Day 1

My alarm goes off at 05:30 and it’s a tough rise after little sleep once again. Nothing a cold bucket shower can’t fix though. Water and electricity have been cut off since last night, a constant problem in Bukavu. I’m scheduled to meet Dr. Nicole, one of the Panzi physicians, at the gates of my lodge at 6am. She will be escorting me to Panzi for the first day. After a 30 minute delay, I start wondering whether this can simply be attributed to “African time” or whether something might have happened. A quick phone call and I find out the car has gotten stuck following last night’s downpour. Quick change of plans and I set out to meet her at the market up the street where we jump into a local minibus. The roads are chaos this morning and the short 10km drive takes around 45 minutes. Transportation here resembles Indonesian traffic on steroids mixed with 4X4 roads and potholes that could swallow small children alive!

Once at Panzi, albeit with some slight “transportational delay”, I get welcomed by Mrs Betoko London, administrative head at Panzi and personal assistant to professor Denis Mukwege. She introduces me to the head of internal medicine, Dr. Dieudonné Bihehe, and I immediately get placed in the deep end with a group of 7th year Médecins stagiaire (intern doctors) finishing their internal medicine rotation. The morning begins with a meeting called “la chaise electric” (the electric chair). This takes place in a small cramped room where a selection of the admissions from last night’s on-call team gets presented to a panel of consultants. I quickly come to understand where the name comes from when intern after intern gets grilled by difficult questions. It looks awfully intimidating but I am highly impressed by the competency of the interns and their approaches to various clinical syndromes. I look forward to my turn in the “electric chair” following my first night call. Once finished, we begin the ward rounds with the same specialists. We have 57 patients to see and this, coupled with a few procedures (venipunctures, peritoneal tap, lumbar puncture), keeps me busy till lunchtime.

 

I get introduced to Maman Sociale, a social worker at Panzi who lovingly prepares lunch for the few visiting staff/students at Panzi. This is where I meet Dr. Marie, a Belgian haematologist, who was invited here by Professor Mukwege to assist in the various clinics and teach at the local university close to the hospital. We bond over the coincidence and I subsequently spend the afternoon shadowing her consultations throughout the hospital. We see a number of cases: a patient with CLL (chronic lymphocytic leukemia), a case of Polycythemia vera requiring repeated venesections and a young lady misdiagnosed with TB adenopathy now undergoing a biopsy for a possible lymphoma. I also get the unexpected honour of meeting Dr Mukwege on one of our consults. He is calm, humble and welcomes me to the hospital.

It’s a chock-full day that can be best summarised in four words: TB, HIV, paludism (malaria) and diabetes. The four staples we encounter throughout the day. The workday comes to an end and I’m grateful to catch a lift with Dr. Marie who stays close to my lodge in Bukavu. Her driver arrives and we jump into an official UN armoured land cruiser responsible for her safety during her stay. Needless to say, the drive home was much quicker and more enjoyable than this morning’s one! Exhausted, I jump into the back seat and roll the window down to catch some fresh air. Bukavu is a small city, but with its previous census well surpassing the million, overpopulation is palpable everywhere we drive. I receive a phone call while driving down a busy street and nonchalantly answer it. I quickly realise my mistake when the watchful driver locks my door and closes my window. I peer outside to notice a small group of people who’d started approaching my window now laughing and pointing at my phone. A foolish mistake not to be repeated, I’ve learnt my lesson. I get home and instantly collapse on the bed, the fatigue finally catching up to me.

 

Day 2

This time, a 5am wake-up in order to finish some writing and elective logs. I grab a quick coffee with some fresh mangoes, maracujas and baby bananas. I’m out the door by six in order to catch the hospital staff bus which departs from the market a kilometre up the street. The sunrise is splendid and I make it just on time for the bus. It’s another 45 minute drive while I meet a few of the staff working at Panzi.

 

The morning starts with another round of the electric chair, but this time with a lighter atmosphere as it’s the last day of the current interns’ three month internal medicine rotation. Once all the patients are presented, the patient files and x-rays are immediately swapped for a table full of food and cooldrinks. The consultants are offered breakfast and words of gratitude are exchanged between all parties. The celebrations are short lived and we soon begin with another grueling ward round throughout the hospital.

 

It’s heartbreaking to see so many patients unable to afford even the simplest of antibiotic courses and having to suffer the preventable consequences and complications thereof. Patients are required to pay out of pocket for their care as there is no subsidised public health system here in the DRC. To give you a brief idea of the situation here, the price list at Panzi is as follows:

• Ward bed for one full day $5.
• A five day course of antibiotics (ampicillin, ceftriaxone etc) $5.
• Full blood count, liver function tests, renal function tests. $2 per lab test (haemoglobin, ALT/AST, urea, creatinine etc).
• PCR (GeneXpert) testing for tuberculosis $15.
• Echocardiography or abdominal ultrasound $10.
• Procedures such as a gastroscopy or colonoscopy $30.
• Specialist consult (cardiologist, pulmonologist, haematologist etc) $5.

Despite its vast natural resources, Congo remains the second poorest country in the world, with 80% of the population living on less than $1.25 per day. It becomes evident that most people here are unable to access the care they need. After the first day, I already find myself pleading specialists not to charge for consults and fishing into my pockets for some spare dollars to purchase antibiotics and contraceptives for my patients. I bring up the issue during lunchtime with a few of the doctors and I’m not surprised to find most of them already splitting their salaries in half to help as best they can.

On a lighter note, Dr. Marie and I head down the road to the medical campus of l’Université Evangélique en Afrique (UEA) after lunch. She has kindly prepared a 30-hour lecture series on the basics of haematology which she will be sharing with the fourth-year medical class. The campus and classrooms are small but packed with eager students all grateful for the opportunity to learn from a world-class haematologist. 150 Enthusiastic students welcome us and I get started on setting up the microphone and projector. A seemingly more dauntful task here in Congo compared to our state of the art auditoriums back at the University of Cape Town. After messing with a number of adapters and frayed cables, the PowerPoint presentation is up and running. Three hours later and all the haematology foundations are covered. The students are grateful and we organise Thursday’s lectures. I get a lift back in the UN squad car and I’m finally home by 17h30.

The sun sets early on the equator so I quickly change and decide to take a walk down to the lake. The road is riddled with buildings owned by the various NGOs settled in the area:

• Médecins Sans Frontières (MSF) International
• International Rescue Committee (IRC)
• World Health Organisation (WHO)
• Mission de l’Organisation des Nations unies pour la stabilisation en République démocratique du Congo (MONUSCO - UN DRC division)
• United Nations Volunteers (UNV)
• Management Systems International (MSI)
• Search for Common Ground (SFCG)
• Mercy corps

These are just a few of the organisations I come across while walking down road. I’m once again reminded this is a war torn country when each of these compounds are guarded by soldiers wielding AK-47s looking questioningly down at me from their lookout towers.

On the edge of the lake, I find a luxurious hotel recommended by a paramedic I met on my flight from Kigali to Kamembe. It stands in stark contrast to the ward I was working in just a few hours ago. I order a bottle of water and I’m shocked to find that it just cost me as much as a course of antibiotics at Panzi. I try and enjoy the sunset but can’t shake the feeling of wanting to do more for these people in dire need. I get lost in thought and find myself having to walk the 2km road back home in pitch-black darkness. Probably not the best idea but I get home safely nonetheless.

Day 3

It’s back to business this morning with the new group of Médecins stagiaire who, for once, look more lost than I do! We’re divided into 4 groups (men’s ward, women’s ward, ICU + clinic, psychiatry + Ethiopia). I’m allocated to the women’s ward and tasked with looking after 7 beds. However, I can’t quite understand why there is an entire ward dedicated for Ethiopian patients and enquire about it. The whole class erupts in laughter and explain that the Tuberculosis isolation ward has fondly been renamed as Ethiopia. Not quite politically correct but I go along with it. I head to my ward and start clerking my patients. The day is filled with carefully selected tests and procedures, various specialist consults and a never-ending ward round throughout the hospital. If there’s one thing I’ve learned today, it’s that every special investigation needs to be justified in terms of a specific goal with an actionable result. Something we should be doing in every tertiary institution regardless of financial difficulties or abundance. An unwarranted echo or course of antibiotics here could mean the difference between a patient having food on their plate for the next month or starving themselves into malnutrition. The number of mindless lab investigations thrown at patients back home at UCT and in other first world countries begins to feel like a luxurious waste of money and resources.

Day 4

I start getting into a routine and begin to find my way around Panzi. The hospital might be small but the absence of electronic records means I find myself walking 15 km+ every day in search of patients, lab results, consults, procedure rooms etc. I can’t complain though and the open-aired walkways are a pleasant distraction from the cramped wards. Throughout the morning, I frequently find myself drawing on and feeling grateful for the knowledge and skills gained during my practical blocks at UCT. It’s here that I realise all the small details that might seem useless while studying become invaluable in practice:

• Using an otoscope and rinsing/suctioning an otitis externa.
• Performing a fundoscopy on a suspected diabetic when there are no glucometers available in order to substantiate a diagnosis.
• Quickly calculating GCS levels in trauma and evaluating airway patency.
• Putting in an intercostal drain for a patient desaturating with a massive pleural effusion.
• Performing an echo with the cardiologist for a suspected TB pericardial effusion.

The morning passes by quickly once again and the afternoon is spent helping Dr. Marie lecture at the faculty down the road.

Day 5

Final day of a long week (or so I thought)! Today, it’s hard not to get frustrated and pessimistic when nothing seems to be working right. There is a large lack of coordination here due to absence of any electronic records. All instructions, lab results, prescriptions and referrals have to be requested and delivered in person. This results in a huge waste of time. Patients’ are often left waiting endlessly if there are any breaks in this “chain of communication”.

One such issue arises today while Dr Marie tries to access an urgent haemogram in ICU which appears to have been lost during the night shift. She makes a quick phone call to Dr. Mukwege and the problem resolves itself almost instantly. Talk about effectiveness when you need it! I spend the day looking after my patients and frequently checking in on our ICU case. He is finally stabilised and Dr Marie and I round the day off in Dr. Mukwege’s office. At the start of the week, I never imagined I would be reporting clinical findings to a Nobel Peace prize winner! I enjoy the drive home, feeling proud and relieved to have survived my first week at Panzi.

Weekend plans

Unfortunately, the week is far from over and my weekend plans to go hiking in the Kahuzi Biega National Park are short lived. Tomorrow morning, I have to be back at the university helping to lecture from 08h00–15h00. This will be followed by a long night shift until noon on Sunday. There goes my weekend, wish me luck!