It has been a pretty chill Saturday. I woke up bright and early, went to the hospital and met Richard on rounds. Most of the patients had been discharged, so I just saw two recovering malaria children, our child with adenitis/tonsillar abscess, our one boy left in traction due to a broken femur, and our boy with the scrotal swelling that Richard now thinks is an appendix testes that's infarcted.
We did have a new case, a 2 year old boy in respiratory distress with what sounds like pneumonia. He's on antibiotics, but still having trouble breathing: going 66 breaths/minute and using his abdominal muscles to breathe. We listen to his chest and he's wheezing. In the US, we would get respiratory therapy to come by and give the kid a couple of updrafts and put the kid on oxygen. Well, Richard and I were respiratory therapy, and all we had was an inhaler.
Little kids aren't very good with inhalers because it's very hard for them to follow instructions like: wait until I squeeze the inhaler and then take a big breathe, hold it, then breathe out. They also aren't good at it if they are breathing so fast. One of the ways you get around that is using a nebulizer or a mask. The nebulizer also helps because you get more of the medicine into the lungs. So what do you do when you don't have a nebulizer? You make one.
All it takes is a plastic bottle. We used an empty bottle of Ringer's Lactate, taped the inhaler into the neck, and cut out the bottom so it fit over the child's face and then taped up the bottom so it didn't cut the child, placed it over the kid's face and squeezed the inhaler.
After rounds, Richard and I sat waiting to see if a car would come by that could take him to Ruhengeri so he could spend the weekend with his family. He quizzed me for a little bit, and then we were discussing the health needs of Rwanda.
Richard is interested in pediatric oncology, but he doesn't want to do the academic nonsense of a fellowship (his words). He just wants a year's worth of post-residency training in peds oncology so he can start a screening program in Rwanda.
As far as public health goes, Rwanda is pretty good. They have a high vaccination rate among children, and their vaccines include measles, DTP, HiB, polio, and BCG. They give out insecticide treated bed nets for all pregnant women and children under the age of 5. They have a national health insurance program called La mutuelle, which is $1.50/person in a household for an entire year, and it covers nearly everything. There is not too much pediatric HIV because they have a good program for preventing mother to child transmission by giving ARVs at the appropriate time.
However, most of Rwanda doesn't have any screening programs for cancer. Louise pointed out to me on the second day or so that she has actually seen a lot of lymphomas here. The thing is, there's not much money for cancer in the developing world. Most of the money for public health in the developing world is for infectious diseases, thanks to the Global Fund, PEPFAR, and the like.
Richard and I talked for a long time about Rwanda's health needs, and we came pretty close to concluding that when we both finish our training, we are going to come back here and work on a collaborative Rwandan/US teaching hospital and public health center.
We'll see if we are able to pull it off.
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