n'tzagukumbura .....I will miss you

Today was the last full day of work for most of us. The majority of our group is off for a bit of R and R and tourism to Akajera, a wild game park.

Sunday some will go back to Bwiza to finish weighing and measuring the village residents and distribute health cards. The Rwandan government has provided national health insurance for 2.00 per person annually. This doesn't buy much but is the beginning of access. The 2.00 is too much for the Twa community (pygmy). We have negotiated with the government for a reduced rate of 1.00 for the first year for a family of 4. We have paid on behalf of the community. Next year, the fee will double. The community has been so isolated that they have no photos for their insurance ID cards. Heron shot 115 photos and then she, Jill and Daniel tried to match name and approximate age to the photos. Interesting task since age and weights are so far off the standardized age weight charts they are using.

The physicians had a cross cultural moment when the word came back to our group that the hospital was adrift in rumors that we were taking back the equipment we had brought and were leaving outdated medications that we were dumping on them. Several hours of apologies and explanations in French, English, and Kinyarwandan resolved the meeting amicably. They want us back and most of us want to come back.

It is so interesting to look at the differences between our US style and Rwandan style. Time is money for us. Time is a renewable resouce in Rwanda. There is always ample time to stop, greet people properly and have a cold drink. Sometimes these proprieties interrupt surgery schedules and the birthing of babies. We have walked in midway in surgeries, clad in street clothes, only to have the surgeon interrupt his or her procedure to properly greet us.

We all are learning. Our kinyarwandan support staff; Dr. Aflodis, Dr. Dan and Eddie have spent more hours investing in us than seems reasonable. Hopefully they benefit from this investment. After spending 12 plus hours with us during the day. Dr. Dan heads off to cover a night shift at King Faisal's ICU. Dr. Aflodis, director of HDI volunteers full time and works manual labor when he runs short of funds. Doctors are paid 800-1000.00US per month, high for Rwandan standards but jaw droppingly low by US standards.

Robb has spent this week designing and purchasing parts for a safe water system for the Bwiza residents. The women hike down through the jungle 270 feet with two empty five gallon jugs, use a cup to slowly fill them up from a dirty spring source and then they hike back up with 10 gallons of water and a baby on their back. As if this doesn't seen daunting,enough they repeat this process two more times on average each day.

I returned to the Kigali Health Institute for Trauma to meet with the director and several of the top staff for future planning. While waiting for the meeting to start ( only 45 minutes late, timely by Rwandan standards) they make a copy of my English/Kinyarwandan phrase book. They want the English. I want the Kinyarwandan. We laugh alot at each other.

The meeting begins and they proudly show me their library. Aspacious room with shelves lining the walls. It has 4 books in it. Without computers and internet, continuing education is nominal. We talked about addressing this and developing a continuing ed program. The Ministry of Health is looking at a national license for mental health workers. Jen, the director, asked for help. She told me it is exhausting showing previous well meaning westerners around her facility. I am careful about what I commit to and what I say I will look into. I am at the minimum able to commit to providing additional learning materials for these courageous women.

AS our meeting draws to a close, they bring out a very official guest register for me to sign. I peruse the signatures of visitors over the past 6 years. I sign off. " Merci. Thank you. Murakoze. Your work is so important. N'tzagukumbura. I will miss you."