Traveling Back Home

  Well,  I am now in Amsterdam Airport on my way back home.  Land in Atlanta tonight, staying with Josh then off to the parents' house tomorrow.  Finally back to South Bend on Monday.  As I think back on my time in Rwanda, it was one of the most rewarding experiences of my life.   I just now that this has been I really life changing experience.

I haven't updated in a while, so I will try to summarize some my travel over the last week.   I took the public buses up to Musanze.  These are like big charter buses, not the most comfortable.   However, it only about $3-4 for the 2 hour trip.  I trek the gorillas at Volcanoes National Park.  The Mountain gorillas can only be seen in 3 countries (Rwanda, Uganda, and the DRC).  Rwanda has the largest population.  My driver was able to get me into the trek for the Susa family.  The Susa family is the largest of the family, and the family that Diane Fossey lived and studies.  The trek to the gorillas was very difficult about 3 hours up the volcano through thick vegetation and nettles.  However, it was well worth it as you get to spend an hour with these amazing creatures.  We were so close to them often just among the group.  Occasionally, one would try to come up to touch you and run by and try to slap you.  However, the guides rightly so discourage this behavior as we share so many genes with the gorillas our diseases can easily be passed to them.  The pictures are just a small sampling of what I was able to get.

  My next day was spent in Kigali, which is the cities capitol and largest city.  There were so many people here is was hard to believe where they all live.  Kigali is fairly higher tech and much more Westernized than the more agricultural rest of Rwanda.  It is always a reminder that you are still in Africa when you have to pass security guards armed with AK-47s to get into the bigger stores and the banks.  The best way to get around Kigali is the Moto-taxis which are motorbikes.  It is nice that the government requires them to provide you with a helmet.   I was a little skeptical at first, but seeing as a car taxi is 5-7x as much I ended up taking them everywhere. 

 

The next day I went out to Akagera, which is in Eastern Rwanda on the Tanzanian border.  It is more like a traditional safari park.  Unfortunately, after the events of the genocide and the aftermath and poachers the big cat population is extinct in the park as are the Rhinos.  However, I did get to see giraffes, zebras, tons of different antelope, hippos, and crocodiles.  Unfortunately because of the heat, we didn't find the elephants.  Also, my memory decided to fry and a lost about half of my pictures from Akagera.  I had already downloaded the rest of the pictures onto my computer, so at least those were safe. 

Yesterday, I spent in Kigali and went to the Genocide Memorial.  It was very good and definitely a must see if you are in Kigali.
  Though after 5 weeks, it is definitely going to be nice to get back home to the regular events of everyday life.  It is truly amazing the little things you take for granted until you don't have it.  Like reliable internet, a cell phone, DIET COKE and DIET MOUNTAIN DEW, nice easily traveled roads. 
  For a first experience in Africa this was definitely a great one, and I will definitely have to do this again.  Though I don't think I am the type that is cut out for long term mission work, I could definitely see myself doing more trips like this in the future.  So ends this chapter of my mission experience.  The first, but hopefully not the last.  I leave you with one last picture of the beautiful sunset on Lake Kivu.

Almost Finished

I can't believe how time flies.  My last day at the hospital was today.  Tomorrow I head back to Kigali to catch a bus to Ruehengeri.  Monday morning I am scheduled to go on my gorilla safari.  I am extremely excited, and how to get lots of good pictures.  I am going to hang around Ruehengeri Monday night and Tuesday morning.  Then is it back to Kigali.  I plan to spend Wednesday around the capitol.  Then Thursday I am going to Akagera National Park, which more of a traditional style safari.  Then Friday I hand around Kigali for the day, and then fly out that night to begin the very long 4 day trip back to South Bend.

Picture of the other doctors and me on my last day.

Sorry I haven't been able to update as much I would have liked.  The internet here is spotty at best and goes out quite a bit often for days at a time.  Well, if you expect reliable telecommunication, Rwanda and much of Africa is not for you.

Most of the women carry things on their heads.  It is amazing what all they carry.  Each of the clay tiles weighs about 5-7 lbs.  Probably more amazing I don't have  a lot of people come into the hospital complaining of neck pain.

Here are some of the tea fields.  Rwanda is a big producer of tea.  The women pick the tea leaves and carry these huge bushels on their heads.

  My time here has been unbelievable.  The people are extraordinarily friendly.  Though I still am not use to the parade that follows anytime I go out in public, I have learned to tolerate it.  I have enjoyed my time at the hospital so much.  It has really helped restore my love of medicine.  Patient are so extremely appreciative.  I feel like I have truly made a difference in the lives of some of the people here in my short time.  I only prayer that I have been able to help in ways that will last after I am gone.
  My time here has allowed me to not only grow as a doctor and person, but I feel I have probably grown the most as a Christian in my time here.  It is amazing how much time you have for prayer and personal reflection without high speed internet, T.V., etc.
  I hope to be on later tonight (morning to afternoon back in the States), but we will just have to see how the internet goes.

Goodbye for now,
James

Last Week

Hey Everyone,


Sorry for the long time between posts.  It has been storming here for the last week, so the internet has been out for days, so I am back to using the mobile internet.  So sorry no pictures this time.  I can't believe that it is already my last week.  Time has flown by.  I just hope that I have been able to make some lasting changes in the hospital.   I did freak out a little today when the doctor overnight had put a 3 week old with pneumonia on IV aspirin.  
  There are many things I will miss about Rwanda.  The amazingly nice people.  I will also miss taking care of patient with true disease instead of things that they did to themselves.  I will also miss seeing the unrelenting faith that they have despite poor health care and lack of nutrition.  
  There are definitely some things I will not miss.  I can't wait to get back to the land of high speed internet.  I really did not realize how dependent on it I was.  I actually have not missed having a cell phone, which has been a surprise for me.  While "Africa" time was funny at first, it has gotten more frustrating as my time has gone on.  However, probably the biggest thing I miss about the U.S. is having my personal space.  People really just don't care about personal space issues here.  People love to hug and grab on you or try to hold you hand.  As most of you know, I am not a touchy, feely person, so I enjoy it when people respect the personal space.
   I did see the funniest thing the other day.  It is not uncommon for two men to be holding hands when walking especially teenagers.  However, yesterday I saw two the military guys with their AK-47s on their back holding hands.  It was the funniest thing I have ever seen.  I wanted so badly to take a picture.  However, I didn't feel like going to Rwandan jail.

Hope all is well,
James


"Not so with you.  Instead, whoever wants to become great among you must be your servant, and whoever wants to be first must be slave to all.  For even the Son of Man did not come to be served, but to serve, and to give his life as a ransom for many."  Mark 10: 43-45

Amazing Day

This is the view over looking the hospital.  How would you like to see this everyday?

  It was a very good day today here at Kibogora.  Since being here I have hoped that I am doing some good and making a difference, but today I really felt it.  The first patient I saw this morning on rounds was an 18 year old student studying pre-medicine who was admitted last night with fever and headaches.  I took one look at the kid and said this kid looks like he has meningitis.  I gave him a dose of ceftaxime (that is the only cephalosporin we have) and a dose of dexamethsone.  Sure enough his lumbar puncture was positive for gram-negative intracellular diplococcus.  For those of you that don’t know, that is nesseria meningitis, which is one of the most contagious and if not caught in the first 24-36 hours deadly bacteria there is.  He is doing well now.  Unfortunately, now we are concerned because these kids live in dorm room of like 50 kids to one big room.  I am praying we don’t have the start of an epidemic. 

 One of the missionary nurses just left, and this Saturday the nurses from the hospital threw her a party at one of their homes.  This would be a tradition Rwandan meal.  It has fish, notice cooked head, scales, and all; noodles, fried bananas, rice, some kind of beef, and a soup/gravy.

  

Later on I saw a patient that I had been trying to convince the other doctors here to start TB treatment since I arrived.  See even though she was a 20 year old with fever, weight loss, and hemoptysis and was still spiking fevers despite 4 different antibiotic trials, she was not able to produce any sputum.  Their national protocols do not let them start TB treatment without positive sputum.  However, last week after my continue persistence we started treatment.  She has been fever free for 3 days and is starting to look a little better.

Just another view of the beautiful Rwanda countryside.

  Finally one of the last patients I rounded on today was a young female who was 6 weeks post partum.  She came in complaining of fever, throat pain, and weight loss.  She had been tried on antibiotics for strep throat as well as anti-fungals.  The doctors had demised her as a psychiatric problem because they felt she was faking because she didn’t want to go home because she had no father to support her and her new baby (not that is completely unheard of here).  However, when I looked at her chart I saw she was still spiking fevers up to 40 C.  I felt that something just wasn’t right.  I ended checking a chest x-ray just because of the fever even though her physical exam was normal except for her being very thin and having a slightly enlarge liver.  However, after 3 weeks here I am convinced almost all of Rwanda has enlarged livers.  Her chest x-ray looked exactly like miliary TB.  This is a very aggressive form of tuberculosis for those who have never seen it.  She is now on TB treatment, and her six week old baby is on INH prophylaxis to hopefully keep him from getting it.

View of sunrise through the rain forest where we saw the chimps.

  As if this wasn’t enough, I gave a lecture yesterday on EKG and common heart problems.  I was trying to correct some of the improper treatments I had seen of patient with hypertension and congestive heart failure.  Today one of the doctors called me into the emergency room to help him look at an EKG.  He had correctly diagnosed the patient as having decompensated heart failure.  He had already given Lasix with potassium.  He had already talked about starting her on an ACE Inhibitor and then a beta blocker when she was feeling better.  He never even once mentioned giving her digoxin, and he had read her EKG complete right.  I was so excited.

  So all in all, it was an amazing day today.  I really felt like that work I am doing is helping people.  Hopefully, I am able to make some changes that will last even after I am gone.  I am so glad that God has given me this amazing opportunity.

 

Great Weekend

   This weekend I went to Nyungwe Forest, which is the rainforest in Southern Rwanda.  It was a beautiful place.  We went to track the chimpanzees.  It was probably the hardest hike I have ever done.  It has rained a lot here, so the path was very slippery.  I was about an 11/2 hours hike to the chimps all down hill in the mud.  When we got there, there were 3 female chimpanzees and a baby in the tree. It was so amazing to watch these creatures in their natural habitat.  Unfortunately, they were high up in the trees, so the pictures didn’t turn out that well, but I did put up a couple of them.  However, the highlight was as one of the females swung from tree to tree and down.  The baby then followed her.  Talk about an amazing thing to witness.  Then trek back took about 2 hours and was uphill almost the entire way.  It was very tiring, but well worth it.

 

      

 

Today was a very hard day on the floor.  We were short on doctors today, so I rounded on both pediatrics and internal medicine.  It was a very long day.  Internal medicine rounds took forever because I am pretty sure about 80% had the complete wrong diagnosis and/or treatment.  Lots of changes and trying to explain my rationale made for a very long day.  However, I feel like I am getting more use to my role here.  I am trying to help the best I can.  I pray from patience from God everyday because we all know that is not one of the things he decided to bless me with.  However, I have been here 2 weeks and haven’t even raised my voice once.  I know my nurses will find that hard to believe, but God can truly create miracles. 

     This experience has been such a blessing for me.  Everyday at home, it seems that I try to help people that could care less.  I have heard “Murakoze”, which means thank you more in 2 weeks here than I have in 3 years of practicing medicine in the states.  Here it just feels like I am actually making a difference in people’s lives.  It has been an amazing experience.  I have definitely been bitten by the missionary bug, and I hope I can continue to do this again and again.  I can’t believe I only have two weeks left in the hospital. 

 

This is Kumbya, which is a retreat on Lake Kivu.  Lake Kivu is a large lake between Rwanda and Congo.  Last weekend I got to go here. 

Pictures

The hospital internet is working, so I can finally download some pictures.  

This is the view looking back at Kigali the capitol city.  I was quite surprised at how big it was.

On the drive from Kigali to the hospital there was a monkey on the road.  Now that is something you don't see in America.

How would you like to be able to practice medicine with this view.  Rwanda just may be the most beautiful place I have ever been.

 

This is the view of the hospital.  All of the blue tin roofs are the hospital buildings.

There are some pictures.  It takes a while to upload, so only a few at a time.  Things are going very well here.  I am getting much more use to my role in the hospital, and the way things work or sometimes don't work here.   This weekend I am taking off, and I am going to Nyungwe Forest to see the chimpanzees.  Super Excited!

Getting Use to Practicing in Africa

Thanks for all the words of support.  It has been to feel so disconnected from everyone.  I can't imagine how missionaries felt before the internet.  I am getting more use to the hospital everyday.  I have learned so much in such a little time.  I have seen things I have only read about in  books.  I have already seen 3-4 cases which I would consider writing up in the states.  It is amazing how much unique pathology there is here.
  It astounds me how accepting of death their culture is.  They don't even name their children until 8 weeks of life because there is such a high infant mortality rate.  While I have lost more patients in my week here than I will in 6 months in the states here, I do feel that I can make a difference.  I have been working mostly in Pediatrics and in the NICU.  Sometimes I have no idea if I get the right story from the patients by the time it is translated form Kinyarwanda to French then to English.  However, the native doctors seem happy to have me here and consult me quite frequently for opinions on cases. 
  The staff is so amazing.  I have someone that cooks 3 meals a day for me plus cleans and does laundry.  Sometimes I think that is a bit of overkill, but I try to remind myself that I am providing someone with a job that might not otherwise have one.  Unfortunately, it has been raining and storming here, so they haven't been able to get the broadband up, so no pictures yet but hopefully soon.  Every time it storms, the power goes in and out.  This adds a whole new challenge to resuscitating a 30 week premie when the power goes out, so you have no oxygen.  
  Saturday afternoon I got to spend some time at Kumbya, which is a cottage on Lake Kivu.  It was absolutely beautiful and so peaceful.  I went to church on Sunday.  The singing was wonderful, however, I didn't understand a word of it.
  Everyday I pray for God to provide me with answers to questions I don't even know to ask. 
I hope everyone is doing well.
James