The rain finally started tonight. It's been threatening for hours and the power was out earlier, but it just now started. It's been a few weeks since we had a good rain. I love the sound of the rain on the roof. It's very different than at home. Maybe because when it rains it pours here and for a long time. There is no such thing as a quick thunderstorm here. When we have thunder the entire house seems to shake. But the rain here is just big fat drops that pound onto the hard red clay and splatter everywhere. It's quite beautiful.
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Knitted caps by my neighbor from home, Aunt Randy
put to good use in the NICU. |
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Dr. Théogène showing a new ICU nurse and GP Dr. Oscar how
to check fetal heart tones on our portable ultrasound. |
Last week was a little bit of a whirlwind. Jet lag finally subsided and I was functioning on a fairly normal level although I couldn't remember what the heck day of the week it was. Vanessa has a surgical resident from UVA here, Rhett, and we had him and Jim over for dinner one night, which was a lot of fun and a nice change from our typical weeknight routine. I also started a more serious workout schedule, where I quickly learned that two weeks at sea level completely wiped out whatever extra red blood cells I gained in my first few months here. I was huffing and puffing with just a small workout. But I went to my first yoga class here with Stacey and Jeff and I really liked the instructor. Joseph is really excited to share the practice of yoga with anyone, so it was a very refreshing environment for a yoga class. I am hoping to make it a Tuesday night regular activity.
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These trees along the road to Kigali always
remind me of something out of Dr. Seuss. |
On Saturday we all made the drive up to Kigali to run errands and the most important one of all was picking up Rupert. At 15 kilos he's not much, but he's sweet, beautiful, kind, but knows to bark at strangers. Yes, we got a dog. We love him. He's pretty well trained, although terrified of the leash. We will have to work on that if we ever expect to take him for walks, but I'm sure that will come with time. Vanessa will probably stay for two years so she will keep him, but if she doesn't then we already have a good home lined up for him. We did discover the hard way that he tends to get car sick, so hopefully we won't have to take him on too many road trips to Kigali to see the vet.
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| So he gets car sick, but we got him safely back to Butare! |
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| Rupert |
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| Such funny ears! |
He is very happy and healthy though, so my fingers are crossed. It's nice to come home to a furry friend, but he's so skinny sometimes I feel like I'm going to break him! Sunday was uneventful, yet productive. I went for a quick bike ride up to the market to buy some carrots and rice and was able to spend the afternoon cooking and relaxing around the house.
Today started off with a bang. Rupert came into my room and cried about 5 am. Since I wasn't sure if he needed to go out I got up and took him out. Later I found out that he had come into all of our rooms and we each had done the same thing about ten minutes apart. Turns out he just wanted breakfast. We will have to do a little training about begging and waking up the humans when there is no intruder. Steph and I decided to be super fit and biked into work, which was a nice way to start the week. My staff always tease me though when I do this because my face stays pink for at least an hour after the fact. They find it so strange and funny at how red I get. Thank you Irish heritage. Anyway, the first thing I noticed when I walked onto the ICU this morning (this after I figured out how to access the unit as they've switched things around again due to the construction) was that all three of the patients from Friday were still there and somewhat stable! The second thing was that we had a little tyke in bed five.
Jacques was admitted Friday afternoon just as I left. I didn't know his entire story until this morning. Here in Rwanda the mothers tie their children to their backs and go about daily life as if they didn't have an additional couple of kilos to carry. My favorite is watching the women balance baskets of fruit on their heads while they have a child on their back. I don't know why, but it's just a great image. Anyway, Jacques is two years old, and was on his mother's back when they were struck by a vehicle. His mother died instantly and he suffered from traumatic brain injury. According to the physician notes and a discussion with Vanessa, he wasn't too terribly off Friday afternoon, but Vanessa immediately filled out the transfer forms for CHUK (University Teaching Hospital of Kigali) since our CT is still not working and regardless, we don't have a neurosurgeon on staff in Butare, only in Kigali.
Due to insurance issues he never left. He deteriorated until he respiratory arrested last night and was intubated around 10 PM. By the time I arrived on the unit at 7:30 AM, his vital signs were not looking good and I was worried, until I read the chart and examined him myself. Pupils were fixed, dilated, and there was no movement. Most likely his head injury progressed and he probably even had an intercranial hemorrhage and he was herniating, but we couldn't diagnosis it. Herniation, simply put, is when your brain swells too much. Due to our skulls the brain has no place to go during this swelling and starts to push down through the magnum foramen, or the hole where your head connects to your neck. As it goes, it compresses your brain stem, which controls your most basic functions and once this happens, you're brain dead. Jacques came into the hospital Friday awake. Now, he's brain dead. It could have been prevented were we just able to get him to Kigali. Or even have gotten a CT to make a stronger case for his immediate transfer to Kigali.
This Monday was a little bit of a reality check. I always think how beautiful a place I live and sometimes, it's easy to forget all the hardships, hunger, and death that occurs. But often, I just need to step onto the ICU to get my head out of my dreamy state. Sadly, it sometimes leads me to not appreciate and enjoy the beauty that surrounds me in my simple life here.
Lessons Learned:
1. Determination can save lives, but you have to be a special type of person to want to change the system.
2. Beauty is surrounded by hardship and vice versa.
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| Hitching a ride up the hill. |
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| Sunset |
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| Sunset |
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