The 7 year old boy I met each day with a hug, so excited just to watch my motorcycle for me. His father and mother were both dead, and he was the caretaker for his grandma, stranded at the hospital day after day with venous ulcers of her feet, waiting for amputation of both legs. The research projects to address chronic osteomyelitis and typhoid that never happened because the ministries demanded payment of $1500 per application. I watch as a woman with one leg hobbles by on crutches. So many things have not changed. The family medicine residents are gone now, their program shut down by a ministry of health director who didn’t believe in family medicine. They are orphaned now in the system they inherited, unable to find jobs as family doctors, scattered without national leadership or support. Brightly colored bishop birds, the smell of woodfire, community health projects to improve basic services, the quiet of an African night with a stream murmuring in the back yard.
Louise joins me now, and we go on rounds. We catch up a bit between patients and we examine an asthmatic who comes in with frequent exacerbations of her disease. There are few medicines in the country, but she could be treated more appropriately, seen regularly, kept out of the hospital in most cases but she lacks one missing ingredient in her medical plan. She needs a family doctor, somebody to see her before disaster strikes, to get her on the right medicines before she ends up in the hospital.
I excuse myself and walk out to the gate with Louse. I promise that next time I will call sooner rather than 10 hours before leaving so we can talk some more and find out about our lives and families. I walk out of the gate and find myself walking with a steady flow of Rwandans moving from here to there. I am alone in my thoughts. I miss much of what is here now and I miss what has been lost. I remember something in my black carry-on. It is a lollipop that I received in 2011, a gift from the boy who guarded my motorcycle. I could never bring myself to eat it. I find myself wondering whatever happened to that boy.