Goodbye for Now

I am leaving Kibogora today. As all goodbyes usually go, it’s a bittersweet moment. Of course I am excited to get back to see my family and friends, wear shorts, drink some Diet Dr. Pepper over crushed ice, go to Starbucks, and eat as much fruit as I want until my heart is content, but the longer I have been here, the more I have grown to love this place and to feel at home. Yesterday we had a final lunch with the surgical staff, and as I looked around the room at the fifteen people there, I realized that these were some of the key reasons why I was sad to leave.  I knew each of their names, from the scrub nurses to the anesthetists to the maintenance staff. They were so warm and welcoming from my first day in the OR, and as we sat around eating lunch, sharing stories and funny cultural differences, I found it very hard to say goodbye.

 

Also, in the past couple weeks I have gotten to know some of the patients very well. Dr. Berg had the brilliant idea of me helping with the physiotherapy for some of the patients. There is a physiotherapy unit at the hospital, but they are usually swamped with many outpatients as well as all of the surgical inpatients, so many patients who need to be doing exercises daily often only are seen about once a week. I started out with about six patients, but after a few were discharged, I ended with four who I worked with several times a day. Marie had a very bad case of necrotizing fasciitis, and it destroyed most of the muscle and other tissue in her leg. She had been in the hospital since April, and was just recently starting to maintain her weight. She was walking with a walker, but she would barely put any weight on her injured foot. My purpose was mainly to encourage her to walk and to force her to put weight on her leg. Basically, I was her cheerleader (literally—I actually did a little chant/dance when I walked with her, which always made her smile).

Beautiful Marie

Samson, another patient of mine, had stage four prostate cancer, which was not realized until after surgery when they saw that it had spread into his colon. When I first saw him last month, he was consistently drenched in urine because his bladder was shred, so instead of draining into the catheter, it was leaking out through any opening, including his sutures from surgery. My heart really went out for him; he seemed so dejected, and he was constantly exposed to everyone. He had the sweetest wife and little girl.  His wife would give him sponge baths and constantly be at his side, and his daughter laughed when I held her (which I loved because many young children are afraid of me). After a month in the ICU bed, he was gaining enough strength to walk, so my job was to support him in walking. This was probably one of my favorite times in the day. We would walk around the hospital, and with a huge smile on his face, Samson would greet just about every person we passed. He would teach me Kinyarwanda, and I would teach him English. He gained enough strength that he will probably be discharged soon. 

Samson and his wife

Marie had a patellar fracture. I had met her during the “prayer rounds” a few weeks before I officially started doing physical therapy with her. [Side note—the prayer rounds are when I go on Sundays to just spend time with the patients and to pray with them. This was something started by another surgeon, Carl Albertson and his wife Francie. I really enjoyed it because one of my good friends translated for me and I was able to communicate well with the patients instead of with random words I knew.]  I learned her sad story—she had given a drink of water to a man who had been working in the fields and was tired, and the man’s wife thought that something was going on, and she hid behind a bush and attacked  Marie when she was walking home and broke her patella. Marie’s biggest prayer request was just go be discharged to go home because had left her baby at home (the village was taking care of her). So when I started working with her, passively flexing her leg to 90 degrees, whenever she complained of pain I just told her, “komera, komera” (the equivalence of be strong)—and knew that the harder that we worked to get her knee functioning, the quicker she would be able to go home.  Obviously, in the states this would be an outpatient PT appointment and no patient would ever be in the hospital for weeks with a broken knee cap, but here, almost every patient is an inpatient because they live far away from the hospital. Anyways, needless to say I was ecstatic when the doctor told me that she could be discharged yesterday! Seeing hard work payoff is such a beautiful thing!

Working with Maria.

Marta had a strange condition—both of her knees were bent up underneath her, stuck like that, so that she could only move around by crawling. For twenty some knees, she had been like that, until she came to Kibogora Hospital and Dr. Albertson had the idea to slowly cast one of her legs in progressions, straightening it over time. He determined which hip was strong enough to support her, and decided to try to work on that leg. By the time I was working with her, the leg was almost straight, and they were trying to work on getting her to hop around with a walker. When I started working with her, the first few times I supported about half of her weight by holding her under her armpits. She soon gained enough confidence to use the walker to get around on her own, and she only needed my help on uneven ground or on stairs. On my last day, we walked past a large group of people waiting in the consultation area, and one woman saw Marta and I walking by and started shouting and screaming “praise God.” I was wondering why she was so hysterical, but then she began acting out to everyone that Marta used to only walk on her knees, and she showed how Martha is now upright and walking almost normally. She could barely recognize Martha. I could tell that Martha was embarrassed, but it was a good embarrassment, because everyone was patting her and giving her a thumbs up and seemed so genuinely happy for her. In a place where handicapped people are often neglected and ignored, I cannot imagine how this change has made an impact on her wellbeing. 

Walking with Marta

Two sweet boys who were both in the hospital for osteomyelitis.

What I have liked the most about doing physical therapy with the patients is seeing how much all of the patients support each other. The hospital truly does become a community. The patients recognize each other’s struggles, they share their troubles, care for each other’s children, share food, and celebrate each other’s successes. Marta, who never before needed shoes because she could not walk, would borrow a sandal from someone else when she wanted to get out of bed. When I walked with Marta, Marie, Maria, and Samson, the other patients and families would give us a thumbs up. Quickly, I learned that “nbiza cyani” means “very good” because the family members and other patients that gathered outside said this to me often as I passed by with a patient.

As I reflect on my trip here, there are many reasons why I loved my time here. I have met many amazing people and formed many lasting friendships with both Rwandans and other missionary families. The Bergs, the reason why I came to Kibogora, are such an amazing couple who have wonderful hearts. The Lands, another family who is here for a year, welcomed me into their home, inviting me to join their family dinners, go on day trips with them, and join their work outs. Stephanie and Regan are such kind, generous people and they have raised three amazing kids. Macy, their fifteen year old, has the wisdom of a 40 year old yet the innocence of a teenager. The Greens were another sweet family who I loved to spend time with. They had a 10 year old, a six year old, and a three year old. It was fun to have kids to play with. I also loved shadowing Joel at the hospital. Paula, his wife, was the sweetest woman and I enjoyed her company greatly. I’m pretty much in love with their entire family.

Valerie, a high school student who was out here to tutor Macy in math, was such an awesome person to be around. She also spent almost every afternoon in the pediatric ward so I was able to see her often. Kim and Beth, two nursing students from the UK, were wonderful as well. Kim was always there to talk with me, share funny stories. She did small things here and there that really meant a lot to me, like preparing chilled coffee for me because she knew my obsession with iced coffee (and then rubbed it in when she returned home to the UK and got to go to Starbucks). Beth taught me my favorite new phrase “I can’t be bothered” and was constantly providing comedic relief. Sherie, a pediatrician who I lived with and shadowed, was someone who I liked and respected immensely. She is very intelligent, kind, and compassionate. She brought all sorts of games and treats for the kids, and you could tell that she cared about each of her patients. I hope to be able to come back and work with her again someday.

Anyways, there is my mini essay to complete my Rwanda blogging series. I am so thankful to have had this experience and that God has continued to open doors for new opportunities and so many wonderful friendships. I have a feeling that this is not my final goodbye to Kibogora.

Give Me Your Eyes

I was recently listening to Brandon Heath’s song “Give Me Your Eyes,” and realized that the lyrics began to reflect a prayer that I have had in my heart for me to see each person I encounter in Rwanda as a child of God and see them through Christ’s eyes rather than my own, jaded ones.

Lord,

Give me your eyes for just one second,

Give me your eyes so I can see everything that I keep missing.

Give me your love for humanity.

Give me your arms for the broken hearted, the ones that are far beyond my reach.

Give me your heart for the ones forgotten.

Give your eyes so I can see…

Give me a second chance to see the way you have see the people all along.

Lord, give me your eyes.

During my first trip to Africa, I remember being so shocked as I rode a bus through South Africa on the way to Swaziland. We passed several communities composed of tin shacks, and less than a quarter of a mile there was a brand new gas station! I remember being indignant—how can you build a brand new, luxurious gas station next to people who are dirt poor? Does no one see the disparity?  On that first trip, I often felt so guilty that I skipped lunch when we were out in the community, giving my bagged lunch to the pastor to give to the children who were most in need.

Now, a short four years later, this is my fourth time in Africa. I realize that in a lot of ways I have become desensitized to the poverty that surrounds me. The need here is so overwhelming—even people who are considered well off and have nice jobs would be on welfare in the US—that at times I wonder how I can help without causing more harm than good. I have been cautioned not to give out money on the street because it just reinforces the kids’ behaviors. The first English phrase that the kids learn is, “give me money.” I get asked for money so many times a day that now I almost come to expect it when a child approaches me and I either ignore the request or say no. 

When did my heart become so hardened in this aspect? When did I stop looking at each child as a child of God? I realize that in some way, it is a survival mechanism. If I walked down the dirt road and gave each child 100 francs (about the equivalence of a 15 cents) like they ask, would that do any good? They could maybe buy a loaf of bread (or more likely a piece of candy), but the next day, they would be hungry again. And before the day is over, I would be out of money. I feel like there is so little I can do individually that at times I find myself asking why do I bother to do something at all? I know that this is very cynical. It is an issue that I have been grappling with since I got here. 

Plus, I hate that some people here see my white skin and think of me as a means to get money. I know that this is not the case for every person, but there have been many times when I feel like I am being used and that people only try to be my friend so that they can get something from me. For example, there was a student who I passed every morning who kept asking me if he could run with me. I agreed to run with him one morning, and the first thing he asked me was to pay for his school fees (about 800 dollars).

I have had some experiences here that have made me reflect on how good intentions can only get you so far. Recently, we tried to partner with compassion (an international organization that helps children in poverty so that they can get meals, go to school, etc) in an event that we thought would result in children getting sponsors, but ended up in a catastrophe. It’s a long, complicated story, but in short, we thought there would only be about 15-30 children there who were registered in the program but did not have sponsors and we agreed to take pictures with the kids and try to find sponsors for them at our churches once we were back in the States. When we got to the small compassion center, there were hundreds of people gathered. Then we learned that none of the 30 children who were supposed to be there were there, and instead there were hundreds of other village children and their mothers crowding the tiny office. We almost just turned around and left, but the compassion leaders urged us to take the pictures anyway, which they could use if these other children decided to register for the program in the future. (Side note—in order to register, the children have to come to the office with a guardian and apply, and the program then determines if they are poor enough to qualify). Things got out of control quickly with many people trying to sneak in the back door and a riot almost ensued. Mothers, desperate to have their children in the program, were shoving their kids into the door. It got to the point where we were afraid that people would get hurt, so we shut it down and left. We found out later that there was a lot of backlash and anger in the community because supposedly the people thought that they would get paid by the mzungus if they got their picture taken-- no wonder they were so frantic to do so! Somehow word had gotten out to all of the village leaders and health ministers to send their poor to get sponsored (and once people heard that they had an opportunity to get money, everyone showed up). It was also sad because there were kids there who really needed the aid, but there were also kids who were healthy and rather plump who really did not need it! Anyways, it was a mess, and it made me realize that even if you have good intentions to help, if you do not go through the right avenues you actually cause a lot more harm than good. It was a hard, but important lesson, and it kind of made me realize that it’s pretty complicated as a missionary. There are plenty of times where our actions help to contribute to the dependence in the society. We need to find ways for them to empower themselves rather than look for handouts.

Hundreds of children and their mothers lined up hoping to be enrolled in the Compassion program.

I want to end this blog on a positive note—because 99% of my experiences here have been amazing. I love how I can walk down the street and almost every single person greets me, I love how the patients in the hospital care for each other and share food, and I love how the staff at the hospital welcome any newcomer who is here to help or just observe. The majority of people my age (nursing students and other hospital staff) who I have gotten to know are remarkable. I have made several good friends. There is one guy, a first year nursing student, who I run with almost every morning and helps me to translate on Sundays when we go around and pray with the patients. He has gotten to be a close friend, and he even invited me to his house to watch the USA-Belgium game and eat with his family. There are other students who have invited me to come play soccer with them, and others who have helped me to shop in the market so that I can get a good price. There are several others who put a smile on my face every time I see them. The one generalization I can make is that the people as a whole are very friendly and welcoming, and that is something that has made me fall in love with the Kibogora community.

Highs and Lows

I am constantly surprised by how many emotions can be packed into a single week. And my highest highs and lowest lows tend to come together.

Yesterday was one of my favorites here so far in Rwanda. There is a program through the hospital where the community’s elderly are given a pound of beans, rice, salt, a bar of soap, and a warm meal (porridge and bread). This is put on quarterly. However, if someone sponsors it (it costs about $300), they can have the program every month. Sheree (the pediatrician who I have been shadowing) raised money for this event to happen because she has been a part of it in the past and it was such a joyous occasion that she wanted to do it again. In order to qualify, you must be in need and above the age of 75; most are widows. Usually, they prepare for about 100 people. Sheree invited Kim, Beth, and I to join her in this event. Before we passed out the meal and the sacks of food, we spent time singing and dancing together and singing praises to the Lord. Man, these women could dance! I have never seen a group of older people with this much spunk and energy! After we danced and prayed together, we passed out the porridge and bread. Then, one by one they came up and got a bag of food. Their eyes have seen a lot in the world; they have seen horrors, pain, suffering (they were all alive during the genocide, which was only 20 years ago). But they live life with joy, awe, general gratitude and today they were just so appreciative that people saw them and reached out to provide for them. It was a moment that I will cherish.

The women were dancing with such joy and energy! [Not pictured: us dancing with them after the picture was taken]

The elderly patiently waiting for the program to start. (They had to take off their shoes before they sat on the straw mat).

Then today, a 7 year old child died in front of my eyes.

Sheree warned me that this child did not look good. She had encephalopathy, and they did not know the cause. They had given her every single medicine that they could think of, yet they did not have the proper imaging to see what was going on. She seized off and on throughout the night. Today, her heart rate spiked to over 200 then it gave out. What was worse was that when we needed to manually bag her to help her breathe, there was not a mask around so there were several minutes where we were hopelessly trying to find a mask. With as little clinical experience as I have had, I felt like an amateur in there. One of the nurses mistakenly first grabbed me and showed me the child when its heart rate was in the 200 and asked what we should do. Once they started bagging her and manually making her breathe, her heart beat a few more times then frothy blood became flowing from her nose and her heart stopped. Part of me thought that something would kick in and she would be fine. On this trip I have seen many sick kids in these precarious positions and they always manage to pull through. An hour earlier I was listening to her heart and lungs and thinking—wow! I have not heard a heart beat this fast (which I was told was due to the atropine that they gave her). I really did not understand the gravity of her condition.

But even with Sheree’s warning, I thought that the little girl was going to be okay. I have personally seen the God work to heal many sick children here.  A few days ago there was a very sick girl about three years old who had pneumonia and after the doctors had given her every medicine they had, she still had a respiration rate of 70. They were giving her nebulization treatments often, and there was no improvement; she was starving for air. Sheree said that she would tire out and would probably die through the night. Every time I was in the girl’s room, I would pray over her. It was hard to watch her struggle to breath as she stared with us with frightened eyes, begging us to help her . On top of that, the mask that we had to put on her for the CPAP machine really traumatized her even more. When we went back to check on her that night before we went to bed, she was still in the same state. However, the next morning her respiratory rate was coming down and by lunch she was nursing! I could not believe how quickly she recovered. The next day she was moved out of ICU.

Hours before the girl died, the nurses, doctors, hospital pastors, and family circled around her bed and prayed for her. I could feel God’s presence in the room as we prayed. I thought for sure that she was going to turn around and begin to improve. God has the power to heal. I had seen it! Why does he choose who he does? 

After she died, we had to resume with morning rounds. I have now found that when kids are crying, if I play the videos from the Lutsemba (meaning hope in Siswati) in Swaziland of the children singing, they usually become mesmorized by the video and stop crying. As I heard these children praise God, I too was comforted by the words, Lord, let you presence come. Lord, we proclaim you now. With your mighty power and your awesome majesty. Lord, come upon us now, release your power, and let your presence fall.  The little boy who was crying because he was frightened by the mzungo doctor was pretty confused about why I was now crying too. 

I am still trying to process death. But I am comforted to know that God’s presence is very much alive here in Africa, and that He knows our pain and is now holding this little girl closely in His arms.

Mark 10:4: But when Jesus saw it, he was indignant and said to them, “Let the children come to me; do not hinder them, for to such belongs the kingdom of God."

pictures speak louder than words

My internet is not allowing me to upload a lot of pictures and text in the same blog, so here are a few extra that I really liked.

Kibogora has breathtaking sunsets.

Kibogora Hospital from afar.

The sweetest friends who like to play "touch the doctor then run away"

Kim and Sherie handing out the sacks of food to the gracious women.

Overview of the hospital

     I realized that so far I have not gone into too much detail about the hospital. It is quite impressive hospital by African standards. It has 270 beds and many different departments. It has a physical therapy center, a palliative care unit, nutrition team, general clinic, dentistry, maternity, neonatology, pediatric, surgery, internal medicine, pharmacy, emergency, and isolation ward. 

The women's surgical ward.

    When I first walked to the hospital, I saw many people outside of the wards and was wondering if they were all family members. Actually, many of them were patients. If you walk into the ward in the afternoon, most of the beds are empty (I don’t blame them, the ward is hot, stuffy, and usually does not have the best odor). In fact, there are times when it is difficult to find a patient that is scheduled for a procedure because they are somewhere around the hospital. It is interesting because most patients become inpatients for many conditions that would require outpatient care back in the states. Once a patient goes to the hospital for an ailment, they stay there until they are healthy enough to make the trip home (by foot). If a patient has a wound or a broken bone, they are usually in the hospital for a couple of weeks as they get surgery and then post-surgical care. Patients with open sores are there much longer so that they can have the proper dressing changes to decrease infection. I was told that many local community health centers can also do these dressing changes, so some patients go home earlier. However, there are patients who get treated and then return later because their open wounds were not cared for properly. 

Outside the pediatric ward. The patients do their own laundry, which you can see hanging on the line.

    When a patient comes to the hospital, they have to bring someone to care for them and provide food, clothing (but most patients remain in the same clothing that they come in), bathing, etc... Also, keeping the patient hydrated falls on the patient’s families as well. The hospital has a nutrition program and they will provide food if the patients are in great need, but most of the patients are fed by family members who bring food from home or the market. There is a sense of community among patients in the hospital. They often share food and help each other out. In the NICU, “veteran” mothers who have been there for weeks with a premature baby will help the new mothers to navigate around the tubes and other difficulties that come with having a baby in the neonatology unit.  

    I have spent the past week at the hospital shadowing Sherie in the neonatology unit and the pediatric ward. This week has definitely been my favorite week at the hospital. Although I am not as hands on as I was in surgery (where I could at least help to retract/open sterile packages, etc for the doctor and I helped to review anatomy with the nursing students), I am still learning a lot and getting a lot of great clinical experience. Plus I love being  among the patients often and I really like working with Sherie. I wrote down all of the antibiotics that we discussed in the immunology unit during first year and now I am able to see which ones are prescribed here for which purposes. It is helping to have some real life application so the drugs are becoming more than just names. Plus, I get to see more of the hospital and how things work. After bible study each morning, we check on each of the babies in the neonatology unit, then we examine the babies who are at the hospital for their checkups, then we round on the pediatric ward. In the afternoon we check any x-rays of patients, do ultrasounds if necessary, and then check on any of the patients who are not in stable condition. 

Lauren (Dr. Green's daughter) with Ester (a cute little girl whose father was in the hospital).

    I love the NICU! Tiny, beautiful babies. The babies under a kilo have about a 50% chance of surviving, but since I have been there, the tiny premature babies have been gaining weight and getting stronger! One baby reached a kilo on Friday after three weeks in the NICU! Sherie is teaching me a lot about what is normal and not normal for newborns (for example, a seizure in a baby can take many forms, and are usually subtle). Also, I am able to follow up behind her and check the babies’ heart rates; lung sounds, and pulses because they are easier patients than the young kids.

The little kids usually like us from a distance and then cry when we get close (especially with a stethoscope) so I’m not able to get as much practice with the physical exam on them because usually it’s too much to have one person examine them, let alone two. But most kids eventually warm up to us. They usually love us during playtime then cry during rounds haha. The parents also warm up to us over several days and go from seeing us as random mzungos to people who are helping their kids get better.

     We often have extra time in the afternoon to just hang out with the patients and their families. On Tuesdays and Thursday afternoons, some of the other families on the mission do a pediatric playtime where they bring an activity for the kids to do (like coloring books, balloons, jump rope, etc). I really enjoy this time with the kids. One afternoon this week I taught several English words to a bunch of the mothers and older kids. They loved it, and the next day I was so excited when they greeted me by saying “good morning, how are you?” I also have stressed to all the mothers (once I know them better) that my name is Caroline, not mzungo. It’s frustrating at times when I don’t know what they are saying and I hear them say mzungo so I know they are talking about Sherie and me. However, as the week went on and I spent some quality time with the patients and the mothers, I think that they talked to us more rather than to each other about us. Some of the patients were discharged on Friday and I am sad that I will not see them on Monday (even though I’m obviously happy for them that they are healthy enough to go home).

Cow in the background behind the pediatric ward!

    Being at this hospital makes me realize how much I take for granted in our health care system, where we can get any medication that we need, we have the best equipment to treat people, and staff who know what they are doing. Earlier in the week, Sherie had to make a choice between which baby would be on a C-Pap machine because there were three in need and only two working machines. Also, Sherie just found out, to her horror, that the nurses were giving the young children aspirin (which, in case you are not aware, can lead to a condition called Reye’s syndrome that can cause liver and brain damage). Often, the optimal drugs to treat a condition are not available. Even with these shortcomings, this is considered the best hospital in Rwanda, and people travel from all over to receive care here. It may not be the best by our standards, but it is making a large impact on healthcare in Rwanda.

Welcome to Kibogora Hospital

     I am working at the Kibogora Hospital in a local community Nyamsheke. After about a week and a half of working, I see many familiar faces, both of patients and of hospital staff, as I walk around the hospital. So far my typical routine has been to get to the hospital at 7:30 for the hospital staff bible study (which is in Kinywarwanda but is translated into English), then spend the rest of the day in the surgical ward or the operating room.  Surgeries usually go until about 6:30 at night.

So far I have seen a lot of hernia surgeries, incision and drainage of osteomyelitis, and repairing broken bones. I was told that almost every patient probably has ascaris (intestinal roundworms) and one of the surgeons recently removed a huge amount of worms from a patient’s intestines that were causing obstruction. I have scrubbed in on a few surgeries so far, but mainly I have just been observing.

     There are three American surgeons here right now. I found out about this opportunity through Dr. Tim Berg, who went to Wake Forest Medical School with my dad and has been the main surgeon at the hospital for the past two years. He has been a great teacher and seems to know almost all of the staff and most of the patients as well. It is awesome to the see the impact that he has made on the local community. His wife, Linda is amazing as well! She knows the stories of most of the people in the local community and cares for many of them. You can tell that she is a saint because all of the children love her. She has helped many women to make a living supporting themselves by buying sewing machines for them.

    Tim was out of town for the first week I was here, so I have been mainly shadowing Dr. Joel Green, a general surgeon from Michigan. He is very nice and a great teacher. He asks me questions but he does not get upset or patronizing if I don’t know the answer (which is often). He asked about the layers of the abdomen, all about hernia anatomy and a bunch questions about osteology and nerve innervation (brachial plexus is actually used in real life—who knew?). Its sad little I recall from anatomy, but he is patient and a good teacher. I have been given new motivation to look back at my notes from first year so I can recall more information and cement some of the concepts that I have learned so far by seeing it in actual clinical cases.

   There is another older doctor who is retired but has been out here for about five months. He is an orthopedic surgeon and has been teaching the other two surgeons here so that they can do the orthopedic cases on their own after he leaves. Because he is here, they have been able to take on some pretty intense ortho cases. This past week a young girl came in who had her humerus sticking out through her skin. The crazy thing is that it had been fractured for a month! The family had tried traditional medicine to treat her arm before deciding to come in to the hospital. In surgery, they removed the humerus, sterilized it as best as they could, then put it back into the arm! Their plan is to treat it like an osteomyelitis case; their hope is that new bone will begin to grow, and they will later go in and remove the dead bone. I don’t think I will see many cases like that again.

    I think I’m going to start working with Sherie (a pediatrician who works in Virginia and just got out of residency) in the pediatric wards. I have realized that although I get to see some very interesting cases in surgery, I would rather spend time interacting with patients. I sometimes try to sneak away from surgery for an hour or so to go down and play with the kids or just visit them in the ward and show them some videos and pictures on my phone (which worked after two days in rice!). The most difficult thing is that I cannot communicate well with them because they don’t speak any English and my Kinyarwanda is horrible (I pretty much only know greetings). It’s especially hard when they are in pain and look at me with sad eyes for me to help them. There is one boy who has a huge tumor that has taken over his entire abdomen and pushed up into his lungs. His PMI is down under his sternum. He is now on palliative care because it is too large to resect and there is really nothing we can do (there is no chemo or radiation therapy here). He is struggling to breathe and it’s so sad to watch, but yesterday I went and spent some time with him just showing him videos I took in Swaziland and working on some coloring books. Although it’s not much, at least he was occupied for a bit because usually he just sits in bed with nothing to do. They also recently put him on a C-pap machine so he can breathe easier.

    I have also helped to transport patients after surgery, and when a child wakes up and sees a white person over them they panic and scream even louder, and that has been difficult because I don’t know how to comfort them (side note—many parents tell their kids that if they don’t behave, the white people will eat them, so no wonder they are afraid of me). That has been a challenge for me because I just want the patients to know that I care, but it is hard to do when they are in pain and are already frightened.

    In the guesthouse I am living with Sherie and two English nursing students, Beth and Kim, who are hilarious. I love their English phrases and I try my best to copy their accent (but have informed me that it is quite horrible). They are conducting a study on the differences in education in the Rwandan nursing school and the English one (some students here know very little about taking vitals, basic hygiene, etc, but they are hoping to improve that). It has been fun to spend time with them, especially after a long day at the hospital. It is nice to get some comedic relief at night over dinner and to share about our experiences.

    I am so thankful to be here. Every day I wake up and am surrounded by a beautiful view and friendly faces. I am about to go play some soccer with some of the hospital staff so I will let you know how that goes…

Right outside the entrance to the Kibogora Hospital.

The ambulance for the hospital.