Kibogora Hospital, Rwanda

I've been increasingly aware of the sad fact that my time with eMiUK is coming to a close in just a few short months.  But if there must be a project to end with, the hospital design for Kibogora Hospital in Rwanda was the perfect one.  


The hospital has been a functioning mission hospital since the first doctor came in the 1960s, after first starting as a dispensary by Free Methodist Missionaries.  Ex-pats pretty much ran the hospital until the genocide in the 1990s.  On Sunday, April 10, 1994 the militias invaded the hospital and killed patients, hospital staff and those who had sought refuge from the violence. It is estimated that 130 men women and children died that afternoon. The hospital has been reopened and re-equipped. Refugees have returned to Kibogora, each with their own story; lost children have been reunited with families and a sense of normality has returned. There is no longer a large expatriate staff at the hospital, the management now being in the hands of Rwandan doctors. Medical assistance is provided by visiting specialists from overseas. Their stay may be for a month or a year, depending on the need and availability of the specialists. Sheila Eterington OBE is now the only medical missionary living permanently at Kibogora.  An amazing British born woman, she has been serving the hospital and the Rwandan people for 28 years and through the war. 

In the 60 or so years the mission has been at Kibogora, the needs of the population have changed but not decreased. Poverty, malaria, AIDS and other debilitating diseases have a devastating effect on many lives. The need for additional funds to treat patients is never ending; the limited medical resources mean that many die who could be cured.  Now the hospital has 250 beds and numerous existing buildings situated on hillside with a significant slope to it.  Recently they were just awarded Reference Hospital Status by the government for the Western Provence of the country.  However, located 240km (a six hour drive) outside of the capital of Kigali, Kirambo is in a very rural and poor region.  It is a great honour for the hospital but it means that much of their facilities and equipment and methods need to be updated and improved.  


Despite the tragedy that engulfed the whole of Rwanda not 20 years ago, the country is amazingly beautiful and well-kept for one of its economic standing.  The last saturday of each month is a national day of community service, where everyone participates in helping to pick up rubbish.  No one is allowed to bring plastic sacks through on the airplane so that no plastic sacks get brought into the country to become litter.  Thus, there is a since of pride and ownership of the country which makes not only the landscape scenery beautiful but the people and the cities as well!

the view outside our guest house

Pre-rwanda, I was mentally preparing myself for a west Africa climate: ridiculously hot, humid, mosquitoes, dust...  only to arrive to a pleasantly warm evening with a cool breeze  and a thunderstorm in the distance, an amazing view situated directly off of Lake Kivu, surrounded by a wealth of amazingly coloured birds, flowers and trees blanketing the rolling topography.  Rwanda definitely made my list of top five beautiful places I've been to.

one of our team nurses at work with the help of one of our team engineers

Despite the beautiful scenery and the amazing ministry, I think what made the trip my favourite yet was the team chemistry that came together in order to serve the hospital during our two weeks in country.  It was the first time an emi team has brought along team members who were not only non-design professionals but were in fact healthcare professionals who could help with the architectural planning as well as more directly serve the hospital during our two weeks with them.  We had an orthopaedic surgeon, a operating theatre nurse, a bio-chemist and a head of nursing along with us on the team, which added a whole new dimension to the trip.  The surgeon stepped in and performed a number of surgeries each day we were there with our operating nurse scrubbing in with him, the head of nurse from Colchester brought along a light-box and held a few training sessions on the importance of hand washing to stop the spread of infection and disease transmission as well as help in business planning and general operating hospital standards, and our bio-chemist helped out in the hospital lab.  On top of all of that, all of them had a hand in surveying the existing site and buildings or spacial planning of the new building designs!  

Proposed Masterplan

Probably the most challenging aspect of the project was the existing site of the hospital.  Across the site there was about a 30 metre drop in elevation with a 20% grade in some places.  The location where Kibogora is in Rwanda is subject to regular power cuts as is all of the country and most any African country.  This means that as a hospital, it would be very unwise to rely on elevators or lifts in buildings.  You can imagine how detrimental a patient moving from a ward to a surgical theatre who gets stuck inside an elevator would be.  With this in mind and the expense and maintenance costs of back-up generators we wanted to solve the problem of the grade by trying to place as many of the functions and spaces where people and equipment get wheeled back and forth from on the same building level with connecting gentle ramps between the floors for staff and public.  This meant not only designing a couple of new buildings but re-planning most of the hospital.  It was, needless to say, a very intense two weeks!
    

Level 1: Paediatrics and Training Centre

 Level 2: Paediatrics and Administration

 Level 3: Mental Health, Outpatients, Staff Changing, Lab, Pharmacy, Storage, Internal Medicine Ward

 Level 4: Diagnostics, Minor Theatres, Isolation, Surgical Ward, Reception, Emergency, Surgical Theatres, Recovery/ITU, Kitchen

Level 5: Neo-Natal, Maternity Theatres, Maternity Ward

Level 6: Chapel, Private Rooms

On our way back from Rwanda, the UK office team members had a chance to stop over for a few days in Kampala, Uganda to visit the eMiEA office.  It was so exciting to see yet another emi office at work and get to share our project with them and see what they were up to!  We saw a traditional tribal dance performance, the headwaters of the Nile in Jinja, as well as the construction progress of the Show Mercy site.  The Show Mercy orphanage was the first project I worked on when I came to the UK office as an intern! It was so exciting to see the buildings that I helped finish drawing up in CAD actually being built!  




In trip-reflection mode, the reoccurring message apparent to me is 'Christ is enough.' 


Philip said, “Lord, show us the Father and that will be enough for us.”
-John 14:8


Although we only had two weeks for a full-on project, although I had never attempted a hospital design in all of its complexities, although my laptop got nicked at the end of the trip, the Lord keeps reminding me that He is enough.  


So the hard work continues until the design and report for Kibogora Hospital are done.  The goal is a completion of the project before our two wonderful interns leave us at the end of May...He is enough!

Thank you to all of you who sent prayers and/or funds to make it possible for this design project to take place!  Keep an eye out for my trip pictures posted on Picasa in the next few days and keep praying for the project completion of the new building designs and masterplan for Kibogora Hospital in Rwanda!!