Places We Go: Rwanda & Burundi

I was privileged to travel to Rwanda and Burundi in early 2018 with a medical team from my local church. As many with similar experiences will attest, I returned to the United States with revised perspectives on the concepts of need, comfort, contentment, resourcefulness, and gratitude, as well as a newfound appreciation for the skills and experience I have been fortunate to cultivate in emergency medicine.

I was the lone physician, but there were two highly experienced and compassionate nurses on our team of 14; by the end of the trip, everyone had received a crash course in wilderness medicine. All of the medications we dispensed were bought locally, daily, at whatever local pharmacy had enough stock for our needs. We ran out every day.

I came home from Africa with innumerable takeaways, the most significant being: Go. All physicians need to do this at least once in the prime of their career. It just might be the key to preventing burnout, soothing frayed nerves, and lightening the load we all carry. It really is true: one of the best ways to improve one’s own outlook is to commit oneself wholeheartedly to the service of others. Americans generally know, instinctively, that we are fortunate in so many respects. There is a difference, however, between knowing something instinctively, and experiencing it firsthand. We see these places in pictures and learn their history from documentaries and films like Hotel Rwanda, and think we have some idea of what their world is like. It’s not until we actually step into it, for only a brief time, that we begin to grasp what it is to be without.

A few other thoughts:

Just because we don’t read or hear about a humanitarian crisis in the news doesn’t mean that there isn’t one, right now. Physicians are virtually nonexistent in Burundi, with about one for every 25,000 to 30,000 people (although accurate statistics are notoriously hard to come by). The people there get sick, then they get better – or they don’t. It is a difficult place to which to travel, and its small geographic size and lack of natural resources limit its appeal to global contemplation. And yet millions of people are without basic medical care and completely reliant on foreigners to provide it. The lack of resources and training in Burundi and many other places constitutes a perpetual crisis that begs for attention.

All over Rwanda are reminders of the cruelty that humans are capable of exacting on one another. Bones of those killed during the genocide are still being recovered in crop fields, all the time. At the incomprehensible Genocide Memorial in Kigali, over 250,000 Rwandan Tutsis are buried in a mass grave. Several people who passed through our clinics during our brief visit are living with HIV, or suffering sequelae of AIDS. Part of the reason for Rwanda’s high prevalence of HIV is due to rape during the genocide, expressly perpetrated by HIV positive men to pass on the infection. And yet, in few other places I’ve ever been have I seen such a desire to listen to instruction, to assist in mundane tasks like setting up a clinic, to show respect for others and their belongings, and to serve in any way possible.

One of the greatest physical needs of people the world over isn’t medicine, or clothing, or shelter. It’s clean water. In the parts of the world where we served, people (usually women) typically spend three or four hours per day obtaining, carrying, cleaning, and storing water. We saw firsthand the life-changing ramifications of the presence of a well that has been placed within a community, and also the negative consequences to health, well-being, and quality of life that the absence of one creates.

Driving back to Bujumbura after our day in Cibitoke, I observed a young boy playing with a stick and a rubber tire; he was simply running along the bus, expertly rolling his tire alongside him with the stick. I watched kids play soccer, only they didn’t have a soccer ball – just a wad of clothes and rags tied up in a ball. Spending time among those who have next to nothing by way of possessions yet appear remarkably content reinforces the idea that possessions are not the source of contentment. This isn’t a new concept for anyone; however, I wonder to what extent this truth can expand, and if it’s also true that more possessions actually contribute to discontentedness. I think many times they do.

I love to travel and take vacations, but it always seems that when I return from a trip, I need more time off to recover. Maybe it’s the places I go (ski trips are tiring), or maybe it’s something else. What I do know for certain is that after returning from Africa, I was invigorated and energized, even with the jetlag. I felt I had accomplished something big – I’d made a difference for a lot of people, using my skills and experience, and I left the continent fulfilled.

This was the practice of medicine, pure and unadulterated. Documentation was limited to a patient’s name, age, and (occasionally) their diagnosis and prescribed course of treatment. The idea of follow-up was, for the most part, laughable. Concerns for things like record keeping, meticulous documentation, exposure to litigation, and patient complaints simply didn’t matter. The only thing that did: the patient in front of us. And the hundreds in a line behind her. This was undeniably liberating, and confirmed for me that I made the right choice of career and specialty; the challenge now is to hang on to that perception with all I have. Until, at least, I get to go back.