anna grace haas silva: Rwanda-- Week 3 and 4

Update: We spent our third week at the hospital in the maternity unit, and this is by far my favorite unit to be in. Claire says the same for herself as well. It is an exciting unit with something always happening.

Roughly seventy percent of women in Rwanda give birth in health centers in this country (as opposed to in their homes), and there are about four hundred if these facilities nationwide. If a woman is high risk or is experiencing complications, she is transferred to a district hospital, and those are the patients that we see here.

During the week Claire and I observed quite a few births (about three per day). Compared to the US, the equipment here is very limited, but they do their best with what they have, and the nurses’ and midwives’ education is increasing with teachers like Leslie.

Felix is the student midwife who became our designated supervisor for the week, and he is always sure that Claire and I are not only learning, but also practicing what we learn. There are a lot of midwifery students on this unit so it is a good learning environment. We also sat in on some of Leslie’s midwifery lectures which we enjoyed very much. She is a great professor!

In the morning, we spend time with the mothers who are laboring if they are struggling to remain calm, and we make sure to give much attention to mothers who may be ready to deliver a stillborn child.

The labor room is small and full of beds, so it gets hot quickly with many people in this small space, especially with no fans and no breeze through the opened windows. Despite the heat and smell of sweat and urine, it is good to be with these women to massage their backs or give them a drink or hold their hand (or catch them as they are passing out, as I had to do our second day on the unit!), since they are otherwise alone to labor in a room full of other laboring women as families are not allowed to be with them except to bring food and water.

The nurses and midwife on duty continually do rounds to keep check on the fetal heart rate and the progress of the mother. The first day I was having trouble hearing the fetal heartbeat through the fetoscope, but I was very excited the next day when I counted accurately the first time listening to a heartbeat.

When a women is ready to give birth, she goes across the hall to one of the three delivery rooms. It is common here in Rwanda for many complications to occur in childbirth because there is a lack of antenatal care. Because of this we have witnessed a variety of situations. Some things we observed and learned how to do this week are:

Under what circumstances to put the mother on oxygen during labor
When a mother needs an episiotomy (far more episiotomies and C-sections are performed in Rwanda than necessary, so this is a point of needed education here)
When a baby needs to be assisted in birth by a vacuum suction
How to get a baby to start breathing if it is not doing so immediately after being born
How to do a full infant examination after birth
How to apply eye cream and give a vitamin K injection to the infant
How to deliver a placenta and check that it is all in tact and no pieces have been left in the uterus
What medicine the to give the mother to prevent and stop hemorrhaging

Highlight of the week: Doing a lot of hands-on learning in the maternity unit this week, and learning a lot from the students and Leslie.

Leslie took us down the street to the Rwamagana School of Nursing and Midwifery for a tour of the campus. There are about three hundred students, two hundred of which live on the campus. It is a beautiful place, and they even grow their own food in big gardens, and they have cows which the milk to make chai tea and they also sell it.

On our second to last weekend we went to lake Kivu in Gisenyi with Emily, Shami, and Babu. It is so beautiful and relaxing there, and it was nice to be in the fresh air and get out of the city for a day!

Our last weekend, we went to the rainforest at Nyungwe National Park to camp overnight and go hiking. No wonder it was named one of the top twenty places to visit in the world! Breathtakingly beautiful, high up in the mountains, we were completely surrounded by forest for miles and miles. Sounds of birds and chimpanzees echoed in the forest. We were so happy to have experienced this beautiful part of Rwanda.

Challenge of the week: Passing people on the sidewalk! I was laughing about this with Emily and Shami, because people don’t walk on the sidewalks here the same way they drive on the road. People tend to walk in crowds on the sidewalk and don’t move out of the way or make a single file when people are passing in the opposite direction. Even when one or two people are walking towards us, they usually walk down the middle of the sidewalk or even on the correct side, but quickly switch sides before passing. It makes for a very attentive walk anywhere, as you are constantly dodging people at the last step or passing crowds on the road. You’d think it would be simple enough to use the sidewalk the same way you drive, but for some reason that doesn’t work here.

Humor of the week: Claire and I spent our last day in Rwanda in Kigali with Babu, wandering around town exploring and getting things that we wanted to bring home. It had been such a successful trip with no casualties, but of course, on the last day, we lost two important things: Claire and my iPhone. Thankfully, at least we got back the more important one!

At the end of the day, we were taking motorbike taxies from town back to the bus station to go home. Babu told the moto drivers that we would stop at one store along the way, but only my driver and his heard the message, Claire’s did not. So we stopped, and when Claire kept going, my driver said that he told him where to take Claire (our final destination). Well that wasn’t the case, so Claire’s driver began looking for us and finally came back to the store where we stopped, after we had already left. When Babu and I arrived to the bus stop and didn’t see Claire, I slightly panicked but realized that Claire had my bag with my phone in it. Babu called her and although she was in a slight frenzy, Babu calmed her and told her to get a moto and tell him to bring her to the Eco Bank where we were waiting. After some confusion with which bank and six motos all surrounding her, Claire jumped on one and hoped he would bring her to the right one. Babu and I had a great laugh at this now that we knew she was safe. I tried to get out all my laughter before she arrived. That didn’t work. I’m still laughing about it.

We got on the bus, and somehow by the time we got off and walked the rest of the way home, my iPhone was gone. It’s totally gone, and I have no idea how. But that was our only casualty this trip, so I’d say it went pretty well!

Claire and I are so thankful for this experience we had in Rwanda— in Rwamagana at the hospital, in Kigali, at Lake Kivu in Gisenyi, and in the rainforest at Nyungwe National Park. We want to again give a special thank you to all of our friends and family who supported us and made this trip possible. It is a time we will never forget!

I have pictures of our last week at the hospital with Leslie and the students we worked with, but they are on Leslie's camera and I have not obtained them yet!