L'espirit: Part II

I have often talked about "l'espirit" of the Burundians, as well as "l'espirit" of Kigutu, and "l'espirit" of the clinic itself. Perhaps I have talked about it so much that my message has become redundant. Rather than talking about it, I thought it would be more instructive to show it. With that end in mine, it is now picture time. A picture is theoretically worth a thousand words. Assuming that is true, this blog posting is worth about fifteen thousand of those words. I have attached no particular order to the photos, but will explain each in turn. Some of the pictures may have previously appeared on my Facebook page, but a little repetition never hurt anyone.

These first pictures were taken at the clinic today. You can see the muganga (doctor) surrounded by many children. The pictures were taken by Melino, who instructed the children to smile and wave. Most did, but, as you can see, some refused. These children are at the clinic today for a government-run program that occurs every ten months. It is a kind of Burundian vaccination clinic. However, instead of vaccinations, all the children receive a free dose of Vitamin A (their diet is woefully deficient in Vitamin A). Children less than one year receive 100,000 units, and older than one, 200,000 units. They all receive, equally free of charge, one dose of Albendazole, an anti-parasitic medication. It is assumed that all children here suffer from some sort of parasitic infestation. We don't try to figure out which one it is; we just give Albendazole for any sort of abdominal or GI complaint. The feeling is that one cannot go wrong in giving it. That's why Albendazole is probably our most commonly prescribed medication, at least in the pediatric age range.

The next pictures are the boys (with one man thrown into the equation) from Kigutu, all posing for the camera. The group grew and grew as I continued to take pictures. They all assume some sort of attitude.

The next two pictures are the Kigutu drummers in their colorful drumming uniforms. They walk and drum simultaneously, with the extremely heavy drums on their heads. This type of drumming is a Burundian tradition. The drummer in the center in the first picture is Peter, who is one of the heads of the troupe. He is also one of the essential members of the clinic staff. I am not sure exactly what he does. I do know, however, that his jobs are many, and all are integral to the effective functioning of the clinic. He is a marathon runner, and trains by running 10-15 kilometers in the hills, both morning and evening every day. He is remarkably strong and flexible, and I sincerely believe that he does not have one ounce of body fat.

The next two pictures are three adorable girls, standing outside the hut where the hospitalized patients cook their food. The cooking takes place both inside and just outside the hut. Sticks of wood are used to make the fires. If there were a Kigutu Fire Department, they might shut down the hut for not adhering to any safety standards. There are generally three or four small fires going inside the hut, and two or three outside the hut. I am convinced that some of the women who cook must have hands made out of asbestos. There is no other explanation for how they handle the burning hot wood with their bare hands. If a patient is too ill to cook for himself or herself, the food is prepared for them by those who are not so ill. That may be a friend or relative. If you want to know what they are eating, I can only tell you give you very partial information. I saw them cooking bread made out of cassava: not very nutritious, but very filling. I also saw them cook a mixture of tomatoes and carrots and onions. Everything is made in a pot over an open flame.

The next five photographs are what I call my fist-bumping series. The fist bump in Kigutu is the equivalent of the high five in the United States. It is an expression of joy and happiness. It is also an expression of a bond between the fist-bumpers. The children seem to learn it at a very young age. The first three pictures are fist-bumps with children on the malnutrition ward. These are children who have come back to life, thanks to the beneficial effects of getting enough nutrition. They are at the end of their hospital stays on the ward.

This fist-bumper is simply a cute little child outside the hospital. All you see is my hand doing the fist-bumping. You can trust that it is me, for there are no other muzungu (white person) mugangas in Kigutu.

This last one is one of my favorite patients. She is twelve years old, and her name is Divine (pronounced Di-vin-a). She has been in the hospital for at least six weeks for the treatment of a massive abscess in her back. The abscess was deep and extended all to the way up to her diaphragm. She needed it surgically drained under anesthesia, but that proved impossible, if only for financial reasons. However, we were finally able to eradicate the abscess with prolonged use of antibiotics, and, more importantly, by repeatedly opening and draining it. She will go home this week. She is a favorite on the ward. She has become my best friend. We always fist bump when I see her, and she gives me the same shy smile you see here. Her mother, who is quite large by Burundian standards, has also become my best friend. She is the one trying to teach me Kurundi.

The next three pictures are the dancing girls of Kigutu. They are wearing the uniforms that were purchased last year. The pictures give you some idea of the pure joy with which they dance. However, that joy can only be appreciated by watching them dance. It is a sight so touching that it is guaranteed to bring tears to your eyes. It may, in fact, do more than that. You may well find yourself in full crying mode, with tears streaming down your face. Perhaps it is these dancing girls, in their beautiful uniforms, who best epitomize "l'espirit" that is Kigutu. One cannot help but fall in love with this place when one sees them dance.

The last two pictures may not be representative of "l'espirit" that is the theme of this blog post. However, they are representative of the medical "espirit" that exists at the clinic. This baby was born at the clinic Saturday evening. It is the first baby for the family. The first picture was taken when she was an hour old, and the second picture the next morning. The story is as follows: the mother is the sister-in-law of one of the doctors at the clinic. His name is Remy, and he, like all of my medical colleagues, is an excellent doctor. The mother's water broke when she was at 35 weeks gestation. She was immediately admitted to the hospital for observation. She was placed on I.V. antibiotics to prevent infection. The mother is very small; she cannot not be more than 4'10", maybe 4'11" on her best day. I mention this in the context of the events that transpired.

The mother was admitted on Friday, and went into labor late Saturday afternoon. Initially things proceeded well, but the mother soon became exhausted. Her tiny body ran out of energy. It was then that her contractions stopped. We do have Pitocin at the clinic, so a Pitocin drip was started, along with I.V. fluids. Labor once again started, but it was ineffective. The baby was stuck in the birth canal. This would have been an obvious indication for a C-section at home. Such a thing is not possible here. Nor can we do a vacuum extraction. Nor do we have forceps.

There is a hospital in Rumonge where a C-section can be performed. I have seen that hospital. I have been inside that hospital. It is a snake pit, an awful place. (More about the Rumonge hospital in a future blog post) It was now almost midnight. To transport her, we would have had to place her in the back of the van, and travel an hour down a bumpy, rocky treacherous mountain road in the dark to get to Rumonge. Such a trip is difficult enough under ideal conditions, and these were far from ideal. There was legitimate concern that the baby would not survive the trip. There was equally legitimate concern that the nature of the ride itself might cause her to deliver the baby. That could have been a disaster for both mother and child.

There were no options at that point. She had to deliver the baby at the clinic. What ensued next was that Dr. Remy and two nurses pushed on the mother's abdomen, and Drs. Melino and Cyriaque tried somehow to extract the baby from below. It was only after almost two hours of perspiration-filled effort on everyone's part that success was achieved. The baby was delivered, and the baby was fine. That's where my limited role came into play. I examined the baby, and she is, indeed, perfect, weighing 2.5 kilos (about 5 1/2 pounds). I suppose that all's well that ends well. Yet I tell this story because it is symptomatic of the medical issues that the clinic faces in the vast wasteland that is medical care in Burundi. I also tell it to show you pictures of a beautiful Burundian newborn baby.