April 3, 2013
Part I: Healing
Part II: Rwanda
Adventures
Healing- Last Days on
the Wards
Last week I finished my rotation on the hospital wards and
we turned over our patients to the incoming fellows and residents. Throughout my month on the male ward we were
constantly busy. There was always something to do, whether a new patient needed
admitting, my old patient needed their daily check up, running sputum down the
lab (yes, for tuberculosis…its everywhere here), walking a patient down to
x-ray to make sure they actually GET the x-ray, writing notes, taking blood,
starting IVs, cleaning wounds, or handing out medications (yes we have nurses but some days they decide not to show up- can you
imagine if this happened in the US!?
Quick true story- one nurse on the female ward didn’t show up to work
for an entire month. She decided to come
back and as punishment she had to write an apology letter. No joke. And she got
her job back without problem—a reflection of the high demand and very low
supply of qualified nurses in this area.)
I’ve tried my best to take my time with my sicker patients-
the ones who have been in the hospital for weeks- to get to know them as a
person instead of just a patient. The
hospital conditions are pretty bad, so I truly know my patients are seriously
sick because if they were feeling any better they definitely would leave. I love a handful of my longer-term patients,
but my favorite was of course a pediatric patient named Joseph. I mentioned him in an earlier blog- he was
diagnosed with Brucellosis of the hip and had to stay in the hospital for 3
weeks of antibiotics. By week two, he
would see me running by to attend to a new patient, and he would say, “Dr. Vanessa, you haven’t examined me yet
today!” or he would try to bargain with me, “If you take out this cannula (his IV), then I will let you examine me.” Joseph is exceptionally bright and knew some
English- he would explain some things to his mom for me. By the third week he was so completely DONE
with the conditions of the hospital. He
was crying one day on his bed (he often cried if Mom left him for even an hour
to go get food), and I stopped to ask him what was wrong- I feared he was
having fevers again or more pain. He told me, “Dr. Vanessa, I just want to go home. Can’t you just give me the
medications to take at home? I will be
such a good patient, I promise. I can’t be in this hospital anymore, there are
such sick people around me, vomiting, coughing and screaming and I will get
some bad disease from them.”
I couldn’t argue with him- he had a very valid point. The guy next to him had spinal tuberculosis
and the guys across the way had pneumonia and gastritis. (These beds are about
4 feet from each other, there are mosquitos, flies, wasps, spiders and even
mice pretty much everywhere, just to add to the ambiance.) In any case, we made an arrangement that he
should spend most of the day outside with his family, I would examine him
outside, and he only had to sleep here for 1 more week. When I could, I’d spend more time with Joseph
(my translator loved him too, so we’d play with him for 30 minutes or so), and
I introduced him to games on my iPad. They’re actually drawing applications for
doctors to show patients where their pathology is, but Joseph gave the fake patients
super cool mohawks and facial hair. By week 3, Joseph had improved greatly and
was ready to continue the rest of his 6-month antibiotic course at home. This picture was taken on the day of his
discharge, and it was the second time I saw him smile.
The body’s ability to heal is always such a beautiful thing to witness. Sometimes it needs a little help from the miracle of antibiotics and sometimes it takes much longer than we’d like. Looking back on my month on the wards, I realize that despite all the crazy things I witnessed, most of my patients recovered and left the hospital in near-perfect health. Some patients left with a new diagnosis of heart failure, were started on diuretics, and feel like they have more energy than they did 10 years ago. Others came into the hospital suffering from pain with each step they took, and after 2 weeks of TB medicine, their gait improved and they started walking without pain. And some, are still there, persevering, and giving their body time.
Below is another one of my favorite patients- I had just taken his blood outside- it’s much more beautiful than inside.:)
Me with my fav nurse's daughter (the nurses carry their babies on their back all day at work- putting in IVs, dealing with patients- crazy!)
To commemorate our month on the wards we had a nice dinner
at Golden Monkey and went dancing at Club Volcanoes—the only club in town (pic below)! It has great music actually, an amazing sound
system, a pool table, and decent bar.
Stoney & 7 is the drink of choice (whiskey with ginger soda), but by
this time I was too full/happy from food and wine that I just danced. Felt good to do something fun- especially as
a group- because since the first day we met, we had only been working!!
Rwanda: “10,000 Rwandan Francs, $1 US, and a Banana!”
Saturday morning we were dropped off at the border of Uganda
and Rwanda, ready for an adventure!
After crossing, we walked about 100 feet, bargained our way
onto a mini-bus for 400rf (Rwandan francs)- about 50 cents- and went to
Ruhengeri where we hopped on a larger bus to Kigali. That bus ride was crazy because we kept
picking up more people until there were 6 people across with only 4 seats. The
bus driver believed he was a race-car driver in a video game and his challenge
was to go as fast as possible without tipping the bus over or hitting
pedestrians/motorcycles/goats/cows. The
other option often taken was to honk long and loud until they got out of the
way- and they did- because he definitely would not stop. The four mizungos
(i.e. us) in the back of the bus would try and lean into the turns, to prevent
the bus from tipping, but we didn’t help much.
Every time the wheels screeched and we swayed one way, I thought, “Oh
shit, this is it.” But then we’d plop back down into the tire’s suspension, and
I felt relief. We arrived safely and
immediately went for good food, as this is what Kigali is well known for
(besides touristy things like Hotel Rwanda and the genocide museum). We wandered into a fancy Indian restaurant,
ate too much, and then went to the Rwandan Genocide Museum. It was heartbreaking of course, and also out
of power, so we saw the exhibit with our flashlights, which added to the
mysteriousness and horror of human nature behind such atrocities.
The museum does a good job of taking you through what
happened chronologically, including the part about the UN headquarters failing
to send more help when their man on the ground urgently asked for it. It is estimated that even 3000 peace-keeping
UN troops would have made all the difference.
The hardest part of the exhibit was the children section where they
feature 15-20 children who were killed. Below their pictures stated their name,
age, favorite food, best friend (many of them said their mom, dad or siblings),
and how they were killed. Most were “hacked with a machete” but some were
thrown down latrines and stoned, others burned to death. The horrible minds that brainwashed the
majority of the Hutus, encouraged them to make the Tutsis’ death as undignified
as possible and with as much torture as possible. I couldn’t imagine in my
wildest dreams the things they did to women, children, and men. I will not repeat
them here as it’s too gruesome, but if you are ever in Kigali, you should go to
this museum as its a very interesting, but sad,
history lesson about human nature and world politics. They also have smaller exhibits of the many
other genocides that have happened throughout the world, with the purpose of
educating the public.
After that we were feeling a bit down and desired something
uplifting. We thought a local art
gallery would reflect progression in Rwanda- and perhaps show us how Rwanda has
tried to heal. Ivuku Art Gallery,
recommended to us by a friend who lived in Rwanda for a year, was that and
more. We met Charles, a worldly,
awesome, half-Uganda half-Rwandan guy who started the art studio and program
with his older brother Collin (a brilliant artist). They bring in young art students, most of who
were victims of the genocide, and give them a space to express themselves
through art, song and dance. We got our
own private dance show and saw many local artist’s works. I still may buy a piece by Collin- depends on
whether they can ship to me in NYC.
Charles was very friendly and we asked him where we should go to dinner.
He recommended Papyris, a new “hotspot,” and mentioned he and his friends would
be there later.
We also met some Americans at the gallery- teachers from
Oregon. They invited to go to the next art gallery with them, and there we met
Immanuel and Innocent of Inema Arts Center. These brothers had actually trained
under Collin, but recently split off to create their own gallery and art
program. We spent a couple hours there and my friends ended up buying a
painting each from Innocent. I settled
for a much cheaper but just as wonderful necklace made by one of the local
artists. Innocent and Immanuel are both
artists and have traveled extensively throughout the US showing their art and
for residencies, and currently they are working with Nike to expand other art
programs.
Next, we headed to Papyris for dinner, about a 15 minute
drive from our hotel. Kigali is like Los
Angeles- pretty spread out and not a “walkable” city. This is why most people use motorcycles, both
personally and as taxis. Hiring a car
taxi is much more expensive- about $7-8 for a 10 minute drive. Motorcycles are
$1. The restaurant had two levels and a roof-top, a very nice tropical ambiance
with lounge chairs and large wooden tables.
It felt like we could be in a trendy spot in NYC…and the prices were
comparable. Charles joined us for dinner
and explained that post-genocide Rwanda has 2 classes- the very rich and very
poor. There is no middle class. The
restaurant was packed with the local rich and tourists, but I still was
surprised that so many locals were there and paid for this sort of dinner once
or twice a week. Our salads and
cocktails were $10 US each and our entrees (roasted chicken or homemade pasta)
were about $15-20 US. Pricey for the
student backpacker, but we decided we deserved a fancy meal after weeks of
beans!
My friends went out to a dance club afterwards but I headed
home because at this point I was feeling a bit sick. Being sick is not fun in general, but being
sick in Africa, very far from home, welcomes hypochondriac-like thoughts,
similar to your first year in medical school. While I dreamt up what extreme
fatigue and myalgia could mean for my health, my friends went to
Sundowner. They had a drink but much to
Masha’s dismay, no one was dancing. (Masha is an awesome travel companion-
always up for anything- and always up for dancing).
The next morning we had a thrilling moto-moto ride to the
bus stop- WITH A HELMET, MOM, don’t worry!
This is a part I loved about the “militaristic” character of Rwanda-
every motorcycle taxi must carry an extra helmet for their passenger, and
everyone must wear one while riding.
Another funny law is that every last Saturday of the month from
11am-2pm, everyone in Rwanda must stop whatever they are doing and clean up
their house and surrounding community.
Charles told us that some people try to get out of this and party until
5am Friday night and just sleep through the cleaning. We realized why on Saturday it was so quiet
when we arrived!
Another 3 hour bus ride (this driver was much less
aggressive), put us in Gisenyi. We had “adventurously” decided not to book a
place to stay but to call when we got there.
I found a lovely spot called Palm Gardens Resort and they luckily had
room for four. Lake Kivu is beautiful
and was a perfect spot for 2 days of pure relaxation. We simply ate, slept and
sat by the water reading our books or talking.
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| masha, me, eman |
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| our lovely inn at Lake Kivu! |
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| best bfast ever- passion fruit juice, banana, pineapple, tree tomatoes |
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| will and masha chilling at Lake Kivu |
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| me dancing with rwandan performer |
I must share one fun fact about Lake Kivu- a fact that made
Will seriously not want to go to Gisenyi but instead drive 3 more hours south
to Kibuye (Will, we have decided, has great fear of the most ridiculous things,
statistically speaking). There are limnic
eruptions on Lake Kivu in the area of Gisenyi, which means pockets of dissolved
CO2 burst from the bottom of the lake, and if you are in the wrong spot
swimming, you could inhale this gas and die (the gas stays very low and sits on
the water because its less dense than air.)
Its usually triggered in this area by volcano activity. In 1984 there was such a large eruption that
it caused a tsunami-like wave, and killed many people. The locals told us that it still happens
sometimes, but to a much smaller scale, and some unlucky folks swimming in
areas they know they shouldn’t, have passed away by suffocating from the
gas. None of this happened on our trip,
but Will worried about it most of the 48 hours. Upon return and further
reading, Lake Kivu has disastrous potential: http://en.wikipedia.org/wiki/Limnic_eruption
On Monday afternoon we took a bus back to the bus depot in
Ruhengeri. We realized we were late and
may miss the border crossing (it closes at 7pm Ugandan time, which is 6pm
Rwandan time). So, we desperately ran
around the bus station asking for a private car to hire to the border- about 30
minutes away. We had limited Rwandan
Francs left and didn’t want to use our Ugandan schillings so we talked him down
to 10,000rf, $1US dollar….and a banana for a ride to the border. Our driver got a kick out of the banana
offering, but took it happily (this conversation was in my broken French- which
also added absurdity to the situation.)
Finally we were ‘home’ and it felt nice after a long weekend
of traveling. I really enjoyed Rwanda
and was happy to meet our artist friends.
This week I start working in the villages- a whole new experience that I
will talk about next time!
Lots of love, vanessa
that crazy will....
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