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