Rwinkwavu Hospital -

I’m up and out of the house before 7:00 am. I’ve finally connected with Shaloy over the skype this morning. I realize how much easier it is since we’re able to see and hear each other almost daily. A quick moto ride and I’m waiting for my bus @ Atraco by 7:10. The crush of people, the people wanting to divert you to another company, the sellers of candy and sellers of mobile minutes are all becoming routine. I’m even getting used to sitting next to a complete stranger for a couple of hours, touching ankle to shoulder with my bag on my lap the entire trip.

I visited for quite a while with a very pleasant young man who works with Atraco. At the appropriate time he walks me to the van and I get that coveted front passenger seat. I’ve shown the driver where I want to go and he nods but doesn’t speak any English. I showed a fellow passenger who also doesn’t speak English but nods approvingly as though we’ll pass that place. After an hour and half of driving my phone rings and It’s Dr. Irenee who I am going to see today. There is a spot at the hospital where they are able to get one bar of reception. She asks to talk to the driver to enquire about the time of my arrival and to instruct him where to leave me. I am thus deposited and to the dismay of the flocking moto drivers quickly picked almost immediately by Dr.Irenee and the Rwinkavu bus.

It’s a lovely 20 minute ride down the dirt road toward Akegera Game Park. Rwinkwavu Hospital is a joint effort between Partners in Health (PIH) and the Rwandan Ministry of Health. The people who I've talked to in Kigali refer to it as the "Clinton Hospital" as the Clinton Foundation has provided some funding, I recognize the road and the scenery from our trip with Dr. Konn and her students a couple of weeks ago. Dr. Irenee tells me that there is a sonosite unit and a new ultrasound unit provided by the Ministry of Health. We find it still in the box and she says it has yet to be used. The unit is made by a Chinese company I’ve not heard of. We take it to an exam room for me to explore how it works. It has a 3.5 MHz curvilinear transducer and a basic OB calculations package. There is no memory so once a measurement is obtained you must write it down. There is no ability to Cine back to a missed image, no Doppler and it won’t store any images. But it does work and provides an acceptable image and we can do measurements. The Hospital director and Dr. Gilbert join us as I play with the unit.

The first patient has a supra-umbilical mass that is visible just under the skin. And extends to the costal margin. It connects to the inferior margin of the left lobe of the liver. Additionally he’s got two other heterogenous masses within the liver both with significant anechoic areas and with a thick rind. They have a similar appearance to the large mass and I suspect they are related and are some sort of parasitic abscesses. Then Dr. Gilbert turned on the Sonosite to show me a case they had saved. Splenomegaly with a very large anechoic area with a large echogenic mass within the apparent fluid. The still images are quite confusing but the patient is in the hospital and within a few minutes we’re scanning him in his bed on the ward. The apparent fluid is totally contained within the splenic capsule and I can see normal splenic tissue around the edges of the fluid with an echogenic mass floating within the fluid. There is no history of trauma and they say they’ve stuck a needle in it and gotten back tomato juice fluid (which they’ve sent to Kigali for pathology analysis). I can describe it but I don’t know it’s cause. A couple of other patients using the Sonosite and one normal and one with a liver mass that is extrinsically compressing the biliary ducts.

Back to the exam room where we scan some OB patients and volunteers. The first question as always, show us how to see the gender of the fetus. Off to a delightful lunch in the employee cafeteria and then back for a few more patients. Dr. Damascene joins us for most of the afternoon. A few patients, a few quick pointers a mini physics lecture on angle of incidence vs angle of reflection and we’re done for the day. Pictures, thank yous both ways and I’m out waiting for the bus.

The Sonosite unit is fantastic, three transducers, Doppler (Spectral and Color), memory for storing images, a full calc package, slots for memory storage devices to attach. I encourage them to use it and promise to e-mail the Sonosite folks to let them know how valuable their unit is to the patient care in Eastern Rwanda.

The Rwinkwavu bus goes to Kigali every Friday evening @ 5:00 pm and returns Sunday evening. While I’m waiting I got a chance to visit with some of the American PIH volunteers who are taking the two days in Kigali. When the bus comes to load us up it seems there won’t be enough seats (and there wouldn’t be in the U.S. but this is Africa and we just put another person in each row and head towards Kigali. Dr. Irenee is on her way to visit a sister in Butare. We sat next to each other and where able to visit. Every so often we reach a worker’s home and we stop to drop them off. By the time we get to Kimihurura the bus has about 1/3 rd of the original occupants.

This second visit to a district hospital has confirmed even more the need to have more sonography training during the physician training at the medical school in Butare, regular scheduled on going/in country training seminars and one on one training with their equipment on site. The physicians are intelligent, hardworking, dedicated professionals who could use a few more tools in their tool bag as they care for the people of Rwanda.