Two Weeks

11/15/2019

It is Friday afternoon here in Rawanda, Africa, the close of a my second full week here. And - wow! - what a crazy two weeks it has been.

I have so far:

• Watched over 150 endoscopies and 2 colonoscopies performed in the space of three days, likely seeing more endoscopies than any other premed in the United States. 
• Wrote over 50 medical charts in Rwanda's nascent electronic medical record (yesterday) in a single day, making me not only a US-certified medical scribe, but now an international medical scribe. 
• And, most importantly, won a cutthroat ping-pong tournament, making me also an international ping-pong player. 

This afternoon, I stuck my nose into a new book and stuck my feet up on a hammock in the Green's backyard which, situated rather high on a mountain, has a panoramic view of Lake Kivu and Rwandan's Western District's mountain-studded landscape. My feet seemed to dangle out over the bright blue water thousands of feet below; two kayaks, looking like small water strider insects, skated the water below; the facing mountains across the lake, a patchwork of bright green forest, red-earthed fields, and small tin-roofed huts, nestled up to a second body of water behind it; another mountain range, blue in the distince and shrouded in mist, seemed to sprout from that water's edge; and behind that, the faint outlines of volcanoes in Congo faintly etched the sky, looming like slumbering giants blanked by clouds. 

Although humans are supposed to be notorious for adapting to pretty much everything (both paraplegics and lottery winners quickly adjust back to their pre-accident and pre-millionaire levels of happiness, for example), I'm still finding myself dropping my keys in the process of unlocking my door, absorbed in the near fairy-tale landscape that stretches out past my house. 

Not everything is fun, games, and scenic vistas however. 

Despite Rwanda quickly becoming the most technologically-advanced country in Africa, with blood samples delivered by drones to our rural hospital, there are still hardships and matters left to be desired: a chronic shortage of basic supplies in the hospital; frequent power outages, the lights once flickering off with an endoscope halfway down a patient's esophagus; frequent equipment malfunctions, causing whole days of surgery to have be re-scheduled (or re-rendez vous'ed, as they would call it here). 

The people all walking on the roads, dressed in peculiar half-brightly colored African garb and half-Western dress, which seemed at first to me to be quaint, and a powerful antidote to obesity which so weights down the US healthcare system, I now see comes with distinct drawbacks, a point struck vividly home for me as I helped unwrap the pus-soaked gauze wrapping around a child's leg and lifted his leg up as a doctor debrided the dead tissue away and re-wrapped it in clean new dressing -- nearly half of front of the child's legs had been shorn clean off by a speeding vehicle. 

And while Rwanda is extraordinarily safe, quickly distancing itself from the horror of 1994, part of the security may be due to vigilante justice. I witnessed a patient yesterday who could barely open his eyes or move, labs revealing a very low hemoglobin (4), possibly due to internal bleeding. 

He had been beaten unconscious for stealing a banana. 

The local blood bank did not have samples matching his blood type and they had to send for matching blood from another hospital. 

He died sometime last night. 

And while almost everyone here has a cell phone, with full bars of the MTN network reaching everywhere, many people still cook over stones set upright around an indoor fire, a hazard for the fall-prone elderly and accident-prone children. Last week, I helped Dr. Green peel thick, leathery, blackened skin (eschar) from a massive burn covering much of an elderly woman's buttock and upper thigh. 

Grotesque injuries notwithstanding, the past two weeks have been a pleasure serving, observing, learning from and laughing with the Rwandan and missionary surgeons. 

I hope my next (and last) two weeks don't fly by just as fast. 

The Rwandan Genocide

Sunday, November 10, 2019
Yesterday, after a short day in the hospital, I was lent the book Left to Tell by Dr. Green's wife.

In Rwanda, "missionary midnight" is nine o'clock.

I stayed up to actual midnight and finished it.

The book tells the story of the Rwandan genocide through the eyes of Immaculée, a Tutsi woman who spent the genocide hidden in a bathroom, hardly larger than a glorified closet, with seven other women.

The first chapter ends like this: after painting a picture of her family, who were well respected and hard-working members of their community, composed of three wonderful older brothers (one who seemed to me to be a better version of myself), a mother who woke up each day before them, tended the fields, cooked them breakfast, and then headed off to her full-time teaching job; and a father who people traveled for miles to obtain counsel from, Immaculée proceeded to explain the meaning behind the title:

At the end of the genocide, she was the only person left to tell her family's story.

I felt chills creep down my vertebrae at that point. As I continued to read the description of her listening in terror to drunken killers stumbling and tearing through the room next to her, concealed in a bathroom behind a wardrobe that didn't even fully cover the door, praying fervently to God to blind the eyes of the killers, a sense of dread crept over me.

I'd admittedly had an idealized vision of Rwanda in my head as a beautiful mountain-filled land with kind, very sociable, people and only a vague notion of a genocide tucked safely away in the pages of history.

But this book felt as if duct tape covering my eyes had been torn off.

Yes, Rwanda is a country that looks like paradise, but its recent history is undeniably stained by blood, littered with buried corpses, and polluted by memories of a senseless slaughter.

I wonder just how much tension seethes below a tranquil and peaceful surface waiting for a trigger, like the demise of the prime minister Paul Kagame, to be unleashed.

What horrified me most was learning that pastors of churches encouraged the government-dictated killings--Immaculée's own brother died thanks to the urging of a pastor.

After being dragged outside in nothing but his underpants, beat in the face with the handles of machetes, her brother Damascene struggled to his feet and smiled at his killers:

"Go ahead," he said, "today is my day to go to God. I can feel Him all around us. He is watching, waiting to take me home ... But I am praying for you ... I pray that you see the evil you're doing and ask God's forgiveness before it's too late."

These were his last words.

As his killers stood confused, a Protestant pastor mocked him: "Does this boy think he is a pastor? I am the pastor here, and I bless this killing. I bless you for ridding this country of another cockroach ... What are you waiting for? ... Kill him!"

At this, they hacked him to death with machetes, slicing open his skull, and bragged about how they had seen the brain of someone with a master's degree.

This incident, this book, was a shocking reminder of how dark and twisted a road can lead ordinary people down when we separate and judge based on the shape of a person's nose, the size of their wallet, or the color of their skin, rather than on the construction of their character; when we simplify and stereotype an entire group of humans rather than listening to people's individual stories; when we skip over the respect due to a person--each person; when our religion becomes a political stance rather than a way of life built on worship and virtue; when we become known for outspoken hate towards certain people groups rather than sacrificial love towards the impoverished.

But so too this book is a reminder of the healing power of forgiveness, a reminder of the nurturing, healing power of a God of Love, and a reminder that everyone, no matter how far gone, can be redeemed.

Perhaps the story of Rwanda is not so foreign from us as it seems.

My First Full Day in Rwanda

Sunday, November 3, 2019
7:58PM
Somewhere in Rwanda, Africa.

I have just completed my first full day in Rwanda. The day began promptly at 4:48AM as I woke up and found it impossible to fall back to sleep.

Breakfast at 7:00AM was a light meal of various kinds of exotic fruit, including pineapple, a miniature banana, a small ball-shaped fruit that split open to reveal a mushy inside of snot-colored flesh and tear-drop shaped black seeds.

It tasted better than it looked.

I met Dr. David Fryman, a family medicine doctor who taught at Indiana University School of Medicine, at breakfast and learned he had first visited Kibogora Hospital as a fourth-year medical student and had been returning ever since.

We boarded a RwandAir plane (the Dream of Africa was painted across its side) and Dr. Fryman regaled me with stories of how, back in the day, the flight from Kigali to Kamembe was a life-endangering adventure. Not trusting the commercial plane with a poor safety record, he flew by missionary plane directly to the hospital during his first visit.

Fortunately, the safety record had improved by then.

We waved goodbye to Rwanda's capital city of Kigali (pronounced kee - GALL - ee) and flew over the Rwandan countryside for the next 25 minutes to Kamembe, where we disembarked and grabbed our luggage from (I kid you not) a one room airport. Dr. Green was waiting for us in the parking lot.

After paying a parking attendant 1,000 francs (~1 US dollars), much gesturing, myriad attempts at sign language, and three attempts, we finally escaped past the gate and motored down the road to Emeraude, where we had a second (real) breakfast of eggs, toast, tea, the vomit-yellow-and-green fruit which, incidentally, turned out to be passion fruit, and completed by
a spectacular view of sapphire-blue lake studded with emerald-green islands.

After breakfast, we then motored through the countryside, which seemed composed of small-to-medium-to-largish-sized mountains, eucalyptus trees, tea farms, banana plants, goats, long-horned cattle, Rwandan farmers, small Rwandan children walking right on the painted lines of the side of the road, bright red soil, and farms planted on the impossibly steep mountains.

Dr. Green narrated to me when he asked how a farmer had broken his leg who, they replied that, "I fell out of my farm."

The day passed after that in a kaleidoscopic blur of short memories: a tour of the mission compound, set high on the hill above the blue-roofed hospital; a short trip to the nearby town of Cyazo (pronounced Chaz - oh); playing 21 with a hoop set on a red brick wall with Dr. Green's son and another missionary family, the Cobb's son; kicking off the wall like a parkour ninja to throw down some monster dunks; a short dance + gymnastics performance of the Green/Cobb children to Black Eyed Peas' I Gotta a Feeling with a spectacular backdrop of the Rwandan mountains and lake behind them; and culminating in a meal of fancy Ramen Noodle soup laced with jalapeno oil called akabanga.

The Green family record was 21 drops of akabanga, so I naturally put in 30 drops and proceeded to breathe fire for the rest of the evening.

I left for my home for the next 28ish days, a little guest house located right by the Green's house, found a small frog hanging on my door, and killed a spider in my bathroom, only to find about 50 baby spiders were beneath the first spider.

After reading up on bile ducts, bed soon followed, and I curled up beneath the mosquito netting to get a good night's sleep before the bile duct obstruction surgery scheduled for the next day. 

My 0.17th Day in Rwanda

On November 2, at quarter to eight Post Meridiem, the plane carrying me touched down in Kigali, the capital city of Rwanda. This was the fifth of five consecutive flights with a final flight to Kamembe scheduled for the next day.

The flights began with

1. Grand Rapids, Michigan, to Chicago, Illinois (1 hr and 5 minutes)
2. Chicago, Illinois, to Montreal, Canada, (2 hr and 17 minute flight)
3. Montreal, Canada, to Brussels, Belgium, (6 hr and 45 minutes)
4. Brussels, Belgium, to Kigali, Rwanda, (8hr and 15 minutes).

During the last two flights from Montreal and Brussels, I found myself wishing I had paid more attention to the French classes I took in elementary school in Canada, since I felt like I was the only one on the plane who couldn't understand more than three words in French (merci, au revoir, merde).

After going through the passport check, and after the security guard examined my crumpled temporary Rwandan visa and asked many suspicious questions, I found my ride--Philip, a thin tall Rwandan teenager--waiting for me outside with a big sign with my name on it.

He'd been waiting over an hour and a half.

Nevertheless, he was still gracious and, as we drove by the lights of Kigali's buildings, glimmering like a thousand fireflies nestled into the mountains of the city, he proceeded to give me a heavily-accented running commentary of Kigali.

I was amazed to find how many people were walking the streets in the dark (it becomes dark around 6 pm in Rwanda). Philip informed me that his favorite part about Kigali was the security. People would still be walking at 11, 12, 1, and 2 in the morning, without any fear of crime. It was a sharp contrast to the US, where similar streets would be deserted and people ensconced in their homes watching television and eating cheetos on their comfy couches.

I was amazed too to find that although the streets were remarkably well-lit and clean, there were absolutely no stop signs or traffic lights! Philip informed me that on the rare chance one did encounter a stop sign, one should look to see if there were any cars coming, and then accelerate past the stop sign without touching the brakes.

Let's just say that my car ride in Kigali was an adrenaline-inducing adventure.

In fifteen minutes, we reached our destination, passing along the way a large domed-conference building on a distant hill, with lights spinning like a coiled serpent around the whole of it in the colors of the Rwandan flag; a police station; an area Philip told me would be turned into an artificial lake before long; and finally Good News Guesthouse, where I would be staying the night. This was situated right behind a large, beautiful circular church with regularly spaced stained glass windows punctuating the wall.

I was passed into the hands of Renee, who led me past star-lit garden walks and swaying tropical trees to a small white room containing a fancy piece of furniture that looked to me like a medieval king or queen's four-postered canopied and curtained bed.

It was, in fact, draped mosquito netting.

A few African paintings adorned the walls and the oddly-fashioned electrical outlets punctured the walls.

I crawled into the bed at the end of a long day and was soon fast asleep.

Africa

In three days, I board a plane for Africa.

Three days.

58 hours.

3490 minutes.

209,400 seconds.

Now 209,399 seconds. Now 209,398 seconds ... (Who's counting? Not me.)

You're wondering, so I'll answer: no, I am not fleeing the country, no, I have not gotten in trouble with the law, and no, I am not in much danger of catching Ebola.

To help you understand how it came to be that on Friday November 1 at 9:10 AM I will be stepping foot onto a plane headed to Africa, let's flip back the pages in the calendar and rewind the hands on the clock

878 days.

52,680 hours.

3,160,800 minutes.

189,648,000 seconds.

Now 189,648,001 seconds. Now 189,648,002 seconds...

Picture me. In college. An idealistic teenager and gung-ho premed, I wanted to become involved in giving back to the community. Short on money, I did have time, and decided to volunteer some of it, preferably somewhere in the medical world.

So I signed up at Exalta Health one fateful day in June 2017.

(Exalta Health is a faith-based medical clinic that serves an underprivileged, mostly Hispanic population in Grand Rapids.)

Over the years I've volunteered there, my key role is to help out Exalta Health's medical director, Dr. Laura VanderMolen, with the less glorious side of being a doctor. Picture the electronic equivalent of mountains of paperwork, and you'd have a pretty good idea of what my time volunteering looks like ...

To give you a quick character sketch, Dr. VanderMolen is a lively and energetic lady with frizzy black hair, a wicked sense of humor, and a huge heart for medicine and missions. In the two years I've volunteered there, she's never failed to regale me with an amusing anecdote or book recommendation, most of which are medically or social-justice geared--all part of her master plan, I suspect, to brainwash me into becoming a missionary doctor.

Anyway, another person of particular interest in this story is Dr. Joel Green. I'd brushed by him only a few times since, as a busy general surgeon, he could spare at most one day a month to visit Exalta and perform minor surgical procedures. When I did get to know him a little better, I was fascinated to learn that he only spent 8-9 months each year practicing surgery in the US. He then spent the other 3-4 months in Africa (Africa!) performing surgery for people in desperate need and with zero access to the sort of surgical expertise taken for granted in American hospitals. To give you a quick mental picture, he is a man with dark brown eyes who exuded a sense of calm, peace, and gentleness that I hadn't seen in the surgeons I'd met thus far, who in my experience tended to be a more frazzled bunch.

I talked about him for weeks -- what a way to combine the rigors of modern medicine and the calling of medical missions!

Behind my back, Dr. VanderMolen asked him if he'd be willing to take a youthful premed (that'd be me!) along, which he was evidently quite amenable to. When she broached the idea to me, I promptly fell off my chair in excitement and bought tickets the next day.

(Just kidding--but I was stoked.)

So there you have it. And just as Dr. VanderMolen helped engineer the path for me, possibly more out of a desire to live vicariously through me than from disinterested altruism, so I plan to pen a few more posts during my stay so that you may, if you choose, travel with me this November to the landlocked republic of Rwanda.

More to follow in ...

7 days.

168 hours.

10,080 minutes.

604,800 seconds.

Now 604,799 seconds.

Now 604,798 ...