Rwandan Time

Rwandan Time

by Rajah Bose

The white coats were taking up most of the room, seven or eight of them, rotating through a battery of tests. They pushed their laptops around on a rolling table from patient bed to patient bed and consulted stacks of paperwork filed into manila folders.  They opened the folders, pointed at the paper, then glanced up at the patients to confirm. The youngest of the four that morning had been sitting on the side of his bed, quietly watching. The white coats spoke English, but he could make out a few of the words. His eyes, bright against his dark brown skin, followed the group. Suddenly they surrounded him, removed the stethoscopes from their necks, and leaned close to listen to his heart.

Clomany opened his shirt to allow the doctors to listen, then taking the stethoscope from one of them, he pressed it to his own chest.

“Can you hear it?,” one of the young residents asked.

“Oh yes,” he said tapping his chest. “I’ve got a 4 over 6 systolic murmur.”

At least that’s how Dr. Hal Goldberg remembers it. He knew Clomany was special from the moment he began to review his case on the second floor of the Cardiac Unit at Sacred Heart Hospital in Spokane, Wash. He’d watched the irate rhythm of his heart that had been recorded on an echocardiogram and projected onto the wall. Along with a team of doctors, he tapped his pen and tried to hypothesize how to best solve the puzzle.

The group of doctors were from Healing Hearts Northwest, a Spokane based non-profit group which had spent the last year preparing for their annual three week visit to King Faisal Hospital in Kigali, Rwanda. Dr. Hal was largely responsible for the team being there. He had first come in 2009, somewhat begrudgingly, with only a backpack over his shoulder. He had been invited by Dr. Joseph Mucumbitsi, the only cardiologist in the country at the time. Dr. Joseph had returned to his country after the genocide which decimated Rwanda’s educated class. Estimates that more than 70% of physicians had been killed or fled the country, many never to return. Joseph was one of the ones who couldn’t stay away, bringing his entire family with him to help with the rebuilding process of the country’s health care system.

Dr. Hal was lukewarm on momentous task until his college-age son convinced him he would never have an opportunity to make such radical change to a county in rebirth. After meeting the patients and doctors in Rwanda who were already working with heart surgery teams across the world (thanks to Dr. Joseph), Dr. Hal couldn’t turn back.  Now six years later, he’d returned with a team of almost 40 people who had brought more than 250 trunk-size-boxes of supplies across the ocean on their fifth mission.

That week they would attempt to save the lives of sixteen patients.

 

Clomany had already been admitted twice to the hospital with heart failure from a backup of fluid around his heart. Two of his heart valves were leaking, severely, which had caused his heart to work twice as hard. He would easily become short of breath, and was unable to keep up with his friends in daily activities.

When Dr. Hal stepped from the back of the group of white coats and asked the boy’s father, a slight man who always seemed to be leaning down but gazing upward, what medications Clomany was taking, the 14-year-old didn’t hesitate before listing them off himself. It was as if he was reading them from a medical chart. Dr. Hal shook his head and laughed – most kids didn’t take their medications, much less know the names.

Clomany is a sharp kid, every nurse, doctor, surgeon and anesthesiologist who met him on the trip made note of that fact. His small size makes him appear younger and even more impressive. Many of the patients had lived with their heart conditions for years, and the extra tax on the body had often stunted their growth

The doctors talked with Clomany and his father through a translator and explained the procedure that was going to happen the following morning. They explained that with the new mechanical heart valves, Clomany would need to take blood thinners the rest of his life. This was no small task, as missing a few pills would mean a stroke or death.

 

Clomany Mugisha at some point in his life had contracted strep throat, a bacterial infection common anywhere in the world. With a dose of penicillin, strep infection is eradicated within a few days. Without it, Clomany’s body had produced antibodies to fight back the infection which also attacked his own tissue, damaging valves of his heart over the next months and years. Untreated, the sore throat had become Rheumatic Fever which had progressed into Rheumatic Heart Disease.

Most doctors won’t ever see a case like this in the U.S., but in developing nations it is still common, affecting 18 million people in Africa alone (most of them children). The reason Rheumatic Heart Disease it isn’t seen by your neighborhood American doc is largely economic – a $1.87 dose of penicillin would have solved the problem.

Now, a few hundred miles from his hometown in Rwanda, Clomany was about to undergo open heart surgery.

 

 

Just down the hall wandering from room to room, a former patient was checking on the new arrivals. Evariste Munyensanga had his heart operated on three years ago by the visiting doctors. At the time he had endured three years of debilitating chest pain which had made it difficult for the former soccer player to even walk to school.

Dr. Hal had met him in the Fall of 2011 and remembered how it took him so much energy just to breathe. He couldn’t speak a word of English and he rarely spoke at all. Now he was stopping to see every nurse and doctor who had met that life-changing year, and talking with the four new patients.

In the pre-operation room he found Clomany laying in his hospital bed staring intently at the ceiling. He told all the new patients that he was a former heart patient. Clomany was the only one to ask about his complications and life after heart surgery.

 

In the theatre, or what is known in the American nomenclature of prime-time medical dramas as the O.R., Clomany was going under anesthesia. His eyes, normally bright and curious, were staring lifeless at the broken ceiling tiles. The nurses moved around him, stepping over dozens of power cords strung overhead and underfoot which ran the dozen or so machines that monitored and kept the patients alive. The room was clamoring in quiet activity as nurses prepped the tables of sutures and anesthesiologists monitored vitals. Clomany was lying still, except for his heaving chest which continued to rise and fall on the operating table as if it was trying to escape his 60 pound body.

All attentions were on center stage, but the star of the afternoon didn’t move as they opened his chest with a power saw, clamped his sternum, and maneuvered with handfuls of instruments around his broken heart.  As the surgeon was preparing his heart for bypass, Clomany’s pulse suddenly jumped to 200 beats per minute. The heart monitor which had been keeping constant tempo in the cavernous room began to sound its tapping siren as if in morse code. The surgeon reached in with two of his fingers and massaged the throbbing heart muscle. He called for the paddles and a nurse handed him what looked like barbecue tongs with two flat white ends. He fit the defibrillator into the small cavity the width of a fist between sternum touching both sides of the heart and sent a shock.  The beeping pulse in the room returned to steady. The surgeon returned to his task of directing the blood to the heart bypass machine. The anesthetist standing near the heart monitor said the boy had died for a minute.

 

Down the hall from the theatre, Everiste and Dr. Hal were sitting on a bench together catching up like old colleagues. Since his surgery three years ago, he had gained some healthy weight, graduated from college, and now was working in the community. He never seemed to lose the smile he was wearing.

Dr. Hal arranged a checkup with him the next afternoon to get a better idea of how his heart was doing.  He’d been there all day and was about to leave to go for a run. Dr. Hal was wide eyed as he realized that his patient had returned to the level of activity he  He patted him on the chest and they both parted ways walked away.

 

When Clomany woke up with a fixed heart, his first word was Amazi. It is the word for water in Kinyarwandan, the language spokane by most Rwandans. After some resisting, the nurses served it to him on the end of a small pink sponge dipped in a plastic bottle. He couldn’t get enough,and he demanded more immediately. They told him he had to start with moderation, otherwise he would most certainly fall sick. After shutting down his organs for than three hours during surgery, he needed to wait for his body to restart. But Clomany didn’t like to wait, he was 14-year-old.

He had woken quickly after his surgery was complete, and the intensive care nurses were still working on securing his IV drips and the plastic tubing which wrapped around his ears and into his nose.

“Why the oxygen?,” he asked in English as if he was ready to get up and walk home.

The nurses laughed and marveled together at his understanding. Then they gave him a heart pillow to hold against his sternum – to reduce the pain and help the healing, and a plastic windmill to blow on – an exercise for strengthening the lungs.

Everiste stood across the room as the dozen nurses and doctors who were working on Clomany began to disperse. He slowly made his way to Clomany’s side and stood at his bedside. He took his hand and they spoke in whispers.  Rwandans often remain close enough to touch as they speak to one another, when walking together they may hold hands and speak soft that nobody else may hear their conversation. From a distance it appeared as if Everiste and Clomany had known one another for years.

Life in Rwanda comes with increased risk and workload, and people move at a slower pace to compensate. The American staff call it Rwandan Time, mostly because it doesn’t align with the clockwork scheduling that they are used to, but also so they have something to say when their appointment shows up an hour after they scheduled.

Clomany blew a few more breaths on his windmill and asked for some more water.  Everest helped him with a capful before he left for the afternoon. He immediately wanted more. The nurses told him he had to wait. He clutched the heart pillow against his heart and fell asleep face first on the hospital bed.

 

By the end of the weekend all 16 surgeries would be complete. A week later those patients would be at home recuperating and the doctors would be on their way back to the States. But the work was far from over.

Everiste arrived and made a stop at every bedside in what was now a full room of recuperating patients bustling with families and friends hoping to take their patients home with them. Doctors and nurses helped paint the fingernails of the female patients – every one of them choosing pink.

He stopped by Clomani’s bed, whose stay had been extended an extra day. His parents were glued his bedside, hoping to soon make the three hour return trip home by public bus. He reminded him that he needed to take his meds and keep his scar clean, and to never stop exercising.

Dr. Hal and his team plan to return every year, but hopes that the expertise they bring will eventually be handed over to the Rwandans. With every surgery and every patient who is able to return home with a new heart, the  Healing Hearts Northwest’s original team consisted of 50 members. Today, they are dwindling, but purposefully.

There’s a brotherhood here, one that extends across gender, or economics, or ethnic lines.

They call it the zipper club – those who have been lucky enough to go under the knife and come out on the other side healed. Everiste is only one of the hundreds of heart patients whose lives have been changed in this hospital by the teams which return yearly, and one of dozens of patients who returns every year to teach the new generation how they can learn to live in this newly changed world.

 

Everiste woke early for his usual morning jog from his house along the airport road. A photographer accompanied him, leaning out the window of a taxi as the city of Kigali passed in the distance, a city in rebirth in the land of a thousand hills. As he ran along the sidewalk full with hundreds of people that morning, they turned to watch as he ran by. Some gave him a high five and yelled his name. Most just stared at the spectacle of what must have been a celebrity in their neighborhood. Though most didn’t know who he was, or that a few years earlier he wouldn’t have been able to even walk up the slight inclines on this road without exhausting himself. He passed another runner who had slowed her pace to a walk. He smiled at her, turned, and yelled back in her direction to never stop.