MMFC In Rwanda 2015: Surgery: Day 3

Happy St. Patrick's Day from Rwanda! While St. Patty's day here may be far different than New York or Boston, the team did it's best to represent our Irish heritage with plenty of green shirts at breakfast this morning. Shannon brought enough shirts to make sure that anyone without green on looked up to par. We even made our own makeshift St. Patty's day parade on our walk up to the hospital from the hotel. Many of the local hospital employees were fascinated to learn of the great Irish holiday and wanted to join in our celebrations.

Day three proved to be very busy here for the team. With a schedule full of patients, we grabbed an early breakfast at 6 and went straight to the hospital to start work.

More residents and local nurses came to observe and learn in the OR today. A Swedish medical school student and a Swedish doctor, conducting research in Kigali for a few months, joined us to observe surgeries in the morning. In addition, the two residents from yesterday remained with us along with local two anesthesia techs, and a nursing student. The residents, Drs. Tuyishimire Gratien and Nkurunziza Charles, part of just the second graduating class from the medical school here in Rwanda, were a pleasure to be around. Strong in knowledge and eager to learn, Rwanda's medical future is bright with young energetic doctors like them. Dr. Jag summed up their progress perfectly exclaiming, "Someday soon we won't be needed here, and that's perfect. That's what we want."

As word spread about our procedures here, more potential patients journeyed to the hospital to be examined. Madaline and I continued to triage individuals, with the help of Dr. Nkurunziza. In total, another twenty potential surgical patients remain on the waiting list for the remainder of the week, with more expected to come in tomorrow. Madaline joked as we screened these patients, asking if we could stay three more weeks instead of just three more days. That's one of the hardest parts of the trip, not being able to perform surgeries on all of the well-deserving people that come here. We're just touching the surface on the people we can help here. The waiting list at the local hospital stretches over 100 patients long. Each carries with them such a unique and compelling story; we wish we could fix them all. Fortunately, many of these patients can be seen on the return trip next year, and as more and more residents and doctors gain experience, these waiting lists for surgery will diminish over time.

On a brighter note, yesterday's patients look great. After dealing with some nausea after surgery yesterday, Nyiraregwa is up, smiling, and eating. It was no surprise that she had a group of people gathered around her laughing when we walked in. She gave a warm smile and a big wave when Jana and I saw her this morning. Overall, the patients have really bonded in the recovery room. One of the nurses staying here described it as a "party" last night in the post-op room. It's great to see how much fun they're having with each other, even as they recover from surgery, and it speaks volumes about the warmth of the culture here.

Each patient holds their own interesting beliefs on the causes and treatments for their health. Our third patient of the day, Pudencienne, explained to the translator that she believed the cause of her goiter was a bug in her throat that got caught and enlarged over the last fifteen years. Another patient we screened, a 69 year-old named Fortune, was having chest pain weeks ago and believed a witch had cast a spell upon her. When she went to see the doctor, they gave her medicine for the pain but she threw it out in fear that it would kill her. Madaline explained that often the people who believe they've been bewitched will go see a spiritual man or woman to drive out the evil spirits. Even worse, they subsequently won't go to the hospital because they believe doctors will kill them. For Fortune, she drank tea and other concoctions from a spiritual healer but refused the medicine given by the doctor for her chest pain. Fortunately, she understood her goiter was the cause of a medical condition after witnessing other successful surgeries on the problem, and she worked up enough courage to come see a doctor to get examined. Drs. Jag and Merry will operate on her tomorrow.

By the same token, sometimes these patients will arrive will small cuts and burn marks across their bodies. Especially popular in northern Rwanda, according to Madaline, people will take small razors and try to cut or burn the areas around the goiter on the neck to rid the body of the harm it causes. Some believe that bleeding out these areas can alleviate the pain and excrete the bad blood. Others conduct this practice out of a more spiritual rationale, believing that cutting or burning around the affected areas of the body can rid the person of evil spirits. We've seen a few of these cases with small cuts and burns around the goiter on their neck. There remains a medical knowledge gap in some of the far reaching communities in Rwanda. As a result, Madeline, one of the brightest young nurses here, wants to set up an education program in rural areas to better explain the benefits of modern medicine. Her PHD focused specifically on the barriers to knowledge in these areas. For her work, the National Honors Society invited her to brief her thesis at the international conference in Puerto Rico, but she is limited by funding and is looking for aid to complete her journey.

Overall, the surgeries went very well again today. The first procedure of the day went quickly, only taking about half an hour to complete. Pudencienne revealed an interesting story of life with her goiter. Embarrassed about her appearance, she consistently wore scarves to cover up her goiter. While on a bike ride, the scarf got caught in the wheel, strangling and nearly killing her. She emerged from surgery flawlessly and had a big smile on her face when she saw her reflection in the mirror, no longer feeling the need to put a scarf around her neck. While there were some challenging cases, especially the last cast, lasting over two hours, the team performed incredibly as always. The team described Dr. Jag as a rock star before I arrived, and he's certainly lived up to the expectation. Dr. Merry has also emerged as an invaluable member of the team and a wizard in the surgical room. Even as the pressure and workload increases, they remain nothing but pleasant to work with. No matter the challenge, this team can accomplish it. In total, we conducted five surgeries today, with every patient emerging stable with a smile after their procedure.

After a long and challenging day, we settled down for dinner at the hotel. Our spirits remain high and we shared stories over Turbo King (the closest thing we could find to Guinness on St. Patrick's Day) and a bottle of wine, laughing the night away. The camaraderie on this team continues to drive it through the long days of operations. We will rest up tonight and prepare for another day of surgery in the early morning. Hope everyone had a great St. Patrick's Day back home!