Leaving Kibogora

The last days at Kibogora were a game of emotional twister--we were simultaneously wrapping up clinical cases (Dr. Albertson was still operating the night before we left), mourning relationships that would either end or become distant due to time and distance, dreading another 30 hours of travel, and longing for home with its emotional and physical comforts--seeing our friends and family, back to our familiar work and school environments, a bed with back support, AND            

                                                                        
                                                                      The Obsession of Certain Members
                                                                    


Things we will miss (not a complete list):

Our group--Carl and Franciie, Duane, Leanna, JC, Britni, Liz, Shannon, Melissa, Bryan (aka Duane), Luke, Cody, William, Brannon, Becky, Caroline (aka Carolina, Carolin), Micki and me--the meals together, Bible study led by Duane, Carl, and Becky at the Black House, lots of laughter and a few tears, sharing of frustrations, losses and victories;

                                                Gathering at the Black House

Games of Catch Phrase (spectator here), less than dignified dancing to Lion King (spectator again), watching nine people who had shared four difficult years work and play together; church at Kibogora Free Methodist with a 1000 of our closest friends,

                                                 Kibogora Free Methodist Church


JC Bataneni, our Congolese surgeon and friend, who is back at Nebobonga in the Congo, and Leanna, who is headed back to the northwest U.S. to continue training for her July marathon--she ran every day, using her GPS watch to measure distance.

                                                             JC and Leanna


 a day in Amsterdam;

                                            The Ladies at Grand Centraal in Amsterdam


Rounds on Destin and "Buddha Belly":

                                                                   Buddha Belly and Mom


sitting in the "internet breezeway" after rounds while being stalked by a local psych patient;

                                              Britni, Liz, and Caroline in The Internet Breezeway (with "friend")



early mornings looking out over Lake Kivu,

                                                      The View from Our Compound
                                                         
the walk to Kumbya Retreat,

                                                         The Road to Kumbya Retreat

The View from Kumbya

                                                       Micki at Kumbya Retreat

time at Good News Guest House in Kigali

                                                 Good News International Guest House

                             Back yard of Good News Guest House overlooking Kigali



Our night at Kinigi Guest House at Volcanoes National Park, gorillas trek stories, bus rides complete with "one lane chicken" provided by our driver** (see ** below)

The Congolese, Rwandan, and European staff members that befriended us and helped us feel welcome upon our arrival, and with whom we worked side by side for three weeks; especially Edi, our German friend who helped us "learn the ropes" even if "the sky was falling"; Jeanne Paul, the head nurse who always seemed to be able to get someone shipped to Kigali or Butare when they REALLY needed to go; Dr. Ngoy, our Congolese "pediatrician" with whom we shared three weeks of patient care and good humor, and Madeline, the Head Nurse on Peds, who "did not have good Eeeenglish" but always knew what we needed and provided it.

                                            Dr. Ngoy with Britni Bradshaw and Liz Donahue

                                          On the Pediatric Deck with Madeline, the Head Nurse

The patience of our patients--their most demanding moments were when they asked to go home; they were cooperative, accepting, and appreciative.

The beauty of our surroundings--every part of Rwanda we saw could have been made into a postcard for a tropical paradise (except for the road construction).  Lake Kivu and its environs were gorgeous--its too bad schisto kept us from being able to enjoy the Lake fully.

The national attitude toward a clean environment--Rwanda has a national clean up day ONCE A MONTH where markets are closed and everyone is expected to help make their surroundings more beautiful.  Litter was virtually absent--I saw one plastic bottle loose on the road and a couple of slips of paper in several hundred miles of driving.

Home made soccer balls:  children will find a way to play ball, and ball in Rwanda is football (soccer).  They tightly wrap dozens of plastic bags together and bind them with twine to create a functional, though slightly less than spherical, soccer ball.  Some of the guys on our team swapped them a real soccer ball for one of the local creations--wonder which one will last the longest?

Little kids with plastic water jugs perched on their heads--children in Rwanda are brought into the family work force early, helping to cart the daily water needs from source to home in dingy yellow jugs that they balance on their heads hands free.  The work ethic here is a necessity of survival.

Missionary midnight:  9 p.m.  The older ones of us were asleep by 9 each night or shortly thereafter.  We learned from the U.S. missionaries in Kigali that 9 p. was "missionary midnight".

Things we probably won't miss:

9 hour plane rides (x2) and (x2)

8 hour bus rides with a driver whose first two names must have been Kinyarwandan for Richard Petty.**

90 degree neonatology units

mosquitoes and the risk of malaria

patients for whom we had no answers

attack rats in our houses

houseflies and horseflies in the OR and L and D

tuna soup

power outages with a 15 minute generator delay

apathy and fatalism

stories of grenade attacks

reminders of the genocide

"Mazunga!! Give me some money!"

no portable xrays for babies

no ventilators for babies or adults


Both lists could go on.

God gives each of us unique opportunities in life.  We either avail ourselves of them or they pass us by.  They do not generally come again.  For that reason, I regret that I waited until age 62 to join a mission group.  At the same time, I am so grateful that circumstances brought us all together and gave each of us the opportunity to go to Kibogora.  Each of us might go again, but not on this trip with this group of individuals.  Part of the recovery from travel is jet lag, part is missing the group and adjusting to "normal" life back home.  I'm glad the most important member of the group for me (Micki) came home with me!!

                                                                             Micki
                                            On the Path from Compound to Hospital Kibogora

Kibogora Week Three

6 April 2012

--see also http://teamrwanda2012.blogspot.com

On Saturday most of the group walked to Kumbya Retreat, a beautiful, quiet spot on Lake Kivu owned by the Free Methodist Church since 1944.  While most went in the morning, Micki and I decided to go after lunch. By that time a large thunderstorm had covered the area, rattling windows with powerful explosions of thunder that followed closely on the heals of brilliant flashes of lightening over the lake.  Storms here come up quickly in this rainy season, often with an accompanying light and sound show, but most last only a short time and roll quickly on over the next mountain.  Those who did go to Kumbya either walked back early and were soaked or sought shelter on the porch of the house there and waited it out. All seemed to have been glad they went.

Sunday was not a day of rest. Just as we were preparing to leave for church, my local cell rang with a call for help--a small preterm infant with respiratory distress had been found in its incubator  with cyanosis and a dangerously low heart rate. There are no heart monitors, so infants often are in extremis by the time anyone realizes there is a problem. Dr. Ngoy (our Congolese friend) had bagged the baby back to viability by the time we arrived, but the infant could not  be sustained without intubation and ongoing positive pressure ventilation.  I intubated him to give all of us time to consider our options--continue bagging for days with only a glimmer of hope of success or stop right then and accept the limitations of life where we were (this infant has a 98-99% survival in our NICU's in the States). The group of students (really doctors for all intents and purposes except for a piece of paper) quickly committed to setting up a schedule to bag the infant during the evening and night, with the nurses to carry on during the day.  The latter part of our plan proved to be the undoing of the baby's chances, as just as the first folks from our team arrived the baby was discovered to be without pulse, a nurse sitting beside the baby, her hand not on the Ambu bag--she was unaware of what had just happened. William Perez gives a moving account of that afternoon in the group blog, teamrwanda2012.blogspot.com.

Unfortunately, the death of that infant was not an exceptional event. Infants with respiratory distress are placed on a nasal oxygen cannula with no means of assessing oxygen levels in the delivered gas or in the babies blood.  Without heart rate monitors and with inadequately functioning saturation monitors, no ventilators and inadequate numbers of staff to watch the babies, unattended deaths are not uncommon. There have been at least four since our arrival.

 On Monday afternoon we attended a stat c/section for a mother with a bleeding placenta previa (a dangerously low lying placenta) at 29-30 weeks gestation. We intubated the infant in the delivery room and then extubated the infant and placed her on a cannula with oxygen in the "nicu".   She weighed 1300 grams (about 2 pounds 14 ounces).  She did reasonably well until Tuesday night when a power outage stopped her oxygen concentrator from working--we went down to find her blue but breathing, with a saturation below 50 (acceptable is greater than 88 in a baby her age). Her father was at bedside and used his cell phone light to help us assess her.  After 10-15 minutes the auxiliary generator came on and she recovered her color.  We said goodbye to her dad and left, praying that the power, which goes out almost daily here, would be sustained until her oxygen needs were gone.  Early the next morning she was found without pulse or any sign of life.  Another infant with a 95+% chance of survival in our country had succumbed to the lack of support here. Lack of artificial surfactant, no mechanical ventilato, no monitors, and an unpredictable power supply were obstacles she and this delivery system could not overcome.

Early in the week, Carl Albertson, the orthopedic surgeon and our group leader after Duane's departure, was asked to see a one year old whose hand had been severely cut by a machete wielded by an slightly older sibling. The injury will require several hours of restorative surgery by Carl and his team, and months of recovery and rehabilitation will follow.  The injury was preventable merely by keeping dangerous tools out of the hands of children.  As I write this, Carl and his team are laboring to return that boy's hand to usefulness-- a critical determinor of his eventual ability to earn a living in this agrarian culture.

Children here are often left unattended at very small ages, something we noted while walking through local villages.  While driving here from Kigali it was common to see three and four year old children walking right beside the road unattended by an adult as buses and cars drove by at 50 mph. Life's value here, to many, is discounted.  The costs of risks are often not clearly counted except in the retrospective agony of injury or death. This rather pervasive attitude appears to be part and parcel of the apathetic and fatalistic view of life that an animistic culture produces.

On Wednesday Micki and I, with an afternoon free of medical activities, decided to walk to Kumbya Retreat with the hope of some quiet rest by the lake. The road to Kumbya is a dirt and rock road (mud and rock with heavy rain) that descends steeply from Kibogora, winding through the countryside, an occasional village, across one field of coffee beans, and down to an inlet to Lake Kivu, where Kumbya sits on a small peninsula.  The walk is about 3 miles, or in Rwandan distance, one to two hours, depending on how fast one walks and how many pictures of the beautiful countryside you choose to take.  No walking trek in Rwanda is taken alone, for children follow everywhere, often shouting "mazuka" and asking for money.   Somber adults speak if spoken to, and smile if they see you smile, some saying "good morning", no matter the time of day.  Children here are now learning English as the new official language so they tend to know more English than the rural adults, but everyone seems to know some form of greeting in English and/ or French.

At the retreat we watched the local boats going to and fro across the lake. They are dugouts, hollowed tree trunks that natives use for travel and fishing. Some came within a few yards of our waterside perch, their occupants waving and speaking if we acknowledged their presence, and laughing if we took their picture.  We did not swim, though the water is quite inviting-- the thought of contracting schistosomiasis, a common pathogen in lake soil and water with serious consequences for the liver, dampened any enthusiasm we had.

After a peaceful hour at Kumbya it was 4 o'clock and we headed back in order to return before dark; traveling at night on foot on the rural roads is not recommended for expatriates-- for all manner of reasons.  We decided to take the local's short cut across a field to shorten the more laborious trip back up to Kibogora.  We did not know that path involved walking across a rapidly flowing, muddy stream on two flattened logs with nothing to hold onto. Micki hesitated a moment and calmly walked across. I didn't.  I stood paralyzed, knowing a muddy dunking would make travel back very uncomfortable and would almost certainly kill Carl's cellphone, which he had loaned us for the walk  (we had excellent cell coverage the whole time).  A Rwandan woman, quietly amused at my indecision, walked over, took my hand, and without a word led me across.  When I thanked her she smiled shyly and walked on, her good deed done and my ego only slightly dinged.  What she did for me--taking my hand and showing me the way with quiet confidence and humility--is a template for all believers.

Someone offered us a hand in our walk of faith, perhaps knowing we were having a difficult time taking that first critical step.  Our vertical relationship with our heavenly Father  and our human relationships both involve a hand reaching out in humility and a hand grasped in gratitude. St. Paul said that the greatest attribute in life is love (1st Corinthians 13). No other accomplishment can take the place of love; all of our best put efforts added together are a "clanging (worthless) cymbal" if we lack love.  Agape' love, unselfish, other-motivated, selfless love begins with the hand of Jesus reaching to us, and continues as we reach out and share Him and His love with others.

Everyone on this trip has been frustrated by inadequacies--sometimes by the facility, sometimes by the attitudes, sometimes by our own shortcomings, sometimes by the obstacles put before us here.  But, as Oswald Chambers said so eloquently in My Utmost for His Highest, God does not give us overcoming life, he gives us life as we overcome--the struggle is part of the process of maturation and without it we would not grow closer to Him or to each other.  Gratitude, Obedience, Dependence is the acronym of a whole and holy life--taking His hand, offering our hands to others, and letting Him be responsible for the results.  Kibogora--the hard working Rwandan and Congolese physicians, the staff who labor under unfavorable work circumstances, the patients who wait in stoic patience for their care, the limitations of the hospital's infrastructure, the very remoteness of its location--is a lesson in offering what is possible and letting God be in charge of the outcome.