Tuesday 20th September

Sunday morning was spent at the genocide memorial museum and each visit there provokes a new thought, the story of a young man who had only fellow students to invite to his wedding as he was the sole survivor  from parents , siblings, aunts , uncles ,cousins neighbours and childhood friends, was chilling.

Sunday pm Emmanuelle drove us 2.5 hrs to Sorwathe (society of Rwandese and the commercialisation of tea) tea plantation guest house. A tea processing factory set up by an American for the local tea growers to process their leaves near to their fields. A fair trade co-operative. The last 18km of our journey took an hour along unmade roads through a sea of tea plantations; it is a spectacular and peaceful place on earth but very bumpy to get too.

The plantation manager drove us the 5 km to the hospital on Monday, it is a 4 year old state of the art hospital with few patients and even fewer staff. Rwanda is short of doctors, Gilbert the 27 year old medical director told us there were no doctors left after the 1994 genocide and the country now has 80 doctors graduate per year , they hope one day the hospital will be fully staffed and utilised. The old joke about doctors and policeman looking younger is a reality here and mentorship for the medical teams here is vital, one cannot book learn experience.

We undertook a very productive ward round with the new consultant (old at 29 - See pictures below) and he was very receptive to ideas of palliative care needs, not ordering  investigations that will not affect management, looking at patients holistically and keeping an open mind , he confessed to finding it very difficult to tell people there is nothing more he can do – he is right. He does not have the advantage of team support as we do at MSH.

Today we have a full day teaching the home based care workers who are coming to the end of their 4 month theoretical training, which is followed by 2 months of practical work, so in true style last evening was spent busily preparing slides whilst swatting mosquitos!! The first half of the day has gone well though and we have found some wifi access which is pretty limited here so who knows when the next instalment will come!