CHUK, 2.0

If you’ve been paying attention, this entry is coming out of order, but I wasn’t feeling the best yesterday... and it was easiest just to write about the current day.  With that said, here’s on overview of my two days at CHUK this week.

My first morning at CHUK got off to a rough start.  We didn’t have a faculty member with us that day to pull some strings (can’t even remember the reason why), so we were mostly left to do the best we could.  Three of us went to the peds morning meeting, but since we didn’t have a doctor with us, they hardly acknowledged us and spoke entirely in French (I’d heard they usually spoke English when we were there).  After trying to stay awake through a meeting that I couldn’t even attempt to follow, we realized that our usual contact in peds wasn’t there either (seems to be my luck)… but we met a couple med students from Belgium who tried to show us around the peds wards for a bit.  They explained that doctors tended to take breaks after the morning meeting, and they weren’t sure when they would show up.  While waiting, I started hanging out with some kids who were tracking us outside of the oncology ward.  Since my camera has become my go-to “toy,” I whipped that out and started showing them how to use it and how to look at their pictures afterward.  They seemed to have a good time, and I got some more interesting pictures out of (some less blurry than others).  A bit of a dilemma arose when a probable parent came out of the oncology ward and brought the camera in to take pictures of patients.  The person went right to straight to a patient with enormous growths on his neck (maybe lymphoma, but I never actually spoke to pediatricians that morning), sat down, and took a picture.  Since I didn’t speak the language, I just took the camera back and went back outside (attempting my best to say “no” without being rude), worried that he was aiming to take pictures of the kids with extreme problems... but I ended up with a picture you’d never get in the US in the process.  I learned that the patient died that night, which didn’t come as too much of a surprise given how much he was struggling to breathe, and I now suspect the person taking the picture was actually his father.  Either way, for better or worse, I now have what is almost undoubtedly the last picture ever taken of him (you can ask me about it when I get back if you really want to see it).

After sitting around for maybe half an hour waiting, we started talking to some Rwandan students to at least learn a little about some patients.  That only went so far, and we ended up heading back to the Smile group for the rest of the morning, where I saw their second noma case of the trip and another cleft lip procedure.  It was really nice having this group available as a sort of back up plan at the hospital, and they were accommodating as always.  The even gave everyone from our group certificates for helping them out over the past two weeks.  In addition to seeing them at the hospital, a few of us have also seen them around town between packing up their portable OR and flying home.  In particular, I spoke with a retired anesthesiologist from the group outside a grocery store who spoke about the importance of doing things like this while there’s still a chance (before residency, setting up a practice, starting a family, etc.).  He expressed hope that hope that we’d at least come back to the mission field at some point, even if it took until we were 67 like him. 

On our second morning at CHUK, I attempted to do internal medicine rounds... and once again, I ran into some issues.  That morning they weren’t actually having a meeting (meaning limited chance to meet up with doctors ahead of time), and our usual contact in IM wasn’t there (seeing a pattern).  A couple of us ended up just wandering around the compound looking for something to do, and we found some Rwandan med students in maternity that helped us out.  One of them took us back IM to help us find a doc (most are young, so students, doctors, and nurses tend to look alike).  We eventually found an intern who was willing to speak in English and explain her patients’ cases, and that took up a chunk of the morning.  I actually spent a fair amount of the time just speaking to the student about various things (more life than medicine), but I’m not too worried about missing out on watching the intern write notes in French.  After the intern wrapped up for the morning, I headed back to peds where our usual contact was there and willing to show us around for a bit.  We spent most of the time in the cardiology department, where we were able to listen to various murmurs.  We also met some kids who can’t be helped here and are on “palliative care” (same with some in oncology), which made for a bittersweet morning.

As with most hospitals here, the afternoons are generally quiet, with the exception of departments like surgery, maternity, emergency, and outpatient.  Because of that, I spent both afternoons in surgery, observing some more orthopedic surgeries and a number of fistula repairs.  On the orthopedic front, a man came in with a cast on his leg, and I originally thought he was just in to have it removed.  Well, it turned out that, once his cast was removed, it was still a mess.  Both the tibia and fibula were fractured, and it looked as though they hadn’t even been set prior to placing the cast.  It could very well be that I don’t know the proper approach for fractures like that (my limited time in the American system has reduced my ability for comparisons), but I suspect it was at least a little off.  As for the fistulas, we observed a fair amount of suturing in the vaginal/anal/perineal region, with the patient awake through all of it again.  My most surreal moment there was when they placed me at the patients head to observe the repair of a fistula between the cervix and bladder caused by a botched C-section.  That’s actually a common place to observe procedures during surgeries (gets you out of the way), but I’ve never had a patient looking at me in the process. 

I believe this blog now has me back on track.  We’re going to be in Kibuye for the next two days, and I don’t know how internet access will work out.  I very well may fall behind again, but it feels good to be caught up again :)

-Scott

If there's one thing you notice with these kids, it's that they're always willing to smile, even when they live their lives in cramped rooms with a number of other sick kids... as some inevitably die around them.  It can be rough looking at pics following days like that.