Let's talk medicine.

My experience in the hospital really has been very great so far. As I think I may have mentionned before, what I was hoping to gain from working here more than anything, was how to work with less. And boy am I learning quickly! We are in a teaching hospital here, and we have an xray and an ultrasound machine. That's it for imaging folks! I never realized how GREAT a CT scan was, let alone MRIs! And bloodwork is severly limited as well...sometime we cannot even get a CBC. So it really feels like you're working in the dark sometimes, which can be scary. But the docs do what they can with what they have and what they know, and generally the patients do well, which is comforting, and something to learn from as well.

We see tons of osteomyelitis here. It's incredible. For a long time I couldn't figure out why we were seeing SO much of it. Then it was explained to me that a lot of the kids we were seeing were malnourished, and thus predisposed to infection, which unfortunately seems to seed in their bones. We saw one boy who's hip had been dislocated for weeks, without anyone having noticed (even though he was in the hospital setting!) and the other hip had been completely eaten away by his infection. When this case was presented in the morning it was hardly even discussed. There is nothing we can do for this boy in Rwanda. He is about 12 years old and need to have both hips completely cleaned out, needs systemic antibiotics and needs bilateral hip replacement. That was depressing.

I'll write about one more depressing case then I'll try and come up with a positive one to end the story with, ok??

We had a child come in last week with an acute abdomen. He was about 1.5 years old and was pretty much comatose on arrival. We realized very quickly that he had an ileus (absolutely silent distended abdomen-so scary) and when we were placing lines (in his scalp) he didn't budge (also a very scary sign in a young child). Afterwards we discussed his case and we figured that he was already in heart and lung failure and that his kidneys had shut down. He had had a history of diarrhea for about a week and had been vomiting prior to presentation as well. What happened was that his electrolytes were completely out of whack and his bowel stopped working, which basically poisoned his blood and eventually killed him. When we were doing CPR on this tiny body it just felt wrong. They tried surgery but honestly, I think no matter what we would have done for him, he had presented too late. Like many of our patients, unfortunately.

So happy time! A lot of the kids who come to hospital present us with happy times! They may be around for awhile (with burns or osteomyelitis) but that means we get shrieks and smiles and giggles, especially as the white girl! One child had a seizure and fell into a fire (from what I understood) and though he'll be permanently disfigured, some plastic surgeons worked on him last week and he can now close his eyes again. And though he lost both his hands to amputations, he has prostheses available to him. And he always comes running to place his stumps in my hands and to receive a hug...which is just great! The kids in the hospital do not treat him any differently and we can only hope that these friendships will help him through what will certainly be a challenging life.

I will stop by saying thank you to everyone for their support and positive wishes over these past several months! I got my first choice for residency programs, and will be starting family medicine on July 1rst in the Greater Vancouver program run through UBC. I am so incredibly excited, but am trying not to let that affect my last several days here in Butare. I've got a great weekend planned and can't wait to tell you all about it, next week! Big hugs!!