December 1, 2009

by Kelly Tschida, Vanderbilt School of Nursing

Frist Global Health Leader Kelly Tschida: Nyamata Hospital, Rwanda

I have now transitioned to working with the physicians. Each physician is responsible for admitted patients on one of the floors and seeing patients in the outpatient consultation area. This change has been eye-opening.

Each morning starts at 7:00 with prayers, singing, and a short sermon. Watching my colleges sing and dance is an incredible way to start the day. By 7:30 we start rounds. There are usually about 40 patients to see and it has to be finished by 9:30 when the outpatient consulting begins.

Outpatient consulting here is like combining your general practitioner's office and an emergency room. We see seven or eight patients an hour and you never know what will come in next. I've seen snake bites, scurvy, leprosy, severe malnutrition, and even a suspected case of Ebola virus. 

Malaria accounts for probably one-third of the patients. Most are not complicated cases and can be treated easily, but this is not always the case. Malaria patients can come in unconscious, delirious, and in desperate condition. A few days ago a six-year old boy was brought in with malaria. He was unconscious and was barely breathing. We ordered medication and oxygen to improve help him breath. To my horror and dismay, we were told the hospital was out of oxygen.

Probably sixty-percent of the patients have stomach problems, usually due to parasites. Sometimes they come in specifically because their stomach is bothering them, often it is just in addition to another problem.  Sadly, with proper hand washing and food preparation most of these cases could be avoided. The severity of the illness ranges from mildly bothersome to life threatening.

I work with the medical doctors both to learn and to teach. I have been able to see diseases here I might never see in the U.S. I'm also learning how illnesses are treated when there are very few resources. In return, I am able to provide the most current guidelines for treatments, offer diagnoses that are not commonly considered here, and share different assessment techniques.

Perhaps one of my biggest contributions is simply providing a different perspective. For example, an infant with a high fever and having seizures was transferred to us by one of the community centers. The records were unclear as to what medicine had been given already. The physician was torn between risking an overdose and not giving lifesaving medicine. He decided not giving the medicine was safer. When I suggested he call someone at the health center he stared at me blankly for a few seconds before realizing how simple it was. Cell phone coverage in rural Rwanda is relatively new so physicians were unable to contact health centers in the past. In the end the infant received desperately needed medicine and the physician learned a new way to help patients.