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.