helen weld public health

Back in Buj. . .

I came down the mountain yesterday with Dziwe and Elvis (one of our amazing translators, who speaks Kirundi, French, Swahili and English) here to Bujumbura in the ambulance with two patients who had been stabilized and needed surgery. One is a woman who had a large ovarian tumour which has caused her to miscarry and hemorrhage and the other was the young man who had the bicycle accident. Accompanying us were two armed army security personnel. Since the July ambush and shooting at the VHW vehicle resulting in the murder of the driver Claude, the army presence and security situation is high.

For the past three weeks I have been on the Kigutu plateau/hilltop, working at the Village Health Works hospital and have not been “off site” except for my big walk with Tolstoy two weeks ago and to watch the drumming. Due to the clean air (the rains have arrived clearing the smoke from the burning fields), open space, incredible views, amazing sunsets, great company and all the work to be done I have not been in the least bit stir crazy.

Every morning at the clinic in Kigutu, the local site crews arrive at 6 AM to work in the fields, dig gardens, paint, work on construction…most walking “not far”…nothing more than an hour. The rest of the staff lives on site in the residence where volunteers stay (except for one nurse, Orestine, who has a family and lives in Mugara…she arrives for work always looking fresh and fashionable, despite the hour walk UP hill!). We all gather for meals and it really feels like a family meal with joking and conversation. A few evenings a week many have a work out session on the verandah which is fun to join in on.

I have been trying to fit in learning some Kirundi at mealtimes. Kirundi is a Bantu language and is agglutinative, which means it combines words to make one sentence. Everyone’s been very patient with me and at least my attempts at pronunciation give them a good laugh. It is also a tonal language, so pronunciation is vital. Given that I am far from a language whiz, it’s pretty challenging. For example….the word for “key” is “urufunguruzo” meaning “the thing that we use to open”… I have a hard time recalling all the syllables, not to mention the pronunciation. Even “good morning” is a mouthful for me…”Mwaramutse”…moo-a-ra-moo-tsay. I have managed to remember “inka” (cow) and “umvubu” (hippo)…not exactly words needed in the hospital setting! I will strive to work on Kirundi so that I have more than “buke buke” (not too much/a little). Another tricky thing…”Oya” (oh-yah) means “no”, so I have to be careful saying, “Oh, yeah”!!!

With the approach of the new moon, I have noticed that the lights from the fishing boats on Lake Tanganyika increase exponentially each night. As I mentioned in a previous posting, I was perplexed to see so much “electricity” across the lake in the Congo and then I was told about the fishermen. The past few nights the lake is ablaze and it looks like a huge metropolis from afar, an amazing sight.

The acuity of the patients admitted to the hospital remains high. Some would certainly be in an ICU in a developed country. The hospital has been full to overflowing and we have to get spare mattresses out and put them in the consultation offices on the floor or some stay on the examination tables for the night. Most come with family members and they sleep with their loved ones on a floor mat at the bedside or in the bed with the patient. I continue to be mind boggled by how far these people walk seeking health care. There are plans to have mobile clinics set up in the distant places.

There is also a three bed pediatric malnutrition ward which is soon to be doubled in capacity. One of my focuses has been to help get this unit more established and setup. The children are very fragile and require consistent feeding at 2-3 hour intervals with special nutritional formulas. They are also very prone to hypothermia. The balance between life and death is a fine line. It reminds me of caring for baby joeys in Australia. We currently have examples of clinical extremes….marasmus (muscle wasting and loss of subcutaneous fat). The baby boy is an orphan (mother died in childbirth) and is being taken care of by his aunt and grandmother. The other is an example of kwashiorkor (edema in the legs and face with loss of appetite, hair discoloration and skin lesions). It’s heart breaking.

Dr. Melino, the Burundian physician/medical director, has just returned from three weeks is Rwanda for ultrasound training. I look forward to working with him. He’s extremely dedicated and proficient with his work.
We will be returning to Kigutu in the morning and I am enjoying taking advantage of the wireless internet access here in Bujumbura, but alas the power gets shut down frequently even in Buj, so connectivity continues to be a crap shoot.

Helen

Helen & Dziwe with clinic staff

Helen with Anna and Floride


Cattle, village huts and mountains


Boy leading cattle through village


Breakfast time at the residence

Family from Tanzania


Baby with marasmus

Baby with kwashiorkor


Helen with baby


Scarring from traditional healers


Melino


Basket stretcher used to carry patients
in from far afield


Women on trail

Happy patient discharge

Dziwe in car with armed guard


Local landscape in late afternoon light


Helen at the end of day