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our group that the hospital was adrift in rumors that we were taking back the equipment we had brought and were leaving outdated medications that we were dumping on them.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."
Friday, June 27, 2008
Wednesday, June 25, 2008
Proteger votre coeur (protect your heart)
Today things are settling into a routine. The physicians are leaving in the morning to round on patients, do surgeries, teach lessons. Folks are getting more comfortable with public transport. Many have abandoned fear and jumped on a moto (small motorcycles) that are ubiquitous. Helmet passed back to the passenger, they zoom in between cars, up the wrong way on one way streets and cost about 1/4 of a taxi.
Our kinyrwandan purple dictionaries are stuffed into white coats, back pockets and purses. Folks are mastereing the basic greetings in both the local language and French.
We no longer move as a group as members are venturing out on their own for meals, shopping and exploration.
Yesterday, Ryan did a surgery on a young man who had two machete wounds on his arm. He was injured in a gang fight. The cardio team has been following several patients and figuring out how to get a patient transferred to the only hospital that can provide the care he requires. Pricilla, our neonatologist has been teaching newborn resuscitation in French to any professional that will listen. The women's health care team had no babies to deliver today so they delivered a lecture to 8 nurses on managing labor. The "village people", the humanitarian team working with the Twa (pygmy) population is making health insurance cards for 114, delivering shoes and clothes, weighing, measuring, deworming and providing Vitamin A to the people of Bwiza. The engineering team has done a site assessment for water supply delivery. Their hope is to have a system up and running by July.
Today I worked at the Kigali Health Institute for the treatment of trauma. I spent 6 hours teaching 8 counselling supervisors about the diagnosis and treatment of depression. In reality, the session ended up being a group session for the counselors themselves. Each had her own trauma story to tell and their work constantly reactivates memories and pain. These are delightful women who struggle to care for a nation in trauma.
We talked about each woman's love bucket that needs to be replenished for their work to continue. We spent an afternoon helping each other figure out what we would do to fill up our buckets. Monique is a tall athletic women in her late thirties. When she answered the question why she was a therapist, she had two reasons. "I believe people can change and I wanted to heal myself." She spent much of the day asking questions about self care. Monique had the hollow eyed look of the walking dead. Yet she still wants to swim again in a swimming pool. By the end of the day we had completed our lists and made commitments to do at least three of the self care items a week.
I have their emails and will check on them. I have pictures of the counseling rooms. Matresses on the floor. Plastic lawn chairs and a box of kleenex on a table. They have asked that I return next year to do a two day retreat for their association's 70 counselors. They need a library. They want to do more.
Monique has promised to start swimming again.
Our kinyrwandan purple dictionaries are stuffed into white coats, back pockets and purses. Folks are mastereing the basic greetings in both the local language and French.
We no longer move as a group as members are venturing out on their own for meals, shopping and exploration.
Yesterday, Ryan did a surgery on a young man who had two machete wounds on his arm. He was injured in a gang fight. The cardio team has been following several patients and figuring out how to get a patient transferred to the only hospital that can provide the care he requires. Pricilla, our neonatologist has been teaching newborn resuscitation in French to any professional that will listen. The women's health care team had no babies to deliver today so they delivered a lecture to 8 nurses on managing labor. The "village people", the humanitarian team working with the Twa (pygmy) population is making health insurance cards for 114, delivering shoes and clothes, weighing, measuring, deworming and providing Vitamin A to the people of Bwiza. The engineering team has done a site assessment for water supply delivery. Their hope is to have a system up and running by July.
Today I worked at the Kigali Health Institute for the treatment of trauma. I spent 6 hours teaching 8 counselling supervisors about the diagnosis and treatment of depression. In reality, the session ended up being a group session for the counselors themselves. Each had her own trauma story to tell and their work constantly reactivates memories and pain. These are delightful women who struggle to care for a nation in trauma.
We talked about each woman's love bucket that needs to be replenished for their work to continue. We spent an afternoon helping each other figure out what we would do to fill up our buckets. Monique is a tall athletic women in her late thirties. When she answered the question why she was a therapist, she had two reasons. "I believe people can change and I wanted to heal myself." She spent much of the day asking questions about self care. Monique had the hollow eyed look of the walking dead. Yet she still wants to swim again in a swimming pool. By the end of the day we had completed our lists and made commitments to do at least three of the self care items a week.
I have their emails and will check on them. I have pictures of the counseling rooms. Matresses on the floor. Plastic lawn chairs and a box of kleenex on a table. They have asked that I return next year to do a two day retreat for their association's 70 counselors. They need a library. They want to do more.
Monique has promised to start swimming again.
Monday, June 23, 2008
Beautiful empty facilities
Last night there was a very serious meeting between the Ujama team and our American liaison as well as two of his Rwandese counterparts. Given that Ujama is a test group, there are many wrinkles. While Rwanda has welcomed one or two health practitioners at a time, they have never hosted agroup of this magnitude.
Last Friday there was a case of symbiotic shock- us and them. Clearly the staff at Kibagabaga Hospital had not been adequately prepped about who and what was to descend on them. The American personnel were taken aback wtih varying levels of dismay at what represented a reasonably well supported district hospital. A patient roaming the hospital grounds with TB, pre op patients sharing a bed with a patient with an infected wound. The delivery of a dead baby that easily could have been saved with the limited resources that this Rwandan hospital offered. Cardiology patients that clearly would have been surgery candidates with no technological or financial means to make that surgery possible. A very African sense of time and cleanliness.
Today, things are better. The OB-Gyn team is delivering babies as fast as women push them out. Three c-sections before 2:30;a couple of other deliveries and a set of twins. Hal and his cardio team are doing echos, diagnosing and teaching. Advocating for the smallest change which may make all the difference in the world and take all the time in the world. Ryan, our surgeon, has been extremely creative in thinking about systems for the future. The remainder of the team is off visiting and beginning a pilot project in a pygmy village.
I visited the center for mental health and trauma treatment. It is a beautiful building on a very large plot of land and potential to expand. The landscaping is beautiful. The director was looking forward to me teaching classes in anxiety, depression and PTSD. Unfortunately the director was called away ...a death in the family. How many times I have heard this line in my past African experience? Without the designated director, decisions can't be made. My tour of the beautiful building included halls of empty counselling rooms with plastic chairs and a mattress covered with a dirty piece of fabric.
No budget for training however, no trainees, and the counselling staff has currently been reduced from 37 to 7.
Two delightful women weree my tour guides. The cancelled counselling program that they work for is a year of training following 9th grade. There have been a total of 115 counselors trained since 1996. One psychiatric hospital prescribing valium or halidol and one psychiatrist for an entire country that is walking around in varing stages of agony. I cannot imagine 16 year old Chloe serving as the trained mental health support for this situation.
Last Friday there was a case of symbiotic shock- us and them. Clearly the staff at Kibagabaga Hospital had not been adequately prepped about who and what was to descend on them. The American personnel were taken aback wtih varying levels of dismay at what represented a reasonably well supported district hospital. A patient roaming the hospital grounds with TB, pre op patients sharing a bed with a patient with an infected wound. The delivery of a dead baby that easily could have been saved with the limited resources that this Rwandan hospital offered. Cardiology patients that clearly would have been surgery candidates with no technological or financial means to make that surgery possible. A very African sense of time and cleanliness.
Today, things are better. The OB-Gyn team is delivering babies as fast as women push them out. Three c-sections before 2:30;a couple of other deliveries and a set of twins. Hal and his cardio team are doing echos, diagnosing and teaching. Advocating for the smallest change which may make all the difference in the world and take all the time in the world. Ryan, our surgeon, has been extremely creative in thinking about systems for the future. The remainder of the team is off visiting and beginning a pilot project in a pygmy village.
I visited the center for mental health and trauma treatment. It is a beautiful building on a very large plot of land and potential to expand. The landscaping is beautiful. The director was looking forward to me teaching classes in anxiety, depression and PTSD. Unfortunately the director was called away ...a death in the family. How many times I have heard this line in my past African experience? Without the designated director, decisions can't be made. My tour of the beautiful building included halls of empty counselling rooms with plastic chairs and a mattress covered with a dirty piece of fabric.
No budget for training however, no trainees, and the counselling staff has currently been reduced from 37 to 7.
Two delightful women weree my tour guides. The cancelled counselling program that they work for is a year of training following 9th grade. There have been a total of 115 counselors trained since 1996. One psychiatric hospital prescribing valium or halidol and one psychiatrist for an entire country that is walking around in varing stages of agony. I cannot imagine 16 year old Chloe serving as the trained mental health support for this situation.
Sunday, June 22, 2008
"I sleep"
Today is Sunday and it is the day we all knew from the moment we left the US was ahead of us. We visited three genocide memorials. The first in Kigali, was the national memorial and the site of 7 mass graves. The museum took the visitor on a tour of Rwanda pre genocide and then looked at other attrocities of the 20th century. Armenia...Bosnia, WWII. There were stories of survivors.
Honore, our guide, was a generous spirit as we have found all Rwandans to be. I asked him how he came to work day after day. He asked back, " how could I not?" I asked him how at the end of the day he took care of himself. "I sleep." was the response.
This visit was a prelude to the memorial at Nyamata, a church that became the burial ground for at least 15,000. The safe sanctuary of a religious home was anything but. The church itself was filled with the fading African fabric that the victims were wearing the day they became a historical statistic. We walked to the rear of the church where underground bunkers served as grave sites. The stairwell of the fist grave led us to wooden coffins stacked one on top of the other draped in purple and white, some with flowers and others with no one left to put flowers on them as a remembrance. The second stairwell was far more painful. A descent into hell. To the left were the purple covered boxes, to the right skulls and bones stacked on shelf after shelf.
We still had one more memorial to atend and I turned to Hal and mumbled, "I don't need to see another memorial to know that humanity can lose sight of its inhumanity. " Given how life held such little value at this moment of human history and in so many other moments, my feelings were of little consequence. Ian our driver pushed on.
Arriving at the third memorial, a Catholic mission, more fading fabric, more bones, and cahiers (school notebooks) crumbled and blood splattered. Each filled with the precise penmanship of African school children. Another driver told me this was too much for him and he walked out. I found him playing soccer with a group of school boys on the grounds outside the memorial, the same grounds where the notebook owners had played 14 years before. There was nothing else to do but show them that an old muzungu (white) lady could play soccer. We all did what we could do. Honore slept, boys played soccer and our cab driver cranked out Cat Stevens' Morning has Broken on his tape deck as we drove back to Kigali.
Honore, our guide, was a generous spirit as we have found all Rwandans to be. I asked him how he came to work day after day. He asked back, " how could I not?" I asked him how at the end of the day he took care of himself. "I sleep." was the response.
This visit was a prelude to the memorial at Nyamata, a church that became the burial ground for at least 15,000. The safe sanctuary of a religious home was anything but. The church itself was filled with the fading African fabric that the victims were wearing the day they became a historical statistic. We walked to the rear of the church where underground bunkers served as grave sites. The stairwell of the fist grave led us to wooden coffins stacked one on top of the other draped in purple and white, some with flowers and others with no one left to put flowers on them as a remembrance. The second stairwell was far more painful. A descent into hell. To the left were the purple covered boxes, to the right skulls and bones stacked on shelf after shelf.
We still had one more memorial to atend and I turned to Hal and mumbled, "I don't need to see another memorial to know that humanity can lose sight of its inhumanity. " Given how life held such little value at this moment of human history and in so many other moments, my feelings were of little consequence. Ian our driver pushed on.
Arriving at the third memorial, a Catholic mission, more fading fabric, more bones, and cahiers (school notebooks) crumbled and blood splattered. Each filled with the precise penmanship of African school children. Another driver told me this was too much for him and he walked out. I found him playing soccer with a group of school boys on the grounds outside the memorial, the same grounds where the notebook owners had played 14 years before. There was nothing else to do but show them that an old muzungu (white) lady could play soccer. We all did what we could do. Honore slept, boys played soccer and our cab driver cranked out Cat Stevens' Morning has Broken on his tape deck as we drove back to Kigali.
Thursday, June 19, 2008
Breaking news
40 bags sitting in the African sun ready to be loaded onto a bus for Kibagaga hospital. Before we go however, a lunch break. When we get back to the hotel to meet the bus we are told a change in plans. Apparently, 19 Spokanites and their luggage are considered to be breaking national news in Rwanda. We are asked to haul all the baggage back to our rooms until tomorrow morning when the bus will return to carry our supplies timed to arrive at the hospital for news crews.
We were asked to calculate the dollar value of all the generous donations of medical equipment and supplies. The resulting 65000 of donations translates into 32 million Rwandan francs, a huge gift worthy of this national attention. This has really taken us all aback.
The morning was spent in an orientation meeting with two Rwandan physicians and their office staff. I asked one of the physicians who has yet to specialize what he wants his specialty to be. He answered, "for a long time I have wanted to be a radiologist. I would help maybe 3-4 people a day. I need to go into public health. That's where I will be of the greatest help."
We have broken out into several smaller teams- cardiology, women's health, surgery, and community development. Following the delivery of medical equipment tomorrow, we begin the real work.
We were asked to calculate the dollar value of all the generous donations of medical equipment and supplies. The resulting 65000 of donations translates into 32 million Rwandan francs, a huge gift worthy of this national attention. This has really taken us all aback.
The morning was spent in an orientation meeting with two Rwandan physicians and their office staff. I asked one of the physicians who has yet to specialize what he wants his specialty to be. He answered, "for a long time I have wanted to be a radiologist. I would help maybe 3-4 people a day. I need to go into public health. That's where I will be of the greatest help."
We have broken out into several smaller teams- cardiology, women's health, surgery, and community development. Following the delivery of medical equipment tomorrow, we begin the real work.
Wednesday, June 18, 2008
African wake up
After 2 days of travelling we are here. We were greeted at Kigali International by Karl, a US physician who has been working with us and Dr. Dan and Dr. Aflodis, two of our Rwandan hosts.
The sun was out and amazizngly all 40 pkus bags arrived in better condition than the travellers.
Showers, money converted and a walk to La Planetta wh ere we were hosted to our first African dinner replete with Mutzig, the Rwandan beer, steamed green bananas and fish brochettes with pili pili sauce ( it makes Tabasco sauce look like a training bra).
We had the opporuntiy to meet with many of the people who have been working on our arrival and both they and our delegation had an apporunity to realize we are HERE. We are referred to as the AMerican Delegation from Washington (then we explain there are two Washingtons).
It is 8:40AM the birds are singing, trucks are moving dirt to fill the giant hole in front of our hotel and we are about to begin our first meeting which will provide us with all the info regarding our work assignments.
On a personal note, my first 20 hours back in Africa have been filled with nostalgia. Foods, (la vache qui rit) and milo, smells, (fa the deoderant I used to use and charcoal fires) and mostl importantly the generosity of Africans both curious and a bit confused by the size of this community descending into their world.
A
The sun was out and amazizngly all 40 pkus bags arrived in better condition than the travellers.
Showers, money converted and a walk to La Planetta wh ere we were hosted to our first African dinner replete with Mutzig, the Rwandan beer, steamed green bananas and fish brochettes with pili pili sauce ( it makes Tabasco sauce look like a training bra).
We had the opporuntiy to meet with many of the people who have been working on our arrival and both they and our delegation had an apporunity to realize we are HERE. We are referred to as the AMerican Delegation from Washington (then we explain there are two Washingtons).
It is 8:40AM the birds are singing, trucks are moving dirt to fill the giant hole in front of our hotel and we are about to begin our first meeting which will provide us with all the info regarding our work assignments.
On a personal note, my first 20 hours back in Africa have been filled with nostalgia. Foods, (la vache qui rit) and milo, smells, (fa the deoderant I used to use and charcoal fires) and mostl importantly the generosity of Africans both curious and a bit confused by the size of this community descending into their world.
A
Sunday, June 15, 2008
The night before take off.....
It's 9:50 PM. Trunks are packed and labelled. We've started taking our antimalarial meds and in five hours we'll be at the airport.
Thanks to each of you reading this who have helped support us in our work. We will hold you in our thoughts.
Mission members:
Sara Holt, CNM (Certified Nurse Midwife)Specialty: Obstetrics and Women's HealthGoals: To teach local providers how to recognize and treat common pregnancy related conditions and complications- preeclampsia, breech presentation, postpartum hemorrhage, etc. I'd also love to deliver a few babies and assist in surgery.Previous mission work: None
Hal Goldberg, MDSpecialty: CardiologyGoals: To teach EKG and cardiac examinations. Also to recommend treatment for patients with valvular heart disease and heart rhythm problems.Previous mission work: None, except the ongoing mission to raise his children.
Christopher ZilarSpecialty: HIV/AIDS educationGoals: Fact finding and preparation for the next trip; train health care providers regarding HIV counseling.Previous mission work: Legally ordained, volunteers with local AIDS organizations.
Le Zilar, ARNPSpecialty: Ob/Gyn Nurse PractitionerGoals: Provide obstetric care and deliver babies in rural areas.Previous mission work: Legally ordained, volunteer with local AIDS organizations.
Pam Silverstein, MDSpecialty: Ob/Gyn PhysicianGoals: Teaching, clinical services, site visit
Sherry AltmaierSpecialty: Certified Surgical TechnologistGoals: To help establish and develop surgical services Previous mission work: Ecuador 2005Sherry has been instrumental in helping us acquire, organize and pack donated supplies- thank you-- wish you were joining us in Africa!
Mary Hadley Specialty: Office organization; computer skillsGoals: To make a difference in at least one person's life and to provide shoes for MANY people. (Mary and her husband Don have raised money to provide shoes for local citizens- they are required for children to attend school and for adults to enter the markets).
Don Hadley, RVT, RCSSpecialty: Cardiac and Vascular UltrasonographerGoals: Learn some french and provide shoes!Previous mission work: Locally with his church
Robb LowySpecialty: Engineering, water resources, energy Goals: To initiate a cooperative relationship between the Rwandans and Gonzaga University Engineering Dept.
Adie Goldberg, Licensed Clinical Social WorkerSpecialty: Post Traumatic Stress Disorder and Crisis InterventionGoals: To assist in rebuilding mental health systems, teaching, healing the healers.Previous mission work: 4 years in the Peace Corps in Togo, Women's Health Ext Agent.
Ryan Holbrook, MDSpecialty: Surgical OncologyGoals: To provide surgical support, teaching and service where possible. To make a difference.Previous mission work: Ecuador 2005
Philip SoucySpecialty: Cardiology Technician, French translation Goals: Continue with french work, help where needed
Barbara Soucy, RNSpecialty: OR, ICU, PACU. Fluent in International Sign Language.Goals: To help where needed.
Thanks to each of you reading this who have helped support us in our work. We will hold you in our thoughts.
Mission members:
Sara Holt, CNM (Certified Nurse Midwife)Specialty: Obstetrics and Women's HealthGoals: To teach local providers how to recognize and treat common pregnancy related conditions and complications- preeclampsia, breech presentation, postpartum hemorrhage, etc. I'd also love to deliver a few babies and assist in surgery.Previous mission work: None
Hal Goldberg, MDSpecialty: CardiologyGoals: To teach EKG and cardiac examinations. Also to recommend treatment for patients with valvular heart disease and heart rhythm problems.Previous mission work: None, except the ongoing mission to raise his children.
Christopher ZilarSpecialty: HIV/AIDS educationGoals: Fact finding and preparation for the next trip; train health care providers regarding HIV counseling.Previous mission work: Legally ordained, volunteers with local AIDS organizations.
Le Zilar, ARNPSpecialty: Ob/Gyn Nurse PractitionerGoals: Provide obstetric care and deliver babies in rural areas.Previous mission work: Legally ordained, volunteer with local AIDS organizations.
Pam Silverstein, MDSpecialty: Ob/Gyn PhysicianGoals: Teaching, clinical services, site visit
Sherry AltmaierSpecialty: Certified Surgical TechnologistGoals: To help establish and develop surgical services Previous mission work: Ecuador 2005Sherry has been instrumental in helping us acquire, organize and pack donated supplies- thank you-- wish you were joining us in Africa!
Mary Hadley Specialty: Office organization; computer skillsGoals: To make a difference in at least one person's life and to provide shoes for MANY people. (Mary and her husband Don have raised money to provide shoes for local citizens- they are required for children to attend school and for adults to enter the markets).
Don Hadley, RVT, RCSSpecialty: Cardiac and Vascular UltrasonographerGoals: Learn some french and provide shoes!Previous mission work: Locally with his church
Robb LowySpecialty: Engineering, water resources, energy Goals: To initiate a cooperative relationship between the Rwandans and Gonzaga University Engineering Dept.
Adie Goldberg, Licensed Clinical Social WorkerSpecialty: Post Traumatic Stress Disorder and Crisis InterventionGoals: To assist in rebuilding mental health systems, teaching, healing the healers.Previous mission work: 4 years in the Peace Corps in Togo, Women's Health Ext Agent.
Ryan Holbrook, MDSpecialty: Surgical OncologyGoals: To provide surgical support, teaching and service where possible. To make a difference.Previous mission work: Ecuador 2005
Philip SoucySpecialty: Cardiology Technician, French translation Goals: Continue with french work, help where needed
Barbara Soucy, RNSpecialty: OR, ICU, PACU. Fluent in International Sign Language.Goals: To help where needed.
Subscribe to:
Posts (Atom)