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

Today we were in the ORs at CHUK (the public hospital). There was only one resident around so he got all our attention - lucky him :) The time in the OR is a little bit of a roller coaster ride in terms of our feeling like we make a difference. Sometimes we feel like we are starting to make an impact(getting the residents to do an airway checklist, perform a machine check etc) and then other time it feels as if they have heard nothing we have said for the past 2 weeks. There are also frustrations with the general organization of the ORs that I think we will never understand. Why do the put all the patients on the OR table at 7 am when no staff even enter the ORs until 7:45? I feel for the patients laying naked under a sheet on the oR table in an empty room. Wouldn't they be better off in the holding area with their familes? It is also frustrating when there is a lack of supplies, in partiular, opioids. It is hard seeing patients in pain when you know that if you had some morphine or fentanyl they would be comfortable. Sometimes I think the OR staff are oblivious to the pain the patients are in. However, I suspect that they cope with their lack of supplies but ignoring the situation. They try to do the best they can with what they have.

Tonight, Anita made her long promised curry (with bug free rice) and it was delicious. The power was out for the last few hours and there has been a very heavy downpour. We really felt like we were camping as we sat by candle light, listening to the rain and playing name games.

Not much else to say for now. We are off to Virunga National Park tomorrow and will hike to see the gorillas on Sat morning. Hopefully we will have many more pictures to post for you Sat night or Sunday.

Janice and Anita

Dinner at Heaven

Today was our academic day with the residents. After a hot and sweaty walk to work (all help hill) ,we settled in to a day of teaching. The residents are very keen to learn but it is often difficult to know if they are truly understanding with the language gap. Paulin (4th yr) is great to help with translation.

Tonight, Anita planned to cook a curry dish (she had been saying she will do this since we arrived :) ). After she had all the vegetables cut and ready to cook she put the rice in a pot. She quickly noticed multiple bugs floating in the rice. The rice was a brand new bag, completely sealed so we are not sure how the bugs got in. After much debate about the merits of protein in the bugs, it was decided to abandon the curry dish and go out for supper. We ended up eating at Heaven and it was wonderful. Tripadvisor has listed it as the best place to eat in Kigali. The food was very good, reasonably priced and the view was fantastic. The couple who runs the restaurant are from the US and moved to Rwanda 4 yrs ago. He teaches public health at Columbia but now just teaches students when they venture to Rwanda. He also mentioned that he is the executive chef. They have done a nice job with the restaurant ensuring that everything is from Rwanda. All the table, chairs, placemats etc are all made locally and all the food is local as well. Overall, a great impromptu night out! (plus I love that it is November and that I am eating outside and there is no snow!)

Janice and Anita

Steve Arrives

Hi everyone!

Just a quick update. Steve (our biomed technician) arrived yesterday morning. Anita went to the airport with Esperance to meet him and take him back to the apartment to get settled. When she returned, we walked into centre town and discovered a great little restaurant (Bourbon cafe) with very good food even by Western standards. Thanks for the tip Patty although we did feel like we were cheating on our Rwandan experience by eating there :)


On our walk home, we got bumped into a fair bit in a crowd and then I realized our phone was missing - stolen I suspect although I can't rule out it being lost. We have been so careful with our money and passports but never imagined the phone being stolen since it seems that everyone has one. Talking to locals at work they said it is very popular to steal phones for the minutes. Now we know. Anyway, bought a new phone last night and are in the process of loading in all the numbers we need.

Today we worked at King Faisal hospital. Steve seemed to be having alot of fun exploring all the different types of equipment. When we got home, we had the bright idea to go for a run even thought Rwanda is the country of a Thousand Hills. Our short run turned into 47 min of some of the biggest hills I have walked let alone run. Anita and Steve led the way while I dragged my butt up the hills. Luckily there are many things I can blame my fatigue on inluding the hills, the altitude, the recent flu, etc and continue denying that I'm out of shape:) Regardless of the difficulty, it was still a lot of fun to run through the neighbourhoods. All the little kids chased us, laughing - I think they thought we were crazy english people....they might be right :)

All for now as we have to work on our teaching for tomorrow.

Janice

Saturday morning we drove up to Akagera National Park to go on safari. Our driver, Youssef was very entertaining and informative on the ride up. Our guide for the first day was Francois, who was very good at finding animals, but had virtually no French or English. This led to many questions being directed to Youssef, who would sometimes translate, but more often attempt to answer from his own expertise. We began to notice a trend towards the end of the afternoon, as most questions about why the animal were acting in different ways (ie. Giraffe butting another, impalas chasing each other) led to the answer “Oh he is trying to make love to the girl”. Often the animals in question were both male or female. We think that we may have been misinformed along the way…. Our guide today, Emmanuel was truly excellent and found us hippos galore.

The animals were spectacular, especially the giraffes. Janice teased me since I didn’t even bring a camera to Rwanda, but stole hers and took about 30 giraffe pictures, I was so enamored with them. What a beautiful and graceful animal! Our guide found us a group of at least 15 together, and we were able to exit the jeep and get within about 20 metres of them. (Please note that for the buffalo, hippos, and crocodiles we stayed a safe distance and often never left the jeep). We also saw zebras, although mostly zebra behinds. They were very shy and ran away. We lost count of the types of antelope and birds we came across. We felt very fortunate to be witness to such a beautiful place.

We stayed at the lodge at the park, which had spectacular panoramic views of Ihema Lake and the surrounding countryside. It was wonderful to relax in the sun by the pool, especially after hearing from Patty that it was snowing in Halifax (sorry, small dig there…). They had made a valiant attempt at a Western style menu. Janice ordered a burger that was quite tasty, although a little overwhelming, weighing in at a full pound. I ordered the chicken sandwich: I’d been having a craving given our near vegan diet that we’d been following since arrival. I found it quite crunchy, but it improved once I removed the chicken knuckles inside. Mmmm… chicken knuckles…

On the drive back, we saw many banana plantations, as well as coffee and beans. We stopped for lunch at Jamba beach and got to see a bit more of the local culture. There was lots of dancing, and I must say, the Rwandans know how to shake it!
We’re back home in Kigali tonight, and it was great to walk in and feel like we’re home. We’re thinking of everyone back home, and Happy Birthday to Janice’s mom!

Anita and Janice

On the Mend

Above: View from inside the Butare hospital

We had a very relaxing day today. Janice and I have both been sick with fever and cough but are finally on the mend today!! On arrival to the ORs today, it turned out that on Fridays they normally do Neurosurgery and OMF on Fridays, but they had no surgeries to do. We decided to come back to Kigali early, and go to Akagera for a safari tomorrow instead of visiting the chimps of Nyungwe this weekend. We had a lovely drive back from Butare. The countryside is idyllic: green and lush with children and goats frolicking through. We’re constantly amazed at the size and weight of things that people are able to carry for miles on their heads. It’s quite a talent. Some irony too- we saw 2 different people carrying backpacks on their heads. I guess it’s easiest to do things the way you’re used to!

Anita and Janice

Above: Main street of Butare

Arrival to Butare

We arrived in Butare this morning after an incredibly beautiful drive through the country. I'm not sure a camera will capture it well but I will have to ask the driver to stop for pictures on one of our trips here. We checked into Credo hotel (very basic, buts seems clean, safe and has hot water!) and then went to the hospital.

Of the three hospitals, this one is probably the least well equipped although the residents get more teaching from the staff in the ORs. We had a scary moment when we put a young girl to sleep and the ventilator would not work. Luckily we found an alternative ambu bag but very disturbing for Anita and I as the equipment seemed so foreign (really piece of multiple machines put together) and we are not sure that there would have been a good outcome if we were not there.

Dinner was at Hotel IBIS. Our pizzas were OK but the chocolate crepes were awesome. The Belgians definitely had at least one good influence on the country.

We are both off to bed early as we having been feeling a little bit under the weather. I'm on the mend but it seems that Anita is just getting the worst of it. Hopefully she will get better as fast as I have so that we continue with our plan to hike to the monkeys and chimpanzees on Saturday.

Janice and Anita

The Day of the Safe

View from King Faisal

We have had an interesting two days. Yesterday we spent the day in the OR at King Faisal hospital - the private hospital. It is quite modern and is much better equipped than CHUK. There also seems to be some organization to how the ORs function so it makes for a much better teaching and learning environment.

Last night we went to the airport to collect Anita's bag that had been delayed. It arrived as expected so all was well. Driving here at night is an interesting experience. There are hundreds of people walking with or without sidewalks and no streetlights. I am amazed that we haven't killed anyone yet. We are not sure when people sleep. No matter what time of morning or night, there always seems to be a lot of people hanging out outside.

When we returned from the airport we noticed that our safe was not functioning. All of our extra money, passports, and computers were in the safe. We tried all of the troubleshooting ideas that previous volunteers had suggested but with no luck. Needless to say, we were a little stressed at not being able to access our valuables. This morning we had the public relations person, Esperance, take us to the store where the safe was bought. We picked up our chinese technician and went back to the apartment. I'm sure we were an interesting sight - 2 white girls, one chinese guy and a local. After an hour of looking at the safe and several calls to China (incl the manufacturer) we were told the safe was not fixable. So this afternoon while Anita was teaching I travelled back to the apartment with a hospital driver and maintenance technician (neither of whom spoke english and very little french) with equipment to cut open the safe. Just as we were to start cutting the safe, I looked at the keypad and saw that it was working again. Obviously I was very excited about this but not sure what my guests thought since they had taken time to help us and we didn't need them.

Despite all the stresses over the safe, teaching went well today. The residents seemed keen to learn and participated actively in the discussions.

Tomorrow morning (really early at 6am), we are off to Butare. We will stay an extra night or two, to hike and see the monkeys/chimpanzees in Nyungwe park.

Janice and Anita

Rwandan time

Above is the view from our apartment balcony.

Sorry for the lack of updates but we were having troubles with our internet. After many hours of trying to sort it out, we have learned a lot, not the least of which is Rwandan time - no one seems in a hurry. Our internet actually comes from a USB drive that has a sim card connected to the mobile and now that we know how to add more minutes to the card we are golden (it did cost us a $30 cab ride to get it all sorted out).

Yesterday was spent trying to get set up. Fred, one of the first year residents, met us and took us into town to Simba (local supermarket). We took a common taxi to get there and it was quite an adventure - didn't know so many people could fit into one little minivan. We spent the evening relaxing and working on presentations. We couldn't get the stove working so lived on peanut butter and bread for the day. If this keeps up, I could come home a lot skinnier :) We also spent an hour doing our P90X workout. We had to close the drapes as we suspect the neighbours would think we were crazy.

Today was our first day at CHUK, the public hospital. We met all of the important people and then spent the morning in the OR with Fred. Poor Fred - Anita and I had lots of advice for him and he may never want to see us again. The cases were challenging ENT airway cases but so far everyone survived. The good news is that they now have 4 new Datex- ohmeda anesthetic machines with all the best monitors (pulse oximeters, end tidal CO2 etc) so we felt at home. Not sure it made up for the fact that we didn't know any of the drugs and that there was no succnylcholine.

Lunch was at the local buffet restaurant called Karibu. The food is a little bland but will keep us satisfied. (still thinking this may be a good weight loss experiment). We walked into the center of town and spent hours sorting out the gorilla permits but are ready to go on Nov 14th. This was followed by more shopping - Anita and I are single handedly supporting the Rwandan economy.

Above - Anita cooking supper. The light is dim so we use our camping lights

The guys came to fix the stove and Anita cooked an excellent vegetarian pasta - the first flavorful meal we have had.

Overall things are good here. The people are very friendly and we feel safe. It is fun exploring a new culture!

Janice and Anita

PS. uploading photos is very slow but we will keep trying

We've arrived!!!

We're alive and well in Kigali! We smell fantastic, and we're one bag short, but other than that it was perfectly smooth. Fred (one of the 1st year residents) met us at the airport and was a very gracious host. We're pretty jetlagged, so we're off to bed now. More in the AM! Miss you all!
Janice + Anita

October 21, 2009

Hi everyone! This is my first ever blogging experience so thought I would try it out before leaving Halifax. It is hard to believe that Anita and I will be in Kigali in less than 2 weeks. We are both frantically trying to get organized for the month and are very much looking forward to the experience. We will try hard to keep you uptodate on how things are going.

Janice