Field trip to a hospital

At 6:45 this morning, my housemate Andrew and I stepped out the tin gate in front of our house and walked up the road to one of the main teaching hospitals in Kigali. One of the doctors at Project San Francisco, Fidele, had previously invited us to the hospital morning meetings where the interns and some medical professors get together to discuss complex cases from the previous day. I was ecstatic to get down and dirty with medicine, the Rwandan way.

As we entered the conference room of the hospital, the first thing I noticed was that the dress code is pretty lax. One of the doctors was wearing an Obama t-shirt (woot woot), jeans, and Converse sneakers. He donned his white doctor coat and stethoscope but apart from that, he looked like anybody else on the street. I kind of liked that.

The meeting began a little late, as expected, but it was all in French. Andrew and I were not prepared for that, as President Kagame proclaimed Rwanda an English-speaking country last year so that it could join the East African Community. All professional organizations were required to speak in English, not French. But for some reason, the teaching hospital had not yet converted. Neither of us speak a lick of French so we spent the entire session staring at the wall and trying to figure out what was significant about the the x-rays of a patient’s hips at which everyone was enthusiastically pointing and chattering. We finally gleaned from a few words that sounded like English (e.g. parapleeej)that the woman was a paraplegic. That’s as far as we got. Boooooo.

After the meeting was over, a very kind intern named Gloria invited us to come on rounds with her. I jumped out of my chair and told her to lead the way. She led me to the infectious disease wing of the hospital, introduced me as “Dr. Eliza” to some other residents, and promptly left. I got red in the face by this false introduction and quickly explained that I’m not even in medical school. The residents were really confused at first but soon dropped the subject and proceeded to explain to me in their best English what they were doing: visiting each patient’s bed and going over the case with the endocrinologist, a very brilliant but severe looking woman of about 40. I sort of hid behind one of the residents every time she spoke because I was afraid she would ask me a medical question that I wouldn’t know the answer to (she still thought I was a doctor or medical student of some sort).

When the doctors were speaking with the patients in Kinyarwandan, I took time to fill my senses with my surroundings. I noticed the paint chipping from the walls and ceiling, little lizards freely roaming the walls and catching mosquitoes with their tongues, flies buzzing around the head of some of the patients whose eyes were downcast so they didn’t seem to notice or care. Little yellow bottles of liquid sat on the floor by many of the beds, which I presumed were water bottles or a nutritious drink. The patient beds stood concave, barely supported by the thin metal frame, and the mattresses weren’t more than two inches thick. There were no curtains, much less walls, separating patient beds. In fact, patients were so close that they could easily hold hands. I chuckled to myself as I thought about patient privacy laws in the US. In the most densely populated country in Africa, privacy is not an option. I then thought about how we were in the infectious diseases department, and how this hospital could possibly prevent something like swine flu from spreading like wildfire in that environment. I suppose they didn’t suspect that any of the patients I saw today had anything that required isolation. At Children’s Hospital Boston, we would isolate a patient immediately if the doctors or nurses even suspected flu, TB, Respiratory Virus, MRSA, etc. There were several patients in the ID department today who were HIV + and had TB. They were resting no more than 2 feet away from the next patient who was also immunocompromised.

As the doctors consulted with each other in French, I made a list in my head of the things I would want my money to go to if I were to donate to this hospital. I first decided that I would not spend the money on repainting the walls, getting privacy curtains, exterminating the lizards, flies, or mosquitoes (they don’t usually carry malaria in this part of the country anyway), or getting new, comfortable patient beds. The patients at this hospital are accustomed to those surroundings, as it is similar to their home environment (I’ve seen them). I once overheard a Rwandan lady in a coffee shop say to her friend that all her life she was so accustomed to sleeping on a thin, hard mattress that when she moved to America and slept on a big fluffy bed for the first time, she hated it. So anyway, if my donations would not go toward aesthetics or things that I would consider comfortable, I would want it to go toward investing in hand sanitizer (they don’t seem to abide by the whole washing hands in between touching patients to minimize disease transmission thing), more advanced medical equipment (they were going to have to send one woman today to Uganda's capital, about 9 hrs away by bus, to do a catheter angiogram to rule out a brain aneurysm), and bedside chairs so that family members can sit with their sick loved ones.

I think it would also be cool if they had some sort of way to boost patient morale. It’s hard to not feel depressed when you’re sick, but the patients I saw today looked like the life in their eyes had been sucked out. I don’t know what in particular I would invest in to change this part, but I think something like Child Life which they have in the US is much needed in pediatrics. As for the adults, I’m not entirely sure what would be culturally appropriate but maybe having a local choir come in for a concert would be nice. Or perhaps having potted plants and flowers that patients could take care of would be meaningful. I’m really at a loss at this point but I hope to come up with a practical idea before I leave here. So if anyone reading this has any suggestions, send them my way! I’m open to any
ideas you may have! Also, all Rwandans have mandatory community service one Saturday a month, so maybe I could elicit a church choir to perform then (everyone here goes to church so there’s no risk of cultural insensitivity).

Okay, off to bed. No photos because it’s too depressing. Thanks for all of your emails/comments! You all are wonderful support!