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Below is a letter from Caleb and Louise. You can also download the first newsletter or a recent Report from the Shyira Learning Center by clicking on NEWSLETTER or First Annual Report button below. It may take a minute or two depending on the speed of your connection. Rwanda News:
Dr. Louise and Dr. Caleb King finish their first year in Shyira: 12:00 (EST) December, 11, 2003
Some of you commented
that the last letter painted an excessively rosy picture of
missionary life, so I thought I might temper this one with the
following section entitled "Rats, Dead Bodies, and
Poison."
It was a Saturday
afternoon at the end of the first rainy season. We had just
come back from Gisenyi, a town which borders the Congo, on the
shores of Lake Kivu. Kivu, the size of Lake Champlain, was formed
when vulcanoes rose up in the North blocking the outlet to the Nile,
filling a vast valley between the mountains of Rwanda and the Congo.
In some seasons, dense mist drifts over the mountainous banks,
studded with banana trees, which rise out of the deep blue
water, but this day the sun was hot, inviting us in to the cool dark water
of the lake. Because of the one mile altitude, the water stays
cool--too cool for crocodiles (an important plus), but just warm
enough to swim in year round. We had met up with Jo and Lyn
Lusi, who run the DOCS Learning Center in Goma, and had enjoyed a
delicious lunch of freshly caught tilapia fish at a small
restaurant right on the water south of town. We had talked and
talked while the children played in the water, and stayed till the
sun was getting low, so by the time we got home, it was dark and we
were all ready for bed. Louise tiptoed into the bedroom with
Lydia asleep in her arms. She set the kerosene lantern by the
door, so as to keep the light out of the baby's face as she put her
down in the crib. As she laid Lydia's head on the
blanket, she heard a rustling and felt warm fur brush against
her hand. I was alerted by Louise's blood curdling scream.
A rat dashed out of the crib into the dark corners of the room.
Louise, and the now awakened, crying baby ran out. At this
point, Samuel (Louise's cousin Samuel Dargan, Jr. who has been
with us, helping out), our driver Dan, and one of the night watchmen
sprung to action. Armed with sticks and flashlights, they took
on the rodent, and after about an hour of heroic
work, in which they emptied the room of our bed, mattress, and
just about every item of furniture, finally knocked him
cold and fed him to our kitten. Our kitten...in fact, the
remarkable feature of the story was that Lyn Lusi had just given
us the kitten that day, having brought her over the border from
the Congo. She was a frail little thing, only about the size
of the rat herself, but she gave us hope for future rat-free nights.
In fact, from that day, none have dared venture in, it seems, and
she seems even to patrol the adjacent guest apartment. We need
to find some more cats--unfortunately, most perished during the war
'90-'98--for the hospital, where telltale droppings litter all the
supply rooms. One day, when I was cleaning out the maternity
stock, I came across a little nest of pink, hairless baby rats.
They were not really very cute, but I brought them home anyhow to
show the children. We were all glad the kitten thought they
were tasty.
Most patients arrive at
the hospital on foot, often having walked for hours over winding
mountain trails. Those too sick to walk arrive on woven reed
stretchers, carried by their neighbors, typically 12 to 24 men, who
take turns as four, at any given time, carry each of the corners of
the stretcher. I always keep a look out for the arriving convoys,
which may bring tidings of great gore, and this day was no
exception. This patient was beyond my help. She had died
the day before and had been buried, only to be exhumed this day for
my perusal, at the request of the local policeman, Edward Nzeyimana.
With the cadaver came a note: "My Dear Doctor, could you please
determine the cause of death, whether it may be the result of the
ingestion of traditional medicines?" Now, if I wanted to
pick a fight, this would be a good place to start--half of the
children from the hills with malaria come with burns in the back of
their throats, caused by hot iron brands applied just above the
uvula to "release the fever." When hot
brands are not handy, a traditional practitioner's long pinky
fingernail may suffice to cut into the tonsillar region. But I
think I'll save some stories about local practitioners for another
time, maybe next Halloween instead of Christmas...
A good number of
patients with acute illnesses assume that their neighbors have
poisoned them. After one morning's prayer meeting, I asked our
staff if any had ever seen a case of verified poisoning.
This question engendered heated discussion, with none citing an
actual case, but with the clear consensus being that "many
might want to poison their neighbors." I have, in fact,
seen many cases of poisoning. In each case, the patient
willingly consumed poison provided by the traditional healer, as a
sort of antidote against the imagined poison. Most of the
poisons are simple emetics. I have learned the hard way that
patients who request early discharge, before they seem really well,
have, in general, concluded that they have been poisoned, and are
trying to get home for a course of forced vomiting. One
patient comes to mind. This mother had had post-partem
malaria and jaundice, and was really sick. Her baby barely
made it, as she had been too ill to nurse her child, but both
were finally turning the corner. She was too weak to
walk, but insisted on going home. Against my better judgment,
I allowed her family to carry her home. I received the report
the next day: she had died that night. The medicines to force
vomiting were more than her frail system could handle.
So what should I write
in the police report? You should know that I have no training
in pathology, and no means, in this setting of carrying out an
autopsy, anyhow. So I stated the obvious: "No evident
burns, lacerations, fractures, or contusions to suggest violent
injury," and took a history from the patient's husband, sister, and
father. They all stated that she had fallen into coma Monday
evening, and had been given emetics Tuesday, prior to her death the
following day. So I concluded, the probable cause of death was
the same the condition, probably cerebral malaria, that had
first caused her coma. While the emetics may have worsened her
condition and likely caused delay of appropriate care, it seems less
likely that they were the proximate cause of death. I shared
my findings with her family. Her father spoke up: "My
daughter did not have malaria. She was poisoned. Last
year, she had similar symptoms; we gave her the diagnostic
medicines. These did not cause vomiting, so we knew, that
time, that she had not been poisoned. This time the medicines
brought about vomiting, so it is clear that she was poisoned."
By his tone, he added, "and if you can't see that, you can't
see much." I haven't seen her father since then, but I
see her 3 month old daughter who is now staying in our
nutrition center to receive formula supplement--since her mother's
death, the child has no way to breastfeed, and no infant formula is
available in the village, nor could her family afford it, since even
a single jar of formula costs more than a day's wages.
But I do see her husband, occasionally accompanied by the other 4
surviving children. He seems a kind man, but tired, with a
good deal on his shoulders, what with caring for all the children
and walking up the hill each day to hold the baby. He needs,
for a change, good news.
"The people living
in darkness have seen a great light. On those living in the
land of the shadow of death a light has dawned." (Isaiah
9:1,2; Matthew 4:16) Will you please pray that these people
will hear the good news and live, that God might open a door for our
effective ministry, not only to all the sick bodies, but to the
hurting hearts and fears and poisons that lay so many low. "For
unto us a child is born. Unto us, a Son is given, and the
government shall be upon His shoulders, and His name shall be called
Wonderful Counselor, the Mighty God, the Everlasting Father, the
Prince of Peace (Isaiah 9:6)."
The local pastor invited
all the hospital staff to run last week's church service, and I, as
usual, was running late. But I wasn't really worried, because
I knew that an hour here or there wouldn't make too much of a dent
in a four hour long service. And, I was having fun loading up
the hospital Jeep with patients who couldn't walk the quarter of a
mile up the hill to the church. Somehow it all seemed just
right at the hospital service to be bringing in children on crutches
and in wheel chairs. A number of patients gave their
testimonies. Uwamaria is about 15. She walked to the
Congo at the time of forced exodus in 1994 and then something
happened to her legs, so that she had to crawl back to Rwanda on her
knees, nearly 100 miles. I had been able to take her to Goma
where Dr. Lusi was able to operate, and there she was, standing
before the church, in two casted legs, supported on crutches.
The week before, the mother of the twins I wrote about in the last
letter came forward to give thanks for them. As you may
remember, I didn't really deliver them quite right. If the
arms of a breech delivery are stuck, you're supposed to do something
called the Loveset manoeuvre, and if the humerus breaks in an infant
you really shouldn't cast it, I later learned (but it didn't matter
as it came off a few days later after getting wet). In all it
was a case of all's well that ends well. And so often, that's
the case here. Somehow, each day, things seem to work
out. Please keep praying for us. I remember my Granddad
telling me just before he died about his friend William Temple
in Britain, who served there as head of the Chuch of England for a
season. He told my Granddad: "It may be coincidence, but
when I stop praying, my coincidences stop happening."
Happy Christmas! Please write us, and we promise to write
again soon.
Caleb and Louise
Shyira Hospital: Headquarters of DOCS training in Rwanda
THE STORY OF THE TEACHING OUTREACH AT SHYIRA:Over the border from Congo, in Rwanda, a new training program is being established for African medical school graduates. The program will follow the same academic curriculum, developed by the Medical University of Southern Africa (MEDUNSA), currently in use at the Learning Center in Goma. Dr. Jo Lusi and Dr. Prosper Lutala, will help Dr. Caleb King and Dr. Louise King (nee: Rambo), of Darlington, South Carolina begin a postgraduate medical training program at Shyira Hospital, just south of Ruhengeri, Rwanda. Click on "Shyira Hospital" for pictures and details.Shyira Hospital was one of three original mission hospitals planted by the Ruanda (now Rwanda) mission in the 1930s. These hospitals were part of a three-fold strategy for sharing the Gospel by serving the people through the development of schools, hospitals and churches. This effective ministry bore fruit in what has been called the start of the East African revival. Unfortunately, the hospital was completely looted, down to the last mattress, in the troubles that followed the war and genocide in Rwanda in 1994. The property was abandoned until 1999, when it was reinstated as a health center, staffed by nurses only. For over eight years now, there has been no doctor for the region surrounding Shyira Hospital (a five district area) with a population over 200,000. In the last several years, the hospital, which housed nearly 150 beds in the 1950s, expanded from a few cots to 50 beds, serves as a nutritional counseling center, a center for immunizations, has delivered over 1000 babies--without a doctor, without even a trained midwife, without electricity, and without running water. During the summer of 2002, Dr. Caleb King, with the help of retired British Obstetrician/Gynecologist Dr. James Derrick, was able to work with the local church to restore running water. A nurse midwife from Liverpool, UK, Jane Morgan, featured the Shyira Hospital maternity ward in an article in the May 2002 RCM Midwives Journal. Save the Children UK has helped with refurbishment of the outpatient center, children’s ward, and nutritional counseling center. There is still so much work to do. Those of you who are handy when it comes to repairing things are invited to come help out with wiring, plumbing, and general refurbishing. The Kings look forward to working with the Kigali Institute of Science, Technology and Management, whose administration and faculty have volunteered to help with the refurbishment project.
*The Kings with their four children, Sara (age 7), Hannah (5), Caleb Jr. (3), and Lydia (born October 13, 2002) live at Shyira Hospital. Caleb is a pediatrician and Louise an internist. Louise’s parents, Bill Rambo, general surgeon, and Lydia Engelhardt, ob/gyn, of Mt. Pleasant, SC, plan to spend some time each year assisting in the work in Rwanda. Caleb and Louise are currently working on recruiting Rwandan medical school graduates to join them for the training program. Please pray for the selection process, that they would find just the right medical Residents for this new work, and for success in gathering necessary medical equipment for the hospital’s renovation. Contributions may be mailed to: DOCS Shyira Hospital Project P.O. Box 24597 St. Simons Island, Georgia 31522
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