Dispatch # 2

As you enter the gates of Rwanda’s major tertiary and teaching hospital, you can’t help but notice a giant sign bearing the hospital’s mission statement, which vows to provide state of the art medicine according to international standards. Unfortunately, it represents a large unfunded mandate. The intentions are wonderful but the resources are few and often not enough to provide the very basic diagnostic and therapeutic needs.

I spent my day with Edmond Ntaganda, a young and energetic surgeon who is pursuing a career in pediatric surgery, and on his way to becoming Rwanda’s first fully trained pediatric surgeon. In three years, a country of 12 million people will have one pediatric surgeon if Edmond’s plans materialize.  During approximately two hours of rounds and patient discussions, I had already encountered more major pediatric surgical pathology than I would encounter at the Children’s in a month or two – congenital anomalies, bowel obstructions, renal tumors, unusual hernias – a museum of pediatric surgical disease.  The first patient I operate with Edmond is a 7 day old baby with bowel obstruction who has never been fed. An impression of Hirschsprung’s disease is dismissed after I look at simple films done 3 days previously.  The baby needs an emergent operation, but we cannot get the most basic studies – electrolytes, contrast enema. We still have to operate because, in a setting where neonatal bowel obstruction has more than 90% mortality, this is a baby who may actually have a chance.

At operation, we find multiple intestinal atresias with borderline short bowel. In our hospital, this would be a challenging case. In sub-Saharan Africa, the baby needs a miracle to survive and I pray earnestly for one as I work with Edmond to custom-tailor an operation. The baby is successfully extubated and taken to the recovery room. The first battle is won – many more to come.

But as I end my day, one feeling overpowers me. Rwanda is lucky. The country is lucky to have a surgeon like Edmond. During the 10 hours we spent together, he never stopped advocating for every patient, advocating for getting x-rays, advocating for performing necessary tests, advocating for operating room time, advocating for accountability. He knows he is pushing a stone the size of a pyramid, but he will not stop pushing. I like to think of myself as a strong patient advocate. But everything I do pales in comparison to Edmond’s efforts and persistence. He embodies the very best of medicine in an environment that can easily demoralize any physician. I came her to teach, but I am already learning a whole lot.

Dr. Sherif Emil [1] is a pediatric surgeon and Director of Pediatric Surgery at the Montreal Children's Hospital. His trip to Rwanda is part of a McGill program to train surgical residents at the National University of Rwanda and the Centre Hospitalier Universitaire Kigali.

Read more dispatches:

• Dispatch #1: From the African skies [2]
• Dispatch #3: An African solution to an African problem [3]
• Dispatch #4: The first (not so) easy case [4]
• Dispatch #5: When good people do nothing [5]
• Dispatch #6: Winning battles but losing the war [6]
• Dispatch #7: The human factor is Rwanda’s best hope [7]
• Dispatch #8: Thanksgiving [8]