Ifrah Ahmed, MPH
A Poem for Rwanda
Oh, Rwanda, land of hills and plains,
Where kindness blooms and hope sustains,
Your people’s grace and humble ways,
A testament to love that stays.
Your children toil to a better home,
And keep it clean, a shining dome,
A land that’s thriving, strong, and free,
A beacon of hope for all to see.
I thank your people for their light,
And pray they guide with wisdom’s might,
To nurture children with tender care,
And shield them from the world’s despair.
May Rwanda never falter, fall,
From shackle of demise and pall,
May courage reign, and pain remind,
Of past, so future’s bright you’ll find.
Oh Rwanda, may you always rise,
Above the tumult, storm and cries,
A land of beauty, grace and peace,
Where love and kindness will never cease.
Yesterday April 10th, I had the pleasure of meeting a tall older gentleman from Rwanda at the airport who left a lasting impression on me. As we started talking, he asked me about my visit to Rwanda, and I explained that I would be researching how aware people were of Streps and its link to RHD and potential primary prevention measures. To my surprise, he said that he had never really thought about throat infections, but when he gets throat issues, he uses lukewarm water with salt and other natural herbs, which helps him.
What struck me the most about our conversation was when he told me that he was turning 60 years old in May and had never stepped foot in a hospital his entire life. He relies mostly on traditional medicine, walks a lot, eats once a day, and has never had the need to be admitted to hospital. When I asked him about physical check-ups, he simply stated that ‘’if he's not sick, what's the point of going to the hospital’’?
As someone born and raised in Africa, his story was not too foreign to my ears. In many African cultures, doctors' visits are often connected to when one really needs attention. It is not uncommon for people to rely on traditional medicine or self-care methods to manage their health.
While this man's story is unique, it sheds light on the importance of understanding different perspectives on healthcare. Traditional medicine can often be effective, but it is essential to balance it with modern medical practices to ensure one's overall health and well-being.
Moreover, his story highlights the need for more awareness campaigns and education around preventive health measures, especially in rural areas, to prevent illnesses and diseases from progressing to advanced stages. Primary prevention is the key to reducing the burden of diseases in developing countries.
In conclusion, my encounter with this Rwanda gentleman was a humbling experience that made me appreciate the diverse approaches to healthcare across cultures. His story shows the importance of bridging the gap between modern medicine and traditional practices while emphasizing the need for preventive health measures.
April 12, 2023 was my first day at Shayashika Hospital in Kigali, Rwanda, where I had the opportunity to sit in a cardiology fellowship lecture with Dr. Laird. And during our rounds, we encountered several patients with complex medical conditions, including a lady who had a stillborn child due to complications arising from her heart disease and possible kidney issues.
I had the opportunity to talk to the lead Midwife assigned to the abortion ward, who reported that midwives rotate through the hospital and are often assigned to the labor and delivery, postnatal unit, and the abortion unit. She mentioned that they deliver 7 to 9 abnormal deliveries in a day, and more than half of those are linked to heart disease and related issues. She also added that they deliver 3 to 4 normal births in a day.
We also encountered a 63 years old man with a rare type of heart disease, according to Dr. Laird we don’t often see cases similar to his in the U.S he had atrial septal defect (ASD), which is present at birth(congenital), as well as another 68 years man with a possible liver complication and heart problems with HIV/AIDs, and a lady who heart problem, a severe cough and required fluid drainage. These cases highlighted the immense need for healthcare in Rwanda, particularly in the realm of cardiac care.
It was humbling to see the dedication and hard work of the healthcare providers at Shayashika Hospital, who work tirelessly to provide the best possible care to their patients. However, despite their best efforts, the lack of resources and limited access to specialized medical care remain a significant challenge for patients in the area.
Perhaps the most striking revelation we learned was that the entire country of Rwanda, with a population of 13 million people, has only one cardiac surgeon. This underscores the immense need for investment in the healthcare infrastructure and resources in the area, particularly in the realm of cardiac care.
The experience left a lasting impression on me and reinforced the importance of access to basic medical services and resources for all individuals, regardless of where they live. It was heart-wrenching to see so much suffering and need at the hospital, but at the same time, it was inspiring to see how hard the healthcare providers are working to provide care and support to those in need. The unity between mothers who came together to support each other was amazing, and the availability of a psychologist who comes to visit the abortion ward and provides counseling to mothers is an important step towards addressing the mental health challenges faced by these women. Overall, it was a moving and brilliant experience, despite my lack of medical expertise.
On April 13th, 2023, I had the privilege of speaking with several medical professionals in Rwanda about the prevalent prevalence of streptococcal infections and the lack of testing available for these infections. Although I was disappointed that I was unable to interview a patient with RHD, the insights shared by the doctors and nurses I spoke with shed light on the challenges of diagnosing and treating streptococcal infections in the country.During my conversations, Dr. David Bradly, a cardiologist, shared with me his experiences treating different types of streptococcal infections in Rwanda and stressed the importance of accurate and timely diagnosis. He emphasized the need for testing methods such as rapid strep tests and throat cultures to enable early identification and treatment of these infections effectively. I also had the opportunity to discuss Dr. Laird's project for strep throat rapid testing with Dr. Bradly, and we explored potential barriers that may need to be addressed to ensure the project's success. Moreover, I spoke with Dr. Emmanuel, a pediatric cardiologist and head of the research department, and a matron in ward 5, both of whom confirmed the lack of strep testing in the country. These medical professionals emphasized the urgent need for strep testing and RHD prevention efforts in Rwanda, highlighting the significant impact that these infections have on individuals and communities. While I was unable to interview a patient with RHD, I remain hopeful that I will be able to speak with someone in the near future. Real-life patient stories can help illustrate the devastating effects of streptococcal infections and RHD on individuals and communities, further highlighting the importance of early detection and treatment.
In conclusion, the prevalence of streptococcal infections and RHD in Rwanda is a significant public health concern that requires immediate attention and intervention. Accurate and timely testing, combined with prevention efforts, are critical to ensuring that individuals receive the care they need to live healthy and productive lives. Given the urgent need for strep testing in the country, the success of Dr. Laird's project would be a significant step towards addressing this critical issue.
I had the opportunity to shadow the pediatric cardiologist Dr. Badley and his team today and I was able to witness some heart-wrenching cases in the Cardiac Pediatric Ward. One of the cases that stood out to me was that of two children suffering from heart failure. The first was under two years old, while the other was a little over two years old and had a severe cough, which might require drainage. Both of these children were also suffering from malnutrition and anemia, and the younger child might need a blood transfusion but just the state and condition they were in was extremely difficult and I remember the provider saying that they were in cardiac distress that is why they would not lay flat on their bed .
We also saw two other children who were only 14 days and 4 days old, respectively, who had fluid in their lungs and would require surgery. Additionally, there was a child who was born with an abnormal heart size. Overall, we saw up to nine children in the cardiac pediatrics ward, and many of them had accompanying cases of pneumonia and were being treated with antibiotics.
It was both inspiring and challenging to witness the dedication and commitment of the pediatric cardiology team in managing the care of these young patients. Each child required personalized care, and the team worked tirelessly to ensure that the best possible outcomes were achieved.
I believe that It is crucial to remember that some of these cases highlight the importance of proper nutrition, vaccinations, and prenatal care for pregnant women, which perhaps could prevent some of these conditions from occurring. As a public health student observer, I was reminded of the significant impact of medical research, health education, and preventative care in reducing the incidence of pediatric cardiac disease. It is our responsibility as a society to support these initiatives to improve the health and wellbeing of our future generations.
The quote "When one saves one life they save all humanity" is a powerful statement that holds a lot of truth. It is a reminder that every life is precious and has the potential to make a difference in the world. Today, as I visited the genocide memorial in Kigali, I was reminded of this quote and how important it is to value and cherish life. The memorial was one of the hardest parts of my trip to Rwanda. The brutality that occurred in this beautiful country truly moved me, and I couldn't help but feel overwhelmed by the pain and suffering that so many innocent people had to endure. The genocide in Rwanda was a dark chapter in human history, and it is hard to comprehend how human beings can be capable of such evil. Women, children, and even the elderly were all victims of this horrific act of violence, all in the name of ethnic differences. As I walked through the memorial, I couldn't help but think about the ethnic killings that happened in my own country, Somalia. I lost my aunts, uncles, and my grandfather to this senseless violence. Seeing the personal stories of the victims in Rwanda brought back painful memories of the brutal stories that I had heard within my own community. It is extremely painful to see how many countries in Africa have to suffer, how many African children have to grow up as orphans, how many mothers have to cry watching their loved ones being killed and them being violated while many of our leaders are just greedy and selfish. It is a sad reality that many of our countries have poor leadership, and we can only hope that our leaders wake up and see the pain they are causing in many of their prospective countries. Despite all the pain and suffering, I am humbled and inspired by the level of resilience that the people of Rwanda have shown. They have grown through so much despair and agony, yet they are willing to forgive and choose to put Rwandans first before any of their ethnic tribes. Their strength and courage are truly inspiring.
In conclusion, the quote "When one saves one life they save all humanity" is a powerful reminder that every life is valuable and has the potential to make a difference in the world. We must cherish and protect the lives of those around us, and work towards building a better world for all.
As someone who has lived in Kenya for a while, I appreciate the importance of accessible healthcare. Unfortunately, many people in rural areas need help accessing hospitals, and some cannot afford to travel to the nearest one. This has led to a dangerous practice where people opt to buy medication without seeking professional medical care.
Recently, I traveled to Rwanda and needed to purchase an antibiotic. I was pleasantly surprised at how easy it was to obtain it. There were no questions asked, and the medication was readily available. However, as future public health personnel, I know the dangers of self-diagnosis and self-medication. While it may seem convenient, it can lead to serious health complications and death. Despite the risks, many rural people prefer to buy medication from local pharmacies. These pharmacies are usually situated near their homes, and the shop owners have built relationships with their customers over time. This makes it easier for people to trust their services and seek medication without a prescription. Additionally, buying medication from pharmacies is often more affordable than visiting a hospital or clinic. However, it is essential to note that self-medication is not a substitute for professional medical care. In cases where someone is experiencing severe symptoms, seeking immediate medical attention is crucial. While it may be tempting to avoid medical fees, the cost of not seeking medical care can be much higher in the long run.
In conclusion, accessible healthcare is a fundamental human right, and efforts should be made to ensure everyone can access it. While pharmacies can provide a temporary solution, seeking professional medical care is always the best course of action.
Today, I had the opportunity to visit the psychiatric unit at the mental health facility, and it was indeed an eye-opening experience. The facility was located within the CHUK hospital, which had an impressive team of five on-site psychiatrists and a handful of psychologists who visited different wards. The psychiatrists and psychologists consulted patients referred to the psychiatric unit. The most common complaints they encountered were substance abuse, depressive disorders, and anxiety. It was inspiring to see the level of dedication and expertise that these mental health professionals brought to their work. However, what was particularly surprising was that there was only one child psychologist in the country. This startling revelation highlights the urgent need for more mental health professionals, especially those who specialize in treating children and young people. The lack of child psychologists in the country is a cause for concern. Mental health issues can manifest at any age, and it is essential to have trained professionals who can provide support and treatment to children and young people who may be struggling with mental health challenges. Without proper care, these issues can lead to lifelong struggles and challenges.