Alice and Emily: Rwanda – Blog #2

Hello again! This is Alice Burgess (UVa 2017; GDS) and Emily Romano (UVa 2016; GPH) writing an update on our last full day in Kigali. Thank you, CGH, for this awesome experience — we are SO saddened to be leaving already, but hope to return in the near future.

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Honey Research

Our Burn Unit investigation has culminated in a narrative-style report that incorporates multiple perspectives on burn care in Rwanda. The head doctor, Dr. Sam Kanyesigye, informed us about his clinical trial, which found that honey works wonders on infected burn wounds, but also spoke of the limitations the Burn Unit faces with respect to providing adequate nutrition to patients. He explained that when a patient receives a burn injury, their metabolism goes into overdrive as patients lose nutrients via the wound itself and healing requires substantial energy. Dr. Clifford Lo, a pediatric gastroenterologist visiting from Harvard, filled us in on the specifics of Total Parenteral Nutrition and potential cost-effective alternatives (such as a nasogastric feeding tube to deliver high-calorie, high-nitrogen formula). The head nurse of the Burn Unit and a local health clinic patient who treated her second degree burn with honey contributed to our range of perspectives. Ultimately, despite lowered mortality rates following the introduction of honey, the Burn Unit still faces the challenge of addressing the increasing levels of morbidity due to malnourishment.

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The sad truth is that burn injuries here are almost entirely preventable, as poverty is the #1 risk factor for burns. Impoverished communities use open fires for cooking, warmth, and light; malnutrition predisposes burn patients to poor prognoses given the advance nutrient loss associated with burn injuries; and finally, epileptic patients without access to medication are susceptible to falling into an open flame during a seizure. In fact, the World Health Organization states that over 96% of fatal fire-related burns occur in low-income settings. Fighting the underlying cause of burn wounds will take decades — but we remain hopeful that health outcomes will continue to improve as poverty is systematically eradicated.

 

Breast Cancer Research

As for the “Breast Cancer Risk Factors for Premenopausal Women” study, we have completed all aspects of the proposal and have submitted all materials to the Rwandan IRB. The head of the DOC-3 medical class, Dr. Jean d’Amour, is helping us translate our materials into Kinyarwanda. We feel confident that between Dr. Jean, Dr. Costas, Dr. Martin, and Dr. Kwizera, we are leaving the project in the hands of a superb team. We hope to assist in data analysis and help prepare the manuscript for publication over the course of the next year.

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Clinical Shadowing

•••In the OR:

Our research mentor Dr. Ainhoa Costas kindly allowed us to shadow in OR at Kanombe Military Hospital. We witnessed the removal of a neurofibroma (a painful tumor in the nervous system), an inguinal hernia repair, and a toe amputation. We also got to watch Dr. Costas perform two mastectomies on women with breast cancer. One of the women had also undergone tumor-shrinking chemotherapy in order to improve the odds that surgery would successfully vanquish her cancer, which had been diagnosed at a late stage. It really drove home the importance of our “Breast Cancer Risk Factors for Premenopausal Rwandan Women” investigation. Research tends to be so systematic that it often feels impersonal — thus, it was meaningful to witness these surgeries and interact with the brave women who fight this aggressive disease.

 

•••In the Adult ED:

We saw many shocking cases alongside Dr. Giles Cattermole, including moto accidents (neck injuries and braces, internal trauma, and permanent disabilities), a horrendous case of bedsores, three young women suffering from complications that arose from traditional medicine, and a young woman with a bleeding and swelling in the brain whose outlook for survival didn’t look good due to the long wait in the OR and the lack of available ICU beds. We also observed two patients suffering from DKA (diabetic ketoacidosis) who both needed treatment, but the hospital only had enough resources to treat a single DKA case. Many of the patients did not have Mutuelles de Sante (the most affordable health insurance) or enough money to pay for treatment. There seemed to be a constant pressure on social workers to connect patients with needed finances. We were reminded many times of the tough choices doctors have to make and the fundamental socioeconomic inequities that impact healthcare access.

 

•••On General Surgery Rounds

We visited the Teaching Hospital of Butare (CHUB) to shadow Dr. Michael Sinclair, who explained all kinds of conditions to us — from skull fractures to leg amputations to hernias. Weighing in on our burn project, Dr. Sinclair remarked that switching from open fires to solar-powered ovens could have a drastic impact on the number of burn injuries in Rwanda. The U.S. hasn’t progressed to mainstream use of solar power yet, but Rwanda has a recent track record of shrewdly navigating technological advancement in a way that we have never done (for example, bypassing landlines and adopting cell phones “out of the gate”). Plus, the sunny climate would be perfect for solar power! Hmmm…

 

•••At a Private Hospital

We spent our final day shadowing at the King Faisal Hospital (KFH) under the direction of Dr. Immaculate Kambutse with the intention of comparing public and private hospitals. There were many striking differences. First of all, the wards were clean and relatively uncrowded. We also happened to be there on  Wednesday, which meant that the entire medical team was rounding together- four senior Rwandan physicians oversaw eight junior physicians. This was triple the number of doctors at CHUK! Other differences included the fact that a great deal of time was allotted to each patient and the injuries and diseases generally seemed less dire. Even patients with severe diagnoses had access to superior care and treatments — an elderly man was receiving a state-of-the-art drug (valued at $4000 per pill) to treat his hepatitis C. One case that stuck out was a comatose man who had lost his job because of his sickness and could no longer afford the expensive private care. A doctor explained that while KFH would probably have to send him to the public hospital, this was effectively a “condemnation” for the gravely ill patient, as there might not be adequate resources to address his complex needs.

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All in all, shadowing a range of doctors at various hospitals has allowed us to learn tons about the human body, medical practice, and the intersections of social, economic, and cultural factors with health and illness. Moreover, it has truly validated our shared commitment to purusing medicine as a career. This summer has provided us with the motivation we need for returning to academic study (Alice) and pursuing a bridge year employment (Emily) in a matter of weeks.

 

Niyo Arts

Every Monday and Wednesday, we head down the street to Niyo to witness fantastic dance performances. A few weeks ago was the monthly showcase, when locals and mzungus alike appreciate traditional dance and drumming. After witnessing all the “blood, sweat, and tears” that the Niyo staff and kids invested over the month of July, it was no surprise that the performance was stellar.

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Exploring

The two of us took public transport to Southwestern Uganda to get in touch with nature after many days in the city. After a night in Mgahinga National Park, we arose bright and early to summit Mount Sabinyo, one of the Virunga Volcanoes. We have since agreed that Sabinyo “takes the cake” for both the coolest variation in vegetation and the steepest climb (rising over 1,400m in less than 6km). The hike began in a bamboo forest packed with elephant footprints, after which we traversed a mythical forest full of Spanish Moss, and finally climbed a ginormous ladder into the clouds to reach the dense forested summits. While we were hobbling around a full week afterwards, this tri-summit, tri-country hike was the ultimate adventure.

 

Porter Nenon, Adam Jones, and Kaija Flood (past/present UVa students working with Porter on evaluating refugee camp education programs) have been living with us for the past few weeks, and together we have been enthusiastically exploring Kigali’s urban treasures and Rwanda’s beautiful countryside. Highlights have been the “Kigali Up!” music festival; a bus trip to Musanze & the Twin Lakes; and a marvelous weekend in the tea fields and forests of Nyungwe National Park. We will miss them very much but wish them all the best as they continue their fascinating and important work.

Murakoze chane, CGH!

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