And then there were two...

2/15/09
We got up early enough today that I was able to see the sunrise – our back yard is really quite beautiful in the morning. We had agreed to leave at 6am but of course Fabreece runs on Rwandan time so he showed up just before 7. In the end it was fine though because it gave me a little time to chat with Mary before we left since she flew back to Chicago this afternoon. It was about a 2 and a half hour drive to Akagera and once we got there we paid the park fees and picked up our guide for the day. We started off seeing zebras and some antelope. Then our guide heard on his radio that the elephants (there’s a herd of about 100 in the park) had been spotted drinking at one of the lakes. So, we turned around and rushed down to the lake since Mary had told us the elephants were elusive (in the 5 times she’s been to Akagera she said she’s only seen them once). Unfortunately by the time we got there they had moved on. We did get to see some buffalo and baboons and then we finished off the day with a giraffe and some more zebras. All in all it was a fun experience but we were tired and hungry by the end of the day… not to mention dirty (the dirt roads had turned my hair red and it almost looked like I had a tan since there was a thin layer of dirt all over me). We all think Fabreece has a crush on Anita and since it hasn’t been reciprocated, he made a point to stop by his “girlfriend’s” house on our way home which was just annoying since we were all so tired. We made it home by about 6 though and after scarfing down some dinner, went to bed.

2/16/09
Today we started the pilot of the study at Nyacyonga – we set everything up and screened 5 women using both VIA and rapid HPV testing. There were definitely some kinks that need to be worked out – mislabeling of tubes, etc – and Eugene (the research coordinator for WE-ACTx) gave me attitude when I tried to address it with him so it was a frustrating day. I kind of feel like I’m expected to supervise everything but then ultimately I’m not really in a position of authority over anyone so it puts me in this vague middle ground where I identify things that need to be fixed but can’t do anything about it. I guess I should be used to it since that’s the basic job description of a medical student but it doesn’t make it any less frustrating. Oh well, tomorrow is another day! We watched a movie at home after dinner and had a quiet night to unwind.

2/17/09
Well unfortunately today was equally as frustrating as yesterday – we screened 30 women but it took almost the whole day and then we had to stay for 3 more hours for the lab techs to finish the HPV testing. So, the whole “screen and treat” purpose of this study was defeated since we had to send the women home and have them come back tomorrow. We also had the same issue with sample mislabeling and I have serious concerns about one of the nurses’ competence in VIA so overall I just felt really defeated by the end of the day. Add to that the fact that I felt kind of uncomfortable being the only person there to provide quality assurance since I’m far from a gynecologist! For example – I caught two VIA positive lesions that the nurses called negative but there were two others that I think were negative but couldn’t be 100% sure. I guess it’s always better to err on the side of overtreatment since cryotherapy is a fairly benign procedure. There was also a woman that I’m pretty sure had a recto-vaginal fistula that the nurses were ready to let go home but thankfully I convinced them to refer her to the local hospital.
I guess this is why we’re doing a pilot for the study though – to work out all of these kinks. I think we will have to set up a third exam room to ensure that the screening is finished by noon at the latest and that way the HPV testing will be done by 3pm and there will still be time to do cryotherapy on the women that need it. They are also going to be paying an MD to supervise at least 2 days/week so that will help with quality assurance. Thankfully I have a meeting with the pediatrician at the Icyuzuzo clinic tomorrow so I’ll get a break from Nyacyonga for the day and I can go back on Thursday less frustrated hopefully!

2/18/09
This morning I had a meeting with the doctor at Icyuzuzo clinic to identify the kids that are receiving antiretroviral therapy with nutritional supplementation but are still losing weight. The goal is to figure out if their malnutrition is being caused by psychosocial factors or by medical issues and then get them the appropriate support. I’ll also be doing a lot of data analysis for the Sosoma program and will be putting together an annual report for the donors who are funding the supplements. I’m pretty excited for this project since I’ll be doing home visits for those that we identify as at risk and I’ll finally be doing some work with kids!
After the meeting I met up with Felicia for lunch (she’s in town from Bujumbura to present a new protocol for pediatric HIV treatment that the Clinton Foundation is getting ready to roll out). She introduced me to a restaurant in town that has good take-away including some delicious samosas and burritos. Tonight is Alesha and Neeva’s last night in Rwanda so we’re headed down to Republika for a drink to unwind a bit.

2/19/09
Back to Nyacyonga this morning. They set up the third exam room yesterday and so things went a lot better today. They got through 20 patients before lunch and we were able to leave by 4pm which was good since Alesha and Neeva had to head to the airport at 6:30pm. Now it's just me and Anita until the new yoga teacher comes in March.

2/20/09
I met with Eugene this morning to discuss some of our communication issues and hopefully that will make things run more smoothly between us over the next few weeks. The biggest news of the day is that Anita and I ordered bagels and picked them up tonight. The whole process was quite bizarre – Felicia gave me a phone number to call, we placed an order for half a dozen bagels yesterday and were given an address to pick them up this evening. After knocking on the door we were led to a back room where we handed over some cash and they gave us the bagels. The whole thing felt a bit like a drug deal until we realized that it’s an orphanage that makes baked goods as a profit making venture so if they’re any good I think we’ll be ordering again. The bagel place is just down the road from Papyrus (a delicious restaurant) so Anita and I shared some homemade ravioli and then walked home and bought a bottle of wine along the way. There was another full meal waiting for us when we got home and now that everyone else is gone we invited Joseph in for dinner (he usually eats out in the guard house). He’s clearly a really talented artist and if language weren’t such a barrier I think he’d be really fun to talk to. SO, with that in mind, Anita and I are starting Kinyarwanda lessons tomorrow morning. We found an instructor to come to the house for $12/hour so we’ll see how it goes. It would just be really nice to be able to do more than stumble through a generic greeting. We’re thinking we may also look into some French lessons since Kinyarwanda is impossible and French would be equally useful here.

That’s it for now… we’ve got a quiet weekend coming up so I may post again tomorrow or Sunday. For now, I uploaded some more pictures from our trip to Akagera – check them out here:

http://www.facebook.com/album.php?aid=2135841&id=2600785&l=ed8bc