Return travels

Home sweet home. Made it back to Memphis on Saturday evening, though my bags haven't yet. No worries! Losing bags on the way back is much, much better than on the way there, isn't it?!? I hear the bags are in Atlanta, and I'm happy that they are so close. I had my doubts when Kenya Airways handwrote my bag tags, including the city codes. Hmm. Maybe they should consider a computer to print the bag tags.

My route back was Kigali (Rwanda), Nairobi (Kenya), London, New York, Memphis. Had a nice drive on Thursday from Kibogora to Kigali with Sheila. Tea stop in Kibuye by Lake Kivo, and lots of time to talk. We had a lovely & delicious dinner outdoors at the Novotel (hotel) in Kigali, with a little live band playing quietly in the background. Friday was Sheila's birthday, and she treated me to breakfast at the luxurious Serena Hotel in Kigali. It's every bit as nice a hotel as I've seen anywhere in the world, and I told her that I was glad to see the other extreme of income in Rwanda. Then I tagged along while she did some shopping on "Indian Street" (so named for the Indian shopkeepers) in Kigali. Kigali driving is pretty civilized by our western standards, meaning that there are traffic lights and traffic laws are observed, including driving between the lines (though Sheila did all of the driving). Indian Street was pretty chaotic though. Best to keep an eye on your valuables there. While I was standing by the car waiting for Sheila to finish purchasing something, someone opened a car door on the other side, presumably to see what he could grab. After that, I kept the car locked and kept a sharp eye on people milling about.

38 hours to travel back, between driving, flying & waiting for flights. Long layovers in busy international airports provide some exceptional people watching opportunities, though! I had uploaded several books on my Kindle (btw, love the Kindle for traveling!) for the return trip, but I didn't read quite as much as I had planned because of watching people and talking to strangers. In the Kigali airport, I met a retired couple from Chicago who were coming back from a long safari through several countries in East Africa. They had taken their children and grandchildren along as a gift. The safari was just for their little group, and it was the kind of safari with your own large stand-up-inside tent containing a (camp) shower and WC (latrine type). Meals are cooked for you by the staff - forget about open-fire weenies, marshmallows & bad coffee - with one-on-one attention from the Africa team the entire time. Now that is my kind of camping! The safari leader was still with them in the Kigali airport, ensuring that their return travel went smoothly. The whole thing must have been incredibly expensive! I got the safari guide's card as he seemed to have done a wonderful job, but I imagine I will have to save for a long time before I can afford him, if ever! (George Mavroudis, gmsafaris.com)

In the Nairobi airport, I saw several mission trip groups with matching shirts - usually brightly colored - I presume so that they can keep up with each other. Spent quite a bit of time talking with an Assembly of God team from Omaha which had been building a chapel for a school in Kenya. They buy the materials pre-fabbed and get them shipped to Kenya in advance, then the team arrives and bolts everything together in a few days. Their church does this every other year. Sounds like a good concept - very organized. Their pastor was from North Carolina, and we ended up comparing barbecue. NC style uses pork too, but with a vinegar sauce. Neither of us understood why Texans use beef, but I guess they just have way more cows there than they know what to do with. ;)

Long layover in NYC, and met some Australians coming to Memphis for 4 days as part of a US holiday. The Memphis portion of their trip is just to visit Graceland! Then they are also going to New York, Disney-Florida, and Las Vegas. They are staying at the Heartbreak Hotel on E. Presley Blvd. And they won't have a car, just a shuttle bus to get around. So they're pretty much limited to that area. Yikes, I hope they are okay there and don't have a bad experience! Perhaps EP Enterprises and/or the City will help to upgrade the area around Graceland - that's what I hear is planned. It's a little embarrassing to think about those visitors walking around EP & Brooks Road. I hope the dad doesn't get propositioned by a lady of the evening.

Eric met me at the Memphis airport and offered to take me to dinner anywhere I wanted to go. I chose Huey's and really enjoyed having a good ol' American burger and fries! Hooray, I'm home in the land of high cholesterol, high calorie meals again!

Thanks Em for handling my mail & bills while I was gone, and even getting my car tags renewed! (above & beyond what a sister should be asked to do) Thanks Eric for keeping my house & yard in great order and fixing up the scary basement! Eric even put up "welcome home" decorations at my house including balloons! It's nice to be home, though I had a great experience in Africa and will miss some things & people there as well. I'm going to try hard to keep the lessons I learned there fresh in my mind, and Sheila has invited me back to Kibogora in the future, probably for a shorter trip next time. I would like to go back. Back to work tomorrow - time to catch up with developments at work and start earning some income again!

July 21

This will probably be my last travel blog entry, as tomorrow I start traveling back and won't have internet access. Thanks, you guys, for being such good company for me! It's been nice to have this linkage with family, friends and close colleagues!

Here's a photo of our dinner tonight - yum! Brandon, the South African, is cooking up these fish (tilapia) for us which came from the huge lake just below the mission and hospital. They cost about $1.00 per fish but were not fileted or gutted - Brandon had to do that. I am not sure if that is a good deal or not. People say the lake is overfished, so I think these larger fish are few and far between. It's probably a good deal.

Took my last 3 mile walk with Lisa today. She's a bit sad because her grandmother just had a stroke back in Great Britain (Isle of Man) and Lisa is thousands of miles away here. She's trying to decide whether to go back. It's a tough call.

Final thoughts from the trip:

- Getting out of your comfort zone is a good way to make new friends (especially if you're alone, because then you are more likely to strike up a conversation with someone new), create some wonderful memories, and learn new things about yourself in the process.

- We have little concept of what real poverty is, living in the U.S. Many U.S. citizens at least have access to public housing and food stamps, so we are unlikely to starve or live without shelter, safe water, and plumbing.

- When resources are few, people figure out how to adapt. This is a lesson that we may have to learn in the U.S. healthcare industry in the next decade or two, as we try to figure out how to reduce our expenditures per capita.

- There are more similarities between Americans and Rwandans than I would have expected.

- English really is becoming the universal global language - that's the good news - but with increasing globalization, we Americans had better try to learn additional languages.

- A place can begin to feel "homey" in as little as 5-6 weeks.

That's it for now! Signing off ......

Rwandan politics

Presidential elections will take place around August 8-9. The current president, Paul Kagame (see photo), has been in office about 15 years, since shortly after the genocide. He held a press conference yesterday, and where I was working at the hospital, the staff were listening to it on the radio. Mr. Kagame held the entire press conference in fluent English. So I could easily understand him, but I wondered how many of the 9 million Rwandans understood what he was saying? I'm told there are 4 candidates, and the elections are held about every 7 years. A couple of expats have mentioned that there could be some unrest around the time of the elections. For a developing central African country, Rwanda seems fairly stable at the present time. However, I suppose that a certain amount of unrest is fairly common in developing countries around the time of any (potential) change in leadership. Mr. Kagame is visiting this district (Nyamasheke) this afternoon, and the hospital is going to let some of the staff off work so that they can go to hear him speak. I asked a couple of the staff what they thought would happen in the elections. Would the president be reelected? One of them said nothing, and the other shrugged and replied, "The people will decide." I reflected on how different this was from American politics, where everyone has an opinion and usually we don't hesitate to share it with each other!

July 20

This lovely secondary school student could be a model, couldn't she? She is carrying a bundle of dried banana leaves on her head. As best as I can tell, there are at least two kinds of bananas grown here. The ones which are eaten fresh like fruit are very tiny (see other picture) and taste much like the bananas we get at home, just in a smaller "package". Larger bananas are not as sweet and are only suitable for cooking - usually frying. Those of us in the Americas would call these plantains, but they do not use that term here.

Finished a couple of hospital projects today successfully - hooray! Took the "3 mile walk" with Lisa after lunch - I will miss that walk. At this altitude, everything looks different - more distinct & colorful - than it does at sea level. Something about the thinness of the air. The road is steep and made of dirt & rock, so it has made for a nice little challenge. Had my last meeting with the English Club this evening. Two doctors and one nurse were there tonight, and I think they enjoyed the yellow fever exercise I made for them (courtesy of the book which I just read about yellow fever, "The American Plague"). We all had a good time! Windows remain open here pretty much all year 'round for ventilation, and we enjoyed listening to the hospital choir practicing nearby while we studied together.

July 19

These are photos at the hospital "kanteen" where the staff takes mid-morning tea break (something I enjoy) and lunch breaks. I have not seen any other muzungu in there. This morning one of the guys at the hospital who I don't know well asked, "are you lost?" I thought that was a little rude but just said "no, I've been coming here every day!" Clementine is a young woman who works at the kanteen. Her English is very good and she is also courteous as well. She calls me by name, which is unusual, because it's hard for the Rwandans to pronounce the "l" sound in my name. Their language has very few L's in it. They use the letters L and R interchangeably and prefer the R's - I still haven't figured out how that works - those two letters are nothing alike in English.

Busy day at the hospital, trying to get some projects finished before I leave. But I like to be busy, so it's not a problem!

July 18

A nice, quiet Sunday. Church service this morning. About 2.5 hours total, but I have learned not to come at the beginning! I came in 30 minutes late, but people wander in during the first hour and a half. Several choirs sang, and the pastor today translated his sermon into English from time to time, so that was very helpful! The seating at church is on wooden benches with no backs, and the benches are only about 9" wide. So one kind of perches on these fairly narrow, hard benches. The Rwandans sense of personal space is different from ours, so everyone sits quite closely together, making it feel warmer. The little local kids sit there quietly the whole time, while I squirm on the hard surface, wish I could lean back a bit, and perspire a bit without air conditioning. The locals are much tougher than I am! Even with the little discomforts, the church services here are heartwarming. Most of the people are quite poor by our standards, but they sing happily and seem very spiritual.

Took the 3 mile walk with Jennifer from the U.S. today. Those are 2 of her children in the picture. The canoe is a traditional one. We see lots of these on Lake Kivu here. Some are for fishing, others are for transporting people or other goods around the lake.

July 17

Today is Saturday and a free day. Around 10:00, Jennifer, Matt, Ella, Brandon and I walked to the market at Karambo. On the walk, we saw people carrying or herding pigs, chickens, sheep and goats. The market we went to is part flea market (clothes, shoes, etc.), part food market. Some of the things I saw : tiny fishes drying in the sun, to be eaten whole (caught last night - they fish mostly at night); cassava roots, which are ground into meal; spicy green peppers and orange peppers; pineapple, avocado, sugar cane, sweet potatoes, cabbage, tomatoes; a Lebron James sports jersey, Obama brand pants, rope being woven from dried freshwater seaweed. Some of the food was still alive, such as chickens and rabbits. And strangely, there were live guinea pigs. I find it hard to believe that Rwandans are keeping guinea pigs as pets when they can barely earn enough to feed themselves, so.....um....I guess they are eating the guinea pigs. There were hoardes of children running around unsupervised, and they tended to congregate around the 5 of us because we were a novelty. It was kind of suffocating, the number of people who would crowd around to watch everything that you did. It tended to keep me moving and not doing too much shopping, so that I could avoid the little "eddies" of people. I had been warned to watch my pockets. Sure enough, at one point, I found my money pocket unzipped by little hands, but they didn't get anything! I didn't dare to take any pictures there, because I didn't want to create a stir or even make my camera visible. The most entrepreneurial Rwandans will ask you for money if you want to take their picture, and who can blame them? Ella bought a pineapple, Brandon an avocado, Jennifer a big stalk of sugar cane, and me, some toothpaste. Afterwards, we stopped in a "duka" for sodas and bought some fried bread to nibble on - like donuts or fritters - very tasty!

Then we walked on to Kumbya, the lakeside retreat for missionaries that I've been to a couple of times. More local children followed us on the walk, and Jennifer kindly gave them candy. Matt and Brandon gave the local kids their water bottles. After that, the local kids wouldn't stop trailing us and became increasingly insistent and demanding, because they wanted more stuff! Finally we arrived at the lake, leaving the local children at the gate, and Lisa arrived at the same time in an SUV containing expat kids, more adults, and a picnic lunch. This made 13 of us total at the lake. Most of the folks swam in spite of the schistosomes (see photo)....everyone just says they will take the medication to treat it..... but Lisa and I sat on the bank and talked (another photo). Lisa's husband Matt stretched out to relax in the shade, and her daughter Chelsea was our official photographer for the afternoon. We saw more monkeys today! One was a mother with a baby clinging to her underside. There is an unusual tree at Kumbya with red spiky flowers - never seen anything like it (one more photo). Somehow, all 13 of us squeezed into the one SUV for the drive back to the mission/hospital. I was prepared to walk back (one hour) with Ella and Brandon, but Matt was determined that we could all fit. Thankfully several of the children were small. It was like a clown car. We had a bit of an incident when we arrived at a trench - about 2 feet wide and 3-4 feet deep - where some workers were digging to lay fiberoptic cable. There was an Asian man in charge of the crew, and the incident quickly drew about 30 local people to the scene out of curiosity. Well, we needed to cross the trench in the vehicle, so after some argument, the workers agreed to lay 2 boards down for the SUV tires. I closed my eyes while the overloaded SUV struggled over the gap, and somehow we made it across without slipping off the boards! (Matt's good driving, no doubt.) All in all, it was a very interesting day in Africa!

July 16

There are always a lot of (fairly) healthy people waiting around the hospital, because families are expected to cook for the patients (over open wood fires), wash clothes by hand, and take care of the patient's basic needs. But it doesn't take all day to do that, so there are lots of people basically hanging around all day with not quite enough to do. This little boy needed a bath, some clean clothes, and some shoes! But at least he had something to eat. He was with his mother, who I recall also had a baby on her back, and the entire family was probably there just in order to take care of someone. At night, if there happen to be empty beds, the families will grab those and sleep in them. But if the weather is nice and the hospital is pretty full, people sleep outside on the grass or on woven mats that they own.

The other picture is of the mission garden. A lot of our food comes directly from here but they supplement with meat and cheese that is bought in the capital city (Kigali) on regular trips that the staff make there. We have plenty to eat, and often I feel guilty about all of the people near here who may only have one meal per day. Someone told me that it takes about 500 francs (just under $1.00) in daily earnings by laborers in order to buy food for a meal. If you don't find work and don't earn 500 francs today, you don't eat today.

Notwithstanding all of this poverty & occasional sadness, the grown-up expats got together tonight for games, thanks to Eric and Jennifer. Usually I am not big on games and not very good at them(!) but entertainment is so hard to come by here (no TV, no movie theatres, no restaurants, no wine bars, no dinner parties) that this was a huge treat. We played for hours and stayed up late. We didn't have any formal games or cards, but we used paper & pens. People recalled games that they had played and what the rules were. One game was like Taboo (Tabu?) with a twist. Another game was called, "what were you thinking?" - I don't think I can describe it briefly enough to write here. At one point we all sat around and counted how many countries we had been to. I had been to 18 countries, but there were two people tied with 35 each. Apparently I need to go to Dubai, because most everyone had already been there! A very fun evening :)

July 15

This is Nelson, who stopped by the hospital with his mother. He was very curious and animated, like so many other little boys are!

Had a great day & busy today at the hospital! Presented to 2 different groups of managers, and both groups seemed interested and engaged. :) The first group was of the 4 top nursing managers, and they wanted to talk about conflict management. The second group was comprised of 20 supervisors of different areas of operation within the hospital. I talked to the 2nd group about time management and division of effort. They all seemed really hungry for information. I think that the management training we have access to at home - both in a college setting, in retail books, and in continuing education forums - is not readily available here. But interestingly, there is not much structure in their supervision processes now. I am not sure if that's just the laid back African culture (hakuna matata, "no worries"), or if it's just that they need more or new tools/resources to put the structure in place.

English club was also held tonight, and I always enjoy that. :) Brandon, the South African, is going to take over English club after I leave, so he was present this evening to observe how it works. (I was training him - ha!)

July 14

These are two "admin kids"....children of administrators I've been working with at the hospital. The little girl in the blue dress is Marthe's daughter, Benitha (the "h" is silent). Little girls usually wear their hair very short, and sometimes it's hard to distinguish them from little boys, except for the skirts or dresses that they always wear. No trousers or shorts for little girls. Benitha speaks very good English, as does her mother (an English Club regular). The little boy is the son of Julienne, the top hospital administrator. He has lost his two front teeth and is even more adorable when he has a big smile on his face. I wish I could have gotten him to show his teeth in the picture!

Today was a very productive day for my work at the hospital! A good meeting, some decisions made. Made some progress in trying to automate a manual part of the billing process in Excel. Tricky when resources are limited (not enough computers, little money to buy them) and staff also have little or no training in using computers. I will leave here a week from tomorrow to start my long journey back, and I should be pretty busy until then trying to wrap up my work. I'm glad - the best days are when I'm busiest (just like work at home).

Still was able to squeeze in a tea break at the hospital canteen. I know enough hospital people now that I can go by myself and not feel too awkward. But my friend Rose (travallier/jack of all trades) noticed me there and sat by me, which was sweet. The canteen is one of Lisa's projects and shows her special touch - they have really good sweet African tea with milk and cinnamon rolls made fresh each morning. If you work at the hospital, the tea is free, and the sweet roll only costs about 20 cents. Though they have a modern kitchen, they still use a wood fire "out back" to cook big pots of rice and beans to sell at lunch. Rice and beans are traditional food for this part of Africa, along with fried plaintains. If one is somewhat prosperous, then goat or beef can be added to the meal (usually boiled or stewed). They have chickens around here too (one rooster used to wake me up early every morning at my first house here, with Lucas) but I don't see much chicken in the food dishes, and I think people mainly raise them for the eggs. There's a pig here at the mission who eats leftover scraps from our table. Someone named him "Smoky". Oh dear. I hope that I leave before his time is up - I am a wimpy carnivore who does not like to see my food walking around beforehand!

Lisa did not feel like walking today, so Ella (British medical student) accompanied me on the 3 mile walk on the dirt road, instead of Lisa. I was a little concerned about getting lost without Lisa, but it was no problem. I was also asked to take Ella on a tour of the hospital this week, in order to get her oriented. Now it seems that I'm the "old hat" showing the "newbie" the ropes. Funny how fast that happened!

July 13

The picture at right was taken at "English Club". I think I enjoy English Club more than the Africans do! They are working so earnestly at learning another language, and they are doing so well. For tonight's class, I wrote three mini-stories to read (ever since the "bear hug" story/fiasco (see July 6 blog), I am creating more of my own material to read to them). After I read to them, they summarize their understanding of what I said. Then we pass around the story and each of them practices reading it aloud. Tonight I photocopied some English-Kinyarwanda translations of medical terminology to give them, from a book I brought with me on the trip. They were so thankful and so excited about these things that at the end of the class, one of them composed a little prayer for me, including a wish that my family was well and safe, since I had left my family to come here. It tells you a little bit about how important family is to them. The prayer was so touching that I was in danger of crying a little bit. I held back so that they wouldn't think Americans were wimps. ;)

The other 2 pictures were taken in Sheila's garden. I think I remember that particular tropical flower is called "passion flower" - is that right?

Today was an interesting day at the hospital. There were auditors visiting the hospital (similar to CMS or Joint Commission), and I had asked to sit in on the meetings as the performance indicators were covered using a government checklist. The head nurse, Emmanuel, translated a few key points for me, and so I was able to follow along reasonably well. How well a hospital scores on their audit determines a portion of their reimbursement. They call it "Performance Based Financing". Good stuff!

July 12

This is Bacquie (I'm not sure of the exact spelling), a very tall and hardy Rwandan man who does a lot of maintenance work here at the mission compound. When part of the tree in front of Lucas' and my house fell onto our fence and also partly in the driveway, he arrived within minutes with his machete and started chopping up the branches and dragging them out of the driveway. Today he was carrying a bag of sand or concrete around when I stopped him to ask permission to take this picture. He is very friendly and is one of the men here who first coached Lucas and I about how to say good morning, how are you, I am fine, and so on in Kinyarwanda. He really worked at it too - if we just looked blank (which we did quite a lot at first), he would exaggerate the words and draw them out, until we successfully repeated the proper response. He looks about 70 years old to me, but Sheila tells me that he is only in his fifties. I suppose that he has lived a hard life, and he has earned those extra few lines on his face.

I took the other picture at Kumbya yesterday. These lavender flowers grow wild among the rocks right at the water's edge. They look a little like petunias, but I don't think that they are. You can see just a little bit of the lake in the corner of the picture.

Visited the HIV clinic at the hospital today. If I understood correctly, they have about 2,000 patients. Unicef and the Rwandan ministry of health report that the country's HIV prevalence is 3%. That is lower than I would have expected - significantly lower than south African countries. They can run HIV serology lab here at the Hospital including CD4 counts. The guy I was talking to said that they try hard to keep up with new research about HIV. As I mentioned in an earlier post, there is plenty of funding for anti-retroviral drugs at the present time. Catholic Relief Services is the most frequently mentioned NGO providing the ARV meds. Hopefully that funding will last long term.

Today I met some new visitors to Kibogora: Ella and Brandon. They are engaged and in their 20's. Ella is British and about to begin her last year of medical school in Edinburgh, and Brandon is studying music production in England, though he is originally from South Africa. It's interesting to hear Brandon's stories about South Africa, and Ella is very bubbly and outgoing. Ella scrubbed in at the OR today to get some surgical exposure, and since Brandon has a flair for landscaping, he was put to work on the grounds. They are a fun couple and a nice addition to our little group here!

July 11

This is a picture of 2 girls in their secondary school uniforms. There is a secondary school just below the mission on this hill. It's not a fancy or modern school - it looks fairly primitive (by U.S. standards) from what I can tell - but I do believe they have electricity in the classrooms, unlike the primary schools I have seen. It's a big deal to get to go to secondary school. Secondary schools are boarding schools, because I suppose the commute is too difficult. More students are making it to the university level. There are only 2 universities in the country at this point - Butare and Kigali - and the one in Kigali was established sometime after the 1994 war/genocide, so it's pretty new.

This morning, I went to the Methodist church which is just a few steps from the mission/hospital with the American family (Eric, Jennifer and their 4 children). We had to go up on the altar to greet the church members, since we were visitors. There were about 1,000 people attending this church today. There were several different choirs which sang beautifully for 2 hours. After 2 hours, we left because the kids were getting restless. So we missed the sermon, but it would have been in Kinyarwanda anyway. Their church services are really long!

Spent the afternoon at the Kumbya retreat on Lake Kivu with several of the "expatriates". It was a lovely day here. Very comfortable temperature, just like it has been the entire trip.

The flowers in this picture are growing on a little tree in Sheila's garden. I think they are the same flowers which grow in Hawaii and are made into leis.

July 10

This afternoon I was invited to tag along to a Rwandan baby naming ceremony, for Oscar who works in the hospital pharmacy, his wife, and their infant. Apparently it is a tradition that family and friends are invited to join the couple as they choose a name for their new baby. There were probably 70 adults there and an untold number of children being supervised inside the house. The ceremony was held outside the couple's home. There were benches to sit on, and tarps were stretched out overhead to provide shade. As you can see in the pictures, there were decorations and people were fairly dressed up. A buffet lunch was served and sodas and water bottles were passed out. Many speeches were made by the father, mother, family, co-workers, and 3 pastors who were present. At one point, I was mentioned as a guest but I just had to wave and smile. Thankfully, no speech was required from me!

The new first name for the baby - a girl - is Nadine. It is typical that a first name is either French or biblical. In Rwanda, last names are usually not passed down from parents to children. Usually the last name is a Kinyarwandan word or phrase. So when deciding what the baby's last name would be, the parents reflected on the difficult pregnancy and delivery they had with this child, and the child's subsequent breathing problems. In thanks for the child's survival, they created a last name which is a Kinyarwanda phrase meaning "thank you, God".

In the pictures above:

1) The mother is saying a prayer. Her husband Oscar is sitting behind her, to the left. Gender equality is a big thing in Rwanda, and someone who was translating a bit for me at the ceremony said that the father specifically mentioned that his wife was in charge of the naming. ;) The mother had on a really pretty yellow gown (what I would call a sarong, I suppose).

2) In the group picture, we see Oscar and his wife, and I think that is an uncle on the left. On the right is Sheila, the British nurse missionary/administrator who is my main contact here. And Sheila is holding Oscar's baby.

3) This couple was seated next to me at the ceremony. He's a Methodist pastor of a nearby church who used to be a chaplain at Kibogora Hospital. His wife was very pretty and had on a beautiful green dress with a matching headdress. She apparently runs one of the little shops (called "ducas") just outside the walls of the mission.

I very much enjoyed being able to experience a little bit of real Rwandan culture and family life today. So glad I was there.

July 9

The mother in this picture stopped to wave at me because her toddler was fascinated by the muzungu. I love the look on this toddler's face; she's thinking something like, "what kind of weird alien are you anyway?" I get that a lot here.

The other picture is of a shrub on the hospital property. I liked the purple flowers, as well as the care that the grounds keepers had taken in spelling out the word "Isuku" in alternating colored plants below it. I asked my friend Rose, the travallier (housekeeper/jack of all trades), what isuku means, and she said it means "clean". Well, that's a pretty good word to go around planting at a hospital. Both the hospital and the mission are very well maintained, very clean. A housekeeper tries to come in and clean my little apartment every day, and if I'm here, I'll tell her no thanks. I'm not quite so messy that someone has to come in and clean up after me every day!

I finished my current project today (hospital billing evaluation) and e-mailed off my report to the British missionary/administrator here. Only 2 weeks remaining now. I think I can get a couple of more things finished before I leave. Though I've had a good trip, I'm looking forward to coming home. :)

July 8

Here is a nurse holding a newborn baby in the maternity ward today. In Rwanda, a typical woman of childbearing age will give birth to 5 children. In the U.S., this figure is closer to 2 children. Therefore, maternity services are very busy here! Unfortunately, this country has the 26th highest under 5 mortality rate in the world at 112 deaths per 1,000 children. So a lot of these babies are born to replace children who are lost before they can grow up.

Here is a picture of a medication cart on the internal medicine ward. This looks a lot like the med carts that I remember from about 10 years ago, before automated medication dispensing systems came into vogue. Even if they had the money (which they don't), any procedure depending fully on automation - like a medication dispensing machine - would not work well here until the infrastructure is improved to address the frequent power outages. There was a 2 hour span yesterday where I estimate the lights went off and on about 30-40 times. Thankfully I am not prone to seizures, otherwise I would have been in trouble.

English club was fun tonight. Three doctors were there (and an accountant), so we talked about medical terminology a lot. They struggled with 'gallbladder' and all wanted to write that one down. We basically went through a list of anatomy in English with lots of pointing and use of a French and Kinyarwanda dictionary. Also we went through an inpatient chart template, which was in French, and translated all of the key words into English. They seem excited about the medical charts here eventually changing from the official language of French to an official language of English, even though it will be hard for them at first to make the transition. Most of these doctors are from Africa but not from Rwanda, so their first language is usually another African language, then they have to learn enough Kinyarwanda to speak with the patients here, and they have learned some French and English as well in order to write in the charts and communicate with other Africans who don't speak their language, in French or English. It is all quite confusing, and I don't know how they manage to communicate at all. Still humbled that I only speak one language.

July 7

This is the family with 4 children which I mentioned in an earlier post. Dad Eric is a surgeon, volunteering at the hospital for a month. The mother is Jennifer, a former social worker and now full time, home-schooling mom. And they brought their 4 children ages 3-9 with them. So for a few of you who said that you thought I was brave or adventurous for coming to Africa...... um..... there's a tiny, precious, 3-year-old American girl here too. I'm not feeling the least bit brave or adventurous!

Took another 3 mile walk with Lisa at lunchtime today. I'm really enjoying the fresh air, sunshine, great company, and stunning views on these lunch walks! Especially the fresh air. At the hospital, all of the ambulatory people (mostly patient's family members, of which there are often many) use outdoor latrines over pits. Downwind of these latrines, the smell is fairly unpleasant. I had not spent time at pediatrics until today, and while I was walking through there, I thought, "these latrines smell just like a barnyard". A few moments later, I noticed that pediatrics is keeping 2 milk cows in a shed. So that's why it smelled like a barnyard! I guess I'm just not used to having cows at a hospital. (I was going to make a joke here about feeling sheepish, but I deleted it out of sympathy to you readers at home.)

July 6

I thought I would include more pictures of folks I have been working with at the hospital. Emmanuel is the head nurse. In this picture, I think he is wearing a lab coat contributed by a visiting doctor. He's very soft spoken. At times his voice is almost like a whisper. Soft spokenness is very common here. The general culture is to be polite and unassuming, with exceptions of course - it's rarely accurate to generalize about 9 million people. :) Emmanuel has kindly shared his office with me on many occasions when I needed a place to write or work on my computer. At the other end of the work hierarchy is Rose, who is basically a cleaning person and jack-of-all-trades. She has a wonderful smile and always goes out of her way to greet me. The hospital has a very catchy name for the people in Rose's position, sounds something like travalliers. Travalliers wear green uniforms, and nurses wear white. (Administration wears black.) Both Emmanuel and Rose speak very good English, which is how I got to know them. I have leaned on Emmanuel to be an interpreter for me a few times.

Most of today I worked on understanding the insurance billing system here in Rwanda. Easy to be discouraged by the language barrier. It is slow going, but I do feel I am making progress. Took a 3 mile walk with Lisa during lunch. It was warm and sunny, but not humid and therefore not unbearably hot. I would say it was about 80F. The roads are cut into sides of hills - it's a very hilly place - and so everywhere I looked during the walk, there are remarkable views of valleys and terraced hillsides planted with banana trees. Also views of the lake, which is never far away.

Some of the managers have formed an English club, and tonight they invited me to join them. We read passages from an English book together, and I explained words or phrases that they did not understand. The passage which I chose tonight unfortunately included the expression "bear hug", and I spent a long time trying to explain what that is to people who've never seen or heard of a bear. It was pretty comical! Well, they seemed to have a good time and to learn a little bit, as they invited me to join them again on Thursday evening, and also twice a week until I leave here.

July 5

Spent most of the day at the hospital meeting with Charles and Marthe, mid-level administrators at the hospital, and trying to understand the health insurance system in Rwanda. This is a bit of a technical subject to discuss in the presence of a language barrier. So it's slow going. Looked at a few of their insurance contracts. They are very short (bonus!) but most are in French (ugh). Lucas knows Charles and Marthe well from his trip here, but for the rest of you, attached are their pictures while they are working at their desks. Doesn't look so different from most of us at work, does it? Marthe told me that she is married to one of the nursing managers here at the hospital and they have 3 daughters. She worries about her daughters getting a good education so that they can obtain jobs, but I reminded her that it will be easier since they have her for a role model. That made her smile. :)

Since my nephew Lucas wasn't here to be the IT expert anymore, I had to fix Charles' computer problem today. It wasn't that hard. No images were showing up on his monitor at all, so I just plugged in another monitor that was sitting around, et voila.... his computer worked again. He was really worried, thinking that his computer had crashed with all of his important files on it. There aren't any regular back-ups done, and computer viruses are common (as Lucas knows all too well). The level of knowledge of how a computer works is fairly low compared with the average user in the U.S. They would really benefit from an intranet, so that they could file-share, but they would need a server and someone who knows how to maintain it. They have neither. Charles is the main hospital accountant, and he uses QuickBooks. Small & easy package.

Had lunch with 4 Brits today: Sheila (long term nurse missionary) and the 3 20-somethings visiting for 2 weeks. The 20 year olds were coloring with the kids in the wards today - they were a big hit! I wish I had been doing that instead of attempting to read French insurance contracts! What they are doing is basically occupational therapy, and Sheila was telling them how effective their interventions really are for the kids. She was saying that depression among kids here is a real problem, due to hopelessness. And a little intervention like coloring can lift their depression and speed up the healing process, especially since many of the kids have never seen crayons before. It's hard to imagine childhood without crayons! Good stuff :)

July 4

It's Sunday the 4th, and I'm missing being at home right now! Craving brats with mustard, watermelon, and sitting with family by the pool.

But I've had a nice day visiting with people here. A bunch of us "expats" went to church together this morning. Aloys, a social worker at the hospital, sat with us and translated the major points of the sermon. I always enjoy the choir singing at the church services, even when there is no one to translate the sermon. But we did get stared at a lot today in church, even more than usual. Probably because there were so many of us muzungu sitting all together. Or perhaps because one of the visiting Brit girls has long blond hair.

Spent some time drinking tea outdoors on the deck at Lisa's place and visiting with a new arrival, Torrie. She's from the States and at only 28 has already produced a documentary film. She is now writing the accompanying book. She said the film is called, "Beyond Good Intentions" and is about how some humanitarian aid agencies are inadvertantly doing more harm than good. To create the film, she traveled around the world interviewing government employees, NGO workers, and local people. That film came out a couple of years ago and did well enough that she is now traveling through Africa and elsewhere to research and write the book. She has been to all 7 continents and I think she said 81 countries. She is traveling by herself here on a very low budget, and hitchhiking occasionally is a requirement of her travels. I admire her creativity, boldness and fearlessness. She is a great example of "if you can dream it, you can do it". (Note: see www.beyondgoodintentions.com)

Another family arrived from the States this afternoon: Eric, Jennifer and their 4 children (picture of 2 of the children above). They will be here a month. Eric is a general surgeon, and the hospital will keep him busy with cases. Though some of the local physicians can operate, most of the hospital's surgeries seem to be done by visiting volunteer surgeons, and the hospital tries to schedule their visits so that there is not too much overlap and not too much of a gap. If the visiting physician is a specialist, then radio ads go out in advance advising people in the local area that a "so-and-so" will be at Kibogora Hospital next month. Then the specialist will have a group of patients ready to see him/her upon their arrival. I believe Jennifer is a nurse or nurse practitioner, but I imagine she will have her hands full taking care of the 4 children aged 3-9 while they are here.

Mother & toddler

See how the baby's legs wrap around mom? That is typical of the way mothers carry their babies here. This baby must be walking because he has shoes on!

From the Economist: The new East African Community officially started this past week (July 1). Burundi, Kenya, Rwanda, Tanzania and Uganda will reduce trade barriers and allow employment across country boundaries. There is some talk of a possible future common currency. English is to be the common language of trade, I believe, hence the push for primary school students, hospital employees, etc. in Rwanda to learn English. It seems this alliance will be good for Rwanda, as it is landlocked and may benefit from aligning with Tanzania and Kenya.

Poinsettia shrub

They are fairly common here. This one is about 5 ft tall.

"Boys will be boys", part 2

Another minor mishap for a little boy at the ER. Mom was really great about letting me take a picture, but the little boy wasn't so sure about it! :)

Bougainvilea