Just Another Day at the Rutshuru Hospital
November 24th, 2009
It’s 8 a.m. when the MSF vehicle enters the hospital grounds. As they arrive, the MSF doctors and nurses are greeted by their surgical and medical team colleagues who handled the night shift. “We had two Cesareans and a laparotomy,” says Dr. Claude, the surgeon on duty. “It wasn’t very busy.” Rutshuru is fairly calm, at least to all appearances. The intensity of the armed conflict may have diminished, but the violence continues. The Congolese Army is hunting down rebels from the Democratic Forces for the Liberation of Rwanda (FDLR) in North Kivu.
As the night team leaves the hospital to rest at the MSF base, Dr. Richard, a physician anesthetist, starts his day by visiting the emergency department. Two women are under observation, a child with second-degree burns on his legs will be moved to the operating room and the other patients will be transferred to different units. The hospital includes several pavilions built around a courtyard planted with mango trees. Intensive care is in one of the pavilions. Gisèle, a 2 year-old girl, arrived with a general infection and was admitted the night before.
“This is a reference hospital,” Dr. Richard explains. “We receive all the complicated cases in the area. People try to get treatment in the surrounding areas and when they see that it’s not working, they come here.”
A covered passageway provides welcome shelter in the rainy season. It leads to the maternity ward. There’s a steady stream of traffic here. Six women delivered during the night. As is often the case, one arrived close to death. By the time she got here – after deciding whether to give birth at the hospital or at home, after the nurse at the health clinic where she finally appeared notified MSF and after an ambulance was sent – her cervix was nearly completely dilated. In the end, everything was fine. Like the other mothers, she lies on a bed with her baby next to her.
The women who had Cesarean sections are resting in another shared room. Several are nursing. This calm contrasts sharply with the energy in the pediatric department downstairs. Today, there are 38 pediatric patients for 25 beds – a fairly standard situation. Despite construction at the hospital, the occupancy rate remains high. Two children must often share a bed. All were hospitalized on an emergency basis. “We have many serious malaria cases that can be complicated by anemia,” Dr. Kamabu says.
The morning visit is still underway when the neonatal nurse comes looking for the doctor. “The newborn in fetal distress has apnea with bradycardia,” she tells him. The baby was born two days ago. His condition was poor and now his heart is slowing. The doctor did everything he could but the baby died at 11:30 a.m. “It’s a difficult moment,” says Chantal, the head nurse. “But we’ve got to think about the other babies. We have a premature infant who was born weighing 950 g and has gained 30% of his weight.”
In an effort to improve quality of care at the Rutshuru hospital, MSF set up a neonatology unit to treat premature infants, opened a burn unit and, last year, built a second operating room in response to the very high number of surgeries required. In October, 471 operations were performed – all emergencies. The operating room is full of patients. They have had surgery for bullet wounds, peritonitis, open fractures and other problems.
And then there are the women who require a Cesarean section, which constitute more than one-third of the operations performed here. Indeed, women’s health care represents a large percentage of the care provided at the hospital. In addition to the maternity ward, the hospital provides a “mother’s village.” This leafy retreat houses women with complicated pregnancies who are waiting to give birth and those monitored by a gynecologist. Victims of sexual violence are also seen here. A woman who arrived in the middle of the afternoon will stay here after her appointment. It’s almost nightfall, so she will not make the return trip tonight.
The day will end soon for the MSF teams. The night shift’s doctors and nurses arrive. At 5:30 p.m., the two surgical teams hand off their responsibilities to the third, which will take over night duty. It may still be early, but no one is allowed to circulate outside the hospital once night falls. Gunfire often sounds at night in Rutshuru and the surrounding areas.
Rutshuru hospital statistics: 2009
260 beds
387 surgeries/month on average
308 deliveries/month on average
41% of patients admitted in the emergency room are children under 5
696 patients admitted in emergency/month on average
81 victims of sexual violence treated/month on average
