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I sit at a desk in the Butaro Hospital pharmacy every day, facing a tall window that looks into the courtyard where patients gather and wait for their clinic visits. We sit facing one another, but it seems they usually don’t see me. The fountain ledge where they rest is about 30 feet away and in most instances I’m obscured just enough by the shadow cast by the overhang. More than a window outside, this secret spot provides me with a candid view of the lives of the people we serve, a constant picture of their strength and humility. The exception, of course, is always the children who must be at just the right level to dodge the shadow, there’s no hiding from them. They scamper up to the window, only their eyes reaching over the sill, to watch the Mzungu girl type at her computer. It’s a far cry from the view in the basement pharmacy in Boston.

This morning I face a woman with a large tumor that encompasses the entire right side of her face. I see her dabbing her mouth from time to time, it’s likely that even swallowing is a challenge for her at this point. I imagine the tremendous transport obstacles she has overcome even to be sitting here across from me at this mountaintop hospital and the length of time it must have taken for her to gather money and resources to make the trek, all while her tumor was growing larger. And I imagine the challenges of treatment that lie ahead of her if there is indeed something we can do to reduce its size, either in palliation or possibly even as an attempt to cure. It’s not impossible that we will be able to diagnose, treat, and ultimately restore this woman to full health. In fact, Inshuti Mu Buzima/Partners In Health and our partner health facilities tout some success stories where we have been able to do just that in similar circumstances since we began treating cancer here a few years ago. But there are so many “if’s” to be checked off before this patient can be added to that list of bright spots.

It’s easy to get discouraged from time to time working in healthcare in a remote setting, particularly when working on new and innovative programs like cancer care in rural Rwanda, where there isn’t much of a precedent to follow and everything must be built from the ground up.  There are structural, resource-related, and systems barriers that sometimes can seem insurmountable.  For example, we can create a perfect forecast of medicine needs for the next 6 months, but the order that arrives at our door from the public supply chain may be leaky IV fluid bottles that are not sufficient for our oncology program. I can train staff and work to ensure chemotherapy is administered safely and appropriately while patients are here, but the mountainous landscape and lack of transportation resources means there’s no guarantee they will return to complete their course of treatment. It’s easy to start questioning your work, question whether or not you can overcome these challenges that seem out of your control, question whether you are actually gaining any ground in the fight for global health equity or just treading water.

But glimpses like this into the courtyard re-ignite the fire and push me to find the energy to move forward on days when things feel stagnant. The window provides a constant reminder of why we’re here. My co-fellow and I use our training to do everything in our power to ensure  medications are available for our patients, and to make sure nurses and clinicians are properly trained and have the proper tools to administer them effectively. Because we’ve heard those success stories and we know it’s possible, and in this global health movement we know we must continue fighting to find ways around these barriers to serve this vulnerable population.  We’ll keep doing our part in the pharmacy to secure our star in the order in the hopes that all will be aligned to help this women and the countless others like her that are sure to sit down on that ledge in the years to come.