Facing daily horror

FLTLT George Dohnalek, a medical officer, wrote this blackhumoured account of his day while on deployment in Rwanda.

FLTLT George Donahlek and FLTLT Belinda Ball take care of a meningitis patient.

Photo by CPL Robin White

LACW Alison Jones, a medical assistant, at Kilgari Hospital.

Photo by SGT Geoff Fox

THE WALK to the hospital, albeit short, reminds you vividly that you’re not in Kigali attending summer camp; there’s no singsongs or holding hands.

From the road, a view across Kigali greets you, often clouded by fog or, more commonly, smoke from the not-so-modern Rwandan stoves. It’s usually quite cool and crisp in the mornings, often wet from the previous evening’s rain, which comes with remarkable frequency.

The walk takes you past the Rwandan Patriotic Army’s (RPA) training academy, heavily guarded by soldiers clad in the latest designs of prosthetic footwear – Target’s rubber gumboot collection.

Once inside the AUSMED gate, we swiftly unload our rifles. After putting to bed our rifles into the lockable cupboards, it’s off to the ward where the warm greetings flow thick and fast.

“How about getting rid of some patients today?”, I would be asked.

Here, the realm of medicine is redefined. Like a stockmarket report in the news, critical patient details are conveyed to the next round of nursing gladiators.

My ward round is then ready to commence.

The toughest task is to distinguish the patients from their live-in carers, who often look worse than the patients.

Each day a different member of the family assumes the carer role, and usually it is someone who wants free medical care from us, or who needs a good feed.

As a UN hospital whose purpose is to treat UN patients primarily, we have very little work on the wards. As an arm of the local hospital, Centre Hospitaliare Kigali, we are constantly inundated with the most amazing plethora of patients.

“Shopping” for the patients, as it’s so fondly come to be known, must go down as one of the all-time best blood sports available in Kigali.

Often there will be patients lying in pools of blood and our first impression is we have found our next transfer.

Not so, because behind door number one is our awaiting prize; usually a little low on life. But wait ... there’s more ... our trolley is now overflowing.

Our other common excuse for admission is the wonderful world of tropical disease.

Everything that flies, bites, burrows and crawls, carries delicious bugs just waiting for a chance to feed on the human breeding grounds.

What a perfect culture medium the human species can make.

Malaria wins the contest for frequency. Basically, if you have a fever, you have malaria. If you think it’s malaria, it is. If you don’t think it’s malaria, it is. If you think you can’t think or are all thinked out, then you yourself probably have malaria.

Occasionally, other organisms rear their ugly heads, sometimes directly out of the mouths of people. Several times patients have opened their mouths to say “miraho” (hello), and a friendly worm pokes its head out to answer the question for them.

It’s not unusual while examining someone’s ear to find ticks staring back at you, annoyed by the rude interruption to their voracious feeding. But most often the animals are so small we need a microscope to see them, and this is where we call in the “great white hunters” from the laboratory jungle.

One of the most complicated processes to be handled on the ward would have to be communication to the vast varieties of peoples and tongues. Almost all dialects and languages inherent to Africa are covered by the range of nations working under the UN umbrella. Subsequently, it’s commonplace to strike a patient who speaks a language not covered by our interpreters.

In this case, we use a chain of people, each capable of understanding two different languages, and arrange them like a set of dominoes to create a flow of information. What is actually said is anyone’s guess, but even simple instructions can be misconstrued.

After my daily working ward round, breakfast is usually in full swing. The highlight has to be the ritual swallow of the doxycycline tablet; our contraceptive from malarial parasite babies.

Immediately following breakfast, still trying to swallow the tablet, it’s time to launch into the consultant ward round, to answer questions that have plagued us since the previous one. Questions such as, “Why did I leave a prosperous job for this?” and “How many Frequent Flyer points will I earn on my way home?”, feature heavily in the minds of our great consultants while reviewing the plight of our ward patients.

Despite these ponderances, they nevertheless still have the energy to save the lives of just so many patients here, their obvious dedication to the maintenance of humanity featuring highly in their minds.

Every day this grand ritual of doctors and nurses moving from patient to patient offers each one at least some hope in the preservation of life, and ultimately the returning of dignity to a devastated population. It is a spectacle to be admired and instils a sense of self pride in me that will be etched in my mind forever.

In contrast to the UN patients who are medevaced out of the country if we cannot give them optimal treatment, what we provide for the Rwandans is the best that they are going to receive; there is no next level. After us, they are left in the hands of God.

For most of our UN patients, our entourage is almost like a morning parade as each patient – due to their military discipline – comes to some form of attention. This is often not without its impracticalities: as a salute is given, a drip pulls out; as a stand to attention is made, a patient falls over forgetting about his recently amputated limb.

Following grand rounds, routine procedural and investigative duties become the order of the day, unless theatre lists are scheduled, which has become a virtual daily occurrence. The operating theatre has been restored to a remarkable level of function with theatre equipment imported from Australia.

Alongside the AUSMED operating theatre, a second theatre is available, which is used by the ophthalmologist from CHK. Imagine the surgeon operating without gloves, but still sterile gowned. Such is medicine in a Third World country.

The theatre lists consist of a large variety of cases, ranging from those relating to war medicine (amputations, wound debridements, etc), to those seen in most hospitals, and those specific only to Third World countries, due either to gross disease often presenting too late, or corrections of the consequences of the genocide. Sometimes the injuries have been just so horrific and devastating that they defy survival.

Many of the patients have managed to survive in the bush hiding with these wounds, often self treating with local remedies such as laying dirt over wounds to stop them bleeding, and voodoo-type witchdoctor treatments involving the laying of tiny scars strategically across their abdomens; likened to a form of acupuncture. On average, alternate days we receive a patient who needs immediate resuscitation.

The commonest condition we see in these circumstances would be car vs human; currently the cars are winning by an alarming margin.

After work, entertainment presents itself in the form of writing letters, sleeping, jogging around our cell block, sleeping, drinking at the mess, sleeping, or working at the hospital as the on-call sleeping slave. Thank God the Australian sense of humour flows freely. Laughter is the best medicine; for without it we all get sick.

FLTLT Dohnalek has since discharged from the Air Force.

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