I am sitting in the Amsterdam airport (which is very nice, by the way), having completed the first leg of my 14+ hour plane ride home. I slept through most of the first 8 hours, which made the time pass quickly.
Before I left yesterday, I rounded with them team to see all the postoperative patients. I also spent some time talking to Claudine, the 17yo patient that I wrote about last week. I saw her with one of the doctors in the hopes that we could clarify our recommendations and give her a treatment plan until we return next year. I also learned some more details of her story.
After laboring at school for days, her baby would not come out, and eventually died. She was taken to a local hospital and put to sleep for a c-section; she probably never saw her baby. When she woke, she could not walk and she leaked urine continuously. This happens when the baby’s head/body compresses the tissues in the vagina, which limits blood flow and damages the nerves and muscles.
She was discharged to her step-mother’s home and forced to sleep outside, but was taken back to the local hospital after a week, presumably because her family didn’t want the burden and shame of this teenager in their house. That was 3 years ago, and she has not walked since. She has been living in a hospital without friends or family or any kind of emotional support. She has no insurance, and she relies on the kindness of strangers to bring her food and clothing. Her feet are now contracted, meaning that the soles of her feet face each other as she sits in a wheelchair. Trying to straighten them is painful, and she is unable to support her own weight (we tried to have her stand–that didn’t go well). Claudine cried and cried as she told us her story, translated to English by one of the Rwandan doctors. She has lost hope.
We had taken her to the far edge of the hospital on a covered sidewalk, which overlooks the surrounding hills of Kigali. Most hospitals in warm climates have this system of buildings connected by covered sidewalks and inner courtyards. The rooms and sidewalks are not too hot, even on warm days. By chance, we were standing in front of the psychological services offices, and two women came out of their office to listen.
The concept of patient privacy is very loosely interpreted here. Staff, patients, and family members would walk by us and stop to listen when they heard her crying. We would shoo them away, but it often took several requests before they would leave. But the presence of the psych staff was lucky. They were not aware of her situation, and Claudine is in desperate need of counseling.
So we gave her a loose plan of what we hope she can do between now and next February: counseling, physical therapy, weight loss, and a change in her attitude from victim to fighter. There is some chance that we can operate on her, and an even smaller chance that the surgery will make her dry. But we told her that unless she can muster some hope and determination of her own, the whole plan is doomed. Cross fingers.
Before I left, I sat down with Barbara and Ira Margolies, the founders of IOWD, and Madame Ratagone, who is the assistant to First Lady Jeannette Kagame. Madame Ratagone is Rwandan but has lived in Canada, and she talked about the need to better educate women about interacting with their infants. Women in Rwanda wear their infants on their back until the child can walk, so there is limited face to face direct interaction. First Lady Kagame leads many initiatives to improve the lives of women and girls, especially those who were left without family after the genocide. As I listened to Madame Ratagone, I wished I could spend a day with her learning more.
And on that note, I have started thinking about going back to school to get a Masters in Public Health. I have considered this idea on and off (mostly off) since I finished my Masters in Nursing. While I love my job at home and have made a very comfortable life for myself and my family, this trip always makes me wonder what else is I could do. I have enrolled in a free online course at the London School of Hygiene and Tropical Medicine about Healthcare in Humanitarian Crisis, so I’ll see how that goes.
Getting on the plane now…more later.