A Journey I'll Never Forget

How the story began

by Tim 

My patient was a young man who just got married last month;  he had collided with another motorcycle and broken his thigh bone.  He was brought to us and we were able to fix his bone in a routine manner just a fews days after the accident, but after the operation his oxygen levels began to drop and we suspected he had developed Fat Embolism Syndrome from the fracture. As he worsened, it became obvious that he would need to be supported with a mechanical ventilator if he was to survive. 

However, transporting such a patient is extremely dangerous. Not only is travel itself difficult- we are at least six hours from the referral hospital, on a good day - but such a patient requires vigilant observation to maintain proper oxygen levels; even a short lapse can be fatal. 

In the States, I have personally witnessed this tragedy with such patients being transported even within a hospital from one department to another.  As I realized that this was a task that I should not delegate, I quickly prepared for the journey. One option arose that seemed to be a good idea at the time; since we are on Lake Kivu, a new water ambulance service with more qualified personnel could shorten the journey and assist medically.

 Lake Kivu Water Ambulance

First, we had a short but difficult drive to the landing area and then to the boat (transfer number 1).

The oxygen concentrator was malfunctioning due to electrical issues and the patient's oxygen levels were dropping precipitously until he could be carried into the boat by stretcher.

My patient was hand carried across the shore but when I prepared to wade in they insisted I be carried- on piggy back- to a great applause and shouting by the huge crowd gathered watching!!

In the boat- very new and nice-  we stabilized the patient again.  It was a nice, smooth ride- no other boats of any kind were on the lake (there ARE no other motorized boats EVER on the lake!) and so, at sunset, the surface was like glass as we sped north to our destination.

I couldn't help but notice the absolutely stunningly beautiful view as we traveled across the lake at sunset!

At the next stop- another hospital

We had run out of oxygen (twice!) at this point.  It was getting dark and we still had two and half hours to go before reaching the destination hospital.  We needed to entubate.  On the boat, we were using oxygen at such a high rate that we went through two canisters!  I swear that the last cylinder was on zero for I don't know how long- but yet it just kept flowing.  The next ambulance didn't have the oxygen which I had asked for repeatedly.  I thought my patient was doomed at this point, yet amazingly, bubbles STILL kept coming and the cannister read zero! (Thank you, Lord.)

The transfer (number 2)  from boat to yet another ambulance to go to a hospital for entubation, again several hundred yards over rocky hillside to get up from the lake. I was beginning to doubt the decision for the entire thing.

Loading into the third and final ambulance (transfer 4) after entubation for 2 1/2 more hours of travel to Kigali, to our destination hospital.  At this point I really was praying:  His oxygen levels were dangerously low and he was extremely difficult to ventilate by hand- which we did for the entire ride, taking turns and literally sweating bullets to get the job done; When a patient is like this the lung is so stiff that it takes a lot of pressure to get air in and out.

Oh yes- riding at high speeds on curvy roads in the back of an ambulance with four people not including the patient tends to cause just a little carsickness.  I got nauseated and fortunately, a basin was handy! Man. that was a real test of endurance for all of us and the patient!

Mission Accomplished!  Finally, we arrived at the hospital in Kigali! I was skeptical at first of these old ventilators but they did the job!

The ICU doc was excellent and inspired confidence- he was alert, interested, and competent  despite the late hour.

Finally, I felt as if my patient had been taken care of and the handoff completed; I began thinking of where I was going to spend the night.  I was  so glad to discover that my Kibogora hospital director had made arrangements for me to be picked up and delivered to a Guest House in the wee morning hours- about 3 a.m., about 9 hours after the initial odyssey had begun.

After arriving at he Good News Guest House- I was exhausted and very relieved to be greeted by their beautiful hostess who had a driver pick me up in the early morning hours.

The next morning, on the back porch of the Guest House drinking coffee and coming to, I reflected.


I felt so so thankful! - for so many things - not the least was just safety in travel, especially at night over the Rwandan countryside, but mostly for my patient's survival of such an arduous journey- so many times he was critically close to dying due to loss of oxygen supply and difficulty with ventilation, yet somehow he made it!  God was indeed with us.  I thank Him for sparing this friend's life.

The Good News Guest House hostess, a friend of Linda's.  

While this was quite a thrilling adventure, I must say, I am glad that every day isn't like this here in Rwanda.  Don't think I'll ever forget this one.