Finally, a blog about medicine.

It has been almost 3 weeks since we arrived in Kigali and I haven’t posted a single blog about Rwandan medicine.  I had BIG intentions to fly halfway around the world to a developing nation and save all of the suffering people.  Now that I am here, I realize how silly that is.  It’s in my nature to get somewhere and want to do do do, rather than to be.  I’m learning that I should take these months to be close to the Lord in the stillness of my eager hands.

Last week I had the great opportunity to tour King Faisal Hospital.  It’s the fancy-pants hospital of the country and likely one of the best in the entire continent.  Dr. Alex is a senior physician at KFH and gave me a very thorough tour (he’s a pretty big deal).  The first part of the tour was to the nation’s pride and joy – the radiology department.  As it turns out, they have the same equipment that we do in the US.  It’s pretty and shiny and new.  The only difference is that they have 1 MRI machine, 1 CT scan, 1 ultrasound machine, and 1 x-ray machine… for 11 million people.   I expected them to be in constant use, 24 hours a day, with a line of people waiting for their turn for imaging, but they’re not.  That morning there was one person being imaged. The people here just can’t afford the luxury of a plain x-ray, let alone an MRI scan.

Next we went to the other departments: Med/Surg (which was mostly used for patients with malaria or those using one of the 6 hemodialysis machines in the country); NICU (which has a fantastic monitoring system…for one baby); Labor & Delivery; Physical Therapy; ICU; Emergency (which is so quiet compared to the ERs I’ve been in - no monitors beeping or people yelling at each other); & Outpatient (family medicine and pediatrics for people who are willing to spend a couple of dollars to avoid the street clinics).  The only department I didn’t go into was the surgical suite.

There are 3 types of patient rooms – private, semiprivate (2 beds, 1 bathroom), and not-private-at-all (10 beds, gender-specific community bathrooms down the hall).

Each bed comes with a mosquito net and a curtain to separate you from your neighbor.  All of the staff speaks English.

I know what I just described to you sounds really nice – and by all African standards it most certainly is - but even the nicest medical center in Rwanda is enough to make any American doe-eyed.  I was invited to spend some time shadowing Dr. Alex at KFH, so I’m going to take a few hours each day this coming week and learn from someone who practices the kind of medicine that isn’t watered down with machines and prescription pads.

(I don't have a picture of the hospital yet, so I've attached one of a hillside of Rwandan homes.)

Yes, please!

On Monday morning, Ryan and I adventurously drove off towards Akagera National Park (the Rwandan safari park) knowing that our map is outdated, not to scale, and in French.  It’s only 3 hours out into the country, down a paved road, and you take a right, and then a left, and then go down a dirt road, and there may or may not be any signs on the way…  My dad is coming to visit in 10 days and we wanted to be sure we knew how to get him there.  I won’t go into too much detail of our trip yet because I know my dad is reading this and I want him to experience the same surprises and excitements that Ryan and I encountered when we showed up to the safari lodge.  The point is it was spectacular, and we didn’t even do the game drive (we’re waiting to do that with him).

The staff at the lodge was so warm and welcoming. It was clear that they had been extensively trained in formal hotel and dining service and were taught a few important phrases in the English language. When we spoke to our waiter, William, it quickly became evident that he didn’t understand us and his responses were recited phrases.  Our favorite response was  “yes, please!”  William would say it as a response of absolute pleasure and confirmation to whatever we ordered from the menu – or to anything we said, really – and he said it with a big smile.  If we ordered a bottle of water, he would say “yes, please!”  If we wanted the club sandwich… “yes please!”  If we asked where the restroom was…“yes, please!” If we thanked him… “yes, please!”  Ryan and I started saying it to each other ALL the time, especially when it didn’t make any sense.  It’s tough to say why that tickled us so much.

So, on our way to the lodge, about an hour away from the entrance, on a terrible dirt road in the absolute middle of no-where African countryside that leads only to the lodge, a pick-up truck blew past us in a hurry.  Tied down in the back of the bed was a 300+ lb pig.  Alive.  It was so crazy to see, especially since we haven’t seen any pigs at all since we’ve been here.  Ryan scrambled to get his camera out while he stepped on the gas and I grabbed the steering wheel.  We got one blurry picture – the truck was going way too fast. 

Anyway, that night we had excellent pork medallions for dinner.

We stayed there for 2 nights, played tennis on clay courts that were on the edge of the mountainside overlooking beautiful valleys, got sun burned, and relaxed.  (We really needed a vacation from our sabbatical...)

Akagera Game Lodge is now one of my favorite places on earth.  The scenery is breathtaking, it’s quiet and peaceful, and there are super-fun fuzzy animals all over the place.

Am I excited to share it with my dad in less than 2 weeks?  Yes, please!

                                                

“I would like you to thank me for eating your dinner.”

Ryan & I had our first dinner guest over last night.  His name is Latimer.  He is a close family friend to Nathan and works as the finance director to his projects.  We’ve been helping him with one of the projects (I’ll get into it in a bit), so we decided to have him over to finish the work and get to know him.  With Latimer’s translation help, we asked Pierre to join us for dinner.  (I’ve tried several times through my broken Kinyarwandan to invite him to our table, but I’m pretty sure he thinks I’m asking him to do the cooking, and then he gets offended when I take the spoon out of his hand and do something totally American -and evidently quite offensive- like put tomato in the beans.  And so he walks out of the kitchen and well, so much for my dinner invitation.)  At the end of the meal, Pierre told Latimer to translate 2 things to me.  

1: to tell me, in whatever the English way is, “thank you for the meal.” 

2: to tell me that in Rwanda, I am to thank him for eating the meal I have prepared for him. 

…you’re welcome?  …thank you?

As it turns out, the thank you comes from women standing over the cook fires preparing the meals for the men who are out in the fields.  The women are privileged to work in a place of warmth, light, and safety, so they must thank the men for that. 

Usually, I thank Ryan for eating my first-year-of-marriage-experimental-meals… but I have never thanked him for allowing me the privilege of cooking for him. 

So, Latimer’s current project is to find sponsors for 18 children to board and attend the Star School.  It’s essentially like one of those commercials you see on TV that “for less than $3 a day you can change a child’s life.”  I know.  You’re rolling your eyes.  But really.  For less than $3 a day, a child will be boarded on the school grounds, fed 3 meals a day, provided with safe drinking water, and will receive an education that would rival most American schools.

Once you meet the kids on those commercials, you don’t roll your eyes anymore. Ryan and I got to meet and take pictures of 18 children that are currently waiting for sponsorship through the World Help program (one of Nathan’s US partners).  Three of the children, sisters, are victims of a scenario far too common out here:  Both parents died of AIDS.  Their mother’s entire family (entire = mom, dad, brothers, sisters, aunts, uncles, cousins, second cousins, etc.) was killed in the genocide. Only her youngest sister survived. The youngest sister had to quit her job to move to Kigali in order to take care of the girls.  Now she has no job and 3 nieces to house, feed, and make sure they get an education (which is required by national law). Nathan had heard about her family’s trouble and chased her down, convincing her to bring those girls to his school and he would find a way to help them.

My heart is breaking in ways that I’ve never experienced.  The people of Rwanda are incredibly stoic.  I’m learning heavy lessons from the least of God’s people.  I should be thanking them for more than just eating my dinners.

Inyama (Goat)

Yesterday Ryan and I had the day to our selves. We got up and went for a jog.  We ran half a mile…  Don’t judge us; this altitude is killer!  Maybe tomorrow we can do a whole mile?  Please.  Who am I kidding?  We get winded walking across the street.

We then set off to find the Blessed Mango Tree Church to take pictures of the roof being put up.  We ended up in Bugasera – which if you look at a map, you realize we definitely took a wrong turn somewhere.  It happened to be exactly the right wrong turn for me.  We drove about an hour into the countryside and boy is it beautiful.   It’s exactly what I pictured Rwanda to be: Vibrant green hillsides covered in banana trees.  A winding river through the valleys.  The lushest scenery you could ever imagine.  And tons of goats.  Okay, I didn’t actually picture all the goats, but it was nice to finally see a fuzzy face.  (We miss our dog.)

Once I had decided we had gone far enough (once my anxiety couldn’t take it any longer) we turned around and guess who drove us all the way home?  Yup.  Me!  WooWoo!  This place is the PERFECT place for woman drivers.  You get to do whatever you want whenever you want.  You can honk the horn, flash your headlights, wave your hands frantically, and drive in the oncoming traffic lane if you want to as long as you avoid hitting pedestrians – it’s a lot harder than it sounds, but so far so good.

I have been praying for some answers as to why I was here and asking Him to show me what I should be doing.  Lord, if only there was someone with whom I could effectively communicate with and who understands my profession…

Last night, our landlord called and asked if he could come by, meanwhile honking to be let into our gate.  (Hey, at least he called, right?)  He brought over a doctor friend of his, a Rwandan who studied medicine in the UK and worked there for 15+ years.  He’s an internist who specializes in diabetes, speaks perfect English, understands the Western thought process, and knows what a PA is!!!  He invited me to tour King Fasial Hospital with him on Friday morning.   

Murakoze Imana! (Thank you God!)

It smells like fish...

Ryan & I went to the Remera market today and loaded up on fresh fruits and veggies.   But instead of reading about it, click on the like below titled "At The Market"and watch our experience:

At The Market

Hari imvura iri bugwe? (Is it going to rain?)

I went to my first Rwandan church service today - 2 of them actually – and they are no joke.  When Rwandans praise the Lord, they PRAISE THE LORD.  It was an incredibly exhausting 4 hours. 

First, we went to an English-speaking service at the Anglican Cathedral.  I was starting to feel better but still pretty fragile, so when I watched Ryan get pulled away from me and heard something muttered about “someone will find a place for you” I began to feel that insecurity sweep over me.  Of course, I got pulled to the front row.  My eyes began to well up with tears and I realized I had 2 choices: I could burst into tears in front of 100 strangers, OR, I could start singing along with the choir.  

“This is the day that the Lord has made, let us rejoice and be glad in it.”

Finally.  Something I was familiar with.  Before the song was over, I was singing, clapping, and smiling.  Rwandans clap all the time and at everything.

Next we hurried over to the Blessed Mango Tree Church - a truly Rwandan service spoken in Kinyarwandan. (I attached a picture of what it looked like today.  This was the last service before using the new building.)  I was ushered to one of the rows in the back and a nice man named John sat next to me to translate for me.  By the end of the service he was, by all American standards, sitting in my lap.  I’m telling you, there’s no such thing as personal space.  At some point in the service (I can’t be sure because I’m not really sure what was happening at any point in the 2 ½ hours) I was called to the front of the church and introduced.  It wasn’t exactly like when I get up in front of the people of University.  I was instructed to greet the people.  Um… I don’t public speak.  I’m the muganga here, not the mushumba.  Anyways, I just yelled “mwaramutse!” (good morning!), and everyone went wild.  However, that wasn’t enough.  They wanted more.  So I said some things in English, watched everyone smile and clap and wave their hands, and then scurried to my seat in the back.  Ryan did a fantastic job preaching today – not that I expected anything less.  He’s a big hit around here.

One last thing about our Sunday: it was our first laundry day since we’ve been here. Thankfully Pierre is here to help us.  I have NO idea how to do laundry in Rwanda. So, now we have our clean-ish clothes hanging on the line outside and it has been raining on them for the last 6 hours.  As soon as we realized this, Ryan and I burst into laughter. 

This Is Africa.

Iki bacyita iki mu Kinyarwanda? (What is it called in Kinyarwandan?)

Is there a Kinyarwandan word for “meltdown?”  As in the emotional kind.  Not the kind where you start smelling smoke coming from the hood of your car on a hot day outside of a partially built building in the middle of Africa -though that too has happened within the last 48 hours.

You know, I have felt pretty good since I have arrived in Kigali.  I’m not exactly sure what the trigger for my meltdown was since all we have been doing is seeing the sights, smelling the smells, visiting schools and churches, walking the unfamiliar streets, navigating my husband through the winding hillsides where stopping doesn’t exist where 2 or 3 (or 4) roads merge or intersect, handling the constant stares, not being able to communicate with anyone, being hungry all the time, being super conscientious of what we put into our bodies as to not get cholera, always aware of where the toilet is because I never know how quickly I may need to find it again (please have a toilet and not just a hole in the ground, I can’t afford to drop my sunglasses in their again…), going to a wedding of two people we don’t know (and don’t know us) and get moved to the front row center immediately in front of their parents with the spotlight and video camera on us instead of the bride and groom……

I know the Lord sent us here.  I thought I knew why, but maybe I made up a reason that sounded good in my own ears.  Maybe I’m not here so much to serve the people of Rwanda but to be served by them.  To be taught what it means to let people get close (very very very close.  No really, there’s no such thing as a personal bubble to Rwandans), to be broken down by humility (the good kind; the kind that says “get over your Muganga self), to struggle with the bare necessities of life, and to be placed in a position of honor when you’d much rather be a wallflower in an uncomfortable surrounding.

Whatever the reason, I’m going to try to hold it together long enough to soak in the beauty of this country and its people.

Ikawa & Igitotsi (coffee & bananas)

Mwaramutse!  (Good Morning!) 

It's 8:15am of Day 3, and I have turned into a true Rwandan.  It's a gorgeous sunny morning in the upper 70's and I'm wearing the insert to my ski jacket while I sip my ikawa. What?  It's cold okay?  Pierre was wearing a parka-like coat too.  Ryan is taunting the Kevins with his best moo-chirp.  I need to start carrying the video camera at all times.  

Let's go back to yesterday:

Day 2.  I had an interview with the Director of Nursing at the Central Hospital of Kigali, the large government hospital.  It is several one story buildings sprawled over 10+ acres of dirt roads with people everywhere - hanging out of windows, standing in doorways begging for help, sitting on the porches, walking around (though nobody looked as lost as we did).   The interview was... interesting.  There was some difficulty trying to explain what a Physician Assistant is since there is no equivalent in Rwanda (and the language barrier wasn't helping either).  They didn't understand why a medical assistant would be performing surgeries.  I'm not a medical assistant.  Nor am I asking to perform surgery.  And no, I won't have the language mastered in 2 months to be able to communicate with patients unless they want to talk about coffee and bananas (2 of my best vocabulary words). 

The fruit here is amazing; the best we have ever had.  Mangos, pineapples, bananas, tiny bananas (?), and a few fruits that we can't find a name for - and neither can the locals.

Fun fact- one of the very few decorations in our house is a stuffed cat.  No really, its as if they stuffed their favorite house-pet and stuck it in the central bookshelf of the living room to preserve its memory forever.  Or something.  It's hands-down the creepiest thing we've seen yet... and that's saying a lot.

Here's a picture of the Kevins.  I'm sure they will be making my blog often.  I know what you really want is a picture of the stuffed cat (Fluffy).  I'll see what I can do.

The Mushumba and Muganga Arrive

As it turns out, Africa is a HUGE continent.  The last leg of the flights from Europe to Rwanda is not to be underestimated.  28 hours after we started our travel, we arrived in Kigali (that's pronounced 'Chigari').  You will be getting lessons in Kinyarwandan throughout my time here.

Nathan and Esther were at the airport to pick us up and they took us for an "American meal" before bringing us to the place we are living for 2 months.   It's a wonderful house which we have all to ourselves - 3 bedrooms, 2 baths, 2 offices (one for Ryan to spend time writing, one for me to keep all of my medications and equipment in), living room, kitchen, 2 giant peacock-looking birds wandering the front yard (our pets for the next couple months- we named them both Kevin after the bird in 'Up') and a very helpful house-boy named Pierre who has been taking great care of us.  His English is about as good as my Kinyarwandan.  Yeah...there's a bit of a breakdown in our communication, but we are getting by with hand signs, loud repetition of the words neither of us are familiar with, and trying out different sentences in our respective language in hopes that something clicks.  It hasn't clicked yet. Today, in my attempt to speak Kinyarwandan without my translation guide, I yelled "TOMORROW"  instead of thanking him for turning on the hot water.  

Nathan picked us up this morning and took us to tour two of his schools.  He must be a very busy man.  They were fantastic.  The younger kids all ran up to hug us, shake our hands, and say "how are you?"  A few of them wanted to touch our skin just to make sure we were real.  We are in fact real - we have the jet lag to prove it.  The older kids mostly stared from inside their classrooms where I overheard lectures of calculus logarithms and the Ideal Gas Law. 

As Ryan and I were introduced to several teachers, school administrators, and other important adults, I could tell (from my small Kinyarwandan vocabulary bank) that I was being introduced as the Mushumba's wife (mushumba = pastor).  Evidently that title holds much higher esteem in African society than Muganga (doctor- which is what I am considered here).  At first I was a little put-out but then I just decided to roll with it, which is really the best attitude to handle just about everything over here.  Hakuna Matata.  No seriously.  Its for real out here.

Now its nighttime.  Ryan and I are going to play cards and listen to the crickets.  We should probably head to bed soon so we can get some sleep before the Kevins begin their early morning calling which sounds like something between a moo and a chirp.  

Crocs, Elephants, & Blogs.

I have a tendency to jump on bandwagons long after they pass me by - sort of like my new pair of red crocs that I wear zealously - which is why I am just now starting my first ever blog (and almost ready to buy a pair of Toms, for that matter).  But really, what better time to start a blog than when Ryan & I are about to embark on a 3 month adventure to Africa (did you notice the elephant in the background?)  

We leave on Monday, and have everything but our clothes packed... I'm hoping to fit our sweet Lexi-dog into one of those air-tight compression bags so she can come with us.  Not really.  She is having a blast chasing squirrels at her winter home in South Texas with her uncles, Scout & Ranger. 

So here's to practicing African medicine, playing tennis on clay courts, and relaxing in paradise with my husband.

Stay tuned for my updates from the beautiful hillsides of Rwanda.