Journal from John Mellott - On the team with John in Rwanda

"Thursday was unbelievable! I will never be able to adequately describe today's events. My writing skills will fail me. I guess the best way is a semi- sequential narrative.

Here goes:

At 6:30 Kate (the medical anthropologist), Edith (local Rwandan college student who translates for Kate), Eddy (project field manager) and I went to the village.

Kate's day was more field interviewing. Eddy and I were going to pick up some extremely injured villagers and take them to the hospital. I will tell you about the injured in a moment.

Upon arrival the villagers were hard at work building terraces. They live on a steep hillside. The principle survival plan is to terrace the hillside to grow their own food. In short, they are learning to be farmers. I proposed an idea. The dirt on the village hillside is marginal. But there is good dirt nearby. I said they will need to move the good dirt from elsewhere to improve the quality of the terraces. At first I said let's get them baskets. Then I said let's get them heavy duty sacks they can load and carry. Here's what Eddy had to say about the idea:

Eddy - What did you eat for breakfast this morning?

I said - Two bananas. Why do you ask?

Eddy: Because I want you to eat bananas every day from now on - that's a brilliant idea!

We went to the local market this afternoon and bought twenty used heavy duty potato sacks. Tomorrow Eddy is going to teach the villagers how to hunt for the best dirt and manure. He said this is perfect - they understand the concept of hunting and gathering.

Shopping is a little different here. When we got to the market young boys came up to us. Better said - they surrounded us. They were all wearing dirty yellow vests. Eddy talked to them, told them what he wanted, paid them 200 Rwandan francs ( 35 cents ) and then they raced off into the market. Ten minutes later we had twenty nice looking sacks. Eddy gave them 3000 francs which they then took back and paid the sellers. You have to have a yellow vest and be known to the shop owners. Eddy said these are "agents" you hire to do your shopping. It is much faster to just hire a small army that fans out into the market than to do it yourself. I told him in America we would call these folks "personal shoppers" and only the rich hire them.

Now on to the hospital:

Dr. Dan (one of the founding doctors of HDI) wanted me to accompany the villagers (patients) and meet him at the hospital. Dan said he wanted me along because the hospital workers would respect him more if he had a white man with him. He said with a white man in tow, he could get a lot more done. He said my height, race and nationality would be very helpful to his efforts. My job was to just be seen with him - following his orders throughout the hospital visit. I looked forward to playing the part. I tagged along in Dan's shadow - subordinating myself and being extremely friendly and professional. I smiled a lot.

These are the patients Eddy gathered up at the village to take to the hospital:

•  An eleven year old boy with a sever infection of the right leg. The infection has gotten all the way to the bone. And when I say severe - I mean severe! He has had the infection for two years. The leg is already deformed and slightly shorter than the other. Eddy took some pictures of the boy and leg which I will e-mail home. Earlier in the week, Eddy and Kate took the boy to the hospital, only to be told to come back Thursday. This little boy will be the main character in today's story.
•  A young boy with a similar leg infection though not yet as severe. This is the boy I met while digging the well/hole. If the wound was not cleaned and the boy placed on antibiotics, his leg would turn into the same condition as the first boy.
•  A young woman with a severe hand infection. Her hand was severely swollen, hot to the touch and in she was in severe pain. Dr. Karl was really concerned, if we didn't act quickly, she was in real danger of losing the functionality of the hand. Dr. Dan agreed.
•  A middle aged man with a deep gash on his chin and jaw. The cut went all the way to the bone. It was caked with blood and dirt. It was nasty! The man approached me in the village this morning when he heard we were taking the other three to the hospital. I looked at the wound and told Eddy we needed to take him too. Eddy agreed and directed the man to the truck. Then a discussion broke out between Eddy and a number of villagers (mainly woman). The villagers said the man had no right to go with us because he had gotten the cut in a fight with another Pygmy. They said he got what he deserved and should suffer the consequences. Eddy said let's go - I'll handle the dispute later. Don't forget, these are the folks who said let's banish the shovel thief and burn his house down. Tough justice in the village.

The hospital is next to a Rwandan army base. It serves both civilian and military folks. The hospital is a collection of open air buildings in poor condition. Each building serves a different function; emergency, out patient, gynecology, surgery, etc. The hospital is filthy. Armed military men mill around. No equipment, no beds, no gurneys, no windows, all open air.

I met Dr. Dan just inside the gate - Pygmies in tow. Right out of the box we were told the orthopedic surgeon who was going to see our most sever case was not in. His house had burned down. They didn't know when he would be coming back. This was a major set back.

Dan told our patients to sit on a bench, stay together and don't go anywhere. Dan then said follow me John and so off we went on our mission to get these people treated.

At first we walked all around. Dan kept stopping and introducing me to all the doctors. The Rwandan medical community is small. They all know each other. Dan is a celebrity. He works in the best mainly private hospital in Kigali. He was working the crowd - laying the ground work to get our people treated.

Next stop was the admission window.

Dan: "John, give me 5000 francs (eight dollars). We need to speed the process along." I pulled out my wallet and handed him the money. I think this was, in part, Dan's way of showing the Rwandans I listened to him. I know he had the money. He never let's us buy him dinner or lunch.

Except for the most severe case, the eleven year old boy, Dan successfully got everyone processed and in line to see the doc's.

Now Dr. Dan turned to the most severe case - the eleven year old boy.

This is when he kicked it into high gear.

He came over to me and said: "We must get this boy admitted. We must! He is going to lose his leg. Follow me."

Back to the admission people we went. Dan said: "John stand by me, I'm becoming angry". A conversation with admissions ensued. Not knowing Rwandan I didn't know what was happening. Dan turned to me and explained the situation.

The admissions folks told Dan the leg was not worth saving. It would be too expensive and wasn't worth the effort. I asked Dan if that was his opinion. He said probably the leg could be saved, it wasn't a sure thing, but right now they just want to take the leg. The admissions people said it would cost too much money to save the leg. Dan said he agreed - it would indeed cost a lot of money. Money admissions correctly assumed the Pygmies would not have. In defense of the admissions folks, they have to make very hard decisions. This is a completely different world.

I asked Dan how much. One thousand dollars was his reply. I said I have that much back at the room - Let's go for it. Dan asked: Are you sure John? I said: You bet yah!

Back to admission again. Just as Dan starts the admissions process, low and behold, he spots the surgeon. Miracle of miracles. Turns out the admissions folks had the wrong doc with the burned down house. Or at least let's hope it was an honest mistake.

The surgeon examines the boy. Dr. Dan consults. Blood work is ordered. X-rays are held up to the sunlight. The surgeon tells Dan to bring the boy back next Thursday. He will perform the surgery, clean out the wound and remove any infected bone and tissue. Following surgery, the boy will need to stay on IV antibiotics until they are sure the infection is gone. Later in the day Eddy and Dan discussed the best way to administer the IV treatment. There is no way this can be performed in the village. Looks like the boy will be staying at Eddy's for post-op.

What an experience!

Dr. Dan Rudasingwa is my nominee for the Nobel Peace Prize. If anyone ever questions God's presence here on earth, they need only to think of Dr. Dan.

Tomorrow Eddy is buying five tons of manure for the terraces. He's going to teach the village to find quality dirt and spread manure. Once again my Johnny McMichael landscape experience will come in handy.

Well that's enough for tonight.
 - John Mellott

PS: One more funny story

In the middle of the day, out of the blue, a group of 6 to 7 men clad in crisp green jump suits, guarded by Rwandan Army MP's, came over to the hospital from the military base. They were clean, healthy, happy go lucky guys. They had a couple of good looking woman with them. The guards kept their distance. I asked Dan what was this all about.

Here's the story: These guys were President Kigami's personal security team. Kigami didn't like the way they conducted themselves. They weren't corrupt - just bullies. Kigami fired them. Following the traditional African way, Kigami personally caned (whipped) them and sentenced them to six months in military prison. Now every day they come over to the hospital, socialize, see their girl friends and eat a nice picnic lunch.

What a crazy world.