Final Days

Time has flown by and with just a few days left I am trying to make the most of them. In that effort, the past two weeks have been some of the busiest and funnest yet.

 

Two weekends ago, all of the EWHers in Rwanda met up in Kigali for an (American) Independence Day bash at the U.S. Embassy. Since July 4th is Liberation Day for Rwanda, the day the 1994 Genocide is said to have ended, the U.S. Embassy held our party on July 11th. I hadn’t seen so many mzungus (white people) since arriving here two months ago. Oddly, it was a little overwhelming. The party was replete with apple pie, live music, volleyball, raffles, and even a drinking fountain (none of the water in Rwanda is safe to drink so this was a pretty big deal). I even met with the Consular Section Chief to learn about the embassy’s inventory system so it can be implemented in my hospital. After the party was over, we left the embassy and returned to Rwandan soil. I felt like I was experiencing culture shock all over again; small shacks adorning the hills, scarce water, and dust everywhere.

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Unfortunately I didn’t get a chance to stand next to the Bear Republic. As it turns out, the Ambassador to Rwanda is a Hopkins graduate!

 

During the week, we resumed work on an anesthesia machine. After fixing the power supply, we realized there was a problem with the oxygen intake. Repairing that led us to discover disconnected tubing, which subsequently led us to the broken volume monitor. While at work one day, our hospital’s BMET turned on the vaporizer to test its ability to convert liquid anesthetic to gas and pump it out to the breathing circuit. We discovered it was working properly when, after our BMET walked out of the room, we started smelling the isolfurane. Luckily we shut it off before it knocked us out. By now, we have nearly refurbished the entire machine. A few days ago we got to watch it being used for the first time since it arrived in Rwanda. Being in the operating theater caused a mix of pride, joy, and nervousness that our machine would not work properly (thankfully it did).

 

Side Project: Quest to Learn About Healthcare in Rwanda

In Rwanda and many other developing countries, governments have implemented community health programs. This strategy helps serve rural, low-resource countries by equipping thousands of people with very basic medical technology and diagnostic equipment. Each small community has their own set of Community Health Workers (CHWs), resulting in better access to healthcare for the entire population.

 

I have been fascinated by this approach to healthcare because it is so different than the approach in the U.S. and can be so effective. In Rwanda, CHWs are split into binomes and maternity. Each village (~100 homes) has two binomes that care for children under five and one maternity CHW that cares for expecting mothers. Binomes focus on malnutrition, malaria, pneumonia, and diarrhea while maternity CHWs do two checkups and help get mothers in labor to the hospital. Here, the program has been widely cited as one of the main reasons for the impressive improvements in health.

 

Hoping to learn more about healthcare here, I scheduled meetings with a private doctor and dentist. Dr. Sarambuye runs a ‘private’ hospital, which means that his patients are not the general population, who are only covered by national health insurance. Rather, his patients are government employees like military personnel and teachers who have special insurance provided through their jobs. However, in just a year this is all set to change: everyone’s insurance will allow to go to any hospital or clinic, regardless of whether it is public or private. Dr. Sarambuye’s clinic was relatively small with just two exam rooms, a surgery suite (very primitive), and a five-bed in-patient ward (no longer used). He also had a small, well-equipped lab that could test for different diseases, including HIV/AIDS and malaria. While I was there to learn more about the current healthcare approach, I also wanted to introduce Dr. Sarambuye to mHealth. As it happens, he has an iPhone so I he able to demo some devices on his own phone. He was ecstatic. His favorite devices by far were the blood pressure cuff, which inflates automatically and takes a reading, and the ECG case. Both devices are cheaper than the hospital equivalent (for example, the GE Dash 2500 patient monitors we were fixing at the hospital) and provide data that is good enough quality to be useful.

 

My real interest, though, is in the CHW program. As a proponent of mHealth, this is an area where I think the technology could transform Rwanda’s and other countries’ healthcare delivery. To this end, I established contact with Thacien, the district supervisor for the CHW program. He let me shadow a community health worker and ask them questions about their job. Just an hour of observation revealed some surprising insights.

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A binome from a local village with her scale. They have to lift up five year olds when using this scale!

 

 

Leisure Time

In addition to my novice foray into public health research and keeping busy at the hospital, I’ve been trying to meet as many of the interesting people here as I can.

 

Last Saturday I saw some people playing tennis on a clay court at a fancy hotel. Even though I had just finished my 10km run, I couldn’t resist the temptation to pick up a racquet, so I asked to join. A few minutes later I was playing singles. It was the first time I’ve played tennis in six months and my serve was pretty rusty. But, I managed to battle to a respectable loss of 4-6. It was then that I discovered that my opponent, Yubarack, is the #3 player in Rwanda. I played well, especially considering how long it’s been, but Rwandan tennis is definitely at a different level than American tennis.

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I may be (slightly) taller than Yubarack, but that doesn’t seem to impair his ability to beat me at tennis!

 

My fun for the day was not over. After borrowing a piano from the church and practicing for a week, I was ready for my debut at Thai Jazz, a local restaurant and jazz club. Once again, my skills were not as polished as they used to be—with classes I rarely practice at school. But I still had a great time (hopefully the diners did too) and played pieces ranging from Take Five to Billy Joels’ Lullaby. The owner, Jamil, offered me compensation by way of a private dinner party the following week. Jonathan and I joined three Canadians and four Dutch people (all were Jamil’s friends) for spaghetti bolognaise and beef curry. The party did not end until 2am, following sugar crepes, swimming in the lake, a bonfire, and a ‘jazz movie’ (a video of a concert that Jamil loves). It was memorable to say the least.

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Jamil is quite a character.

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I attempt to play jazz.

 

During one of our first dinners in Gisenyi, Jonathan thought he overheard an American talking about biomedical engineering students. We were pretty curious so we waived the man down as he was leaving his table. As it turned out, Jonathan had heard wrong, but the man gave us his card anyway and told us to stay in touch. I googled his name and company and discovered that he had started a Rwandan social benefit company, Inyenyeri, that leases clean-burning gasification stoves. His business model is very innovative and allows for even the poorest families to make the switch to stoves whose emissions are not toxic. I continued reading about him online when a routine search for his LinkedIn profile revealed that he is the founder of Marmot. Jonathan and I were already interested in meeting him to learn about his business and how he uses local resources, but the Marmot factoid piqued our interested even more.

 

Just this week we were finally able to meet up with him. What a guy! He has a massive library in his house and lives here full-time. We heard about some of his crazy adventures—from ascending Everest on the steepest side to secretly hiking mountains in Tibet. But what most impressed me was his thoughtfulness. He is an incredibly intelligent and caring person. To top it all off, he gave Jonathan and I each our own copy of his favorite book on Gandhi, who he credits as his inspiration.

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This is just one third of Eric’s library!

 

Now we are headed back to Kigali for the end-of-the-program conference. Time has flown by and I’ve thoroughly enjoyed Rwanda. I still can’t decide whether I’m ready to go home or not.

 

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Week 2 at Rubavu District Hospital

Happy Independence Day from Rwanda!

For the past week and a half, Jonathan and I have been braving it on our own in Gisenyi. All of the EWH SI participants were assigned hospitals in more rural parts of Rwanda, and ours is located right next to the DRC (Democratic Republic of the Congo) border where a firefight took place just a few weeks ago. Needless to say, we were slightly apprehensive. But when we arrived, our misgivings were quickly allayed; the Rwandan side of the border is very safe. In fact, nestled on Lake Kivu, Gisenyi is a beautiful city and offers a resort-like lifestyle to tourists that can afford it. We’ve been spoiled with luxuries like hot and running water, American style toilets, awesome lake views, and great food. Just a few kilometers away, though, many Rwandans face a very different reality. Our two worlds converge at the hospital.

 

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The city of Gisenyi overlooks Lake Kivu.

 

“Our” hospital is moderately sized for a district hospital but, like many of them, is short on resources. Dr. William, the director, explained that the infrastructure is old and disorganized, and that the hospital lacks a lot of equipment. After doing our inventory, we found they had about 100 pieces of equipment (not including lab equipment, of which they have over 200 pieces), ranging from anesthesia machines to dental drills. We spent three days trying (and failing) to fix an anesthesia machine. Turns out it’s tough to fix something when you’ve never used one and don’t know how it is supposed to work. Although we still haven’t figured out the anesthesia machine, we’ve now fixed multiple vitals monitoring units, a couple oxygen concentrators, and a centrifuge. Fixes can be anything from re-soldering connections for a new power cord to building a new pulse oximetry sensor out of spare parts.

 

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Rubavu District Hospital.

 

While we work with Celestine, the head of maintenance at the hospital, doctors and nurses are busy serving patients. In general, the hospital seems quieter and less urgent than U.S. hospitals, but that’s not to say people aren’t busy. Even the director, who is in charge of administration of the hospital and 10 health centers in the district, pitches in by doing surgeries, working in the ER, and delivering babies.

 

We’ve been speaking a lot with the Dr. William who has great insights into the healthcare system here. His is fluent in English and has done fellowships in infectious diseases and emergency medicine in Holland and South Korea, respectively. He views the infrastructure as the biggest challenge at his hospital, but acknowledges that a shortage of doctors and poor maintenance of equipment are major issues. I introduced him to the world of mHealth and let him try out some devices I brought from Quantified Care. He was like a kid in a candy store. As one of the few Rwandans with an iPhone (although a decent number have smartphones, they are all Android), he enjoyed using his phone for pulse oximetry, ECG, and blood pressure.

 

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The director uses the Cellscope Oto to examine my ear with his iPhone.

 

After speaking with him about telemedicine and mHealth, I believe there is great potential for these fields in the realm of community health workers. These ‘lay’ people (numbering about 50,000 in Rwanda) have some minimal training in medicine. They know how to test for and administer treatments for things like HIV/AIDS and malaria. With a shortage of doctors, it is these community health workers that have allowed Rwanda to make significant public health gains in such a short time. Dr. William said that the Ministry of Health was working with the South Korean government to equip the workers with smartphones, which would open a world of possibilities—leveraging mHealth devices to do telemedicine in rural areas could be a huge boon!

 

With just three and a half weeks left, it’s starting to hit that we won’t be here forever. I’ve been redoubling my efforts to meet people who can help me understand Rwanda and ways their health system can benefit from new technology. I recently met an American physician, Patrick, who works at the hospital here full-time. He serves as an on the ground coordinator for his non-profit, Go Beyond the Cross, which sends medical equipment to Rwanda. Over dinner with him and a group of Americans returning from Goma (they are part of the nonprofit Project Congo), I started to hear bits and pieces of a different perspective on the genocide and ensuing reconstruction. Needless to say, it was a very different viewpoint than the one we were fed at the Kigali Genocide Memorial and the Millennium Village.

 

Last night, I had dinner with Mike, who I know from the local market where I buy crackers and peanut butter for breakfast. He is tapped into a diverse network due to his job and has promised to connect me a range of people, including both community health workers and doctors from a local private hospital. I am eager to hear from these people and get their reactions to my ideas for new medical technologies.

 

 

Bonus Pictures:

 

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Celestine, our BMET, insists that we keep our toolbox in the refrigerator when we are not using it.

 

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An anesthesia machine and patient monitor, respectively.

 

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Even the most modern looking buildings here are a façade covering the mud bricks.

 

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On the way from Kigali to our hospitals: Five large guys in a car no bigger than a Ford Edge. We each had a suitcase. By the time we all climbed in the suspension rode 5 inches lower. Right after we pulled out of the IPRC driveway, we pulled into a gas station where the driver had two of the tires replaced.

Week 3

With just one week left in Kigali, we’re starting to prepare for our five weeklong jobs of fixing hospital equipment full time. But that hasn’t stopped us from experiencing all that Rwanda has to offer. In addition to having two “hospital days,” we managed to squeeze in a volcano hike and a safari, all in addition to our regular schedule of French and medical device repair classes. Here’s a brief recap of some of the events:

 

Hospital Assignment

In preparation for the second month of the EWH Summer Institute, each ‘team’ was assigned their respective hospitals. Jonathan and I will be working in the Western Province at the Rubavu District Hospital near the city of Gisenyi. Although we do not know much about it yet, our current host family told us the city is a major tourist area and is “very nice.” We’ll find out more about the hospital and our lodging accommodations at our briefing tomorrow. Here’s a map I made of the hospital assignments.

 

Hospital Work Days

So far, we have had three ‘hospital days’ interspersed with our classroom studies. During these days, we had the opportunity to go to hospitals in Kigali and try our hand at actually fixing some medical equipment. We first went to CHUK (Centre Hospitalier Universitaire de Kigali), a teaching hospital and one of the best hospitals in the country. While there, Jonathan and I ‘fixed’ some equipment, which mostly just amounted to finding the correct chargers and then charging batteries. We also tried our hand at an ultrasound machine. This was the first time either of us had ever touched an ultrasound machine, let alone powered it on (luckily that part was pretty easy). Someone had sent the machine to the workshop because it was “displaying images twice.” What does that mean? Good question, we were wondering the same thing. Unfortunately, that is typical for repair requests. We realized that, in addition to the technical aspect of fixing equipment, this communication barrier could easily inhibit our ability to do our job. Since neither of us had used an ultrasound machine before, we didn’t know how it was supposed to work. So how can we fix it if we don’t even know what the problem is?

After powering it on, we realized the screen was flickering every second or so, which we fixed by adjusting the video cables between the monitor and the computer. Then it took us about an hour to figure out how to configure the device, select the proper mode (B mode, which is the mode usually shown for TV shows like House), adjust the gain, and select the different sensors. At first, we weren’t even getting an image when we pressed the sensor to our skin. We quickly realized that it was probably do to lack of conductivity (all of the ultrasound gel squirt bottles were empty, something we were learning to expect in Rwandan hospitals). After two hours we finally had the machine working as it was supposed to, or at least how we thought it was supposed to work. Then we saw how it was “displaying images twice.” Essentially, it was overlaying the image on top of itself, which can cause confusion for a physician trying to make a diagnosis. We troublshooted the problem and, since it occurred with all three sensors, decided it was probably a software issue rather than a hardware one. Thus, the next hour was spent testing every single setting (and there were probably over a hundred), but unfortunately we never found the fix. We sent an email to GE (the maker of the machine) but haven’t heard back yet.

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The ultrasound machine with ‘double vision.’

In addition to working with medical equipment, we also got a chance to tour the hospital and speak with some doctors. I wrote about some of my interactions and perceptions in my monthly article for the Hopkins Biotech Network publication, The Transcript, which can be found here.

Tomorrow, we will be going to Kanombe Military Hospital—hopefully we’ll have better luck!

 

Volcano Hike

Two Saturdays ago we hiked Mount Bisoke, one of the volcanoes in Rwanda. Although not the tallest, it still towers at over 12,000 feet. Fortunately, we didn’t have to ascend all 12,000 feet because the base of the mountain is around 8,000 feet. But the ascent was brutal. It was incredibly steep, but the real challenge was navigating the mud. Most of the trail was either very slippery or so thick with mud that your shoes would get stuck without being careful. After about an hour of intense hiking we took a rest break at a small clearing. Our guide smiled at us and said, “That was the easy part.” It’s great when you know your guide well enough that they can joke with you like that. Unfortunately he wasn’t joking. Somehow it managed to get steeper and muddier. At the top of Bisoke is a beautiful crater lake that makes the trek worth it. Supposedly. We didn’t get to see the lake because when we reached the top (after around three hours of hiking), it was so foggy you could only see ten feet in front of you. On the way down we had apparently gotten to know our guide well enough that he felt comfortable joking with us. At one point he shushed us and whispered, “Gorilla!” The volcano is one of the few regions in Rwanda where the gorillas live. For at least three to four minutes we stood as still as possible, our boots sinking into the mud. It was then that our guide said, “Gotcha! There’s no gorilla!” As funny as it was, it was tough to smile. When we reached the bottom, the clouds at the top were just starting to part. I tried to get a group interested in going back up to see the lake, but for some reason no one felt compelled to do the hike all over again.

As it turns out, Jonathan and I’s hospital is about thirty minutes away from Mount Bisoke. Although it’s tempting, we probably won’t do the hike again.

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Mud, mud, and more mud. This picture doesn’t do justice to the steep incline of the mountain.

 

Akagera Safari

This past Saturday we went on a safari through the Akagera National Park. The trip lasted about six hours, most of which we spent sitting atop our Land Cruisers enjoying the wildlife. We started out in the densely vegetated southern part of the park and made our way northeast along the Tanzanian border. Initially, we only saw some water buffalo and baboons. But as we made our way onto Lake Shore Road (the park is scattered with lakes) we began to see hippos, a massive Nile crocodile, and some African eagles (they look very similar to bald eagles). The winding road eventually led to the savanna, but before we could get there our vehicles suddenly stopped. Just twenty feet in front of us there stood a family of giraffes, right in the middle of the road. Seeing them run was quite a spectacle—their legs seemed to barely move but their heads glided rapidly some eighteen feet above the ground. By the time we reached the open savanna, there were dozens of zebras and impalas grazing with each other in harmony. There were also wart hogs trotting across the savanna (they had a striking resemblance to Pumba, but sadly there was no meerkat to serve as Timon).

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My favorite was probably the impala—they were jumping as high as ten feet in the air, virtually from a stand still!

 

Miscellaneous

During the evenings I’ve been keeping busy with a range of different activities. Sometimes we play ultimate Frisbee or basketball with some of the locals (despite ever having seen a Frisbee before they pick it up very quickly). I also taught my host family how to play some card games—Crazy 8’s, Black Jack, Egyptian War, and even Killer. They love playing cards. Last night Jonathan and I made peanut butter cookies for them, which was a real treat since they don’t have an oven and thus rarely have baked goods. The cookies didn’t taste quite like they usually do, but they still brought smiles to our host family—mission accomplished.

Last week I met Herve Kubwimana, a friend of a friend of a friend. Herve is the director of the Africa Innovation Prize, a nonprofit that strives to “inspire university entrepreneurship in Africa” with annual business plan competitions. He offered some great insights into the economy of Rwanda and how the unemployment rate, even for university graduates, is quite high. One major problem, he said, is the prevalence of humanities majors—economics, language, business management—and lack of technically trained workers. At some point I want to visit The Office, which Herve described as a co-working space for people trying to build businesses in Rwanda. Sounds pretty cool!

It’s hard to believe that the trip is 1/3 over, but I’m excited to get to the hospital to start fixing medical equipment.

 

 

Bonus Picture:

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People traveling on bikes hitch rides up the steep hills. The really scary part is when the car they are holding onto tries to pass another one (Rwandans like to cut it REALLY close when it comes to driving).

The Genocide

Muarho! (“Hello!”)

On Saturday our entire group ventured out to the Eastern District to visit the Millennium Village. This region was historically forested and fertile but is now the most infertile due to deforestation that occurred in the 1950s. In that time, the Tutsi people (~25% of the population) were sent there by the newly empowered Hutu (~74% of the population) with the hopes that they would die of disease in the jungle. This started Rwanda’s bloodied history of ethnic tension. [note: the other 1% is the Twa, a pygmy people who were largely forest dwellers] The Hutu’s ‘superiority complex’ (a vast oversimplification of the complex ethnic tensions rooted in the Belgium colonialism) was sadly promoted by doctrines taught by Belgian colonists and reinforced by religious teachings by missionaries. This tension resulted in multiple massacres of Tutsi people by Hutu people, which culminated in the 1994 genocide. Starting on April 7th and lasting 100 days, the genocide took the lives of over 1 million Rwandans, the vast majority being Tutsi who were brutally murdered.

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On the way to the Millennium Village. Rwanda has a beautiful landscape.

 

This backstory is pertinent because most things in Rwanda exist against the looming backdrop of the genocide. This is certainly true of the Millennium Village. The genocide displaced 2/3 of the Rwandan people and destroyed the infrastructure, governing system, and economy in general. This Millennium Village was started by the UN as an example of how the Millennium Goals can be reached in places like Rwanda.

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At least half of the buildings here seem to have the “tigo,” “Mutzig,” or “Primus” logos and paint colors. Tigo is a cellular provider and the latter two are beer companies.

 

The UN support has helped tremendously. The village school has doubled in size, now serving over 1,000 students, and the teaching staff has grown (although still rather understaffed by American standards!). As with all Rwandan schools, only English is spoken while at school (this changed from French about 6 years ago).

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The school’s enrollment and one of its classrooms, respectively.

 

The Health Center’s nursing staff (health centers don’t have doctors, only hospitals do) increased from 5 to 19 with the Millennium support. This was accompanied by the addition of a new maternity ward, which has allowed all local births to take place in a professional medical setting rather than in the home.

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The health center and some of its lab equipment.

 

The Village also sponsors co-ops for farmers, artisans, and other skilled workers. These co-ops help the people sell their goods in markets, which helps drive the local economy (historically the economy has involved a lot of subsistence farming). The farm we visited was about 2 hectares and maintained by one man. He had two cows, a couple pigs, a goat, and a few hens. He didn’t have a single power tool to help with the work.

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The farm and some of the livestock.

 

Midway through our day we visited a genocide memorial (one of many in the country). This one was located at what used to be a Catholic church where 11,000 Tutsi were murdered in just 1-2 days. It was a sobering experience. The pews in the sanctuary are filled with the clothes of victims, and the altar bears the weapons used- spears, guns, machetes, and blunt sticks. Beneath the sanctuary, there is a glass case housing the skulls of hundreds of victims, a graphic reminder of the gruesome atrocities committed at this site and throughout the country. Outside, there were stairs descending down to a mass grave located beneath a cement slab. It is impossible to encapsulate the anguish and anger the site evoked. Again, there were piles of bones of unidentified victims. Many of the skulls were shattered by blunt objects, sliced by machete, or bored through by a bullet. No one left the memorial unaffected.

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The memorial- no photos allowed inside.

 

How could people be so filled with hate that they could gruesomely kill so many people? How could a person kill his neighbor? How could a father kill his wife and children because they were of a ‘different’ ethnic group? Where was the rest of the world when this was happening? And why does this keep happening throughout history (the Holocaust, Armenian genocide, Cambodian genocide, and many others) with some being as recent as just a decade or two ago? I am convinced that I am no better than the Rwandans I have met. Does that mean that I too am capable of such heinous actions under the right social priming?

 

Although the emotions still pervade my mind even now, they were quickly countered by the wonder and awe I experienced upon our visit to a ‘reconciliation village.’ At this site and many others like it throughout the country, victims and perpetrators of the genocide live together. The nation pursued an avenue of reconciliation over retaliation, which involved the daunting challenges of people forgiving each other and forgiving themselves. I desperately want to learn more about the social forces that helped bring about this largely successful reconciliation, and why it has not occurred after other conflicts. But the wonder and awe wasn’t over for the day.

 

As it happened, it was also the last Saturday of the month. In Rwanda, that means the day is reserved for Umuganda, or “coming together in common purpose to achieve an outcome.” The tradition started in 1995, the first year following the genocide. It is a day where Rwandans come together to improve their communities through activities like picking up trash or even building new homes. We met up with one community that was building mud-brick houses for refugees from Tanzania. These were actually refugees of the genocide from 20 years ago that are just now returning to their homeland. The event is an impressive showing of national unity and pride. I am amazed and perplexed at how it was first instituted, especially so quickly after the genocide when tensions between ethnic groups were high. But it has undoubtedly helped with the reconciliation process. I am interested to see how the model can be used in different communities throughout the world.

 

It was a day filled with confusion, anger, and amazement at the genocide and the events that have taken place since. On Sunday, I visited the Kigali Genocide Memorial and learned more about the history preceding and following the genocide. Even with more context, I still cannot fully comprehend the events that transpired. Rwandans, too, seem to struggle with their past, though they have made tremendous strides in terms of economic development and social reconciliation. These intertwined advancements have been significantly influenced by the introspection encouraged by the nation each year during the 100 days following April 7th, which commemorate the genocide.

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Again, no pictures allowed inside.

 

In my next post I’ll talk about our visit to a local hospital—the people we met, the equipment we saw, and how differs from the hospitals most of us have seen. Stay tuned!

 

 

The First Week

The trip so far has been great, though replete with challenges.

 

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My flight on Ethiopian Airlines to Rwanda. I thought I took this picture in Rwanda, but I was wrong.

 

Here was my first sight of Rwanda after landing. Except it wasn’t Rwanda. It was Uganda. I went all the way through the passport line and was about to withdraw 140,000 Ugandan Shillings from the ATM to pay the visa fee when, despite my 10 hours of sleep over 3 days, it dawned on me that I should be paying in Rwandan Francs. Whoops. The sprint back to the plane (as the stair car was getting ready to pull away) was a nice stretch after 19 hours in the air.

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The actual Rwandan airport.

 

Here’s the real first sight of Rwanda, from right outside the airport. The Kigali airport was has no jetways and only had one other plane deboarding when I arrived.

 

We arrived at IPRC (Integrated Polytechnic Regional Center) Sunday afternoon and were whisked away by our host families. Jonathan (another student) and I are staying with Augustine, his wife, and his two children. We were both exhausted, but Augustine offered to show us around the city so we ventured out with him. After an hour walk, we arrived in the town of Remera. The streets were dark by the time we arrived—the sun sets around 6pm here (it rises around 5am though).

 

Augustine wanted to meet up with one of his colleagues from IPRC who is also hosting EWH students (all students were staying with IPRC faculty). We ended up meeting them at a bar and watching the live music for two hours.

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Live contemporary music, sung in Swahili, during my first night in Rwanda.

 

What a first day! I was exhausted, but managed to stay awake during the moto-taxi ride (similar to a Vespa) back to our home with Augustine. (Don’t worry, Gram, I do not plan to take a moto-taxi again)

 

 

Here’s a quick rundown of some of the highlights so far. I apologize for the long narrative but I want to give a good description of the setting here before venturing out into other topics.

 

HOMESTAY:

The host families generally get up around 5, but I’ve only been able to get up around 6. Their housemaids cook our breakfasts and dinners for us, which we eat in the living room.

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The living room at my host family’s home.

 

For breakfast we typically eat some fruit (bananas or oranges), bread, and fried eggs. Dinner always comprises a starch (either rice, potatoes, or pasta), fresh beans, some vegetables, and plantains. It took a few days for my digestive system to adjust, but finally my appetite is almost back to normal.

 

Even though our host family is considered fairly well off, they don’t having continuously running water. Instead, their water supply only works during the early mornings, at which point they fill the bathtub as a reserve to be used for the rest of the day. I can’t use any of the water for drinking or brushing teeth, but I do use it for my ‘baths.’ Our home has two toilets; one is a hole in the ground and the other is a regular toilet that is connected to the hole in the ground. Flushing consists of dumping a bucket of water down the toilet.

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Jonathan and I’s bedroom, and the nets to protect us from mosquitoes while we sleep.

 

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The bathroom. The tub is filled with water here, and the tile around the sink is actually a shower. Unfortunately, due to the lack of running water, the showerhead is useless and instead all bathers dump water on themselves using a bucket.

 

Our hosts have electricity (when their isn’t a blackout, which happens multiple times a day but usually only lasts a few seconds), a television with cable, cell phones, and a small car. They have been incredibly hospitable, like all of the Rwandan people we have met.

 

CLASSES:

From 8:00-12:00 we take Kinyarwanda lessons from our instructor, Francis. Next week we will start learning French to prepare for our work at the hospitals. In the afternoons (1:00-5:00) we have a lecture and associated lab course on medical devices in the developing world.

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Day 1 of class.

 

Today, we built an ECG simulator kit with BMETs from Rwanda. The kit will be used to test ECGs. The BMETs (Biomedical Engineering Technicians) are local Rwandans that, through a 4 year program with EWH, learn how to fix medical equipment. Their training is similar to what I am doing this summer, but much more extensive and challenging. I worked with Abraham, who was awesome at soldering!

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Abraham and I after completing our ECG test kit. Yes, even hunching over I’m considerably taller than most Rwandans. And yes, they usually stop and stare, and then shout “muzungu!” (white person).

 

All of our classes are taught at IPRC. The school offers the equivalent of bachelors degrees in mechanical, electrical, and biomedical engineering, as well programs in plumbing and other skills.

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IPRC. The entire campus is gated and guarded. All of our homestay families live within the gated campus.

 

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Some classrooms at IPRC.

 

IPRC has wifi through a 4G connection provided by Airtel, one of the wireless providers here. But with all of the students from EWH and all of the IPRC students trying to access it, it’s practically useless. In my first three days here, I was able to check email twice, which involved sending 2 and reading 30. I recently purchased my own USB internet dongle from Airtel for about $50 per month that will give me 1.5 GB a day, which is why I’m finally able to do a blog post. However, I still couldn’t have a video chat that lasted more than a continuous minute.

 

 

TRIP TO TOWN CENTRE:

Aside from Remera, I have only ventured out to one other place. Some other students and I traveled to the Town Centre by bus to get to a working ATM (a lot of them don’t have any cash in them!). It also gave us the chance to buy some snacks at a grocery store. This is a building in the main business district in Kigali, which looks more like a 21st century American city. Amazingly, just a few blocks away there are residential areas that most Americans would consider inadequate for living.

 

Just about every street corner has a soldier keeping watch. They’re usually brandishing an impressively large rifle or shotgun (I don’t have any pictures of them at the moment because I thought it might be a bad idea to stop and stare). Luckily we’ve never seen them use it, and frankly it seems unlikely that they ever would—the people are very amiable and the country is one of the safest in this part of Africa.

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View of Kigali during the bus ride to Town Centre.

 

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Town centre and some of its modern buildings.

 

 

That’s all for now! Feel free to post comments or email me at neilerens@gmail.com

 

The Journey Begins

In true Rens fashion my room still looked like this just hours before I was set to embark.photo   Admittedly, I was a little distracted by all of the goodies I got from my friends Mike and Shiv at a startup called Quantified Care. I’ll be showing some of the mHealth devices they use to clinicians in Rwanda to see if the devices could be of help. All of them interface with a smartphone, are easy to use, and provide high quality data. Take a look at my ECG reading. It looks normal (I hope). I’ll spend some of the plane ride trying to decipher that signal (I guess there really is no escape from Fourier, Dr. Miller).

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Tomorrow my journey begins with a 6:10am train ride into DC, then Metro and bus rides to Dulles Airport. Once I’m on my plane it’s just a quick 19 hours to Kigali, Rwanda, including a layover in Addis Ababa, Ethiopia.

Ijoro ryiza (good night)