Sunday, July 6, 2008
Weekend
Weekends were made for networking
Saturday was community work day as I described before. Everyone who does not have to be at a regular job shows up to clean up their neighborhoods. Given that, we were not able to rush out and go to the Kimirongo market that we were looking forward to visiting. We had a few moments of forced relaxation and it felt wonderful. We caught up on other teams progress, checked emails and spent longer over our cups of tea. After lunch at La Planete we were off to the market which opens at 1 on community work days. We decided to take the bus for 150 rwandan francs or approx 30 cents US. We were fortunate when a coaster came our way- this is basically a small to medium sized bus--- perhaps something that may have previously been used as a tour bus, anyway they are much larger than the standard bus which is about the size of a van. The coasters also have the added benefit of a blasting stereo system- we have heard everything - usually its loud reggae but people have heard country music and Patsy Cline. Yesterday we had blasting African music- anyway, we don't really fit in so we get a lot of stares on public transport. We got off at the market which is HUGE- The first part of the market is the stalls of clothing-- new stuff in the front and used towards the back, fabric sellers are mixed in with sheafs of fabric arranged up to about 9 feet into the air as well as people selling toys, cell phones and costume jewelery. The back part of the market is the grocery area where people are selling flour off of huge piles, eggs, vegetables and fruits. On the side is a butcher's area with small shops with hanging sides of beef (flies anyone?), goats meat and chickens. I must rethink this plan of being a carnivore. Outside of one of the butcher shops I saw the only cat I have seen in Rwanda, an orange and brown tabby, crouched outside the butcher. The unfortunate thing is that no one is allowed to take photos in the market--- not really sure why-- but the photo ops were everywhere. The market is very crowded but not many Mzungus make it there so it was sort of like the parting of the red sea as we made our way around. We bought fabric, a couple of premade gauzy dresses and some of the flaming hot pili pili sauce.
Saturday night was a dinner in honor of our HDI sponsers. We also hosted the the Head of USAID, the Dean of the Medical School in Butare and the Heads of King Faisal and Kibagabaga Hospital. Interesting people to talk to and find out more about the Rwandan system. The HDI folks gave us certificates acknoweldging our service to Rwanda and it was very touching.
After the dinner wound up we went off to Skyy a club in downtown Kigali. They had a dance troup from Uganda that preformed lip synching to different music. At times they pull ramdom people form the audience to get up and dance with them. Christopher was first-- he had been there the night before and also danced. I was second- and was pulled up by a traditional tribal dancer- what pressure! We had just arrived at the club and I was NOT prepared--- also, I think I could have done much better with a pop or rap song--- but oh well- I think the locals got a good laugh- I'm fine with it. We ordered a drink wiht vodka and they brought me like a 6 or 8 ounce bottle to fix into my fanta. It was called Uganda Wagrazi or something. I guess we missed the real fun when group went on to Cadillac for more dancing.
Sunday morning we woke up and relaxed around the hotel until it was time to go to lunch with Alice Cannon (the Nurse-manager for the NICU) and her husband Nick Cannon the british diplomat. Again we went to Sole Luna for more pizza- it was great conversation though as we compared notes about the medical system in general and the private vs public sectors. She needs many supplies and we will try to help her. After lunch I wandered behind the market and bought an oil painting for 2 women collecting fruit- one of them is pregnant- it's a really nice orignial oil.
After lunch we headed downtown for a little shoppping- most of the stores were closed but we found one market open to take our monies. Phil, Barb, Christopher and I headed to Chez Lando for a mutzig and then walked down to SoleLuna for ice cream- best dinner so far!
Saturday was community work day as I described before. Everyone who does not have to be at a regular job shows up to clean up their neighborhoods. Given that, we were not able to rush out and go to the Kimirongo market that we were looking forward to visiting. We had a few moments of forced relaxation and it felt wonderful. We caught up on other teams progress, checked emails and spent longer over our cups of tea. After lunch at La Planete we were off to the market which opens at 1 on community work days. We decided to take the bus for 150 rwandan francs or approx 30 cents US. We were fortunate when a coaster came our way- this is basically a small to medium sized bus--- perhaps something that may have previously been used as a tour bus, anyway they are much larger than the standard bus which is about the size of a van. The coasters also have the added benefit of a blasting stereo system- we have heard everything - usually its loud reggae but people have heard country music and Patsy Cline. Yesterday we had blasting African music- anyway, we don't really fit in so we get a lot of stares on public transport. We got off at the market which is HUGE- The first part of the market is the stalls of clothing-- new stuff in the front and used towards the back, fabric sellers are mixed in with sheafs of fabric arranged up to about 9 feet into the air as well as people selling toys, cell phones and costume jewelery. The back part of the market is the grocery area where people are selling flour off of huge piles, eggs, vegetables and fruits. On the side is a butcher's area with small shops with hanging sides of beef (flies anyone?), goats meat and chickens. I must rethink this plan of being a carnivore. Outside of one of the butcher shops I saw the only cat I have seen in Rwanda, an orange and brown tabby, crouched outside the butcher. The unfortunate thing is that no one is allowed to take photos in the market--- not really sure why-- but the photo ops were everywhere. The market is very crowded but not many Mzungus make it there so it was sort of like the parting of the red sea as we made our way around. We bought fabric, a couple of premade gauzy dresses and some of the flaming hot pili pili sauce.
Saturday night was a dinner in honor of our HDI sponsers. We also hosted the the Head of USAID, the Dean of the Medical School in Butare and the Heads of King Faisal and Kibagabaga Hospital. Interesting people to talk to and find out more about the Rwandan system. The HDI folks gave us certificates acknoweldging our service to Rwanda and it was very touching.
After the dinner wound up we went off to Skyy a club in downtown Kigali. They had a dance troup from Uganda that preformed lip synching to different music. At times they pull ramdom people form the audience to get up and dance with them. Christopher was first-- he had been there the night before and also danced. I was second- and was pulled up by a traditional tribal dancer- what pressure! We had just arrived at the club and I was NOT prepared--- also, I think I could have done much better with a pop or rap song--- but oh well- I think the locals got a good laugh- I'm fine with it. We ordered a drink wiht vodka and they brought me like a 6 or 8 ounce bottle to fix into my fanta. It was called Uganda Wagrazi or something. I guess we missed the real fun when group went on to Cadillac for more dancing.
Sunday morning we woke up and relaxed around the hotel until it was time to go to lunch with Alice Cannon (the Nurse-manager for the NICU) and her husband Nick Cannon the british diplomat. Again we went to Sole Luna for more pizza- it was great conversation though as we compared notes about the medical system in general and the private vs public sectors. She needs many supplies and we will try to help her. After lunch I wandered behind the market and bought an oil painting for 2 women collecting fruit- one of them is pregnant- it's a really nice orignial oil.
After lunch we headed downtown for a little shoppping- most of the stores were closed but we found one market open to take our monies. Phil, Barb, Christopher and I headed to Chez Lando for a mutzig and then walked down to SoleLuna for ice cream- best dinner so far!
Hypertension
Hypertensive Crisis
Because Kibagabaga is the referral hospital they get all the tough cases that are able to make the trip from district hospitals. The health centers in the villages can be as far as 25k from the district hospital. There are 10-12 health centers that refer to the district hospitals and there is usually only 1 ambulance per district hospital.The district hospitals refer there toughest cases to the referral hospital such as kibagabaga. Anyway, the barriers to get to the referral hospital are many.
We were working working one afternoon when a woman arrived with high blood pressure. Nothing moves quickly in Africa and this situation was no different. After the patient had been there for 15 minutes or so I went over to check her BP (not knowing that she was here for hypertension) and the reading was 230/120-zowie. So I informed the nurse Ildephonse and he got Dr Monique. She wanted to start some nifedipine so she had to send the patient's family out to go buy it. The first pharmacy they went to did not have it so they returned. Again they were sent out to another pharmacy. The hours tick by. Finally the decision was made to start some Magnesium Sulfate as we had it available. She was given a bolus by drip and then an hourly maintainence dose. Magnesium has the side effect of respiratory depression and/or respiratory or cardiac arrest if one receives too much medication. There is a protocol for measuring blood levels of magnesium in the US- but no labs are done here. One we got her stabilized we decided to proceed with a cesarean. We are ready to move on to the surgery but there were no clean linens- they need to be ironed and sterilized- So we wait. Finally she was given a general anesthetic because of the hypertension and we were ready to proceed.
Because the general anesthetic crosses the placenta it is known that you need to hurry to get the baby out so that the exposure doesn't cause the baby to have difficulty transitioning to extrauterine life. Anyway, thankfully we had the forethought to have Leanne to come into the OR to care for the baby after delivery. Anticipation is not the strong suit in Africa it turns out. Finally the surgery begins and the mother begins struggling against us and trying to yell around the endotracheal tube. We stop to try to get her more asleep and then proceed. Again, she begins to struggle. We can't enter the peritoneum or she will expell her bowel from the pressure she is exerting. Now on a good day the OR is about 90 degrees- we wear fishing waders, our scrubs, a heavy rubber butcher's apron, then the sterile gown and 2 pairs of gloves. Add a little stress and concern onto that. Anesthesia is afraid of giving her too much drugs, "She'll sleep for 2 days!" says the nurse anesthetist. "It may be the best 2 days of her life" I am thinking.
After 2 or 3 stops and goes we are able to proceed and deliver a baby with no respiratory effort, no tone and a weak heartbeat- too much exposure to general, especially for such a little human being. Thank god for Leanne- she began resuscitation immediately complete with CPR and the baby recovered. We take so much for granted in the US: good medical care (despite the issues we have, no one is going to have to go out and buy their own meds while they are in hospital), a healthy baby, a caring nursing system, etc. The end of this story is a good outcome- thank goodness- mom and baby did well.
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