The Rwanda Monologues

2/26/2009

“All at once, as it seemed, something we could have only imagined was upon us – and we could still only imagine it. This is what fascinates me most in existence: the peculiar necessity of imagining what is, in fact, real… The word ‘genocide’ and the images of the nameless and numberless dead left too much to the imagination.”

- We Wish To Inform You That Tomorrow We Will Be Killed With Our Families: Stories from Rwanda by Philip Gourevitch

Today was a hard day. After seven weeks in Rwanda I finally mustered up enough energy (read: emotional strength) to make the trip to the national genocide memorial in Kigali. It’s been a mere 10 minute drive away for the past 49 days and yet it has felt like an impossibly hard trip to make until today. I had finished about half of Philip Gourevitch’s book (quoted above) over the course of about a week in New York but upon arriving in Rwanda, it took me a solid month to finish the other half. After finishing, I put it away and have taken the past couple weeks away from it to try and process all the emotions it brought up. I finally went back to it earlier this week and looked over some of the pages I had marked and was particularly struck by the quotation above. I realized that really, even with all the emotions I’d experienced and conversations I’ve had with people here, I had still only imagined the events of 15 years ago. Suddenly I felt a tremendous guilt for not actively pursuing a more tangible experience earlier in my trip and made the decision to visit the memorial immediately.
Two hours, thousands of haunting images and several mass graves later, I left with the realization that the enormity of it all isn’t really comprehensible and I’m still just left with my imagination. But I’m also left with the faces and heart wrenching last words of 30 children killed in the genocide. And I’m left with a greater understanding of the historical context of not only the Rwandan genocide but others throughout history. So, overall I’m extremely grateful to the creators of the monument for their beautiful memorial to the victims of such {barely} imaginable violence and hatred. While the entire scope of what happened here may only ever be fully captured in one’s imagination, I am honored to have been witness to a few people’s personal stories and to have brought a touch of reality into what has all too easily and commonly been dismissed in history as a far off and intangible concept: genocide.

Please consider contributing to Ageis Trust, the organization that runs the Kigali Memorial Center. They are having a candle lighting ceremony for the 15th anniversary of the genocide this April.
http://www.candlesforrwanda.org/view/10/the-project.html

As a fitting complement to the visit to the genocide memorial this morning, I attended a performance of the “Rwanda Monologues” this evening at Torero Café. The performance was an adaptation of Eve Ensler’s “The Vagina Monologues” and was the first ever performance of any part of The Vagina Monologues in Rwanda (not to mention only the fourth ever production in all of Africa). As a part of the V-DAY 2009 campaign (the "V" stands for valentine, vagina and victory over violence), the proceeds of the performance benefit an organization called Achieving a Better Life which works to prevent gender-based violence in Rwanda.
The theme of V-DAY 2009 is “Stop Raping Our Greatest Resource: Power to the Women and Girls of Democratic Republic of the Congo.” Eve Ensler wrote a monologue called Baptized specifically for this cause after interviewing an eight year old girl, Noella, at Panzi Hospital in eastern DRC. After the interview, Eve tried to hug Noella and she squirmed away. Eve realized then that Noella probably hadn’t been hugged since she was raped by a group of Militia every day for two weeks straight. The rapes had given her a fistula so she was no longer continent. Eve hugged her anyway and held her on her lap and after that, there was no turning back…

Baptized
by Eve Ensler

Look out your window
The dead live everywhere
Think of your luxuries as corpses
Count the bodies

30 hacked children for a new play station

20 tortured women so you can text photos from the party

50 amputated men, waving their missing hands
as sweet Andrew mindlessly bounces his rubber ball

I hold an eight year old girl in my lap
Who had been raped by so many men
She had an extra hole inside her

When she accidentally peed on me
I was baptized

It isn’t over there

The Congo

It’s inside everything you touch and do

Or do not do.

Sosoma and such

2/23/09 – 2/24/09
The past couple of days have been full of frustration and annoyances so I’ve decided not to rehash all the details… Let’s just say that after bringing several quality assurance issues to everyone’s attention so that they could be addressed, it seems that Eugene (the WE-ACTx research coordinator) now has a grudge against me and is making it very difficult for me to actually accomplish anything further with the HPV study. So, I think I’ve done what I can in terms of setting everything up to run smoothly and now it’s time to shift focus.

2/25/2009
Today was the distribution day for the Sosoma nutritional supplement (it gets its name from the three principal ingredients - SOrgho, SOja, et MAis in French which is Sorghum, Soy and Corn) so I spent the afternoon handing out 8kg bags of the mixture along with 2kg bags of sugar to about 120 HIV+ kids and their families. The idea is for the Sosoma to supplement their diet so that they can take antiretroviral drugs without nausea and can avoid malnutrition. Unfortunately many of them continue to lose weight despite the supplement and so my task now is to identify these kids and do home visits to find out why they’re not doing well. I’ve also been in touch with Lisa back in NY and it looks like I will be going back to Kibogora for a week or two to work with the community health workers there in preparation for her maternal/child health program out there. Throw a few weekend trips around Rwanda plus a longer trip to Tanzania/Uganda into the mix and I think I’ll have enough stuff going on to fill the rest of my time here.

When in doubt, pitch it out!

2/21/09
So Diane came this morning and worked with Anita and I for about an hour and a half on Kinyarwanda. Her English pretty good so we got by and I think we’ll try to fit in a lesson with her once a week.
After she left we spent the day cleaning the house – this place has accumulated 4 years worth of people’s junk and we decided no one else was ever going to throw anything out so we made it our project for the day. There is something cathartic about throwing out other people’s junk – it also brought back surprisingly fond memories the days I used to clean out our house when I knew my father wouldn’t be home for a while. Four hours and three huge trash bags later, however, the nostalgia wore off and we left the rest for another day. Now comes the hard part – actually throwing this stuff out. Since I’ve been here I’ve noted that several items have somehow made their way back onto a shelf after being placed in the garbage so I think Josie, Seraphine and Joseph are reluctant to throw things out (understandably given the difficulty and expense of getting a lot of things in Rwanda). Considering that among the items we threw out were expired suppositories and empty ink cartridges for printers that no longer exist, hopefully we can manage to ensure they actually get thrown out. Now “thrown out” is a relative term here since there is no regular garbage collection and as far as I can tell most people just incinerate whatever garbage they create. So who knows what the ultimate fate of those suppositories will be – maybe they would have been better off gathering dust here for four more years! Anyway, we’ve decided to slowly divide the trash over the next few weeks and we’ll see what happens. One huge bonus of our mega cleanup though was the discovery of an electric-mosquito-killing-tennis-racquet-like contraption. We have a real fruit fly problem so I’ve been diligently zapping them which is disturbingly satisfying… I think of Eunice and feel guilty every time I zap something since I know she would have a conniption (she yelled at me every time I killed a mosquito even if it was about to bite me).
Anyway, after calling it quits on the clean up (all we have left is the bookshelf and two bedroom closets) I went for a run (which I’m now going to really try to incorporate into my daily routine) and then Anita and I joined Katie for dinner at Sun & Moon – a new pizza shop in Centre Ville. It still hasn’t ceased to amaze me how dead Kigali is at night and a Saturday night at that! I mean there certainly are hot spots and popular bars/clubs but overwhelmingly this city is NOT nocturnal – quite a switch from NY.

2/22/09
Well today has been my laziest day in Kigali thus far. I went for another run this morning and spent the rest of the day leisurely reading and doing a whole lotta nothin! Anita and I are planning several weekend trips to occupy ourselves and explore as much of Rwanda as possible so I don’t think I’ll have too many more quiet weekends in Kigali… probably a good thing since a little bit of boredom has started to set in this evening.

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

Will you be my Valentine?

Well it’s been over week since my last post so get ready for another novel… to those of you who actually read through all of these entries, thanks for your interest in my life! To those of you who don’t, I’m planning on doing some entries just about my observations about life here and what some of my experiences have meant to me instead of just a play by play of events so keep your eyes open for those – I think they’ll be more interesting.

2/5/09
I got a late start today which was nice since my flight wasn’t until 2pm. Rwandair Express is quite an interesting little operation – they don’t actually own any airplanes… they just charter out their flights to a bunch of private carriers so I had a nice little flight on a no-name aircraft. It was only 25 minutes though (compared to about an 8 hour drive) so I can’t complain. I got into Bujumbura and Mary was waiting for me which was a relief since the bank at the airport was closed - it was “National Unity Day” and I didn’t have any Burundian Francs to pay for a taxi with!
We got back to Jeff’s house where he generously offered for me to stay for the weekend. Jeff works for Heartland Alliance – the same organization that Mary and Sean work for – and has been on the ground in Bujumbura for about 7 months setting up their child soldier treatment program. I continue to be amazed with the outstanding international work Heartland is doing! I got a tour of the house including the amazing backyard with every kind of fruit tree you could imagine. His house really feels like a little walled off piece of paradise which is a bit bizarre considering it’s in the middle of a city that has been deep in conflict for decades.
Anyway, Mary and I spent the evening chatting about relationships and life accomplishments over a few glasses of wine. As I said I really think the work that she and her colleagues are doing is phenomenal and it’s had not to feel dwarfed by their achievements. Between Mary’s work with torture victims, Sean’s work with global HIV initiatives and LGBT grassroots organizations in some of the most oppressive nations in the world, Mardge’s activism at Cook County Hospital working for access to healthcare for a highly underserved community, Donna Rae’s work as an activist in the HIV/AIDS movement in the late 80’s and for human rights in Southeast Asia, and Kathy’s work in the Bronx (not to mention the work WE-ACTx is doing in Rwanda), I really feel like I couldn’t possibly have been surrounded by any more accomplished and heroic people. The stories they share and the knowledge and experience they bring to the table have been eye opening and have made me reexamine my own career aspirations and ideas of how to use medicine as a vehicle for social change. I know I am lucky to have met each and every one of them and I have no doubt that my interaction with them has changed my goals for the future (career and otherwise) - I can’t wait to see what opportunities await! It’s totally this kind of inspiration I was hoping to find during my time here and I feel really excited to jump back into school with some new perspectives.
So, after reaching all these conclusions, I went to bed feeling really good but was awoken at 2am either by the sound of Cher’s “Do you believe in life after love” blaring from a bar down the street or by the insect that was in bed with me and had bitten me about 10 times. That’s what I get for sleeping on a mattress on the floor I suppose! Thankfully I had earplugs and cortisone cream and was able to fall back to sleep eventually.

2/6/09
We started the morning off changing money (at a Forex Bureau called “change for peace” which I found rather ironic considering its war torn location). We went and got Mary’s visa extended and then checked out the craft market where I promptly spent all $50 that I changed. There are some good deals to be had on crafts in Bujumbura though so I’m pretty excited about what I got! We also ran into Neelah (the coordinator for the Human Rights Watch in Burundi) twice in the span of about two hours which tells you just how few westerners there are in Bujumbura. It’s really quite sad because the city is about the same size as Kigali and they have just as great if not a greater need for foreign aid yet there’s millions of dollars flowing through Rwanda and basically NO foreign investment in Burundi. We had dinner at a restaurant called BoraBora (which was right on the beach and had a strangely Caribbean feel) and it was with just about every NGO employee in Bujumbura as far as I could tell. I guess I’m exaggerating but everyone at dinner was an NGO employee - Catherine (from Catholic Relief Services), Felicia (from the Clinton Foundation), Michael (from Orphans of Rwanda) and then Jeff and Mary. Felicia has been working on the Clinton Foundation’s new pediatric HIV treatment protocol in Kigali for the past year so we had a great convo about that and she connected me with some good resources in Kigali including a random number to call to order bagels (every kind you could imagine including cinnamon rasin – now if only I could find cream cheese)! Michael was a friend of hers visiting from NY via Kigali and his organization provides full scholarships for graduate level education in Rwanda so yet again I was surrounded by amazing people doing amazing work!
I also got to enjoy an Amstel Bach for the first time which is a delicious beer that I highly recommend. I had enough of it that I slept pretty deeply but woke up in a half dream state to the sound of a large mob of screaming people. I fell back asleep immediately after dismissing it as a dream but found out in the morning that a man had been beaten pretty severely outside of the house – no doubt on his way home from the bar that was blasting Cher the night before. Apparently an off duty police officer was one of the attackers and the mob I heard was actually intervening on the man’s behalf. If the large pool of blood we found in the morning was any indication though I think perhaps they got there a little too late… Jeff assures me this is the first time anything like this has happened but I think it’s fairly indicative of the continuing safety issues after dark in Bujumbura.

2/7/09
We woke up at 6am to go to the Parc National de la Rusizi which is about 15km outside of Bujumbura. Two French journalists that Jeff met earlier in the week accompanied us since they had been previously but forgot their cameras. Unfortunately every Saturday morning in Burundi is a national service day – similar to Umuganda in Rwanda that I talked about in an earlier post but instead of the last Saturday of the month, they do it EVERY Saturday from 7-10am. We managed to make it to the park by 7am but almost plowed through a road block on our way there since Jeff wasn’t paying attention! The park was kind of limited but we were able to see a bunch of hippopotami as well as some pretty birds called weavers. It really only took about an hour and a half to hike through the whole park though so by the time we were finished it was about 8:45. Unfortunately the road blocks were up to 10:00 and so when we got in the car and attempted our trip back we encountered a mob of Congolese people who were stopped on their way into Burundi. When the soldiers started to let our car through, two men on bicycles loaded to the brim with goods cut in front of the car and blocked the way. At that point we were surrounded by about 50-100 people all laughing and pointing at the stupid muzungus that thought they could force their way through. Mary and I kind of took the viewpoint that we should just wait it out until 10 when the roads opened up – why should we have any more right to get through than everyone else? Jeff and the French journalists, however, felt that we should be able to get through and so after about 10 minutes of sitting there, the two French journalists got out to talk to the soldiers and I was sent out to protect them from the mob – a lot of good I would have been if things had gone badly! Anyway after a screaming match in French of which all I was able to pick up was “we are human beings too” they were able to convince the bicyclists to move aside. I felt like the whole situation was just wrong and it had the potential to be a real issue. On we went thouth, the privileged muzungus, and we stopped for brunch at the hotel club du lac which felt a bit like adding insult to injury. Mary and I debriefed afterwards and agreed the sense of entitlement was a bit disturbing especially considering these people made a conscious choice to come and work in Burundi ostensibly to make a difference for the very people they pushed their way through. AND we made a choice to squeeze in this leisure activity that morning – it’s not like we had an important meeting or something to go to. Over brunch we agreed to disagree but there was clearly a little tension… Mary and I decided to stay at the beach for a while and the three of them went back into town once 10am passed and the road blocks were down.
The beach was gorgeous with a misty view of the DRC across the lake and cute (but worm infested) dogs running around. We ran into Felicia and Michael there of course – yet again an indication of just how small the ex-pat community is there! On the way out of the resort we walked by a cage with two Chimpanzees inside which I must say was one of the saddest things I’ve seen in Africa (which is saying A LOT). We stopped by t2000 on the way home which is a dollar store full of crappy Chinese goods that is popular in Kigali and I didn’t realize is a chain! For dinner, Jeff, Mary and I met Felicia and Michael at Khanah Khazanah which is THE BEST Indian food I’ve ever had in my life and definitely ranks pretty high in the best food of any kind I’ve ever had. It’s a funny story but basically a very popular restaurant in Kigali called Indian Khazanah was shut down for tax evasion and the same family set up shop in Bujumbura instead. Fingers crossed - the owner promised they would reopen in Kigali in mid April so hopefully I’ll have the chance to go again before I leave!

2/8/09
I woke up early to take a walk down to the soccer fields and watch a troop of Burundian drummers that I had heard practices on Sunday mornings. I guess I got there a bit too early and ultimately headed back because the walk got a little sketchy. I went back at 10:30 with Jeff and Mary and after watching a bit of a soccer match, we saw a troop called Rukinzo Legacy practice for about an hour. Their leader was a magistrate named Posper who introduced himself and the troop to us afterwards. I was hot just watching them – I can’t imagine how hot they must have been. I treated myself to my first Diet Coke (aka coke light) since I’ve been here and we bought them all a round of Fantas. Sean came in the afternoon from Kigali and we went grocery shopping (including purchasing 18 cans of coke zero to feed his addiction) for his trip into the Congo this week. He’s going to Uvira tomorrow to work on establishing a former girl soldier treatment program in southeastern Congo.
We all had dinner at Felicia's – she made delicious eggplant parmesan and Jeff brought over some delicious couscous. All in all my culinary experiences in Burundi were quite impressive!

2/9/09
Mary and Jeff had actual work to do today so I entertained myself by walking down to the HUGE central market. I put my money in my shoe since I was forewarned that I would be the only muzungu and indeed I stuck out like a sore thumb. It was a great if not slightly claustrophobic experience and I’m glad I went but it was quite sad since amidst the endless stalls of fabrics and goods, I encountered about 10 amputee and otherwise sick children on display asking for money. I headed back to the house and then packed up my bag and Jeff gave me a ride to the airport.
Arriving in Kigali was actually a really nice experience – despite immediately recognizing just how sanitary and oppressive Kigali can feel compared to other cities in developing countries, I had a sense of homecoming. There are definitely good and bad things about the way things are done in Rwanda but I was really happy to realize that in a lot of ways I already felt at home in this city. There was even a rainbow over the airport when I landed which felt a bit over the top but I went with it and took a picture! I also got a nice welcome from everyone at the house and Donna Rae and Mardge were particularly happy to see me which was really nice. I think I’ve definitely made some lasting connections here!

2/10/09
Back to work this morning… apparently training on Friday went well but one of the machines from Qiagen was broken so things have been a bit delayed. We went out to Nyacyunga for another day of training only to discover power lines were down so we came back to town. I had a package to pick up (thank you again Mama) and so I took a Mutatu (local buses) out to Kaciyru to pick it up at the central post office (iposti in Kinyarwanda) which I am proud to say I figured out how to do all by myself! Anita, Neeva and Alesha came along too and we checked out Top Tower Hotel & Casino which Michael had told me he had fun gambling at. They’re only open at night so we’ll have to check that out another time… We also finally made it over to the Novotel to see the infamous pool where apparently a lot of ex-pats spend their Sundays (the other two hotels with pools are both under construction). We got a buffet lunch at Ma Collines and ran into Savannah & Meredith there – if you haven’t identified a trend yet there’s a lot of running into people here! I had a meeting in the afternoon with Bernadette who works for WE-ACTx to discuss what role I can play in a nutritional supplement program they have for children on anti-retroviral therapy. The cervical cancer study won’t be taking up all of my time after next week so hopefully this Sosoma project will be something else interesting to work on. I also bought Kinyarwanda phrasebook this afternoon since I’ve been lagging in my efforts to learn more words and Anita and I are going to look into possibly taking lessons.

2/11/09
Today was a pretty uneventful day. We went up to Nyacyunga for training in the morning, came back and had lunch at home where we discovered there was a meeting of all the grass roots organizations that work with WE-ACTx (there’s about 20+ of them so it was a full house)! I took a nice nap and after discovering there was no internet we watched Blood Diamond on Anita’s computer and then headed to bed early.

2/12/09
I met Michael (Felicia’s friend from Bujumbura) at the offices for his organization – Orphans Of Rwanda. It’s a scholarship program for graduate students in Rwanda and Michael and I discussed possibly starting an internship program with WE-ACTx for some of their nursing/lab tech students. Then I went to a store called Dancing Pots with Mardge & Donna Rae to check out some Twa (a pygmy people from central Africa) pottery. I also met with Eugene to finalize plans to start the pilot for the study on Monday and I helped Anita set up the machine for her study. Mardge also met with me to discuss another project I can work on while I’m here… they want to start screening all of their pediatric patients for depression and so I’ll be spearheading that along with the two trauma counselors. We had lunch at Ma Collines again with Merideth and when I got home, I discovered Josie had left me a rose from the garden in my room since the one Eunice gave me before I left was dried out… too cute! Mary arrived home from Burundi and it’s Donna Rae’s last night here so there’s more goodbyes coming up.

2/13/09
Said goodbye to Donna Rae this morning and I’ve promised to apply to the pediatrics program at UCSF if for no other reason than to go visit her if I get an interview. I met with one of the doctors for the Sosoma (pediatric HIV nutritional supplement) program in the morning... we were supposed to meet with two doctors but the one from Icyuzuzu called to say his brother had been electrocuted so he had to cancel. Things like this are said so casually here that I was strangely not surprised! Anita and I grabbed some coffee at Bourbon (where we ran into Katie) and then back at the clinic I narrowly escaped Bernadette asking me out for Valentines Day… she asked me casually about what I did usually at home for Valentines Day and thankfully I had to leave right before I could tell she was going to ask me to do something tomorrow. I felt bad but at least I avoided the awkwardness of having to make up an excuse why that wouldn’t be such a good idea.
I took a trip out to Remera (a neighborhood near the airport) to visit the Ineza sewing cooperative which is an income generating project for WE-ACTx patients. Two of Lara’s yoga clients (Roy & Sarah) and Meredith joined me. They make beautiful bags and aprons and such there… there will surely be a few gifts coming back to NY from there.
Afterwards we went to a debut concert at the Hill Top Hotel in Remera. It was a concert for a new artist named Eric Sendeli that Bertin (the coordinator of the WE-ACTx children’s program) invited us to. It was supposed to start by 5:00pm but in typical Rwandan fashion it didn’t start until 8pm. We got a few drinks and actually Savannah was randomly at the same concert so we just hung out with her for a while. Bertin gave us “VIP” tickets which basically meant that we had to sit in the front row but considering there were only about 40 people there it was a bit awkward. Despite best attempts to get drunk on uguagua (banana beer), the concert was still not very enjoyable and after about 2 hours of TERRIBLE lip syncing, Alesha and I decided to head home.

2/14/09
Today has been a pretty chill day. Mardge left at around noon. The weather was gorgeous so I sat out in the yard for a little while and then Alesha, Nevea and I took a walk into town so they could check out the craft market here. Candida made a delicious chocolate cake for Valentines Day and we’re heading out to Torero Café tonight to meet up with Amy and check out some live music they’re having there. It will hopefully be an early night since we’re getting up at 6am to drive out East to Akagera National Park which is a savanna reserve with all kinds of animals. Fabreece (one of the lab tech’s we’ve been training) arranged for us to rent a 4-wheel drive vehicle. Should be an interesting day!

Phew, that was long! But now for the most important part… I finally got around to uploading pictures so feel free to take a look – they’re on Facebook but if you don’t have an account then just use the links below. There are three albums so far:

http://www.facebook.com/album.php?aid=2135819&id=2600785&l=0b683

http://www.facebook.com/album.php?aid=2135841&id=2600785&l=63c48

http://www.facebook.com/album.php?aid=2135955&id=2600785&l=54c60

Groundhogs Day in Rwanda

2/2/09
So 6 more weeks of winter, huh? Sucks for you all! I must say though I’m glad I’m not going to have to repeat today over and over again a la Bill Murray – it’s been a kind of frustrating day. It turns out that after all the debate back and forth, today actually was NOT a holiday in Rwanda so we were up at 7:30 with the hopes of getting the 500kg of supplies that Quiagen shipped out of customs and set up so we could start training on Tuesday. While that was being arranged, we met with the lab techs that will be trained and made up a schedule for the coming two weeks that includes 8 hour days since only two techs can be trained at a time and the training is split up into 4 hour modules so there are some long days coming up! Ultimately it became clear that the supplies wouldn’t be getting out of customs any time today since the minister of health hadn’t personally stamped some piece of paper. As soon as we found that out and were about to head home, it started POURING rain so we were stuck waiting around the clinic for another 2 hours until the rain passed. Ultimately we made it home and the only saving grace of the day was that Anita seems to be pretty cool and I think she and I will do some traveling together when there’s down time here. That and I went for my first run in Kigali now that I’m fully healthy again and other than everyone staring at me, it was a really nice and cathartic run. I’m looking forward to making that part of my regular routine here although with all the hills here just walking is a workout!
I also found out that tonight my friend Katie got accosted by some man who tried to steal her cell phone out of her hand. One might not find that so unbelievable but Kigali really is the safest city I’ve ever been in and things like that really just don’t happen here. Thankfully Katie was able to fend off her attacker (after he tried biting her hand so she would let go of her phone) and other than being a bit shaken up she’s fine. The saddest part of the story for me though was the reaction of the two men who came running over to help her. They were extremely apologetic and insisted on walking her all the way home (this is the typical Rwandan hospitality I’ve come to know and love) but Katie said they were clearly shaken up by the attack as well. They wondered if perhaps the man was a member of the interahamwe (the group of Hutus that perpetrated the genocide in 1994). It just made me so sad to think that 15 years later the first thing to come to the minds of these men with even such a petty crime was related to the genocide. I find it’s really easy for me to forget about the atrocities that have happened in this place that I find so peaceful but stories like this one are a reminder of just how much the history is at the forefront of people’s minds here. It’s also a little scary because I have heard grumblings that many people feel the atmosphere in Rwanda right now is eerily similar to the period immediately before the genocide. The DR Congo has recently reached a deal with Rwanda after the arrest of General Nkunda to let several former members of the interahamwe return to Rwanda with amnesty and I think it has really unsettled a lot of people here…

2/3/09
What did I say about being glad I didn’t have to repeat yesterday over and over again??? Well today started off with high hopes of customs clearance and so we headed up to the clinic at 8:00am only to be told nothing would be happening with the shipment until early afternoon, meaning training will be delayed by yet another day. So in order to avoid the frustration of yesterday I just spent the day with Eunice (her last full day in Kigali) and told Eugene to be in touch via cell phone because I couldn’t spend another day filled with “hurry up and wait” moments. So Eunice and I had a really nice day together and we met up with Savannah, Anita, Alesha and Neeva for a buffet lunch (which sadly is not all you can eat here). It was also quite a productive day for me in the end because I decided to go to Bujumbura, Burundi for the weekend and bought my plane ticket… I’m taking a long weekend (Thurs-Mon) and meeting Mary (and hopefully Sean) in Buj to hang out for the weekend. Lake Tanganyika is supposed to have gorgeous white sand beaches and despite being unsafe at night, Bujumbura sounds like a fun city to visit. Mary arranged for me to crash on a colleague’s couch so it should be a pretty low cost trip and I’m really looking forward to it!
The shipment finally got delivered at about 6pm tonight so we’ll be heading up to Nyacyunga to set everything up in the morning and start the training tomorrow afternoon. Once that was all settled I joined Eunice at the Serena Hotel to have a celebratory drink with her on her last night in Kigali. I feel like I’ve said so many goodbyes in my short time here but while each one is sad, ultimately it’s pretty cool to feel like I’m actually rooted here for a while. And Euni and I have plans to reunite in London on my way home in April so hopefully that’ll work out!

2/4/09
After a rainy morning and a delayed departure for Nyacyunga, we finally made it there around 1pm and got all the equipment set up for the training which started by 3pm and went through until 7pm today. We unpacked 19 boxes and 500kg of supplies from Quiagen in this rickety building in the back of a rural health center just outside of Kigali – a scene that attracted quite an audience. We’re training 4 lab techs on how to do the HPV testing and only two of them are proficient in English so it was definitely an interesting day. Alesha and Neeva seem to think it went pretty well though and hopefully by the end of next week they’ll have it down and we can start piloting the study. I’m really looking forward to my trip to Buj tomorrow and I promise once I’m back I’ll upload some pictures! I’ll be out of touch till Monday night probably. Some appropriate Kinyarwanda courtesy of Logan: Uragendo rwiza – safe journey!

Hero's Day aka Y2K Rwanda style.

2/1/09
This morning I went with Alicia and Neva (the Quiagen trainers) to visit the clinic at Nyachunga and figure out the logistics for the HPV training. When we got back we walked up to the Kadafi Mosque where WE-ACTx sponsors a children's program every Sunday. Lara and Eunice do a yoga program there with the kids and the group of donors for Heartland Alliance came to observe that. I made friends with two deaf boys who can't really sign (I can't even imagine how isolated they must be) and we played marbles and one of them had a good time taking pictures with my camera. Neva passed out while we were there from a combination of not eating and altitude issues I think so she went home in a taxi and is doing fine now.
We had a going away dinner for Lara tonight at Soleluna which has excellent pizza and a nice view of the city. I met a few more new people that will hopefully fill the void that Lara and Eunice are leaving once they abandon me here. After that we got a drink with Sean at the Mille Collines and when we got home Anita (a medical student from Downstate) arrived so now the house is really full (but Lara leaves tomorrow so we'll only be at capacity for 1 night).

And now for a little taste of the quirky country that is Rwanda:
So today is a national holiday known as Hero’s Day… it’s somewhat controversial since it basically celebrates the start of the civil war – an odd thing to have a holiday for. Even stranger is the fact that they announced on the news tonight that tomorrow would indeed be a national holiday in observance of Hero’s Day but up until that announcement they hadn’t actually decided. Can you imagine an announcement on the evening news in the US that the next day would be a holiday when up until that point it hadn’t been planned to be?
Anyway, in addition to being Hero’s Day today is also the Rwandan version of Y-2K… they decided to change some of the phone numbers to standardize them and make them all 10 digits so a bunch of people had a 78 added into the middle their number today – talk about confusing. Thankfully my cell number stays the same since it already had 10 digits but the cell network has been busy for most of the day with everyone trying to figure out the new numbers. So between that and the national non-holiday, I’m telling you this country just gets more and more bizarre as the days go on (don’t get me wrong though, I’m loving it).

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.

Jesus apparently can't heal Staph aureus toxin poisoning...

1/25/09

So after a day full of internetting and a chicken salad sandwich (more to come on this) at Bourbon Coffee we came home last night and watched The Curious Case of Benjamin Button on the LCD projector... Kathy's friend is a member of the Academy so she had one of the screening DVDs. About 2 hours in I started getting crazy stomach cramps and by about 2am I was making regular trips to the bathroom. I got complaints that my descriptions of my Ecuadorian bathroom escapades were too detailed so I'll just say that damned chicken salad has been coming out both ends for about 24 hours now. My own fault for eating something with mayo in it I suppose but oh well - live and learn. At least we have a flush toilet and I'm not on an island in the middle of lake Titicaca! I was particularly annoyed though because Bourbon is a very expensive restaurant and I made a conscious effort not to order the hamburger for fear of food poisoning and yet I still got sick! Anyway I made use of the oral rehydration salts Aron gave me and by the end of the day today I have stopped going to the bathroom. Another update tomorrow - off to bed for me now.

1/26/09

I fell asleep last night at 7pm and woke up this morning at 8am - slept through the whole night which was nice after getting about 30mins of cumulative sleep on Saturday night. Everyone in the house has been really sweet and I did not go to work today so I just stayed in bed napping and reading all day. I'm finally finishing up the book I've been reading forever (We Wish to Inform You That Tomorrow We Will Be Killed With Our Families) which is an account of the aftermath of the Rwandan Genocide. It's a little weird to be reading it while in Kigali since I often think of who was living in our house at that time and what their experience must have been like. Add to that the eerie and disturbing soundtrack of Joseph cutting the grass out back with a Machete and it was a little too much to handle. Why we don't have hand powered push lawn mower I do not know but I had to put the book down.
I had a granola bar for lunch and Mary bought me some Ramen noodles for dinner so it seems that I'm on the mend since both of those stayed down. I'm now back at Bourbon Coffee (the site of the food poisoning but also the only reliable source of internet in all of Kigali). Needless to say I won't be eating here but I was feeling well enough finally to get out of the house for a bit. I fully intend to tell Titina tomorrow that Jesus isn't quite the healer she thought he was... The car Jon rented for the week has a window sticker that says "Thanks Jesus." My thought on seeing that this morning and thinking of Titina was "Yeah, thanks for nothing!" I guess it's my fault for not taking him into my heart.
Internet is still down and I don't want to give any more of my money to Bourbon so it may be a few days until I post again.

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!

Eight is enough...

1/14/08

Word of the day: Bitese? (What's up?)

Today we finished the didactic portion of the training with a lecture on VIA (visual inspection with acetic acid) and another on cryotherapy. The OB's have been really great about getting me involved and today Mark referred to me as the "4th trainer" to someone which was nice. The nurses all seem to be picking up everything really quickly despite the occasional translation issue. They have started reviewing slides of normal cervices and then ones that are either VIA positive or suspicious for cancer. There is a computer lab with 20 computers at the Kigali Health Institute which is unbelievable - better than the stupid lab we have at Einstein. It's been really interactive to everyone's surprise since the Rwandan people are generally not very emotive. In fact today during our lunch break we were walking over to the cafeteria (which by the way has served the EXACT same food for the past 3 days - rice, potatoes, spinach, cole slaw and the toughest beef I've ever experienced in my life) and Titina, one of the nurses, came up to me and asked if I was an actor in the show One Tree Hill (Chad Michael Murray plays a character named Lucas). She was obviously joking but it got her laughing and then her friends started teasing her because she's "single and searching" which apparently is a common phrase here... Unfortunately it was also used to introduce me the first time I presented to the group so now I get teased about it. Sadly I don't think she realizes she's not exactly the person I'm searching for... I may have found a potential African bride though so my Aunt Anne will be happy!

The two 100kg cryo tanks arrived today and magically made it up 3 flights of steep stairs while we were at lunch - no one knows who actually carried them up! Anyway, we're going to be demonstrating cryotherapy on sausages tomorrow for the group. I'll try to get some good pictures of that!

Dr. Anastos and her husband arrived tonight so now there are 9 of us in the house - hence the name of today's blog post. Eight is definitely the max capacity of this house so I'm sleeping on a mattress on the floor tonight which will be interesting considering how many insects there are here. There are only 2 bathrooms (one of which is in Dr. Anastos' room) so that leaves 1 bathroom for 7 of us... YAY! I'm sure it will be fine. It also appears that I will now be accompanying Kathy, Mark, Lisa and Dan to Cyangugu this weekend (south western tip of the country at the southern point of Lake Kivu) in order to check out this rural health center and determine if it's a good site to start a Maternal/Child health center with capacity for labor services. We'll be there from the 17th - 21st so it will be intersting trying to find somewhere to watch or at least listen to the innauguration... considering that part of the reason we're going is to figure out how to bring electricity to the health outpost. To get there we have to drive through the Nyungwe Forest National Park which the travel guide I have describes as the "best reason to prolong your stay in Rwanda." Considering I'll already be here for 4 months I don't think I need an extension but I'm sure it will be a fun experience.

I'm totally ready for bed but since the livingroom has become my bedroom I guess I'm staying up until everyone goes to bed. These training days are really fun and productive but totally draining. I'm looking forward to a change of pace this weekend.

Ijoro Rwiza!

"And here is the clitoris..."

So today was definitely the most interesting day yet. We set out at 7:15am for the conference room at the Kigali Health Institute which is about a 10 minute walk directly uphill. They have an amazing supply of anatomical models there which turned out to be extremely helpful for my presentation today on normal female anatomy. In the end there are 18 participants in our training program - 15 Rwandan nurses and 3 Rwandan doctors who will ultimately be involved in the research study. We started off the day doing a demonstration on proper technique for universal precautions and infection control. That was followed up by my presentation after lunch. Needless to say I found it quite amusing that I was presenting the intricacies of female anatomy to a bunch of women that I thought would certainly have more intimate knowledge of the subject than I... It turned out to be a great interactive session (minus some translation issues) and I think we answered a lot of questions for everyone. That was followed up by my demonstrating a pelvic exam including speculum and bimanual on one of the anatomic models. I think overall it went really well and the participants got really involved. Here are some pictures for you all to enjoy!

Now that you've all laughed at me sufficiently... Time for our word(s) of the day.

Witwa nde? (What is your name?)
Nitwa Lukas. (My name is Lukas.)

Goodnight all!

Ijoro rwiza!

1/11/09
I've decided to include a Kinyarwanda word of the day in each blog post so that it will encourage me to learn a new word every day and you all can learn with me if you want. To make up for the past few days I'll do the entire standard introduction today:

Mwaramutse, amakuru? / Mwiriwe, amakuru? (Good morning, how are you? / Good afternoon, how are you?)
Ni meza (I'm fine)
Yawe? (And you?)
Ni meza (I'm fine)

OK, now who is coming to visit so you can use your new Kinyarwanda skills??? Didn't think so :(

Anyway, last night I got bitten by what I can only guess was a spider since I woke up after feeling a sharp pain on my knuckle and then had the terrible sensation of a burning/itching spreading up my entire right arm... it started just as an itching feeling but my entire arm was burning for a solid half hour. I took some benadryl (which helped me sleep anyway) and coated my arm with hydrocortisone which helped a lot but I can still feel the bite today. From now on I think I will be sleeping with the mosquito net over me... I haven't been using it since I'm taking Malarone and I hadn't gotten bitten yet but today I got about 5 mosquito bites and I figure trypanosomiasis (African sleeping sickness) wouldn't be much fun either. Guess it's time to break out the DEET too.

Today was an interesting day. We went to the Kigali Health Institute which is where the training sessions we're leading this week will be held. They have a bunch of anatomical models that we'll be using to demonstrate proper technique for speculum and bimanual exams as well as teaching normal female anatomy... in fact I have the distinct pleasure of lecturing 15 Rwandan nurses and midwives on female anatomy tomorrow - should be interesting! I'm going to do my best to get some pictures of my lecture tomorrow because the idea of ME lecturing on female anatomy to Rwandan women is just hysterical in my mind. I'm kind of excited and very grateful that Mark and Lisa are getting me so involved.

After setting up the room we went to Bourbon cafe which is the Rwandan equivalent of Starbucks (to my surprise there are no American chains in Kigali - it's so refreshing). Despite the lack of American chains, though, American prices are intact... can you believe that I spent 6,000rfw ($12usd) on an iced coffee and a chicken sandwich for lunch in KIGALI!?!?!? I mean obviously the average Rwandan isn't eating at Bourbon Cafe but I don't understand how people here afford anything - the prices are basically the same as NY. Some things are even worse... we went to the grocery store after lunch and it was 2,000rwf for a large thing of yogurt - that's $4usd!!! In the end we bought some fresh vegetables, pasta, garlic, butter and bread and made a delicious pasta primavera at home for dinner which we all ate together at the dining room table (minus Lara who still isn't feeling well). We're like one big happy family. Marc put on some Miles Davis and we worked on our PowerPoint presentations for tomorrow until now and I'm headed to bed soon. I'm glad to hear people have been enjoying my blog... I feel like it's mostly just a play by play of my day but as things get more interesting I'll try to spice it up a bit.

Ijoro rwiza (Have a good night).

Days 2-3 in Kigali

1/9/09 - Day 2
Well after sleeping almost 11 hours (interrupted only by the sound of thousands of birds chirping at 6am with the sunrise) I think perhaps I made the timezone adjustment in only one night (knock on wood). I woke up at 10:30 and got myself ready for a big day exploring Kigali (I'm being a bit sarcastic here since I was told ahead of time that the center of Kigali really only consists of two main streets). I headed out with Eunice and Lara first to the WE-ACTx clinic to meet with Dr. Eugene Mutimura who is the in-country clinical director for WE-ACT. The walk to the clinic takes about 20 minutes and takes you by the home of President Kagame (a large blocked off compound just 3 blocks from our house), as well as the Chinese, Belgian and Swiss embassies. Since we live in such a swanky neighborhood I've been told it means that usually our electricity doesn't go out. Anyway, my meeting with Dr. Mutimura was just a short introduction and it seems that training for the cervical cancer research project will begin on Monday morning at 8am. I'm still not 100% sure what my role will be (and he didn't seem to be sure either) but I'm just going with the flow and I'm sure it will all work out in the end.

From there we explored a few shops and then headed to the UTC (Union Trade Center) which is the mall at the center of town. The main stores for MTN and RwandaTel (the two cell phone service providers in Rwanda) are there and I went with the hopes of buying a SIM card for the phone Steve Torres so generously lent me. Only problem is that AT&T locks their phones so unfortunately I now need to go in search of an unlock code. More to come on that later I suppose.

We also hit up the big grocery store in the UTC (Nakumatt) which is lovingly referred to as the MuzunguMart - Muzungu is the local term for white people and it seems that most of the foreigners in town do their shopping there. It is much more than a grocery store really - perhaps more like a WalMart since they carry treasures such as slurpie machines and electric ovens (each for only $1,000,000rwf - about $2000 dollars). From there we went to quite a few more cell phone stores in search of a technician to unlock the phone with no luck.

I was feeling the effects of the high altitude (1,500m or about 5,000ft) by the time we got back to the house around 3:30. Rwanda is known as the "land of a thousand hills" and I'd say there's at least 1,000 hills just in Kigali itself so a walk anywhere involves doing a good deal of climbing. So, I took a nice nap and at 5:00pm, Eunice, Logan, Claire and I (Lara wasn't feeling well) headed out to an Ethiopian restaurant in Rimera (a neighborhood of Kigali). Getting there involved a walk to the central bus-station (and by bus-station I mean a line of minivans along a crowded street with people screaming their destination out of the window until enough people pile in to fill all the seats). We all piled in and took a 15 minute ride to Remera while feeling a bit like a sardine. Once there we met up with several of Logan's friends (Cassandra and Kate who are fellow Canadian interns as well as Penny who is a Rwandan student Logan knows through her program here). It was my first experience eating Ethiopian food and I was promptly scolded for using my left hand (also known as your poo-hand apparently) to scoop up the food. After some interesting conversation about dexterity and personal hygiene we went on to enjoy a delicious meal. Thus far everything I've eaten here has been vegetarian (Elisabeth aren't you proud?) but I've been assured Brochette (goat kebabs) is a Rwandan staple so I'll let you know how that is. I've also been warned not to order chicken at a restaurant because they are underfed and basically all you get is bones with no meat.

So we left dinner and made it home around 9:30pm after passing by a clearly starving dog sleeping in the gutter which led to Logan telling a story about finding an injured child in the gutter recently - so sad... She said that several other people stopped to help though and in the end the police came to help. ANYWAY, we were expecting to find Lisa, Daniel and Marc at the house when we got back but only Lara was here. I suppose their flights are delayed or else will be getting in late this evening... Eunice and I made up their beds and I left out a note so we shall see.

I've just finished purchasing an unlock code on eBay thanks to Shauna's much appreciated help since apparently you can't use an American credit card to purchase stuff online while in Rwanda. They are supposed to e-mail me the code in 1-3 hours but it's now almost midnight so I'm going to bed and will finish this post in the tomorrow. Goodnight all!

1/10/09 - Day 3

Lisa Nathan and Marc Sklar (OB-GYNs running the cervical cancer screening program) both arrived late last night from NY with Daniel Murokura, a physician from Uganda. So there are 7 of us in the house right now... a little like big brother since there is no TV or any other distraction except internet! There are some issues with delivery of materials from Quiagen (the pharmaceutical company sponsoring the cervical cancer study I'm working on) in order for training to start as scheduled on Monday so it sounds like things are totally up in the air right now. Such is the nature of research in Africa I suppose. I think we're going to go ahead with training the nurses and staff in how to do visual inspection with acetic acid (VIA) and cryotherapy for any identified cervical lesions and just hold off on the training for HPV testing (the part Quiagen is providing). It looks like I may also get involved with another project Lisa is working on to improve maternal and neonatal outcomes in a rural province of Rwanda... we'll see what happens with that.

Anyway, enough technical stuff... I finally got the phone unlocked (again thank you Shauna) and got a SIM card today so I have a functional cell phone! The number is 011-250-0750329933 and you all can feel free to call me (it's free for me to receive calls) but I'm also on Skype so that would most likely be the easiest and cheapest way to contact me.

Marc treated Lisa, Daniel and me to dinner at Republika Lounge which is a really nice restaurant/bar that was started by a brother and sister that came back to Rwanda after the genocide with the goal of creating a fun space for Rwandan youth to come and enjoy their time together. It felt like we were in a dance club with all the loud music they were playing but it was fun and I got to try the traditional goat Brochette with a Kenyan beer called Tuska. Once we got home we got to work on the power point presentations we'll be using this week for the training and now it's already after midnight so I'm headed to bed.

I HAVE ARRIVED!

After two layovers in Paris and Nairobi (both in business class lounges so I can't really complain) and 30+ hours of traveling, I've finally arrived in Kigali! I enjoyed lie flat seats, free WiFi and a couple of movies along the way. Once I arrived at the airport in Kigali, I picked up my bags and went out to the arrivals area where someone from WE-ACTx was supposed to meet me. After waiting for half an hour, I realized that no one was coming. Thankfully I had the number for the WE-ACTx office and after some finagling with a nice Rwandan woman I borrowed a cellphone to call. They sent one of their drivers named Alex to pick me up pretty quickly and I made it in one piece to the house by about 2:00pm. For those of you that are interested the address is: 25 Avenue des Grands Lacs - Kiyovu, Rwanda BUT if you're planning on sending me care packages of any sort (fully encouraged and appreciated by the way), this is the address you have to use:


WE-ACTx Rwanda
c/o Lukas Austin-Page
PO Box 5141
Kigali, Rwanda

I was promptly greeted by Josie, the housekeeper (who it turns out will be doing my laundry - YAY). Lara (from NJ) and Eunice (from Australia via London) are two Astanga Yoga instructors who are living in the house and incorporate yoga into the care of HIV+ women and children (http://we-actxyoga.org/). They have been very friendly and are giving me the lay of the land. Logan is a third occupant of the house - she's an intern from Canada working with WE-ACT and her friend Claire (another Canadian intern working for another group in Kigali) has been hanging out at the house this afternoon.

Sarafin is the house cook during the week and she made a delicious dinner for us (albeit at 4pm) of pizza, spinach, rice and stew which I ate cold at around 8. The "pizza" was really just flatbread with cheese, tomato sauce and veggies. Joseph arrived around 6... he is the "guard" who stays in a hut outside overnight but I've been told he's really mostly a figurehead since we are in a very safe upscale suburban-esque neighborhood and he's a lightweight 20 year-old. Good to know he's there nevertheless - his greeting to me was "Are you happy Lukas? It makes me so happy to meet you." Very cute.

We all sat around and had a few glasses of Australian wine (a special treat in Rwanda I've been told), popcorn and snickers minis in honor of my arrival. It sounds like there will be a lot of turnover in the house in January... Lisa Nathan (an OB-GYN chief resident I worked with last year who is now an attending) arrives tomorrow and will be here through the end of February. Two others are coming with her tomorrow - Daniel & Marc... I don't really know their deal but I'll update once I do.

Dr. Kathy Anastos (the founder of the organization that works at Monte and got me involved in the project) and her husband Jon will be arriving on Jan 14th at which time apparently I will have to vacate the house for 3 days since there won't be room for me... I'll update you all on what pans out with that situation but there is supposedly a cheap inn down the street from here.

The plan tomorrow is to go explore the city a bit and buy a SIM card so I can get a mobile phone number while I'm here. I'll post the number tomorrow. The girls in the house are all going out for Ethiopian food tomorrow night so I may tag along with that. As for when I actually start work I'm not sure but my guess is Monday... we'll see. As for now it's almost 10pm here so I'm going to try to go to bed soon and get on schedule. Goodnight all!

Women's Equity in Access to Care and Treatment (WE-ACTx)

So I thought I'd give you all a little intro into the organization I'm volunteering for... A little excerpt from www.we-actx.org

WE-ACTx is an international community-based initiative that was launched in fall 2003 by frontline AIDS physicians, activists and researchers with extensive experience in caring and advocating for HIV-positive women. Our primary goal is to increase women’s and children’s access to HIV testing, care, treatment, support, education and training in resource-limited settings at the grassroots level. We are committed to helping survivors of genocidal rape and sexual violence. WE-ACTx began working in Rwanda in early 2004 to provide HIV care to genocide rape survivors, in active partnership with the Rwandan government and five local NGO partners. We focus on empowering HIV-postive women and girls to take charge of their lives and become leaders in the fight against AIDS.