July 8

Here is a nurse holding a newborn baby in the maternity ward today. In Rwanda, a typical woman of childbearing age will give birth to 5 children. In the U.S., this figure is closer to 2 children. Therefore, maternity services are very busy here! Unfortunately, this country has the 26th highest under 5 mortality rate in the world at 112 deaths per 1,000 children. So a lot of these babies are born to replace children who are lost before they can grow up.

Here is a picture of a medication cart on the internal medicine ward. This looks a lot like the med carts that I remember from about 10 years ago, before automated medication dispensing systems came into vogue. Even if they had the money (which they don't), any procedure depending fully on automation - like a medication dispensing machine - would not work well here until the infrastructure is improved to address the frequent power outages. There was a 2 hour span yesterday where I estimate the lights went off and on about 30-40 times. Thankfully I am not prone to seizures, otherwise I would have been in trouble.

English club was fun tonight. Three doctors were there (and an accountant), so we talked about medical terminology a lot. They struggled with 'gallbladder' and all wanted to write that one down. We basically went through a list of anatomy in English with lots of pointing and use of a French and Kinyarwanda dictionary. Also we went through an inpatient chart template, which was in French, and translated all of the key words into English. They seem excited about the medical charts here eventually changing from the official language of French to an official language of English, even though it will be hard for them at first to make the transition. Most of these doctors are from Africa but not from Rwanda, so their first language is usually another African language, then they have to learn enough Kinyarwanda to speak with the patients here, and they have learned some French and English as well in order to write in the charts and communicate with other Africans who don't speak their language, in French or English. It is all quite confusing, and I don't know how they manage to communicate at all. Still humbled that I only speak one language.