Sunday, August 3, 2008

The Poll Clinic - Nyangezi DR-Congo

For those who are curious of what this clinic is like in Nyangezi (ne'on-gez-zee) allow me to explain how it came to be and what my role was there on the trip. I first must explain how it came to be. Our connection to this place is a man named Florimond Kabanda. In the '90's he had strong presence in the government as a human rights advocate. As the war loomed in Rwanda and spread over to the Congo some weren't too happy with his influence and there was a plan to assassinate him. Enough people got word to him a long story short he was whisked out of the country by the US and was relocated to Grandville MI. Already a Christian he went to work and earned his doctorate in psychology at GVSU, and also got a masters in divinity from Cornerstone University. He eventually started the Congo International Ministries (CIM), an NGO, that established itself in Nyangezi.

CIM set up a community type center in Nyangezi, and worked with the local government to provide some vital services to the area. The big project was to build a training center for to be used to help strengthen the Christian church in the region, the medical clinic, and Florimond has many future plans for the area such as establishing a university in the area and there was talk of opening a medical school in the area... In Africa I learned they like to make many big plans, and see what can come to fruition..

The Poll clinic is named after a generous family in West Michigan. They worked with Florimond early to get it started and worked to arrange to get modern equipment there. They do have an autoclave, a transabdominal ultrasound, basic surgical equipment, an OR table and the typical attachments, a basic lab with microscope and various equipment, a pharmacy with many types of antibiotics, OTC drugs, creams, and some IV/IM meds with various uses, and power is provided via generator and water by faucet (i think by well?).

The outside view of the Poll Clinique.

The building has an OR, a prep room for the OR, a treatment / exam / labor and delivery room, an interview room, patient waiting, a pharmacy and dispensary area, and then there were three patient rooms with multiple beds.

The view of the OR.... yes small but it works. For those curious, they use Ketamine for anesthesia and titrate to sleep but breathing. Archaic yes, but don't have anything else! Anyone want to donate an anesthesia machine?

The autoclave... small but gets the job done...

So my day was a relatively simple one. I was the first western physician to come and work there. Basically I helped with the normal activities of the clinic. When I arrived they already had some surgeries scheduled... various things such as hernia repairs, appendectomies, oophorectomies.... My first surgery was a c-section the second day we were there... It serves as a good example of my role there. They did all their c-sections with a vertical incision (old) and it was a challenge for me to do a pfannenstiel incision (bikini cut). The medicine practiced in much of Africa is 50 years out of date... They prepped the belly with rubbing alcohol, didn't place a foley... The doctors assumed that I did general surg cases in the US too (like they do in Africa) and it wasn't towards the end of the trip that they realized I specialize in OBGyn cases... oh well.

They have 3 doctors on staff there. Two are relatively new med school grads, and one (part time) is a surgeon for the last 25 yrs. I found that my role was to teach a lot of basic clinical medicine, and challenge many of the old or out of date methods of medicine practiced there. The big frustration I had was that many of the surgeries that were done were really not necessary... but I found the mind set there was if you don't actively do something you are doing nothing... where in the US surgery is often a last resort. So in a place where resources are scarce, it did not make sense to waste them on unesessary things that could potentially hurt, kill, or just not work. One example was a scheduled appendectomy on a old man. When they were getting him ready for surgery I found that he didn't look painful, had a soft belly, no pain on palpation, no rebound tenderness, no other symptoms other than having some abd pain a day or two prior (i.e. not an appy...). When I challenge the surgeon (the older) he chuckled and still went on and removed the mans normal appendix....

Other than surgery the clinic operates like a walk in clinic. Patients bring a small booklet with scribbles of medical information. They come with rashes, infertility, pain, seizures... whatever the ailment. They come in, we talk and do the exam, then decide if they need reassurance, meds, or in some cases discuss surgery. Some patients they would schedule for ultrasound to evaluate pain. One of my other frustrations was they thought that the transabdominal ultrasound was a great diagnostic tool... so they used it to look at the gall bladder (ok), the uterus and ovaries (not very good use, but acceptable), but also for gastric ulcers (not a use), or for other abdominal pains (again not a great use). We brought a number of meds a supplies with us on the trip. We had some limited abilities to admit (if there were spaces open). They did very little prenatal care, but if someone came in in labor they would manage that and do the delivery. At night time the doctors were all gone, so the nurse there for the night watch then would do the delivery.

I did a couple deliveries while there. I had to challenge the doctors again as they routinely cut episiotomies on most deliveries, and employ the use of fundal pressure to speed the delivery. This is dangerous and potentially can cause nerve injury for the baby... This is how they were taught to do things... They did stop, and hopefully will continue to not do that any more... The mother of that baby named her little boy Brad :)

A picture of the medical record....

They see a great variety of problems in the population. Somethings we had to just realize that we didn't have the abilities to take care of things. Things such as a 6 year old with status epilepticus and likely brain damage (lost speech weeks before)... all we had was phenobarbital, and she already had failed that treatment... So the only solution was to plead to a higher power and see if there was another way to get her a CT and a way to talk with a neurologist. If any readers out there know anyone who can help, I have her information.

It was a blessing to be able to minister with my training. The two younger doctors are Christians, and all the people in that region and country could use your prayers. I will post other topics as time allows this week. Other team members had drastically different roles in our ministry to the people of Nyangezi.


Ginger said...

the labor nurse in me is so glad that you taught them to not use fundal pressure. I am so sure that you taught them so many things. Glad to read all about it.

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We need more pictures and stories from all of you.....please... kath

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