Kibagabaga

We’ve now progressed to Monday.  We’re three days behind, but my goal is to get caught up by tonight or tomorrow. 

I think I mentioned it before, but Kibagabaga is a district hospital like Nyamata.  However, while the Nyamata hospital is located in more of a rural setting, Kibagabaga is essentially located in a suburb of Kigali.  The surrounding neighborhoods are filled with what I’d consider to be high income housing, and the hospital looks the part.  There are courtyards with well-groomed landscaping, and we went to a guesthouse up the street for lunches in the yard. 

As for the hospital itself, what we saw didn’t differ too much from what was available at Nyamata.  I did internal medicine rounds, observed some surgeries, spent time in maternity, and visited their emergency department.  During the internal medicine rounds, we saw more cases of malaria and likely TB (had double-layered paper masks, so here’s hoping they worked), as well as some patients receiving “palliative care” on their way out.  In regards to palliative care, it doesn’t exactly exist in Rwanda.  For one patient with a gastric carcinoma, his palliative care amounted to IV fluids and a woman (likely relative) holding a bucket for him to spit into.  We actually spoke to the head of the hospital at Kibagabaga who is headed to Harvard later this year to study palliative care and hopefully introduce some reform.  At the moment, it is quite hard to prescribe painkillers like morphine, requiring multiple signatures and red tape.  Psych is another area of medicine sorely lacking in Rwanda (run only by nurses, phenobarb is often prescribed for “epilepsy”)… but, while a few in our group were able to go to the only psychiatric institution in Rwanda, I never spent time observing the system (we were told specifically that the nurses at Kibagabaga preferred we not visit their department after apparently feeling uncomfortable the previous day when a psychiatrist with us visited them). 

Anyway, as for the internal medicine rounds, they were lackluster compared to those at Nyamata.  The doctor wasn’t the best with English, and he made it through about 12 patients in the entire morning.  Given that those patients were only spread between two rooms, and that he was on his cell phone half the time, it was a slow morning.  Just that alone was interesting to see, given how fast pace American medicine tends to be.  Speaking to another physician about the paternalistic approach to medicine in Rwanda, it was suggested that part of the reason for the approach is that doctors are so busy and don’t have enough time to have full conversations with patients.  Keeping in mind that these were the same physicians who had drawn out meetings in the mornings, took half hour breaks between meetings and rounds, and went home at 5:00 every night, it was hard to see where they were coming from.  But I suppose that’s just another difference in approach (and besides the slow rounds, there were loads of patients going through the out-patient department). 

Getting outside of medicine, I spent some time observing a couple surgeries and C-sections.  The surgery department was actually fairly slow the morning I headed that way (seems to be a semi-frequent problem I ran into), but I found a French student who was willing to show me around for the rest of the day (I was the only student at Kibagabaga that morning, and it was a nice surprise).  The surgeries that morning were a hemorrhoidectomy on a woman and a circumcision of an elderly man (a lot messier than on infants).  After that, we went around checking on other departments that also seemed to be having slow days, and wrapped up the morning in the emergency department where a patient had come in with brain trauma after crashing his bike (although not as common with regular bikes, motorcycle accidents are a common problem here). 

While I attempted to observe a live birth within their system here, C-sections are incredibly common once a woman gets referred to a larger hospital from a health center.  So, C-sections were the name of the game.  With the baby out in less than five minutes, the hour-long procedure was really composed primarily of stitching and more stitching.  It came across as a fairly rough procedure, with tearing and yanking, but I suppose it works for them (and I can’t compare it to American approaches).

-Scott

Kibagabaga hosts one of two buildings for multidrug resistant TB cases in Rwanda.  Needless to say, we didn't enter the building.