Bracelets for Babies Fundraiser

My latest fundraiser....

Handbeaded Tanzanian bracelets in groups of 5......

Main colors of white, black, blue, red, yellow, green or mixed-- all with colorful accents. 100% of the profits go toward educating nurses and midwives in Rwanda.
$5 plus $1 to ship in the US.

Contact me for more information! greysmama@yahoo.com

NPR Report from Joseph's Wedding

Anna submitted this piece about Jospeh's wedding to NPR!
Pre-Wedding Battle Of WitsIn Rwanda : NPR
http://www.npr.org/templates/story/story.php?storyId=93522572&sc=emaf

videos from joseph's wedding

Weekend

Weekends were made for networking
Saturday was community work day as I described before. Everyone who does not have to be at a regular job shows up to clean up their neighborhoods. Given that, we were not able to rush out and go to the Kimirongo market that we were looking forward to visiting. We had a few moments of forced relaxation and it felt wonderful. We caught up on other teams progress, checked emails and spent longer over our cups of tea. After lunch at La Planete we were off to the market which opens at 1 on community work days. We decided to take the bus for 150 rwandan francs or approx 30 cents US. We were fortunate when a coaster came our way- this is basically a small to medium sized bus--- perhaps something that may have previously been used as a tour bus, anyway they are much larger than the standard bus which is about the size of a van. The coasters also have the added benefit of a blasting stereo system- we have heard everything - usually its loud reggae but people have heard country music and Patsy Cline. Yesterday we had blasting African music- anyway, we don't really fit in so we get a lot of stares on public transport. We got off at the market which is HUGE- The first part of the market is the stalls of clothing-- new stuff in the front and used towards the back, fabric sellers are mixed in with sheafs of fabric arranged up to about 9 feet into the air as well as people selling toys, cell phones and costume jewelery. The back part of the market is the grocery area where people are selling flour off of huge piles, eggs, vegetables and fruits. On the side is a butcher's area with small shops with hanging sides of beef (flies anyone?), goats meat and chickens. I must rethink this plan of being a carnivore. Outside of one of the butcher shops I saw the only cat I have seen in Rwanda, an orange and brown tabby, crouched outside the butcher. The unfortunate thing is that no one is allowed to take photos in the market--- not really sure why-- but the photo ops were everywhere. The market is very crowded but not many Mzungus make it there so it was sort of like the parting of the red sea as we made our way around. We bought fabric, a couple of premade gauzy dresses and some of the flaming hot pili pili sauce.
Saturday night was a dinner in honor of our HDI sponsers. We also hosted the the Head of USAID, the Dean of the Medical School in Butare and the Heads of King Faisal and Kibagabaga Hospital. Interesting people to talk to and find out more about the Rwandan system. The HDI folks gave us certificates acknoweldging our service to Rwanda and it was very touching.
After the dinner wound up we went off to Skyy a club in downtown Kigali. They had a dance troup from Uganda that preformed lip synching to different music. At times they pull ramdom people form the audience to get up and dance with them. Christopher was first-- he had been there the night before and also danced. I was second- and was pulled up by a traditional tribal dancer- what pressure! We had just arrived at the club and I was NOT prepared--- also, I think I could have done much better with a pop or rap song--- but oh well- I think the locals got a good laugh- I'm fine with it. We ordered a drink wiht vodka and they brought me like a 6 or 8 ounce bottle to fix into my fanta. It was called Uganda Wagrazi or something. I guess we missed the real fun when group went on to Cadillac for more dancing.
Sunday morning we woke up and relaxed around the hotel until it was time to go to lunch with Alice Cannon (the Nurse-manager for the NICU) and her husband Nick Cannon the british diplomat. Again we went to Sole Luna for more pizza- it was great conversation though as we compared notes about the medical system in general and the private vs public sectors. She needs many supplies and we will try to help her. After lunch I wandered behind the market and bought an oil painting for 2 women collecting fruit- one of them is pregnant- it's a really nice orignial oil.
After lunch we headed downtown for a little shoppping- most of the stores were closed but we found one market open to take our monies. Phil, Barb, Christopher and I headed to Chez Lando for a mutzig and then walked down to SoleLuna for ice cream- best dinner so far!

Hypertension

Hypertensive Crisis
Because Kibagabaga is the referral hospital they get all the tough cases that are able to make the trip from district hospitals. The health centers in the villages can be as far as 25k from the district hospital. There are 10-12 health centers that refer to the district hospitals and there is usually only 1 ambulance per district hospital.The district hospitals refer there toughest cases to the referral hospital such as kibagabaga. Anyway, the barriers to get to the referral hospital are many.
We were working working one afternoon when a woman arrived with high blood pressure. Nothing moves quickly in Africa and this situation was no different. After the patient had been there for 15 minutes or so I went over to check her BP (not knowing that she was here for hypertension) and the reading was 230/120-zowie. So I informed the nurse Ildephonse and he got Dr Monique. She wanted to start some nifedipine so she had to send the patient's family out to go buy it. The first pharmacy they went to did not have it so they returned. Again they were sent out to another pharmacy. The hours tick by. Finally the decision was made to start some Magnesium Sulfate as we had it available. She was given a bolus by drip and then an hourly maintainence dose. Magnesium has the side effect of respiratory depression and/or respiratory or cardiac arrest if one receives too much medication. There is a protocol for measuring blood levels of magnesium in the US- but no labs are done here. One we got her stabilized we decided to proceed with a cesarean. We are ready to move on to the surgery but there were no clean linens- they need to be ironed and sterilized- So we wait. Finally she was given a general anesthetic because of the hypertension and we were ready to proceed.
Because the general anesthetic crosses the placenta it is known that you need to hurry to get the baby out so that the exposure doesn't cause the baby to have difficulty transitioning to extrauterine life. Anyway, thankfully we had the forethought to have Leanne to come into the OR to care for the baby after delivery. Anticipation is not the strong suit in Africa it turns out. Finally the surgery begins and the mother begins struggling against us and trying to yell around the endotracheal tube. We stop to try to get her more asleep and then proceed. Again, she begins to struggle. We can't enter the peritoneum or she will expell her bowel from the pressure she is exerting. Now on a good day the OR is about 90 degrees- we wear fishing waders, our scrubs, a heavy rubber butcher's apron, then the sterile gown and 2 pairs of gloves. Add a little stress and concern onto that. Anesthesia is afraid of giving her too much drugs, "She'll sleep for 2 days!" says the nurse anesthetist. "It may be the best 2 days of her life" I am thinking.
After 2 or 3 stops and goes we are able to proceed and deliver a baby with no respiratory effort, no tone and a weak heartbeat- too much exposure to general, especially for such a little human being. Thank god for Leanne- she began resuscitation immediately complete with CPR and the baby recovered. We take so much for granted in the US: good medical care (despite the issues we have, no one is going to have to go out and buy their own meds while they are in hospital), a healthy baby, a caring nursing system, etc. The end of this story is a good outcome- thank goodness- mom and baby did well.

Routine Day

Borrowed from tht Ujama1 blog
http://www.ujama1.blogspot.com/

Work days have settled into a routine. The doctors and nurses 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.

Photo Gallery

I think I have taken 600+ photos so far--- here are a very few... Wedding cows
Peering over the fence to watch the wedding festivities
Woman at the wedding

Children along the road

She wanted me to photograph her leg

At the prenatal clinic

Crazy Mzungu with upside-down basket. The policeman even smiled at me!

Painted on the side of the school

The Road, Work and the Village People

Outside the hotel they are building a new road. Small rocks are placed by hand- we watched as the small rocks slowly developed into a beautiful circling pattern. Then the sand is poured over the rocks and brushed away by an old woman crouched over with a small homemade hand brush. Next the bulldozer comes in and packs everything together. The process is then repeated as many times as needed to reach the proper level above the sewer. During the week that we have been here the sounds of pounding rocks have drifted through the hotel gardens reminding us of the travails of everyday life here. This morning (Saturday) at 6 am a new load of rocks was delivered- there is no weekend here. Saturday morning is a time of community work. If you do not have a job you are expected to do community volunteer work.
One subset of our team who we are calling the "village people", is working with the Twa (pygmy) population making health insurance cards for 114, delivering shoes and clothes, weighing, measuring, deworming and providing Vitamin A to the people of Bwiza. The villagers walk to the water sources 2-3 times a day carrying 2 gallon jugs. The sources are between 1/4 of a mile to 2 miles away up and down a very steep hill. The engineering team has done a site assessment for water supply delivery. Their hope is to have a system up and running by July.
Hard to sleep in when you know all of this is happening.

New Friends

Mutzig For 2

We had a meeting this morning at with the Obstertician and midwife from King Faisal. We decided to brave the motos again and it was a different ride from last night. More traffic than last night and all of us in skirts. Very fun though in the morning air.
At King Faisal we were greeted warmly and it was clear that they were expecting us. Sharp contrast to Kibagabaga as this is the private pay hospital. We toured the birthing center and the NICU. The woman in charge of the NICU staff, I believe she is a Pediactric Nurse Practitioner, (From Cambridge University), is the wife of the British Ambassador and she is quite dismayed with the conditions at Faisal. We told her that is she wanted to feel better about her job that she should go to Kibagabaga and have a look around. Beryl told us all about the different staff members and the certifications that they held- Lactation, Advanced Life Support Obstetrics, etc. They have reached an amazing level of success especially considering that the exams all have to be taken in English. They are currently working on getting certified as a "Baby Friendly" hospital. Primarily this has to do with the promotion of breastfeeding and bonding. It will be the only hospital in Rwanda to meet these standards.
We had a great discussion with Alice Cannon, Dr Javier and Midwife Beryl about the needs of the hospital and the medical community in general in Kigali. It seems to be such a dichotomy of the old traditions that work mixed in with 50s and 60s "modern" information. I am very much looking forward to corresponding with these folks to try to figure this whole system out and how we can be most helpful in the future. They too have trouble getting the supplies that they need.
After Faisal we went back out to shop. We have been looking for traditional cloth or pagnes and we finally hit the jackpot. We asked a taxi driver downtown where to buy the traditional fabrics and got directions to a bunch of stores-- they were down a long hallway and each stand was packed with cloth. Overwhelming but so beautiful. I was able to speak french and bargain a little bit with the vendors. We each picked out several fabrics. The bargaining is getting old.
This afternoon it was back on the motos to Kibagabaga to distribute the educational info that we had collected as well as to give out more of our supplies. I got teary-eyed when I saw that the metal cart that the babies had previously been set upon after birth was gone. In it's place was a warmer which was turned on and warm in anticipation of a baby! So wonderful to see the concrete signs of change. The staff gave us big hugs and thanked us profusely. The moto ride was a bit different in rush hour and along the winding road that dips far into the valley. I had to close my eyes at certain points.
A group of us went out for spicy ethiopian food cooled by mutzig then walked home through the crazy city streets.

Priviledge and Prejudice

Outside the Gates of King Faisal Hospital

A study in contrasts. Africa does not always know what to do with us. Yesterday an older man with one half of a hand missing - (machete?) was put off of a bus by the police to make room for me. There is graciousness everywhere you turn and then suddenly you feel uncomfortable. At times you know you are being made fun of- (Hey, we're here to help!). We asked our good friend Eddie tonight what he thought of us in general and he said, "You know, you can tell from the start when you meeet someone that you will be able to be with them or not, I can be with you". Some things are universal; fear of the unknown, insecurity, hope, need for acceptance, doctor's stealing nurse's pens, women trying to balance work and home life, certain ringtones. Pay attention.

Slower days

Today was slow. We started at HDI where I printed some of the articles that I chose for Monique. I will never complain about my computer being slow again! When we arrived at the hospital it was a new crew working mostly- a few of the same folks.
There were no women in labor. We hung around a while. I met the nursing supervisor Patrick and talked to him about the issues he thought were the most important for the hospital. He felt that they needed help with education, supplies and aseptic technique.
We went over to King Faycal hospital and met the head of the department Dr Javier and FINALLY midwife Beryl who is from New Zealand. I have a meeting with her tomorrow morning which will be wonderful as far as future planning.
In the afternoon we took a short nap and then went to Caplika market- looks like a good spot but not much time. Chez Robert buffet for dinner and then we followed the sound of the drumming at the Mille Colline- another wedding or something. Stood by the pool and watched the dancers and drummers. Caught the moto back- absolutely exhilerating- wish we would have done it earlier! The other folks were waiting for us - we should have called them to tell them we were going to go to the Mille Colline! Drifted up the street for ice cream. Another great day.

Teaching Day

Teaching session on labor dystocia

Waiting at Kibagabaga

Finally today we had a teaching session with the staff of Maternite at Kibagabaga. We came to the hospital and the maternity ward was quiet for once. We spent some time visiting with the nurses and staff. We handed out the rest of the printed surgical hats that Leann brought- the staff is so tickled by them. We'll need to make more for next time. We donate the american scrubs that we wear every day and the ratio of Rwandan scrubs to US scrubs is declining rapidly. We also noticed that the paper gowns that we had used the day before were hanging about for re-use. They use everything here again and again- they have nothing. In surgery Dr Monique is a miracle worker with the suture- she does more with each little stitch than I could dream of doing. Anyway, we spent quite abit of time visiting with the staff and getting to know them as best we can with the language barriers. Most speak 2 languages but the options include English, French or Kenyarwandan. I have been identified as one of the french speakers which is indredible since I was so awful at it when I studied it previously. Anyway, when we realized that the time was right for some teaching we got out the ALSO (advanced life support obstetrics) slides and did a teaching on management of labor dystocias. We made several suggestions that are very basic (drinking water or soda in labor rather than black tea to decrease dehydration) and discussed pearls of labor management and identification of problems. When we were finished Dr Monique told me how thankful she was and I said that we in turn were very happy to be here and working together--- then she said, "you cannot be happier than we are". I felt like this was so productive. We decided to head home and get some rest as certainly we will be very busy tomorrow.

I ended up visiting another market this afternoon (really!) with some of the other team members. I ended up finding the cloth that I had been searching for this whole time and did not know it existed. It shows a mother with a child on her back with her midwife. I was so thrilled and I asked the shop keeper, "quest q'ce?" (what is this) and she said immediatley "sage-femme" (midwife). I paid way too much (mzungu price) but didn't care, it was just incredible to stumble across.

Tonight I am working on finding some other files on the internet for Dr Monique. I decided to just order a cheese and tomato baguette and of course it is fabulous. So much of the food is so simple, but so natural and fresh.

Looking forward to tomorrow~

June 24, 2008

This morning we arose and got ready to come to the hospital.
When we were in the taxi the driver asked us what we were doing in Rwanda and then he said, "Oh, you are the ones that have given the money and supplies". Nice to know the word has gotten out. He also couldn't believe our ages, not can the nurses in the hospital--- they say that when a woman here is 40 she is old--- one of the nurses acted out hobbling along with a cane. We had to show them our passports so they would believe us!
We decided to get into the area that the supplies were stored in to get better gloves, lidocaine and shoe covers. It took a while for the key to be located and during that time we sat with the mothers nursing babies and waiting for clinic appointments. I think I understood that Tuesday is a family clinic with HIV testing and general health screening. Again we are in awe of the beautiful outfits and the traditional colorful cloths that the women wrap around themselves to signify status as a mother.
After we were able to get our supplies we went to maternite and met with some of the nurses from yesterday, some new nurses and Dr Monique. The unit was quiet except for a cesarean ready to do. Pam and I did the surgery so Dr Monique could observe us. All went well. We had a few more women circling the labor area--- they walk through the entire labor and when they are 9 or 10 centimeters they are allowed to lay down and prepare for birth. I had a delivery with Leann and started to do the repair- I showed the nurses how we soak the gauze in lidocaine and let it sit on the wound before we begin to sew and they thought that was great. I had another birth and then we admitted a woman with hypertension-- BP 220/130. The pharmacy is very short of the drugs that they wanted to treat hypertension so they tried to get a family member to go into town to try to find some medication to purchase. Meanwhile we started a medication that was not the one we wanted but since that was all we had...... The patient needed to be stablized before we could do a cesarean, and besides, the laundry for the procedure wasn't ready yet. The time goes by. Finally the decision was made to proceed and the patient was given a general anesthetic. Nothing moves quickly here-- calling neonatology is an afterthought, there is very little anticipation.
As we finished the cesarean Monique and I had a chance to visit and discuss the difference is the way that she grew up, was married, studied, etc. She is from Kenya and is here with her husband who is an architect. When I told her that we were near to Seattle she asked, "Do you know Grey's Anatomy?". Apparently she is a huge fan. I will be interested to see how everyone (mom and babe) is doing tomorrow. The nurses love the colorful surgical hats that Leann brought and anything that we can give them is a plus. They were even going to try to wash the paper gowns that we wear.

Front Page News - Rwanda Daily News

BY EDWIN MUSONI
KIGALI - A team of American medical experts are in the country on a two-week mission aimed at providing free training to Rwandan doctors and extending treatment to vulnerable people. The 19-member team is from Spokane, Washington, and is composed of physicians and ancillary healthcare providers.
The healthcare professionals were invited by Health Development Initiative Rwanda (HDI), a local NGO that promotes community-based healthcare development to build sustainable alliances between community and professional healthcare providers, as well as to train local practitioners in reproductive health and family planning.
The delegation, which arrived in the country last week, is currently based at Kibagabaga Hospital where it is carrying out surgeries and assisting in complicated deliveries. According to Dr. Pam Silverfein, the team leader, they arrived with medical equipment worth Frw33 million.
“All the equipment we brought is to be used for treatment and training of doctors and nurses here; they include some state-of-the-art machines that we have donated to the hospital,” said Silverfein.
“It is greatly uplifting to be working here in Rwanda,” she said, adding that her team would continue helping Rwandans even after the end of their mission.
The Director of Kibagabaga Hospital, Dr. Diane Gashumba, hailed HDI for coordinating the team. She said the experts will conduct training sessions for the hospital staff and assist in the daily business of the hospital.
Meanwhile, a member of the team, Dr Goldberg Addrienne from Deaconess Hospital, said that the donation was collected from Washington DC and that the team has plans to increase its medical aid to Rwanda.
“We are planning to launch our campaign in all US states to raise funds for more aid in medical equipment,” Adrienne said.
The Managing Director of HDI, Aphrodis Kagaba, said the team would carry out surgical operations during their two-week stay in Rwanda.
He added that they have a programme of bringing more medical volunteers who will operate outside Kigali City handling complicated cases.
In a related development, the president of Health Leadership International (HLI) and the founder of Coffee Rwanda Company, Dr. Karl Weyreauch, said that Rwandan doctors will gain from post-training experience from the Americans.

Twins! With Nurse Candide
Nurses Candide and Ildephonce

Ahhhh, Finally....
Today we arose early and had breakfast. The breakfast here is such a happy way to start the day. I am getting addicted to the tea, papaya and bread.
We left for the hospital to unload supplies and ended up stumbling onto the Clinic Prenatal. Every monday there is a prenatal clinic. Women generally have 3 prenatal visits- 1 per trimester. The fourth visit is the delivery. On the initial visit they identify the due date and do testing for HIV. There is no pelvic exam. The women will return to the clinic the same afternoon to get the results of the HIV test and counseling about diet, avoiding malaria, etc. They are given "Mamanets" to sleep under and iron tablets.
We have so many supplies to go through- we figured out that we have at least $65,000 worth of supplies.I gave the my beanie babies to Dr Aflotis who is going to take them to the children's play room at King Faisal hospital. After we unloaded supplies we were met by Dr Bernard for our formal intrroductions to the unit staff. We were met happily by the nurse Ildephonse who decided that he would take us under his wing. He spoke a little english and I spoke a little french so we stumbled though the day together. We also worked closely with nurse Rose and nurse Candide. Dr Mark was there again as well as a doctor who speaks english, Dr Christian. Everyone here has a very relaxed attitude. My first delivery nearly fell out onto the bed as I was trying to get anyone's attention, "L'enfant..... C'est Ici!!!!!". After that there was another delivery that I helped Leanne with. This is where it gets interesting. We were finishing the 2nd delivery and a woman was admitted. She was laying on her side and rolled slowly over to her back showing us a HUGE belly. I asked Ildephonse, "Un bebe ou deux????". Two babies- no problem (everything is no problem). Between the first and second babies birth we were scurrying around trying to figure out the position of the baby when a butterfly flew into my face then continued on around the delivery room. The second baby was delivered with much difficulty but did well after resuscitation. I love seeing how they wrap up the babies after delivery and fashion diapers out of long strips of cloth. They then dress them in very warm outfits- usually decorated sweat suits, hats and bunting bags. The baby is returned to the mother and they move over to the postpartum area. As I write this I realized that I never saw anyone take vital signs on an infant-- no problem. I noticed also that even the high-up physicians many times don't even own thier own stethescope- we are giving them everything we have and leaving anything extra we have brought for our personal use.
I am realizing that the idea of formal meetings is not really a reality in this culture. One on one discussions and working together and trading tips seems to be the way to go. The staff is so crafy with thier supplies and it really is incredible that they can do so much with so little.
Tomorrow we'll return for more, I think the same crew is working so we'll all be acquainted. Overall, a great day!

Mum, where do I run?

This morning we had arranged a tour of 3 of the genocide memorials. We met and got into taxis and drove to the Kigali Memorial. It is a beautiful garden setting with a museum type buiding housing diplays about the history of Rwanda, the build up to the genocide, the genocide in Rwanda and information about genocide all over the world. In the gardens are mass graves covered in concrete where there are over 250,000 people buried. Sobering. At the end of the display was a special section honoring the children lost- it had many photos and a few children highlighted with names, ages and other information about them like thier favorite foods, best friends, favorite activities. Awful. Many tears. We then visited 2 of the churches where people were hidden. Some of the team members ended up playing soccer with a group of boys from one of the small villages. I didn't even realize that it was a soccer ball it was so old and faded- I thought it was a large piece of fruit. No one throws anything away here- they have nothing. The children ask you for a pen - they have nothing to do lessons with. A group of children got really intersted in my braces and all I could say was, "J'ai mal a les dents"- I have a toothache. Everyone has fallen in love with the children.
We had dinner at the Hotel des Mille Collines. We sat at the pool area where people were swimming and playing-- hard to believe that is was truly hotel Rwanda. Dinner was upstairs in the panorama restaurant--- wonderful views of the town below, all the lights.
An exhausting day.

So we have not done much in the way of medical work this weekend save a few planning meetings. One of the physicians that is part of the group that brought us here was married today so we had the incredible experience of attending his wedding today.
This morning we had breakfast and went to the dress shop for tailoring of the garmets we had made to wear to the wedding. We had decided earlier to go to the downtown area and look into some shops. We took the bus into the downtown area-- more like a van crammed with people, but very inexpensive - 150f which is a little less that 30 cents US. We visited some shops and were basically accosted by the vendors in the street who had similar wares at cheaper prices, but not as much selection - we ended up buying stuff all over the place. Prices were varied-- some really good and some similair to what you would pay in the US. We were trying to go to an artist's cooperative, but we weren't in the right place it turns out. We bought a few souvenirs and really enjoyed the experience.
After everyone was dressed and ready to go to the wedding we all piled onto the bus and headed to a stop about 5 blocks away-- we were caravaning with the rest of the wedding party from the groom's side. When we reached the entryway of where the ceremony was to be held - a dirt road to travel down, we again got off the bus and waited-- we had to let the wise man, or the matchmaker, go in before us. We finally made the long trip down a bumpy dirt road with the local people coming up from thier houses below to watch us. We then arrived at the wedding site- very well set up with covered chairs, brides and groom's sides across from each other and an open area in the front. The first part of the wedding was the fathers negotiating a bride price and trading jokes- the brides's family made a joke about all the mizungas (white people) on the groom's side. They negotiated and traded fantas and cokes (the bride's family does not drink so there was no alcohol where it normally would have been used). The grooms family paid 2 cow and they actually brought the cows out to be displayed and given amoungst the other presents. Then when it was finalized thery brought out the bride using dancers and music, they drank champagne and sat for entertainment of tribal dancers with bells and drums and spears. There was one young boy of about 3 who kept trying to get out and dance with the rest and he was just adorable, it really made me miss my boys. The music starts slower and less intense and then it builds as the dancers change outfits and wigs and spears, it all builds to a big creshendo. Unbelievable.
Afterward we got back onto the bus and went to Dr Joseph's house for the traditional review of the days events- people stood up and explained things that should have been done differently or better- the matchmaker and Joseph's father apologized that we couldn't understand a lot becuase of the language. They also said how honored they were with the person Joseph had become, how nice Betty the bride is, etc. The bride was with her family for the evening as it is customary. We finally departed for Chez John for dinner where they had everything arranged for us- we had pizzas and brouchette of fish, beef and goat. Exhausting day but exhilerating and the chance of a lifetime. Again, the wheels are turning a little slowly for me and we are so anxious to get to the hospital to begin helping or working or whatever. The plans are needing to be flexible- it doesn't really appear that they are totally certain what to do with us which is frustrating. I am looking forward to getting going on the medical work in earnest on monday morning.

View from our hotel

Mothers and babies waiting outside the lab

June 20
This morning I enjoyed a hot bath and it was wonderful. Breakfast was the same - lovely. Le and Miranda and I went to the dress shop and picked out fabric for a dress to be made for the wedding tomorrow. Apparently being "Muzunga" or white people, we paid about twice the normal price.

We then went back to the hotel and prepared to take the supply trunks and donations to the hospital. The local media was there when we arrived at Kibagabaga with TV cameras. I felt so anxious to get going and we finally were given the go-ahead to go to the maternity area.

Le, Miranda, Pam and I went to the labor ward and introduced ourselves. There are 3 labor beds and they move people in and out when new women arrive.
People seem very concious about infection risk, but the gloves pretty much shred when you put then on. We quickly dove into work and got some of our gloves from the supply that we brought. The way it works is that basically the women labor in the hall and then they pretty much decide amoungst themselves who needs to go into the delivery area. They come in and the blood pressure is taken, fetal heart tones auscultated and the cervix examined. They have 3 beds with curtains between them but the curtains are open and shut ad lib. There is no privacy. The beds are not cleaned between patients, but a large green drape is changed. They have an anti HIV drug that they give to all the new babies.

The women overall are very stoic and they know what to expect. They get up onto the labor tables and immediately start untying all the beautiful wraps to be examined. Some women arrive with notes from the outlying clinics, and some are just women from the city. The main doctor, Monique, is Kenyan and very soft spoken, her english is excellent. I scrubbed a cesarean with her and she had many questions about how we did things in the US. When I scrubbed there was a man that poured water over my soapy hands to rinse because the water tap was not working. The surgery tray had about 1/3 of the amount of insturments on them. We have become very concious about waste- Monique used every inch of suture. She had many questions about how things were in the US- and she couldn't believe the epidural rates, of course. She did comment that she wanted to have her babies in the US so she could have an epidural. We were invited back to work with Dr Mark and Dr Monique on Sunday.

After our work in the labor area, we had the first encounter with the hospital public toilet--- there are a couple at the hospital that are multi-purpose. They have showers and the women wash clothes for thier families. The management of cases is different here and some people are getting frustrated. The culture is much slower and very indirect, so no one really says straight out what they think or need. Its hard to know how to help without forcing your way in and to respect the way things are done here.

Tomorrow is the wedding of Dr Joseph and some of us are hoping to go downtown in the morning to do a little shopping. The restaurants we are eating at are wonderful, but not as inexpensive as we thought they would be- prices here seem to be fluid depending on who you are.

I am happy that today was a more hands-on day and I am eager to get back at it!

June 19

Patients at Kibagabaga

Team members with Diane, Hospital Administrator and Pediatrician

Today we woke and had breakfast together in the dining room- beautiful fruit- papaya, banana, avocado and crusty french bread with raw honey and jam. The tea is wonderful also.
We gathered in the garden for a team orientation and to ask questions-- so many things to think about- local customs, tipping, travel around the city, hospital questions, etc. We broke into our specialty teams for strategy development and a plan of action. Karl is going to try to get us some press coverage through the local media.
The medical system here is quite different. If you have a nurse in a building somewhere you have a "clinic". They nurses use their judgement to diagnose and treat things like pneumonia, malaria, etc. If you have a physician in house it is a "hospital" and each region has a hospital of varying capability. There is one physician for every 48,000 people in Rwanda. There are perhaps 15 surgeons in total in the country and they rest of the time people just learn as they go. Kibagabaga hospital has one midwife and between 6 and 15 births per day.
So, we finally got to the hospital. Its hard to describe it exactly. The hospital is 2 years old- a beautiful building with courtyard in the middle. It was built by the Belgian government as one team member said "out of guilt". Anyway, the surroundings are very open- all the doors hang open to the outside. Medications sit here and there, supplies are very limited. The patients always have family members with them to help them out - no call buttons here! The result is that there are many people everywhere- sleeping, preparing food, etc, but at least no one is left alone.
The neonatal unit is probably the most advanced- 5 incubators in one room with the mothers on fold out chairs sitting next to them. There is no ventilator. They had a newly born 28 week baby awaiting transfer to King Faisal hospital- no nurses hovering, no monitors alarming, etc.
It feels a little intrusive to tour the hospital and not to be helping, but that will all change tomorrow when I am put to work. I really enjoyed visiting with the families and children running about, the children love to be photographed and to see themselves on the screen. I took some video to show them and it was clear they had never seen that technology. So, of course this is where the homesickness reached the maximum. One of the women wanted me to use her cell phone to call home because she could see I was sad, but I knew everyone would be sleeping. Cell phone minutes are expensive here, so it was a touching gesture.
I don't know if I have ever been so exhausted, but this work is important and I am really looking forward to getting busy tomorrow.

*** the photos are taking forever to upload so there may only be a few, wish I could post more. Also we are struggling with cell phone issues so it is really hard to be out of touch.

In Rwanda

Landing in Nairobi
Kigali bag claim---- ALL the bags arrived!

We are here! Finally!

The flights went off without a hitch - Kenya airlines was amazing- new huge jetliners, on time, all the amenities. With the time difference it was almost exactly 48 hours of travel time.

We were met at the airport by Karl (the seattle family practice doc) and 3 of the doctors from the hospital. The world is so huge and so small at the same time--- I spotted a young man across the airport wearning an Iowa Hawkeyes shirt- probably donated clothing but unbelievable nonetheless!

The hotel is gorgeous - little rooms and villas in a garden setting- amazing flowers and (very loud) birds. The rooms are clean and bright. The Rwandans take a lot of pride in offering good service- I haven't lifted any bag since I arrived. The people seem friendly and warm overall, the genocide seems inconceivable. Most people speak French, Kenyarwandan and some also speak english. My french is coming back - slowly.

They arranged a dinner for us last night at La Planete- a traditional Rwandan buffet. We met some of the other physicians and workers from HDI. Working along with Karl they have made so many plans for us and are quite organized. It was great to be welcomed in that way.

We were all exhausted so we were glad to get to bed early. We were woken early by the birds-- they're so loud. The sun rises at 6 and sets quickly at 6- were are just about exactly on the equator.

i've learned so much and thought so deeply over the past 3 days.... i didn't anticipate that aspect of it nearly to the degree that i am experiencing it.

You CAN get there from here

Flight information and mileage~
Spokane to Seattle - 231 miles
Seattle to Newark - 2888 miles
Newark to London - 3548 miles
London to Nairobi - 4246
Nairobi to Kigali miles - 468 miles

Grand Total - 11,381 Miles!

About Rwanda

Republic of Rwanda
National name: Repubulika y'u Rwanda
President: Paul Kagame (2000)
Prime Minister: Bernard Makuza (2000)
Current government officials
Land area: 9,633 sq mi (24,949 sq km); total area: 10,169 sq mi (26,338 sq km)
Population (2007 est.): 9,907,509 (growth rate: 2.8%); birth rate: 40.2/1000; infant mortality rate: 85.3/1000; life expectancy: 49.0; density per sq mi: 1,029 Capital and largest city (2003 est.): Kigali, 298,100
Monetary unit: Rwanda franc
Languages: Kinyarwanda, French, and English (all official); Kiswahili in commercial centers
Ethnicity/race: Hutu 84%, Tutsi 15%, Twa (Pygmoid) 1%
Religions: Roman Catholic 56.5%, Protestant 26%, Adventist 11.1%, Islam 4.6%, indigenous beliefs 0.1%, none 1.7% (2001)
Literacy rate: 70% (2003 est.)
Economic summary: GDP/PPP (2007 est.): $8.576 billion; per capita $1,000. Real growth rate: 6%. Inflation: 8%. Unemployment: n.a. Arable land: 46%. Agriculture: coffee, tea, pyrethrum (insecticide made from chrysanthemums), bananas, beans, sorghum, potatoes; livestock. Labor force: 4.6 million (2000); agriculture 90%, industry and services 10%. Industries: cement, agricultural products, small-scale beverages, soap, furniture, shoes, plastic goods, textiles, cigarettes. Natural resources: gold, cassiterite (tin ore), wolframite (tungsten ore), methane, hydropower, arable land. Exports: $170.8 million f.o.b. (2007 est.): coffee, tea, hides, tin ore. Imports: $472.5 million f.o.b. (2007 est.): foodstuffs, machinery and equipment, steel, petroleum products, cement and construction material. Major trading partners: Indonesia, China, Germany, Kenya, Belgium, Uganda, France (2004).
Communications: Telephones: main lines in use: 22,000 (2005); mobile cellular: 290,000 (2005). Radio broadcast stations: AM 0, FM 3 (two main FM programs are broadcast through a system of repeaters and the third FM program is a 24 hour BBC program), shortwave 1 (2002). Radios: 601,000 (1997). Television broadcast stations: 2 (2004). Televisions: n.a.; probably less than 1,000 (1997). Internet Service Providers (ISPs): 1,592 (2007). Internet users: 65,000 (2006).
Transportation: Railways: 0 km. Highways: total: total: 14,008 km paved: 2,662 km unpaved: 11,346 km (2004). Waterways: Lac Kivu navigable by shallow-draft barges and native craft. Ports and harbors: Cyangugu, Gisenyi, Kibuye. Airports: 9 (2007).
International disputes: Tutsi, Hutu, and other conflicting ethnic groups, associated political rebels, armed gangs, and various government forces continue fighting in Great Lakes region, transcending the boundaries of Burundi, Democratic Republic of the Congo, Rwanda, and Uganda to gain control over populated areas and natural resources - government heads pledge to end conflicts, but localized violence continues despite UN peacekeeping efforts.

Rwanda Today

Rwanda today struggles to heal and rebuild, but shows signs of rapid development. Some Rwandans continue to grapple with the legacy of almost 60 years of intermittent war.
One agent in Rwanda's rebuilding effort is the Benebikira Sisters, a Catholic order of nuns whose ministry is dedicated to education and healthcare. Since the genocide, the Sisters have housed and supported hundreds of orphans, and created and staffed schools to educate the next generation of Rwandans.[25]
The major markets for Rwandan exports are Belgium, Germany, and China. In April 2007, an investment and trade agreement, 4 years in the making, was worked out between Belgium and Rwanda. Belgium contributes €25-35 million per year to Rwanda.[26]
Belgian co-operation with the Ministry of Agriculture and Animal Husbandry continues to develop and rebuild agricultural practices in the country. It has distributed agricultural tools and seed to help rebuild the country. Belgium also helped in re-launching fisheries in Lake Kivu, at a value of US$470,000, in 2001.[27]
In Eastern Rwanda, The Clinton Hunter Development Initiative, along with Partners in Health, are helping to improve agricultural productivity, improve water and sanitation and health services, and help cultivate international markets for agricultural products.[28][29]
Since 2000, the Rwandan government has expressed interest in transforming the country from agricultural subsistence to a knowledge-based economy, and plans to provide high-speed broadband across the entire country.[30]

Ujama team members at the packing "party"

This weekend we met to pack our supplies for Rwanda. We have 23 suitcases, trunks and duffles full of almost everything you can imagine- gloves, instruments, heart monitors, ultrasounds, surgical packs, toys, candy, toiletries, etc. Its hard to know precisely what our needs will be now, but we're trying to anticipate all the contingencies. Each bag was inventoried, assigned to a team member, marked and weighed. We are hopeful that the bags will make the transfer in Nairobi without being compromised and will meet us in Kigali! Actually we have 22 bags - no one wanted to take bag number #13 so we skipped it and renamed it #14. We are allowed 30 bags so we are thrilled to each have some space for personal items. We are also allotting one bag to just snacks, power bars, etc.

Here is a rundown of the team members~

Sara Holt, CNM (Certified Nurse Midwife), ME!
Specialty: Obstetrics and Women's Health
Goals: 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 while in country and assist in surgery.
Previous mission work: None

Hal Goldberg, MD
Specialty: Cardiology
Goals: 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 Zilar
Specialty: HIV/AIDS education
Goals: 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, ARNP
Specialty: Ob/Gyn Nurse Practitioner
Goals: Provide obstetric care and deliver babies in rural areas.
Previous mission work: Legally ordained, volunteer with local AIDS organizations.

Pam Silverstein, MD
Specialty: Ob/Gyn Physician
Goals: Teaching, clinical services, site visit

Sherry Altmaier
Specialty: Certified Surgical Technologist
Goals: To help establish and develop surgical services
Previous mission work: Ecuador 2005
Sherry 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 skills
Goals: 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, RCS
Specialty: Cardiac and Vascular Ultrasonographer
Goals: Learn some french and provide shoes!
Previous mission work: Locally with his church

Robb Lowy
Specialty: Engineering, water resources, energy
Goals: To initiate a cooperative relationship between the Rwandans and Gonzaga University Engineering Dept.

Adie Goldberg, Licensed Clinical Social Worker
Specialty: Post Traumatic Stress Disorder and Crisis Intervention
Goals: 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, MD
Specialty: Surgical Oncology
Goals: To provide surgical support, teaching and service where possible. To make a difference.
Previous mission work: Ecuador 2005

Philip Soucy
Specialty: Cardiology Technician, French translation
Goals: Continue with french work, help where needed

Barbara Soucy, RN
Specialty: OR, ICU, PACU. Fluent in International Sign Language.
Goals: To help where needed.

Preparing for the trip to Rwanda

As many of you know I am part of a medical group travelling to Kigali, Rwanda this June. I have created this blog to document my trip and to disperse information about the medical needs in Rwanda.

Our group- MedicalConnections:UJAMA is a diverse group of physicians and allied health care providers based in Spokane, Washington, who will provide healthcare services and training programs for international communities.We now have a team of 18 medical personnel, who will not only see clinic patients, but also do teaching rounds and surgery with the young doctors who are in training at the medical school at the National University of Rwanda. We will be a part of the Rwanda Clinical Faculty Teaching Project at Kibagabaga Hospital in Kigali.The need for advanced and speciality training is huge, as is the need to see and treat the patients who stand in long lines at the hospital clinics.

We are bringing a team that has expertise in general medicine and cardiology, neonatology, obstetrics, women's health care, gynecologic, urologic and general surgery, mental health, STD and HIV and public health educators; this team will not only see patients, but will also teach and provide workshops in specialty areas. This is a site and planning visit as well, as we hope to establish the ongoing partnership that both HDI and UJAMA envision.We are bringing basic medical supplies and equipment on this trip. Obviously the need for monetary support is great as just the list of needed drugs is 20 pages long!! This doesn't even include basic supplies and equipment.

Recently our team attended a meeting with 2 physicians who just returned from Rwanda and worked at Kibagabaga Hospital. They said that the need for basic medical supplies is great. Items such as stethoscopes and blood pressure cuffs are in very short supply.

I am working with a medical company to order supplies for our trip. This company has agreed to sell us what we need at a generous discount. Your donations will allow us to bring extra supplies to the doctors and nurses and in turn will help the people of Rwanda have greater access to health care.

For $10 dollars you can provide a fetoscope – a special stethoscope used for listening to fetal heart tones.
For $12 you can provide a stethoscope.
For $20 you can provide a blood pressure cuff or an otoscope.
Additionally, the children of Rwanda need books and learning tools. Suggested donations of $5 will go toward purchasing books, alphabet cards, small toys and other learning supplies.

To donate to the medical supply fund you can send contributions to me. My address is: Sara Holt, 1602 S Monroe, Spokane, WA 99203

Contributions to the Ujama general fund can be sent either to me or to: UJAMAc/o WomanHealth, 910 W. Fifth Ste 510, Spokane Wa 99204

Our group Medical Connections:UJAMA has been granted 501c3 status under Community Minded Enterprises, which means that any contribution to the Ujama general fund will be tax deductible- we will send you a receipt for your donation.

Please forward this information on to anyone who you think might be interested in our trip, or who might like to help! And please check back for blog updates as we near our departure date of June 16th!

Sara