Live from Butaro!

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!