So just what am I doing in Rwanda?

After 2 weeks of adjusting, I decided to bite the bullet, and head to work as an observer until my Rwandan Medical License was cleared.

I am assigned to the Centre Hospitalier Universitaire de Butare (CHUB), one of the main teaching hospitals in Rwanda. It is actually the oldest teaching hospital in the country. The referral base is approximately 1/3 of the country, mostly from the West to Lake Kivu, South to the Burundi border (only about 30 min away!) and the Southwestern part of the country, all the way to the Democratic Republic of Congo.

The hospital itself is situated on the Southern part of town, about a 30 min walk from my house, or an 8 min moto ride. It is a large complex of mostly 2 story buildings, each different departments: Internal Medicine, OB/GYN, ENT, Surgery, etc. The pediatric department has its own ward, divided into separate sections. The newest part is the Outpatient Department (OPD), with offices for staff and clinical personnel, as well as exam rooms. This leads into an outdoor patio, which then leads to the hospitalized patients. Ward A has the sicker children, Ward B is a step-down unit prior to discharge. For the patients that require extra stay, they stay in the Pathology Ward (IMHO, not the best name, but, it is a bed.) The Emergency Department has about 8 beds.  Surprisingly, there are some private rooms for patients that can afford a little extra comfort, above that which the medical insurance provides. There is no PICU yet (here it is called a High Dependency Unit), but there is a plan in the works. There is a separate area that houses the NICU. There have a little more than 30 beds, usually full. They even have an area for breastfeeding mothers who are having problems breastfeeding.

For now, I have my own office. It was previously inhabited by the 3 HRH doctors here last year. The High Dependency Unit I spoke of will be next door, and there is a plan to change my office into the nurses’s office who can observe the sick patients there. I will likely have to change my office, which I am OK with.

I was very impressed when I took the tour a few days after arriving in Butare. Over the past two weeks, I have slowly grown accustomed to the layout. It may not make much sense to the outsider, but it has a surprisingly good flow after you get used to it.

My job is to teach the Pediatric residents and medical students. The past 3 years there were 3 HRH doctors here. This year, for a variety of reasons, there is just me! I am an “Attending,” which for those of you non-Medical people, is like the head doctor. Imagine the lead doctors on your favorite MD TV shows like ER, and, ugh, Gray’s Anatomy (Sorry, y’all, I just never got into it, not my thing. My Mom, on the other hand, can't get enough!) Like the rest of the world, medical school in Rwanda is 6 years. The first 2 years are strict book learning. Year 3 starts their clinical experience (called Doc 1 here in Rwanda.) There are about 8 Doc 1s per 8 week rotation. Then there are interns (Doc 4) and the Pediatric Residents. Typically there are about 6 interns, and 8 residents. Here, pediatric residency is 4 years as opposed to 3 in the US. They have to spend at least 1 year working as an MD at one of the District Hospitals prior to applying for residency.

My official job description includes the following: assisting the Rwandan doctors who are in charge of organizing the curriculum for the undergraduates and the Post-graduates, rounding on the Pediatric patients daily, teaching the undergraduates 1x week in physical exam skills, lecturing at least once a month to the pediatric residents, administrative work, and helping the Rwandans with their research projects. It is a lot to cram into a 10 hour day, and some of it has already involved some after work time. A lot of the ground work was laid by my predecessors, and I have them to thank immensely.

My usual day starts at 730 with morning report, where the on call interns and residents discuss the admissions the night before, and any other sick patients. We usually focus on the more complicated patients first, then discuss the more routine ones. They also discuss any concerns about the clerkship. i am usually up at 545 or so for a quick workout, walk the dog, eat breakfast, and make sure I have enough time to get to the hospital prior to 730.

Lunch is usually out of the hospital. Afternoons are rather loose right now, but a lot of the time, will involve a case presentation or lecturing the peds residents once the medical students start. I use a lot of that time to read up on patients.

I am still learning the ropes, and have a lot to remember from my days as a Pediatric resident. However, it is surprising how much of that knowledge is still in that large cranial mass of mine.

The pathology (i.e. the illnesses) here are complex, and truly tropical medicine: peritoneal tuberculosis, rheumatic heart disease with heart failure, HIV and chronic cough of unknown cause, rickets, malnutrition, malaria (only one case as of now!), schistosomiasis, Hepatitis B infection with cirrhosis of the liver, amongst other diseases we see back in the US. And there are very few specialists here for say, Peds Hematology/Oncology, Peds Pulmonology. We are the de facto MDs that must decide how to treat these patients. And that was just my first 2 weeks!

So far, I love it! I go in with a smile on my face every day, and continue smiling throughout the day. There have been some challenges (lack of clear schedule for this current round of residents, no blood culture vials, not enough CPAP machines for sick babies, 5 premature infants dying in 3 days, upset parents requiring the assistance of a SW (I wish you were here, Linda Van Camp!)) but overall, it has been a positive experience, and I can’t wait for more.

Talk to you soon!

P.S. I received an email from the HRH coordinator last week: My medical license and Visa were approved, and ready for me to pick them up in Kigali! I am official, Gulp.......

P.P.S. As I write this on the front porch, my dog Magnum is chasing the monkeys that usually migrate through our yard to feed around dusk. Ya know, just a usual day here in Butare, Rwanda…