Looking for Easter eggs in... Nyungwe Forest?!

Happy Easter everyone!

As you might derive from the title, Nyungwe Forest, and after that Cyangugu, are our goals for this 4-day-long weekend.
After a busy week, strolling around the forest and swimming in the Kivu Lake, once more, sounds like soft (or more techno when it concerns Muriel ;-)) music to our ears!

After our busy weekend in Kibuye, we arrived back in Huye (aka Butare) at 8 am on Monday (after taking the bus in Kigali at 6 am). So we surely didn't sleep much -see pics- and the Mosque in Kigali made sure that we definitely didn't sleep between 4 and 5 am... But after a coffee and cold -what else- shower in Igisaza we managed to make it to the hospital anyway.
The incredible amount of ONE Congolese docter (Stephane) was present, so we did our best helping the pour guy out by finally taking a chance at doing consultations with the aid of Javan (a male nurse) translating the Kinyarwanda (that still pretty much is Chinese to us) to French and the other way around. Then of course at night there was gym tonique and avocado-tomato salate for dinner. And guess what, at 9 pm I was called to go and assist two cesarians! (actually the first time of all the times that one of us was 'on call', they actually called!) So after a long day, I was picked up by the ambulance (transporting docters and nurses is the main purpose of the ambulances here... strange isn't it?) and I worked some more -it reminded me of the internship in the emergency department in UZ Gent; I love the quite atmosphere that comes over the hospital by night, especially here in Rwanda (it's so much more quiet)- and by 3 am I got back home to Igisaza...

Of course on Tuesday, no earthquake could have woken me up, so Muriel was nice enough to go and do the tour in pediatrics and then she attended a formation on Malaria that was organised in Kabutare hospital; and afterwards she shared here newly acquired wisdom with me(beside the swimming pool in Hotel Credo; mens sana in corpore sano), of course! And we planned our trip to Nyungwe.

Wednesday, another day, with few docters, as Alice and Johnny were still on their way back from Congo... Luckily the Cuban docters (internal medicin specialists, Carmen and Orlando) are there to see the patients in the internal medicine department. Then there's a new Rwandese docter, Evarest, that did the consultations and the Medecin Directeur took care of the maternity. And so, for the third day we did the tour in the pediatric department (normally we change pretty much every day between maternity, pediatrics, internal medicin, and surgery, or the operation room on operating days), getting to know the children pretty well. Two cases really caught our attention: a little boy of 3 years old, hospitalised for a week and a half then, with breathing difficulties -tirage, as they say in French-, a very fast heart beat and a very quiet, no-effort-tolerance, feverish, kind of state. He had been treated with quinine, antibiotics and anti-astma medication, without result. Luckily we convinced the mother, that has no health insurance ('Mutuel') for her kid, and no money, that taking a chest X-ray was really necessary. And it showed a completely 'white' (normal is black = air in the lungs) right lung.
Another little boy of 1 year and 3 months was lucky that we do tend to use our stethoscopes to actually listen to every kids lungs (indeed, some sarcasm is present...), and we noticed clearly that it 'didn't sound very well' (diffuse ronchi for the Med nerds), although he had been treated with quinine (anti-malaria) and antibiotics for one week (for symptoms of fever, throwing up and diarrhea that were more prominent at first). So once again we asked for an X-ray and an infiltration of the medial lobe of the right lung, with some less clear images of possible 'cavities' (that might suggest TBC for instance) were seen. Also we asked the HIV serology of the child as the mother didn't know hers (in HIV +, immunocompromised patients, 'pneumocystis' pneumonia is frequent and it calls for a different antibiotic treatment with cotrimoxazole).
Oof, sorry for all the medical terms, but it was to illustrate that we do get to use our brains here, and get to learn a lot about tropical and infectious diseases. Pediatrics is a very interesting department in Kabutare, and one of the toughest, seeing all the little children that are often very ill...

And so we presented the two cases in the staff this morning in order to come to a good treatment plan. The first will get a diagnostic pleural punction (meanwhile we payed for the material for the punction as the mother has no money and the social assistant helping her out was not in the hospital today -it was the least we could do for the poor kid!) and the second kid is, fortunately, HIV negative (thank God! After a while here in Rwanda we would start praying like the Congolese docters do before every cezarian section ;-)), so the antibiotics were adapted (only thing to exclude is TBC, as the kid also has a history of chronic cough; but a Mantoux test -very simple test to see if someone has been in contact with tuberculose- is difficult, because the liquid used comes in a bottle that is enough for 10 tests, and unfortunately, one kid with possible TBC infection is not enough reason to spill another 9 possible tests from the same bottle... Medicine in Rwanda, c'est pas facile!). The clinical evolution under antibiotics will have to tell us if further investigation (bronchoscopy for getting 'crachats' -the slimy things one coughs up when having a pulmonar infection; sorry, can't come up with the English word) will be needed.

And so it was a busy week of taking care of, what have become, "our kids", in a manner of speaking; time for some 'brain relaxing' time, looking for... why not... Easter eggs in Nyungwe Forest!

Big kiss,
The Rwandese Easter bunnies.