Coming Home

We're both relaxing in the Brussels airport right now so we decided to do a joint blog about our experiences.

Drew:
This past month was one of the fastest months I've ever experienced. It started out overwhelming and a little scary, but it ended as an amazing experience that I'm so thankful to have been able to do. All three of the settings I worked in were wonderful, and I feel that I learned a ton every day I went to work. Actually, I think one of the biggest things I gained from this experience was confidence. Every resident goes through periods of worry about whether he or she will be ready to practice on their own when they finish. Of course, I am not immune to this problem. When I first was thrown into the work at the hospital, I almost freaked out. I didn't speak the language, I didn't know the diseases, the uses of the medications were a little different, and I had never really worked without supervision. The first few days, and several periodic instances afterward, were frustrating. I was told I would have a "what have I gotten myself into?" moment, and that prediction was correct. However, now that I've completed my month, I think that I did a pretty good job given the limited resources we had. I think I was able to help a bunch of children and families, and I even think I did a little education to some of the health care workers in Rwanda. I'll give a big thank you to my dad and Dr. Elliott for helping me with some infectious disease questions. In the end, I was able to practice pediatrics in an unfamiliar environment, and I felt that first feeling of wanting to be on my own and do things the way I thought they should be done. It was a wonderful feeling of independence, and it makes me even more excited about finishing residency and joining a practice next year.

I also greatly enjoyed working with families and communities that did not have many resources. I've enjoyed this in Tucson, working in a clinic where many families have less money. I've wanted to find a spot in Nashville that works with similar patients, but this experience just confirms my desire. I hope that wherever I end up next year, I will be able to feel this same sense of purpose that I'm feeling right now.

As far as non-medical things go, I've absolutely loved meeting the Rwandan people and immersing myself in their culture a little. Looking back, we could have done so much more, but living in Kibungo has been wonderful. I was really sad when our bus pulled away from the town, and I wish I would have been able to communicate a little better in order to feel more a part of the community. I would definitely love to come back to Africa some day, and I hope that Rwanda can be on that itinerary. I'd love to see how far the country progresses over the next few years, and I hope that it can maintain it's inspiring example of forgiveness and reconciliation.

Now I go back to Tucson, getting ready to work two weeks of nights. I think it will be a little easier adjusting due to the time zone differences, but it's still going to take some time. I hear that reverse culture shock can sometimes be worse than the initial shock of traveling to a foreign land, and I hope that I'm prepared to rejoin the community back in Tucson. It's going to be weird having reliable water, water pressure, and electricity, but I can't wait to enjoy it again. I'm also really looking forward to some food variety, although our diet of potatoes, rice, and beans was quite delicious at times. We'll have to keep making melange with brochettes occasionally.


Emily:
As we sit here in the Brussels airport, it feels like it was just yesterday when we were here waiting to get on a plane to Africa. I remember feeling so excited and extremely nervous all at the same time. Before we had even arrived, I was having the "what have we gotten ourselves into?" moment Drew described above. When we finally landed in Kigali and met our hosts, the nervousness started to subside, as we learned how to navigate the city and met the kind and generous people of Rwanda. Everywhere we went, people wanted to ask questions, practice their English, or just make sure we were on the right bus at the right time. I soon felt safe and secure in this new place and began to settle in.

Over the course of the month, we definitely had our ups and downs, especially as we struggled through the language barriers, but overall the experience was amazing. Like Drew, I look forward to coming back to Africa and Rwanda one day and learning more about the culture and seeing the progress. Yesterday, as we were leaving Kibungo, Drew asked me what my favorite part of the trip was. My initial reaction was my daily interactions with the kids at the orphanage, but as I think more about it, I think it is something more. My favorite thing about our month was seeing a community of people taking care of each other. At the orphanage, people visited the children of deceased neighbors, and the teachers working there had so much love for the children. On the garden projects I helped with, neighbors came together to help prepare the ground and plant. Even for us, when we were in town (despite the stares and calls of "muzungu"), people were ready to help us find the right store or bus, or let us practice our broken kinyarwanda, trying to understand.

The other day, I accompanied Tom to an English class he was teaching for adults in town, and I ended up "teaching" the Beginners section with Teo (Theophile). Many of the students were nervous to speak English in front of me, or hesitant to talk to me...unsure of this new American teacher. Towards the middle of the lesson, Teo stopped talking about objects around the house, and askd the students to cast aside their fears. He talked about how new things (like speaking English) and new people (like me) can be scary sometimes, but we have to cast our fears aside and embrace the new experiences. He went on to say that he had only met me a couple weeks ago, but had made a new friend, and embraced me in a hug. He described to the students that only by facing our fears can we become better humans that are able to accept and join the world around us and beyond us. Many of the students began nodding and started to participate a little more for the rest of the lesson. His mini-lesson struck me as the perfect summary of my experience over the past month. I was fearful and anxious at times, but I had to throw these fears aside in order to embrace new experiences and new friends. It was a beautiful way to encourage the students, and I was thankful he had put it into words for them. The class will be blessed to have such a teacher for their beginner lessons, and I am blessed to have had such an experience.

A Day Trip to Rusumo Gone Awry...

Being sick when you are far away from home is miserable.  When you aren’t feeling well, the last thing you want to deal with is new situations, language barriers, and other challenges.  A comfortable, familiar bed, a warm cup of tea, and a loved one to dote on you is really the best medicine.  Fortunately for me I have a loving husband that has made the last few days less miserable, but oh I really could have used my own bed!  Now, don’t get me wrong I have had some amazing experiences over the last few days, but I can’t ignore the little black cloud that has been following me around, especially today.

It all started last Thursday morning when I woke up feeling nauseous with a major case of heartburn.  Signs soon showed that I was having a reaction to the dreaded malaria medicine.  I had become too confident that I was going to make it through the month with little to no side effects, and the medicine gods were having their revenge.  I tried to eat throughout the day with a side of Tums at every meal, but the pain in my stomach would just not subside.  Progressively, over the next couple days, the pain got so bad that I couldn’t eat without tears coming to my eyes.  In preparation for our visit to the gorillas, I knew I would need a lot of energy, so I tried not taking my malaria pill the day before in hopes that the side effects would wear off, but it appeared the damage had been done.  My esophagus had been irritated by the pill and acid, and every time I eat, it irritates it further.  If I try to delay eating though (in hopes of allowing it to heal a little), I get irritated and no one is happy.  So, a once enjoyable experience has turned into a miserable chore, necessary for sustenance.

Like I mentioned before though, the amazing experiences I have been having during this misery (gorilla trekking – wow!, public health day – amazing!) have been able to push the black cloud away, and it hasn’t really affected my mood too much…until today, that is.  Let me back up a little…

For the past couple weeks, Drew and I have been trying to decide on a day trip we could take during our final week.  Many people had told us to try to go to Akageera National Park, which is Rwanda’s much smaller version of the large game parks in Kenya and Tanzania.  While it doesn’t have the land space or number of animals that the other countries do, it is supposed to be a pretty great experience (especially if you have never safaried before).  It also only an hour and a half from Kibungo.  We decided this would be our day trip.  After calling several tour companies, we soon discovered that it wouldn’t be so easy to organize the trip from Kibungo, since many of the cars come out of Kigali which is 2 hours a way.  It was going to cost several hundred dollars to arrange, and after the gorilla experience, our pockets were feeling empty, so we decided to find another trip and save our money for one day when we could come back to visit one of the other big parks for a true safari.  Instead, we decided to visit a town called Rusumo.

Rusomo sits on the border of Rwanda and Tanzania.  There is a river that runs along the border of the two countries in this area, and right at the border crossing, the river forms a large waterfall, “chutes de Rusumo.”  The views in the area are also pretty spectacular.  We had heard that it was cheap and easy to get to Rusumo by bus, and that there was a great hill with a nice hike you could do to look down over the border and the falls.  Also, on the way to Rusumo, there is a town with a co-op where you can watch Rwandan artists create dung paintings.  So, we decided to pack a lunch, take the hour-long bus trip to Rusumo to see the falls, do the hike, and then stop off at the co-op on the way home…perfect day trip!

Well, except, when we arrived in Rusumo, things didn’t quite work out the way everyone had said they would.  There is a bridge across the river from Rwanda to Tanzania that overlooks the falls.  It is a great spot to take photos and watch the huge rush of water.  We were told that you could walk out onto the bridge without a problem to see the falls.  Well things weren’t exactly so easy.  As we started across the bridge, a Rwandan police officer stopped us and asked what we were doing.  We told him we were taking photos of the falls, but were planning on staying in Rwanda.  He said something about immigration, and we told him again we weren’t crossing the border.  He didn’t really respond, so we kept walking across the bridge, and when he didn’t immediately follow, we thought we were ok.  Well a few minutes later, he came out onto the bridge and something again about immigration.  We decided to go back and see what it was all about.  When we got to the immigration office and told the border officer what we were trying to do, he kind of laughed, took our passports, asked a few questions, and then wrote a handwritten note saying, “Please allow them to walk on the bridge to take photographs of waterfall only.”  He told us to give it to the police officer.  We went back down to the bridge and the officer let us pass.  After a few more minutes looking at the falls, we decided to start on our hike up the hill.

Well, when we got to the turn off where we were told to start up the hill, we found a gate and a police officer.  We decided to keep walking up the road and collect ourselves before making conversation with our second police officer of the day.  After about 30 minutes, we walked back ready to talk to the officer and start our hike up the hill for lunch.  We asked the officer if we could pass the gate and continue up the hill to look over the falls and see the view.  At first, he just said no, but then asked why we wanted to go up there.  We said again that we were hoping to see the view.  He told us to go down to the bridge and see it from there.  We told him we had been there already and were hoping to see it from the hilltop.  He then started laughing at us, and said that it was too dangerous and we could not pass because of the snakes.  We told him we would watch out for snakes, and some friends had said it was a good view from atop the hill.  He then said no again, and we turned around and walked back to bus station, defeated.  The sun was beating down, Drew and I were both hungry, since we had now missed our picnic lunch, and no one seemed to understand what we were trying to do, or just thought it was outright comical.  I was at my wit’s end!  So, we decided to climb back on the bus and head towards home.

As we left Rusumo and got to the next town, it started pouring down rain, so we quickly decided after our luck earlier that morning that we probably shouldn’t stop at the co-op. We did not feel like getting stranded in rainstorm in the middle of nowhere.  Anyway, we made it back to Kibungo safely, and told our story.  It seems that there is heightened security for some reason at the border, as no one else had the same experience with so many police officers and gates at the falls.  The falls were pretty cool to see, and we got to “see” Tanzania from across the river, so that is cool too.  I was just glad to have Drew along this morning, as I know there were a couple times when I would have had a breakdown and begun crying.  The Rwandans really wouldn’t have known what to think of me then!  I also feel pretty lucky that this was the first experience we have had that didn’t go as planned, and it fell at the end of the trip.  If it had been at the start, we probably would have lost a little confidence in navigating the country, while now we can look at it as just one rough incident among many great experiences.

I am starting to feel better, though only since I have decided to stop taking my malaria medicine for a few days until I can recover.  I cannot believe we only have 2 days left.  I am looking forward to helping on another garden project tomorrow and visiting the orphanage for a couple more afternoons.  I know we will leave on a good note.

Health Day in Gashanda

We finally had our public health day in Rwanda. Actually, when I first heard about the opportunity in Rwanda, the clinic in Gashanda was where I was supposed to work. Over time, it evolved into a mixture of clinic and hospital work, and I’ve greatly enjoyed my experience. However, it was nice to see the rural setting I had originally envisioned. Here’s some background on the clinic. I’m volunteering for an organization called Humanity for Children, which is based out of the US. They’ve set up two clinics in the area that are eventually to be used as health centers for the rural population. As it stands now, the people in that area have to walk a long way to be seen by a health professional. On of our hosts in Kibungo, Tom, helps to organize community health days whenever a volunteer pediatrician is here. The days are usually attended by a public health nurse, a nutritionist, and several other volunteers who help to run the clinic. The clinics are not open yet due to problems getting final approval from the Rwandan government and a lack of money due to donation shortcomings back in America due to the recent economical situation. Regardless, every time they have done a health day it has been extremely successful and much appreciated by the local population

My first feelings about doing a day like this were filled with apprehension. I would be the only doctor present in a foreign atmosphere. I was just coming to terms with practicing on my own back home, and doing it in Rwanda was very intimidating. Luckily, I’ve learned much since arriving in Kibungo, especially from working in the public health center where I’ve had nurses to help me get used to how things typically run here. The last days leading up to the day found me excited, although I still felt pretty humbled that so much work was being done so that patients could come to see me.

After arriving at the clinic we started getting organized and taking stock of the supplies present. I figured out what few medications we had and made a chart for a quick reference for doses. Yuki, our nutritionist from Japan, set up a counseling station in the waiting room, accompanied by Malea, Anna, and Theophile, who acted as child life specialists to keep the kids entertained during their long wait to be seen. There were no appointments, so some of the kids were waiting for hours. Each kid received a toothbrush and basic information about dental care, and then Yuki evaluated their growth and gave advice on good nutrition. The kids were then funneled into the consultation room, where I was working.

I had two wonderful assistants during the day. The first was an interpreter, which rotated between Lisian and Raymond. Lisian has been with me the entire month, and I think she’s starting to figure out what questions I ask for certain complaints. We’re becoming much more efficient than we were at the beginning. My second helper was Emily, who functioned as a recorder, photographer, and makeshift pharmacist. She also helped to distract the often screaming children while I was examining them. It was nice to work together for the first time since we arrived in Rwanda. I reckon that there are not better handwritten medical records in the entire country.

The day passed by as I saw patient after patient. Every time I looked out in the lobby it seemed that I wasn’t making even a dent in the number of kiddos. We saw diarrhea, colds, weird rashes, asthma, pneumonia, and even some weird liver disease. I tried to help as many of the kids as I could, but with the limited number of medications, I suspect many of the kids will need to go to a health center eventually. Every child that had not been treated for worms in the last 6 months received treatment, and we gave out a ton of zinc to kids with diarrhea. It was one of those times where I felt like I was actually making a difference, and I’m so grateful for the opportunity. By the end of the day, we had seen 55 patients, and the remaining patients we didn’t see received multivitamins and anti-worm medication. Every person at the clinic was extremely helpful in making the day successful, and I thank every one of them.

Unfortunately, we were not able to set up two health days during our stay, as we had initially hoped. Had the original plan to have me work in Gashanda worked out, it would have been an exhausting, but extremely rewarding experience. That said, I’m happy about the way our trip has turned out. It’s been, at times, relaxing and, at other times, stressful. The end result has been a pace that has allowed me to slowly get comfortable with the work I’ve been doing, culminating in a day where I was calling many of the shots. My confidence in my abilities has grown during this trip, and I have no doubt that I will be able to make the transition to being a full pediatrician next year. That said, I’m very aware of the vast amount of knowledge that is still out there for me to learn. My day in Gashanda was something I will always remember and cherish, and I hope to do something like it again some day.

Gorilla Trekking

Wow! That word seems insignificant, but it is the best word I can think of to describe today. We’re in the northwestern part of Rwanda this weekend going on our Gorilla trekking adventure. Anything I type is going to seem insufficient to portray everything, but I will try my best. Saturday morning we woke up early and took the bus to Kigali. Once there we stopped for a quick bite to eat at Café Bourbon and Emily satisfied her coffee addiction. I also satisfied my longing for two foods that I had not had in awhile, ham and cheese. After lunch, we hopped on a bus to Ruhengeri. This bus was huge compared to what we’ve been used to, and we each had individual seats. People have been telling us that the area around Kibungo is the “flat” part of Rwanda. We’ve been laughing at this because it’s all hills and mountains similar to the Appalachian Mountains… but with palm and banana trees. After this trip, we understand why they made this distinction. The bus traveled up into huge mountains, with farms going up to the top of most of them. It’s amazing that the Rwandan people do not waste an inch of land. I can’t imagine hiking up those slopes every day to farm, but even the children here seem to have no problem doing it.

Once we arrived in Ruhengeri, we hired a car for the quick drive to Kinigi, which is right next to Volcanoes National Park. Once I saw the volcanoes I had to catch my breath. They are enormous mountains covered in trees that extend up into the mist and clouds. I almost feel like it would be worth it to come to Rwanda and see the park, even if you didn’t see the gorillas. We stayed at the Kinigi Guest House, which is a cozy little place just a short walk from the park office. We grabbed a bite to eat at the restaurant there, where we met several other travelers who were trekking the next day. Emily and I sat next to a lovely couple from South Africa who had spent the previous three days viewing the gorillas and were going to view the Golden Monkeys today. The lady was wheelchair-bound, and they have been hiring porters to carry her and a chair into the jungle so that she can enjoy seeing something that few people in the world get to see. The organization of the people at the park is truly amazing. During dinner, we secured a group to share in the expensive cost of hiring a driver to take us into the park, and then we were quickly off to bed to rest up before the big hike.

I started off today with a luxury that I have not enjoyed in three weeks: a standing shower. Please don’t take reliable hot water, electricity, or water pressure for granted. Being without it is tolerable, but enjoying a nice shower in the morning is awesome. Ok, enough of that… on with the story. After a delicious breakfast, we headed over to the ranger station. There are seven families of gorillas and one group of Golden Monkeys, and each group can have up to eight visitors. The guides quickly divided us all into groups based on their estimate of how fit we were and a few special requests from people who knew a little bit more about the differences than we did. We were just happy to see a gorilla. We ended up with a diverse group, including a couple our age from Australia, a married American and German, and a couple from France. Our guide was hilarious and very informative. We found out we were going to see the Ugenda group, which consists of thirteen gorillas, including three silverback males, several females, and a small bunch of young babies.

After a somewhat nauseating drive on a very bumpy gravel/dirt road, we arrived at our hiking point. The ride was tolerable only because the whole road was filled with people, many of whom were children, who all laughed, yelled, and waved at us as we passed. I have no idea what they were saying, but the Rwandan children, as always, are impossible to be around without a smile. The path started out walking through farmland. Before you think that farmland doesn’t sound too bad, remember that I earlier said that the farms went all the way up the mountains. Our path was very steep up a hillside filled with crops and occasional goats, sheep, and cattle. There were children along this path as well, but they may have kept their distance from us because of our two military guards carrying Kalashnikovs. They were our insurance in case we ran into an unfriendly guest, such as an elephant or buffalo. We were also warned not to take any pictures of the soldiers. The hike was somewhat difficult, but we tackled it at a reasonable pace. The view was breathtaking, with the volcanoes rising up out of valleys covered in mist and reaching up into the clouds. I kept telling myself, “Remember this moment.” Before we knew it, we were standing at an old stone fence with a small opening. Beyond it stood a huge forest of bamboo and stinging nettles. We had arrived at the border to Volcanoes National Park.

Journeying into the jungle was pretty surreal. It was hard to believe that the land we were walking on was inhabited by such creatures that I’ve only seen in zoos or on television. We had to watch our step, because the path had been made by a buffalo who seemed to have a case of indigestion. The front part of our group actually saw the animal at one point before it meandered off into the bush. After about ten minutes of hiking, our guide asked us to put down our walking sticks and backpacks, and he told us to try to be quiet… the gorillas were nearby. We were told that this time of year, the hikes are a little shorter than normal. The furthest group can take hours to reach at times, but since this is the rainy season, the bamboo is throwing up new shoots in the lower parts of the mountains, making the hikes much shorter. Our guide asked us to not call it bamboo, however, we called it “gorilla beer.” Apparently the new bamboo shoots have a somewhat intoxicating affect on the gorillas, making them either extremely playful or very lazy. I think it is safe to say that we were hoping for the former.

We carefully crept through some low lying bamboo and suddenly, no more than about twenty feet ahead, there was a huge mass of black fur. Several legs were sticking out of the pile at various angles. One of the mounds of fur had an area of silver and he was identified as the dominant male of the family. There was the one male and about four or five females all grouped together lounging in a small clearing. We could hear the rest of the group moving nearby, and occasionally we’d see a small tree or bamboo shoot get toppled, followed my loud munching. They seemed to be pretty lazy at this time, but even a group of lazy gorillas is fascinating when they’re just a few feet in front of you. Eventually, smaller individuals emerged from the mound of fur, and the babies became more visible. They rolled around and climbed all over the adults. Unfortunately, every time one would look at us, they’d turn away before anyone was able to get a good photo.

After about twenty minutes, the big fella decided he’d had enough of that location, and he suddenly got up and walked out of the clearing, passing our shocked and silent group by only about five feet. The rest of the group followed, with the babies jumping on the backs of the females. It was at this time we spotted the second ranking male. He brought up the rear of the group and kept a close eye on us as we tried to follow them further into the brush. At one point he decided to stop and eat, so we continued on, leaving him somewhere further behind us. I was a curious about putting us in between a big male gorilla and the rest of his pack. I didn’t have to wait long to satisfy this curiosity, however. Our guide suddenly asked us to move quickly. He seemed a little louder and more nervous than usual, and he quickly told us to step aside. It turns out the other male was following us and was literally right behind some of our group. He walked by us seemingly without a care. I could have reached out and pet him if I had wanted, but I am not insane and value my limbs, so I did not.

The remainder of our time was spent following the group and trying to get the best views possible. The main silverback was at the front of the group, so our views of him became pretty limited. Fortunately we were able to get very close to some of the females and the other male, and the picture we obtained were wonderful. They really didn’t seem to care at all that we were there, as long as none of us gave off threatening or surprising impressions. It was one of the most humbling experiences of my life, and I am so fortunate to have been able to do this. Our time was limited to the fastest hour I’ve ever experienced, and we finally had to leave our hosts. After a final glance at the group, we headed back down the mountain.

There is one final thing that our guide asked of us before we left him. I’ll use this blog to partially fulfill that request. He stated that we were now ambassadors for the gorillas and for the country of Rwanda. We may have had many friends or family who warned us not to come here because of the recent violent history. After the experiences we’ve had, I feel that I could suggest Rwanda as a destination to anyone. As you may have guessed from our previous postings, we have received nothing but warm greetings from everyone we’ve met. There’s almost a palpable pride here that the people show in how welcoming they are. Everyone seems to want to put the past behind them and move forward, something which the country seems to be doing better than any other country in Africa. As for being an ambassador for the gorillas, I think reading about our experience and that of others should do the trick. If anyone has the opportunity or privilege to do this, I highly recommend it. There are many other things to do in the national park, and the view alone is worth it.

So now we’re relaxing in the guest house, enjoying some peace before we have to make the long journey back across the country. We’ve swapped e-mail addresses with several of the group members, so I’m sure the best pictures from our group will be shared. We’ll make sure to post the videos and photos once we’re back home with a faster internet, but I think we’re going to try to upload one to Facebook today. So we now go off into our final week in Rwanda. The public health day is coming soon, and then we pack up to go back to Arizona. This week is going to fly by.

Rainy afternoon in Kibungo...

It is really hard to believe that we have been in Rwanda for 3 weeks now, and we only have 1 week left in our stay.  I know the last week is going to fly by since we will be traveling and wrapping things up with each of our placements here in Kibungo.  Tomorrow, we are headed to the northwestern part of Rwanda to Volcanoes National Park where we will embark on our gorilla trek to see the endangered mountain gorillas.  I won’t say much about that now, as I know we will have a lot to say afterwards.  We are going to spend 2 days away from Kibungo for the trip.  There is a town near the park entrance that is supposed to have a great craft market, so we are hoping to do some shopping while we are there.  We will be going through Kigali on our way there and back, so I am sure we will stop for a “mizungo” meal while we are there too.  Luckily Rwanda is a small country, so the trip from Kibungo in the southeastern corner to Kinigi in the northwest should only take 5-6 hours.  We will be going by mini-bus most of the way, but we will take a moto the last few kilometers and a hired car to the actual park entrance on Sunday morning. 

Next week when we return, we also have plans to visit Akageera National Park for the day.  It is the game park here in Rwanda.  While it may not have the same number or variety of animals of many of the safari parks in Kenya or Tanzania, it promises to be a cool trip as well.  Drew will also be doing a community health day in one of the nearby villages and will work a couple more days in the hospital, while I will visit the kids at the orphanage a couple more times.

We have really hit a routine the past couple of weeks, and it has been cool to feel like part of a community.  We still get lots of stares as we walk down the street (there aren’t many white people here, especially in Kibungo), but we have also met several people through our work that have been so open and welcoming to us.  Many ask when we will be coming back, and if we can stay longer.  There is also a tight knit group of volunteers here from around the world.  Most of them are here for long-term projects similar to Peace Corps, so they have had a chance to settle in.

Earlier this week, we were invited to dinner by the Japanese volunteers and enjoyed a delicious meal of chicken curry and sticky rice (sent from Japan…so good!).  One of the Japanese volunteers, Yuki, is working as a nutritionist at the clinic where Drew works a couple times a week, and she invited several people over including two Rwandans, five Americans (Drew and myself included), three other Japanese volunteers, two Canadian students, and a Korean volunteer.  We sat around sharing stories of our experiences in Africa, as well as back home in a mixture of languages.  It was a wonderful evening of good conversation, laughter, and learning about the culture of the world.

I have continued visiting the orphanage each afternoon for a few hours to hang out and “teach English.”  It has been a lot of fun getting to know the children, and we have really started to get to know each other.  They are no longer afraid to laugh at my silly acting and dancing, and ask me lots of questions (though not always in English…luckily I have Constantina, their regular teacher, there to do some translating).  Yesterday, when I told them that I would be gone for a few days to visit the gorillas and animals at Akageera, they became frightened that I would not return because the animals would eat me!  So, we talked about how I would ride in car through the park, and that gorillas, while large, were very kind and peaceful creatures.  They also ask questions about my family--what their names are and what they do, why they aren’t here too. 

I ask them questions too.  Right now, many of them are obsessed with cars and trucks.  We went to play on the football pitch (soccer field) the other day, but rather than play, they wanted to stand at the edge of the field and watch the cars drive by.  At each passing car, they would shout, “mine!” trying to be the first to “claim” each one.  They are always so happy and joyful, full of life, despite the tragedies they have already faced in their short lives.  It is hard to believe that these children have no families to speak of, and will soon be sent away to boarding school away from the nuns that have cared so well for them since they were born.  I know many of them will continue to do well, while others it is hard to tell.  I will miss my afternoon visits with them, and I cannot believe I only have a couple left.

Other than the orphanage, I have accompanied Tom on a couple other garden projects, learning even more about how to grow food.  There are definitely many different issues here than the ones I would face in the desert of Tucson, but it has really peaked my curiosity and inspired me to continue reading and experimenting once I get home.  It has also been really cool to see families come together to help each other, sharing land and working together to plant food to help the community.  Many of the families have plenty of one crop, such as bananas, but this is all they have, so while they may have plenty of calories, they are not getting diverse nutrients.  In the new gardens, designed to supplement what they already have, we try to include a protein, starch, and green vegetable and teach the family about how important it is to have a balanced diet of all three.  Since many of the families do not have a job other than growing their crop, they can’t always afford other food, so having a garden at their home will make it easier for them to feed themselves.

I started off teaching a class in the mornings at the primary school, but once exams started, my students lost interest, and I do not blame them!  Since they changed the official government language to English from French a couple years ago, all of the students now sit for their national exams in English, even if they have not become sufficient yet.  The exams include difficult content in math, science, social studies, language, etc, and on top of that in a language that many of them don’t know.  They last for one week, and it is a very intense time for teachers and students alike.  Many of the teachers don’t necessarily know English that well either, but are doing their best to teach the students what they can.  Many of the students in the big city of Kigali are starting to fare better, but it will be a while before the rest of the towns like Kibungo catch up.  Once exams finished, the children began their 3-month break, similar to summer vacation in the US, except here the school year begins in January, so they will now be on break for the rest of the year.  It was no surprise to me when the students did not show up for my class on the first week of break.  The teachers were disappointed, but I know, kids will be kids, and they deserve their time off after working so hard!

Now, I am sitting and watching it rain outside the window.  We haven’t had any rain for a week, so it is a welcome sight, since it provides relief from the tropical humidity.  It does also mean that I may be stuck at home for the rest of the afternoon, and our laundry is not going to dry any faster in preparation for our trip this weekend. Ahh, well…I will roll with the punches. (I have learned a lot about that in the past few weeks.)  Stay tuned for our gorilla adventure!

The Great Turkey Adventure

I hope everyone had an excellent Halloween. We definitely missed having kids come to our house and giving out candy, then eating all the candy that was left over. Unfortunately, Rwandans don’t celebrate Halloween, and we got a very strange look every time we tried to describe the holiday. Honestly, try to describe the purpose of Halloween… it’s really an odd celebration. Despite all of this, we did not pass the weekend without celebration. Tom and Malea invited several other Peace Corps volunteers to the house for the weekend, and we had a group that reached about 15 members. The question then arises, how do you feed so many guests? And that’s how our recent adventure began.

One of the first things we heard about when we got here was Tom’s famous (infamous?) goat roasts. You can go to the market and buy a goat, which is later led to your house… alive. There, he’s had Timo or Jean Claude (our guards) slaughter and butcher the thing, and he’s roasted it over charcoal in the backyard. Tom’s done this twice since he’s been here, and both occurrences have been great successes. He wanted to change things up a bit this year, however. He wants to roast a turkey for Thanksgiving, and he deemed this past weekend as an excellent time for practice. I know what you’re thinking… turkeys in Rwanda? Yes, we’ve seen, and heard, several turkeys since arriving here. Most of the locals laugh when you ask them about “dendo,” but there are a few people who raise and sell the birds.

Tom made arrangements to get a turkey last week, and we asked one of our friends, Teo, to pick it up for us. Unfortunately, when he got there, the guy had sold it to his son, despite our reservation, and Teo had to go to a different town to find a bird. He brought it back to the house and it sat in our backyard for the evening making occasional pitiful noises. If you’ve never seen a turkey up close, they’re actually quite ugly, but our bird was immediately dubbed “cute.” I’ll admit, I did bond with the very American bird, and I felt a connection to home with it. We even named it Turkems. Timo wanted to name it Indestructible, but that name would have been sadly inappropriate. Unfortunately for the bird, several hungry guests were coming to the house, so no amount of bonding was going to save it.

We awoke the next morning to hear Turkems making quite a ruckus. Tom later came to my room and said, “the turkey flew over the wall, we have to go catch it.” So, Tom, Emmett, Timo, and I walked around the block to our neighbor’s house to recapture the escapee. Our neighbors have a bunch of chickens. They formerly had a rooster, which I’m guessing met an early demise due to its tendency to crow every 30 seconds in the morning, starting at about 5:00. None of us were sad to see, I mean hear, that thing go. As we approached the house, there was no mistaking which yard was the hiding spot. There were kids running around in the street and yard yelling, “Mizungo!” which means “white people.” They all thought it was hilarious, and I immediately thought of several movies where some city slicker tries to catch a turkey and ends up in the mud. I brought my video camera, but I think Turkems desire for escape had faded, and we easily captured her without much of a fuss.

The rest of the morning was pretty routine. By routine I mean that a large bird was decapitated in the yard, drained of its blood, boiled in a pot, defeathered, then roasted on an open charcoal pit for a couple hours. The dinner was a great success, and the stuffing and baked beans were delicious. The turkey, while it’s always nice to have meat, was a little tough and “gamey.” The turkeys here are the wild variety, and not the white birds that are farmed back in the US. Despite that, the whole experience was quite exciting, albeit tragic. I’d just like to say, “Turkems, your sacrifice was greatly appreciated, and we will always remember you.” Again, I promise to have tons of pictures of this story, and all of our other ones, uploaded when we get back.

An Update on the Healthcare Situation in Kibungo

So, we’ve been in Rwanda almost two weeks now, and I finally feel like we’ve got a routine down. My circumstances have improved a little bit since the last time I wrote about them. Most of my week is still spent working at the hospital. I go in at around 8:30 and meet up with whichever pediatrician is doing rounds for the day. There are several of them, and they never communicate which one is doing what. Lately, there’s a new Rwandan pediatrician who has been beating Dr. Bao, the Chinese doctor, to the pediatric ward. Dr. Bao usually shows up, then storms off to the neonatology area after seeing the new doctor is already there. I still don’t think I could do rounds on my own, as there are so many things in the chart that I don’t understand. Just viewing the lab results gives me a headache, as they’re neither written in English or French, like the rest of the chart.

It’s often frustrating doing rounds, as several of the children every day need to be sent to Kigali to see a specialist that we don’t have here. Unfortunately, the government health insurance that most of the people have does not cover ambulances, and we frequently walk away from a bed with a crying mother who can’t afford a transfer. Some things that would be fairly simple back home may end up being fatal for some of the children here. Also, I’ve started to come across several kids with developmental problems. There aren’t early intervention programs here in Rwanda, so we often have to tell the moms that we can treat what brought the child to the hospital, not the long-term problem. I almost got choked up the other day when I told a nursing student that a 4y/o boy who had not walked yet would probably never walk.

One of the other points of frustration I’ve had is concerning hygiene. There’s no sink to wash your hands in the entire pediatric building. Tom says they put one in at one point, but it was never hooked up and has since been taken out. I bring some hand sanitizer with me, and everyone there looks at me like I’m crazy when I wash my hands between touching patients. Also, there aren’t many gloves or masks. They’re all contained in locked storage places, and only the doctors seem to have access. I frequently walk into a room with 6-10 patients, and there’s a coughing child in the corner who I’m told has tuberculosis. I’m definitely going to be tested once I get back to the US. The hospital is filling up too. Forget having multiple patients to a room, there are now multiple patients to a bed here. I know it’s cliché to say this, but we really need to appreciate what we have back in the US.

Rounds usually take up most of the morning, including a trip to neonatology, which is always heart wrenching. The neonatology rounds consist of a line-up of mothers holding their premature infants as we walk down the line and look over each of the charts. There are a few incubators present, but they’re not used much, and I’ve even seen roaches crawling in the babies’ beds. One mother refuses to let us put a feeding tube into a set of twins, and she doesn’t have enough money for formula. She doesn’t have enough breastmilk for the twins, and I fear we’re slowly watching them starve to death.

Despite all of these issues, I'm really enjoying my time at the hospital. The Rwandan doctors are very friendly and eager to discuss the cases with me. Dr. Bao is very good and has been practicing pediatrics for 30 years. I'm learning alot from her, and she seems to be opening up to the fact that I'm here. She actually said, "Bonjour" to me once! The rest of the Chinese doctors speak more English, and they're definitely characters. The head of the group is very friendly and funny, and I enjoy talking with him. However, he does tend to whip out a camera and take a picture of me whenever I'm standing next to Dr. Bao and appearing to work with her. The nursing staff, mostly consisting of students, all pay very close attention to anything I say. There's even one nursing student who writes everything I say down. I'll have to be careful not to talk about anything ridiculous....

So that’s my time in the hospital. Usually we finish at around noon, so I have much of the rest of the day to read, go to the market, or start cooking dinner. I’ve learned how to make a pretty satisfying meal with only a few vegetables and some potatoes. The rule of thumb has been that cayenne pepper is your friend.

Aside from working in the hospital, I’ve also started working in the local public health center. There aren’t any other doctors there, and it’s generally run by nurses, dieticians, and other miscellaneous staff members. My first day there I had to arrive early for a staff meeting. This was ok, except that my translator couldn’t be there until after the meeting. I sat there for about 40 minutes, not understanding a single word that was being said. Finally, one of the other staff members sat next to me and explained what was going on. They had been talking for the whole time about the importance of wearing the correct uniform and remembering to wear an ID badge. I’m not sure I would have paid any more attention if the meeting had been in English.

Anyway, they’ve set me up in the consultation area of the clinic. I work with one of the nurses who is used to working on his/her own. The first 3 patients I saw on the first day had rashes that looked like nothing I had ever seen before. Everyone there gives me a confused look when I ask questions. They think that I’m a doctor, so I automatically know more than they do about what is wrong with the child. It doesn’t matter how much explaining I do, I can’t seem to get the message across that much of what I’m seeing is not present in Arizona. Despite these problems, I’ve had a good experience at the clinic. I’ve seen parasites, worms, chicken pox, malnutrition, and even easy things like colds. I get a funny look when I tell people that they don’t need any antibiotics, so I make sure to tell them to return immediately if they don’t get better soon or if they worsen, just in case there’s some rare tropical illness that I’m not familiar with.

The final medical thing I’ll be doing is a public health day next Thursday. We’ll be traveling to a rural medical clinic where it will be advertised that there will be an American doctor. We’ll have a public health nurse, a dietician, interpreters, and several other volunteer staffers. People from the rural area who usually have to walk over an hour for health care will be able to come see me for free. I’ll have very few options for treatment, but at least I should be able to point them in the right direction if further help is needed. It’s definitely intimidating, but I think my days at the clinic in town will be very good practice. I’m told one of the biggest things is dental problems, which I won’t be able to help with much, but if you’re reading this, and you’re a dentist, I know a ton of people in need of your assistance.

I’ll keep you updated on how the next week goes. Also, stay tuned for the story of our turkey roast planned for tomorrow. Currently, the bird, named “Indestructible” by the guy who brought it to the house, is living in our backyard. Jean Claude, our night guard, is letting it sleep in his room. I’m sure the roast will be interesting, as we still need to butcher, de-feather, and cook the thing. It was almost going to be a goat, but Tom wanted practice before Thanksgiving. I’m sure we’ll have some good stories after tomorrow.

A Day of Luxury

Yesterday, Drew and I took the day to head into Kigali to take care of our gorilla tracking plans.  Kigali is the capital city of Rwanda, and it is where we spent the first couple nights when we flew in.  This trip, we had a much different experience from our initial visit, since we were not as anxious about being in a new place, and we had some tricks and key phrases down for navigation. 

We left Kibungo around 9:30 for the 2 hour drive.  To our surprise, we happened to be on a bus that was a little larger than the last time, more like the size of an airport shuttle than a 15-passenger van.  They still have jump seats in the aisle, but it is a lot more spacious than the other option.  The drive in was fairly uneventful without too many stops.  We arrived in central Kigali just before 12:00. 

Before beginning our wanderings through town, we were sure to find ourselves a bus ticket for the trip back later that afternoon.  Even though, Drew had been practicing how to say “2 tickets for 4:00 to Kibungo please,” in kinyarwanda, the man at the bus station wanted to practice his English with us, so he didn’t get to use his phrase this time.

We wandered into the city center to find some lunch, and decided upon the restaurant where Tom and Malea had taken us the first day we arrived, Blues Café.  At that time, they commented that it was the best place in Kigali for sandwiches and burgers.  While we enjoyed the sandwiches then, we could not fully appreciate how delicious they really were.  When we took a bite of our cheeseburgers yesterday, it was heaven.   Cheeseburgers are a little different here than back home.  Instead of pickles, they use fresh cucumbers, and the ketchup here is very sweet, and a little runnier than the Heinz we are used to.  We also had a side of fries and a bottle of coke.  They eat fries and coke all over Rwanda, but pairing it with a burger was delicious.  Since, we have been eating a vegan diet, the meat & cheese on our sandwich was a nice change of pace.

After a long lunch (when you sit down for a meal at a restaurant here, it often takes an hour to an hour and a half, even for something simple like sandwiches), we headed over to the ORTPN office.  This is the Rwanda Tourism board that coordinates all fees and permits for visiting the various parks around Rwanda.  We were hoping to purchase our gorilla tracking permits for the last week we are here.  Because it is the rainy season, we were told we shouldn’t have much problem, as tourism is often down during this time of year.  When we got to the counter though, and requested a permit for any of the days during the last week, the woman said that they were sold out of permits! 

Fortunately, one of the tour companies had had a cancellation about an hour prior for Sunday, the 7^th.  She called the representative, and he came down to the office.  Because we had to buy through the tour company now instead of the official permit office, we would have to use cash (the permits are $500 a piece!).  Fortunately, the international bank was just across the street, and the tour company rep was VERY patient.  He also gave us advice for doing the trek on the cheap, rather than booking through a company like his.  We were so appreciative.  He also gave us his card, and he told us to call if we had any questions before our trek.  He spoke lovely English and was so helpful.  So, we will be trekking gorillas on the 7^th of November, the weekend before we leave, and we cannot wait!

After getting the permits squared away (our main goal for the day trip), we were originally going to head to the genocide memorial museum, but after a long lunch and the long permit meeting, we were shorter on time than we had hoped, which left us with a couple hours to spend in the city center.  We happened upon the Nakumatt and spent a while wandering the aisles.  The Nakumatt is the closest thing to an American supermarket we have seen.  We picked up a few items – oatmeal, spices, soy sauce – that we haven’t been able to find in Kibungo.  We resisted the cheese and wine they also had there, since by Rwandan standards they were very pricey, but we did stand and look at them for a while.

After our shopping excursion, we found a very swanky coffee shop called Café Bourbon, where we sat and had a cappuccino while waiting for our bus…superb!  All in all, it was a lovely day in the city enjoying some of the comforts of home for the afternoon.  We have been doing well in Kibungo and hadn’t really been missing a lot of the things we enjoyed yesterday in Kigali, but it was certainly nice to have the chance to experience them while we were there.

After a successful afternoon navigating the hilly, curvy streets of downtown Kigali, we caught the 4:00 “bus” back to Kibungo.  It was a smaller bus again (like the one we took when we first arrived), crammed tight with people, but we made it back in one piece in time for a simple dinner of red beans and rice.

Trying to turn a black thumb into a green one...

This week, the primary school is not in session as the Primary 6 level (8^th grade-ish, I believe) is taking National Exams…a HUGE deal.  So, my regular class of Primary 3 & Primary 4 students is on vacation for the week.  This means I have my mornings open for other adventures.

Today, I joined Tom, Anna (another Peace Corps volunteer), and Teo (a local Rwandan who works for Humanity for Children as an interpreter – he is very helpful to have along) on a garden project.  Each week, Tom organizes a garden project in the town of Karama where HFC is currently building a community health center.  The goal of these projects is to help families that suffer from malnutrition to start gardens of their own, so that they are able to prepare balanced meals.  The gardens are 2-4 beds depending on the amount of land, and they plant some type of protein (generally beans), a starch (like taro root, but there are others as well), and a couple of other vegetables.  The Rwandan climate is perfect for gardening and makes it easy for anyone.  Each week, a new family across town is chosen and Tom and Teo provide a demonstration for that family and their neighbors.  When the project is successful, the neighbors help the family prepare and plant the first bed and then the family later helps the neighbors start a bed of their own. Ultimately, the families that can’t afford to buy their food will be growing their own!

Now, as many of you know, I am unable to grow anything.  Even the heartiest of plants manage to die under my care.  It makes no sense…I come from a family of gardeners!  As you can imagine, Drew laughed when he found out I would be helping on a garden project.   I was excited though to help out and learn a little about how to grow food, something I have always been interested in, but never done.  After today’s project, I am inspired to have a food garden of my own, once we are in a house with space to grow one.

I do want to make sure I record what I learned today though, so I remember how to get things started later, so bear with me as I try my best to describe how to create a perma-garden (and all be hand too!)  It was a big morning of firsts for me, so I will include those as well.

We headed to Karama this morning around 8:00.  Karama is a village on the other side of the valley from Kibungo.  There is a road along the top of the ridge that connects the two places, but it is about a 2 hour walk, and there are no buses that run through there, so we walked as the crow flies, down the valley and back up the other side.  It cuts about an hour off the journey.  Knowing, I was in for a strenuous morning of digging, I made sure to eat a protein rich breakfast of bread with peanut butter.  I did not however take into account the walk to get there.  The walk down into the valley was ok, but once we started going back up the other side, I was hurting.  First of all, the elevation here is about 6000 ft – definitely a lot thinner air up here than I am used to.  Then, the morning equator sun was beating down on us for much of the walk.  And, we were carrying garden tools.  Ooof…we made several stops on the way up for water and rest.  Luckily, the group I was with was understanding of my physical needs.  I will definitely be in a lot better shape by the time we leave here!

During all of our stops up the mountain, I learned a lot about Rwandan fruit.  There were many banana groves, and farmers harvesting bananas with a machete, easily cutting away the fruit and leaves.  Apparently, banana trees are similar to celery stalks - very porous and very easy to cut.  Also, banana trees do not reproduce like regular trees, so they are all clones of each other, started from a branch of another.  There were also TONS of mango trees, with mangos that are getting ready to be perfect (another week and they will be at market!).  It is important to remember to never fall asleep under a mango tree here, or use it to dry your clothes.  There is a fly called a mango fly that will attach to your clothes.  They then burrow into your skin where they nest.  After a couple of days, apparently baby mango flies are coming out of your skin, and you end up with a severe skin infection.  It does not sound pleasant, so it is ok to enjoy the shade of a mango tree for a few minutes, but don’t hang out too long.  We also saw a new type of fruit that generally grows in Southeastern Asia, but also grows here.  It is called a Jackfruit.  They are massive and are full of hundreds of seeds surrounded by an edible pod.  They are very sticky to pull apart, but once you are able to taste it, you enjoy a very sweet flavor, similar to bubblegum.  After we saw one on the trail this morning, Teo brought one by the house this afternoon for us to try.  It is very interesting looking and pretty good, but sooooo sweet.  I could not eat more than 2 or 3 pods at a time.

We finally arrived at the home of Madelena, the community leader who would be hosting the demo garden.  As we walked around her yard scoping out the perfect spot for a garden, we looked down to discover our feet and legs were covered in large black ants.  We had chosen a giant ant mound as our garden.  We quickly moved away and tried to rid ourselves of the crawling creatures, especially since they would crawl up our pant legs and bite.  Eventually, we found a spot free of ants, but before we could start working, we each took turns using the latrine to strip off our pants and shake out the ants.  They were persistent little guys!

The plot that we settled on was a small open space on the side of the hill.  It was a bit uneven and overgrown with vegetation, so we started on the first tasks of the morning, clearing and leveling.  We pulled up all the vegetation that had taken over a small taro root garden.  We set the taro plants to the side, so that we could reuse them later.  We then moved some dirt to level the space.  We then started to draw out the garden.  Because the garden was on a hill, it was important to consider a couple of things…erosion from wind and water.  Because of these factors, in our map of the garden, we included 2 water holes on either end to catch excess run off.  There was a wall all around that would also act as a bed, and a path around the central bed, so that in the maintenance of the garden, you would never step on the actual bed.  On the downhill wall, we planted plants that do not need to be pulled up to be harvested.  Their root systems will hold the dirt in place and help prevent wind erosion.  For this garden, they chose to plant pumpkins.  In the other walls, we planted to the taro root that was left over from the original plot of land.  I am getting ahead of myself though. 

Once the map or design had been “drawn” in the dirt, we began moving dirt around to complete a process called double digging.  This basically means you dig up a lot of dirt, and then you dig up more dirt and break it all loose with a fork or hoe before shoveling it back in.  This process creates a spongelike consistency that allows the roots to grow straight down rather than fighting for space with their neighbors.  This way when you are planting, you can put plants closer together and plant more within one bed.  While refilling the bed with the “sponge-y dirt,” we added charcoal, manure, and ash (from burning old garden foliage) into the dirt.  The charcoal helps the soil hold water.  The manure provides oxygen and some nutrients, and the ash provides nutrients.  If no manure is available then compost is a good substitute.  Once the dirt was all back in its place, we replanted the taro root.  We also left seeds with Madelena to plant pumpkin, carrots, beans, and a spinach-like plant that is found here in Rwanda. 

Once the garden was complete, Madalena took us to meet another family that would be in need of a garden for next week’s project.  It will be a special garden, as 2 families share a plot of land and will therefore share the garden. We also stopped by the community health center that is going up in Karama to check on the progress.  It is currently awaiting an inspection before work can continue.  Around lunchtime, we were headed on our way, back across the valley.

On the way back, the sun was hidden behind some clouds and I did much better with the hike.  We also took it a little slower to start since everyone was so tired.  At the bottom of the valley, Anna stopped to visit with a family that she has met over the past few months while walking to Karama for the garden projects.  The family has a momma goat with 2 babies.  During her encounters with this family, she had requested that they let her milk their goat, so that she would be able to make goat cheese.  While this is very common in other parts of the world, it is almost unheard of here in Rwanda, so when we came through, and Anna attempted to milk the goat, many people gathered to see the sight.  Unfortunately, she only got about 5 or 6 good squirts, so not enough to do much with, but it was a great experience to watch my first goat milking.  The family said she could try again next week and to come early in the morning, so she can get the milk before the kids feed.

After quite an eventful morning, we made it back to the house around 1:30, very ready for some lunch.  It was such a cool morning to see projects in action, learn a lot about gardening, and see more of the Rwandan countryside.  I took some photos that I will have to share later, since I can’t figure out how to get them to upload to the blog since we have been here.  Our internet access is interesting, but I promise to share photos when we arrive home.

Lazy weekend and dinner surprises

After our first week in Kibungo, it was nice to have a change of pace for the weekend. It's not that the weekly pace is fast... we just enjoyed relaxing and getting some time to take in all that we had been through. There was a ton of rain this weekend, so there wasn't a whole lot to do anyway, and rain always tends to make me a little more sleepy than usual.

Saturday we just were lazy around the house for most of the day. We did take a break to go to the market again. It was a little easier this time since we knew what to expect and how to say, "How much does it cost?" Unfortunately, if you ask a question in kinyarwanda, the answer typically returns in kinyarwanda, and we haven't gotten to numbers yet.

Overall, the food we've been making has been pretty good. I've learned how to make tomato sauce from scratch, and our meals have consisted mainly of different versions of spaghetti and hash browns. The veggies are excellent and fresh. Our hosts are much more adventuresome (I'll get to that in a second), and they frequently have some gourmet dishes that are occasionally shared with us. Friday night Malea made a chocolate chip/walnut cake without an oven, topped off with some excellent home-made ice cream. It was delicious!

Sunday found us being pretty lazy again. I've read two novels since getting here and am about to jump into the books already present at the volunteer house. The biggest problem with the weekend is that there was no running water in the house for almost three days. Taking cold showers is bad enough, but cold showers with water from a bucket is even worse.

We had a friend of Tom and Malea stay with us Sunday night, so they were both preparing a big meal. They were making chili, and Tom decided to be adventurous and buy some meat. This is only the 5th or 6th time he's bought meat since getting here, so it was a big deal. When I walked into the kitchen for lunch, I noticed him cutting it up. At first glance, it looked a little funny, and at that point I said, "Tom, is that a valve?" After further examination of the meat, we determined that, yes, Tom had bought a cow heart. Emily and Malea definitely were not very happy about this, but Tom, Emmett, and I decided we'd be adventurous. I figured, meat is just muscle, and heart tissue is nothing but a big muscle... so everything should be fine. The girls were happy to have their chili vegetarian style, and it had plenty of spice and flavor to it for that. I will say the meat was pretty good, and it added alot to the chili. It was a little gamey, but since this was Tom's first heart to cook, we decided to let him off the hook. We washed it all down with some more ice cream, which Malea had added nutmeg and a few others spices to, making it even better.

Overall, things continue to go well here. We got to talk to Emily's mom and sisters (and Matt) as well as my parents via Skype. We'll continue to keep people updated as things change. We miss everyone back home and really enjoy getting your e-mails and blog comments. We'll have to fix the pictures when we get back home.

Daily Life In Kibungo

I am going to try to upload a photo or two with this post, but our Internet connection here is pretty slow, so I am not sure if it will work.  I do promise to put up all of our photos when we get back though.

We have been in Rwanda for one week, and we are starting to learn many things about life here.  I think Drew and I are both starting to settle in to our routine while we are here, and life is definitely more laid back than it is at home.  We have a lot more free time on our hands, and so we have been reading a lot of books, and watching a lot of movies on our computer (the Peace Corps volunteers we are living with have quite a collection).  Don’t worry, that is not ALL we are doing. ;-)

Each morning, Drew and I are up around 7:00 to get ready for the day.  We generally alternate shower days, since the water isn’t always on, and can be scarce.  Between less washings, and a lot higher humidity, my hair has been doing lovely things since we have been here.  We then have a quick breakfast, usually a banana with some bread, and a cup of tea or coffee (though not everyday…my caffeine addiction may be broken before I get home!).  I head to school around 7:30-7:40ish, and Drew leaves around 8:15 for the hospital.  I walk about 20 minutes through town to get to the primary school where I am teaching an English class in the mornings.  (Even though we are living in the “flat region” of Rwanda, my hike to work is up a pretty steep hill.  The mountains here are massive and Kibungo is situated right on the side of one…I should have some good leg muscles by the time we leave here.  Apparently, the mountains on the other side of the country are even taller…thus making this the flat part.  It has definitely earned its nickname of “land of a thousand hills.”)

View on my way to work

The kids I am working with are so thirsty for knowledge - it is amazing!  My class has about 45-50 students in it ranging in age from 7 years to 12 years.  They have a huge range of abilities in speaking, reading, writing, and understanding English.  They each have a composition book of paper and a pen.  There are about 15-20 desks with bench seats, and a long chalkboard that runs the length of the classroom.  I have the teacher manual for 3 levels of English classes that was issued by the government of Rwanda when they made the switch from French to English a couple years ago, but there don’t seem to be any copies of the books for the children.  So, generally, I use the book as a loose guide, and let the children direct me in what they want to learn. 

Yesterday, we spent about half an hour talking about the different parts of the body and clothes and accessories that you can wear.  I started drawing a person on the chalkboard, and many of the children copied it exactly into their notebooks.  We do some verb conjugations and such but this is what they have been learning from their English teachers here, so I try to stick with conversational tools.  It is definitely not easy to manage that many children, but I think we all have a good time along the way. 

The way of teaching over here is much more traditional than my style generally is in the US, and it is has been an adjustment getting used to it.  The children are well disciplined and know the routine each day.  Each morning when I arrive, the class stands up together and says, “Good morning teacher.  How are you today, teacher?” and at the end before I leave, they say, “Thank you, teacher.”  It definitely caught me off guard at first, but I definitely see the way the children respect their teachers and the education process.  Some things, I am not sure I could adapt too, but seem to work for the children.  Many of the teachers have a stick that they use to point at things on the chalkboard, but they also come in handy, just in case a child gets out of line.  I have heard they don’t actually hit the children in class, but as soon as that stick comes out, the kids shape up and remember their manners.

I usually stay at the school until about 10 or 10:30 depending on how restless the kids are getting, and then I walk back home through town.  Drew is generally done at the hospital around 11 or 11:30, and then we have lunch together and a siesta…we really should adopt this practice in the US!! J  Around 2:00 I head back across town to the orphanage, which is right next door to the primary school. 

At the orphanage, they house about 45 children aged birth to 6 years old.  It is run by the Catholic Church (which owns a lot of things in town actually including a lovely restaurant and the “grocery store”).  I take the 5 & 6 year olds for a couple hours in the afternoon to teach English.  It is a group of about 14 boys (the girls are shipped off to Kigali to a larger orphanage there), who have so much love and enthusiasm to give.  They speak English fairly well, as they have been raised by nuns who come from around the world and speak English as their common language.  They are so much fun and LOVE to listen to stories.  I have a limited selection of books, and many are ones they have already heard before, since they are from their classroom, but they always ask for a story, and often times want to hear it more than once.  They laugh hysterically when I use different voices to read, and they are very good impressionists of a variety of animals and vehicles.  Their classroom has a little more than the primary classroom, but is still limited in resources.  Yesterday, I tore some blank pages from a notebook I brought with me, and took them along with a pack of colored pencils.  I gave each child one to draw with, and they treated the pencils and paper, as if they were a treasure.  These kids may not have a lot of physical materials, but they have so much spirit, it seems to make up for it.  I love being with them each afternoon, which is a good thing since I often spend longer than my allotted 2 hours cooped up in a room with them.

This seems to be a good spot in the day to mention the rain and the tradition of a rainy day here.  Rwanda has 4 seasons: January – March: Dry, April – June: Really Wet, July – September: Really Dry, October – December: Wet.  We got here at the start of the wet season.  What this means is that every day, it rains for about 3 hours.  It is a nice gentle rain with a little thunder and lightning and some brief strong winds.  It reminds me a lot of the rain in Seattle.  You never know when the rains will come through, but when they do, the village freezes.  Everyone retreats to the nearest building and nothing is done until the rain stops.  If you are at home, you get a free nap, and if you are out, you get a little extra time to be social. 

So far this week, the rains have come each afternoon about 2:30, just as I am arriving at the orphanage.  Since I am new at this I haven’t had much planned beyond the 2-hour block that I am scheduled to be there, yet the rains continue for a while after I am finished.  Luckily, the children are good at entertaining themselves. 

On Wednesday, the rain was really coming down with no sign of letting up.  I had brought my rain jacket with me and was ready to make the trek back home – I did live in Seattle for 2 years – but the nuns would not let me leave.  They insisted that I wait out the rain.  So there I was in a classroom with 14 5-year olds, no other activities for them to do.  The nun that was in the room with me to help out invited them to sing for me.  Those kids started singing every song they knew.  They would get to the end of one song, and another kid would start the next one, and they would all join in.  It was a mixture of hymns, songs they’d learned from other American volunteers, traditional kinyarwanda songs…it was incredible.  They danced for me to some of the songs, and taught me the clapping rhythm to others.  It continued for about 30 minutes straight, and they could have gone for 30 minutes more, but the priest came in to offer me a ride home in his truck since the rainstorm didn’t seem to be moving on anytime soon, and he was headed to town anyway.  I am pretty sure that this will not be my last concert from the children on a rainy afternoon.

I usually get back home from the orphanage between 5 and 5:30 depending on the rain schedule.  Then Drew and I cook dinner and settle in for the evening reading books, playing a board game with Tom and Malea (our Peace Corps hosts), or watching movies on the computer.  Sometimes, we read by candlelight since the power tends to go in and out.  Around 10 or so, we pull the mosquito netting out and climb into bed for a cozy night’s sleep.

Our small but comfortable bedroom

First day at the hospital

Here's the impression I got when I first signed up for this whole adventure. I'd be working in a rural health clinic that was being run by an American pediatrician. I'd have alot of autonomy, but the other doctor would be there to help supervise me and give me advice when needed. I've been slowly coming to terms with the fact that this is my last year of residency and I'd be on my own next year, so this plan sounded like a great idea. I learned a little over a month ago that the clinic would not be open yet, and that I'd be working primarily in a hospital. The final word I got was that I'd mostly be shadowing for the first week, then supervised by the Rwandan "attendings" as I got more familiar with the system. I was still pretty ok with that plan, so I was excited to start today.

However, here's the reality of what happened. I walked up to the hospital at around 8:00 where I was told that there was a department meeting. I saw some people in white coats who I initially thought were doctors, but turned out to be nurses. Once they saw me and realized I was a pediatrician, they led me into the pediatric ward and to a patient's bed. I was pretty sure rounds weren't starting until 9:00 and that I was just shadowing today, but everyone seemed to be looking at me to do something. Finally, one of the nurses handed me a chart, which was only about 50% in English (which is one of the higher percentages as far as the charts went). I looked through it and could only figure out that the kid had come in with fevers that had since stopped. The nurse then looked at me and said, "He has malaria, but his blood test is negative, what do you want to do?" I tried to stall a little bit by examining the kid and asking a few questions, but then I finally ran out of filler material and asked where the other doctors were. They all got a confused look on their faces and said, "You are the doctor, there are no others." I almost passed out.

It turns out, the doctors, who are a mix of Rwandan and Chinese, usually blow through rounds in the morning and rarely coordinate care between the two groups. I guess everyone thought I was adding my bit of American style to the mix. Luckily, my interpreter showed up at that moment and I was able to convey to everyone that I was only observing today. We eventually met up with one of the Chinese doctors, who only speaks Chinese and very bad French, and I followed her around the NICU and pediatric wards. I only gleamed about 10% of what was going on, and while my interpreter is great, she doesn't have a large medical knowledge, so clarifying methods of treatment and the reasoning for diagnoses was difficult.

I also stopped by the public health clinic today with Tom, our housemate and Peace Corps worker. The clinic has no doctors and is run by 4 nurses, at least I think they're nurses. Nobody speaks English there, and they seem to think that I'm going to show up and run the clinic and give advice to the nurses. While I may have more medical knowledge than they do, they have a much better understanding of how things work here and the specific diseases that the people here suffer from. Plus, the administrator initially told us they didn't need a doctor, and if I wanted to work there, I needed written permission from the hospital administrator.

Basically, I feel a little bit like a beginning 3rd year medical student. I have alot of experience and knowledge, but I'm not quite sure how to get past the language, cultural, and systemic barriers. I have this bad feeling that the people at the hospital, the clinic, and even Tom and Malea have these high expectations from me that I'm not quite sure how to meet yet. I want to be helpful and make a difference in these kids lives, but I think the most I can accomplish this month is to learn about malaria, typhoid, and the other conditions that we don't have back in Tucson, and figure out how to navigate the system here. These goals are in line with what I set out to do, as I really am interested in how medicine is practiced in other areas of the world, but I'm not quite sure how to convey to everyone here that I'm not some expert on these things and they shouldn't expect me to come in and solve riddles that their own doctors haven't been able to solve. That would be hard enough if I could communicate with anyone, but it's going to be incredibly difficult here.

I guess I'm having the mandatory "freak out" moment that Dr. Berg, the head of Humanity for Children, said I'd have. I also assured me that things will get better the longer I'm here. I'm confident they will too, I just need to figure out a few things first. For example, how to simply order IV fluids on a kid, or more importantly, how not to seem like a dufus before I figure out what's going on. I'll keep everyone posted. I'm not even sure what time or where I'm supposed to show up tomorrow, but at least everyone knows my face.