Day one - Gihembe

The road to Byumba from Kigali winds along green hillsides where steppes are carved into the hills for cultivation. Everywhere there are goats and cows being herded by scampering children. I’m still fighting jet lag and despite all of the amazing sight I am fast asleep in the careening SUV.

Gihembe – the camp right outside Byumba houses 15,000 refugees and is set at the top of a hillside. The shelters are simple wood frame with plastic sheeting for roof and walls, some have crafted supporting walls of earthen bricks, but most just have the plastic sheeting.

We go first to where I will be staying – with Kebe a Senegalese who is camp manager and have lunch. Then given the option to settle in and rest or go along with Louise (an American who has been here the past month doing seminars on income generation and starting small businesses) to see one of her workshops in the camp – decide to accompany Louise. The children run alongside our SUV as we enter the camp – waving and smiling and saying things in Kinyarwanda (the local dialect) that I don’t understand. But kids are kids anywhere and a smile and wave or a surreptitious tongue stuck out at them will make them laugh in no time.

When we arrive in the camp, thinking I will be accompanying Louise to see her seminar – I am immediately pulled away by one of the nurses for an “emergency.” The clinic is fairly bare – a few benches, an exam / consultation table and a cabinet with a few medicines. In the farthest corner in a carboard box piled high w/ rags is my emergency – an IV bottle hanging on a hook above. The little girl looks like she’s maybe 32-33 weeks gestation, the nurse says she is 10 days old and she is grunting flaring and retracting w/ thick brown mucous coming out of her nose. When I go to feel her head she feels so cold to me, her skin is mottled. She is 1,060 grams and I immediately feel the absence of my 1st world supplies. We have no incubator, warming lights or oxygen. My French is not coming back as fast as I would like and when a thermometer is finally located – it doesn’t work. Still just feeling her, she is so cold and I ask for anything that can warm her – boiled water in bottles to tuck around her rags. Once I have gotten the French words for cold and hot sorted out someone is sent to fetch the water. About 20 minutes later 3 glass bottles w/o covers, filled with boiling water arrive. We tuck them around her as well as we can, use a manual suction w/ foot pump to suction her nose out. We are out of ampicillin but to have gentamicin, the IV is running OK w/ D10 NS going in and a gavage tube has been placed (which is really quite advanced given that the camp doctor, Dr. Moses has been away and this was all done by the nursing staff).

She is getting sicker as I watch her over the next 45 minutes and I hate to think that I will lose the first patient I see in Rwanda. I tell the nurse that I am very worried about her breathing (in my broken French) and the nurse looks at me and says maybe we should transfer her to the hospital. I am *thrilled* to find that the town of Byumba has a hospital that has an agreement w/ the camp to take all ill patients. A cell phone call later (technology is truly amazing) an ambulance of sorts pulls up the dirt road and we pile the baby into the back (cardboard box and hot water bottles and all) w/ many other passengers going to town .

The hospital is several different wards – seems fairly clean – and the Rwandan physician takes the history from the nurse, writes his notes and orders without speaking at all to me. I hold back not wanting overstep my place, but am relieved when after he finishes – says to me – “neonatal infection, bronchopneumonia, hypothermia.” He has ordered an incubator (the only one I think they have) to come over from the birthing area, Ampicillin and Gentamicin and oxygen therapy.

The rest of the afternoon I spend having attracted a large contingent of children playing with them – learning to count in Kinyarwandan and allowing them each in turn to listen to their own heartbeats with my stethoscope.

Tomorrow will be my first full day of clinic … I have a feeling I will never be bored here. Thanks for all of your messages – I love reading them …

Ann