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.