Sunday, July 31, 2011

Mille Collines: Part Deux

So here we are, my last Sunday in Rwanda falling on the last Sunday of the month.  Besides being a special occasion for me (I guess?), the last Sunday of the month is also umuganda for Seventh Day Adventists... and that’s really all I have to say about that.  When I saw a large group of people with shovels and various other tools (basically the same ones we used yesterday), I asked a guy on the bus into town what was going on, and it would appear there’s actually a decently large population of Adventists here.  Suppose that’s your trivia for the day.

Anyway, the group went to Hotel des Mille Collines this morning for an all day buffet poolside.  For 10,000 RWF ($16.67 USD), you get a decently large buffet (with waffles, pasta, hummus, guacamole, brochettes, burgers, etc.) and access to their pool.  With the buffet advertised to run from 10:00 – 4:00, we had the hope that we could cover all of our meals for the day while hanging out by the only pool I’ve seen in Rwanda.  Of course, the buffet ended up running from 12:15 – 3:00 (“Rwandan time” strikes again)... and they didn’t care to do a last call on the food... but it was still a good time, and I feel like I got my fill on the first couple go rounds.  Moreover, they took Visa, which was particularly nice given my low cash reserve (I’m at the point where I’m pretty sure I have enough to get by, enough so that I don’t want to take out anymore money).  So, that was my day.  I ate food and swam in a pool that I’m convinced is so cold they must actually refrigerate it (probably the only pool I’ve been in where it’s warmer to get out and drip dry). 

Other than Mille Collines, we also had the trip back, which seems to always be an adventure.  A couple days ago we tried coming back around what I assume must be when everyone got off work, and there was a massive line waiting for us, causing us to eventually bail and grab a taxi (usually run from $8-10 USD).  Today we tried our luck at a bus stop closer to our location but away from the usual center of the spokes, and it turned out our bus didn’t stop there.  So, after walking back in the opposite direction, we finally got on our bus.  The good news is that, when the bus finally arrived at the last stop near the bottom of our hill, a neighbor who had seen us at umuganda yesterday stopped us in his pickup truck and offered to take us up the hill (30 minutes turned into 5). It was nice and appreciated.  On the way he told us about more upcoming construction projects, including a “university of tourism” and street-paving (looks like people won’t be washing off their tans as much next year).

As for tonight, we had some euchre games going, and I’ve been getting by munching on my staple snack here: Frosties.

-Scott

For those wanting to avoid the personal-bubble-busting of the bus system or cost of the taxi system (which essentially amounts to people in unmarked cars calling themselves taxi drivers), there are moto-taxis.  These things generally cost around $1 USD to get home, and they are absolutely everywhere... in hordes.  The catch is that they drive like maniacs, bobbing and weaving through traffic which is already iffy to begin with (I've hardly seen any traffic lights, although I have seen a couple).  Moreover, from what I've heard, 70% of traffic accidents involve moto-taxis, and the results aren't pretty.  You'll looking at neurological damage and shattered bones.  But, they're always there if you're willing to roll the dice. 

Saturday, July 30, 2011

Umuganda

So here we are, my last weekend in Rwanda falling on the last weekend of the month.  Besides being a special occasion for me (I guess?), the last Saturday of the month is also umuganda, a day when shops are closed in the mornings and Rwandans are required to do work in their community.  This is essentially what we took part in last week at the AMU near Kibuye (although not officially the same), and we joined in with the one in our neighborhood this morning.  Frankly, we probably accomplished even less than we did while tearing down the building (even with our brick passing expertise), but I suppose it means something that they let us join in.  This time around we were cleaning up a dirt road a ways up the hill from our house, and we obtained some tools to help with the process (probably the dullest of the bunch).  Shovels and hoes tended to be the best at clearing weeds and brush, but I worked with what was essentially a rake (kind of looked like a bent trident) and a machete as dull as a butter knife (likely explains why so many people survived with scars on their heads and necks).  We once again joined in after work had begun, and we had probably finished within an hour.  After that, there was a community meeting held in Kinyarwanda, but we stopped in to say thank you.

After singlehandedly saving that road from certain disaster (possible overgrowth), a group of us decided to walk down to the Rwanda International Trade Fair held in town (about an hour or so walk).  Running for about two weeks, this seemed to be a fairly big deal in town, garnering multiple billboards... but it would probably be comparable to a county fair back stateside.  They brought in a bunch of vendors including ministries of this and that, beer tents, tea tents, people selling everything under the sun (from farm equipment, to bags, to musical instruments), and rickety carnival rides (one of those spinning swing contraptions, which had quite the line).  The one catch was that it was umuganda... and we hadn’t necessarily accounted for that.  Since the expo was a big deal, the general consensus was that it would be open as usual, but it was umuganda... and we waited.  I think we showed up about 11:30, and it didn’t actually open until 1:00.  Thankfully, we were at least let in a little early while most vendors were still setting up, and we went to one of the vendors which was run/managed/something important by a South African.  He gave us some free drinks while we were there and told us they’d be grilling burgers later in the afternoon.  We thanked him and eventually made our way toward the rest of the vendors. 

The good news is that I came away with a fair supply of souvenirs.  The bad news is you definitely win some and lose some in the souvenir game (I feel like my game face breaks down after a while, particularly since this was plausibly our last souvenir day).  Anyway, I walked away from a particular vendor having traded my State hat and still gotten ripped off, but at least it was a fairly fun process, and I bought the hat on sale for $10 a year ago (and it was covered in red dirt/dust by this point).  Also, I took a picture with the guy wearing my MSU hat, easing the pain a bit (I’ll assume picture is worth 1000 Rwandan francs in this case).  Moreover, my HU hat fits better anyway.  And, I’d already lost my sunglasses on the trip, so it seemed fitting that I lose all of my non-liquid sun blocking capabilities (can you tell I’m reasoning through it at this point?)  If nothing else, I’d say there were some wins in the souvenir shopping game to (somewhat) cancel out the losses, and we had a good time at the vender providing free drinks and cheap food.  It turns out that they had a guy from Toronto cooking up cheeseburgers, and I was able to get a double cheeseburger and fries made by a guy who knew how to make a double cheeseburger and fries for $5 USD.  It was a nice respite from Rwandan food, if you could call it that. (I actually like the food here for the most part, but they certainly limit the spices/sodium content, which can be rough on the American palate).  And for the Canadians in the crowd, the cook said he was originally from the Hamilton area, and he had two kids recently graduate from med school, one at McMaster and the other in London.  He was apparently here to open a fastfood joint (I have yet to see one in Kigali) after spending ten years in Siberia opening restaurants. 

So, there’s my day in a nutshell.  Not sure how it got into the nutshell in the first place, but it was probably a slow process if my sense of “Rwanda time” serves me right. 

-Scott

For no reason other than a lack of new pictures, I'm going to talk about the busing system in Kigali.  For 160 RWF (about a quarter), we can take the half hour walk down our hill and hop on a bus to take us into town.  The buses essentially operate in a wheel-and-spoke approach, with all buses running to a central location "in town" and then running back out. I think the key to keeping prices so low is that their "buses" are really just 15 passenger vans, and it's not uncommon to pack 18-20 people into a bus, including the driver and guy handling the money (record is 21 at this point).  If the bus isn't full when you get on, it's your lucky day.  It's now going to take you 2-4 times longer to get where you want to go as you drive a block, attempt to get passengers, drive another block, attempt to get more passengers, and repeat.  So, if the process is so bad, why do you even use it?  Please see the parenthetical of the second sentence above.

Thursday, July 28, 2011

AMU Stars

Pre-Game

Yesterday, we began a sort of AMU doubleheader with members of the AMU Stars, a football team composed of “at risk” kids (based more on home situation than whether or not they have HIV/AIDS).  AMU provides balls, uniforms, and a coach, and they act sort of like a travel team would stateside.  They have a U-10 team, U-13 team, and U-16 team, with the U-16 being based more on “football age” than real age.  (From the sounds of it, it’s common to lie about age in these situations, since many Rwandans come across as young for their age, meaning you end up with some “big kids” in the U-16 age range.)  The teams had games scheduled for this morning, and the intent of AMU was for us to get to know some of the players before having us root them on.

In order to become closer with the kids as planned, AMU set up home visits utilizing three interpreters (splitting us into three groups again).  Prior to heading off, we were provided with one bag of flour + sugar (basically oatmeal) to give to each family as a gift in exchange for letting us visit (this was apparently purchased with funds we raised prior to leaving Michigan).  With bags in hand, we first walked to Samuel’s house, winding through thin alleys between clay houses, and eventually arriving at a tiny three room hut/house with no yard and children collected out front.  We packed into what I suppose could be considered their living room, a space maybe half the size of our bedroom here, with no windows and a single light bulb hanging from the ceiling (surprisingly, they did seem to have electricity in a limited fashion).  While only five of Samuel’s siblings and his mother were visiting with us today, his mother had apparently given birth to 17 children, with 12 surviving.   His father was in prison, and his mother worked various day jobs to support the family.  It was a rough thing to see, but the family was incredibly welcoming and talkative while we were there. 

The trek to Frederic’s home wasn’t any easier or straightforward than that to Samuel’s, requiring us to walk down what I suppose was a steep alley with a deep gutter running down the middle (the gutters here are huge, allowing for necessary drainage in the rainy seasons).  Frederic’s house was somewhat larger, at least having a window in the room in which we met, but his father was also in prison, with his mother working day jobs.  While we never asked about why Samuel’s father was in prison, we learned that Frederic’s father had been accused of taking part in the genocide, and he had been waiting for his gacaca trial for three months.  Being that the 100 day genocide took place 17 years ago, this was a bit of a revelation, although not necessarily surprising.  In fact, it wouldn’t be surprising if Samuel’s father was in prison for similar reasons.  However, for me at least, it did bring up the question of just how many children have been born well after the genocide, only to lose fathers to prison years after the fact.  It’s incredibly hard to sympathize with men who murdered and are now getting (limited) justice, but I do empathize with children who played no part but are now scraping by as the legal system catches up.  (Keeping in mind that rape was used as a weapon in ’94, a genocide survivor close to our program this summer actually spoke to us about children being born as results of rape during the genocide, and their lives seem particularly difficult, as extended family often disown them and mothers struggle with their own trauma.) 

After the morning visits, I went into town on my own to exchange some money and buy some pop (I generally live on warm water and enjoy some flavor when I can get it).  On the ride back, I sat next to a man on the bus who had a linear scar running from his cheek, through his ear, and to the back of his head, with an additional scar on the back of his neck.  It was just another example of how signs of the genocide survive today and people continue to live on. 

Side note: Yesterday we had a first rainfall since we arrived on July 6th.  

The Games
This morning, we met briefly at AMU before heading off to watch the games scheduled against YOSC  (Youth Sports Contact), which I believe has a mission comparable to that of the AMU Stars program. The field, which was part of three tiered complex, was composed entirely of dirt and had goalposts without nets.  Since the field was built on a hill (as are most things around here), one side of the field was walled off by a steep incline and the other had a steep drop into a neighborhood.  The incline was fair game, and it was treated essentially as a wall would be in indoor soccer.  The decline was guarded by ball boys, and teams took throw-ins if the ball went out on that side.  We were stationed with a horde of kids on the hill overlooking the field. 

We arrived at the beginning of the U-10 game, and it was quickly apparent how much the kids cared about the game (if it wasn’t already).  Granted, I don’t know how many of the kids were actually under 10, but it was still impressive seeing them heading the ball around pulling out moves that I may or may not have been able to do in my “prime.”  The AMU stars won that game 1-0, and on came the U-13 teams, from which we had visited players yesterday.  Samuel predicted that their team would score 3 goals, and Frederic predicted a 4-0 blowout.  Sure enough, their team won 4-0 (they must do some serious scouting here).  Throughout the process, the kids surrounding us started paying less attention to the game and more attention to the muzungus around them.  It’s not uncommon for them to want to pet my furry arms/legs, but today was especially full of it.  They were petting my arms, petting my legs, petting my head, petting my eyebrows, rubbing their faces to my arms... If I had a personal-space bubble it had been popped many times over.

After the U-13 game, we made our way to the shade of a tree with the kids and basically hung out there for the duration of the U-16 game.  There was more mauling and some little games of soccer.  While we were over there, we were informed that we would need to put a team together to play against their U-16 team after the game.  With most of the girls in our group having left for lunch, I think we ended up finding 8 of us to play, and they supplied some players to round us out.  Thankfully, they took it plenty easy on us, and we ended up “winning” after their keeper let a shot through his legs... and a spectator by one of the posts deflected the shot in. 

In the process, I got fried.  I had been getting minimal color at best this trip, likely less than I would have back home, and I hadn’t actually applied sunscreen since my first week here.  However, we were outside much longer than planned this morning, and my attempt to put on sunscreen after I had already gotten too much sun was quickly offset by more mauling and petting (they liked to rub sunscreen off of arms and smell it).  The good news is that I wore a shirt all day, meaning I can still sleep at night.  Also, my face and neck seemed to take the least heat, so I should still look okay in a tux. 


Post-Game
After the game, we went back to AMU for some corn (pretty waxy), some Fanta, and a dance party.  I don’t quite understand the reasoning behind it, but it’s apparently a tradition.  They had kids from both AMU and YOSC there, with music pounding through some speakers they set up... and it was a sweaty free-for-all.  I believe we finally got home around 4:30, at which point I was running on a hardboiled egg, some bread, and Fanta (I was actually in the bathroom while the corn was being passed out).  It was a long day, which was compounded by the girls’ demands to go out tonight (remember that they ate at a buffet while the rest of us ran around a dirt field). So, I’m exhausted.   

Like I said before, my camera is toast.  So, here's a picture of my bedroom.  It's pretty bare-bones, with two beds, two mosquito nets, and some windows.  The mosquito nets aren't exactly the most effective devices, just barely reaching down to the bed.  While the nets at the hotel in Kibuye covered the entire bed and reached the floor, you have to tuck these under your pillow and hope that your head or an arm doesn't come out during the night (the mosquitoes are vicious if it happens).  It's even worse if a mosquito manages to spend the night inside the net.

Tuesday, July 26, 2011

Akagera

Today had safari #2 on the docket.  A true safari in comparison to visiting the golden monkeys, we boarded our safari bus at 4:00 AM again this morning and headed to Akagera National Park on the eastern border of Rwanda (by Tanzania).  We once again had Claude the bus driver as well, but this time neither vehicle had a flat (we split ourselves into two groups, and the other group had a flat early in the trip on Friday).  And for those keeping track at home, I have now been to the northern border of the country (Volcanoes National Park), western border of the country (Lake Kivu), and eastern border of the country (Akagera National Park).  Of the three directions we’ve traveled, I’d say this area came across as the poorest, and I noticed that a number of the kids outright held out their hands in a sort of begging gesture rather than waved. (With a mass of kids waving as we pass everywhere we go, it’s likely that a number of them do so in hopes that we’ll stop and give them something, but up to this point begging has been mostly reserved for when we’re walking by some children). 

Anyway, the park is quite large, and it took us 7 hours to get from the southern section to the northern section (a whole lot longer than the golden monkey expedition, which cost twice as much).   From the outset, the safari actually seemed promising.  We saw a bat hanging from the welcome center building, and we saw some baboons, monkeys, and monster storks early on in the trek... and then came the flies.  Two hours of flies.  Constant bombardment of flies.  Biting, blood sucking flies.  We saw a couple fish eagles and some warthogs in what I’ll call the “fly zone,” but it was mostly flies.  These flies could bite through clothes.  These flies also could survive kill shot after kill shot.  They also seemed to revel in the smell of DEET. I was twitchy the whole ride home anytime I thought I felt something, so let’s hope there’s no long-lasting trauma.

After the fly zone, we finally started finding some animals.  We had been warned ahead of time that many of the animals had likely migrated toward the northern end of the park where more water was available (it’s the dry season here), and that seemed to be the case.  Early on in the “animal zone” we saw a number of hippos, water buffalo, and impalas.  The impalas then carried on for the rest of the park (they’re everywhere), and we stopped at a distance from a lake where we could see some elephants through binoculars.  Zebras were another animal in large supply (also everywhere), and we reached a plain with a number of giraffes as well.  Overall, it was a good time, and I was able to borrow someone’s point-and-shoot camera to get a few shots (although they were spread over two SD cards, and my computer seems to only read one of them).  With that said, I’ve decided to share a few pics along with some wikitrivia (I’m going to force you non-clickers to learn something today). 

-Scott

Impalas: The breeding season of impalas, also called rutting, begins toward the end of the wet  season  in May.  The entire affair typically lasts approximately three weeks.  While young are usually born after 6-7 months, the mother has the ability to delay giving birth for an additional month if conditions are harsh.  When giving birth, a female impala will isolate herself from the herd, despite numerous attempts by the male to keep her in his territory.
Zebras: Zebras have excellent eyesight.  It is believed that they can see in color.  Like most ungulates, the zerba has its eyes on the sides of its head, giving it a wide field of view.  Zebras also have night vision, although not as advanced as that of most of their predators.
Giraffes: Old males are sometimes nicknamed "stink bulls."  There are at least eleven main aromatic chemicals in the fur, although indole and 3-methylindole are responsible for most of their smell.  Because the males have a stronger odor than the females, it is also suspected that it has a sexual function.

Monday, July 25, 2011

Demolition

After our 7:00 AM breakfast this morning along the lake (surprisingly prepared on time), we took off for our next destination, of which I’m honestly not sure.  Our schedule (it’s a stretch to call it that) says “AMU Kibuye,” but it took an hour of driving over winding dirt roads to actually get there from our hotel.  However, we’ll just assume it was AMU’s set up in Kibuye.  Once we arrived, we were greeted by a crowd of kids, per usual, and we wandered out of the bus receiving handshakes and stares.  We were under the assumption that we would be teaching little classes on brushing teeth and HIV transmission, but we ended up coming around a building to see a crowd of people tearing down what I believe was an old classroom.  Next thing you know, we were forming lines to haul clay bricks from the rubble.  Rumor has it that AMU brought the community in to help clear out the clay-based building to make room for a sturdier building (made out of actual bricks, rather than clay ones which crumble when passed from person to person). 

After most of the building was demolished and clay bricks piled how off to the side, we went into a dark gym for what we again suspected would be our HIV/toothbrush presentation, but instead we were presented with an hour and a half of singing, dancing, and drumming.  It was a fun (but long) show, which they explained represented how guests of the king would be greeted back in the day.  Once again they asked us to sing a song as well… and once again, we bombed.  Somehow, after some semi-valid possibilities were presented by the group, we ended up singing “A Whole New World” from Aladdin.  Normally you’d be able to brush off a mess like that as a joke, but I feel like they thanked us for our song 3-5 times throughout the rest of the presentation (“Even if [they] couldn’t understand all of the words”).  It would appear that they take songs very seriously, and I hope we’re able to figure out a safe song to sing in the event we’re asked again.

After the welcome ceremony, we attempted to make our way off for lunch (more hand shakes, high fives, fist bumps, stares).  After lunch, we decided to hand out toothbrushes (we brought something like 800), even though we hadn’t presented the topic.  And chaos ensued.  There’s always a mad rush to see what the muzungus are giving away, even if it’s just something like toothbrushes, and this was no different.  A number of the kids were visibly hording them (though they would hide them while asking for one), older kids were stealing from younger kids, and fights broke out over the Colgates (came in boxes rather than bags).  While we ran into this issue a bit with candy at the last AMU compound, the group was generally smaller and more easily controlled, and we had plenty of stickers to go around.  Today, you could just see how desperate people here can be at times (not to mention the commonly uttered phrase “Give me my money,” but that’s really heard anywhere when some older kids see muzungus). 

-Scott

The clay building wasn't the only thing to be demolished today.  My camera also bit the dust (more literally than figuratively).  It had been having trouble already, probably due in part to the generally dusty nature of the country, and today was the last nail in the coffin.  The lens will no longer open, and I am instead greeted with an unpleasant BEEP, BEEP, BEEP... before it turns itself off again.  So, here is one of the last pictures taken with my Samsung SL502. From here on out, I'm just along for the ride.  I'll still try to get some updates up, but I imagine I'll just be inserting unrelated pictures from previous days.

Saturday, July 23, 2011

Lake Kivu

As I mentioned yesterday, our group hopped on a bus to Kibuye this morning, with the first destination being Lake Kivu on the western border of Rwanda.  According to Wikipedia, it’s one of three “exploding lakes,” where mass extinction can occur due to gigantic gaseous discharges.  The concept is fascinating enough that I’ve decided to save you some hyperlink reading and just paste it here:

Scientists hypothesize that sufficient volcanic interaction with the lake's bottom water that has high gas concentrations would heat water, force the methane out of the water, spark a methane explosion, and trigger a nearly simultaneous release of carbon dioxide. The carbon dioxide would then suffocate large numbers of people in the lake basin as the gases roll off the lake surface. It is also possible that the lake could spawn lake tsunamis as gas explodes out of it.”

It apparently happens on a millennial scale, so here’s to hoping it doesn’t pick today or tomorrow to do its thing.  In the meantime, since I seem to have better internet availability here, I’ve decided to go with more of a photo blog this time around.  And here goes. 

We left from Kigali around 9:00 AM this morning, and the drive to Kibuye was over three hours through winding countryside.  It was gorgeous as always, but it was rough on those with weaker stomachs. We stopped a few times to let one or two people vomit (at least they had a good view in the process), and it wouldn't be too much of a stretch to say that half of the group ordered Sprite at lunch.  I wasn't feeling the need to order Sprite, and that may have been for the best when my (whole) Tilapia came out after a 2-3 hour wait.  In all reality, it actually tasted  quite good, although there was limited meat to be found.


The lake itself seems to be full of islands and peninsulas.  Add a seemingly constant fog/mist to the mix, and it appears that some of the islands further out are just floating in the sky.  It's really surreal at times.

We took a boat ride out onto the lake after "lunch" to see the area near the guesthouse where we're staying.  It was nearing sunset by the time we actually loaded up (gets dark around 6:00 PM here), and I tried my best to capture some of the sights with my camera's limited capabilities (it's been having a number of errors lately  making focusing difficult and causing it to randomly shut down on occasion).  It the case of this picture, I tried to show just how much it looked like boats were floating in the sky at times.


After driving around for a bit and checking out some of the surrounding islands, we stopped on a small island with a restaurant (one-room kitchen with outdoor seating).  They had some cute swings and hammocks set up, and a few of us went swimming for a bit (here's to hoping I didn't have a run-in with schisto.

And, there it is. Short and sweet.  We're hanging out with more AMU kids tomorrow morning, bright and early, and I'll aim to have another entry up tomorrow night or Tuesday.

Laundry Day

Today is pretty much a day off, so I did laundry this morning.  Since I think washing machines and dryers are essentially unheard of (it’d be cheaper just to hire someone to do it for you), we just use a soap bucket, a rinse bucket, and our hands.  A washboard or wringer would be great, but that may be a bit of a luxury as well.  Being Rwanda’s dry season, our wet clothes can generally dry over the course of the day, but it does come with its issues (as would be expected).  It’s not uncommon to have bugs climbing over your clothes, and a pair of my shorts ended up splattered in bird poop last week.  Such is life. 

-Scott

Really, this entry was just an excuse to post a picture of the spider I found crawling around my clothes this morning during the washing process.  Welcome to Africa.

Friday, July 22, 2011

Golden Monkeys

A major tourist draw of Rwanda is the ability to visit mountain gorillas (the ones of Gorillas in the Mist fame) in Volcanoes National Park.  It’s a pricey trip, running for over $600 USD when I checked, but we learned that it’s been sold out until October when some people checked.  With around 60 permits available on each day, it seemed that we’d be able to find available dates, but that wasn’t the case.  Even still, there is a separate trip to visit golden monkeys in the bamboo forests of the same park for about 1/6 of the price.  We take the same trip out to a welcome center, mingle with the gorilla-destined muzungus, and watch the same tribal dance over coffee (definitely tourist oriented)... but where they headed up the volcanoes, we hung out around the base.  In the process, I learned something today: When it comes to gorillas, it’s not if you want to visit the gorillas, but how often you want to visit the gorillas.  We talked to multiple people who were there for a repeat gorilla visit (often days in a row) or were splitting up gorilla visits with monkey visits.  It seemed selfish to me given the limited supply of permits, and given the woman we met who backed out of her second visit after finding the previous day too strenuous, but at least I saved some money in the process. 

/rant

Anyway, we left the house around 4 AM this morning, arrived something like 3 hours later, and were hiking by 8:30-ish.  We were at elevation, so the temp was probably only in the 60s (far cry from what it sounds like they’re dealing with back home), and it was even cooler in the shade of bamboo.  The monkeys themselves travel in groups, and our tour guide was in contact with trackers during the hike.  When we finally arrived, we saw a single monkey in the trees, but we quickly learned that they were all over the place.  There were little ones who liked to put on shows, hopping from tree to tree, and larger ones who seemed prone to fights (at least two fights broke out while we were there, dropping to the ground to duke it out a bit).  It was a fun trip, and the volcanoes looked great in the distance.  Even the trip there and back was an experience, with most of the hills (essentially mountains) covered with a patchwork of crops and clay huts.  If there’s one thing to take away from today, it’s that Rwanda is a gorgeous country, with sites to spare. 

-Scott

The bamboo kept the area pretty dark, meaning the monkeys had to be quite close to get a decent shot with the flash.  I ended up shooting a bunch of video (so you could at least see the movement), but I was able to get a few good shots.


Thursday, July 21, 2011

CHUK, 2.0

If you’ve been paying attention, this entry is coming out of order, but I wasn’t feeling the best yesterday... and it was easiest just to write about the current day.  With that said, here’s on overview of my two days at CHUK this week.

My first morning at CHUK got off to a rough start.  We didn’t have a faculty member with us that day to pull some strings (can’t even remember the reason why), so we were mostly left to do the best we could.  Three of us went to the peds morning meeting, but since we didn’t have a doctor with us, they hardly acknowledged us and spoke entirely in French (I’d heard they usually spoke English when we were there).  After trying to stay awake through a meeting that I couldn’t even attempt to follow, we realized that our usual contact in peds wasn’t there either (seems to be my luck)… but we met a couple med students from Belgium who tried to show us around the peds wards for a bit.  They explained that doctors tended to take breaks after the morning meeting, and they weren’t sure when they would show up.  While waiting, I started hanging out with some kids who were tracking us outside of the oncology ward.  Since my camera has become my go-to “toy,” I whipped that out and started showing them how to use it and how to look at their pictures afterward.  They seemed to have a good time, and I got some more interesting pictures out of (some less blurry than others).  A bit of a dilemma arose when a probable parent came out of the oncology ward and brought the camera in to take pictures of patients.  The person went right to straight to a patient with enormous growths on his neck (maybe lymphoma, but I never actually spoke to pediatricians that morning), sat down, and took a picture.  Since I didn’t speak the language, I just took the camera back and went back outside (attempting my best to say “no” without being rude), worried that he was aiming to take pictures of the kids with extreme problems... but I ended up with a picture you’d never get in the US in the process.  I learned that the patient died that night, which didn’t come as too much of a surprise given how much he was struggling to breathe, and I now suspect the person taking the picture was actually his father.  Either way, for better or worse, I now have what is almost undoubtedly the last picture ever taken of him (you can ask me about it when I get back if you really want to see it).

After sitting around for maybe half an hour waiting, we started talking to some Rwandan students to at least learn a little about some patients.  That only went so far, and we ended up heading back to the Smile group for the rest of the morning, where I saw their second noma case of the trip and another cleft lip procedure.  It was really nice having this group available as a sort of back up plan at the hospital, and they were accommodating as always.  The even gave everyone from our group certificates for helping them out over the past two weeks.  In addition to seeing them at the hospital, a few of us have also seen them around town between packing up their portable OR and flying home.  In particular, I spoke with a retired anesthesiologist from the group outside a grocery store who spoke about the importance of doing things like this while there’s still a chance (before residency, setting up a practice, starting a family, etc.).  He expressed hope that hope that we’d at least come back to the mission field at some point, even if it took until we were 67 like him. 
On our second morning at CHUK, I attempted to do internal medicine rounds... and once again, I ran into some issues.  That morning they weren’t actually having a meeting (meaning limited chance to meet up with doctors ahead of time), and our usual contact in IM wasn’t there (seeing a pattern).  A couple of us ended up just wandering around the compound looking for something to do, and we found some Rwandan med students in maternity that helped us out.  One of them took us back IM to help us find a doc (most are young, so students, doctors, and nurses tend to look alike).  We eventually found an intern who was willing to speak in English and explain her patients’ cases, and that took up a chunk of the morning.  I actually spent a fair amount of the time just speaking to the student about various things (more life than medicine), but I’m not too worried about missing out on watching the intern write notes in French.  After the intern wrapped up for the morning, I headed back to peds where our usual contact was there and willing to show us around for a bit.  We spent most of the time in the cardiology department, where we were able to listen to various murmurs.  We also met some kids who can’t be helped here and are on “palliative care” (same with some in oncology), which made for a bittersweet morning.

As with most hospitals here, the afternoons are generally quiet, with the exception of departments like surgery, maternity, emergency, and outpatient.  Because of that, I spent both afternoons in surgery, observing some more orthopedic surgeries and a number of fistula repairs.  On the orthopedic front, a man came in with a cast on his leg, and I originally thought he was just in to have it removed.  Well, it turned out that, once his cast was removed, it was still a mess.  Both the tibia and fibula were fractured, and it looked as though they hadn’t even been set prior to placing the cast.  It could very well be that I don’t know the proper approach for fractures like that (my limited time in the American system has reduced my ability for comparisons), but I suspect it was at least a little off.  As for the fistulas, we observed a fair amount of suturing in the vaginal/anal/perineal region, with the patient awake through all of it again.  My most surreal moment there was when they placed me at the patients head to observe the repair of a fistula between the cervix and bladder caused by a botched C-section.  That’s actually a common place to observe procedures during surgeries (gets you out of the way), but I’ve never had a patient looking at me in the process. 

I believe this blog now has me back on track.  We’re going to be in Kibuye for the next two days, and I don’t know how internet access will work out.  I very well may fall behind again, but it feels good to be caught up again :)

-Scott

If there's one thing you notice with these kids, it's that they're always willing to smile, even when they live their lives in cramped rooms with a number of other sick kids... as some inevitably die around them.  It can be rough looking at pics following days like that.


Kibagabaga

We’ve now progressed to Monday.  We’re three days behind, but my goal is to get caught up by tonight or tomorrow. 

I think I mentioned it before, but Kibagabaga is a district hospital like Nyamata.  However, while the Nyamata hospital is located in more of a rural setting, Kibagabaga is essentially located in a suburb of Kigali.  The surrounding neighborhoods are filled with what I’d consider to be high income housing, and the hospital looks the part.  There are courtyards with well-groomed landscaping, and we went to a guesthouse up the street for lunches in the yard. 

As for the hospital itself, what we saw didn’t differ too much from what was available at Nyamata.  I did internal medicine rounds, observed some surgeries, spent time in maternity, and visited their emergency department.  During the internal medicine rounds, we saw more cases of malaria and likely TB (had double-layered paper masks, so here’s hoping they worked), as well as some patients receiving “palliative care” on their way out.  In regards to palliative care, it doesn’t exactly exist in Rwanda.  For one patient with a gastric carcinoma, his palliative care amounted to IV fluids and a woman (likely relative) holding a bucket for him to spit into.  We actually spoke to the head of the hospital at Kibagabaga who is headed to Harvard later this year to study palliative care and hopefully introduce some reform.  At the moment, it is quite hard to prescribe painkillers like morphine, requiring multiple signatures and red tape.  Psych is another area of medicine sorely lacking in Rwanda (run only by nurses, phenobarb is often prescribed for “epilepsy”)… but, while a few in our group were able to go to the only psychiatric institution in Rwanda, I never spent time observing the system (we were told specifically that the nurses at Kibagabaga preferred we not visit their department after apparently feeling uncomfortable the previous day when a psychiatrist with us visited them). 

Anyway, as for the internal medicine rounds, they were lackluster compared to those at Nyamata.  The doctor wasn’t the best with English, and he made it through about 12 patients in the entire morning.  Given that those patients were only spread between two rooms, and that he was on his cell phone half the time, it was a slow morning.  Just that alone was interesting to see, given how fast pace American medicine tends to be.  Speaking to another physician about the paternalistic approach to medicine in Rwanda, it was suggested that part of the reason for the approach is that doctors are so busy and don’t have enough time to have full conversations with patients.  Keeping in mind that these were the same physicians who had drawn out meetings in the mornings, took half hour breaks between meetings and rounds, and went home at 5:00 every night, it was hard to see where they were coming from.  But I suppose that’s just another difference in approach (and besides the slow rounds, there were loads of patients going through the out-patient department). 

Getting outside of medicine, I spent some time observing a couple surgeries and C-sections.  The surgery department was actually fairly slow the morning I headed that way (seems to be a semi-frequent problem I ran into), but I found a French student who was willing to show me around for the rest of the day (I was the only student at Kibagabaga that morning, and it was a nice surprise).  The surgeries that morning were a hemorrhoidectomy on a woman and a circumcision of an elderly man (a lot messier than on infants).  After that, we went around checking on other departments that also seemed to be having slow days, and wrapped up the morning in the emergency department where a patient had come in with brain trauma after crashing his bike (although not as common with regular bikes, motorcycle accidents are a common problem here). 

While I attempted to observe a live birth within their system here, C-sections are incredibly common once a woman gets referred to a larger hospital from a health center.  So, C-sections were the name of the game.  With the baby out in less than five minutes, the hour-long procedure was really composed primarily of stitching and more stitching.  It came across as a fairly rough procedure, with tearing and yanking, but I suppose it works for them (and I can’t compare it to American approaches).

-Scott

Kibagabaga hosts one of two buildings for multidrug resistant TB cases in Rwanda.  Needless to say, we didn't enter the building. 

Wednesday, July 20, 2011

God and Football

Well, life seems to be catching up with me here.  It’s now Wednesday night, and I’m finally getting around to writing about Sunday.  The good news is that I can generally combine my hospital experiences in single blogs, so we’ll hope I remember enough when I get around to writing that tomorrow or Friday. 

On Sunday morning, a few of us rode with Gloriuse (daughter of Rose, who started AMU) to her church in Kigali.  We weren’t sure what to expect at all, but it ended up coming across as a higher class establishment (read more money), with English as the primary language (seemed to attract muzungus).  In general, it was probably similar to a Baptist church with a large African American community.  The first half was made up of worship music, and a sermon followed, with the offering plates passed in between.  They took a sort of “wall of sound” approach to worship, with two keyboards, a guitar, drums, and at least 10 singers (not really a choir, just worship singers).  Even still, if you’ve been to protestant worship services in the last 5-10, you’d probably know all of the songs.  They even had a muzungu running the sound board... and he started an accompaniment track in the wrong key during the offering... and a mic fell over at one point.  It was a “normal” church.

As for the sermon, it was very directed and specific to Rwandans.  The preacher spoke on work ethic, the necessity of work, and the Biblical basis of work. He still called out TV, still called out prosperity preachers… but he also referenced how nice Rwanda was compared to the Congo, how Rwanda was building their own paradise through their work, and was passionate about students working to pay their way through school.  He also prayed that God help Rwandan leaders and more common requests heard in some US churches (if you replace America with Rwanda).  It drew correlations to American preachers claiming that the US is the best country in the world, but I suppose that’s best left to another discussion. 

In the evening, we went to a place called the “Executive Car Wash” to have supper and watch the Women’s World Cup Final.  I’ve grown used to long waits for food at this point (at least an hour is the norm), but this meal was a mess.  We arrived before 6:00, and we didn’t receive our food until after 8:00… and the meals came out in spurts, spread across 20-30 minutes.  Even then, we had people who didn’t receive all of their food (one person received sides but not a burger, another received a burger without the patty… it was bad).  After all of that, we had to fight about the bill.  They still charged us for food that was never received, and there were a number of drinks tacked onto the bill that may or may not have been ordered but never received (in one case, I ordered a flavor of Fanta that they had run out of, so the waiter brought out other options for me to choose from... and charged us for every option he brought out).  I suppose we should have expected as much from a restaurant named for the attached car wash, but we had heard good things about it.  Anyway, combine that with a US loss and an almost hilariously flat singer in the cab on the way home, and you have a probably the lousiest night of the trip.

TL;DR – Don’t eat at car washes. 

-Scott

After church, there was a large group of kids playing football in the parking lot.  I played with them for a bit and snuck a picture with my camera at my waist.   The ball they used (circled in orange) was made out of twine and the waxy paper that bread comes in.  I heard that they actually sell them in markets, but I thought it was a really good idea nonetheless.  At one point early on we had looked into buying a normal basketball (we have a court outside our house), and they were charging in the range of $40-80 USD.  Since that's outrageous even by our standards, this is a nice alternative.


Saturday, July 16, 2011

Missing: Pair of Sunglasses

On Friday, our group spent the evening at a new pizza restaurant, Onyx, relatively close to our house (30-40 minute walk).  A group of us, myself not included, had eaten there the previous night, and there was a rather pervasive rumor that the owner had offered to feed us all pizza for free if we came back the following night (and some tacked on free drinks).  Naturally, we paid for all of it, but it was still good pizza nonetheless.  I think it probably took up to two hours from the time of ordering for everyone to have their pizzas, but that’s not terribly out of the norm from what I’ve seen so far. 

In the morning, we met with Ken (who’s been organizing the trip) at Onyx and began a 10 minute walk through some neighborhoods to one of AMU’s facilities.  After coming through the gates, we were greeted by a number of kids who wanted to hug and shake hands. The kids were spread between a building and the lawn, and I went into the building (just a large open room with chairs and a stage) to essentially mingle.  It started fairly cordially, with all of us sitting in a large circle, making necklaces and bracelets with pipe cleaners, and giving brief introductions.  It then started moving closer to organized chaos, with the first step being the introduction of cameras.  A number of us had brought cameras, and the kids were all over them.  While the camera I brought has been nice for pocketability and basic shots, it’s not particularly valuable or high quality, and I had no problem handing it off to the kids (first to David, then to Frederick, then through an unknown number of hands before ending with Marcel).  I was later asked if I had been worried about my camera being dropped or damaged, and I really wasn’t.  By the end of our time there, I wound up with over 400 pictures, some actually pretty good and some of unrecognizably blurry blobs.  But most of all, I had free photographers for the day, freeing up my hands in the process, and ending up with lots of pictures from kids’ points of views. 

The move to disorder continued with the introduction of chalk and stickers.  Things went fast, so I’m not actually sure how much chalk we handed out, but it seemed to keep a chunk of kids busy.  As for the stickers, we had ample supply, and most of us were riddled with them by the end.  Even the empty sticker sheets became “masks,” and I was still finding hidden stickers in the shower last night (thankfully I found all of the ones on visible skin, so I didn’t end up with any flower shaped tan lines). 

After all of that, we rearranged chairs in the building to face the stage, and the kids had a couple songs to sing (with two men on keyboard and tambourine off to the side).  This was followed by a dance competition between select kids from prearranged “groups” and some MSU students.  The festivities were wrapped up by bringing us up on stage to introduce ourselves (name, age, and state of origin) and sing a song for the kids.  This part definitely wasn’t preplanned, and we ended up singing an A capella rendition of I Want it That Way by the Backstreet Boys... for whatever reason.  Before sending everyone home for the day, we served them lunch and hung out a little longer. 

Throughout the process, you wouldn’t know the kids had HIV/AIDS.  They were just normal kids having a good time, doing kung-fu poses for the camera and attempting to imitate Michael Jackson (the young version that sang and danced, not the one that hung children over balconies).  I ended up losing my sunglasses in the process ($10 Walmart special), but I’d say I lost more than that.  It looks like I’ll be leaving a piece of my heart in Rwanda as well. (This cheese goes to 11!)

-Scott

One plus with handing off my camera is that I actually got to be in some pictures rather than hiding behind the camera.  Here being sported by the probable perpetrator, you can see that I decorated my sunglasses with pipe cleaners before handing them off.  Also, if you check out my neck, you can also see a necklace that they made for me.  Since they put it on while I wasn't looking, I honestly didn't see how color coordinated it was until after I took it off to avoid a necklace tan line (orange with white and black).  Pretty impressive.


Amputation

I ran into more internet problems between uploading this and the previous entry.  With that said, this is part 2 describing Thursday’s adventures at CHUK (a day late and two dollars short?).  I can’t really complain… I’m using the internet in sub-Saharan Africa.

While the morning took on more of an uplifting tone, the afternoon shot that down a fair amount. The Alliance for Smiles group had finished checking in patients for the day (some girls in the group helped with that earlier in the day), and we figured it would be worth finding something else to observe within the local system.  With the addition of a French speaking student, we decided to try our hand in the surgery department again.  This time around we spoke with a nurse in the preparation area who told us we could talk to a surgeon in a staff room… but we couldn’t enter the main portion of the surgery building, which was a “sterile area.” I then pulled out some stuff I had saved from the smile group (hair net, shoe covers, mask), asked if those would work, and we were in.  The situation served as an example of the kind of interesting approach to sterility and sanitation that I’ve seen in the country.  The doctors that I’ve seen have generally been trying to move closer toward what we would recognize as proper precautions, but I’ve also seen a nurse in the OR put on gloves just to pick up her phone when it rang… and then hand something to the surgeon (just one example).  It’s progress, but it still wouldn’t fly stateside.  

Once in, we walked in on an orthopedic surgery involving a shattered femur.  We didn’t stay terribly long since the surgeon we initially talked to said he would be performing an amputation soon, but it was a sight to behold.  The patient’s thigh had been opened wide with a ~12 inch incision, and the broken pieces were in plain sight.  We were shown X-rays of the leg, but it really wasn’t necessary at that point in the procedure.  Besides walking in to see a leg hanging open, the most surprising aspect of the surgery was that the patient was still awake, staring at us.  I’ve heard that there are limited anesthesia options here, and our amputation patient was awake throughout the procedure as well…

The patient being prepped for the amputation above the ankle was a woman about my age, whose foot had failed to heal properly after a mid-foot amputation a few years ago.  The surgeon performing the amputation came across as rather young, but he took more of an interest in pointing things out as he went along.  Given that he needed to cut through the entire lower leg, it became an anatomy refresher course with more wincing and more squirting (he could at least cauterize arteries, but we still observed a number of spurts).  As for the procedure itself, it turned out to be a bumpy ride.  If there’s one thing to be taken away from my time in Rwanda, it’s that they work with what they have (like using an NG tube for a catheter), but limited resources can really be problematic on occasion.  The surgeon seemed to do fine getting through skin and muscle, but getting through bone naturally required some sort of saw.  He started with what was comparable to a Dremel with a relatively dull blade.  This actually worked adequately on the first time through, but he realized that not enough tissue had been left to close the wound after removing the foot.  After failing to cut off more bone with blades meant for single use (not sure how many times they had already been used and autoclaved), he told us we would be going “back to the stone age.”  Out came the bone saw.  He seemed to get through most of the fibula, and he broke off the rest with some twisting.  The tibia, however, proved more difficult.  Out came a chisel.  After failing with the chisel, we went back to the bone saw.  Now, keep in mind that the patient was awake through all of this.  Not only that, but the nurse assisting on the surgery had placed the severed foot in view of the patient after removal (another student in the OR with me said he saw the patient’s heart rate jump from 60 bpm to 90 bpm).  The patient eventually pointed it out to another nurse in the room who had the first assistant cover it up, but it was likely half an hour later at that point. (Another student and I had initially tried to slide the table holding the foot out of the line of site, but it was a sterile table which prevented much movement.  We were also attempting to limit the amount of attention drawn to the missing appendage.)  After noticing the surgeon’s frustration building due to difficulty closing the wound, among everything else, we thanked him for his time and told him that our ride had arrived. 

While this was certainly a less than stellar procedure to sit in on, it’s hard to blame the surgeon or the system.  He probably could have left some more tissue to work with in his initial incisions; but he couldn’t control the issue with supplies, and he didn’t know the patient would have some sort of pathology that toughened the tissue around the bones (either due to inflammation from complications from the previous amputation or impaired circulation from a gunshot to the buttock in ’94).  It was a tough situation that just seems more likely to happen in a system making do with what they have. 

-Scott

Once again, since I didn't take any pictures today, here's a picture of the Rwandan flag.


Thursday, July 14, 2011

"Because every child deserves a smile"

Yesterday was my third and final day in Nyamata, and it was expected that my group would move on to another district hospital in Kibagabaga.  However, our primary contact in Nyamata was scheduled to be out of the hospital today and asked that we skip his hospital until next week (they only have a total of ten doctors, and we only worked with 3-4 of them while we were there).  In an attempt to sort out the dilemma and make things fair for students, we were sent to CHUK instead (I already had two days planned at this university hospital next week).  This shouldn’t have been a problem given that the hospital is larger than Nyamata and Kibagabaga combined, but this also turned out to be the day that 6th year medical students had their oral exams… which were being proctored by many of the doctors.  When we arrived, half of the group headed to peds, and my half of the group headed to internal medicine.  We had contacts in each, and it sounds like the peds morning moved along as expected.  However, when we finally found our contact in internal medicine (a resident from Yale), we learned that the normal morning meeting had been canceled and rounds postponed due to the testing.  He gave us his number and told us to call him if we couldn’t find anything else to do, but we were basically on our own.  I’d say we got a decent lay of the land as we wandered aimlessly looking for doctors willing to show us around, but we eventually gave up after being turned away from the surgery department (they still had their meeting, and they weren’t all that pleased that we walked in on them).  Having heard of a group of Americans in Kigali to repair cleft lips and palates for a couple weeks, we set off to find them in a corner of the compound. 

The Alliance for Smiles is essentially made up of retired plastic surgeons and nurses (and non-retirees as well) who travel to developing countries setting up multiple clinics each year.  They’re a great bunch of people, and we had learned from the previous CHUK group that they loved to chat if you had the time.  However, we also learned that they had run into trouble finding patients, performing just a few operations the past two days (a really tragic situation when spending tens of thousands of dollars to essentially fly in your own OR).  Thankfully, we arrived at their ophthalmology-turned-plastic surgery building to find a congregation of patients and family members waiting outside.  The staff were in especially good spirits when we met them, and they brought us right in to see the first patients (after tossing us hair nets, masks, and booties).

The OR had two beds, with a team consisting of a surgeon, anesthesiologist and nurses at each.  While one bed moved relatively quickly through cleft lip cases (all babies this morning), the other prepped for a facial reconstruction on a noma patient.  The operation was scheduled to take 4.25 hours, and I believe they used all of that (and possibly more).  For those fighting off the urge to click on my hyperlinks (right click, open in new tab), noma is an infection that essentially leads to destruction of the face and mouth.  It’s rarely seen in developed countries, but it’s still an issue in sub-Saharan countries like Rwanda.  In the case of our 13-year-old patient, it was clear that a large portion of her mouth and nose had been eaten away (and then reformed improperly with scar tissue).  It was a discouraging thing to see, but Dr. Z, an arthritic plastic surgeon with a bark worse than his bite, did a great job.  After twisting and bending my back for four hours in attempts to lessen the pain of constant standing, the patient had a face again.  She’ll still need reconstructive surgery for her nose on another date (which probably won’t happen), but it looked as though the biggest step was complete.

No one knew that this group would be here for the two weeks that overlapped our time in the Rwandan hospital system (or that we’d find a resident from Yale over here for that matter), but some things just work out better than you’d expect.  

Since I didn't take any pictures today, here's a picture of a Rwandan sunset.

Tuesday, July 12, 2011

Nyamata

Today marked my third day exploring the Rwandan medical system.  Per usual, I’ll start with some background.  Rwanda has a universal healthcare system, with each citizen receiving government aid.  The hospitals are set up with a tiered approach, with more people being served by higher level hospitals.  At the bottom of the ladder are (very) low educated health workers who each cover 10-20 homes.  At the next level are health centers that cover 25-30,000 people; these centers include departments for family planning (showing education videos), vaccinations, normal delivery, nutrition, HIV patients, general consults for adults and peds, and pharmaceuticals.  Patients can be referred from there to district hospitals that cover 6-15 health centers.  From there, patients can be referred to university teaching hospitals (for the nasty stuff). 

Since we have lined up three hospitals at which to visit this summer, our group of 15 has been split into three groups of five, with my group starting at a district hospital in Nyamata.  It’s all open air, which is to be expected in a warm climate (same approach in Florida and Costa Rica).  Patients are packed into the rooms, with up to ten beds in a room.  The wards have a particular stench about them that you can’t really pinpoint (pediatrics in particular), and it looked as though there was vomit or feces splattered on the walls.  Lines of patients wait outside of the two outpatient rooms, and a guard with an AK-47 sits outside of the building housing ill prisoners (dressed in orange or pink scrubs).  Since there are no hospital staff to feed or care for in-house patients, family members may be found out back cooking food, sitting on beds with patients, or waiting on benches outside of the buildings. Even though the country is moving to English, all of the signs are written in French or Kinyarwanda, and the medical personnel speak entirely in French in the morning meetings.  With all of that said, many of the doctors speak English well, they are quite knowledgeable, they seem proud of their system compared to others in the region, and they love to teach. 

Although I’ve heard stories of strange congenital abnormalities and extreme cases coming from students at one of the teaching hospitals in Kigali (where I’ll be next week), Nyamata has been great for learning about tropical diseases, anemias, and malnutrition.  Although rarely seen stateside, it’s actually quite common to see patients with various parasitic infections like amoebiasis and malaria (malaria is actually high up on the differential in cases of fever).  I also had a doctor teach me about different kinds of tuberculosis using X-rays of patients that he currently had under his watch.  Over in maternity, the rest of the group observed births and C-sections (I’ll hopefully head over to that department in the next hospital), and I observed a number of ultrasounds of both live and dead fetuses (fetal death seems to happen too often, with pregnant mothers displaying varying emotions ranging from upset to apparent disinterest). 

Over in the outpatient department (OPD), we primarily get to observe the paternal approach of the physicians in full effect.  Patients are called into an office one at a time, and the doctor will ask questions of the patient in French or Kinyarwanda.  After a brief discussion, the doctor will either write a script as the patient sits quietly or tell the patient to sit on the exam table.  If the doctor writes a script, he will hand it to the patient with specific instructions and little conversation.  If the patient is told to sit on the table, they will do whatever they are told without hesitation, including disrobing (both tops and bottoms).  As one example, another male student and I observed as a male doctor manually examined a woman’s cervix without a speculum or female observer in the room.  Going along with limited discussion, I also learned today that patients are not told if they are being tested for “cancer.”  Instead, they are told that the biopsy is testing for neoplasm, adenocarcinoma, etc.  It’s far from what you’d see (or I’ve seen) in the U.S., but it’s just they way they operate here. While the American patient is generally becoming more knowledgeable, empowered, and demanding, I’m told the Rwandan patient would likely question the doctor’s competence if asked about opinions on treatments.  Once again, it’s different, but not necessarily wrong in this context. 

Along with many Rwandans supposedly lacking the knowledge to have a meaningful clinical discussion, “traditional” and herbal medications are commonplace among some patients.  Just this morning I saw a sick baby whose abdomen was covered in scars from an attempt at traditional healing.  I also saw a toddler whose forehead was scarred from the mother pressing hot knives against her head in an attempt to alleviate a fever/headache.  In another case, a man with malaria had stopped taking his prescribed medication in favor of herbal medications.  He had such and extreme case of splenomegaly that the spleen extended down below his umbilicus (it should normally be tucked up within the rib cage).  And in yet another case, I met an HIV patient who had stopped taking her antiretrovirals a few months ago but continued to breastfeed her child without hesitation in front of us.  While we are taught to respect such traditional practices and attempt to work alongside them if possible, it’s as saddening as it is frustrating to see children covered in scars and fed tainted breast milk. 

In addition to my time at Nyamata, I was also given the opportunity to travel to one of the health centers in a village 45 minutes from the district hospital.  A doctor will visit a given center once a week (it’s primarily run by nurses), and I rode out with one this afternoon.  Our stay was actually shorter than the ride out there, but I was able to meet some patients in the HIV department and see some cute kids around the facility.  In reality, though, I’d say the best parts of the experience were just flying (read bouncing) across dirt roads and seeing Rwanda outside of the city.  The thousand hills aren’t reserved solely for Kigali.

I was without internet for the majority of yesterday for whatever reason (seems to happen here), so I attempted to fit some of today’s experiences into the blog I wrote up yesterday.  I proofed it once, but it could still be an iffy read as a result.  

-Scott

Along with seeing TB on X-ray at Nyamata, we also came across a patient with silicosis. The man had been working in a mine for only a few years but claimed that eight of his coworkers had already died from complications.  He was only in his 20s.  For those interested, a normal long should look more like this.  Wikipedia side note: Pneumonoultramicroscopicsilicovolcanoconiosis, apparently the longest English word in the world, describes a particular type of silicosis.)

Monday, July 11, 2011

Hotel Rwanda

If you haven’t seen the film Hotel Rwanda starring Don Cheadle, I advise you do so.  With that said, here’s an overview of the story from 30,000 feet.  As the genocide takes place in Kigali, a four star hotel becomes a safe haven of sorts.  The temporary manager, Paul Rusesabagina, uses his connections to protect over 1000 people from death.  The movie was based on a true story, and it was nominated for three Oscars.  There’s since been some controversy surrounding the story as Rusesabagina (a Hutu) has called out the current president and government (installed after the Tutsi-led RPF took the capital), but it’s good story nonetheless.

Anyway, as I mentioned before, Rwanda is known as the Land of a Thousand Hills, and the story centers on the Hotel des Mille Collines (hotel of a thousand hills).  While the movie was filmed at a hotel in South Africa, it is in fact a real place in downtown Kigali, and they offer day passes to their pool for 5000 Rawanda Francs ($8.33 USD).  Our group took up the offer on Saturday, and it was somewhat of a surreal experience.  To many outside of the country the hotel is known for its role in the genocide, but the reality is that it’s still a hotel.  There are still workers to pay and bills to be met.  In effect, they’ve moved on because they had to move on.  It’s an interesting situation that seems to permeate the country, and it was one of the main reasons for instigating the Gacaca courts. Sentencing confessed murderers to anything less than life in prison seems unthinkable, but locking away 100,000 accused criminals in a land of 12 million just isn’t feasible.  For more on the topic, read this article by Philip Gourevitch (it’s long but good). 

If you’ve paid attention to my few facebook statuses, you’ll know that today was my first day in the hospitals.  However, I’m still behind on my posts, so I probably won’t begin discussing that until tomorrow or Wednesday. 

-Scott  

A bottle of coke generally costs around 300 RF ($0.50 USD) at local bars, with prices extending up to 1000 RF ($1.67 USD) at fancier restaurants.  A bottle of coke costs 1500 RF ($2.50) at Hotel des Mille Collines.  Here is my 1500 RF coke bottle sitting poolside.


David, age 10, killed by machete

A few days ago our group of students visited the Kigali Memorial Center in downtown Kigali.  The grounds include some memorial gardens, a museum documenting the 1994 genocide, and mass graves containing around 250,000 genocide victims.  It’s both impressive and informative.  We took a generally self-led tour using audio guides that began with a flame that burns for 100 days every April-July (to signify the ~100 days of genocide).  We then walked past the rows of mass graves, with one grave still prior to completion (they continue to transfer bodies to the site as more graves are found elsewhere).  After that we walked through gardens with varying meanings and fountains representing unity followed by division.  The museum itself was created by the same group that designed the Holocaust Centre in the UK, and it looks like it was made with as much care.  All captions are written in Kinyarwanda, French, and English, and video clips provide options for subtitles. 

As a little background, since the genocide was so widespread, Rwanda enacted a judicial process called Gacaca courts for perpetrators of the genocide.  Here, people could confess to murders (aka “work”) in exchange for reduced sentences (i.e. 10 years of prison for 10+ murders).  One of the most interesting videos in the museum was of a man listing off who he had killed at such a court.  He showed no remorse and almost seemed put off by the questioning.  Keeping in mind that the Hutu were killing the Tutsis during the genocide, he also explained how he prevented the death of a Hutu woman who had married a Tutsi.  While he hacked her arm with a machete for her choice of a spouse, he made it sound as though it would have been barbaric to let others kill her for her spouse alone.  It was as disturbing as it was fascinating.

The museum tour winds down with some history of other genocides (e.g. The Holocaust, Cambodia, Bosnia) and ends with rooms dedicated to children of the genocide.  Sparsely decorated, the rooms present brief pictures of children who were murdered 17 years ago.  Each picture is accompanied by the child’s name, age at death, favorite food, aspirations in life, and mode of death.  One example that stood out was David who wanted to be a doctor.  Killed by machete at 10 years of age. 

-Scott

A line of roses has been laid along the edge of a mass grave along the outskirts of the memorial grounds.  Noticing a few red roses mixed in with mostly white, I took the opportunity to take a picture drawing focus to the individual in the sea of death.