Inzu y’inkoko n’abana (House of chickens and children)

The last week or so, I’ve been working on building a chicken house in our yard. It’s involved a few trips to different hardware stores (no Bunnings in Rwanda!) and a trip to the local sawmill to buy wood. Both Catherine and the kids have been heavily involved; Catherine sewing lengths of chicken wire together, Will hammering in nails, and Hannah just generally being enthusiastic about everything and getting as muddy as possible.

Did I mention the mud… Yes, well we’ve had an unseasonal ‘short wet’ season in the middle of the dry the last week or so. Which has converted dirt everywhere into sticky mud that will build up on your shoes to centimetres deep, and then, if you are a small child, can then be walked obliviously through three rooms of white tiled floors in about 10 seconds. A great time for a building project!

Eventually though, we finished it. Nepo is off on a 1 1/2 hour bike ride tomorrow am to pick up chickens for us from the special chicken market. And the kids and I road tested the chicken house this morning straight after breakfast (hence the toothbrush):

Which leaves us wondering: where will the chickens live now that the kids have got a new house?

Death

 

I was rather shaken up today when one of my patients died.

Now, this sounds silly at first glance. I’m a doctor, people die, inevitably some of my patients will be among those who die. But this death felt different.

The man who died was my own age, a secondary school teacher with a wife and a young family. He’d been suffering from headaches for a few months, that no-one had been able to figure out a cause for. Eventually he was referred from an outlying district to our hospital to try and sort things out.

When I first saw him mid last week, I was worried. He had nasty sounding headaches vomiting, and some subtle problems with double vision. We don’t have a CT scanner in Butare, so we arranged for him to go Kigali ASAP (within 1-2days) for a scan of his head, looking for a problem in his brain.

The scan I saw last Friday. It showed advanced neurocysticercosis; a disease caused by the pork tapeworm larvae (from eating tapeworm eggs) migrating into his brain and dying there. This had blocked the outflow of fluid (CSF) from inside his head and the pressure had built up, causing headaches. The question was what to do. The only neurosurgeon was in Kigali, and a transfer required a letter which would take days to organise. I decided to treat him with antiworm medication, steroids to reduce inflammation and mannitol to get the pressure inside his head down while we waited.

It was a long weekend, so nothing moved on the letter front until this morning. Unfortunately this morning, the pressure inside his head became too great and he died. The first I knew of it was his wife wailing as she ran through the ward corridor grieving her husband’s death as I started my ward round nearby. The memory of that cry still sickens me.

I liked this man. I really wanted to save his life. I feel tremendously sorry for his wife and family, now deprived of their husband and father, as well as their breadwinner. I wonder what else could have been done. Should I have ignored the letter and tried to get him urgent neurosurgery? Truthfully I doubt the surgeon would have operated without the correct paperwork, and even if he had, it would probably not have been done on the weekend, in time to save his life.

The barriers to emergency care are often just too great here. The transfer systems, as with so much of the other bureaucracy are so Byzantine. The capacity to pay for treatment is often so low. Many cases find their way here so late that sometimes little can be done.

But my job here, as i see it, is to both to try to help these patients and to model this helping for my colleagues and junior staff. Sometimes I’m not sure what I’m trying to model. I know my Christian faith is a big part of it, but even then I don’t have all the the answers, especially to the medical, culturo-political, and health system issues. This too is part of the equation: vulnerability, seeking advice, not taking one’s power or position as a right but as a trust and privilege. But modelling fallibility is one thing; feeling it and experiencing its consequences is quite another. A fallen world is a painful place to live, even when much of the worst pain is experienced second-hand.

Maybe then, my conclusion is that there is no conclusion, at least not this side of heaven. I can model hope, but never be it. I can point and cajole, but never command or direct. I can teach, but only brokenly and imperfectly, I am only a signpost to the Great healer of this world. And my care will fail, but His love and care never will.

I am praying for this man’s family tonight.

She’s OK!

Hannah slept all night (I was too worried to sleep very well!) and she woke up happy, smiling and quite pleased with the special bandages on her hand and feet! We checked under the dressings and the burns are minor. Thankyou God!!

I still feel sick when I go into the bathroom, don’t want to run a bath, and am haunted by Tim explaining, “We might have to air lift her to a burns unit” (i.e. to another country). I shouldn’t have learnt this lesson the hard way. Never again will I run pure hot water into the bath (even if the water supply is so feeble at that time that if I turn the cold water on it will overrule the hot, I’m worried it might stop completely any second and I know I at least have cold water in jerry cans). Next time I’ll tip a jerry can of cold water in and then add the hot.

Meanwhile, just to reassure you that she’s fine, Hannah wanted her face bandaged as well as her feet this morning…and then giggled as she tried to bandage mine. She’s been trotting around the house in her usual happy, busy, determined manner, and greeted William (when he finally woke up) with an enthusiastic cuddle.

Prayer Request

 

Hannah unfortunately managed to dive head first into a bath of pure hot water.

Fortunately, she landed with her hands and feet outstretched and thus only hands burns to her hands and (mostly) her feet. Praise God, she only has superficial burns to these parts and no deep burns anywhere I can see. But she’s pretty sore and sorry for herself.

I’ve had diarrhoea all day again today, the 3rd time in 10 days, and tonight am running a fever despite panadol. I was well enough to go to the hospital and get the dressings and medicine we needed for Hannah. She is sleeping now, after Bacitracin ointment, and paraffin gauze dressing to her hands and feet, and panadol, ibuprofen and tramadol to help her sleep.

While we’re all ok, understandably we’re all upset about what happened, although we’re all really grateful to God that it wasn’t any worse.

Please pray for us tonight.

Kumbya

We’re just back from five night camping beside Lake Kivu at an annual Missionary Conference (running since the 1940s!) called Kumbya. It was great to get away on our first real break since arriving in Rwanda 6 months ago, and equally good to get home to our own house, in our own car, afterwards to find Nepo had taken great care of everything in our absence!

Kumbya is about 4 hours drive from Butare, down a progressively deteriorating road that heads towards Congo. About an hour from Butare, you enter the Nyungwe Forest, a large and pristine National park that the road runs through for 90 minutes or so, going over a mountain pass about 2500m above sea level. We stopped for lunch at the roadside and went for a little stroll into the forest.

Kumbya is a special place. Gifted to the Protestant missions in the 1940s, it juts out into Lake Kivu on an isolated promontory and is now an amazing bird sanctuary, being one of the few stretches of lake shore not subject to clearing and intensive farming. Over 100 bird species have been spotted on this one tiny peninsula, less than a square kilometre in size. We set up our tent  in one of the few remaining spots (about 130 people attended the conference) and explored our home for the week.

Both William and (especially) Hannah thrived: camping, exploring and playing with the many other children attending the conference. They both loved the lake “beach” where they spent many hours playing in the sand. Catherine and I both enjoyed the teaching and fellowship of the morning and evening sessions, catching up with a few old friends, and making new ones. While we only stayed five days, half of the total conference length, it was a great time of rest and spiritual refreshment.

On the way home, we stopped at the Nyungwe Forest Lodge, a five star resort, for a cup of tea! The kids loved running and jumping all over the place, and Catherine and I both enjoyed some respite from the travelling. The setting is beautiful; in the midst of a tea plantation on the edge of the Nyungwe Forest, so I took even more photos!