Thursday, April 1, 2010
One of the areas of proficiency that is fairly critical to anesthesia in Rwanda is pediatrics. These cases are considerable, as 44% of the population is under 15 years of age (2005 data). Most cases are of fractures, but some common pediatric diagnoses such as pyloric stenosis exist.
Wednesday, March 31, 2010
Those of you in the medical field will know that M and M rounds (morbidity and mortality) are essential as they provide an opportunity to review unfortunate outcomes; to learn from these and to make improvements in future care. To date there have been no M and M rounds in Rwanda.... until today. We are very proud that this morning we had a combined M and M round with Obstetrics and Gynecology and Anesthesia to review the tragic case we had earlier this month of maternal death from severe pre-eclampsia.
Tuesday, March 30, 2010
One of the most enjoyable parts about walking about in Kigali is seeing the wonderful fabrics that the women wear. Our plan is to take fabric back to Canada to make OR hats, and sell them as a fundraiser for CASIEF, the Canadian Anesthesia Society International Education Foundation, who sponsors the residency program in Rwanda. Also, to have skirts made.
Sunday, March 28, 2010
Note - a word of caution: this may be somewhat graphic for some people.
We met Steven outside the genocide memorial. It is a rather non-descript, one-story brick building surrounded by a high white metal fence that used to be a Catholic church. In 1992, 2 years before the genocide, an Italian nun named Tonia Locatelli sheltered many Tutsis against the sporadic violence that had already begun. 680 tutsis were killed in the village of Nyamata, and the rest were driven from their homes, dying of starvation. Many tutsis had started moving to this area to flee violence in the rest of Rwanda. She brought international attention to the situation: “we must save these people. We must protect them. It is the government itself that is doing this”. She was assassinated outside her house, later that year.
In 1993, tutsis were told that it was safe to return to their homes, which they did. But by 1994, when the persecution began again, they came back to this church which once was safe. For 3 days Hutu forces waited outside. They shot tear gas into openings in the roof, weakening the people inside who were already sick and starving. Then they stormed the church, killing 10 000 people in one day, mostly with machetes and blunt objects. The pews still stand, holding the clothing of the people that died there. Some of their possessions, such as rosaries, and a knife and a machete, remain on the altar.
From there you descend into a white tiled morgue, where you see the coffin of a pregnant woman, who was raped, stabbed in the abdomen, and then through the groin up to her brain with a sharp wooden pole. Skulls and other bones are stacked neatly beside. Identification cards, leftover from the Belgian regime, clearly state ethnicity: tutsi.
In the back yard there are 2 large mass graves. Approximately 40 000 people are buried there, from the church massacre as well as others in the area. You descend down narrow concrete steps into the dark tomb. Another narrow corridor leads between the rows of coffins, barely wide enough for my shoulders to pass. I don’t want to brush against them. I feel like vomiting, like shrinking into myself. There are more stacks of skulls, arm and leg bones, that were recovered from a pit that had been dug to dispose of the bodies. The families took them and cleaned them, according to their tradition, and tried to keep the bones of family members together.
Our guide is Steven. He is from Nyamata. His parents and older brother, as well as numerous extended family members, were killed in the genocide. Patty first met him when he was a guide at the memorial, and they have kept in touch since then. He and his family hid in the sugar can fields for days, starving. You drive past these fields, as well as a river that eventually drains into a major river in Ethiopia, and into the Nile. Militias killed thousands and dumped the bodies in this river, saying that they would return to their homeland (tutsis are decscended from the tall, slim Ethiopian tribes). Steven’s friend Charles is also a guide at the memorial – he was one of 7 people who survived the massacre. He was 8 at the time. Patty remembers him from the last time she visited, in 2008.
I just don’t know what to do with what I have seen, what I have experienced. It is revolting. The skulls have obvious fractures, giant holes that have been bludgeoned. Tears seem so useless. Your whole face crinkles into this mask of pain and disgust and misery. It is a very raw experience, unlike the genocide memorial in Kigali. I’m so glad Daniel did not see this one. He was horrified enough by the Kigali version.
Nyungwe National Park is something of a hidden treasure in Rwanda. It somewhat recently became a national park, the largest protected high-altitude rainforest in East Africa. And rainforest it is: at times I can't tell if it's raining, or if I'm experiencing condensation from the trees, or if we're hiking through a giant cloud.
Friday, March 26, 2010
We are spending the night at the ORTPN guesthouse in Nyungwe Forest in southwest Rwanda. The guesthouse is very basic but delightful in its simplicity. There are calla lilies just outside our door and gentle forest sounds with a light rain falling. We are with Emmy, our wonderful driver and guide. We seem to be the only western guests but there are a few Rwandan guides here. After dinner we sat around a campfire and Ariane sang then later Emmy sang some songs in Kinyarwanda and drummed the beat on the table. Delightful to be here.