August 19, 2005

Words from Rwanda: Life as a Durant fellow

Ann Kao, MD, of the MGH Chelsea HealthCare Center, has spent the past month in Rwanda as part of the Thomas S. Durant Fellowship in Refugee Medicine program. The Durant Fellowship provides either six to nine months or one year of sponsorship for MGHers who wish to serve refugee populations and victims of war and natural disaster with medical care and support. Kao, who will be in Rwanda until December, is keeping a blog — a web log — to keep in touch with family, friends and coworkers. The following are excerpts from Kao's blog that give a glimpse into what life is like in Rwanda providing health care to refugees.

Wednesday, July 20 (Arrival in Rwanda)
Two days of travel, four airports, seven time zones, and I am in need of a change of clothes, bleary-eyed, tired beyond belief and I am also, finally home. At least my home for this little stretch of my life. I am so thankful to be here and so excited to start working — there is much to be done.

Sunday, July 24
The mayor has expressed interest in my helping out at the local hospital, which serves a population of almost 150,000 people and is staffed by only two doctors. I will be happy to oblige, although I once again get the feeling that I will be learning far more than I contribute. There are a few things I would like to help get started — HIV education/treatment at this camp, and a health survey of children under age 5 assessing nutritional status, growth parameters and continued basic hygiene issues. It's still a delicate balance of not "taking over" but collaborating at every step of the way.

Saturday, Aug. 6
Saturday comes, my first weekend on call and the minute I arrive at [the refugee] camp there is an extremely ill 4-year-old to greet me. The child came in with severe vomiting and has received fluid resuscitation (probably too much for his weight) but still has altered mental status. The child is breathing about 80 times a minute very shallowly, is lethargic and weak, and I once again miss things that were routine at home like oxygen, endotracheal tubes and ventilators. This is one of the days I feel so inadequate — so unable to help in any meaningful way — it's hard to swallow. I understand more the feeling of responsibility — no matter how often you see this — it doesn't make it right or OK. And I do feel responsible for this child's welfare.

To view Kao's blog, visit http://ann-kao.blogspot.com/.