P-Neumonia, as my dear friend Monica would call it...

Flashback: July 2011

Interviewer for my current position: If I may be blunt and go off the script for a moment, can I ask you what you are afraid of because you seem to be fearless.

Me: I am afraid of not having access to Western medicine and a drugstore around the corner. 

Present Day: June 2012

Yes, the same fear still lives inside me and I have yet to adjust to the Rwandan medical system or seemingly complex pharmacy protocol for purchasing over-the-counter pain or cold relief.  Recently I had my second more serious bout with “sickness” since I arrived in Rwanda, and the frustration with being so far away from Western medicine and my grandmother’s homemade chicken noodle soup recipe has not ceased.  I have always been one of those people who gets SICK when I get sick, and more often than not, I am the one who somehow picks up the random affliction that only affects 1000 people per year (ie. Rocky Mountain Spotted Fever at the beginning of 2011).  One of the downsides of feeling under the weather here is that whatever it is that has a hold of your system, doesn’t seem to let go for a long time.  Simple colds last weeks, coughs drag on for nearly a month, and allergies never seem to go away.  This does not just affect me, as each of the volunteers in the Village has battled one too many long-lasting colds, coughs, and other medical problems.  I can deal with all of that, despite the long duration, but when more serious symptoms arise, medical advice is needed, yet in short supply.  Despite Rwanda being the most densely populated African country, very few of those people are medical doctors.   On top of that, most every doctor is a general practitioner, without a specialty in any area.  Case in point, Rwanda is a country with 12.5 million people, however there are only 10 Pediatricians - 10!  This is a place where the sun is intense and it feels as though you are baking each time you are outside, yet there is only 1 Dermatologist.  

There are common go-to diagnoses for sickness in Rwanda.  If you are sneezing, or have a runny nose, people diagnose you with the “flu.”  If you are having difficulty breathing, you have “the asthma” (yes, they call it THE asthma).  If you have a headache, you have malaria, and if you are coughing, you have TB.  Things here are very black and white, except when they aren’t.  

Case #1

In March, I developed a headache which lasted many days without relief.  It was dizzying and just downright awful.  Of course everyone immediately said that I had malaria, so I went to the hospital that “white people” go to in Kigali to seek medical advice and to get tested for malaria.  What would seem to be a simple process was anything but straightforward, and the conversation with the ER doctor went like this: 

Dr.: What seems to be the problem?

Me: I have had a headache for over 2 weeks.

Dr.: Where are you from?

Me: America

Dr.: NO, WHERE?

Me: You mean the state?  Originally I am from Ohio.

Dr.: What about your grandparents?

Me: Is it going to help you diagnose my problem if I tell you they are from Germany?

Dr.: Ah, you come from an intelligent family.

Me: Is that a question?

Dr.: Are you married?

Me: No

Dr.: Why not?

Me: I have a headache

Dr.: What about a boyfriend?

Me: I live in Rwanda.  I have been here since December, and my head has hurt since March 18^th.

Dr.: Do you have children?

Me: No

Dr.: How do you feel about pregnancy without marriage?

Me: Do you want to know if I think it is right or wrong?

Dr.: mmm (Rwandan way of saying ‘yes’ without really saying anything – sometimes it’s accompanied with a raised eyebrow)

Me: It doesn’t jive with my life, but it works for some people, and for them it is fine and I won’t judge them.

Dr.: So you say your head hurts?

Me: (sigh) Yes.

Following that riveting examination, the doctor felt my pulse, and sent me for blood work and a urinalysis.  (I am still waiting for the urinalysis results…3 months later…)

I returned to his office several hours after the lab work, and the following transpired:

Dr.: You are sick.

Me: Oh? What did the lab results show?

Dr.: Results? I don’t have any results. But you are sweating and look tired. I will give you medicine.

Me: It is a hot day and I have had to walk a long distance from the lab to the pharmacy to here.  That is why I am sweating and look tired.

Dr.: No, I believe you have a fever and are sick.

Me: ok

He then wrote me an order for 3 prescriptions and several weeks later my headache subsided.  

Case #2

I developed chest pain several days ago, and with each passing day, the pressure and intensity became more and more severe.  Chest pain doesn’t fall into any of the “usual” categories (flu, the asthma, etc.), so I caused a bit of a conundrum among those who wanted to diagnose me within the Village.  I know that the chest and lungs are quite connected to the nervous system and emotions, so I hoped that I could attribute it just to that, but feared it might be something more serious.  I was bound and determined not to return to the hospital for the same circus-act of an examination, so this time I went to a private doctor at his practice.  When I entered the clinic (spelled CLINIQUE here), the nurses/lab techs were sitting with their bare feet propped up on the sofa, watching a Rwandan soap opera, of sorts.  I almost turned and walked out, but was encouraged to give it a chance by a colleague who said that what I was witnessing was, “normal” in Rwanda.  Normal?  Right.  I could hear my mom in my head, saying, “Why the hell are you doing this to me – living in Rwanda????”  (Indeed she said that exact phrase to me that night when I called to tell her what had transpired.  Do I know her well or what?)    

This time the doctor actually listened to me, took copious notes, truly EXAMINED me (even with a stethoscope), and 5 minutes after his tech took lab samples, the results were being reviewed by the doctor himself.  Efficiency and effectiveness…amazing!  The bad part was that some of the results were inconclusive, but I did find out that I don’t have worms, and I don’t have parasites.  The doctor said that it is likely that I am trying to recover from bacterial pneumonia and that my chest pain is from musculoskeletal bruising from all the coughing.  He put me on 2000mg of antibiotics a day, cough syrup with codeine, and a prescription pain killer.  If nothing else, I’m more comfortable than I have been in days, and I can finally get some sleep without squirming in pain every few hours and turning like a rotisserie, trying to get comfortable.  I asked the doctor if the medicines will help me feel better, and his response was, “I hope so.  Good luck!”  I honestly don’t know what I expected him to say, so why did I even bother? 

There are so many medical issues here that don’t exist in America.  Aside from a mosquito bite being annoying, itchy, and red, you don’t give a bite much thought in America.  Here, that simple, annoying mosquito bite could very likely be the cause of malaria -  a painful, scary, and sometimes deadly disease.  A simple cough in the states is aggravating, but you don’t automatically think that it might be tuberculosis if it lasts a few days longer than you hope.  I live in a whole new world over here in Rwanda, with new realities and those realities can be a bit terrifying.  

Hopefully I have had my fill of medical mysteries and curiosities in Rwanda.  If nothing else, each medical experience seems to make for a good story for everyone back home.  Think of me next time you run into CVS or Walgreen’s for some cough and cold relief, and be thankful that you have a doctor nearby who is well trained, trustworthy, thorough, and knowledgeable.  Maybe he or she wants to volunteer in Rwanda????  

Favorite Picture of the Week is to the Right (story coming in another blog...): 

Favorite Quote of the Week: “I do not understand why you are not feeling better – I prayed for you last night.” 

Highlight of the Week: A traditional dance performance by the students at Agahozo-Shalom Youth Village to wrap up the “Restoring the Rhythm of Life” celebration week in the Village.  See a portion of the performance in the video below: