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.