Out of Africa

Above: Pool at Hotel Milles Collines (Hotel Rwanda)

Well, this is our last blog and I can happily say I am writing it from the comfort of my house in Halifax.

We went to work Thursday morning and spent the time helping out with a 7 month old ICU patient that they were trying to ventilate using the anesthesia machine. We left the hospital at noon and had lunch by the pool at Hotel Milles Collines. It was a little surreal to sit there knowing this place was the centre of so many stories from around the time of the genocide.

We went back to the apartment and finished packing. Unfortunately there was little to no water presure we didn't begin our long journey home feeling as clean as we would have liked.

Emmy, our driver, picked us up and took us to a nearby orphanage so we could donate a few soccer balls that we had remaining. The orphanage was the only one in Kigali during the genocide and was run by a Hutu who took in any children needing help. Currently the center houses 137 children aged 3-23. It was sad to walk around and see the conditions in which they were living. The kids seemed excited about the gifts and were playing with the balls before we even left.

We had a nice overnight flight to Brussels and then a quick flight to London. With hours to spare in London, we enjoyed the Air Canada lounge. We had the best showers we had had in a month - lovely hot water and water pressure. Our flight to Ottawa went well but was late arriving and our luggage didn't arrive to clear customs. We ended up missing our connection to Halifax by just a few minutes. We were quite upset after travelling so long and just wanting to be home. Air Canada ended up routing us through Toronto and we finally arrived home at 10:30last night.

We had a great month with lots of emotional ups and downs. The country and people were terrific but it is nice to be home. Being away always makes you appreiate what you have.

Thanks for everyone's support over the past month,

Janice and Anita

It is very hard to believe that this is our last morning in Rwanda. The month has gone by very fast. We have enjoyed our time here but are excited to be heading home.

Yesterday was our last day of teaching and it was an enjoyable day. The residents did quite well on their exam so we felt as though at least some of our teaching was effective.

We went out to supper at Heaven restaurant and had 8 of the 9 residents join us as well as Dr. Nepo (one of the staff anesthesiologists). The food was great but the company was even better. The people we have met here are very special. They are warm and open and have been very generous with us. There were lots of laughs last night and I think the evening was enjoyed by everyone.

Off to work this morning and to say a few more goodbyes. We will skip off early to finish packing and then get a plane tonight. 30 hrs of flying and we will be home!

See all of you soon!

Janice and Anita

PS. no time to add pictures

We had a great day teaching with Antoine yesterday at CHUK in the maternity part of the hospital. We did 3 c-sections and all went well. Antoine demonstrated good organizational skills and a solid knowledge base. One of the patients was a Jehovah Witness patient with a low starting hemoglobin of 84 so it was quite a good case to do some teaching around. In the afternoon, Antoine was called to manage a patient 6 days post c-section who was not doing well. We had the opportunity to do a central line together and then talk about the management of a critically ill patient with complications of eclampsia.

Last night we met up with the Danish dermatologist we had met in Butare, and went out to dinner at Khana Khazana Indian restaurant. It was fabulous and would rank up there with some of the best Indian restaurants we have eaten at. We ate way too much food but couldn't help it because it was so good - the $60 bottle of wine also helped.

Today was spent at King Faisal Hospital with 3rd year resident Theoneste. We had planned to do a lobectomy on a patient with tuberculosis. Theoneste did a great job of getting everything prepared and assessing his patient. We were a little stressed about placing the double lumen tube because of equipment issues but all went well. Unfortunately, as we were trying to teach Theoneste about central line insertions, he hit the lung and had a pneumothorax. After much commotion and discussion, the patient was resuscitated but ultimately the case was cancelled. We felt really bad about all this, even though we know complications occur. We felt like we left King Faisal on a bad note.

Tonight we are trying to get everything ready for teaching tomorrow as well as pack. We are taking the residents out to dinner tomorrow night and then we fly out on Thursday evening. We can't believe our time has come to an end. It has been a great experience but we are looking forward to getting home.

Janice and Anita

Theogene, Damasene and Anita providing anesthesia to a 6 day old with spina bifida

We had a great day in Nyungwe National Park yesterday. Our driver Emmy picked us up at 7am and we drove 3 hrs to the park reception. The drive was incredibly beautiful but the last 1.5 hrs was over a horrible road with some of the largest potholes I have ever seen. Large transport trucks on route to the DRC have to go so slow that the drive takes days.

Emmy suggested we do a 10 km hike into a spectacular waterfall with the opportunity to see monkeys and birds along the way. The hike was challenging in places but well worth it. The rain forest was so tranquil and it was great fun to see the monkeys - although they were so fast that they seemed adept at avoiding the camera. The spot where the waterfall was, was spectaular. The greenery, the flowers and the power of the waterfall made for a great experience.

On the way back to Butare, we stopped at the Murambi Genocide Memorial where 50 000 Tutsis had been killed. It was incredibly moving but difficult to see as there were rooms full of preserved skeletons of the victims. It was an important place to stop and see but not easy to actually be there. The Rwandese people are amazing in that they believe they need to forgive those who committed the crimes but not forget so as it never happens again.

By the time we made it back to Butare we were starving so we stopped at a local supermarket. Emmy worked his magic with the staff there and got us some hot samosas (meat) that were awesome. We often see the samosas at all the local stores but are leary to eat them as you never know how long they have been sitting around.

After another 2.5 hrs driving back to Kigali, we finally arrived back at the apartment. What a differene it makes to have a great driver. We were so relaxed and it felt like a different road completely. We did see a car run into a cow. No one seemed to be hurt except the cow. Anita and I were both upset worrying that the animal was in pain so were hoping that someone put it out if its misery quickly. An interesting part of this story is that the driver will be responsible to pay the farmer for the cost of the cow - the farmer is not considered to be at fault for letting the cow roam onto the road.

Today we are having a quiet day catching up on work. We had a wonderful lunch at the Bourban Cafe. Anita is currently helping Paulin with translating his thesis to english and Steve has been at the Serena hotel all day hanging out by the pool.

We can't believe that we leave in 4 days! We are looking forward to seeing you all!

Janice and Anita

It is Friday night and we are in our hotel in Butare listening to the rain and sitting in the dark (power is out again which seems to happen everytime it rains). We had a nice dinner at Hotel Ibis and it is relaxing to be sitting here listening to the rain.

We have had a busy few days with teaching and travelling to Butare. Our teaching went well on Wednesday. We had Steve take a part an anesthetic machine and showed them how it works. They were all amazed! They have been using the machines every day but really had no understanding of how they worked. Hopefully they will retain some of what we showed them.

Wednesday evening we drove to Butare. The usual driver had a "problem" and sent his brother to drive us. The car was in poor condition (not sure the brakes worked or the wheels had ever been aligned). It was one of the scariest drives of our lives. Bewteen the car istelf, the bad driving, the fact that it was dark and the hundreds of pedestrians on the unlit road, I'm surprised we made it alive. I was actually glad to be in the back seat so I couldn't witness it all. I did hear Anita gasp several times and then the driver apologizing. Needless to say, we have arranged alternative plans to return to Kigali.

The OR teaching has been all over the place. The residents in Butare have definitely been supervised more than at CHUK and it shows in their clinical skills. However, there were a few challenging cases and the lack of equipment and drugs definitely made Anita and I sweat but everyone survived. There is also one resident who is clearly struggling and working with him makes for a very trying day.

Last night we ate again at Hotel Ibis and ended up staying out for a few drinks to relax after a stressful day. We ended up socializing with a physician from Denmark and 3 guys from South Africa working on the cellular phone systems. It was a very entertaining evening. The restaurant /bar was hopping with people as there had been a big cycling race come into town that day.

Tomorrow, we are off to Nyungwe National Park to see the monkeys and chimpanzees. We have arranged for our driver from last weekend, Emmy, to pick us up and take us to the park and then back to Kigali. We trust him completely and know that he will drive safely plus be an excellent driver. I suspect tomorrow will be a long day but it should be fun.

It is funny how we are looking forward to getting back to our apartment in Kigali. It has become our home and we feel comfortable there. Hotel Credo is a good hotel but the apartment in Nyamirumbo is our home in Rwanda.

Anita and Janice

Above: Anita standing at the top of a hill in Nyamirambo (we ran up it on our first run and near died)

Above: Janice walking home from the hospital

We have a quiet couple of days, which is not a bad thing. Sunday afternoon we took a taxi to the Kigali Genocide Memorial. It was an excellent exhibit but very heartbreaking. It is so hard to believe that these wonderful people we have met lived through such an awful crisis. It is incredible to see how they have healed over the last 15 yrs and how much progress they have made. I suspect that many other countries, religions, ethnicities etc. could learn from their example.

Yesterday we had one of our best days of teaching in the OR. We were with one of the first year residents, Alfred, and got to do a whole case with him. The nurse anesthetist was great to let Alfred be in charge and he demonstrated some organizational/preparation skills that we have been trying to teach. Also, the general OR atmosphere seemed a little less hectic than usual so we actually got to do some intraop teaching - felt almost like home.

Today on the other hand was much less productive. Two of the residents worked with a team from Australia doing cardiac surgery, one was post call and the other was in the ICU so that left us no one teach. We had a nice day preparing talks for tomorrow and generally just relaxing. Anita had a little time to do some exam prep for herself so I think this helped to relieve some of the worries of missing all the exam prep that is happening back home.

Steve, Anita and I went out for another run. We all agreed that we must be getting more acclimatized to the altitude. Although the hills are still very challenging we do seem to be breathing a little easier. We are even starting to wonder if the locals are starting to get used to the white people running around in spandex as there seems to be a few less stares. We do get many shouts of encouragement and still a few kids running with us.

Tonight we will finish up our talks for tomorrow and prepare to go to Butare tomorrow night. We are looking forward to the chocolate crepes at Hotel Ibis and perhaps a swim in the pool at our hotel Credo.

Janice and Anita

On Friday, we left work early and drove to Volcanoes National Park with Emmanuel our driver. The drive was incredible over beautiful mountains looking down to the valleys on either side. There was a major downpour on route so it was slow going but we were very happy to be with Emmy as he is the safest driver we have seen to date while in Rwanda.

We arrived at Hotel Ihema around 4pm and had an interesting supper. Anita and I ordered chicken which we decided was clearly Rwandan and not North American as there was no meat to be found.
Above: View of some of the nountains of Volcanoes National Park

After an early morning breakfast of bread and eggs, Emmy picked us up at 6 am and we were off to the park. Emmy worked his magic with the park rangers (told them we were VIPS from Canada) and we were assigned to the Suza group which is the largest group of gorillas that are available for viewing (also, the toughest hike). It then took about 1.5 hrs to drive to the trail head on some of the worst roads I have ever seen. Unbelievably, the local people don’t seem to even notice the bumps and inclines as they ride bikes and carry hefty loads of potatoes. Everywhere we go, we feel like royalty as the little kids run to wave at the car going by.

Above: Anita, Steve, and I before climbing to the gorillas

The hike up to the gorillas was through incredible farmland and then up through a treacherous bamboo forest. We were quite happy to hear that the gorillas had moved down the mountain so our hike was shorter than it is sometimes. We spent an hour watching the gorillas and were amazed by the likeness to human behaviour. Definitely an experience of a lifetime!

Above: Happy at the end of the hike


Above: exicted kids after we gave them a soccer ball

On the drive back from the gorilla trek we stopped for a snack and washroom break. As luck has it, there was a local wedding happening. We thought we could just peek our heads in to see what was happening but ended up being invited in. They treated us like VIP guests. They found chairs for us and someone was always translating for us. At one point the father of the groom was making a speech telling everyone why his family was so worthy of having this bride welcomed in the family. He said that even foreigners had come to see the event. They made us stand up and wave to the crowd. Apparently, they wanted to bring us to the front but Emmy explained we wouldn’t be staying long (whew! Especially given that we were still in our muddy smelly hiking clothes) When the drinks came out, we were the first served after the head table. It was all a little embarrassing but an awesome experience in Rwandan culture and hospitality!

We arrived home exhausted last night after 2 amazing days discovering the country. Today we are working on some teaching for Wednesday and will go to the Kigali Genocide Memorial in the afternoon.

That’s all for now. Hope you enjoy the pictures!
Janice and Anita