Army Week!

3 Aug

June 26th to July 29th was Army Week in Cyangugu. Staff from Rwanda’s Kanombe Military Hospital packed up, and came down to three health centers in Nyamasheke and Rusizi Districts. The health center I work at was the only site to host military personnel in Nyamasheke district.

Since I had been gone the previous two weeks I was pretty out of the loop with health center happenings. Thankfully my coworker filled me in on our walk to work Monday morning. Or at least he tried to. His explanation of, “Soldiers from the military hospital are coming to see all the indwara” was the extent of the explanation in English. From there I mistakenly teased out that the abaganga (doctors, but the word used by villagers for anyone associated with the health center. For example, my friend is called ‘umuganga wa Mutuelle’ or the doctor of health insurance) were coming to do a census of the illnesses of people in our sector. Like most things that don’t require special preparation on my part, I didn’t ask too many questions, knowing that all (well most) would be revealed to me shortly. The important thing was that we had visitors for the week.

The doctors were staying about 45 minutes by car South of my site at the fancy muzungu hospital because those were the nearest accommodations for the 30 or so of them. This means that they didn’t roll up until after 9 am, probably closer to 10 on Monday. In all fairness, to the road is not great would be a gross understatement and we did have a rain delay that morning, my coworker and I were even 30 minutes late because of the rain. Despite the rain there were A LOT of people waiting for a chance to be seen by doctors. Still, I got a chuckle out of the fact that apparently not even military personnel are immune from the phenomenon known as ‘African time’.

The medical staff from Kanombe were a mix of civilian and military personnel. There was one physician doing general consultations, also one of the two senior ranking military officials (I forget the different ranks), a couple of dental providers, a psychologist, a psychiatrist prescribing drugs, staff performing circumcisions (there’s been a big push lately in Rwanda), internal medicine docs, two ophthalmology technicians, nurses working handing out medications, and an overall logistics guy. In addition there were some nurses and a physician from Kibogora hospital and some nurses from neighboring health centers who were brought in to help manage the influx of patients. The patients weren’t just from our sector, but from neighboring sectors. Many people walking four hours or more and being told to come back the next day for follow-up.

Monday I just kind of kept to myself and held down the fort in the ARV office since many of my coworkers were had been roped into helping. It was a pretty boring day though since we’re typically through the rush of patients by 10 am. Not to mention ‘my office’ had been commandeered by the psychologist and the health center was over flowing with people everywhere you looked. So Tuesday after we finished handing out ARV meds I decided to ask my supervisor if he could find somewhere for me to work. I explained to him that everyone was really busy and I had already finished my work  and thought it would be good if I could help out in some way, as long as it wasn’t going to be too much trouble.

That’s how I wound up working with the second top ranking officer and another civilian ophthalmology tech for the rest of the week. At first it was a bit comical as we figured out exactly how I could help and I learned the ropes. Within a couple hours we had a system down. By the end of the week we were chit chatting (IN ENGLISH) like old friends. They couldn’t figure out why in the world I would choose to lie in a village or why I didn’t head into Kigali/Kamembe every weekend. By the end of the week I’d also become really good at figuring out the diagnoses and medications based on the symptoms causing jokes how I could work as a tech, except that I didn’t actually know how to diagnose the symptoms. The most common thing diagnosed was allergies the solution being prescription eye drops. There were also some older people with cataracts, some people who needed referrals to get glasses, as well as some other ocular oddities. Tuesday we saw around 40ish people, Wednesday around 60 I think, Thursday was the big day with 103 people, and Friday since they only worked until 2 we saw 80. My job was to write forms, sometimes as many as 3 forms per person. Suffice it to say that my hand felt like it was going to fall off, especially after Thursday.

Even if it was just filling out forms, something I frown upon doing on a daily basis, it felt good to be busy for the entire day and feel like I was contributing to an overall good. The whole goal of Army week is for people to be able to get medical care/referrals closer to home than would normally be possible. There are definitely a lot of benefits to such a program but there were also some drawbacks. Such as the fact that we quickly ran out of the prescriptions eye medicine and while people could pick up a month prescription for most the things immediately at the temporary pharmacy, refills would require the person or a family member to make the expensive trip to the fancy hospital because health center pharmacies are only qualified to carry a certain tier of drugs, which makes sense since there aren’t actually any doctors on staff.

Visitors in Rwanda are a pretty big deal, especially of the military/Kigali variety so the head of my health center provided lunch for everyone at his house, catered by some restaurant. After I started helping on Tuesday I was invited to lunch with the other army week workers. It gave me an opportunity to  learn a little more about the week and to field a plethora of personal questions of course. Including how many kilos I have, which I turned into a lesson on how American women do not like to be asked their age or weight.

During one of the lunches I was able to talk to the psychologist and clear up burning questions. Most people work with a counselor at a minimum for a couple of sessions, often for months or years. I couldn’t quite figure out what service he was providing in a one-off visit. He explained that mostly he was collecting information about the various ‘mental disorders’ that people have. This prompted a talk about how the government wants each health center to have a psychologist, but because of tight budgets, a lack of qualified personnel and the undesirable locations/distances from cities of most health centers this was not a reality.

I got permission from one of the senior officers to take pictures and to share them. It’s not acceptable to take pictures of military personnel, not to mention many Rwandans are suspicious when you want to take their picture. BUT I thought Army Week was too good of an opportunity to pass up sharing with folks. So, please pardon the poor quality of the photos, I was trying not to single any one/group of people out. Enjoy!

First stop for patients- one of the private rooms to have a photocopy of their insurance card made. Since we have only solar power they brought in a generator and one of the local elementary school’s copy machine.

 Dental services at the front of the health center. The front of the line for photocopying insurance cards is around the building to the left.

People waiting on paperwork in the large meeting room.

Students from the local schools came, some to see docs, many just to witness (and contribute to) the madness.

Outside the lab, through that doorway is the meeting room from the pictures above.

The makeshift pharmacy. Also the area where we do vaccinations every Friday.

This is normally just a walk way in the health center but in a pinch, it works as a place to vaccinate kids.

SO MANY PEOPLE! This is the waiting area of my health center. With the exception of Friday mornings before the market, it is seldom this full.

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