Bourbon Coffee's wireless internet is my savior!

So I’ve been MIA for over a week now – sorry about that. I was out of Kigali for 4 days and then when I got back there was no internet service in the house so it’s been difficult to get back into blogging. I’m going to pick up where I left off on last Thursday but since I’m doing this retrospectively it’ll be a rehash of the events with some hopefully interesting commentary… I’ll try to keep it as brief as possible but it’s been a busy week and a half! I’m going to forgo the words of the day since it’s been so long... enjoy the novella!

1/15/09
So today we did cryotherapy on sausages placed inside of toilet paper rolls to try to simulate the cervix (I know, a sausage would seem to be more appropriate for the male genitalia than the female but it actually works quite well). I’ve got some great pictures that I would try to post but the internet is still not fully functional so I’ll try to update this with pictures once the connection is fully restored. Today was the last day of didactic training so everyone took a written exam and an image review test which about 85% of the class passed so it seems our training is working well. We’re now done at KHI and we’ll be moving the training to the WE-ACTx clinic for the practical part of the training where the nurses will be practicing on patients (or clients as Marc likes to call them). Dan is leaving next Friday so Marc wants me to learn as much as I can over the next week and then I’ll replace Dan as one of the trainers so we can keep 3 exam rooms going at once. One week to become a VIA expert seems like a lofty goal to me but hopefully it’ll work out!

1/16/09
We screened 35 women in 5 hours today – I was quite impressed with the efficiency once we got started! They all showed up at 7:00am and unfortunately we didn’t have everything set up in the clinic until 9:30 but once we got started we were able to see everyone by 2:30pm. I’ve been participating in the VIA and every once in a while Lisa has asked me for my opinion on whether or not something is positive so I feel like I’m actually learning and playing a real role in all of this. Out of the 35 women there were 3 that were VIA positive and needed cryotherapy. We treated 2 of them and unfortunately the third woman refused because she said her husband wouldn’t be willing to be abstinent for 4 weeks (a highly recommended condition of cryotherapy since the cervix becomes extremely friable). We offered to speak to her husband and so she will be returning to the clinic next week and hopefully we can convince him of the importance of the treatment. It’s amazing to me how little autonomy women here have in their sex lives. We won’t be returning to the clinic until next Wednesday (the 21st) since tomorrow we leave for Kibogora. I think everyone is happy to have a few days away from things since it’s been a pretty intense week. I’m sure Titina will miss me but absence makes the heart grow fonder and she can watch One Tree Hill over the weekend to get her fill of Lucas.

1/17/09
Our 7:30am departure turned into more like 9:00 once everything was said and done. We hired two SUVs each with a driver for this trip so John, Chantal (a nurse at WE-ACTx) and I were in one car and Kathy, Marc, Dan and Lisa were in the other. It’s about a 6 hour drive from Kigali to Kibogora, mostly because of the curvy and poor quality roads… the distance really isn’t that great considering the whole country is about the size of New Jersey. Kibogora is in the Western province of Cyangugu right on Lake Kivu and within sight of the DR Congo. To get there we drove West to Gitarama, South to Butare (now also known as Huye and the second largest “city” in Rwanda) and then West again through Gikongoro and the Nyungwe Forest National Park where we got to see several monkeys on the side of the road. It was a gorgeous but somewhat nauseating drive and just before getting to Cyangugu we turned off the main road and spent a bumpy 45 minutes traveling on a dirt road to Kibogora. We stayed at a Methodist Mission overlooking Lake Kivu with a view of the volcanoes about 70km away to the north – really breathtaking views. I again was the odd man out so I slept on the couch (we were in a 3 bedroom house with 7 people) but it was actually quite comfortable minus the mosquitoes buzzing in my ear. That is until I put my head down on the pillow and immediately had a severe allergic reaction – my eyes started streaming, I went through an entire pack of tissues since I was sneezing so much and then I started wheezing and feeling my airway tighten up. Thankfully I had Benadryl and I took 50mg which I think managed to prevent full blown anaphylaxis! Needless to day I didn’t sleep so well that first night but that’s been a common theme of the trip so far so nothing new.

As an aside – to explain the trip to Kibogora a little: Lisa Nathan is starting a project to improve maternal & child health outcomes in rural Rwanda and there is an organization called Imbabazi that has been identified as a possible partner for WE-ACTx to work with to achieve this. Imbabazi was started by the mother (Sevarina) of the first nurse to work for WE-ACTx in Kigali and so Kathy has a strong tie to this organization. It mainly functions as an aid organization to orphans in and around Kibogora but has also started a health post about 7km outside of Kibogora (basically as far out in the boondocks on the worst roads you can imagine) in order to serve several small villages that aren’t really accessible to the district hospital in Kibogora. This health post is where Lisa is hoping to establish labor and delivery services by training several local midwives. The project also aims to provide mobile prenatal services by training community health workers to track the pregnant women in each village. Ultimately the goal is to improve maternal morality rates (quite high in this region of Rwanda) and in turn improve infant mortality as well. This trip was really to evaluate the site of the clinic to determine what physical upgrades need to be made as well as to meet with the director of the district hospital in Kibogora to get approval for this project.

1/18/09
Well I was up bright and early this morning for services at the Methodist church in Kibogora where we were honored guests of Sevarina. So honored, in fact, that we were brought up onto the pulpit and each personally introduced to the congregation of about 1,000 members… quite an experience! The service was quite lengthy (about 3 hours) but about 2 hours of that was filled with choir music that was really beautiful – it seems to me that all Africans are born with amazing singing voices. There were 5 separate choirs in the church two of which were children’s groups and so it was really amazing to just take in all of the music. All eyes were on us as well considering that we were the only Muzungus (white people) in the whole church… that made it all the more interesting. After church, Sevarina took us to the Imbabazi headquarters where again we were sung to by about 100 orphans. It was a really bizarre but moving experience which I managed to capture on film and will try to post (again, once the internet is back up and running). We got to help pass out their one meal a day that consists of a high protein porridge and then took some pictures with the kids. The one meal a day as well as their school fees and school uniforms are all funded through WE-ACTx which has created a partnership with a sister community in the USA. I’m thinking once I get back to NY I may work on securing funding to sponsor another community of children since this really was such an incredible experience for me. It really gives a new perspective on those stupid Sally Struthers commercials we’ve all seen back in the day for Save The Children…
After the presentation of the children, Sevarina took us down to Kumbya which is a little rocky area down on the lake (Kibogora is about 1,000 feet directly above the lake) to go swimming. After considering the likelihood of getting a parasite (the downside of my medical education) I compromised and waded in up to my knees but didn’t actually go swimming. So fingers crossed, I won’t be coming home with Schistosomiasis.

1/19/09
This morning we had our big meeting at Kibogora District Hospital. Sheila is the head midwife and runs the Methodist Mission where we stayed so she arranged for us to meet with the hospital director Dr. Damien. A representative of the health center closest to Imbabazi clinic as well as a translator met with us as well. The meeting seemed to be going off course due to some concern over government regulations dealing with NGO involvement in healthcare in Rwanda but Kathy worked her magic and managed to convince Dr. Damien of the benefit of this project. It was really great to be able to sit in on this meeting and see for myself just how difficult it is to get things done here… But, in the end, all were agreed that this project is in the best interest of the local women and children and so we should move forward with establishing a maternity skills training program. Hopefully this is something I can be involved in setting up (since after mid-February the cervical cancer screening project will likely be pretty much self sustaining and won’t take up too much of my time). The goal is for Lisa and Marc to come back in mid-March to do the three week maternity skills training and in the mean time I can do all the necessary data collection and statistical analysis to figure out how best to move forward. The slight hitch is that the Methodist mission is entirely booked in March and there is nowhere else for us to stay in Kibogora. Hopefully that will get worked out because otherwise I’m going to have to figure out another project to fill my time here.

1/20/09
We went out and visited the Imbabazi clinic this morning before heading back to Kigali (with the goal of arriving before 7pm so we could watch the inauguration live… there are no TVs in Kibogora). The community health workers came and met with us to express their excitement about the program and we also got to look at the facility and figure out what needs upgrading (there’s no electricity or running water so that’s where we’re going to start). We headed back by around 12:30pm and made it into Kigali around 6:30pm. We quickly dropped off our stuff and headed to the Serena Hotel which has satellite TV service in their bar/restaurant. We each shelled out 12,000rwf (about $25usd) for a buffet meal just so we could sit by the TV but it was well worth it. I must say there was something really profound about hearing Obama’s speech after returning from a trip spent with hundreds of African orphans and women without access to basic maternity services. His speech really solidified my desire to be here doing what I’m doing and made me excited for what’s to come over the next 4 (and hopefully 8) years!
Sadly, Lara and Eunice moved out of the house while we were gone because Mary Fabree (a trauma counselor for survivors of the genocide and their families) arrived and there was really not enough room for us all. Logan is going home to Canada on Thursday and Daniel will be leaving on Friday though so hopefully we will be reunited again soon!

1/21/09
Back in the clinic today to do more VIA practice with the nurses… we screened another 33 women of which 5 were positive. We only did 4 cryos though since yet again a woman told us that her husband wouldn’t be willing to be abstinent for 4 weeks. It looks like this may be a real obstacle to treatment here but hopefully with some counseling we can convince these men of the importance to their wives’ health. Lisa, Marc, Lara, Eunice, Logan and I went out for Indian food at Ice & Spice to say goodbye to Logan since she’s leaving in the morning. There has been some tension in the house over Lara and Eunice having to move out so it was nice to see them and do a little venting about all of the politics that go into volunteering for an NGO. Enough said about that – dinner was fun and it will be sad to see Logan go!

1/22/09
Logan’s departure this morning was quite sad – I suppose Montreal isn’t that far from New York though and we’ll always have Skype to keep in touch (if the F-ing internet ever starts working again… I’m storing these blog entries on my computer until I can finally post them all). Coming home to see her bed stripped and empty was a bit heart wrenching since she and I have been sharing the bunk beds in the front room for the past few nights… now I’ve got “the box” all to myself and I don’t know what to do with all this freedom. I’d much rather have Logan on top of me! Anyway, we screened another 35 women today and then headed over to Blues Café which is an internet place downtown. At 4pm we had a meeting with the rector of KHI to discuss the possibility of establishing regional cervical cancer screening and prevention training program as a joint effort between WE-ACTx and the KHI skills lab that we used for our training last week. Everyone seems quite enthusiastic about the idea and assuming the Minister of Health agrees we may be able to establish a capacity building “training of trainers” program that will allow VIA and cryotherapy to be incorporated into midwifery classes at KHI. The goal of everything WE-ACTx does in Rwanda is sustainability so by training Rwandans who will ultimately train others in the future, we eliminate the need for a permanent presence of non-Rwandan doctors.
After that we went to Ice & Spice again (yes, two nights in a row… it was that good) for a nice goodbye dinner for Dan who leaves to go back to Uganda tomorrow afternoon. I’m off to sleep in my lonely bunk bed – miss you Logan!

1/23/09
Yesterday my stomach was feeling a bit funky and so this morning everyone (especially Titina) was asking me how I felt… when I told her I was feeling much better, her response was “Jesus is a healer.” Of course my response was “What?” after which she told me that she had prayed for me. Of course that was quite sweet of her but it looks like we’ve found another reason she and I won’t make it as husband and wife – my agnosticism might be an issue for her.
Anyway, 25 more women were screened today which we finished in the morning before Dan left for his flight at 1pm. One of the women who screened positive was a commercial sex worker and her pimp pays her on the last Thursday of the month so she didn’t want to get cryotherapy until after she gets paid next week. It is a crazy world we live in!
Internet is still down and we finally found out that Rwandatel is upgrading their DSL lines to fiber optic cables in all of Kigali so it could be quite a long time without internet :( Luckily we found an internet café that uses satellite for internet so that’s why I’ve been able to respond to a few of your e-mails. Sorry I’ve been so out of touch – hopefully I can post all these blog entries soon!
Lisa, Marc and I visited Eunice and Lara at their little home away from home – The Dream Inn. It’s right next to a chicken slaughter house and in quite an interesting little neighborhood. They have internet service and CNN though so it’s not so bad I guess. After we got back to our house we watched a double feature on the LCD projector we brought home after we used it for the image test during the training. Kathy and Jon brought Grand Torino and Burn After Reading so it was a fun Friday night in.

1/24/09
I’m at Bourbon Coffee and I brought my computer with me since they have internet service so I can finally post all these blog entries! I just came from Remera market where we went to look at some local fabrics. Not much else going on today. In fact it was the first morning so far that I haven’t had to get up early for work so I slept until 9 and then just lounged around. I also unpacked my suitcase for the first time since I now (hopefully) have my own room for the rest of my stay here. Feels good to finally settle in somewhere!

So if you've made it this far I'm quite impressed as to your level of interest in my life and greatly appreciate it. Hope you're all doing well and I'd love to get some comments or e-mails from each of you!