Umuganda and other bizzare Rwandan experiences...

1/28/09
Went back to the clinic yesterday which was clearly a mistake – even though I got a ride up the hill from Kathy I just didn’t have the energy to make it through the day. Today I got a ride with Mary on her way to Remera so I wouldn’t have to climb the hill and although I still felt a little weak I made it through the day with the help of a chocolate bar and a lot of water. We finished seeing patients early today and it was a nice sunny afternoon so Marc, Lisa and I headed up to the Hotel des Mille Collines (of Hotel Rwanda fame) to try to go swimming… sadly they are doing renovations and so the pool is closed. From there we tried to go to the Bourbon Coffee at the UTC which was supposed to open on the 24th after renovations but it too was closed. So we went to Blues Café in hopes of getting a snack and they were out of virtually everything on the menu. So, all in all it was a pretty unsuccessful afternoon! By the time we got home I was fully spent and after an early dinner went to bed early.

1/29/09
Today was our last day of the VIA clinical training and the commercial sex worker I told you all about before returned today to have cryotherapy. She was in tears when she came into clinic, clearly upset about the circumstances of her life. It’s really sad how little social support there is here for people in her situation and I could tell the nurses really had no sympathy for her. Even though we may have prevented her from getting cervical cancer, it seems like such a small thing compared to the suffering she experiences on a day to day basis and unfortunately there’s not much we can do for that with vinegar and compressed nitrous oxide. Marc inquired about getting her some work at the clinic so she wouldn’t have to return to “work” right away but there is so much stigma attached that the idea was quickly shot down.
After we finished seeing patients Marc, Lisa and I took Dr. Venant (the only doctor we trained in VIA) and Bosco (a nurse and administrator at WE-ACTx) out to lunch since they will be working with me to provide quality assurance once Lisa and Marc are gone – observing the nurses doing VIA and making sure no lesions are missed and no one is treated unnecessarily. Bosco is also expecting his second baby in the next few days/weeks so we all chipped in for a crib for him to say thanks for all the hard work he put in not only as a participant but also in planning the training. He has invited me to the naming ceremony of his baby at his home so I’m excited for that! We went from lunch back to Blues Café to get a coffee with Dr. Natalie (the Belgian OB/GYN working at CHUK) to discuss more about sending her the patients that are not appropriate for cryotherapy and need either LEEP or cold-knife cone biopsies. Sounds like she’s on board so hopefully I’ll get to do a little work with her over the coming months.
From there Marc, Lisa and I headed out to dinner with Lara and Eunice since it’s Marc & Lisa’s last night in Kigali. We went to New Cactus (not sure if there is an old cactus but who knows) which is a restaurant about 2 blocks from the house with gorgeous views of Kigali. After some heavy conversation about religion and its role in global health work we finished off the night with some delicious ice cream and sorbet. When we got home I set Lisa up with a facebook account and before we knew it, 2am rolled around.

1/30/09
Today was certainly the most eventful day I’ve had in Kigali thus far though for some of the details you’ll have to actually call or email me since parts of the evening are not quite appropriate for such a public forum!
Anyway, the day started off with the closing ceremonies for the training during which we showed a slideshow of some pictures and videos we took along the way and then presented the certificates of competence in VIA and cryotherapy to all but 2 of the nurses (which created a little drama but we felt they hadn’t attended enough of the training to receive a certificate). Bosco will be working with them during the study to assess their skill level and hopefully eventually they’ll get a certificate.
Kathy and Jon left for NY at around 11am and then Lisa and Marc abandoned me at around 2pm. Luckily I was only home alone for a couple of hours until Lara and Eunice moved back into the house and then Donna Rae (WE-ACTx’s executive administrator in San Francisco) arrived in the afternoon. So it was a big day of goodbyes and yet the house is still pretty full for the time being.
Claire got back from Ethiopia today and it’s her last night in Kigali (and her birthday) so Lara, Eunice and I joined her for a celebratory/goodbye dinner at Papyrus (a really nice restaurant in Kimihurara). Coincidentally Mary was having dinner there with a big group of donors for her organization (Heartland Alliance) and so we shared a taxi and then met some people from her group. She took special care to introduce me (not so subtly I might add) to Sean who also works for Heartland Alliance on a project called the Global Equality Network. It’s a grassroots global network focused on protection of sexual minorities (read LGBT populations) in danger and building local capacity in regions where LGBT rights are hampered by political, social, and religious opposition. He’s leading this group of donors in a tour of East Africa over the next few weeks so he’ll be in and out of Kigali, Bujumbura and DR Congo until mid February.
After dinner, Lara, Eunice and I stayed to have a drink with Sean and his friend Amy. One drink led into a few more and by midnight Lara and Eunice headed home and Sean, Amy and I went out dancing. Sean lived in Kigali for a year so he knows the city really well and we made the rounds to a couple of night spots – we started off at B-club which was in the middle of nowhere and yet still charged 9000rwf for a vodka soda (that’s about $18usd – unbelievable how expensive this city is). Needless to say we didn’t order any more drinks there and after a bit we headed to a Congolese bar called Atmosphere which upon arrival turned out to be empty and everyone in there stopped what they were doing and stared at the three muzungos so we immediately hopped back in the cab and made our way to the Planete Club at the KBC. It was packed and had much more affordable drinks so we got in some good dancing (including some unsolicited dance floor action with a couple of very drunk Rwandan women who I guess took a liking to me). All in all a very fun night – I made it home by 5am!

1/31/09
Somehow I woke up at 8am today and haven’t felt tired despite only getting 3 hours of sleep! Today (and every last Saturday of the month) is known as Umuganda. It’s a mandatory morning of community service where everyone returns to their home village and is instructed by their Umudugudu (village leader) as to what tasks they have to perform. No cars are allowed to drive on the road (except taxis to the airport) and typically Muzungus don’t go out until after noon. If a Rwandan doesn’t participate and doesn’t have pre-approval, they are fined really heavily. I don’t know how I feel about mandatory community service but I will tell you Kigali is one of the cleanest cities I’ve ever been to so I guess the end result is pretty impressive. Just another example of how bizarre this place is though.
So we had a kind of forced lazy morning since we couldn’t really go out. We went to CAPLAKI arts & craft market in the afternoon which was a nice 30 minute walk from the house. They’ve got a lot of really nice things – just looked today but I’ll definitely be bringing a lot of stuff home. Mardge, Mary and Donna Rae took Lara, Eunice and me out to dinner tonight at Comme Chez Moi in Kimihurura which despite sounding quite French is actually a “Thai” restaurant. I put that in quotations because the only Thai items on the menu were sate and sesame noodles. Still quite good though! Actually the restaurant has become known as “mousse and juice” since the best items on the menu are their chocolate mousse and fresh squeezed juices. Quite a nice night! When we got home the two Qiagen employees (names TBA) had arrived and they went directly to bed. In fact now I’m off to bed to make up for my 3 hours of sleep last night.