1) Nyamata Internal Nursing Hospital Staff
2) Nyamata Hospital
It is hard to believe it has only been two weeks since I arrived in Rwanda. I landed late Thursday evening and was taken directly to the Nyamata hospital guest house where I will stay the next three months. I started work in the hospital the next day at 7:30 am and I have been busy ever since.
The Nyamata hospital is a public hospital serving the people of the Buresera district in Rwanda. The patients are generally from the surrounding villages and do not have much money. The services are not expensive, but the patients have to pay for everything before they are treated. For example, if they need to have an intravenous line (IV) put in so they can receive IV fluids and it is not an emergency, they have to send someone to the pharmacy to buy the IV and all the equipment before it is done. Yesterday, when I asked the staff why a patient had not had an IV started yet, they told me the patient’s family had gone home to sell a goat to get the needed money.
The hospital offers much more than I had expected. Inpatient units of the hospital include surgery, post surgery care, maternity, obstetrics and gynecology, pediatrics, emergency care, internal medicine, and mental health. They also have several rooms designated for isolating patients with severe cases of TB. On site services include a pharmacy, out-patient consulting, physical services, imaging, laboratories, a dentist and an optometrist. There are also consultation offices for HIV and tuberculosis (TB) and a voluntary HIV testing center.
I am spending my first month working as a Registered Nurse in the internal medicine unit. After this first month I will start working as a family nurse practitioner in the outpatient area and in the community. Working as a nurse is a great way to learn the common illnesses, the skills of the staff, and the challenges they face here. Every morning I see patients with the physicians and am able to discuss the problems and treatments of the people I care for. I spend the rest of the day working with the nurses. The nurses are well trained and we spend the day exchanging techniques and caring for the patients. There are usually 40-45 patients in our area with only two nurses taking care of them on each shift.
Although there are a full range of services resources are limited. For example, there are a total of 170 beds in the hospital and they seem to run at near capacity. Patients stay in rooms together, with as many as 11 per room with the beds spaced only two feet apart. They sometimes lack some basic equipment. Last week we were unable to find a working nasal cannula in order to deliver oxygen to a patient who desperately needed it. Fortunately, as in the case of the cannula, the staff are accustom to working under these conditions and are often able to fix broken equipment or find another way.
Patient illnesses vary, but there seems to be some common trends. Acute cases of malaria, TB, HIV, and hepatitis are all common. Gastrointestinal problems, caused by parasites and bacteria, are present in the majority of the patients. Pneumonia and severe anemia are also common problems. Parasites that cause internal bleeding and malnutrition seem to be the reason for 90% of the anemia. It’s tragic that people are dying from things so easy to fix.
I have been there long enough to have seen many patents sent home healthy after having arrived in critical condition. For example, one elderly woman with severe malaria was brought in from one of the nearby villages. She had a severe fever and anemia and was unconscious, and going into shock. I was not sure if she could survive. However, she after receiving anti-malaria medications and a few blood transfusions she started improving. A couple of days ago she walked into the nurses’ station, smiling and full of energy. She had come to thank the nurses and say goodbye. I cannot express how good this made me feel.
Of course not everyone gets better. Although there is a full range of services the limited resources has an impact. We seem to lose a few patients a week. It is heart-breaking to see someone die when you know how to help them but the medications, manpower, and equipment needed are not available.
It is not always easy to work in the hospital but I am grateful for this opportunity. I am helping people who are in desperate need while gaining invaluable experience. I don’t know what else someone could ask for.
3) Looking at Blood Smears