Food, speciality care, sadness and success

The biggest difference in food here is that we rarely have dessert and only fruit which is very good. Familiar items include regular and small bananas which take two years to grow on trees, mango, limes, and pineapples. They have a small type of passion fruit and wrinkled plum. Breakfast is white bread with peanut butter if lucky, rice, bananas, and occasionally fried eggs. Most of the people I work with drink tea and not coffee, both of which are grown in Rwanda and surrounding countries. We eat lots of starches. Rice is almost always served as are potatoes in multiple forms. I have had a few French fries! Meat is usually beef cooked in a tomato or peanut sauce. Occasionally we have fish from lakes (ocean fish is too expensive) or chicken. Fresh peas are in season and good, though not as sweet as garden types in Minnesota. We’ve eaten carrots, cucumbers, tomatoes, onions and some green somewhat like cooked spinach. I’ve been eating only cooked or pealed vegetables and have had no intestinal infections.

Specialty and technologically advanced medical care in Rwanda is markedly different from the U.S. There are only four pediatricians in the country and they are attempting to form a residency program. Only on urologist and endocrinologist work here. There is one CT scanner in the country of eight million people and no MRI scanners. I estimate the service area of Mercy Hospital in Coon Rapids, MN, which has 300,000 people, has 5-7 CT scanners and 3-4 MRIs. Many patients are treated by their primary doctor or nurse as best possible. Many primary care physicians learn to do procedures such as C -sections and treat complicated conditions. Of course many people do not receive what we would consider reasonable care. Recently a teenager did have a CT scan of the head. A month earlier he had head trauma, loss of consciousness and expressive aphasia (loss of speech with retention of ability to understand). Seizures were also present. His CT was normal so we instructed the family in some speech therapy techniques and referred him to neurology for evaluation and an EEG. The neurologist apparently wants a psychiatric evaluation. I hope to receive some follow up, although it will likely be sketchy and the family will likely not have much to report.

I’ve been impressed by the interest of the medical workers at the refugee camps in learning more about diagnosing and treating their patients. Those who speak or read some English have shown enthusiasm about the books and information I have brought. Teaching sessions are well attended and the questions show an interest in learning. This week the staff and management at one camp decided to start work 30 minutes earlier so that they would have more time for learning. The nurses requested the French version of a World Health Organization (WHO) detailed guideline on evaluation and treatment of ill and malnourished children. I had the English version on my computer (free) and printed a book for them. After several tries I found and printed the French version. I am hopeful that this will help improve patient care. Last weekend a five year old died of malnutrition two days into starting treatment in our hospital.

This week I became aware that we have had several deaths and many patients with difficult and depressing conditions during my six weeks here. I should not over emphathasize these because there have been many more happy and successful outcomes. This week a four year old with fever, dehydration and coma was successfully treated with IV fluids and quinine for cerebral malaria and was sent home after four days of treatment. Several healthy babies were born to happy mothers, several cases of pneumonia recovered and we received and started the clinic’s first patient on antidepressant drugs.