Visit to a Catholic Community & Chapel

 

Butare is known as The Little Vatican because it has about 100 communities of Catholic Nuns and Brothers. We visited one with our friends; the only other missionary family we know of in Butare.

After a lovely (as far as we could tell) service in French in the little chapel, we explored the beautiful garden and new brick making project on the grounds. Afterwards we shared a really delicious lunch with the community.

 

What do you do when…

 

An inexperienced nurse leaves your only gastroscope soaking in water without its waterproof cap on for three days? And then the video keeps shorting out because of water in the electronics meaning it’s unusable?

Well this solution is definitely not in the Olympus repair manual:

I decided to immerse our newly donated scope, with all it’s protective caps removed, in rice for a week. And, praise God, it worked! The desiccant properties of the rice seem to have sucked all the water out of the scope and it is now functional again! Now we just need to find a couple more scopes just in case…

The Month Of November

 

 

 

Grandma & Grandad Visit
This month has been an emotional rollercoaster. We were extremely excited by the arrival of Tim’s parents three weeks ago. Tim enjoyed taking his Mum and Dad along to the hospital to share his work there with them. Being a doctor, his Mum was pleased to join in some of the teaching. The kids were very excited to have the attention of their beloved Grandma and Grandad and made full use of it. And we were all relieved to discover as the first days passed that a gluten-free diet is actually easier here than in Australia.

A Special Anniversary
On the 11/11/11 Tim and I celebrated our 11th wedding anniversary. We went out for dinner alone for the first time since leaving Australia, which made it memorable enough, but it was even more so after a bat dropped from the ceiling onto my arm and lay on the floor beside my chair throughout the evening. Other dinner guests popped by our table to have a look.

Adventure In Uganda
In the second week we all squeezed into the car to go on an adventure in Uganda. It was a long way on relatively difficult roads, but the scenery was stunning. Rwanda is truly the land of a thousand hills – lush, green and busy with people walking. We stayed three nights on a small island in Lake Bunyonyi, then had three nights seeing wild animals on safari in Queen Elizabeth National Park. Hannah in particular loved this. She chased a family of mongoose around, alarmed me by confidently running up to and trying to pat a warthog, and excitedly called out, ‘Ears! Ears!’ whenever we saw an elephant. We were even privileged to see a pride of lions on the prowl amongst a very uneasy herd of antelope and a leopard 100m away from our dinner table. It was a very special holiday.

Below: pictures taken at Lake Bunyonyi, Uganda

The guide informed us the small barren island (above right) is Punishment Island, for obvious reasons. Hannah was quite stuck on the idea of ‘Naughty Island’ and talked about it for the rest of the day.

Below: Pictures taken while on safari at Queen Elizabeth National Park, Uganda

On the way home we were grateful for God’s help when our muffler fell off on a particularly big bump. It could have happened in some very remote places, but happened in a small town that had a repair shop. God even sent an angel in the form of a catholic brother, who stopped immediately on his motorbike to offer help, directed us to the repair shop 100m back, negotiated the price for us in $US even though the man did not want to take them (we were out of Ugandan shillings with no money exchange close by), and made sure all was well before saying farewell. We were a tad glad we had prayed for His help in our day’s travel.

Baby Rabbits
We arrived home to discover that our rabbit had died that afternoon, leaving behind four two week old babies. I was touched that my friend Mama Bishop, who happened to have found out, rang to offer Nepo help not knowing we were home. Tim researched how to care for them on the net, and we began to hand-rear them. They’re very cute and, we’re happy to report, have doubled in size since the event and even begun to munch on greens. Hannah loves to cuddle them.

Good News For Nepo
A few days later we told Nepo the wonderful news that some friends in the UK had offered to pay off his house debt. You may remember his story from some months ago. We refinanced his debt a while back so that the bank did not turn the family out on the street, but he has been unable most months to repay any of it, for good reasons like mandatory health insurance, secondary school fees and food (this is the hardest month for those who live off their own crops). This has been such a burden for him over a number of years, and he couldn’t contain his joy at the news. He began to praise God and obviously couldn’t wait to return home and tell his family. I have a strong image of him walking quietly out into the garden after the excitement had died down, and pouring over the letter and photo I had given him to explain.

A Grieving Family Returns
Last night was Bill and Genny’s final evening with us. Our neighbours (a doctor couple whose older son plays a lot with William) came to visit. We ran into them the day before at the little supermarket in town, but this was our first proper catch-up since their return from Europe where their younger son died suddenly (aged 10 months) some weeks ago. My friend shared with me some of the details of her son’s death and her own grief. Her son died while in her care in France, early one morning, and the ambulance officers were unable to resuscitate him. Her husband and older son were in Belgium at the time. They buried the baby boy in France, with siblings and friends who live in Europe in attendance. In the midst of this discussion Hannah came and put her arms around my neck; she was full of living warmth and I felt overwhelmed with thankfulness that I still had her and awareness that my friend sitting next to me was watching and must be missing her son even more. Speed the day when Jesus returns to wipe away every tear and there will be no more death.

A Warm Community
We have loved sharing our community here with our family. We love them all even more for welcoming Bill and Genny so warmly. A colleague of Tim’s generously took us and the other senior doctors out to dinner one night to honour them. There have been lots of cups of tea and dinners shared, and this morning a neighbour popped in to say a final goodbye before they left for the airport.

Kids from our neighbourhood in the sand pit

Walking down the Butare aerodrome runway with our friends ‘The French Family’

 

Above right: watching a movie with Will’s special friend G and his brothers

Mama Bishop and Bishop Nathan, who had dinner at Tim’s parents’ house many years ago and invited us for our first visit to Rwanda

Bill and Genny are now in Kigali with Tim, about to board the plane. The kids and I have been grieving already (it’s much harder being left behind than doing the leaving), and William sensibly suggested we invite ourselves over to a friend’s house to distract ourselves. He’s a clever boy. When we walked in they had just finished decorating their Christmas tree, and I sat around the table with all five kids making Christmas decorations while my friend cooked lunch. Ahhhh, community. I love it.

False Hopes

 

Today was a busy day.

We have twenty new third year medical students, ten new interns, seven new Masters level postgraduates, as well as all our continuing postgraduates from last year. But the main circumstance that made my day busy was not teaching. It was trying to care of a 23 year old girl with sudden severe illness.

She had been admitted two weeks ago and I had seen her then. A thin slip of a girl, still smiling through her laboured breathing, in florid heart failure from severe anaemia. We had treated her heart failure, arranged several gradual blood transfusions, and she looked to be on the road to recovery.

Over the weekend that all changed.

By Monday she was sicker than she’d ever looked, neck veins bulging with extra fluid, half conscious as she puffed and panted away. We did what we could; the hospital had no ampoules of diuretic medicine to remove the excess fluid so we improvised, borrowing some from other patients and those left by discharged patients. I was hopeful but worried; why had she deteriorated so far so fast? Her mother, a weary middle aged woman with eyes that had seen too much death and misery, rearranged the pillows with resignation.

At nine that night her blood results came and with it a diagnosis; kidney failure, cause uncertain. Her kidneys had worked when she reached the hospital but that was changing fast for some reason. By next morning she had made no urine at all. In the midst of teaching and wading through scores of students, I tried to make a plan. I did a quick ultrasound to ensure no blockages in her waterworks, gave calcium and insulin to reduce the danger from her high blood potassium, and prescribed urgent dialysis to remove the fluid and excess minerals that were poisoning her.

In theory, we are a major dialysis centre taking referrals from across the country. In practice, supplies and equipment are difficult to obtain and bureaucratic processes too slow for many of our patients’ needs. Today, it was more complicated than ever. We had only 2 of the single use lines for the dialysis machines left, and another patient with severe renal failure after a difficult Caesarean section was already assigned these. I negotiated, I cajoled, I rang senior administrators. Finally an agreement: one for each patient then an urgent request to our sister hospital in Kigali to lend us some more.

I revisited the patient: still alive, just. Then home for a Kinyarwanda class and lunchtime and back to the hospital for an afternoon’s teaching to fifteen undergraduates. In the midst of this, I was asked to sign her dialysis approval letter, surely a good sign?

As soon as teaching was finished I made a beeline through the rain to the ward. She must have had dialysis by now. All had approved, everyone had been convinced or coerced, at the very least I could pray for her and her family that she might live the long night before a morning transfer to Kigali….

A roll of sticking plaster. Balls of cotton wool. New clothes. The accessories of death.

Her mouth taped shut, her eyes and nose blocked against the world that could no longer disappoint her, her tatty T shirt removed and replaced with a fine new one. The rituals of death, performed by a resigned by kindly mother with all-knowing eyes.

It had been water in the end, I discovered as I trudged home through deepening mud and rain. No water from the mains this afternoon. A minor inconvenience at home necessitating the use of jerry cans. Such a simple thing, but no water means no dialysis, and for her time had run out. I prayed for her anyway, and for her mother, and debriefed the fresh intern who had done his best for her all day. Rain hid any chance of detectable tears.

A surprising theme for the day!

My friend, our kids and I were walking down the streets in Taba; the 'nice' side of town. We were on our way to visit her mother’s project, which she had told me about but I’d never seen. As we passed six women hoeing a field behind a high school, I stopped to wipe Hannah's nose. The women stopped to watch Hannah. Hannah asked for the tissue, lay her toy rabbit back in her arm and gently wiped its nose in a very motherly fashion. The women 'oohed' and 'aahed', laughing. On we walked, soon arriving at the project.

Thirteen girls live there who have mentally unwell mothers, so were on the streets. The government authorities bring new girls there sometimes. There is another branch that places children with AIDS in homes and helps families to support them, growing food and paying school fees etc. and another branch that runs income generating projects (making stuff) for women with AIDS. Research is done to make sure that each person they help has a genuine need. It was quite impressive!

On the way home we saw a group of ragged boys leaving the back of the high school where the women were still hoeing. The boys looked pleased. My friend told me they come daily to eat the students' leftovers – what’s been left on their plates. Today they had some second hand mosquito nets too! They passed us in the street (Hannah is interested in every rock and flower) and my friend chatted cheerfully with them. It reminded me that she has helped many street boys in the past, managing a project, and seen the boys grow up and come good.

After we arrived home at my friend's house we were visited by a young man about to start law at the university who wanted to share his passion for helping street children. He said he had seen me on the street a couple of months ago and for some reason wanted to talk to me about it. I was waiting for a request for money but it didn’t come – he’s just overflowing with passion and had to share it. I've put him in touch with a music therapist / lawyer running a project for street boys here and we're all going to visit the project this week.

A surprising theme for the day! I wonder where it will lead…

Monkey Troup Visits Us

William, cornered in the tree house, screamed for help and spent the rest of their visit sitting in the house. Hannah ran after them calling out “Monkeys! Monkeys!”

Whose the king of the castle (tree house) now?!

Night driving, Rwandan style

 

… is not for the faint hearted.

I’ve been in Kigali all week, working on putting together protocols for all the hospitals around the country to use in managing their medical patients (sort of like a big recipe book for doctors!). It’s been a useful but tiring exercise, and I was glad to be finally heading home to Catherine and the kids this afternoon. We’ve had lots of rain this week, and it was pouring steadily most of the afternoon.

After a quick shopping trip (foods and spices, small presents for the kids and a gift from a lovely Indian spice-seller of a curry leaf tree!) it was time to hit the road for Butare. It’s about 150km, usually a 2-2.5 hour trip as the road, while good, is very windy. Unfortunately time had slipped away and it was after 5 when I left and the sun sets at 5.45 year-round here.

It’s hard to describe the road to Butare. Perhaps the closest I can come is to suggest you imagine the Great Ocean Road, on a day when the Great Ocean Marathon is being run along it (so there’s people all over the place), and then pretend there’s also a simultaneous bike race along it, with prizes for who can carry the most stuff while they race their bike (placegetters on my trip – man in blue top with 35 deck chairs stacked on the back, man in Arsenal singlet with 6 50 litre jerry cans and 15 broomsticks etc etc.). It’s also the main overland truck route to Burundi, so add that in and you’re starting to build up the picture.

Now, after dusk the bikes and pedestrians don’t go away. But the real hazard is the buses. They are quite literally lethal. There are really only three main problems with them:

• They drive at 90km/hr down the aforementioned windy road
• They think the dividing line down the middle is  irrelevant and, in any case, they’re travelling too fast to be able to corner on their own side
• They rarely dip their headlights, so you’re often blinded by their high beams

This in turn poses three slight issues for your night-time motorist:

• Any contact with a bus at a combined speed of 160km/hr (their 90 plus your 70) is almost certainly fatal
• You can’t see the bus, road or any other bikes and travellers on the roadside because of the blinding highbeams
• You thus have to chose how far to swerve (always necessary because they’re on your side of the road) for each bus based on a combination of luck, instinct and sheer panic, hoping you don’t hit anyone on the verge in the process

I said a lot of prayers on the way, and survived several near misses. Thankyou God. I think I’ll be avoiding inter-city night driving at all costs in the future.