"Because every child deserves a smile"

Yesterday was my third and final day in Nyamata, and it was expected that my group would move on to another district hospital in Kibagabaga.  However, our primary contact in Nyamata was scheduled to be out of the hospital today and asked that we skip his hospital until next week (they only have a total of ten doctors, and we only worked with 3-4 of them while we were there).  In an attempt to sort out the dilemma and make things fair for students, we were sent to CHUK instead (I already had two days planned at this university hospital next week).  This shouldn’t have been a problem given that the hospital is larger than Nyamata and Kibagabaga combined, but this also turned out to be the day that 6^th year medical students had their oral exams… which were being proctored by many of the doctors.  When we arrived, half of the group headed to peds, and my half of the group headed to internal medicine.  We had contacts in each, and it sounds like the peds morning moved along as expected.  However, when we finally found our contact in internal medicine (a resident from Yale), we learned that the normal morning meeting had been canceled and rounds postponed due to the testing.  He gave us his number and told us to call him if we couldn’t find anything else to do, but we were basically on our own.  I’d say we got a decent lay of the land as we wandered aimlessly looking for doctors willing to show us around, but we eventually gave up after being turned away from the surgery department (they still had their meeting, and they weren’t all that pleased that we walked in on them).  Having heard of a group of Americans in Kigali to repair cleft lips and palates for a couple weeks, we set off to find them in a corner of the compound. 

The Alliance for Smiles is essentially made up of retired plastic surgeons and nurses (and non-retirees as well) who travel to developing countries setting up multiple clinics each year.  They’re a great bunch of people, and we had learned from the previous CHUK group that they loved to chat if you had the time.  However, we also learned that they had run into trouble finding patients, performing just a few operations the past two days (a really tragic situation when spending tens of thousands of dollars to essentially fly in your own OR).  Thankfully, we arrived at their ophthalmology-turned-plastic surgery building to find a congregation of patients and family members waiting outside.  The staff were in especially good spirits when we met them, and they brought us right in to see the first patients (after tossing us hair nets, masks, and booties).

The OR had two beds, with a team consisting of a surgeon, anesthesiologist and nurses at each.  While one bed moved relatively quickly through cleft lip cases (all babies this morning), the other prepped for a facial reconstruction on a noma patient.  The operation was scheduled to take 4.25 hours, and I believe they used all of that (and possibly more).  For those fighting off the urge to click on my hyperlinks (right click, open in new tab), noma is an infection that essentially leads to destruction of the face and mouth.  It’s rarely seen in developed countries, but it’s still an issue in sub-Saharan countries like Rwanda.  In the case of our 13-year-old patient, it was clear that a large portion of her mouth and nose had been eaten away (and then reformed improperly with scar tissue).  It was a discouraging thing to see, but Dr. Z, an arthritic plastic surgeon with a bark worse than his bite, did a great job.  After twisting and bending my back for four hours in attempts to lessen the pain of constant standing, the patient had a face again.  She’ll still need reconstructive surgery for her nose on another date (which probably won’t happen), but it looked as though the biggest step was complete.

No one knew that this group would be here for the two weeks that overlapped our time in the Rwandan hospital system (or that we’d find a resident from Yale over here for that matter), but some things just work out better than you’d expect.  

Since I didn't take any pictures today, here's a picture of a Rwandan sunset.