The summit Mount Muhavura volcano is 4127 meters.
The Rwandan village of Nyamucucu is too small to be found on most maps. An extinct volcano, Mount Muhavura, dominates the western sky. The eastern border with Uganda is unmarked, somewhere between Nyamucucu’s high ridge top and the lush valley below.
Uganda is seen from behind the Nyamucucu village school at Rwanda’s northern border.
At 9:30 am a team of doctors and clinicians from the Butaro Hospital, run by the Boston based Partners in Health, sets out in three vehicles for a one hour drive to Nyamucucu. A mobile health clinic will be set up at the local primary school. The road there, in places no more than a dirt path, winds slowly down a hillside, across a valley floor, and up a steep terraced ridge.
Rain falls lightly when the journey begins, turning parts of the red clay road bed ice slick. One of the Land Cruisers slides into a ditch. An audience of 30 rural children gather to watch while we push it free. Nyamucucu appears to be no more than a small collection of huts, along a short stretch of road at the top of brilliant green ridge. But looks can be deceiving in rural areas. Rwanda is the most densely populated country in Africa, and hundreds of people are waiting for treatment when the vehicles arrive. The hospital team has a short meeting and assigns three classrooms for the doctors, and another for use as a pharmacy.
A doctor speaks with Nyamucucu villagers, directing them to the proper examination room at the school house.
Work begins in the absence of electricity and running water. Villagers are quickly triaged and form lines in front of the three patient rooms. A young boy with a high fever is sent by ambulance back to the Butaro hospital for treatment. In the next seven hours over 200 patients will be seen. The mix is dominated by elderly women with age related symptoms and non specific aches and pains. Older men are scarce in this part of Rwanda, a result of the 1994 genocide and the preceding war that further ravaged this area of the country.
Lines form quickly as Nyamucucu residents wait to see a doctor.
Waiting their turn to see one of the Partners in Health doctors.
Children play outside during the wait.
Doctor greeting patient in school house examination room.
Checking blood pressure of local resident.
Cardiologist listens to patient’s heart.
Most of the patients are treated on site. Some are referred to the hospital clinic for cardio-vascular and other problems. One woman’s resting heart rate is 130 beats per minute. Others have high blood pressure and will need medication and follow up visits.
Medical worries are difficult no matter what country you live in.
Two of the children seen have distended bellies. To an untrained eye the cases look similar to malnutrition, but the diagnosis is worms. One pill and 4-6 months time will return them to good health. A man with vision problems is brought to a window where the light is better for examination. His hearing is also weak and a loud voice is necessary to communicate. Two mental health patients are examined – one believes he’s the president of Rwanda, the other claims she’s allergic to both hot and cold water.
Light from a window is needed to preform an eye examination.
The Pharmacy.
Counting out and dispensing medicine at Nyamucucu mobile clinic school house pharmacy.
By early evening the team is tired and hungry. Food arrives with one of the two vehicles sent to pick up the group. The ride back is cramped but enthusiasm is high for the accomplishments of the day. The mobile health clinic preformed well given the constraints of limited resources. One of the doctors revels in what he describes as an act of solidarity with the local population.
These men are among the last patients seen.
When the final patient is checked out, the clinic is packed up for the trip home.
Copyright 2009 Adam Bacher. All rights reserved. Absolutely no usage without prior authorization.
Dear Adam,
i have not met you but thank you so much for documenting this important step of outreach. Part of solidarity is meeting people where they are whether it is emotionally, physicially or geographically. The gift that we all receive as providers in this exercise of solidarity is that we are received with goodness and kindness by those who have suffered so much at the hand of the oppressive dominant culture that we, as Northerners, represent.
may i share your blog with the people from PIH Haiti, that is where this kind of work–mobile outreach–has been so doggedly pursued.
Sincerely,
Joia Mukherjee, MD, MPH
Medical Director of Partners In Health
Director of the Institute for Health and Social Justice
Boston
Each of your pictures tell so much – fantastic work!
Adam, amazing words and pictures. A great example and inspiration.
This post tells an amazing story. They should make use of advanced practice nurses to increase the number of health care providers. The Ethiopian restaurant and Turkish coffee shop sounded yummy. But no sushi!
Wow, I’m a huge fan of PIH after reading Tracy Kidder’s book Mountains Beyond Mountains!