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.

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.

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.

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. 

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.