Thanks papa Peevy!!

Papa Peevy bought us all earrings on our last day in Kigali!!

Shenanigans in what we should now call our Rwandan family

Unsurprisingly when you live and work with people for two weeks or more, you just happen to catch some funny remarks along the way. Here are some pearls from our trip. Enjoy! Some people may appear more frequently than others. :)

"You have to give me a prophylactic no." -Andrew Bright

"If it's no shave Rwanda, the girls have to wear long dresses." -Dr. Albertson

"Rainbow bright?" -Meagan Pate misheard "Rambo Bright" in reference to our protector Dr. Bright

"Is there a Dr. Telesforo who looks like Dr. Jospin?" -Carter Edwards

"That shows you how frivolous it is to do body building." -Dr. Albertson

"Cheater, cheater, pumpkin eater. That's what we say in England." -Carter Edwards

"You get ALL the vitamins you need from meat." -Joseph Sewell

"Always for woman." -Jean Rene (a nursing student in English club in response to the "panic attack" question in the English class jeopardy)

Carter Edwards: I'll make the popcorn. (1 minute later) Does anyone know how to make popcorn in a microwave without a popcorn button? (Laughter subsides, and Katy gets up to help.) Wait. I can make it. So, like four minutes, right?

"PROTEIN." -Daniel Smith

In closing, in order to honor the many physicians that we had the opportunity to work with in the hospital. We had delicious M&M cookies made by Katy, along with other treats made by our wonderful house staff. There were many conversations about music, marriage, children, and good byes. Most importantly, there was a dance movement lead by Joseph. Don't worry, we have many incriminating videos that we will gladly post once we get access to a faster Internet connection. For now, pictures will have to suffice.

-Anna

New post on kjacksonp.blogspot.com--week 3 at Kibogora, 2013

kjacksonp.blogspot.com

Easy like Sunday morning

Abs & cardio on the grounds

One Glad Morning When This Life Is O'er...

I started writing this post a few days ago, the same day Jamie posted about this experience, but it was hard to put it all down into words in such a short amount of time. But here it is. Spoiler alert: might want to grab your tissues first.

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We’ve had many great days in Rwanda, even when we’ve been working hard. Today wasn’t one of those…

I lost my first patient.

It began like any typical day for Team Pediatrics. NICU, newborn, wards… During the middle of our first wards room, Dr. Peevy received a call from Julie that a mother of a term pregnancy was about to undergo emergent C-section for a prolapsed cord. Dr. Peevy sent Jamie (our NICU nurse) and Katy up to standby during the C-section in case the baby needed resuscitating. Within minutes, Dr. Peevy receives another call – this time, Katy, explaining to Dr. Peevy that this one baby with a prolapsed cord was actually three very small preterm babies – two girls and a boy. So up the hill we ran.

From there it was a whirlwind. The resuscitation room was chaotic. Three tiny babies and many adult hands trying to revive them. Making room for all three in the already packed NICU (as you might remember from my previous post is quite small). Trying to find enough plugs for all the monitors, oxygen concentrators, incubators, CPAP machines, and other various equipment. After moving them all to the NICU and evaluating them, it was clear that the little boy I had helped Dr. Peevy resuscitate was in bad shape.

This is Rwanda. They don’t have surfactant. The only mechanical ventilation they have is our team making a schedule and taking turns hand-bagging. Our experienced NICU nurse Jamie and Dr. Peevy both agreed – palliative care was the only option.

Julie wrapped him in a blanket, put on a yellow hat, and handed him to me. I immediately put my steth in my ears and listened for a heartbeat. But Jamie said, “Don’t even worry about that right now. Just hold him. And talk to him. And love on him.” 

So I did.

And I cried. And I rocked him. And I prayed. My first prayer, I admit, was an incredibly selfish one. I prayed and askedbegged God to please never put me in this situation with any child of mine. Then I prayed that God would take him quickly and painlessly, and help me to let him feel love for his short time on the Earth.

 Jamie told him to go play with all her little babies who were already happy in Heaven with God. I told him that, too. I told him that Heaven was a wonderful place where he could breathe so easy, and God would take such good care of him. I even told him to find my grandmother so she could hold him, since she never got to hold MY baby here on earth. Then I sang to him. First I sang a song I used to sing (and still do occasionally) to Angel called, “If I Were A Butterfly”. But I kept tearing up at the line “…and you gave me a smile…” because I knew this little guy would never get to smile. So many things he would never get to experience. Then I sang a few verses of “Amazing Grace” to him. It seemed fitting. It always is.

Then I thought about one of my favorite hymns and how fitting it was for the situation – “I’ll Fly Away”. I’d been telling him how wonderful Heaven would be, but I was crying. Seemed like a mixed message. So I sang it over and over, at least 5 times in a row. The first couple times were for him. The others were to convince myself that this was what was best for this sweet child. Even though he wouldn’t know the wonders of the Earth, Heaven was infinitely better than any of it. And God’s love is so unfathomably great that it makes even a mother’s love seem like less than a casual acquaintanceship. This is something that I feel is easy for Christians to say, but incredibly hard to feel while waiting for the inevitable death of a loved one.  Afterward – much easier. But before – almost impossible. But I knew it was the truth. If he did survive, he would have had significant impairment, considering it was HIS cord that was prolapsed, and that it was quite some time after delivery that he’d started attempting to breathe on his own. He would be free of those burdens in Heaven. There wouldn’t be a struggle to breathe. And his little tiny body would be perfect.

Sometime during all this, it became inevitable that his sister would also not make it. Micki wrapped her up and held her, too. So we held them together. Talked to them. Rocked them. And loved them.

To understand the next part of the story, I need to explain something. The Rwandan culture is historically a very stoic culture. They never show outward signs of emotion, and are discouraged from childhood from doing so. Most of the mothers in the pediatric wards will tell their children to stop crying if they even make a peep. This has been especially true since that dark part of Rwandan history a couple of decades ago, that I feel very uncomfortable mentioning while still here. The NICU nurse Euphrasine explained that the country did so much crying during that time that they had finished all their crying. They shed so many tears that they had no more to shed. So they don’t cry, with the exception of the memorial week for said dark times. Only during that week is it acceptable to show emotion publicly. That week begins April 7^th.  Also, here mothers do not name their children until they are two months old. If the children die in the hospital, generally they don’t even want to see them. Most of this stems from the high infant mortality rate in this country. Most mothers have lost a baby or two here.  It’s a coping mechanism so they don’t get attached before they know they are going to survive.

The first unexpected event that happened was that Euphrasine actually cried for these babies. In the NICU. In front of the mothers of all the babies. The last set of triplets that had been born nearby had gone somewhere else and didn’t survive. They were excited for the chance to try to make a difference in these babies and keep them alive. And we just couldn’t.   

The second unexpected thing came after Julie and Euphrasine told the mother that she was losing two of her children. The mother actually wanted to see them and hold them. Julie and Euphrasine took them to her. She prayed over them and told them to go forth to Heaven.

Micki and I had been standing by and considering if we would continue to hold them until they passed. Once I found out what would happen to them if we didn’t, I decided I was absolutely holding him. So we sat in a private room and each held and rocked a baby while sitting on a bed, talking with Julie and Euphrasine.  I checked his little heart again. This time, I didn’t hear it beating. I asked Jamie for confirmation. She concurred. And, I think in that moment, I felt a release. I felt comforted by the fact that he was with Jesus and he would get to play with his tiny sister very soon.

And we still had our tiny Sunshine. This is the name we gave to the last remaining triplet. The tiny, feisty one. The one who looked as if she had the best chance of surviving. She was our sunshine on such a  cloudy day. Micki even made her a yellow hat. We prayed that the Mama would have at least one baby to take home with her. And she held her own for a little while…

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-- Mary Margaret

More information about Jean-Claude's hospital

Earlier I had mentioned praying for our friend, JC (Jean-Claude Bataneni), and the hospital he works for in the Democratic Republic of the Congo, Nebobongo Hospital.  I wanted to attach a couple of links so that readers would have more information about it:

http://www.slideshare.net/jcbat25/nebobongo-hospital-power-point

http://www.unitedforrelief.org/partners.html

Please continue your prayers, and if you'd like more information, let me know.

-Joseph

Week of mourning, faith, and prayer

April 7th marks the memorial of the 1994 Genocide here in Rwanda. A time when the dark hand of evil cast a shadow over this beautiful country. It is illegal in the country of Rwanda to speak of the genocide in public. For fear that it will cause dissension. In keeping respect for this we will limit this topic of discussion, but would like to share with you a few things. The week is filled with solemnness. No dancing, clapping, or cheer. It is said, during that tragic time the women shed all of their tears, and have none left. It is culturally unacceptable to cry in public. This is evident at the hospital when children are chastised for crying even though they are injured. They learn to grow up stoic, not showing emotion. During the memorial week these cultural taboos are relaxed as the whole country grieves. Post traumatic stress becomes a common diagnosis at the hospital as they are confronted with images and memories of the past. Outside our compound is a purple building that marks a mass grave of 1,200 people who were massacred in this small village of Kibogora. It is a daily reminder of the pain and suffering these people have endured. On Sunday it will be opened so everyone can pay their respects to the names printed on the walls in remembrance. As outsiders we can show our support by offering our prayers. Prayers for all those whose lives were cut short by evil, prayers for all those who were left behind to grieve.

Orthopaedics at Kibogora Hospital

I want to begin by begging your collective pardon for the brevity of this post. We have had many cases recently and will continue to have many more, so the ortho team's time is limited at best.
Part of the appeal of orthopaedics is how missions-applicable it is. It's been a sincere joy to be able to come into this hospital, identify patients and their needs, and surgically correct the malady to the best of our ability. For example, we got a boy named Pierre into our clinic last week who had the absolute worst case of knock knees I've ever seen. Pierre could barely walk, and if he did, he was in excruciating pain. After much research into the angles and surgical correction by Dr. Albertson, we were able to surgically correct his left knee with plans for he right knee when his left heals. Now, this, in and of itself, doesn't leave you with this deep feeling of happiness or the typical warm fuzzies you get when you usually are able to help someone. However, after surgery, when his sister was waiting for him outside the OR, we pulled back the sheet covering his newly-straight leg, and her face broke into the broadest, brightest smile I've seen since I've been here. From my standpoint, I consider that a job well done. If you're reading this blog and need a blessing in your life, go out and do something for someone else. Not only do you bless them, but the blessing you receive in return is far greater than you can ever imagine. I'm so thankful that God placed me into such a missions-applicable field.
Borrowed from Philippians 4:21
Give my greetings to each of God’s holy people—all who belong to Christ Jesus. The brothers and sisters who are with me send you their greetings.
-Daniel

Sunshine on a cloudy day

April 2, 2013 started out as a typical day here in Rwanda. We began our morning with a group breakfast, great discussion of the word of God, and off to work. Every team went their separate ways to discover what this great day had in store. The pediatrics team; Dr. & Mrs. Peevy, Katy, Mary Margaret, and myself began our day in the NICU as always and worked our way through the infants there. Moving on we went to room B which would be known at USACW as the "fat farm." Finally, we moved to the "newborn nursery" area where all the mothers are recovering from vaginal or cesarean deliveries with their newborn infants in the same bed. Around 10:30 the team moved to the pediatrics ward and started making our way through various childhood diseases. The phone rang around 1100 alerting us to an impending delivery of a term infant with a prolapsed umbilical cord. This is a serious medical situation in which the infants umbilical cord is protruding through the vaginal canal. This is an emergency situation because the infant is compromised as pressure occludes the umbilical cord...aka the infants source of life while in utero.

Katy and I arrived in the OR to help Julie (an American working on improving the NICU mortality here in Rwanda) as the c-section was underway.The surgeons began to pull a body part from the abdomen and we realized the infant was breech and preterm. Then they said "There are 2." I began working on infant number 1 who was 1000 grams. As infant 2 was delivered they realized there was another infant. We called for Dr. Peevy and the rest of the peds team to come assist with this triplet delivery of 30 week infants. Everyone worked hard to resuscitate these infants. Sadly, at the end of the day we lost two infants. The limited resources of Kibogora played a major role in the loss of these infants. However, the nurses that staff that NICU worked incredibly hard to give these infants all they needed for a chance to survive. They took the loss hard.

The beauty of the day was found as we finally left the unit at 3 p.m. after sending two sweet angels to heaven. Micki has been knitting hats for the infants in the NICU. She began creating a yellow hat for our newest patient. Leading to her nickname "Sunshine." She is still doing well for today. Here is a little glimpse of how precious she is. Please keep her and her family in your prayers.

-Jamie

THe Muzungos Will Eat You!!!

(For those of you who don’t remember much from your high school Kinyarwandan class, muzungos are rich white people.)

Long time stalker, first time blogger here. I’ve spent my time so far on the Peds side which includes NICU, well nursery, Peds wards, and PICU. During the first part of our day, we examine the NICU babies. If adorable could kill, this room would be enough to take out the entire continent. Some of the social situations these children and mothers are dealing with also tug at our hearts very strongly. Unfortunately my carry-on isn’t big enough for all of them, and the Rwandan government apparently doesn’t allow international adoptions. This room is maybe 12’ x 20’ and contains 5 isolets (some containing multiple babies), 5 cribs (again, some containing multiple babies), two counters, a sink, and two benches for the mothers. All mothers here breastfeed, so the mothers, who have clearly very recently given birth, must stay in this room almost ALL DAY LONG in order to be able to feed their children, unless they are in the recovery room next door, which they stay in only a few days after giving birth. Currently there are 12 or 13 babies in this room, with only two sets of twins. Not only are most of those mothers present in the room along with that many babies and that many places for the babies to lie, but also three Rwandan nurses who translate for us and who care for the babies while we are not there, Julie Yerger (another Muzungo), Dr. Peevy, Micki, three medical students (Anna, Katy, and myself) and Jamie, our own NICU nurse. Can you say, “crowded”?

Then we go across the hall to neonatology B, which functions as a step-down unit for the NICU as well as a place for discharged NICU babies to come for follow-up appointments. We’ve had a few play musical rooms with us and move back and forth across the hall multiple times, but for the most part, moving here means leaving soon. This room has adult sized beds so mom and baby stay together in the same bed.

After that it’s off to newborn wards. This room also has twin beds, and is where mothers come shortly after delivery with medically stable babies. We try to find the charts and match them with each baby (not an easy task when you can’t pronounce the names) and attempt to see each baby once before the mom is discharged to ensure that the baby is stable. The moms play musical beds and sometimes go to another building to use the restroom, eat, or bathe, and the babies can’t tell us their mothers’ names, so sorting them out can be a little difficult. Luckily the nurses and nursing students speak somewhere between a little and much English, and can also remember which women were in which beds.

Next is PICU time with Dr. Nathaniel (aka Pastor), Leonard, the intern and/or Dr. Ngoy. Kids are placed in the PICU if they need closer monitoring or if they need oxygen. This is where our sweet twins Happy and Hope resided, both of whom are aptly named. Hope is a beautiful little girl who is requiring oxygen who has been difficult for us to treat. Since mom has to be around, as she’s only 7 months old, her twin, Happy was there, too. This kid LOVES the muzungos almost as much as Daniel loves protein. Their mom is a teacher and actually speaks ENGLISH!  She allowed us to pray over Hope and her condition, and thanked us when we were done. Such a bittersweet moment – happy to be sharing my love for Christ, but so sad for this sick little girl.  Yesterday, Hope was finally taken via ambulance to Kigali (which is a 6-7 hour drive despite being less than 100 miles). We hope and pray the doctors in Kigali can figure out what’s wrong and treat her! Any prayers for this wonderful family would be much appreciated. Not only is she very sick, but the parents have no family in Kigali so they must find living arrangements, or live with the ENTIRE family in Hope's hospital room.

Baby Hope and Katy

Twin sister Happy

Finally, we tackle pediatric wards. Peds wards are split into three general rooms, which I haven’t found a rhyme or reason for why which kids are in which rooms, but they do move around between them. Here most kids stare at us but usually comply. But in the past few days, we’ve met MULTIPLE kids who cry blood-curling screams when we approach them. The first time that happened to me was a child of about age 3 or 4 in room C. I at first thought that the kid was afraid because of the stethoscope and scrubs, but the child calmed as Dr. Nathaniel approached. His younger sister, who was maybe a year old, crawled toward Katy’s backpack as Katy sat on the adjacent bed looking at another patient. However, when Katy looked at the baby, this kid completely LOST it and also screamed and fled. We had a couple other experiences that day and in the couple days following. We assumed it was because these kids don’t really get much exposure to muzungos. Upon mentioning our experience to Julie, we learned that it is quite common here for the parents to tell children that if they are bad, the muzungos will eat them. Knowing that I’m the equivalent of a bear or the boogey man to these little ones, I now understand why they are terrified of me. For those patients, I stay low, try to avoid eye contact, and just let the non-Muzungo doctor see them

The past couple weeks here have been incredible! We’ve come closer as a team and made some great new friendships. The surgeons, Sarah, and Duane abandoned us already. We hated to say goodbye, and are surprised that half our time here is done! We are praying for safe, speedy travel for those guys and can’t wait to reunite back in the States!

-- Mary Margaret

Adventures of Katy, Carter, and Laura

What a fun and exciting weekend! After a rainy Saturday morning we decided to head to Kumbya; a secluded peninsula located on Lake Kivu. Kumbya was set up as a retreat for missionaries. We had been down to the market before and were told you would reach Kumbya if you followed the road around...OR you could take the shortcut. So we of course took the short cut. Along our journey we would here muzungo far off in the distance. it would get louder and louder until hoards of kids would come out of the trees, bushes, up the mountains, and down the mountains to walk with us. We decided to impart some of our wisdoms on these impressionable young kids....check out the video! Well, it turns out we took the wrong shortcut! We ended up at the edge of the lake looking across at Kumbya the place we wanted to be with 20 kids surrounding us. Luckily there was a boat. And it happened to be leaving. So we bartered a price, climbed on board, and waved goodbye to all our new friends on shore. As we made it out across the lake we discovered that not only did we have to pay the boat owner but we had to row ourselves! Haha so Carter and I got to work using muscles I'm pretty sure I never knew I had. But we made it! And Kumbya was beautiful! (Ill have carter post more pics!) Katy and I tanned ourselves and washed our feet in the lake, and rested for our long journey back.... No shortcuts this time! :) - laura

Some more pictures from the adventure: