Do you, like me, find your eyes avoiding the front pages of the newspapers if they have a headline story complete with pictures of Rwanda or the refugee camps in Goma? Do you, like me, experience that heavy 'tug' in your psyche when Nightline runs yet another story on Rwanda? Do you, like me, try to resist that compelling "tie" to the luckless people of that country – the connection that developed ever since MARCO's MediShare Program dispatched its first shipment to little Mugonero Hospital in 1989? I'll bet you do, too.
| In view of the ongoing horror, this might be the time to reprise MARCO's interest in tiny Rwanda, and especially as it concerns Mugonero Hospital and its two satellite clinics. To do this, let me quote extensively from a so–far unpublished letter received from Mr. Colin Richardson who, at that time in 1989, was the hospital's administrator and the associate operator at amateur radio station, 9X5KP. (Kirby Palmer was the chief operator). |
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30 May, 1989
Dear "Smitty":
"Sorry I haven't yet succeeded making direct contact with you on the ham bands. – – –. I believe Ken (GJ0KKB) in Jersey especially relayed to you some of the information, but it was difficult to confirm. Propagation surely has been bad.
We surely do appreciate your offer to help with the finding of equipment for this institution. Ken mentioned that you had 2 autoclaves available for us. We do appreciate all help offered – – –.
I'd be happy to give you some rundown on the hospital and its background. It was founded here at the auspices of the Seventh–day Adventist Church and its mission in Rwanda. Over the years it has grown and until recently was a 110 bed hospital. In 1982 a new wing was commenced under a grant from ASHA (American Schools and Hospitals Abroad) in association with USAID and the State Department, and to do this, some wards were shortened, reducing us temporarily to 85 beds. This was supposed to be completed at least 22 months ago, but the contractor delayed, then defaulted, and although the structure is completed, the internal finishings are still under way as best we can manage it ourselves. Thanks to the contractor, and the legal problems involved, it is unlikely that we will be able to recoup much of the loss involved there. When it is finished, we should have 145 beds. We still have to furnish it.
(Note: MARCO member Ken Kirk–Bayley, through his Bush Hospital Foundation, now a partner of MediShare, contributed enough to furnish the new wing and Ken personally, along with Dr. Mike Marks helped them move into the new wing two years ago.)
At the same time, due to financial restraints (compulsory increases in salaries compared with compulsory limits on price increases), our budget was too limited to enable us to replace equipment as it wears out. I do not say "becomes obsolete" – as almost all our equipment is obsolete and has been for years! The autoclave in question, our only electric one, is the only one of capacity to use in surgery (we have a couple of very small ones that can cope with dressings, instruments, etc. on a small scale: gas operated). We estimate it to be at least 40 years old. A couple of years ago its electrical system failed completely, and our maintenance manager, Kirby Palmer (owner of station 9X5KP). completely rewired the machine, and rigged a system of safety alarms.
It held together for another two years until this month when the sealing gasket in the door blew out. It was supposed to be 3/8" thick, but is so old that the rubber had both thinned and hardened. That was when I was on the radio calling "CQ" stateside, trying to get the manufacturer to see if the gasket was even available now. It was on that occasion that I first made contact with Ken (GJ0KKB) who helped relay, then talked with W9DDP in Illinois who helped us obtain a new gasket. (Note: this was the conversation that I joined and discovered their equipment plight. – RCS).
I had also mentioned to him the problem we have with the radiography department. Our X–ray machine replacement parts are now impossible to find – the machine is indeed obsolete. Kirby tried last year while in the States. The machine in question broke down in January, 1987, and since that date we have been without an X–ray. We have tried many means of replacement, including appeals to various friends in Europe and America. The government of the German state of Rheinland–Pfalz in association with some donors there gave us a reconditioned X–ray and had it air–freighted over about a year ago. Only 2 out of the 7 crates involved arrived. The error has been traced to the departing airport in Germany, but no trace of the other 5 crates have been found and the story seems there to be at a halt. The 2 crates available are just so much junk without the rest!"
(Note: after an appeal made on MARCO amateur radio network for a surplus used and usable X–ray machine we received the offer of THREE machines within a two–week period! Ken found an X–ray machine in Europe which was eventually shipped to Mugonero. In fact, Ken traveled to Mugonero himself and assisted in its installation)
(Colin proceeds to describe the particulars of the power available at the hospital and lists other urgently needed equipment. Then continues – –)
"Mugonero, located 20 Km south of Kibuye and overlooking Lake Kivu on the west side of Rwanda, is at an altitude of 5,800 feet, some 1,800 feet above Lake Kivu. (Note: this is approximately 45 miles south of the Zaire border and Goma, the site of the largest refugee camp). It is in one of the most densely populated parts of the country, and in one of the poorest. The national average population density is about 650 per sq. mile. On this side of the country it rises to well over 1000 per sq. mile. In more fertile areas it can rise to 1,800 per sq. mile. The country as a whole is 96% rural subsistence farming. People do not live in villages as a rule, but each on his own little plot of garden. The average land available for the subsistence of a family is a little under 1 acre. Some have less, of course. The country is extremely hilly, even mountainous, with steep narrow valleys. Most hillsides, even the most steep, are cultivated from top to bottom, except those designated for reforestation. The average annual income (including some very rich people in the capital!) is under $300 per year. About 10% of 8th graders obtain places in high school by competition. Only half of these will complete high school. (Nursing is a 6 year high school program here). Of high school graduates, some 10% will obtain university places.
With increasing medication resistance, malaria is becoming a rapidly increasing scourge, and accounts for a good proportion of our patients. In 1988, there was more than a 50% increase nationwide in both morbidity and mortality from malaria. Other important problems here are diarrheal diseases (bacillary and amoebic dysentery among others), pneumonias, gastric diseases, sexually transmitted diseases (including AIDS – much higher incidence than official figures indicate), malnutrition, chicken pox, road accidents, trauma and other traumas, and recurrent fevers. Tuberculosis is still well known, though becoming less common than it was; leprosy is fortunately on the decline. Of course there are many sundry infections. Fortunately we can obtain many of the medications we need in Kigali - though at a price which we have to pass on to our patients.
Medical costs here are cheap compared with the more developed countries. A physician's consultation costs about $2.50, and a major surgery such as hysterectomy costs only some $30. Patients are charged about 65 cents a day for ward fees, or $2.50 a day for semi–private room (food not included). But from our point of view, nurses must be paid about $180 a month as a minimum. As professionals, their income is much higher than that of the subsistence farmer. So fees must be kept down. Our fees are of necessity a little higher than government patients. If a patient can't afford the fees, he just stays home and suffers. And if we can't collect the fees, we cannot operate. Vicious cycle at times.
Mugonero is the only hospital serving 3 communes (equivalent to your counties). The next nearest are at Kibuye (20 Km north as the sunbird flies, but 30 Km by road); Kirinda (35 Km NW directly, but some 60 by road), and Kibogora (about 30o Km south directly, but 50 Km by road). We serve a population of some 300,000 people. In the same area are 4 dispensaries/clinics. We have normally 2 physicians, one an internist, the other a surgeon–obstetrician. Rwanda as a whole has 33 hospitals, and some 240 clinics and dispensaries. Mugonero is thus an integral part of the national medical network, even though, being private, it receives negligible state assistance.
Well, I've rambled on – – – feel it isn't fair to anyone trying to help us to have him working in the dark.
Many thanks again for your willingness to help. No matter how small it may be (or how big!), we very much appreciate it all. May God bless you."
Sincerely,(Colin came to the United States for a brief tour in 1990, then returned to his native Australia, where he enrolled at a university for graduate study)