More Trauma and Drama

Last night just before dinner Sheila came and told us that they were requesting a "muzungu consult" at the hospital for a trauma patient. Apparently it is a cultural thing that doctors will not listen to nurse's regarding clinical decisions so as you can immagine we were all very surprized by this.

Naomi and I went down to the hospital to find an 18 year old boy who had been hit by a bus. He had a very badly fractured left arm with multiple rib fractures on his left side accompanied by deminished lung sounds. I'm not an expert at reading x-rays but I think he also had a small pneumothorax. The physicians wanted to transfer to him to Butari for surgery consult. They were asking us if we thought this would be safe and advisable or if we should keep the patient at Kibogora.

He was too unstable to transfer in the "ambulance" with no oxygen for 3 hours, a potentially expanding pneumothorax, and unstable rib fractures on a "road" that is more like a dry river bed. So... Long story short we prayed hard and admitted him to the ICU. I wrote a "nursing care plan" (ICU orders in reality) and wrote a very thorough note in English. I checked on him again during the night and agian in the morning. He has been stable! I'm not sure how he will do long term as there are a million possible complications but I'm confident that the decision to keep in Kibogora was the right thing to do and the ICU nurse did a fantastic job of caring for him.

ER

While having dinner last night at Julie’s house, Sheila received a call from the head nurse at the hospital. Three emergent surgery cases had come in since afternoon and hospitals only surgeon is unexpectedly out of town. Two of the cases had been successfully transferred to Butari, the next closest hospital with surgery capabilities. The third case was a soldier with a suspected head injury. After her phone conversation Sheila asked if Naomi and I would go down to the hospital and “have a look at the soldier.” We arrived in the ER to find it full with only one poor nurse taking vital signs on the next bed.
We found our soldier unresponsive with a large palpable mass on his back. I suspect he may have been bleeding from a lacerated spleen and traumatic brain injury. He was too unstable to transfer to another hospital and there was no vehicle available to take him anyway. Sadly, there was nothing to be done and the man died 30 minutes later.
In the mean time, something on the next patient seemed to be alarming. When I looked behind the curtain I found an unconscious man lying face down in vomit gasping for breath and a malfunctioning oxygen concentrator.
Everyone helped to reposition the patient and we got the oxygen concentrator momentarily working again (it still required someone “rebooting” it every three minutes) but the patient had already aspirated. There was no suction available. His oxygen levels went from 47% to 88% and we decided to make a break for the ICU.
The whole night was an intense experience for everyone. I am beginning to understand how things work here and the everyday challenges that the staff face while caring for their patients. It is very different here…

Muzungu Moments Part 3

This afternoon I took my laptop down to the hospital to use the internet. In order to get a faster connection I encamped outside directly below the satellite dish. I was just about to finish posting the second edition of Muzungu Moments when out of the corner of my eye I spotted two little girls peaking around a corner at me. Once they knew I had seen them they giggled and waved, I waved back and said “Mediwe.” (Good afternoon in Kinyarwandan). They approached me slowly and cautiously with curious looks on their faces. After a few minutes they sat next to me on the ground watching as I typed. In the past I have been rightly accused of being “nerdy” and/or “teacherly” but I also know watching someone type isn’t one of the most riveting of activities.
Fortunately I had recently downloaded my camera’s memory card onto my hard drive. The girls smiled and giggled when I showed them pictures of snowy college campuses, water skiing, blin cakes, and some of the pictures of Kibogora that I had just taken. I also had some pictures of the fake injuries I had concocted before leaving the states. We skipped over those pictures quickly!
Soon the girls had figured out that they could move the arrow on the screen by using the touch pad. The biggest kick in the pants was when they learned to type their names; another Muzungu Moment.

Muzungu Moments Part 2

We made it through our first full week of teaching! It's hard work teaching through a translator but I think we're starting to get the hang of it. After teaching the same class so many times it gets a little easier. The nurses seem to really be "getting into" the classes. The particularly seem to enjoy skills practice and the scenarios we give them as application exercises.
Julie and I went through some closets at the hospital and found a muzungo body! Ok, it was a mannequin, but as we carried it out of the closet and to the classroom in a sheet it certainly elicited some strange looks. So far our poor muzungu has suffered a car vs. pedestrian accident, a fall from a roof, a traumatic right foot and left hand amputation, an open abdominal wound, a host of other unfortunate ailments.
At first I was slighltly concerned that all of our teaching materials, photos, diagrams, and examples were caucasion and thus might be viewed as ethnocentric. However, during one of scenarios on shock and bleeding, one of the participants told me that the patient was very pale and therefore in a state of hypoperfusion! I love it, another muzungu moment!

Muzungu Moments Part 1

The day started at 7 am with breakfast at Sheila’s. I think she’s still amused over our American accents. At 7:30 we went down to the hospital for morning prayers and got introduced to the hospital staff. After experiencing some technical difficulties with the French translations of our documents, we decided to wing it with our English versions. This morning’s class (Monday) was for the ER staff. We had to teach the class in the x-ray room as many of the staff who were in attendance were also on duty.
Our translator this morning was the anesthesiologist. After class he asked if would teach the material to his staff in the OR. By the end of the afternoon we were booked for three more classes than anticipated including two all day seminars. We are finding we have to make a few alterations in the material as we go but overall things have been going quite well.
After class I went down to the ICU for bit. I walked by a bed which appeared empty and noticed an IV dripping into the bed sheets. Upon further investigation I found a tiny 5 pound baby lying in the bed. The baby had quite the hernia for being such a tiny thing and was in need of surgery. Unfortunately the hospital’s only surgeon is out of town so the baby will have to be transferred to another hospital far away.
After lunch Naomi and I worked on our ever evolving curriculum to meet the demands of our unanticipated class load. When our brains could take it no longer we ventured down to the hospital just to see what was happening. Naomi is quite in to photography so we wondered about saying “photo?” Everyone we asked was delighted to have their pictures taken. They laughed and giggled to see themselves on the screen of the digital camera. Many of them have never seen themselves before as they do not have mirrors. Naomi soon found herself surrounded. I sneakily went to the balcony of another building and shot a photo of her “Muzungu moment.” In late afternoon we took a walk about the town. As I’m sure you could have guessed we once again surrounded by children curious of the muzungu.

Kibogora

The internet here is pretty slow so I apologize for the rather short and incomplete posts. I’m trying the copy and paste method this time so we’ll see if this works any better. So far all is going very well. We are sharing our house with Kate, a British medical student, which has proven to be a lot of fun. The view from our little house is breath taking!
Friday morning Julie took Naomi and me into to town to an elders gathering. It’s actually like a mini Bible study for the poor elderly. They have a time of singing and dancing and short message. Afterward they serve everyone tea and bread and then send them home with a small bag of rice, beans, salt, and a bar of soap.
We toured the hospital and met most of the doctors and nurses we will be working with. We found out that there isn’t a backboard here. Julie and Sheila (our gracious hostesses) have suggested that we could help design one so they could have one made. Probably doesn’t sound very exciting to most people but it’s quite exciting to us! We will start teaching our classes tomorrow.
On a walk around town with Kate the idea that we are celebrities around her finally sunk in. We seemed to cause a bit of a stir and I think had there been more cars on the road we could have caused an accident! The children followed us smiling and giggling saying “muzungu, muzungu.” (Muzungu means ‘stranger’ but it’s used mostly around here for non African people.)
In a few minutes we’ll be heading out to church. I hear the choir is amazing! After church we’ll take a picnic lunch to Kumbya by the Lake Kivu and enjoy some time relaxing before we start our curriculathon to prepare for tomorrows class.

The Monkey Incident

We made it safely to Kibogora on Thursday afternoon after a 6 hour drive through numerous small towns and a rain forest! Julie told us to keep an eye out for monkeys as we drove. Yes, we saw several monkeys and yes we have pictures to prove it! Naomi had the window rolled down to facilitate the prime photography opportunity. This little guy seemed to enjoy the attention as he modeled for us until he jumped up on the side mirror and nearly into Naomi's lap! We all laughed so hard we could barely breathe. As Sheila says "we were all creased." (She's British and apparently this means doubled over laughing.)