Since I am the overprivileged Muzungu, I got to ride in the front passenger seat. It was still dark, and Apollinaire, the patient, her "guarde de malade," Anastasie the Francophone nurse, Phocus the pharmacist, and Leonard the chaffeur piled in. It took us 20 minutes to get down the mountain in the dark. We made it to the paved road to Ruhengeri at 6:26, then it was 9:00 before we hit Kigali.
We went straight to CHK, where we first were taken to the Salle d'Urgence, then to Internal Medicine, and then finally Ward 5, where the one doctor who could do a bone marrow aspirate would come by later. All along, everyone was staring at me since I was the only Muzungu, and I was carrying a huge backpacker's backpack on my back, and a regular backpack with a computer on it in front, like I was pregnant with an iMac and the Oxford Handbook of Tropical Medicine.
When we got to Ward 5, a nurse went to look for him, so we waited in a conference room for 2 hours. I, thinking ahead, brought War and Peace with me and started reading it, and promptly dozed off. Finally, around 11:00, someone came in, and Anastasie grabbed me. I go into a procedure room, and there is a man in a white coat sit and waiting expectantly. He has me sit down, and so I start in French to tell him about my patient. I have a nicely typed summary in my hand, and he then starts speaking in English. "Does she have any lymphadenopathy?" No. "Has she been having fevers?" No. "Well, we don't quite have the right needle, but we can try anyway. The only thing is, we don't have a pathologist here who could read it."
Thankfully, Louise had told me that she wanted to make sure an extra slide was done anyway that I could take back to the US because it turns out that they know a pathologist in Little Rock who has volunteered to read it. I just said, "that's okay. I will take it with me to the US next week."
"Okay," he said.
While we were waiting for Apollinaire to come in and undress, he asked me how medical training was set up in the US. I told him how we did 4 years at university, then 4 years of medical school, and so on. He then asked about the 4 years of university. And I said, well, one can go to university, study anything you want, from chemistry to biology to literature to music. One has to make sure that they take the basic sciences required for medical school, but after that, they teach you everything you need to know in medical school.
This doctor couldn't stop laughing when I told him that. "Maybe, if we could study music and then medicine, then we would have less depressed doctors."
Then, the patient is there, he preps the patient, and decides to do a sternal bone marrow aspirate, with only a little bit of local anesthesia. Poor Apollinaire. After she is prepped, the local is injected, and he begins to drill the hole into her breastbone, the thought suddenly occured to me that to an illiterate peasant, this could very easily appear to be the same practice as the traditonal healers with their herbs, tonsillar swabs, and cuttings. I'm not sure how much she understood about her disease, its diagnosis, or its treatment, and suddenly we are drilling a hole into her sternum and taking some bloody stuff out.
I felt terrible for her....terrible. I would have switched places with her in a heartbeat, if my bone marrow would have given us her diagnosis. There's nothing worse than bad things happening to you and you don't know why.
After we finally finished with that, I talked to Louise and she said to take a biopsy to King Faisal, the nice private hospital in Kigali. So we get in the ambulance, kept driving around for a long time, and then suddenly, I realized that we had just passed the restaurant that is next to my friend's apartment. The restaurant, Sol de Luna, is no where near King Faisal. I'm good with maps and directions, so I look this stuff up. I theorize that we are lost. I test that theory by asking, "Ou est King Faisal?"
"King Faisal, c'est....j'en sais pas." Theory reinforced. I pulled out my Bradt's Rwanda guidebook.
"Ah, elle a une carte!" I quickly figure out where we are (by the Egyptian embassy), but before I can find out where we are supposed to go, they stop for directions. A very nice lady tells us, "turn around, and go to the Hotel Novotel, then turn immediately after that." Boom, I locate it immediately on the map. We turn around, get to the hotel novotel, and I'm saying "Gauche! Gauche!" and then there it is right in front of us.
Anastasie and I go inside, and we talk to the laboratory receptionist. A pathologist? or maybe he's just a lab tech, comes out, and then he says, "you don't have a request form. You ought to know that the standard is to have a request." I'm sorry, dude, but I haven't even had time to get a request form. I can fill one out in no time though. I finally get one and fill it out, while he's looking at the slides, being a jerk, shaking his head, saying, "you have to have a request form, and you ought to know that." Eventually, he says, "this is not a bone marrow aspirate. This is just blood. And there is not enough on the slides. It should not be this faint."
So I only gave him one slide and I'm hoping that the people, whoever Caleb and Louise know in Arkansas, will be able to get something more off of it if he's such a pessimist.
Afterwards, the ambulance took me to Sol de Luna, which I was able to direct us to without any problem (back to the roundabout, take it for 270 degrees, and then keep going up the hill until you see the sign), and then got out at the restaurant. It was 3 minutes of me waiting on the sidewalk when Mawuena came up...my long lost travel buddy from grad school. She had to laugh at me carrying two bags that were about the same size as me, and then she took me to her house where I have just crashed for the past 3 hours. We are going to a restaurant to watch the Ghana v. Nigeria African Cup match with some of her friends. Mawuena's parents immigrated from Ghana, so that is who we will be rooting for.
I may finally get some food in my stomach and just crash. Mawuena will have to wake me up with the game is over.
Genius.
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