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.

Settling in to Kibungo...

Mwaramutse!

We have arrived in Kibungo (pronounced “Chibungo”) and settled in to our new digs.  Our bedroom is cozy, but the rest of the house is pretty spacious.  There are definitely some things we will have to get used to, but overall our space is comfortable.  Kibungo is a relatively small town situated on the side of a mountain.  It is the city center for the district (kind of like a state from what I have gathered), so it is have most of the main amenities you would expect from a city: a bus stop, post office, hospital, university, several churches and schools, and a large market every Wednesday and Sunday. There is one main road that runs through town, and then smaller walking trails that go down the mountain into the valley or a little further up the mountain.  Our house is about a 5 minute walk down the road from the main shopping district in town.  Five minutes further is the district hospital where Drew will spend his mornings, across the street is the town health center where Drew will spend his afternoons, and about 20 minutes walk back through town is the primary school and orphanage where I will spend most of my time – more on all that a little later though.

In our house there is a large yard surrounded by a fence and a gate.  There is a vegetable/herb garden out back that was put in by the Peace Corps volunteers, Tom and Malea who have been living here since January ’09.  There are 2 large avocado trees out front that appear to be loaded down with avocados. The house is about the size of our house in Tucson with a large open front room/dining room, a small kitchen with large pantry, and three small bedrooms and 1 bathroom. 

The kitchen has 2 water filtration systems so we are able to have good water readily available.  There is also a 2 burner gas stove and a small refrigerator.  Drew and I will be doing our grocery shopping tomorrow at the market, so we will be able to cook.  We will be eating as vegetarians while we are here (as do most of the Rwandans, since meat is expensive and hard to come by).  We also learned today that if you purchase a chicken, turkey, or goat, it will arrive at your house still alive and ready to be slaughtered...definitely not going to happen while I am here. 

In the bathroom, the hot water heater is built into the wall above the tub, and is plugged in 10-15 minutes before your shower to heat the water.  It only works though if there is water pressure and electricity available which luckily is 75-80% of the time, though not always at the same time.  Just in case there is no water or electricity available, there are large buckets of water ready to be warmed over the gas stove for light washing.  They do not have stand up showers here, nor do they have tub stoppers for a full bath, which definitely makes showering and washing hair pretty difficult, but there is running water in the sink and toilet though so going to the bathroom and washing up is a pretty easy task.

Like I said earlier, our bedroom is cozy but accommodates us well.  We have a fairly large wardrobe that holds all of our clothes easily, and a “large” double bed that holds me well and Drew fairly well  (his feet only hang off a little).  Sleeping under mosquito netting definitely feels exotic but has taken some getting used to.  It is also really necessary this time of year, as Rwanda has just begun its rainy season and the mosquitoes are out in full force at night.

So, things around the house are definitely a little different but certainly comfortable and will make for a nice living situation over the next month.  Today, in town, we were able to meet with the hospital director for the district, and he showed Drew some of the ropes of the pediatric ward, so he will be getting started there tomorrow morning.  We also went by the primary school where I will be working with elementary-aged kids who are on break for the next 4 weeks, but are excited enough to have a white American English teacher that they are willing to come hang out at school every morning anyway.  In the afternoons, I will be hanging out at the orphanage with the younger kids (5 and under) playing and “teaching English” as well.  I was only there briefly today, but already I can see that the kids at the orphanage especially will be heartbreakers, so sweet and loving and excited!  We will definitely be giving better updates about our job situations once we have been here a little longer.  We are definitely anxious to get started tomorrow and see how things go.

One of the biggest challenges so far has been the language barrier.  Many Rwandans speak kinyarwanda as their first language (a Bantu language similar to Swahili), and French as their second language (since it was the official language of the country until 2008), and are only now learning English as their third or even fourth language (behind Swahili), now that it is the official language.  Many of the young children are better at speaking English than the adults, and many of the adults are definitely learning, but overall it is difficult to communicate beyond basic wants or needs.  Drew will fortunately have an interpreter with him that speaks French, English, and kinyarwanda which will hopefully make life a little easier at the hospital, and I will try to learn a few key phrases in kinyarwanda for classroom management and sing and dance for the rest ( a universal language for most children right?) J

We do have a phone here, as well as a modem for the laptop that are both pay as you go.  We haven’t quite figured out how expensive it is to use the phone to call home, but we will certainly try to continue updating here and e-mailing as much as we can, and f you want to try to call, we can message you our phone number.  All in all, we are doing well, and have had a positive experience so far.  We are still a little anxious and hesitant about some things which may get worse before it gets better, but we are both pretty sure we will have a good experience overall.

Murabeho!

We made it!

So, we finally made it to Rwanda! We had two ~8hr long flights and a couple layovers, but the traveling has finally come to a close. We ended up getting into Kigali in the early evening last night and almost immediately went to bed. However, the brief night was not without its worrisome moments. We hadn't done any currency exchange yet, figuring we'd get it done at the airport once we arrived. However, the airport was very small... it makes the one in Tucson look gigantic. There wasn't a currency exchange open at that our. When we finally got to our room, we asked one of the workers where we could get money, and he looked at me with wide eyes and said, "Tomorrow's Sunday...." I had a brief moment of panic that we were stuck in a foreign city without money for two days. Luckily, that moment passed quickly, and we were assured that there were places open on Sunday where we could get money. It turns out that the airport exchange is a huge ripoff, so we may have lucked out!

We woke up this morning to tons of talking and singing right outside of our window. There's a large group of people who were doing a religious fast... and it ended today. It was pretty loud, and given that it was 5:30am, we tried to roll over and ignore it. When we finally got up, we enjoyed a nice breakfast, including bananas, pancakes, fried eggs, and hot tea. We then received a phone call from Malea, who is one of the Peace Corps workers who will be sharing the house with us over the next month. She and her husband, Tom, met us for lunch and gave us a quick orientation of the city. We were finally able to get some cash and enjoyed a nice hamburger and Coke right across the street from the hotel that "Hotel Rwanda" is based on.

Tom and Malea have now gone their separate way, and we're taking a brief moment to let everyone back home know that we've made it here alright. Hopefully we'll be able to make it back to the A.E.E (African Evangelical E... something) without incident (the bus that we were on earlier ran out of gas. It's all a little overwhelming at this time, but having Emily here definitely makes it easier. We're both very excited about getting to Kibungo tomorrow, and we look forward to getting to know Tom and Malea better.

On our way to Africa!

Well, we managed to fit everything into our limited luggage, well within the weight limits, and we have made it to the airport.  Our bags are checked all the way through to Kigali!

All week, Drew and I have been on autopilot trying to get everything tied up, and we haven't really had time to stop and be nervous, excited, or anything else for that matter.  Now, that we are sitting at the airport, it is starting to set in, and I can't really describe how I feel now either.  I am so pumped for this opportunity and experience and at the same time wondering how we are going to make it through!

I am so grateful to have Drew with me.  I think we make a pretty good team, and I know we will be able to offer each other the love and support we will need while we are there.  I would also like to thank all of you for your prayers and thoughts while we are abroad.  They are so appreciated, and already we have been able to feel the support that surrounds us on so many levels.

We will try to keep this updated while we are there.  We aren't sure of our accessibility, but we will certainly try to share as often as we can, so check back frequently! 

We love you all!

Crazy Dogs

 THANK YOU MARY, MOM, & KATIE!!!

The realization that we are leaving soon has finally started to really set in.  This weekend, Annabelle and Albert arrived at their luxurious accommodations for the next month or so, where they will be well taken care of by my mom and sister, Katie.  While I would like to say the trip was uneventful, it never is when it comes to the pups and me.   I will say that I am sure MANY of the behaviors on this trip were escalated because of their unfamiliarity with their surroundings, my nervousness about leaving them for so long, and a break from their normal routine, but there are several things that have shown me we need to work on some things.  I have definitely decided we are ready for a full-on intervention with a dog behaviorist when we return from our trip. But, let’s back up a second….

This weekend, Mary flew out to Tucson to join me in the car as we brought the two dogs back to Nashville to stay for the duration of our African adventure.  Mary is a true friend, and I am so thankful to have her around.  She is amazing, so patient and willing to help, and she is a great listener and talker.  We make a pretty good road trip pair: a pair of small bladders, laid back enough to cruise along without too much of a plan, but responsible enough to get where we are going in a timely fashion.  Again, I am so thankful to have her in my life, and even more grateful that she was willing to embark on this trip with me.

First let me begin by saying that both of our dogs are excellent car travelers.  They settle into the back seat and sit or lay down quietly as we cruise down the freeway.  You almost don’t know they are there.  This is certainly a wonderful thing when you are going to be spending 24 hours in the car with them.  Apart from a couple of attempts to come up front to sniff out whatever snacks were being eaten, Albert spread himself out across the seat and slept almost the entire time.  Annabelle generally sits and stares out the window for most of the drive, watching the other cars go by.  I don’t think she enjoys the car, but she certainly tolerates it well.

Also, the two of them get along really well 99.9% of the time.  Annabelle definitely lets Albert know who’s boss when he has released a bit too much of his puppy energy, but he usually listens and goes along his merry way.  They are both wonderful dogs, sweet, loving, and playful.  I love them so much.

BUT, they definitely have their issues.  First of all, while they are great car travelers, the same cannot be said for time out of the car, particularly in hotels.  Despite spending the first couple years of her life living in an apartment, Annabelle has forgotten that just because she hears people outside the door, it does not mean they are trying to come in and find us.  On our first night stop in Santa Rosa, NM, nobody slept a wink except for Albert.  Annabelle woke with a start and a bark EVERY time she heard a noise and we were staying in a Super 8 with paper walls, so heard lots of noises.  She just could not relax.  She even continued to whine and bark through her entire morning walk before we hit the road.  Mary and I were not happy in the morning.  

Albert was not without his faults either.  Albert is the only dog I have ever known who refuses to go to the bathroom on a leash.  You can take him for a 5-6 mile walk, and he will still wait til we get home and let him off the leash to relieve himself.  Luckily for us, he quickly got over his pee shy-ness, but the pooping is another story.  Albert is a routine 2 poops a day kind of guy, but he would not go for the first 24 hours.  Eventually, he got so desperate that he let it all out, but it did make for some stinky gassy moments before that happened.  Hopefully, he is now broken of his bathroom shyness.

During day 2 in the car, we kept the stops to a minimum and cruised across Texas and Oklahoma in good time.  Whenever the car began to dip below 40 mph as we pulled off on an exit though, Annabelle would begin whining which turned into screeching by the time we pulled in to whatever parking lot we were looking for.  Of course this screeching got Albert worked up as he started bouncing across the backseat.  All knowledge of the commands: sit, wait, quiet, and stay were out the window. 

Luckily for night 2, we were in a much quieter hotel with a room that seemed to be separated from most other guests.  Everyone settled in a little better, and Mary and I even had a chance to take the dogs on a long walk, and sit down for a drink and dinner at Chili’s.  Annabelle and Albert slept through the night, and we were all much less cranky the next morning.

We made good time across Arkansas and Tennessee and made it in to Nashville by mid afternoon.  As we pulled in to the driveway, Annabelle’s ears perked up, and as soon as she jumped out of the car and took a sniff around the backyard, she remembered exactly where she was and was in heaven with her nose to the ground and her tail up as she tracked squirrels and other creatures that we don’t really have in Tucson.  Also to see her rolling around on her back in the grass… I knew she was in heaven.  She saw Charlotte and they sniffed each other and talked it out, remembered each other and went on their merry way together.  Unfortunately Charlotte’s first meeting with Albert did not go as well.

Let me back up again for a second.  Drew and I adopted Albert when he was about 6 months old.  He had been found on the street, skin and bones and covered with fleas and ticks.  Who knows how long he had been there and what experiences he had.  When we first brought him home, he and Annabelle got along pretty easily from the beginning.  There were a couple back and forths for dominance, but Annabelle quickly won, and Albert seemed to understand he was at the bottom of the back, submitting to Annabelle when she had had enough.  We soon discovered though that Albert did not do so well with other dogs especially in controlled environments.  When we first started puppy class, he soon earned the nickname, “the bully.”  He was always making this awful sound in his throat at other dogs.  We stayed in puppy class for 24 weeks working on this behavior.  He excelled at the commands and leash walking, but still did not seem to get along well with the other dogs.  Eventually, he learned to ignore other dogs when walking on a leash or while he was sitting on the curb as other dogs went by…HUGE progress, but he still did not want to be social with other dogs.  We went to the dog park a lot in those beginning days, and he would do OK when we let him off leash and he could roam around to meet other dogs on his own, but if we were there or another person was nearby, the noise in his throat would start again.  The heat soon set in and trips to the dog park became few and very far between.  Albert still did well on the leash walking by other dogs when you gave him the simple command to leave it, but he wasn’t making any new friends.

So, needless to say, when we arrived at my mom’s and it was time to introduce Charlotte, I was a bit uneasy about how the whole situation was going to go (which certainly doesn’t help matters).  Albert and Charlotte got a glimpse of each other and Albert’s throat gurgle would start again. It is not a pleasant noise.  Also Annabelle soon became the middle child, remembering that she was in Charlotte’s domain, but also wanting to protect her little brother.  This did not make for a very good scenario.   

Charlotte is a strong, gentle dog (who is about 40 pounds larger than Albert) who doesn’t put up with a lot of shenanigans.  She is several years older and has a bum leg (from a squirrel chasing incident).  She gets along well with other dogs and quickly earns their respect as a “matron.”  Well other dogs except Albert.  He does not seem to want to get to know Charlotte at all. 

(SIGH)

I had to leave them this morning to come back to Tucson for final preparations for our departure on Friday morning.  I have high hopes that Albert will soon figure out that Charlotte is family and a dog he can trust.  He has my mom around as a strong pack leader, as well as my sister Katie who is great with animals. 

I also know though that once I get back, there are lots of things I want to work on with both of the pups – making myself a stronger pack leader, alleviating some of their anxiety about things, so that they are able to relax, listen, and respond, and we are all able enjoy the ride a little more.  Anyway, it has been an exhausting few days and I know I have a lot of anxiety about the dogs and also about our trip.  It definitely helps to share and make a goal for the dogs for our return.

More soon about our final preparations…