Stoic Children and a Somber Day

This is a potentially painful story for anyone who might be reading this, especially you guys.  I wanted to illustrate how different Rwandan kids and American kids.  I know I talked about how the kids ask for things and how they like to follow me around, but there are some significant differences, the everyday ones, and then there was the kid today.

First of all, the Rwandan kids are pretty independent.  As soon as they are five or six years old, they will be sent out alone on the mountainside, and have their infant sibling strapped to their back while carrying  some bananas on their head.  I don't know of many five or six year old American kids that I would send it out alone, period, much less with a three month old sibling attached to them.  

Also, in areas where adults are crowded around, like the hospital waiting areas, you don't see parents getting frustrated trying to keep their children maintained.  The parents rarely have to pay attention to the child, who just waits patiently with the parent.  

So, the story of a remarkably brave boy:  

Today we had a little boy, about 5 years old, with a three month history of left-sided scrotal swelling.  We looked at it, and there was some question as to what was causing the swelling.  At first we thought it could have been an indirect inguinal hernia that had been incarcerated, but the kid wasn't puking up his guts.  Then we thought, well maybe this was untreated testicular torsion and now the testes is necrotic.  I had someone describe testicular torsion (sudden onset of EXTREME groin pain and being unable to walk) to see if the boy had ever experienced it.  The answer was no.  I asked if there was a history of trauma, and when mom said "no" I had them ask the boy himself, "Did any of your friends or anyone ever hit you in the balls?"  Again no. 

We consulted the visiting surgeon, Louise's father.  He thought we had to aspirate it to make sure that there wasn't any pus inside, meaning an infection.  Richard was going to do it on the hospital bed, but I quickly interjected that it would be cleaner in the treatment room.  Thankfully, that's where we took him, because the wards really are pretty nasty.  We had him lie down on the exam table, and Richard and Abega explained what was going to happen.  

The boy didn't freak out--he just lay there.  Richard cleaned off the scrotum with iodine.  His mom held his arms and his head, Abega held his legs down, and I lay across his chest.  I saw the boy's eyes go wide as he saw the needle, and  although I know he couldn't understand me, I couldn't help but say, "No, don't look at it!"  Then Richard stuck the needle in.  

Amazingly, the boy didn't move or jerk.  He just cried out, but I didn't feel his torso twitch at all beneath me.  He cried for a little bit afterwards.  I felt so bad for him that I gave him half a sheet of Cars stickers.   

In the US, if we were to try to attempt something like that, I couldn't imagine a child that we would have been able to hold down like that.  I remember on my ENT rotation that they had to send kids to be anesthetized in order to remove whatever objects the kids had stuck in their ears since they wouldn't sit still to let us take it out in the office.  

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Also, I have one week left at Shyira, and two weeks before I'm back in the US.  It's really sad.  I've been waiting all my adult-ish life to go to the tropics and do medicine, and I'm going to leave, and not come back for another one or two years.

Really, if you can get used to having to boil water to add to your bathwater, if you can put up with always having to filter your water, if you don't mind bugs, and if you aren't scared of the dark, then this is a gorgeous, lush, and beautifu place with good food. And as a physician-to-be, it's always fun when every day you always go, "whoa, what is that!?!" at least five times a day.  

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I'd also like to add, though,  today was a sad day at the hospital.  We had one little boy who had metastatic osteosarcoma, a cancer of the bone, die last night, as well as an 18 year old girl was brought in yesterday.  She was already in a coma from cerebral malaria when she came to us, but she also died.  

So a somber day.  Until tomorrow!