A Partnership In Caring Volunteer Reflects on a Visit to a Health Centre in Rwanda

We received this post from A Partnership in Caring volunteer Maria van Vonderen. Maria visited a health centre.

I spent yesterday morning at the Health Center with Emmanuel, he is an A 2 Nurse, ( diploma). I spent the morning in Out Patient Consultation with him. The Out Patient service sees clients , assesses, triages and the Nurse can prescribe medications to treat. The health clinic has its own lab and pharmacy.
The routine is that when the client presents the nurse obtains weight and vitals and assesses. There is much paperwork. They do all their reporting in large ledgers.
If blood work or meds are needed, the nurse writes the orders in the ledger and in a small notebook that the patient carries with them. The patient goes to the lab or pharmacy to have the orders filled.
The lab returns the results to the nurse and the patient is followed up.
For example, and this was the case for the majority of clients we saw, the presentation was headache, fever, cough, achy muscles and bones, decreased appetite with nausea. The nurse suspected malaria, orders a blood smear from the lab. The patient goes to the lab, has the necessary lab work done, returns to the consultation area to with the results. Normally within one hour the results are given to the nurse, the nurse calls the patient back in and reviews the results. In all the. As all the cases we saw (12 in total for the morning) all the blood smears returned negative for malaria. So the next step is to treat the presenting symptoms with pain relief meds or antibiotics etc.
One patient we saw, an older woman, was very sick. She needed to be observed for at least 24 hours, out patient/ consultation nurse is responsible to take the woman to an observation bed, started an IV, then returned to the clinic to continue seeing patients, yet still monitor the woman in observation.
The nurses are skilled, they have very few supplies to work with. For example, no sharp scissors to cut tape, IV poles are in bad shape, (they need to be rigged to stay extended) no tourniquets ( they used a rubber glove to create a tourniquet ). No proper disposable containers for sharp items or contaminated items. They need more BP cuffs and a new stethoscope and better oral thermometers.
There are no sheets or pillows on the beds. In the female observation room, there were 5 beds, only 3 had mattresses.
Infection control practices need to be improved.
They are very short staffed.
We saw 12 patients in the morning, there were at least 50 more waiting to be seen.
The health center needs its own ambulance to transfer clients to district hospitals, they do not have an ambulance and rely on the district hospitals to transfer, it can take hours.
Despite the challenges, the patients are grateful for the services provided.

We are looking now to support Fabrice, he is 5 years old, developmentally and physically delayed. He does not speak. He is bright in so many ways and I believe he has great potential. So we are working on hiring a person and setting up a room where he will receive much needed stimulation. We will see that he gets to a Paediatrician and have his hearing checked.
We have 2 people who have stepped up to offer financial support for Fabrice.
My job is to buy items to stock the room with items that will help stimulate language, improve cognitive function And also to improve his physical function.
This could be the beginning of a pre school program at SAVE. We will see how it goes over the next few months.

When I was playing with Fabrice, he caught on quickly to things I introduced him to. For example, when I gave him a water bottle and we pretended it was a ball, he would kick it, then I would kick it and if he saw that I was going to kick it again he would grab it, I would tease him and he would break out into such a lovely smile. This went on for quite a while until he realized that if he threw the bottle farther, i would chase it, over-exaggerating my despair. He loved that.
I had him stack Jenga blocks, he has good hand eye coordination.
He could grab 3 or 4 blocks at a time.
This is a young boy, who just one year ago could not walk.
A Partnership in Caring sent him for rehab. As you can see in the pictures and video, he is able to run!
We gave him a hat which he loves, today we will buy him much needed shoes.