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.

Heart Check

My heart is filled with joy. In Rwanda more than anywhere else I have been, the focus is on developing relationships. It has been absolutely wonderful to get to know the gardeners, the guards, local nursing students, the patients, the hospital staff, and the fellow missionaries. I have been here for not even five full days and I already feel at home. Not only am I surrounded by beautiful landscape that reflects God’s wonderful creation, but I am also surrounded by beautiful people. I love the huge smiles on everyone’s faces. 

The only blip in my journey so far was yesterday--when we walked down the Igishigishigi Trail (sweet name) through this beautiful rain forest in the Nyunge National Park and true to its nature, it rained (literally poured) on us for the first hour of the hike. I wore a rain jacket and thought that it was waterproof, but the rain soaked through four layers of clothing and drenched my phone and now it does not work. It is currently in rice and I am hoping and praying very hard that it works because if it does not I am without a phone, I lose my ability to text other people, my camera, my notepad, my music, and my connection to the rest of my friends via Instagram and Facebook. Also, the children love to take pictures and see themselves in the pictures, and they love it when we take selfies. 

      To blow off some steam I decided to run. I started to run on the dirt road outside the compound, and when the dirt road turned into the paved road, I continue to run. I greeted every person we passed—by saying Amakuru (how are you) or mwiriwe (good afternoon) or muraho (hello). Each time I greeted someone, their face would light up. Everyone here is so friendly!  Up ahead I saw a Rwandan in athletic clothes stretching and looking like he was about to run. I motioned for him to join me and start running, and we ran for 40 minutes up and down in the mountainous area. Two younger boys joined wearing flip flops joined us (and kept up with us the whole time—in flip flops!). The boy (Immanuel was his name) spoke some English and from what I gathered was in college studying secondary education. It was awesome to run with someone else!  

From the hills above us, I could hear cries of  “muzungu” and swarms of children would line up and look at me and point and scream! I was quite the spectacle for free reasons:

1. I was white (or muzungu) 2. I was a white person running 3. I was a white girl who was running.

I had the biggest smile on my face the entire time. I kind of felt like they were cheering me on (like at the end of a race when cheers from the crowds help you get to the finish line).

This run gave me a huge change in perspective. Here I am complaining about a broken toy—a luxury that I am so lucky to have—when I am surrounded by people living in poverty. And they are so happy just to see me. Reality hit of how spoiled I have become and how much I take everything I have for granted—when I am surrounded by people who are so thankful for every small thing that they have, and they cherish it. 

This is also a lesson to stay in the moment. I am in Africa—I need to be fully present here and really soak in the experience. I may have been physically in Rwanda, but a part of me was always checking in on the rest of the world. So from here on I vow to live here and enjoy every moment, and every blessing that God has given me. I hope to be able to spread the joy that I feel in my heart.

Learning how to take selfies at the Kigobora Hospital.

Learning how to shake their hips from the "muzungos"

Beautiful view from my run!

Stay tuned for a post about my experiences in the hospital…

thoughts on Rwanda's history

                  After about 30 hours of travel, I am in Rwanda. On my flight I began to read a book that my aunt gave to me entitled "Mirror to the Church: Resurrecting Faith after Genocide in Rwanda.” I am embarrassed to admit that before reading the book, I really did not know much about Rwanda's history. Sure, I had watched Hotel Rwanda (many years ago) and I had a picture in my head of little boys with guns and many gruesome death scenes. I knew that a horrible genocide had taken place, but beyond that, I could not tell you much. This book helped to open my eyes to the divisions behind the genocide and how they originated. For those of you who know about as much as I did, I will share with you what I have learned.

                  The Tutsis and the Hutus are two different groups in Rwanda. These groups originated as a fluid class distinction. The Tutsis tended to be wealthier because they owned cattle, and the Hutus were in charge of agriculture. However, you a Hutu could trade cattle for produce and become a Tutsi and the Tutsi could lose cattle or marry down and become a Hutu. Sadly, it seems that the political differences between the Hutus and Tutsis were actually imposed by European settlers back in the late 1800s who brought the idea of race to Rwanda. They decided that the Tutsis had physical features that showed their Assyrian descent and made up superior to the Hutus, and so they gave positions of power to the Tutsis and only allowed Tutsis to attend the Christian schools. Over time, the identities of Tutsi and Hutu became so ingrained in Rwandans that they divided themselves this way and they understood themselves through this identity.

                  Before the genocide, Rwanda was considered the most Christian nation, but sadly their tribal blood ran deeper than the baptism in Christ that they all shared. The real question that the book was asking was how much of an impact did the gospel have in their country? Based on the events of 1994, the answer seems obvious: if you can kill your neighbor, when one of the greatest commandments of the Bible is to love your neighbor, then obviously it did not have much influence in their daily lives. The book said that many of the 800,000 people killed were actually killed inside of churches. The Tutsis and Hutus were not opposing tribes; they were neighbors who lived together, worshiped together, and did life together. When the Hutus were told to kill their Tutsi neighbors, it was either abide or be killed. The Hutus used machetes to do much of the killing. As I sit on the patio of the guest house I am staying in and watch a gardener use a machete to cut some weeds, I can imagine how personal and the gruesome the massacre must have been.

                  It may be easy for me to sit here judge the Rwandans, but if I look into our own society, and even my own life, I can ask the same question—how much of an impact has Christ had on my life? And in our nation? Would we really look any different if no one claimed to be Christian? In Romans 12:2, the apostle Paul writes “do not be conformed to the patterns of this world, but be transformed by the renewing of your mind.” This should be a fresh lens in which we view ourselves and the world around us. Christianity is meant to shape a new identity in us in which we have a new view of we—one that is in Christ instead of political identity, race, etc. Do I view myself as a Christian above every other identity that I use to define me?

                  The book says, “we are functions of how we imagine ourselves and how others imagine us—and that itself is the connected to the stories that we tell ourselves and the stories others tell about us.” It is important for us to question the patterns that shape our lives and our identities. For me, this book gave me a lot of food for thought and a fresh lens to view my experiences here, as almost every person I will meet has been impacted by the events in 1994. Today, no one in Rwanda is allowed to say the words “Tutsi” or “Hutu.” I wonder how many people still use this distinction as a lens to view their world, even if it is unspoken.