Old Habits Die Hard

Everyday as I walk to work, I encounter a good number of children on their way to school, many of whom use their latest lesson in English to engage in a simple conversation with me. “Good morning”, “How are you?”, “Give me my pen”, “Give me my book”, these are the daily questions and commands I get from children as I walk around Shyria. Regardless of what time it is, I am always greeted in English by, “Good morning, how are you?” When I answer this question to a group of little girls or boys, they often smile and run away talking quickly amongst themselves. I was told that many of the teachers’ first lessons in English instruct the kids how to ask for school supplies or money from foreigners. This is no surprise, because some kid demanding I give him his pen usually confronts me as I walk to the hospital. I always slowly inform them that I do not have their pen and that I’m sorry, I don’t have an extra. The policy here in Shyira is that none of the volunteers can give money, food, or any other items away because it would cause problems and perpetuate an image that the doctors are really trying to shake. Although it would be nice to occasionally had out a couple sheets of paper or give a pen to one of the children, the fact is that there is no way that we can meet the demand of the entire school, and thus a simple act of kindness sparks an onslaught of jealousy and begging.
Mazongo is a term used by the Rwandans to indicate a person of wealth. I initially misinterpreted this as a racial phrase, but was clued-up to now know that it is given to any Rwandan or non-Rwandan that has a lot of material goods. The people here openly refer to all white people in Shyira as Mazongos, both to our face and in conversation between each other. I have had a hard time dealing with this even though I know it is not derogatory. As I walk with the doctors or alone, I hear Mazongo said between friends as they approach, and both parties smile and wave as we pass. I have tried to use some Kinyawandan, saying “Oya, Mazongo” (No, Mazongo), but this does nothing. It is a name I will learn to live with and I am now sure that I will never be able to shed the stereotype of being a white person in a lab coat, which is fine.
There are some customs that would be very difficult to pick up on, and I am sure that I have many more to learn. My latest humbling moment was when I realized that it is very rude not to walk your guest down the road when they leave your house. In the States it is good manners to see your guest to the door, wish them a nice evening, and that’s that. Here it is proper form to walk some of the journey home with your guest. When my French teacher hangs around my door for a moment after my next lesson, I now know to accompany him part way on his walk home.
One example of a deeply rooted practice is the fact that many people will take their sick ones to a traditional healer before coming to the hospital. The cause of all death and disease is poisoning by your enemies, a belief still held my many in our community. Older people stare at me as I walk from one house to the next carrying food for an evening potluck, because the potential of the food getting poisoned from those who want me dead is very likely. Today at the hospital I encountered the first death due to this mindset. A man with acute meningitis was admitted only 3 days ago. As his eyes danced wildly around the room and his shrunken body hardly resembled a man in his late 20’s, his loved ones told us that the healer had determined he was poisoned because he threw up after given the testing concoction. Immediately taking some spinal fluid to confirm the meningitis and giving him strong antibiotics, we thought we had a chance to combat this late stage infection. Yet this morning I was informed that this man had died last night, alone in isolation, because he did not receive care soon enough. As I sat in on the consultation with his family, the doctor informed them that whenever they thought someone was “poisoned”, they should bring them to the hospital. Although it was hard for me to see a family that had just lost a loved one who was in the prime of his life, I hope that they will tell other families to come get true medical attention when a family member is sick.
I love Shyira and the people so far, but there are some difficult aspects of this change that I am still adapting to.

Patching It Up

I awoke on Sunday morning to the sound of knocking at my door. Quickly glancing at my watch, I squinted a little when it read 5:42 am. I opened the door in my boxers to see Dr. Kohls looking alert and ready to go. “Do you want to assist me in a cesarean?” He asked me. Without thinking I quickly agreed. I put my clothes on, chugged a glass of water, and ran out the door.
I walked briskly down the dirt road to the hospital with Matthias contemplating my ability to stay on my feet for this procedure, as it was the first one since my little episode on Wednesday. We entered the changing room and the both of us put on our scrubs without exchanging any words of encouragement. As I entered the OR, the nurses put the sterilized
Surgical gown on me and I immediately washed my hands and put the two sets of gloves on. The woman had been in labor for almost 15 hours now and it was apparent that this baby wasn’t coming out on its own. After arranging his tools, Dr. Kohls made the first incision and we never looked back after that. My surgical masked drooped slightly about 10 minutes into the procedure, and I beckoned on of the nurses to help me out. Matthias immediately thought I was going down, so stopped everything to make sure I was okay. As I turned back around he smiled and said that I had given him a little scare, but I assured him I was feeling great. The baby came out great and we started to patch the mother up right away. Matthias give me the honor of doing the final stitching, which I did very carefully and enjoyed immensely. My confidence was back, and although it was only 7:00 in the morning, there was no way I was going back to bed.
I am now working with Dr. Louise King, an Internist here at Shyira, and the wife of the director of the hospital. Although this differs greatly from the OBGYN, I really enjoy the problem solving aspect of internal medicine, and I hope to learn a lot about her daily routine in the following week. The weather is getting a little wetter, but the sun still comes out for a good portion of each day. I start my French lessons today and I hope I can get to a level where I can have a simple conversation with the children before I leave. Thanks again for reading and I hope to get those gorilla pics up in the near future.

Down For the Count

I am continuing to work with Dr. Kohls, but before I have a chance to beat around the bush, I have something that I have to get off my chest. I fainted outside the operating room. It was perhaps the most embarrassing experience I’ve had in a while, but I was assured I was not the first person who this had happened to. Earlier in the day I saw some very sick patients and scrubbed in for a whole cesarean section. I found these cases all interesting and wasn’t getting uneasy in the least bit as usual, but when I got in the OR to help tie the tubes of a 26 year old with 6 kids, I slowly walked out of the room, sat down, and then a minute later I was on my back with my feet propped up by one of the nurses. I was only out for a second or two and I hear this happens to a lot of medical students, but still! Here is how I justify this occurrence to myself: I had been on my feet for a while, I didn’t eat much for breakfast, and I was fairly warm in the OR. However, I still fainted 5 minutes into surgery and now I feel like a sucker. I offered to stay on call tonight so I can redeem myself, I’m still nervous though.
On a better note, I returned from seeing the mountain gorillas today and it was a great experience. I saw the Susa group with 7 other people who were visiting Rwanda from a variety of home countries. After an hour and a half of strenuous hiking up to the Volcanoes National Park, our guides radioed the trackers and we had only another 15-minute walk to see almost 20 gorillas eating, playing, and socializing. It is hard to put into words how sweet this was. They paid very little attention to us and I was able to take many photos and a couple movies of them jovially interacting with each other and occasionally beating their chest to display their high spirits. The silver back leader of their group did not intend on staying in one place for two long, so during our hour-long encounter we were obliged to slowly follow them through the dense forest of the steep volcano. We had two armed guards with us at all times protecting us not from the Rwandan Mountain Gorillas, but from the Congolese Rebel Guerrillas. The volcano is on the Congo, Rwanda boarder and there is a lot of political unrest at the moment, which has greatly affected the Gorillas living on the Congo side. The whole experience of the mountain gorillas was exactly what I hoped for, and I would recommend it to anyone coming to Central Africa. I plan on staying in Shyira for a bit now and am looking forward to a little R & R.

Back to the Grind

I started at the hospital and am currently shadowing Dr. Matthias Kohls, a German OBGYN. The doctors here are very eager to explain everything, which is nice because I ask questions about every 30 seconds. In the morning of my first day, I had the experience of examining the cervical dilation of a very pregnant lady. I came to Shyria to learn and do things I wouldn’t be able to do in the United States, but I had no idea I would be learning Gynecology right away. Although I was a little uncomfortable trying my hand at this, pun intended, it soon faded and my confidence rose as I saw more and more patients. Each day as we make the rounds through the maternity ward, we use a portable ultrasound machine to see how each pregnancy is coming along. As the doctor explains the anatomy of both the baby and the mother using these images, my time studying the MCAT material helps me to understand what is going on.
This past Friday, I saw my first birth and couldn’t help laughing a little when Matthias yelled, “Full armor!” As I soon witnessed, the apron, boots, and goggles were very necessary. I am really enjoying working in the maternity ward and am glad this is where I started. I hope to jump over to Pediatrics in the next couple days so I can get a nice chronological trend in my learning here at the hospital.
I headed down to Kigali today to pick up tickets to see the mountain gorillas on Friday, as well as accompany 6 child patients traveling to see a Pediatric Cardiologist. Most of the doctors in Shyira are expected to go outside their specialty due to the lack of physicians on the rural hill, so to see a specialist working in the city was exciting. Some of the children were cleared with conditions that would not require surgery, while others will have to wait for two Australian surgeons to fly in to remedy their conditions. It was a long day because we had to leave early and I had very little room in the crowded car on both legs of the 3-hour trip to Kigali. I can’t wait to see the gorillas and travel a bit, so I hope my next post will have some great pictures.

Arrival in Shyira

Dr. King and I arrived in Shyira last week just in time for the pizza dinner put on every Friday. At dinner I met the Kohl family, who are here for a year from Germany, Caroline, a New Yorker working in the hospital and soon attending physician assistance school, Stephy, another German, who is taking a gap year after high school to home school the Kohl children, Martin, a carpenter from Germany, and the parents of Louise King, here to offer their services as doctors for a week. Although I was happy to finally meet everyone and be in once place for a while, the 9 hour time difference was still taking its toil and I went to bed very early to unfortunately wake up very early.
The sunrise at Shyira is incredible; the light slowly creeps along the mountainous terrain exposing the lush, green vegetation of rural Rwanda. As the people begin their day by walking up the steep hillsides to fetch the water found near the top, the cool, thin, air allows the routine to go about comfortably. I have been working with Martin on building a community center, a project he has overseen for the entire 5 weeks he has been here. The foundation and walls of the fairly simple building have been completed just recently, so Martin constructed the rafters to hold the roof in place, a very necessary addition as the rainy season is quickly coming upon us. We have now completed 2 of the 6 rafters and only yesterday did we have the necessary manpower to put these gigantic wood structures on. While I enjoy the manual labor, it is difficult to help due to the language barrier. I unfortunately do not speak the local tongue Kenyawandan or French, but a smile and a helping hand goes a long way. Martin left today to Uganda and so I begin my work at the hospital tomorrow, working with Dr. Kohl in the maternity ward. As a practicing OBGYN, I am looking forward to learning a lot from him and seeing how Rwandans are brought into the world in Shyira.
I am so far enjoying this place a lot and although my meals consist of mostly rice and beans and we only have electricity 2 hours a day, I have found a lot of time to get to know some great people and enjoy some reading. The doctor’s kids are great and I have had a blast playing with them from time to time. I can’t wait to start shadowing in the hospital and it seems like the doctors are ready to show me as much as they can. I apologize for the lack of posts; our generator and satellite were down for a couple days. Thanks for reading and I hope to keep this up.