September 7, 8 and 9

Some Reflections from Randy Bergen:
Thursday night was exceptionally stormy; it rained hard with thunder, lightning, and wind all night. It was nature making all the noise however not fighting. But the UN helicopter gun ships returning over the lake at dusk from the west drove home the point that this is a part of the world in conflict. Friday morning in Goma seemed just the same as other days, the streets had the same amount of activity and work at the hospital was unchanged. Goma seems safe but with this wet weather the conditions for the people displaced by the fighting another 2000 feet up in the hills must be very difficult.

Goma is on the northern tip of Lake Kivu, a huge lake which is part of a chain of lakes that run north-south through central Africa. It is about 5000 ft elevation, so it gets chilly at night. Just north of the city is an active volcano that still glows red on clear nights. In 2002 lava flows from this volcano destroyed much of the city, including the HEAL Africa hospital. Some of the city burned, like the hospital, and the rest was covered in many feet of lava. Most of the city rebuilt on top of the lava, but there is a section of the main street where the buildings remained intact, just buried. They just built another floor on top of the old second story. That section of the city looks eerily like the inland part of Banda Aceh where the main force of the tsunami wave had spent itself but as it receded it left behind a thick, black layer of mud from the ocean bottom. Most of the roads are still an obstacle course of jagged lava rocks. If I ever give up medicine and settle here I am going to open an auto tire dealership.

The hospital is a series of mostly small buildings, the largest 2 being the central hospital rooms for mostly pediatric and gynecological patients and the OR building. Across the street is the chapel, a row of buildings that include the pediatric HIV clinic, and the Jubilee Conference Center. It is a beautiful building with rich hardwood details and on the second floor a view which is the best in town of the perfectly shaped cinder cone of the volcano.

The house where the Luci’s live (Joe is the chief surgeon and Lyn is the program administrator) is where we all stay. It is right on the lake, west of the main town. It is a huge home with spare bedrooms galore for all the visitors; a large common dining/living room; a beautiful garden; and a covered porch by the lake where we have many of our common meals unless it is pouring rain. To sit under the porch watching the light change and the kingfishers dive for food and to listen to the waves or the rain on the metal roof and to realize that I am in Central Africa, in a place so troubled by violence, 9 times zones away from home is surreal at best.

The rest of the (second) team from 1st Pres- Art, Bridget, and Laura, left Friday morning. I miss them but there are other wonderful people to be in community with here. Besides I get to move into Art’s room where there is hot water. My work started with a talk at the General Hospital and another case presentation. This time a 9 year-old with chest pain who as far as I could tell had no evidence of a cardiac problem. It was the 4th time she had come in to the hospital for this in the last few months. The last time they had started her on digoxin. I tried to suggest that there were other reasons for chest pain in a 9 year-old with a normal cardiac exam, like living in such a stressful place, and maybe they should see how she did off digoxin. I then worked with Dr Vindu in the Pediatric HIV clinic the rest of the morning and early afternoon.

Saturday was a short morning pediatric HIV clinic but after clinic I went over to the hospital and the general pediatric clinic. There Dr. Denise and Dr. Amani, 2 other young MDs interested in pediatrics told me that before inpatient rounds that they had to tell the family of an 11 year old boy who had been losing weight that he is HIV positive. They wanted to translate my “consultation” with the family. Then they told me it was not part of their culture to just tell the family. I then said maybe I should learn how they did it so maybe they should tell the family and someone could translate for me. They said no they would rather I go ahead with the consultation. It was the mother and paternal uncle whom I told. The mother obviously got the implications for not only her son but herself and her other younger children. She made the comment that there was once a rumor that her husband had a second wife but she didn’t believe it. The family is not from Goma so if they wish to pursue treatment they would have to make a decision to relocate because we would have to see him regularly. We will see the family on Monday in clinic. Inpatient rounds included the 8 year-old boy with an abdominal infection from Thursday. We had expanded the antibiotic coverage by adding Flagyl, for anaerobic bacteria, and he was now without fever and had a much improved exam.

The rest of the day was spent relaxing; the highlight was a group of us visited a chimpanzee rehabilitation center about 100 meters down the road from the house. There were 3 baby chimps playing around the grounds. I am not sure that playing with humans is the best way to “rehabilitate “chimps but it sure was a trip to hold them.

Sunday was a day of rest. There was a beautiful sunrise over the lake silhouetting the mountains of western Rwanda behind it. We had a leisurely breakfast and then went to church. There is a chapel at the hospital where there is a 7:30 service in Swahili, which is mostly attended by the hospital patients, and a 9:00 service in French, which is mostly attended by the hospital staff. Everyone in their festive Sunday best filled the chapel and its annex to overflowing with prayer and song. Prayer and song that comes from a community that struggles in a physical environment of hardship that is beyond my understanding. The sermon was “Persevere- we are here because of the endurance of Another”. It was a moving 2 hours, especially during the prayers, even though I understood few of the words. The tradition here is for everyone to join in with their own prayer as the minister prays. As the mixture of languages and voices being raised in praise grew louder and louder I thought again, as I did at the beginning of this e-mail, of thunder. But this was the thunder of a glorious, bright, Sunday morning, a morning to celebrate The Light.

Blessings from Goma,



Randy