Sitting here cross-legged on the corrugated iron roof of the guesthouse, I am wrapped in a blanket looking out across Lake Kivu to the to the shores of the Congo. Barefoot children laugh happily and play in the field out front with a homemade football. The dusk sky, being sung in by a chorus of cicadas, is a mix of pinks, blues and greys. Above me black fruit bats dot the evening sky as they make their nightly migration back across the lake from the Congo. Singing coming from nearby is interrupted by the occasional cry of a goat and I can taste a smokiness in my mouth as the smoke from wood cooking fires drifts past. Night has fallen quickly and the soft orange glow from the volcano across the lake is now visible and I notice for the first time how bright the stars are out here away from the city. It seems like a good spot to sit and reflect. Today I witnessed both birth and death. The call from the clinic came not too long after we had arrived at the orphanage. A woman had walked herself to the clinic and was ready to birth. We waved down a bus and scrambled on board, climbing over passengers and the back of the drivers seat so we could squeeze into the only spare seat in the front. A short way down the road we got off the bus and jumped on the back of pushbikes. The rural road was muddy and potholed. We had to get off the bikes at one stage and run up the hill before climbing back on the bikes. Upon arriving at the clinic we found the woman lying on her back in the birthing room, feet in stirrups, a bucket on the floor below. There was little more in the room apart from the bed which was covered in plastic sheet and a mop propped up against the wall. Paint was chipping off the concrete walls and two aprons hung from a hook. I put on gloves and grabbed one of the disposable aprons - noting that it looked well used, torn in places and stained. The lady was fully dilated and the baby crowning. The sole nurse of the clinic and another volunteer - whose 'medical' background was 2 years in veterinary college - were also in the room with Cait and I. The nurse was concerned that the labour was not progressing so made the decision to insert a catheter to empty the woman's bladder. This speed things up. After a few pushes and a bit of assistance pulling the head out the baby was born and placed on a stainless steel bench. While the nurse and Patrick delivered the placenta, Cait and I checked over and wiped the baby. Under Patrick's guidance I tied the cord with two pieces of wool and cut it before weighing and measuring the baby - 3kg exactly and 45cm long. After swaddling the baby I took him over to meet his Mum. She glanced at him briefly but appeared almost uninterested - we later found out that contact between mother and baby after birth is not a common occurrence over here. So for the first 15 minutes of this baby's life I held him, watching him open his eyes for the first time and welcoming him to the world. After being checked for hemorrhaging the new mother matter-of-factly put her skirt back on - she didn't own any underwear - and walked herself into the connecting room, the 'maternity ward', where she lay down on one of the six beds - none of which had sheets, blankets or pillows.
We left the Mother to rest and went to see our next patient, a 52 year old man in the final stages of AIDS. Emaciated, with sunken eyes and temples it was evident there was little medically that could be done to help this man but make him comfortable and sit with him in his final hours. All to often patients come to the clinic and end up dying alone in one of the concrete rooms without even a blanket. We sat beside this man, whose name no one seemed to know, holding his hand and fanning him. I hoped that our love and care was being conveyed through these gestures and the look in our eyes - as this was the only common language we shared. Helping him to sit up to take a sip of Fanta I could feel each one of his ribs down his back. His whole body rattled violently with pneumonia each breath he took. As his heart rate decreased and his breathing became increasingly shallow and rapid I prayed that death would come quickly and without pain. For me the reality of this devastating disease hit home today and I struggle knowing the death I witnessed today was preventable. The clinic nurse called an 'ambulance' to take this man to the hospital to die as it would mean less paperwork for this already under resourced and under staffed clinic. The ambulance arrived 3 hours later. After the ambulance driver finished his cell phone call for 10 minutes, he made the poor man walk to the stretcher (which had wheels) himself. Although there were no medical miracles today; the kindness and compassion that we were able to share with the patients made up for our lack of experience and resources.
Axx
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