The Routine

Kigutu Day 3. We wake up between 6:45 and 7:00 to get ready and make it to breakfast before the clinic meetings begin at 7:30. There is locally made bread with butter and delicious coffee with sugar. At the clinic meeting the 5 nurses, 1 laboratory technician, Dr. Melino, Rachele and I hear about the patients in the inpatient ward. Two being treated with IV quinine for malaria, one being started back on TB therapy after stopping for one week just as the intensive phase was about to be completed, one woman with a UTI and fever despite two days of antibiotics, one woman with pneumonia whose child also has TB, one child being with severe malnourishment, and two women who have recently been diagnosed with HIV and are experiencing complications likely do to HIV. The women will likely need to be started on antiretrovirals and partnered with a local health worker to visit here each day and ensure that she takes her medication and is not having any side effects. But before they can be started, they need to show that their CD4 count (a type of immune cell) is sufficiently low. The only CD4 counter in the area is a several hour drive away, and to encourage them to perform the test on our patients’ blood requires Dr. Melino to travel there and get through all the red tape. Then someone would need to go the following day to pick up the results. This would mean the clinic would have to close while Melino is gone and the ambulance would not be available while the results were being picked up. It is one of several challenges that the workers here are faced with. The good news is that there are plans to improve these challenges, but in the meantime, difficult decisions need to be made.

We walked around the village yesterday with the project directory, Joey, and his girlfriend. The village is made up of several interconnecting footpaths lined by corn, manioc and other farmed plants. There are goats and chickens, which roam, seemingly freely, though the fields and are tended to by children who look no older than 4 or 5. Since we are the only white people outside of the capital, we are quite the spectacle, although probably less so in this village since there has been many Mizungus who have traveled here before us to work at the clinic. We are greeted by some with points and others with ‘nisawa’ (how are you in Kirundi), but always with a smile. My favorite is when the children say ‘good morning’ in English. One of Americans here, Justin, teaches English at the local elementary school on Wednesdays and his lessons are paying off. We found out later that they haven’t gotten to ‘good evening’ yet so it is good morning all day long.

The picture here is taken from the inpatient clinic. This child is severely malnourished and is on protocol for therapeutic feedings. He was treated earlier this year for malnourishment at another feeding center, but quickly lost the ground he had gained when he returned home.