was stung by a bee today was done by making a fair amount of buzzing sounds and ordering a sputum culture has now become a cough-spitting-into-a-cup action with sound effects and all (no sputum involved in the charade, though, that would just be gross.)
My housing arrangement continues to be amusing with a variety of people coming and going at all times - the American oncologist, the Haitian ObGyn, the Harvard medical and MPH students, two other Haitians who were friends of the ObGyn who stayed with us for a few days, and then all of the staff that is in and out morning and night. There is no TV in the house so we end up watching television series on our computers and spent this past weekend playing Connect 4 (not just for kids, it turns out) and ping pong. Last weekend, my housemates and I piled into our car (piled being the operative term) and went to Gisenyi for the weekend. It's a pretty little town on the shore of Lake Kivu in western Rwanda about 2 hours from here with a nice park, fancy hotels, and warmer weather (it's really cold in Butaro!) and is about 100 meters from madness of Goma (in the Congo). We had lunch and dinner with the extended the Haitian family (they work for the UN) and ended up randomly hanging out with the Indian Air Force - they fly the UN helicopters in Goma - and hitched a ride back to our hotel in UN jeeps (though got a bit lost first and ended up at the border of the Congo by accident). I then travelled pretty much clear across the country - by car, public bus, and then on the back of a motorcycle for about a half an hour with my backpack on my back and my laptop tucked between me in the driver - to another Partners in Health site in eastern Rwanda. It turns out riding on a motorbike with a backpack is a pretty good workout for your abdominal muscles and good entertainment for all the local children (there were two other PIH folks on motos in front of me prompting cries of "muzungu!" (which translates to some blend of foreigner or white person) from adults and children alike).
The hospital has kept me busy - 12 hour days the past few days including an hour in the middle of the night last night when the on-call doctor slept through his phone and the nurses callled another doctor (who lives down the hill) who called me (since I live at the hospital) to go see the child in respiratory distress at 2 am. (She did okay and I was back in bed by 3 am.) The pediatric ward is incredibly busy - two kids and two parents per twin bed. It makes infection control a bit challenging. We have one pulse oximeter for the hospital (with a few more on the way tonight, hopefully!), one glucometer for the hospital, and a limited number of oxygen tanks that seem to be perpetually going on empty. Our x-ray machine has been broken for months and though we are promised another one soon... soon keeps becoming later. I walked onto the ward on Saturday night to reexamine a 7 year old boy who is inexplicably paralyzed from the neck down and happened upon a 6 year old girl who had been seizing for hours after a week of diarrhea and a dose of traditional medicine (I'm not sure what is in traditional medicine - but in my experience to date it seems to do more harm then good). We treated her for everything - meningitis, malaria, typhoid fever, antibiotics for other causes of diarrhea, seizure medications... but she died this afternoon at the same time as we were treating another seizing, apneic (not breathing) 1 month old who may or may not survive the night.
On a good note - there are kids who get better and go home. We discharged a baby with severe malnutrition today, another severely malnourished baby who likely has HIV is finally gaining weight (after 26 days in the hospital!) on antiretrovirals (we are waiting for the confirmatory studies still) and we sent home another kiddo with typhoid fever yesterday who looked like crud when she showed up last week and was drawing on an etch-a-sketch before she left. We had an excellent neonatology course last week - taught be a neonatologist and a neonatology nurse practitioner from Boston - and serendipitously ended up with 32 week twins weighing in at 1.5 kg and 1.7 kg (just over 3 lbs each) on Friday morning so that everyone could put the class into action. It took us a few hours to settle them in - they were freezing by the time someone told us about them - and at one point I ended up with a baby and a hot water bottle inside my sweatshirt trying to get the kid warm. In the end, after attempting to warm them by placing one on mom's chest and dropping another into grandma's blouse (she was a bit surprised with that - since I couldn't explain what exactly I was doing when I pulled open her blouse and dropped in a naked baby - I haven't learned the term, "kangaroo care" in Kinyarwandan yet) we ended up with a washbucket, some hot water bottles, and a warming light (that has to be reset every 15 minutes) and we now have two ridiculously cute (and nice and warm!) babies. They've done wonderfully all weekend and should be on full feeds by tonight (that's medical talk to say that they are rock stars). The internal medicine wards are just as challenging with cases of head trauma, metastatic melanoma, advanced HIV, and literally half a dozen patients with mental health problems ranging from severe depression to psychosis and there seems to be very little we can actually do for them here..
And, on that note, I'm off to figure out some maddening warfarin and heparin doses and adjust cardiac medications before dinner...
Lots of love from Butaro,
Alex
Tuesday, July 13, 2010
Hello from Butaro!
I've been in Rwanda for just under a week now - for those of you who don't know, I finished my internal medicine and pediatrics residency 13 days ago (finally!) and took a job working in Rwanda with Partners in Health with plans to spend 8 months of the year here and 3 months working (and taking board exams!) in Boston. So, last week I moved into a storage container (and left boxes with friends - thanks Michelle and Venee!) and am now one of the 9 pediatricians in the country of Rwanda. I landed in Kigali (imagine a large town in the US) on Tuesday after a nice long flight from Boston to NYC to Brussels and finally to Rwanda. Unfortunately, most of underwear and socks are still somewhere en route (having literally fallen out of my bag when the luggage people ripped open my suitcase) and seem unlikely ever to surface again. I spent my first day at a conference in Kigali (not the best thing to do when you're jet lagged but interesting none the less) and then Wednesday night we took a bumpy 3 hour ride up to Butaro which is where I am going to spend most of my year.
So some brief geography - Rwanda is divided up into districts and I'm in one of the larger northern districts on the border of Uganda. (Uganda is supposedly 9 miles away from where I am living - but with all the hills it takes a bit to get there.) We're up in the mountains here - I think a couple thousand feet (just enough so that I'm particularly winded when walking up hills here - and there are a lot of hills!) - and the hills are terraced and divided into patchwork plots of various shades of green and the roads are a red dirt that seems to cover everything from shoes, to cars, to the leaves on trees, and even the little kids are coated in red dust! The town here (which I can't spell yet) is just one short street with a soccer field (aka Clinton's helicopter landing pad) at one end that is lined with houses that look like they would fit in in Mexico or some Spanish villa and a few tiny shops and a lot of people hanging out on the street.
I live at the top of a hill in between the old hospital - which is a collection of houses with a men's ward, a women's ward, pediatrics, surgery, and a maternity ward in addition to the outpatient area - and the new hospital which is an incredibly beautiful collection of pavilions overlooking the valleys and hills that is still under construction and supposedly opens at the end of August but in reality might need a few more months. My home is half-house and half-administration offices and with that we have people wandering in and out all day most of whom I haven't figured out exactly who they are yet. I live with the program coordinator for the site here, the architect, the carpenter, and a medical student all from the US. The hospital logistician (also American) lives down the road in one of the other PIH houses and spends most of his time with us up here as well (since we have electricity and internet all of the time). There are people who cook for us (bananas that taste more like potatoes, vegetable and meat stews, rice and even crepes for breakfast!) and wash our clothes (albeit a bit too vigourosly and the hem on my pants came undone!) and even make our beds (a bit over the top) and get the red dust off of our shoes (much appreciated). The only hard part is the cold showers! I may be in equatorial Africa, but it's a bit chilly up here in the hills - think somewhere in the mid-to-high 60s in the day and at night it drops to the low 50s - so I heated up some water and took a bucket shower today and I think that'll be my plan. A rat just ran into our house as well - but one of the drivers and the logistician trapped it in the bathroom and killed it. There are a fair number of cockroaches wandering around but we just ignore them.
I only rounded once in the hospital so far - on Friday- and everthing was said in mumbled soft-spoken French, so I can't say I caught all of it and have spent the rest of my time orienting, sleeping, and studying for the medicine board exams! I stayed here in Butaro for the weekend and made cocktails and Bloody Mary's and Mexican food and hung out with the guys. I also went out with one of the guys on his motorcycle to check out the water fall in town which is stunning. Going anywhere here is interesting because you get stared at by pretty much everyone - yesterday I was in a car downtown and had about 10 kids sit down on the lawn next to me and watch me as if I were a movie. Some of the kids are really shockingly poor looking - tattered clothes, big bellies, and no shoes - which really breaks your heart.
Anyway, back to memorizing some more French and then off to watch the World Cup (there is a TV here that the whole hospital staff watches the games on!) Wish me luck rounding tomorrow!
So some brief geography - Rwanda is divided up into districts and I'm in one of the larger northern districts on the border of Uganda. (Uganda is supposedly 9 miles away from where I am living - but with all the hills it takes a bit to get there.) We're up in the mountains here - I think a couple thousand feet (just enough so that I'm particularly winded when walking up hills here - and there are a lot of hills!) - and the hills are terraced and divided into patchwork plots of various shades of green and the roads are a red dirt that seems to cover everything from shoes, to cars, to the leaves on trees, and even the little kids are coated in red dust! The town here (which I can't spell yet) is just one short street with a soccer field (aka Clinton's helicopter landing pad) at one end that is lined with houses that look like they would fit in in Mexico or some Spanish villa and a few tiny shops and a lot of people hanging out on the street.
I live at the top of a hill in between the old hospital - which is a collection of houses with a men's ward, a women's ward, pediatrics, surgery, and a maternity ward in addition to the outpatient area - and the new hospital which is an incredibly beautiful collection of pavilions overlooking the valleys and hills that is still under construction and supposedly opens at the end of August but in reality might need a few more months. My home is half-house and half-administration offices and with that we have people wandering in and out all day most of whom I haven't figured out exactly who they are yet. I live with the program coordinator for the site here, the architect, the carpenter, and a medical student all from the US. The hospital logistician (also American) lives down the road in one of the other PIH houses and spends most of his time with us up here as well (since we have electricity and internet all of the time). There are people who cook for us (bananas that taste more like potatoes, vegetable and meat stews, rice and even crepes for breakfast!) and wash our clothes (albeit a bit too vigourosly and the hem on my pants came undone!) and even make our beds (a bit over the top) and get the red dust off of our shoes (much appreciated). The only hard part is the cold showers! I may be in equatorial Africa, but it's a bit chilly up here in the hills - think somewhere in the mid-to-high 60s in the day and at night it drops to the low 50s - so I heated up some water and took a bucket shower today and I think that'll be my plan. A rat just ran into our house as well - but one of the drivers and the logistician trapped it in the bathroom and killed it. There are a fair number of cockroaches wandering around but we just ignore them.
I only rounded once in the hospital so far - on Friday- and everthing was said in mumbled soft-spoken French, so I can't say I caught all of it and have spent the rest of my time orienting, sleeping, and studying for the medicine board exams! I stayed here in Butaro for the weekend and made cocktails and Bloody Mary's and Mexican food and hung out with the guys. I also went out with one of the guys on his motorcycle to check out the water fall in town which is stunning. Going anywhere here is interesting because you get stared at by pretty much everyone - yesterday I was in a car downtown and had about 10 kids sit down on the lawn next to me and watch me as if I were a movie. Some of the kids are really shockingly poor looking - tattered clothes, big bellies, and no shoes - which really breaks your heart.
Anyway, back to memorizing some more French and then off to watch the World Cup (there is a TV here that the whole hospital staff watches the games on!) Wish me luck rounding tomorrow!
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