Let me begin with the patients. Dr. Ronald is a Rwandan surgeon who has recently graduated residency from a PAACS residency in Ethiopia. (PAACS = Pan Africa Academy of Christian Surgeons)
He is committing to a minimum of 5 years serving as a general surgeon at Kibogora Hospital. His wife Cissy has a masters degree in business. We met Ronald way back in 2009 on our first trip here. He was a medical student - a good one with great potential! Joel liked him right away. We re-met Ronald and Cissy last year when they did a visiting surgical rotation here during the time Joel was working in Kibogora. They are good people. The best. They are trustworthy, humble, so kind, generous and exactly lovely. On Ronald's time off, he goes to the surgical ward to talk with the patients about Jesus. Last week, 2 patients gave their lives to the Lord. Cissy is choosing to volunteer here at Kibogora in the local university and remain by Ronald's side instead of moving to Kigali to find a good paying job - this also goes against a cultural norm, and much pressure from their families. They are a gift to the hospital and to the community.... and definitely to us.
When I visited Cissy during the first week after their arrival, she asked me about the patients at the hospital and how they eat. I didn't have much information to give her, but I did know that there is a nutrition service that is responsible to work closely with social services to make sure the poorest patients get food. I also knew that the patients are responsible for their own food. The hospital does not provide a food service. She was saddened by this, but had many questions. Maybe we could survey the patients and see what the reality is for them. Possibly food is not a problem. And equally possible we might find that the patients have difficulty getting food. So, you know... like all smart folks do, we asked Joel :)
Joel suggested that we write up a survey with the questions we wanted to ask the patients and present it to the director (the interim director.... but that's a story for another day). So we got to work. Our questions included "Do you have a caretaker?.... How far away do you live?..... Do you eat meals at the hospital?.... Do you ever miss meals?.... Why is that?..... What food do you eat?....Would you be interested in a food service?.... How much per meal would you be able to pay?...... " and several others.
We made an appointment and visited the director to present our survey. His response was calm, calculated and confident. He told us that he knew the answers already. There are patients who do not eat. There will be 80% of patients who will not be able to pay for a food service. The government will not help us because they require every hospital to provide food for patients and they see Kibogora as fulfilling that requirement due to our nutrition service for the poorest patients. I asked him if he felt the survey was a bad idea. He said,
"No. Since the question has been raised, let's do the survey."
That same day, we met with the social service workers as well as the nutritionist. All involved had the same bleak outlook. This is a hopeless project. Everyone knows the patients are hungry. Everyone is too poor to pay for food. But do the survey anyway.
Over the next week, Cissy and I spent hours of our afternoons in the wards. We interviewed 100 patients in surgery, pediatrics and internal medicine. Cissy asked the questions and translated the answers for me into English and I recorded them on the iPad. She later told me that as soon as the patients saw me, they shared the sad details of their stories with her and begged her to ask me to pay for their medical bills. (We are commonly seen here as holding the answers to all the financial problems.... it is maybe the single most difficult part Joel & I struggle with while here.... the tension that we live with being wealthy Americans and knowing that to hand out money is not the best way for the community to thrive... and yet Jesus even said to give to those who ask and to give up everything for Him.... )
We then analyzed our data. The results were as expected. The most enlightening to me is that we found 51% of patients/caretakers eat less than a meal a day. Most of them share food with other patients and wait for a family member or neighbor to bring them something to eat - and most of them live hours and hours of walking distance away. In many cases, a husband will walk 6 hours to bring a meal to his wife in the hospital .... once every few days. Because so many stories are similar, the food that is "shared" is very minimal. For those patients who receive nutrition services, we found that they, too, were suffering. They had eaten only porridge once in the past two days, or maybe one egg when the surgeon had put orders in for them to have protein daily to help heal their wounds.
We created tables and excel spreadsheets and were excited to run to the hospital director with our results.... but Joel, wise once again, reminded us that a problem is just another frustration, unless there is a solution. He suggested we research more and try to develop a solution.
We emailed other hospitals in country who do feed patients. We met with a local woman, Thamar, who is a retired hospital chaplain (another woman who might, in reality, be an angel). She is a successful shop owner. Thamar gave much needed direction, such as: how many people one kilogram of porridge would feed... how much sugar we would need for that porridge... how many people could be fed with 1 kilogram of rice, beans, potatoes, etc....
We interviewed an important person at the local high school - a boarding school that feeds 734 people three meals a day. We saw their kitchen and the special, giant pots that cook rice, beans, potatoes and water for drinking over fire. We asked him our same questions: how many people can one kilogram of rice feed?... How many people for one kilo of porridge .... and we compared them to our other info. How much do they pay their kitchen staff? How many staff are required? How do they find enough food locally to provide that many meals? So many questions.... and so many answers! He encouraged us that this can actually be done. But it will cost money.
After all of our research, two ideas stand out above all others. 1. We cannot begin this project if it is doomed to fail. It would be better not to begin. So go slowly and make a careful long-term plan. And 2. We cannot expect the patients to pay for the food, or plan on this service being self-sustaining. It will fail.
We have also learned that just as the poverty and needs are never-ending in this Kibogora community, so are the grace, compassion, surprises and unlimited loving kindness of our God. So we wait with our results. Cissy and I pray together. We pray with Ronald and Joel. Our mission community prays for this project together at our weekly meetings. We don't know what we wait for.... but we wait expectantly.
To give an idea to you of what we're looking at..... Our initial results have yielded the following:
To feed 300 patients a healthy porridge for breakfast will cost $44.
To feed them a meal of rice, veggies and beans will cost about $105.
To feed them potatoes, veggies & beans will cost about $70.
In total, somewhere in the ballpark of $50,000 per year
We may be able lower costs by purchasing wholesale foods.
We have learned that there are several gardens on hospital grounds.... might be a possibility for growing some of our patient food?
Please pray and hope with us!
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| YOU ARE WELCOME! |
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| .... and they say we had an earthquake right here this week.... 2 actually. But we didn't feel anything! |
