Week 2

Kigutu

African drumming as the sun sets. The cook apparently doubles as an expert drummer on the national team. He only cooks rice and beans for three meals a day, so I guess he has time to drum:) but I’m not complaining He teaches some of the kids in the village. The beat calls you out into the setting sun after clinic.

Sunday afternoon:

Come quick, kid bleeding, bad. I run 100 yards to a room and find an 8 year old with his tibia sticking out of his leg. Snapped in half broken straight through skin. Oozing blood over the blue sheet. I want to hover over him, look over my shoulder and say “can someone page orthopedics to get down here. “He needs to go to the OR”.

I felt like that I love lucy episode where Lucy is driving through this small town and gets thrown in jail by the police officer. And she asks to speak to the mayor and the police office just changes hats, and is now the mayor. I left the room, opened up a few books and came back a half ass orthopedic surgeon with no surgery skills.

I got the nurse to start an IV and we started abx, and washed out his leg

wanted to give a tetanus shot but we didn't have any.

I walked myself through some ER book, doses for ketamine to knock him out, and realign and stabilize his leg. We call MSF(doctors without borders) but they are strictly focused on obstetrical complications. Public doctors are on strike and private surgeons are way too expensive. We find this hospital two hours away that will accept him, and operate. A public hospital staffed by many Egyptians. Not sure why Egyptians- apparently an agreement between governments.

he gets operated on two days later. no infection. he does fine.

An afterthought- where will his family sleep, 5 or 6 of them before this boy, Milan, gets transferred the next day to a hospital who can surgically repair his leg. I go to check on him before I go to bed for the night and they are huddled together on the dirty floor, in the dark, in the corner of the room.


The hardest thing this week: a 60-65 year old woman, a dirty button down green shirt. She opens her shirt like she has fake rolex watches to sell. Underneath the shirt a festering mass. An open ulcer on her right chest wall. A putrid wound-mass masquerading as breast.

Breast cancer. 6 years. And she has watched it grow. And wants something other than antibiotics to treat her cancer

There are no oncologists here.

There is no chemotherapy here. There is no biopsy to diagnose the cancer that has no chemotherapy. There are no oncologists to give the chemo that does not exist. I guess I knew that before I came.

Huge work force issues. We have an amazing Burundian doctor here. 32. top of his class. He has stories of fleeing 4th grade running through the forest as rebels followed and gunned down some of his classmates. His father was killed during the war. He memorized medicine as it was taught since there were not enough books to go around. he knows a helluva lot. But we are not sure how long he will stay. I can tell he is getting restless. Tired of working so hard and being so smart but still poor.

There are 75 or so doctors in this country for 8 million people. Doctors leave. Nurses leave. To Rwanda to south Africa, to Belgium, to France. Anywhere but here. Many of our nurses haven’t finished secondary school. The ones who have are in Rwanda. The doctors in the public hospitals are on strike because they make 100 dollars a month. Without the tools or the support to truly explore the possibilities of their craft they open up private clinics.

Second hardest thing: an HIV positive mother breast feeding her child. Because we don’t have the formula to allow them not to breast feed. And the stigma of being HIV + is huge. There are many studies that show breast feeding for a full two years increases transmission to child to 50%. In the states the transmission from mother to child is down to 1.5 %.

But we are starting to give HIV positive mothers drugs at 28 weeks, which is a start.

Josalyn(that is her with her daughter) was transferred to a small room to die a few days ago. She is hallucinating and we don't have any pain meds to really keep her comfortable.

On two bright notes, one of our HIV patients family runs away from him when he goes home, because they think he is a ghost. They don't believe someone so sick

when they last saw him can actually be alive.

We picked him up an emaciated skeleton and now he shadow boxes around the compound.

and I have seen so many malnourished babies. Kwashiorkor. and they recover. food as medicine. plumpy nut provided by unicef. an inpatient ward.

a custodian trained to heat milk, administer plumpy nut and these kids turn around. re-animation.

its pretty satisfying though its ridiculous that so many children are so food insecure.


Hope you all are well and I am not depressing you too much, because it is pretty inspiring, alot of the work.

If you guys have any medical equipment you are rounding up, that would be awesome.

Here is a prelim wishlist enclosed

It takes about three weeks to get here.

Village Health Works

Kigutu Community Health Center

Attn. : Nestor Ntibateganya

B.P. 1604, Bujumbura

Burundi, Africa

Thanks,

Sri