Kibogora 2013: The first two weeks.

Kibogora 2013

From Grace Community Church to Mobile Regional Airport to Houston' Texas to Washington, D.C. to Addis Abbaba, Ethiopia to Entebbe, Uganda to Kigali, Rwanda to Kibogora Hospital on Lake Kivu in southwestern Rwanda--Saturday morning to Tuesday evening--eighteen souls from the Mobile area and one from Nebobongo in the Congo who joined us in Kigali--arrived to share medical care and nursing care and physical therapy and respiratory therapy and English skills and, most importantly, share and experience  the love of God with the patients and staff of the Kibogora community and with each other.

The flight from Washington to Addis Abbaba, a long thirteen hours regardless of the conditions, was not one for someone who did not like children--directly behind us and audible to everyone on the plane was an 18 month old whose shrieking began with boarding and recurred periodically until we landed the next morning. Fortunately, he was occasionally distracted by his three year old sibling, who with another couple of toddler travelers made the two aisles of the plane a full circuit track, laughing with delight as they completed their mid air marathon while the Ethiopian attendants turned a blind eye and a very deaf ear.  No sleep was to be had.

There was a little excitement in Addis as six of us found that our status was "standby" shortly before leaving Washington, and initial attempts in Addis to change to an assigned seat were met with a lack of urgency only achievable in Africa.  But, we had prayed about it at Carl's suggestion and about an hour before boarding the gate attendant assigned us seats.

We spent the night in Kigali after visiting the currency exchange and a grocery store, staying at the Good News Guest House, a remarkable improvement over last year's Eden (after the Fall) Motel.  Tuesday morning we boarded a big yellow Canary Buslines vehicle and were off for the eight hour ride to Kibogora--the road was much better this year, much of the mud and rock roads from last year having been paved by the Chinese who are draining the natural resources of Rwanda in exchange for the improvements in infrastructure.  Last year's driver (Mario Andretti Nugashami) would probably have made the trip in under six hours, but we would have all aged years in the process, as we did last year.

We began our first day at the hospital on Wednesday, the 20th, and were delighted to find that the "neonatology" unit was under the guidance of Julie Yerger, a native of Washington state who is serving her second four year tour at Kibogora.  Julie is the "go to" person this trip for everything from housing and food provision to laundry services and travel, but her job as a nurse trying to improve neonatal outcomes via improvements in OB care and newborn services makes her an invaluable asset to Kibogora; and her cheerful, matter of fact approach to each new question has been great.  Edi, a nurse from Germany who spends months here every year and was a great asset last year arrived about the time we did.

Just after we began work we were asked to evaluate a three year old whose name is Valentine (pronounced with the last syllable "teen") whose surgery to relieve post burn contractures at the elbow had been postponed because of a heart murmur and low oxygen saturations (80's).  After examining her we are convinced she has a form of congenital structural heart malformation--probably Tetrealogy of Fallot.  Her surgery has been indefinitely postponed while we try to get her heart evaluated by the pediatric cardiologist in Kigali.  Valentine, meanwhile, is the life of the pediatric ward and has captured Micki's heart.  She has a ready smile and is a ham as soon as a camera appears.  Please pray that she can be properly evaluated and get the surgery she needs, which if it occurs, will be done by a team of Belgiun surgeons who visit twice a year in Kigali.

Both the neonatology unit and the pediatric wards are busier than last year.  We have already seen children with malaria, many xray proven pneumonias, severe thrombocytopenia (as in zero platelets), and a variety of other respiratory and neurological disorders. There are no platelet transfusions available and no IVIG so treatment for thrombocytopenia, a life threatening disorder readily treatable in the States, is limited to steroids, prayer, and patience.  Leukemia is part of the differential, but we pray that this is a post viral syndrome that will be self limited.  

One little boy with malaria had a hematocrit of 13.  He was considerably more active after a transfusion that raised his hematocrit to 20, a level that would leave most of us unable to do much but sit.  We are also evaluating him for sickle cell disease, but Rwandans seldom have that problem, unlike many other African groups.  

Another boy about 12 years old is bed bound for reasons that are unclear.  He was beaten by his parents and has clear neurological deficits. His older brother lovingly cares for him-- his parents have not been permanently incarcerated because to do so would make orphans of all the children.

We are caring for a newborn whose mother threw him down a toilet pit after birth. A neighbor discovered what had happened and helped to retrieve the infant from the sewage and get it to Kibogora. 

The baby appears okay in spite of worms crawling from its ears and eye lids.  The mother was arrested, but brought to the nursery so that she can nourish the baby with feeding.  When the baby is discharged it will go to the jail with the mother so that she can continue to feed it.

On our first Saturday we traveled to the Nyungen Forest and hiked a 1.5 hour trail in an African rain forest--aptly named that day--and traversed three suspension foot bridges over deep valleys hundreds of feet below--not a trek best suited for the acrophobic.  After our hike we drove through a several hundred acre tea plantation to the Nyungen Lodge, an exclusive tourist lodge catering to expats who study the chimpanzee population of the area.  We had tea, coffee, and hot chocolate served with tea biscuits.

Sunday we attended Kibogora Free Methodist Church and then retreated as a group to the gathering house where we listened to a great Tim Keller sermon on the first chapter of Phillipians.   That afternoon the three volcanoes on the north end of Lake Kivu were clearly visible, and the active one in the Congo could be seen emitting smoke as the sun set and glowing as night fell. I have seen few thigs as beautiful as that view.

Returning here is a blessing mixed with the same sorrow and sadness that life can be so cruel and unfair to the "least of these".  The blessing of American and Western medicine is never more apparent than when we see easily diagnosable and treatable disorders here that go without adequate management because of the poverty and the limited technology and training.  People like Julie Yerger and Edi and Janet Stewart (the head of the new nursing school) live out their faith in trying to change the course of care and the quality of the training of the care-takers---the turns in direction are often analogous to turning the Titanic only to find a larger obstruction dead ahead--but they are resilient, dedicated individuals who are sharing God's love and their expertise each day of their service.

Drs. Carl Albertson, J. C. Bataneni, John Simmons, Kristen Hummel, and Andrew Bright all are contributing their surgical skills, and though our time here is limited, they change lives one person at a time and give Dr.Tim Berg, the resident expat surgeon, a chance for a much needed break from the unending cascade of orthopedic and general surgery cases that flow onto this "hill far away".  Others working in our group are Dr. Sarah Beaver, physical therapist and (importantly!) a fellow Duke Blue Devil, Jamie Partain, a nurse from our NICU in Mobile, Francie Albertson, who is the warm and loving wife of Carl, and Micki, my sweet wife and the Ipad Piper of Kibogora for all the children (same as last year).  

Eight senior medical students gave up Match Day weekend celebrations with their families and a much easier last rotation of medical school to serve as internists (Meagan Pate, Joseph Sewell, and Carter Edwards), surgeons (Laura Jelf, Daniel Smith), and pediatricians (Anna Foust, Mary Margaret Clapp, Katy Lalor) to the Rwandan people of Kibogora.  Like last year, my confidence in the future of American medicine is greatly increased by observing the skills and love displayed by these individuals, who will only continue to grow as physicians as they enter their last years of preparation.  Already they have made a quick study of the system here and have plunged into caring for their patients with enthusiasm and thoughtfulness.  I have done my best to overlook the fact that almost to a person they are die hard Alabama fans.  Everyone has flaws.

Duane Baxter put it all together. He leads the Christian Medical Ministry, coordinates all of our travel plans, leads us to Rwanda and leads the spiritual emphasis of our group in the morning and evening gatherings, all the while keeping it real with a good sense of humor and many rewarding discussions.  The trip last year was his vision, and with Carl Albertson, Duane traveled three days in October 2011 to see Kibogora for 30 hours to be assured that the site could accommodate our group. 

Please pray for our health and energy, for safe travel for those already returning, and for continued opportunities to see God's hand on these children of His.

28 March 2013

See the team blog: teamrwanda2013.blogspot.com