A life less ordinary by Dr Richard Johnson
In 2004 a young British doctor left his comfort zone. He was struggling with who he was and what he was doing, where his life was taking him.
Training to be a surgeon and living in first world luxury, with first world pressures and first world problems did not seem to be answering the questions posed by life.
A little lost he had turned his back on the career that had consumed the last 10 years and searched for something else. Chance events in that search led him to a tiny part of the Dark Heart of Africa.
In July he arrived in Kigali to be met by an American physician at the airport in Kigali, the capitol of the country of Rwanda, about the size of Wales, Belgium or half the size of Tasmania where11 million people crowd the steep but lush and fertile slopes of the ‘land of a thousand hills’.
The plan was to spend three months working in a mission hospital in the far West of the country in a village called Mugonero. The hospital had around 100 beds, depending on how many mattresses were laid on the floor. There was the American physician and one other Rwandan doctor. Most care was provided by nurses, and food and washing by patients’ relatives. Within days it was evident that a life had changed and that time was almost immediately extended to nearly six months.
What happened in that six months was a social, psychological and emotional journey that changed many more than that one life and still has far reaching effects today.
Working in an environment of extreme poverty with minimal resources and great need, clinical conditions that are not seen in the modern developed world and the realization of the impact one can have, can have profound effects. Being accepted into a community and a family of vibrancy and love led to life decisions that would change everything.
The experiences that were had were diverse and often very new and confronting; delivering babies by caesarian section, operating on infected bones and children with typhoid, seeing children die of malaria and other diseases that we have largely eradicated with immunisation in the developed world; exploring the rainforests with the kids of the adoptive family and seeing the wonder, interest and intrigue of the local population; seeing a catholic Mother Superior handing out contraception against the teaching of her calling because it was the right thing to do (and swimming with nuns in Lake Kivu); watching starving children carting water for one and a half hours from the nearest (unsafe) source to their home; and walking the same path to church on a Sunday.
On the 24th July a baby girl was left at the hospital by a grieving father who had just watched his wife die, unassisted, at home in childbirth. The baby was very premature, a tiny 900g and expected by all not to survive.
The baby was placed in the sole incubator in the hospital’s maternity room by the nursing staff to be palliated. The young doctor chanced to walk through the maternity room even though he thought there were no patients in there to be seen. He found the baby lying there, expected to die. With no neonatal training and little paediatric experience he started something, the consequences of which he could not have dreamt.
The challenges were huge, the incubator was dependent on mains electricity which, in Mugonero was running only about 50% of the time and the nights at that altitude are cold. The baby was too weak to suckle, there was no medical equipment small enough to provide any intravenous treatments, there was no formula to feed to premature babies and there was a huge lack of knowledge and experience. What there was, was determination and perseverance.
The baby was Kangaroo nursed, fed with home made soy, olive oil and sugar formula and treated empirically with subcutaneous injections of medications in miniscule doses when sickness would threaten her. Initially she was fed by naso-gastric tube. A roster of feeding was designed with an American volunteer, a pre-medical student visiting for a couple of months and the nursing staff providing much needed relief when the young doctor was needed elsewhere. Slowly she started to gain weight and develop some energy for life. After about six weeks she was suddenly strong enough to cry, carried, Kangaroo style, in the middle of a ward round. At that moment the young doctor also cried because there was a sudden realization that this tiny life may last.
Four months later she still seemed very much like a new-born baby, tiny and still only weighing 2kg but the young doctor was preparing for his departure.
At that stage the local orphanage, L’Esperance children’s village had no capacity to look after her. In conjunction with the hospital and the orphanage it was decided that a surrogate carer would be employed to look after the baby until she was old enough to enter the orphanage. The young doctor left as much money as he could with the Director of the orphanage to pay for the carer and pledged to send more as needed to secure the baby’s future.
Such was the impact of the place that his fiancé had flown out to meet him and they had got married there, in the Dark Heart of Africa a shining light had changed so many things. The community all attended and the couple was blessed under the boughs of a giant and ancient cotton wood tree of the rainforest. There was more than one heart into which the people and place had forever entered. The baby was named Rebecca by the doctor and his new wife.
On his return to the UK the doctor realized a new direction and enrolled in Emergency Medicine training and together they started along an amazing adventure together. He now lives with his wife and two beautiful daughters in Alice Springs in Central Australia and works as the Director of Aeromedical Retrieval providing high level medical care and rescue to remote and mostly Indigenous Aboriginal communities in the outback.
Back in Rwanda there was a realization that Xavarine, the lady employed to care for Rebecca could look after others and with the funds left by the newly wed couple and others raised from a variety of sources the Baby Project was added to the orphanage as a separate but linked entity. Over the next 9 years more than 20 babies were admitted to the Baby Project, sadly some of which did not survive but many did and are thriving and have a chance of life they did not have before.
The young couple kept in contact and friends and family helped with funds and indeed returned to visit with their first born; a promise made to the hospital staff at the wedding. They watched Rebecca grow from afar and indeed attempted to adopt her but were thwarted by bureaucracy and politics.
Over the years the pressures and politics in Rwanda changed and communication became very much more difficult with the orphanage. Contact was lost around 2012.
In 2014 UNICEF and USAID as part of the ‘Better Care Network’ presented a paper to the UN which stated the institutional care was damaging for children and that they should be cared for in a family home. The Rwandan government took that word for word and commenced a programme to close all orphanages with the aim of settling children with relatives or other families in the villages where they originated from. It is easy to state in a developed world framework that institutional care is harmful but when it provides shelter, food, clothing, schooling and constant, predictable and dependable adult support and the alternative grinding poverty, hunger, no education and often violence and exploitation it may be a vastly superior alternative. It must also be understood that in a culture like Rwanda it does not require both parents and all close family to die to produce orphans; poverty and social reasons and an inability to care for a child may result in it’s entry into an orphanage. These children are there because they would not have survived otherwise for many different reasons.
L’Esperance is now closed, the children do not go to school, they miss their friends, what they grew up to understand to be their family and they are hungry.
On hearing of the closures the doctor and his wife increased their attempts to find news of Rebecca and thankfully came across the Facebook page of a Dutch journalist who was setting up a project to support schooling (but only covering school fees) of a small group of the disenfranchised ‘ex-orphans’. Through this journalist the couple received the contact details of an old friend, Prince, from Rwanda who spent his time and found Rebecca. On hearing of the closure her father came for her. He has since had further tragedy, his second wife had also died, life expectancy in Rwanda is around 40yrs and a women has a 12% life time risk of dying due to pregnancy related complications. Rebecca now lives with him and his third wife and 5 other children, in a single room, mud brick hut with no bathroom or kitchen, they cook on an open wood fire and have significant food insecurity. They sleep on the dirt floor. Which is damp in the wet season and dusty in the dry.
She does not go to school anymore.
The doctor has sent some money to Prince to buy a mattress, some emergency food and a chicken for eggs but this is barely a scratch on the surface. Rebecca is not included in the back to school project as she left the orphanage before it was set up. The doctor will pay for her schooling. He is also flying to Rwanda in November 2015 to find out what sustainable projects can be started to assist those children whose school fees have been paid. If the children are to get to school they and their families must have the means to send them, they must have enough food so that the child does not have to work in the fields and they must have fuel so the child does not have to forage for wood. They must have water so that the child does not have to walk to and from the lake several times per day. Basic things that we take for granted that can help to change lives by supporting education to break the cycle of poverty and allow these children a chance of a choice in life to achieve something of their potential.
The doctor does not have all the answers and they may be more questions than he even realises. But to do nothing is not an option, again where there is lack of knowledge and experience there is also determination and perseverance.
But there are also friends and family and love and support.
The aims are to provide for those children some basics that we take for granted, but in a culturally, environmentally and technologically appropriate and sustainable way.
A hungry child cannot learn; sustainable food security, chickens, seeds to grow vegetables if land is available, or even a goat.
A tired child cannot learn; mattresses and bed nets to improve sleep hygiene and protect against insect borne disease.
Energy insecurity reduces the time available for learning; wood for cooking and kerosene for lighting is costly (estimated to consume up to 40%of income) and time consuming to source and comes with health risks (equivalent to smoking 40 cigarettes per day); solar ovens and wind-up/solar lamps may be an efficient way of allowing transfer of time and financial resources to education.
Schooling costs; AS$760/yr
A Chicken costs; AS$10
A goat costs; AS$50
A mattress costs; AS$50
A bed net costs; AS$10
A wind up lamp costs; AS$30
A solar lamp costs; AS$20
A solar oven costs; AS$600