Rwanda, Thyroid | Mar 7-17, 2013

Mary Beth Hagey is a docent for the Fine Arts Museums of San Francisco and a board member of a private foundation awarding scholarships to students demonstrating outstanding service in their communities and academic excellence. For the past 25 years, Mary Beth has been an active volunteer for the local schools (room mother to PTA President), in her community (scout leader, coach and mentor), as well as on a global level (participated in and organized the AIDS Walk Africa for the Elizabeth Glaser Pediatric AIDS Foundation).  The “Greg Feldman, MD, Memorial Surgical Mission to Rwanda” is Mary Beth’s first trip with MMFC. 

Screening Day

Sunday, March 10, 2013

“Muraho, Odette.  May I take your photo?” all the while pantomiming with my camera.  My Kinyarwanda vocabulary is limited to a few pleasantries.  I needn’t have worried though.  Her infectious smile lights the room; words seem unnecessary.  The goiter on Odette’s neck resembles a lumpy grapefruit.  With the help of a local interpreter, I come to understand that Odette and her younger sister have walked for 3 days to Gitwe Hospital in hopes that she will be selected to have this life changing surgery performed by American doctors and nurses donating their time and skill with Medical Mission for Children.  She made this identical trek last year, but by the time she arrived, the schedule was already filled.  Her enthusiasm and gratitude are palpable.  Odette recounts her difficulty breathing when she carries her burdens on her head as well as when she sleeps.  Odette asks to see her “before” photo as I head for the door.  She wants to remember what she used to look like. Somehow I think she will be excited to see the “after” photo as well.

Odette, before
Odette, after

Surgery Day 1 – “Hitting Their Stride”

Monday, March 11, 2013

Today had fits of rain so intense that you might liken the downpours to being doused with a fire hose.  The power comes and goes, but the team is adept at rolling with the havoc mother nature wreaks…perhaps the most difficult to contend with is not in the OR, but back at the guest house where showering involves icy water in an inky stall after a walk home along the dusty path.  Despite the unpredictable weather, the team has hit its stride and each case proceeds with remarkable efficiency.  Doctors adapt to each situation/complication by tapping into their bank of experience and also knowing the depth of the professionals supporting them. The OR nurses anticipate the surgeons’ needs and the Post-Operative nurses are an incredible balance of professionalism and warm empathy. One patient that was vomiting after surgery necessitated a return visit to the hospital after the team had settled back into the guest house and eaten dinner.

A nice reminder of what an incredible impact MMFC has on the lives of the patients occurred today.  A beautiful Rwandan woman introduced herself to me.  She said that she had received an operation on her goiter at MMFC’s Rwanda mission in 2012.  She exclaimed that it was truly a miracle!  She was hopeful that the doctors might consider helping her with her arthritis.  Our mission is goiters so unfortunately this will not be possible, but it was wonderful to see a patient thriving twelve months later. Obviously the gratitude survives and lingers even after the team heads back to their practices in their home countries.

Immacule Mukandutiye, who returned a year later to show her gratitute to MMFC for the life-changing surgery she received in 2012

Surgery Day 3

Wednesday, March 13, 2013

There is quiet calmness to the start of day 4.  The team stayed up late into the night discussing a patient named Liliane after a return visit to the hospital.  Today’s schedule includes another very large goiter, although not as large as the previous day.  Many of the previous patients that had drains will be released today. There is much to celebrate today as patients head home and return to their families.  The surgeries just seem to click off at a sustained, even pace.  The patients go to the post-operative room and then head up to the wards.  The most angst today does not seem to be focused in the operating room, but rather in that breezeway where the patients have been waiting all week for their chance to have their name added to the surgery schedule.  Given our departure timing, it is apparent that we will be unable to operate on everyone. Dr. Dhingra does another pass through to prioritize the women and tighten up the schedule. Unfortunately, some that have been waiting will need to be turned away.  Naturally, some restrained emotions well up in the women that need to head home.  They have been given instructions on medications and ultrasounds and reminded to return next year for the mission in 2014.

A treat awaits the team tonight… Our in-country partner, Vianney, has graciously arranged a brisk hike to his family home here in Gitwe and a delicious Rwandan barbecue dinner.  The team gathers around the fire in the courtyard and listens as the young neighborhood children serenade us.  We head home and hit the sack… it’s a 5:30am breakfast and back to the hospital.

Surgery Days 4 and 5

Thursday, March 14 and Friday, March 15, 2013

Music is a large part of these next few days.  We’ve been serenaded by the small school children around a fire.  We’ve heard locals harmonizing in halls and churches on our walk back to the guesthouse and the faint sounds of the Beatles can be heard when entering the operating room.  Spirits are high. We are over the hump.  The first patient is prepped and in the OR by 6:30am. There is a sense of familiarity and camaraderie among professionals now.  A minor hiccup comes after lunch, when one of the patients exhibits signs of hypertension.  They decide to cancel her surgery and one more name to the schedule. Being flexible is critical to our success.

The upbeat, almost festive mood carries over to dinner.  The team is energized by the impact they have made in a short amount of time.

Friday is our last day of surgery with two straightforward cases.  The doctors and nurses complete their mission and discharge all but Liliane and the last two patients. Now it’s time to take apart the operating and recovery rooms.  It’s bittersweet as we pack it all in the bus and head to Kigali. We will scatter back to the places we all call home (SF Bay Area, New York, Boston and Washington, DC) richer for having had this experience. Murakoze, Rwanda!

By the end of the last surgery day, the team had finished 25 goiter cases. One of those patients was Liliane, a slim, attractive 38 year old Rwandan with clear skin and close cropped hair.  When you first meet Liliane you can’t help but feel overwhelmed by the enormous goiter that has taken over her neck and wraps up the side of her face to her ear.  Liliane’s goiter will prove to be the most complicated and challenging surgery of the mission here in Rwanda. She will be in surgery all day and spend the night with a doctor on vigil in the recovery room.  She will be the last MMFC patient discharged from Gitwe.

It was sheer luck that Liliane made her way to Gitwe this year.  If not for the fact that she has a friend with a goiter who heard about the American doctors coming to Gitwe to donate their services from an employee of Gitwe, Liliane would have been unaware of this unique opportunity and forced to continue to live with this honey dew melon sized growth on her neck and face.  As it was, Liliane has seven children at home and walked 6 hours to Gitwe.  While all of the operations performed by the doctors here are life altering, Liliane’s change in appearance is the most dramatic.  Despite the pain associated with the recovery, her gratitude is deep and authentic.

In addition to the incredible marathon performance by the doctors and nurses in the OR, I’d also like to highlight the incredible compassion and care given to Liliane by the recovery room nurses.  A couple days after her operation, Liliane was back in the post-op room for observation and care.  This was rough going for sure…as much as she wanted to mask the pain she was in, even the casual observer recognized that wince.  The two nurses knew she was in need of a boost.  One went to her secret stash and pulled out a brand new pair of fuchsia and blue flip flops and slid them on her feet.  She tucked her old, worn-out ones in a canvas tote that she filled with socks and a “Race for Survival” t-shirt.  She slid three red, white and blue beaded bracelets on her arm to accompany the hospital one she got when she was admitted.  She embraced her shoulders and let her know she understood that this was difficult. The exchange was touching and just what Liliane needed.

Another patient treated was Joseph, who was hard to miss in the sea of women waiting to be examined.  Although he is 18 years old, he emits an aura of youthful innocence.  His slight frame reinforces the notion that he is younger than his years suggest.  His openness and his understanding of the English language allow a playful banter between doctor and patient.  Dr. Dhingra teases Joseph about the female patients having been very brave and stoic when it came to accepting injections in their neck without so much as a flinch.  Joseph carried the burden of proving that the men could also tolerate this somewhat scary needle coming at their neck! If this was not enough pain to endure, Joseph had been clearing the land with a machete a couple days before and had accidentally whacked his knee open and needed a tetanus shot as well.

I met Joseph’s mother in the recovery room as well as later on the ward.  She was anxious to tell me that Joseph was a diligent student. She kept repeating ‘murakoze’ or ‘thank you’ for the surgery and care Joseph received.  We will miss that disarming smile and bravado!

Rwanda is known fondly as the Land of a Thousand Hills and a Million Smiles.  Let’s continue with that theme and consider the 2013 MMFC Rwanda “by the numbers.”

The mission included:

  • 13 health care professionals from 3 US states and the District of Columbia as well as one local Rwandan
    • 2 surgeons and 2 surgical residents
    • 2 anesthesiologists and 2 anesthesiologist residents
    • 2 surgical techs
    • 1 operating room nurse circulator
    • 2 post anesthesia recovery room nurse practitioners
  • 1 in-country partner
  • 1 MMFC alumni Ob/Gyn
  • 2 local translators
  • 1 administrator
  • 44 pieces of luggage carrying supplies and equipment traveled across 10 time zones and over 9,400 miles as the crow flies
    • 1 lost preppy pink suitcase finally surfaced after 3 days time and finally made its way to Gitwe
    • 1 very happy team member after its arrival
  • 1 tire blew out traveling from Kigali to Gitwe
  • 25 life-altering surgeries were performed on:
    • 24 women and 1 young man
  • 71 years old was the oldest patient
  • 17 years old was the youngest patient
  • >850 grams was the largest goiter removed
  • 7 hours and 10 minutes was the longest time spent in the operating room (surgery time was shorter)
  • 50 minutes was the shortest time spent in the operating room
  • 3 days walking was the longest distance traveled by a patient to have this surgery performed
  • 1 hugely inspirational human spirit for whom this mission is dedicated – Dr. Greg Feldman.  Numbers seem insufficient in quantifying the lasting impact Greg had on MMFC, the doctors and nurses, the patients, and the community of Gitwe.  Not unlike the red dusty earth of Rwanda that found it’s way under our skin, between our toes and permanently enmeshed in our clothes, so too has Greg’s spirit.  Each morning as we crossed the threshold of Gitwe Hospital we passed his memorial tree – one that has taken root and is thriving. We felt his presence each day and were grateful for the reminder and inspiration to be the best version of our selves. Peace and Murakoze, Greg!