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.