Tuesday, November 19, 2019

Clinical Rotation in an Emergency Department in Kigali


Lara Vogel, M.D. 
Resident, Harvard Affiliated Emergency Medicine Residency MGH/BWH, 
PGY4
08/28/2019

In my work prior to medicine, I lived and worked in East Africa for multiple years, focusing primarily on education and the ways the HIV/AIDS epidemic impacted children in Kenya. Working on public health projects in rural Kenya through my twenties pushed me toward medicine, so now that residency was nearly finished for me, it was time for me to go back to the place where my interest in medicine started. Or at least get closer. Through attendings in the BWH ER Trish Henwood, Alice Bukhman and Regan Marsh, I was able to connect with the new Rwandan attendings running one of the first EM residencies in Sub-Saharan Africa. The Centre Hospitalier Universitaire de Kigali (CHUK) is about to graduate its second class of residents, and the ER is currently run entirely by its prior graduates. There are three of them. They work a lot.

Nyungwe Forest National Park
I technically know that EM is a relatively new specialty in the US but seeing a new specialty establish itself is a fascinating process. This process at CHUK is relatively far along and I had the smallest glimpse, but watching these residents navigate their own hospital system, the ambulances, the insurance system (they often have to wait for proof of payment before they can treat), and the consultants’ understanding of patient care was an education in itself. Unsurprisingly, the medicine was the same between the two countries and the residents were exceptionally well trained—their comfort with trauma far exceeded my own, and their ability to make do with much less support from consultants, supplies, and patient’s understanding of disease was incredible—but ultimately, they had many more fights everyday to define the boundaries of their ER to themselves, to their patients and certainly to the hospital system. Their actions were always defined by the best interests of the patient, but when ICU patients spent weeks boarding in the ER, when the orthopedists could not operate or admit and yet would not stop accepting transfers, and when social services did not exist to support patients unable to care for themselves, the question of what was best for the patient became extremely complex and well beyond the scope of what I expect from an ER physician. Needless to say, they all managed it with grace and I was the one left confused.

41 comments:

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  11. God bless Dr. USELU for his marvelous work in my life, I was diagnosed of HERPES SIMPLEX VIRUS since 2018 and I was taking my medications, I wasn't satisfied i needed to get the HERPES out of my system, I searched about some possible cure for HERPES i saw a comment about Dr. USELU , how he cured HERPES with his herbal medicine, I contacted him and he guided me. I asked for solutions, he started the remedy for my health, he sent me the medicine within 3 days. I took the medicine as prescribed by him and 2weeks later  i was cured from HERPES contact him via email (dr.uselucaregiver@gmail.com) once again thanks to you Dr. USELU cure the flowing virus, contact his email or add him on whatsapp (+2349019328641) cancer cure
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  12. I WILL CONTINUE TO POST THIS, I'm so happy to share this testimony thank you Dr.idowu  am so happy i never believed i will be herpes negative again despite all i passed through Dr.idowu you are truly God sent, am so happy that am negative again thank you Dr idowu.email him
    (Dr.idowuherbalhome@gmail.com)
    If you have any problem like
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    *HIV/Aids,
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    *Breast cancer/cancer,
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    *Pregnancy problem,
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    Please give him a try ,no harm in trying ok....

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  13. Good day to all viewer online am so happy sharing this great testimony on how i was checking for solution in the internet then miraculously i came Across Dr.idowu the powerful herbalist that Cure Numerous individuals Herpes simplex Virus,so I contacted him base on the testimonies I?m seeing about him on the internet, I was cured too by him, kindly contact him actoday through his email he can help you email ; {dr.idowuherbalhome@gmail.com} and so he can cure types of diseases like,HEPATITIS B,DIABETICS,CANCER,HPV,LOW SPERM CAM HIV/STDS FIBROSIS LOST OF WEIGHT .. all thank to you Dr idowu for your kindly help in my life his whatsapp  number +2348052789941.{+2348052789941} if you have any problem you can contract him immediately save life pls ,yours health is urs  wealth ,is not  fake pls ,give him a trial ..thanks  you dr,idowu onces again,thanks you .

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  14. I already gave up on ever getting cured of HSV2 because i have tried many treatment none of them worked out for me i have gone to different hospital they always tell me same thing there is no cure for herpes when i came across a post about Dr RAZOR on the internet from a lady called Angela[USA] i contacted him and he reassured me of the effectiveness of his herbal medicine and he sent me thy medication after he promised to guide me, i took the medication according to the way he instructed, within 18 days i started having some changes in me and i went to the medical hospital for check up and i was confirmed herpes negative. I doubted at first because i have been to a whole lot of reputable doctors, tried a lot of medicines but none was able to cure me. so i decided to listen to him and he commenced treatment, and under 18 days i was totally freed from #Herpes. i want to say a very big thank you to DR RAZOR for what he has done in my life. You can leave him a message on email drrazorherbalhome@gmail.com and also WhatsApp him +2349065420442..
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  15. The Great Dr.EROSION herbal medicine is a good or perfect cure remedy for Genital Herpes, I was diagnose of Herpes for almost 5 years, everyday i am always on research looking for a perfect way to get rid of this terrible disease as i always knew that what we need for our health is right here on earth though the scientist say there is know cure for this disease,on my search I saw some different testimony on how Dr.EROSION has been able to cure Genital Herpes with is herbal medicine. I decided to contact this man, I contacted him and he guided me on how to purchase for the medicine. I asked him for solutions and he started the remedies for my health. Thank God, now everything is fine, I’m cured by Dr. EROSION herbal medicine, I’m very grateful to Dr. EROSION, reach him now on email (amdrerosion@gmail.com) or Whatsapp him +2348116071831
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  16. Hello everyone i am very delighted that i recently got cured of herpes virus. I have been battling with this disease for over 4 years now, ever since i got diagnosed of the virus i have been using medical pills and therapies to suppress the virus. But inside of me i needed the Virus gone cause my health was deteriorating, So  i went on to the internet to search on how one could get cured from this virus, when i came across some testimonies on how herbalist razor has helped them get rid of Herpes virus, Hiv/aids, Cancer. I copied out his details (email ; drrazorherbalhome@gmail.com) and Whatsapp number +2349065420442) as provided by the testifiers on a blog site. But before that i was so skeptical, i knew there are so many herbal doctors on the internet,i needed the one who can help me get through this Herpes Virus completely with his herbal Remedy. I got in contact with doctor Razor,and i explained my problem to him and he promised to help me, which he actually did. I got my medication in the US sent by doctor razor and he instructed me on how i was to take it for 18 days. After the said 18 days i went for medical check up and the doctors ran some test on me and told me i was Herpes Negative, i was amazed and dumb-folded, so i had to go back home, i noticed my health for some months, i didn't have any outbreaks nor symptoms of the virus, but i went to another hospital after 2 months to conduct another test and the same result. I will be forever grateful to you doctor Razor and I will make sure the world gets to know about your herbal exploits sir. Reach doctor razor on his email : drrazorherbalhome@gmail.com or whatsapp/call his cell on +2349065420442

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  17. Six weeks previously, I had attended my primary care doctor (PCD) with dysuria and was treated for a urinary tract infection, however, symptoms persisted. Several days later I noticed an acute onset of bilateral vulvar blisters. I was clinically diagnosed with genital herpes and commenced taking valacyclovir 500 mg bd for one week as instructed by my  PCD. The blisters resolved within five days, however, I developed burning and exquisite sensitivity to touch in both inner thighs and in my left buttock extending down my left leg and including the sole of my left foot and toes. I found that at times, I was unable to walk and sit. So returned to her PCD who told me to continue taking valacyclovir for another week, however, the burning persisted. And I knew this was never going to cure me. I sorted for Natural Herbs And Gos so good i came across doctor razor's Details,I contacted him and we spoke and he assured me everything is going to be permanently fine. Few days after I reached out to him he sent me herbal medicine to take for 18 days. after completing the dosage for 18 days. I started noticing some changes in my Genital Area. so i told the herbalist about it, he asked me to go for a medical test, which i did. Lo and behold, My PCD was surprised to see my result out Negative,. I was overwhelmed with joy, I waited for 2 weeks to make sure the Virus was not laying dormant in my Nerve Cells, So i went for another test After the two months, And it had the same Negative result. I am forever indebted to you Doctor Razor. If you are having hard times with this same virus or you do know of anyone with herpes virus, i kindly recommend you to him. Email drrazorherbalhome@gmail.com
    WhatsApp or Call his cell phone +2349065420442..,.

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  18. TO EVERYONE BATTLING WITH HERPES INFECTION ,I want to quickly drop my life story on how a specialized healer called DR RAZOR cured me from HERPES virus, A good man who have used his herbal roots and herbs to cure all kind of deadly disease. I was infected with HERPES virus and I never thought HERPES virus could be cured,but with the medication DR RAZOR sent to me i was cured,I saw his email on web page by a patient he has cured from HERPES,who dropped the email and phone contact of the doctor.I really thank FLORENCE for sharing her testimony on how she was cured When I contacted him he prepared the herbal medication for my HERPES cure and send it to me via DHL And i got cured within 18 days of using the herbal medicine,Contact him through E-MAIL drrazorherbalhome@gmail.com or for easy communication you can WHATSAPP/CALL him via his mobile number +2349065420442. He can Also cure Infections like :HSV 1 & HSV 2ASTHMADIABETESEPILEPSYCANCERINFERTILITYSTAPHYLOCOCCUS.BARRENNESSHIV /AIDSHEPATITIS B Kidney?

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  19. My Sincere Gratitude to Dr Razor, I was infected with HERPES SIMPLEX VIRUS 2 November 13 2018, I went to many hospitals for cure but there was no solution, I was confused because the medical drugs has become my daily food, but i decided to sort after Natural Herbs. One day I sat beside the pool, Browsing and thinking where I could get a solution to end this my predicament. I saw a blog on how Dr Razor cured people with his herbal medicine, i did not believe but i just decided to give him a try, Visit Doctor's Razor's Website : https://drrazorherbalhome.wixsite.com/drrazorherbalhome .I contacted him and he prepare the herbs for me which i took, and he instructed me to go for check up, after the test i was confirmed herpes negative, i am so happy. If you have any problem or you are also infected with any disease, kindly contact him now with his Email: drrazorherbalhome@gmail.com or call +2349065420442This testimonial serves as an expression of my gratitude.
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    Contact him on this email: drrazorherbalhome@gmail.com , or call his cell phone number on +2349065420442

    ReplyDelete
  20. I want to use this medium to let everyone know that Herpes Simplex Virus has a complete and Permanent cure and that Dr Razor Herbal Medicine is the solution. I was Diagnosed with Herpes Virus type 1 in January 16, 2015, I have made several Research Hoping to see a true Cure or Healer, Fortunately for me i saw on a blog site how Dr Razor has been saving different lives and marriages with his herbal medicine, At first i did not believe but on a second thought, i decided to give him a try, I contacted him and he assured me of a cure, he prepared the herbal medication for me, which i took for 18 days, he told me to go for a medical check up, could you believe that i was confirm Herpes type 1 Negative after the test, and i went to a different hospital and it was also Negative, I became very happy and decided to write my appreciation article about this Good man. If you are battling with this same Infection or you know of a person who is infected with any disease like Herpes, HIV, Cancer, Syphilis, Hepatitis A,B,C, all types of Cancer, Gonorrhea, life's problems that you might have etc. kindly Reach out to Doctor Razor on Email : drrazorherbalhome@gmail.com. Whatsapp/Call him on +2349065420442. You can Also Visit His website : https://drrazorherbalhome.wixsite.com/drrazorherbalhome . My Sincere Gratitude to you Sir, God will surely Keep you safe from harms way. Please share so Other lives can be saved

    ReplyDelete
  21. Irrespective of receiving daily oral or future injectable depot therapies, these require health care visits for medication and monitoring of safety and response. If patients are treated early enough, before a lot of immune system damage has occurred, life expectancy is close to normal, as long as they remain on successful treatment. However, when patients stop therapy, virus rebounds to high levels in most patients, sometimes associated with severe illness because i have gone through this and even an increased risk of death. The aim of “cure”is ongoing but i still do believe my government made millions of ARV drugs instead of finding a cure. for ongoing therapy and monitoring. ARV alone cannot cure HIV as among the cells that are infected are very long-living CD4 memory cells and possibly other cells that act as long-term reservoirs. HIV can hide in these cells without being detected by the body’s immune system. Therefore even when ART completely blocks subsequent rounds of infection of cells, reservoirs that have been infected before therapy initiation persist and from these reservoirs HIV rebounds if therapy is stopped. “Cure” could either mean an eradication cure, which means to completely rid the body of reservoir virus or a functional HIV cure, where HIV may remain in reservoir cells but rebound to high levels is prevented after therapy interruption.Dr Afrid Herbal Medicine makes me believes there is a hope for people suffering from,Parkinson's disease,Schizophrenia,Cancer,Scoliosis,Fibromyalgia,Fluoroquinolone Toxicity
    Syndrome Fibrodysplasia Ossificans Progressiva.Fatal Familial Insomnia Factor V Leiden Mutation ,Epilepsy Dupuytren's disease,Desmoplastic small-round-cell tumor Diabetes ,Coeliac disease,Creutzfeldt–Jakob disease,Cerebral Amyloid Angiopathy, Ataxia,Arthritis,Amyotrophic Lateral Sclerosis,Alzheimer's disease,Adrenocortical carcinoma.Asthma,Allergic diseases.Hiv_ Aids,Herpes,Inflammatory bowel disease ,Copd,Diabetes,Hepatitis,I read about him online how he cure Tasha and Tara so i contacted him on drafridherbalhome@gmail.com even talked on whatsapps +2349057260738 believe me it was easy i drank his herbal medicine for two weeks and i was cured just like that isn't Dr Afrid a wonder man? Yes he is! I thank him so much so i will advise if you are suffering from one of those diseases please do contact him he's a nice man.

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  22. NATURAL HERBS AND VEGANS CURE FOR Herpes 1&2 THAT WORK FAST WITHIN 14 DAYS WITH DR ELINFOH HERBAL MEDICINE, I saw so many testimonies about Dr ELINFOH a great HERBAL DOCTOR that will help you CURE and give you the rightful health to live a joyful life, i didn't believe it at first, but as the pain got worsen and my life was at risk after using lots of ARV drugs from the hospital and no changes so i decided to give a try to Dr Elinfoh I contacted him also and told him i want a cure for Herpes , he gave me advice on what i must do and he deliver it to me in my home address i gave him and i got the medicine which i use according to his instruction, and today i must say I am so grateful to this man Dr Elinfoh for curing me from Herpes and for restoring me back to my normal health and a sound life and i am making this known to every one out there who have been trying all day to be cured from Herpes or any sickness should not waste more time just contact him with his details below, believe me this is the only way to get cured from Hepres , this is the real solution we all have been searching for. Do not waste more time contacting him today for you can also leave a sound and happy life. contact info below. Email: (drelinfohherbalhome@gmail.com ) or WhatsApp or Call him on: +2348110492072. and you can as well contact him on other issues you are having like*HEPATITIS B*DIABETICS*CANCER*ALS*HERPES*BODY REDUCTION*BREAST ENLARGEMENT*FIBROD*CANCER*PREGNANCY MISCARRIAGE*Relationship issues etc.. ** Neoplasms*Cardiovascular Disease (CVD)
    *Chronic Respiratory Diseases
    * Mental and Behavioral Disorders
    *Alzheimer’s Disease
    Email: (drelinfohherbalhome@gmail.com).

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  23. Does anyone still doubt natural herbs? I've seen the great importance of
    natural supplements and the wonderful work they have done in people's
    lives. I wonder why people still spend their money on surgery, injections
    and drugs each time they are sick. Natural herbs can cure all kinds of
    illness. My Herpes virus was totally reversed with natural herbs this
    year. Earlier this year my sister who lives in New Delhi India Purchased
    HSV herbal remedy from Dr Patrick and he told her that his HSV herbal
    remedy only takes five weeks to reverse HSV completely, which she didn’t’
    believe, but she had no choice than to purchase, because she knew COLD
    SORES was killing me slowly. When I received the herbal remedy, I only used
    it for five weeks, it was so shocking to see the outcome, all my cold sore
    disappeared and my HERPES VIRUS was fully reversed. I know it is hard to
    believe but am a living testimony, There is no harm in trying natural herbs
    supplements. Contact Dr Patrick for his herbal remedy today...
    Email;patrickherbalcenter1@gmail.com Call/Whatsapp +2348118116254 for more
    information Thanks

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  24. I visited my doctor for a second opinion to verify that I am currently experiencing genital warts on both sides of my inner labia caused by HSV which I was not aware I had until the genital warts appeared. I discovered them about 2 months ago and it saddened me to find the warts because I felt it meant I had contracted an STD,I never applied medical drugs or therapies,because I prefer going natural routes first if any are available. At first, I was not sure I’d be able to use anything since the labia is such a sensitive area but I remembered that I had been reviewing series of testimonies on how herbal doctor razor had been curing people of Genital warts, And I had Them on the bottoms of my feet so I decided to try doctor razor herbs. Thankfully, Doctor razor herbal medication seems to be getting rid of the genital warts. When I first began applying it I noticed some slight aching feelings in my vaginal area that I had never felt before. I no longer feel the aches though. I AM SO GRATEFUL TO BE COMPLETELY CURED OF THIS VIRUS.However, I don’t feel the shame anymore and am so grateful to Mother Nature and Doctor Razor for helping a sister out. Reach him on Email : drrazorherbalhome@gmail.com Whatsapp/Call his cell phone on +2349065420442. Visit Doctor Razor's Website : https://drrazorherbalhome.wixsite.com/drrazorherbalhome

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  25. God bless Dr. USELU for his marvelous work in my life, I was diagnosed of HERPES SIMPLEX VIRUS since 2018 and I was taking my medications, I wasn’t satisfied i needed to get the HERPES out of my system, I searched about some possible cure for HERPES i saw a comment about Dr. USELU , how he cured HERPES with his herbal medicine, I contacted him and he guided me. I asked for solutions, he started the remedy for my health, he sent me the medicine within 3 days. I took the medicine as prescribed by him and 2weeks later i was cured from HERPES contact him via email (dr.uselucaregiver@gmail.com) once again thanks to you Dr. USELU cure the flowing virus, contact his email or add him on whatsapp (+2348132015009) cancer cure
    diabetes cure
    ringing ear
    herpes cure
    warts cure
    HPV cure
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    get your ex back
    pregnancy herbal medicine
    Hepatitis  

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  26. All these post about HERBAL MEDICINE,are scams and fake trying to collect money all in the name of HERPES cure and when you contact them they will be asking for your name, pictures, country, phone number,occupation and when you have given them all the information, they will be asking for money. my name is jame mary,from Palm coast Florida U.S.A,a woman of 56years I was once suffering from herpes for good 3years and i spent a lot of money going from one herbal doctor to another but they all scam and take my money away until i told my friend the problems am facing in life he quickly introduce me to this powerful herbal man called Dr. Agbawo who cured me from Herpes with his herbal medication , after Doctor Agbawo has finished preparing the herbal medicine, he asked me to send him my residential address, so that he will send the herbal medicine to me via D.H.L so i did. 2days later, i received the herbal medicine and i had to follow the instructions he gave to me on how i will use it. After using for a week and few days and I noticed that all the symptoms, pain,itch and blisters are gone. 2weekslater i went to hospital for test and according to the test done by theMedical doctor called Marly it stated that i was herpes negative.So viewers be wise and beware of fake people and fake herbal doctors, they are all over the internet trying to steal from poor people. Iwill drop the email of this powerful herbal doctor just in case you want to contact him for help,CHECK HIS BIO ON INSTAGRAM: WWW.INSTAGRAM.COM/herbalist_agbawo1 Or EMAIL HIM ON :HERBALISTAGBAWO1@GMAIL.COM OR WHATSAPP HIM ON +234815889995 HERBALIST AGBAWO CAN AS WELL CURE THE FOLLOWING DISEASE:-1. HERPES2. PENIS ENLARGEMENT3. GONORRHEA 4. HIV/AIDS5. LOW SPERM COUNT6. MENOPAUSE DISEASE7. EPILEPSY8. ASEPSIS9. CANCER10. ANXIETY DEPRESSION11. PREGNANCY PROBLEM12. SHORT SIGHTEDNESS PROBLEM13.YOU NEED YOUR WIFE OR HUSBAND BACRK14.ZIKA VIRUS15 ADHD  

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  27. Hi Friends i am so glad to writing this article today to tell the world how Dr Sayo cured my HSV VIRUS,i have been detected with HSV-1 AND HSV-2 since five years ago, ever since then my life has been in complete bizarre and agony,i have used so many drugs that was prescribed to me by several doctors,but it didn't cure my HSV VIRUS neither did it reduce the pain,until a certain i was checking for solution in the internet,then miraculously came across Dr Sayo the powerful herbalist that cure numerous individuals HSV-1 AND HSV-2 INFECTION,then i contacted his email: sayoherbalhealer@gmail.com i explained everything to him and prepared a cure that cure my HSV-1 AND HSV-2 disease totally after receiving his herbal medicine, so my friends viewers why wait and be suffer when there is someone like Dr Sayo that can cure any disease HIV/ CANCER/ HEPATITIS B VIRUS, you can contact his via email: (sayoherbalhealer@gmail.com) check his FB page:  https://www.facebook.com/Sayo-Herbal-Healer-100145798345000/ OR visit his websites website; http://sayoherbalhealer.website2.me/  check blog: https://sayoherbalhealer.blogspot.com/  

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  28. Am Laura Mildred by name, i was diagnosed with Herpes 4 years ago i lived in pain with the knowledge that i wasn't going to ever be well again i contacted so many herbal doctors on this issue and wasted a large sum of money but my condition never got better i was determined to get my life back so one day i saw Mr. Morrison Hansen post on how Dr. Emu saved him from Herpes with herbal medicine i contacted Dr. Emu on his Email: Emutemple@gmail.com we spoke on the issue i told him all that i went through and he told me not to worry that everything will be fine again so he prepared the medicine and send it to me and told me how to use it, after 14 days of usage I went to see the doctor for test,then the result was negative, am the happiest woman on earth now thanks to Dr. Emu God bless you. Email him at: Emutemple@gmail.com Whats-app or Call him: +2347012841542

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