11.01.2010 24 °C
We hit Rwanda at the perfect time.
The rains are just starting when we arrived - so we can hide in our nice dry house, rather than in our leaky tent. Last night it rained so hard all night that I couldn't sleep, thinking that our house was going to slide down the hill. Then this morning the first patient I saw broke his arm as his house did fall down in the rain overnight!
More importantly the country has just pulled itself out of one of the bloodiest civil wars in history and is making a huge effort to rebuild itself. There is such an incredible welcoming and positive vibe – even the genocidaires out and about working in padi fields and on building projects seem friendly! (genocidaires in pink, regular convicts in orange)
In addition Rwanda is changing from being Francophone to Anglophone. The Country joined the English speaking East African Community recently and The Commonwealth last week. The government has made a decree that all educated people should learn English over the next 3yrs, so there is a huge need for English teachers and the students are incredibly enthusiastic and excited to be taught by someone who's mother tongue is English.
Polly is a qualified 'English as a Foreign Language' teacher and has been loving teaching the teachers at the local 2ndry school, the hospital staff and some domestic staff. She is also home schooling the missionaries kids and trying to broaden the repertoire of the “English Choir” - which actually isn't very English and isn't very choir-like!!
Rob has been working in the hospital. Which has been a very positive experience.
Rob: The first thing that hit me as I walked through the wards is that there are empty beds and very few patients with HIV and TB. The Hospital I worked at in South Africa served a population half the size of Shyira's yet was probably 4x as busy. In SA HIV, TB and drug Resistant TB are spiralling out of control. The HIV problem seems to have been tackled aggressively by the Government here and, unlike SA, no sex before marriage and monogamous relationships seem the norm rather than the exception, consequently the prevalence of HIV here is 15x less than SA. Despite having a far lower GDP Rwanda has a better selection of Antiretroviral Drugs and people are started on treatment far earlier than SA which is great at both prolonging life for the HIV patients and preventing transmission (once someone is on Antiretrovirals they are far less contagious).
Of course another explanation of why Shyira is less busy is that it is perched upon a rather steep hill, there are no tarred roads for miles, no public transport to speak of and the ambulance service consists of a very bumpy, precarious ride in a wicker stretcher on the shoulders some of the local men up and down precipitous slopes, for a fee!
With the lack of HIV work here, the medicine has been rather more traditional 'Bush Dr' than it was in SA. With the patients presenting with surgical rather than medical problems. There are lots of conditions that are so easily preventable with better infrastucture and access to healthcare.
What happens if you wait 2 months before going to the doctor with an infected finger..
Shyira also supports 11 heath centres, each of these have full time staff but also need regular visits from the doctor. My clinic is called Jomba – meaning mountain, and for good reason. The hike is uphill all the way and takes 1 ½ hours if you are fit (as all Rwandans are!). The path ascends 850 vertical meters! It is the highlight of my week. Every Friday, leaving the hospital in the early morning mist and then an hour later looking out over the blanket of cloud to the volcanoes in the distance (but still only half way to clinic!):
Paediactrics is very different to what I am used to, HIV is vanishingly rare. Malnutrition, malaria, diarrhoea are the common killers – subsistence lifestyle is tough even when you live somewhere as lush and fertile as Rwanda. I always used to think that a life with no cars, no bills to pay, and no tesco – where all you have to worry about is growing enough food for the family and a little for market would be great, but here I see it is not as stress free as I once thought.
Of course, working in a resource poor country, it is easy to find areas in which with a little training and a small amount of cash mortality can be decreased. Rob had wanted to identify one such area that he could work on during our 3 months. And he found it – improving children's care by starting up a paediatric 'Critical Care Area'. This area would house seriously ill children and ensure the basics were done well and that oxygen could be administered – currently Shyira cannot supply oxygen to critically ill patients even though it owns 3 functional oxygen concentrators! The problem is that the solar electricity is only available in theatre (O.R.) and the admin block. This is now being routed down to a bay in the paeds ward which will allow this live saving gas to save lives – the little bay will be repainted, supplied with some basic equipment and called 'Paed Critical Care'!
As we are now stationary for a few months it gives a chance for visitors. Our first visitors arrived less than 24hrs after us. Chris and Jigs, great friends from SA, who have been travelling on a dirt bike and making small promo films for charities that need publicity – check out www.africauncut.co.za.
It was so fun to catch up and compare notes and get tips for our northward route especially as next week we will be back on the road and heading towards Uganda with our new friend Miriam and Pol's sister Beth!