Sometimes it’s hard to know where to start… This day was another busy one, with lots of things happening. Paul and I were commenting how it’s hard to believe we’ve only been in Rwanda about 5 days. It seems like weeks…
Okay then: rode to work, packed in the little car that picks up Seth and one of his colleagues in the morning. We got to the hospital around 7:30, but the OR doesn’t usually start until 9, so we had plenty of time to go over a new ICU admission of the past night: a very typical story of an elderly patient, transferred from a district hospital in severe septic shock because of bowel perforation (probably typhoid, but the lab results will not be back for at least a week). He was operated on in the middle of the night. The state of his gut was so bad that they just did a “damage control” procedure, i.e. remove the dead piece but not reconnect anything – he’ll have to go back to the operating room in a few days to finish the procedure, if he lives that long. Now we were battling severe hypotension with fluids and high doses of dopamine. Monitoring was almost impossible since neither the blood pressure cuff nor the pulse oximeter would work on his cold, underperfused extremities. Paul and the resident tried a transthoracic echo to assess his left ventricular filling status, but it was difficult to get good views.
These cases happen a lot and usually have bad outcomes: extremely sick patients, operated on under difficult circumstances, and then in the ICU one is severely limited by the lack of monitoring and therapeutic options (essentially: dopamine and epinephrine). We’ll let you know how this patient winds up doing.
Then to the OR, where there was… nothing going on. There were cases posted, but no patients or surgeons. Someone told us that “the surgeons aren’t here”; someone else said there was a problem with sterile supplies. Either way, there was nothing for us to do (which always stresses me out…) so we made use of the time by walking around the campus and checking out some of the wards. The last time we got an update from the OR, around 11, nothing had happened there yet.
At 10 we did ICU rounds. I enjoy those greatly, although I’m painfully aware all the time that I haven’t worked in an ICU for a very long time. Still, people constantly want suggestions and help on various issues, so one does the best one can. It’s great to have Paul here who has much more recent ICU experience. Since ICU management is much simpler here than in the US, because of limited options, I hope even my limited knowledge may have some use.
Then, around 12, we took off for Inzozi Nziza, the ice cream place, where we met with Vincent, the beekeeper. The story of how we got involved in beekeeping in Rwanda is long, and I’m not going to repeat it here; there’s a pretty comprehensive entry in our 2012 blog. Suffice it to say that Vincent is beekeeping consultant for the University of Rwanda, and in charge of beekeeping training. He was going to show us some of his recent work.
We found him in Inzozi Nziza, where we were soon joined by Sarah, in whose house we’re staying. We had a coffee while Vincent told us an intense story of how he had treated a woman with a bad breast abscess using his honey, and then we were ready to go. I hadn’t seen a car outside, and when I asked him about it he said: “Oh no, we’re going by taxi-moto“. Now, in a previous entry I wrote that minibuses are responsible for many of the traffic accidents here. But the motorbike taxis may be even worse (this despite the fact that they carry a helmet for the passenger). But there has to be a first time for everything, so soon after we were buzzing our way through Butare traffic.
We then walked through the woods to Vincent’s training apiary, where we looked at his new topbar hives, gave him the donated equipment from Valley Bee Supply, and he gave a highly entertaining and animated explanation of how he had got into beekeeping.
And then, back on the taxi-moto and off to his house, where we were to have lunch. This ride was slightly scarier than the first, since we left the surfaced roads, bumping along for a while on dirt, and my helmet visor was so scratched and dirty that I could barely see where my chauffeur was going, which was a little disconcerting.
As last year, the visit with Vincent’s family was memorable. He lives in a very small and bare house, but his wife (who speaks only Kinyarwanda) is the kindest person and makes the best lunch on the fire in her small kitchen.
We sat and chatted for a long time, as a torrential rain burst loose over the Butare area. We exchanged honeys, and his two children (both dressed their best for the occasion) entertained us with poems and songs (in English, French and Kinyarwanda) they had learned in school.
Since the rain didn’t stop, we eventually took a taxi-voiture (a regular taxi) back to our house.
In the evening, though, the rain did stop and we were back on the taxi-moto, since we took Sarah and Seth out to dinner at The Chinese Restaurant to thank them for letting us stay at their house. To paraphrase Churchill: never in the history of my travels have I been received by strangers with so much hospitality, for so long and on such short notice.
Tomorrow we’ll be heading back to Kigali. It wasn’t until late this afternoon that we finally heard how that will be accomplished. Emmy had worked his magic, and had put enough pressure on enough people that the Ministry of Health is sending a car to pick us up (they normally will do this for these visits to Butare, but only if the trip is arranged well in advance). So we can avoid the other option: 3 hours in a packed minibus.