Kibogora Week Two

Saturday, the 24th, was a day of exploration for many as most of our team went to the National Forest to see a colony of Colobus monkeys and then lunched on a Rwandan island in a river that forms the boundary between Rwanda and the Congo.  The Congo is visible across Lake Kivu from our compound at Kibogora.

Micki and I decided to stay behind to rest up and I had a chance to write some, which is my way of recharging and decompressing the emotions of these days.  We made morning rounds in the "nicu" for Dr. Ngoy, who had a mandatory meeting off site.  We discovered a baby girl who was eating poorly at breast--a real problem in a culture where formula is unaffordable and carries a much greater risk of infection due to unsafe water and the removal of Mom's immune system as the final milk purifier.  More below on this little infant girl.

Sunday began with church at the Kibogora Church located a few yards outside of our compound, a large brick structure which could seat over a thousand.  The second service began at 9 a.m. (the first was a youth service--no late sleepers among Rwandan Christian teens, who came in their school uniforms) and was complete with electric keyboard and guitars that accompanied five different choirs, all of whom had clearly put effort into preparation both of the music and the choreography. Each choir, from children's to adult and all those in between, sang with a rhythmic to and fro side step. They were all quite good. After congregational singing--familiar melodies with Kinyarwandran lyrics--we were formally welcomed, and Duane went before the congregation to express our thanks.  Since the sermon was also in Kinyarwandran we left as it began and had our own worship time at the "black house" (our houses are designated by colors).

The new week began with a busy schedule, including the addition of "health center" visits by two students each day. The nearest center is a 20 minute walk*. There are 11 others throughout the countryside, and they provide much of the outpatient care as well as performing many uncomplicated deliveries. Kibogora Hospital serves as the referral center for all of them for problems that exceed the clinic's level of care.

*(It is notable that distances as measured by miles or kilometers are seldom expressed. In a country where most walk everywhere and even a 90 mile trip by car can take 5 to 7 hours, time becomes the currency of distance.)

Paradoxes abound here.  In a place where McDonald's has not yet sold a happy meal, where Starbuck's is outstripped by the coffee grown down the road and CVS and Walmart are unknowns, where paved roads and air conditioning, mowers and electric dishwashers and elevators are absent, 25 yards from the hospital gate sits a computer store. Cell minutes are sold in 90 cent increments (roughly 550 R. Francs); minutes for your wireless Internet access can also be purchased, or, if you have no computer, you can purchase time on theirs, all in a 10x10 building. Cell coverage here is better than at USA Children's Hospital, and texting to the U.S. is as instantaneous as being in the next room. Our bus driver on the way here, when not actively risking the lives of pedestrians in an uneven game of chicken, entertained himself by texting and talking on his cell, all the while negotiating curves and construction zones. Some behaviors appear to be universal. :)


By Tuesday, the baby mentioned above was no better, and with a persistent heart murmur since Saturday, we had ordered a chest X-ray, which along with auscultation and an EKG constitute the extent of available cardiac evaluation. The murmur had been louder on the right, and as it turned out, so was the heart. About the time we viewed the X-ray the infant's color deteriorated rapidly and we spent some time trying to achieve viable oxygenation, hampered by poorly functioning equipment, an oxygen concentrator as the only source of oxygen, and poor lighting and thermal support. Mom had no resources for transport or evaluation in Kigali, 7 hours away, but the hospital administration okayed the transport anyway and the next morning the babe was off to Kigali with her Mom. No report on her status as of yet, but the ultimate fate of infant's with complex congenital heart disease here is not good.


The entire week we have been treating Destin, a four year old with a major pneumonia and empyema (basically a left chest full of pus).  We needled his chest on Monday, and after the minimal test we can do on the fluid suggested a staph infection and not tuberculosis, Shannon Burgess, on Wednesday, inserted a chest tube, draining about 200 cc's of milk chocolate colored fluid with an odor that made one wretch. We have drained an additional 200 hundred cc's over the last two days, and Friday his fever was beginning to diminish.  Please pray for him--he has a long way to go if he is to recover.


Both of these patients' care have driven home how blessed we are to have simple things like wall suction, portable X-rays (when an X-ray is ordered the mother carts her child, paper in hand to X-ray), blood gases, oxygen with analyzers and saturation monitors, echocardiagrams, and, oh yeah, basic electrolytes.  For those in medicine you will perhaps be amused to know that neonatal bilirubins are reported as positive or negative, making them of use only to those dependent on Braille.  Physical exam is enormously more important when all of the tools (spelled c-r-u-t-c-h-e-s) we lean upon are absent. I think we will all be better doctors, certainly more appreciative doctors, upon returning to our technologically dependent medical worlds.


Thursday was a sad day as two of our team members and another U.S. physician headed to Kigali and on to their homes.  Richard Ellingstad is a family doc from Wisconsin who was here for two months without his wife, who had contracted severe malaria on a previous trip to Tanzania.  He was very gracious and helpful in getting us oriented to Kibogora. We will miss his presence at our group meals. Jeanne Claude Bataneni, a Congolese surgeon who traveled with us from Kigali to Kibogora, returned to his mission hospital in the eastern Congo's jungle. JC, as we know him, has returned to his birth village as the only surgeon, passing up much more lucrative and prestigious positions because he and his wife, also from the village and also a physician, have felt God calling them to serve His Kingdom there in Nebogongo Hospital. He is a kind and gentle man with a great testimony of persistence in the face of major obstacles to the practice of medicine.  Please pray for him and his family.


Our spiritual leader, Duane, also headed home to Kim and the kids.  He did a magnificent job of organizing this trip and in leading the group both in terms of logistical support, spiritual stimulation, and sensitivity to the emotions of a group far from home in a strange culture.  His calm in the face of his own fatigue and a sharp witted bunch of tired travelers has been a lighthouse emotionally. He will be missed.


Comment on week two After two weeks in this land, where Christianity is more of a palpably present influence than in Alabama, we are struck by the fatalistic approach to illness, death, and dying that an animistic cultural inflence produces. Tradional medicine practitioners (think "medicine men") discourage allopathic medicine and value their own power base and influence mor than human life. Compare that to our home culture, where a secular utilitarian view of life also erodes the Christian's high value on the sanctity of life, and deluded influence peddlers (think "politician") sell their souls on the alter of public opinion at the expense of the unborn and unprotected. Both are evils that medical providers who follow Christ will battle throughout their careers.

Here in Rwanda the battle is one on one, a relational effort to change people's hearts through the establishment of trust in our skills, our love and our faith in Christ. In the U.S. the battle is no less intense on the personal, relational front, but is compounded by the increasingly aggressive attack by the government on our rights as providers and patients to determine our own attitudes and actions in protecting all human life. Unless we are firmly founded in what AND why we believe what we do in regards to human dignity and sanctity of life, we risk having our resolve eroded.  On this issue the daily renewing of our minds in Christ through the leading of the Holy Spirit is an indispensable habit of life.  Please pray that these weeks "on a hill far away"** will be a time of formation and strengthening of values that will last a lifetime, however long those lives may be.

**see: On a Hill Far Away by Dr. Al Snyder, who gave his life to serve Christ at Kibogora