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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