back in Halifax

The weary travelers return to Halifax

After 41 hours of travel, Genevieve and I finally made it home to Halifax.  We are glad to be back but already thinking about when we can return to Rwanda again.  As you can tell from the blog, our experience was amazing.  We were so touched by the kindness of the people we met.  Our teaching felt valued but we also feel there is so much more to do.  It is wonderful the next volunteer for the CASIEF program in February will also be from Dalhousie (Dr. Tom Coonan).

This will be the last blog entry.  Thank you to everyone who followed our journey and for you kind comments.

May our efforts help benefit the people of Rwanda.

All best wishes,

Patty

No Peace Without Mercy

I had this outfit made at a local market. Do I look African?

Both Patty and I have spent the last 3 weeks admiring the beautiful fabrics and clothes worn by the Rwandan women. Patty has been determined to aquire her own special outfit and today was the day! Earlier in the week we visited the local open-air market and Patty had a wonderful time selecting the cloth and being measured for an outfit. We weren't quite sure how much would be lost in translation, so the result was going to be a mystery. Today we returned for the finished product. What do you think? The women and children immensely enjoyed the spectacle of Patty dressed in her new clothes complete with a Rwandan head-dress. In the spirit of the moment, I too selected some cloth, was measured and will have an outfit of my own. I'm not yet convinced of the head-dress, however.

In the last 2 days, we had the opportunity of meeting Terry. Terry was our driver to Butare and during the course of our travels he shared some of his life with us. Unfortunately, Terry's father, brother, uncle and aunt were killed in the Genocide of 1994. He was 15 at the time. We had been wanting to visit one of the Genocide memorials and he generously offered to accompany us there. We were concerned that it might be a difficult experience for him, but to our surprise he replied that it is "like visiting his family" and would be pleased to take us there.

So today, Terry, Patty and I drove to a small town just outside of Kigali called Nyamata. Nyamata historically has had a large percentage of Tutsi residents. We have since learned that it has also been the site for previous persecutions of the Tutsi people prior to the 1994 Genocide. The memorial in Nyamata is in fact a church. During our drive, Terry told us that after his family was killed he joined the army even though he was just a teenager. His first job was cleaning the streets. He recalls removing the bodies of the victims and attempting to protect them from the dogs that had begun to eat them. He recalls feeling intense hatred towards those that performed such atrocities, but was governed by the edict from Paul Kagame, the current president, that they were not to retaliate, to kill, to destroy homes, or to loot. Even today, he knows many of the individuals who participated in the killings.

Upon arriving we were introduced to 2 very nice young men at the reception. Both appeared to be in their late 20's.

Steven, our guide, spoke very good English and described in detail, the events of 1994. The experience was quite overwhelming for both Patty and me. The church itself is not very large, yet 10,000 people were crammed into the building. Initially, they sought refuge from the Sisters and Brothers there. However, once inside, the militia barricaded the doors. Three days later, those that weren't killed because of the conditions, were bombarded by grenades or killed individually. The second young man, Charles, is one of seven survivors of the original 10,000. He was 9 at the time. He remembers the events.

While inside the church, Steven graciously shared his experiences of the Genocide with us. He was 10 years old at the time and the fourth child of 5. His mother and father were both teachers. During the genocide, his family was separated from each other. He discovered later that his mother, father, 2 olders and his older brother were killed. He was ultimately placed in an orphanage. It was subsequently discovered that his younger sister, who was only four at the time, had escaped with his Grandmother. They were reunited some time later. He described their reunion as the "happiest moment of (his) life".

Incredibly, soon after they were reunited, a man arrived at their door. He confessed to having participated in the killing of Steven's family and asked for forgiveness. He also said that he knew where his family was buried and could take Steven to find them. A few days later, they went to a local church where the congregation was praying. The man pointed to 15 of the parishioners and implicated them in the killings. He then proceeded to summon them from the congregation and to lead them, as a group, to retrieve the bodies of Steven's family. In a nearby building, in the latrine, they exhumed 45 bodies, including Steven's parents.

Time and again, we are struck by the willingness of the Rwandan people to forgive. In fact, Steven himself said that, "there will never be peace without mercy".

Steven is currently supporting his grandmother and his younger sister. He has withdrawn from his studies to work as a street cleaner so that his sister can complete high school.

Both Patty and I felt very honoured that Terry and Steven were willing to share their lives and stories with us, especially because they have been so traumatic.

Genevieve

back from Butare

We returned last night from our final stay in Butare, where we teach every two weeks. Butare is about three hours south west of Kigali and is a much quieter town where the National University of Rwanda is located. The trip there and back is an opportunity to see the beautiful Rwandan countryside and yesterday afternoon it was at its best. The sun was shining on the terraced hills, rice fields and banana groves making everything a brilliant green. The houses are all brick, stone or clay and reddish brown. And everywhere, along the road, are people - women with bright yellow dresses, a baby on the back and a huge load of potatoes on her head; men cycling with just about anything you can name (yes, we've seen two mattresses on the back of a bike, a dresser, a dozen stacked chairs and, of course, a family); children as young as 4 or 5 with heavy jugs of water. No one is Rwanda is obese! Still, they appear to be healthy and reasonably well nourished. In the country the way of life cannot have changed much.

As a backdrop to this landscape there are the hills that fad in layers into the distance. The country is absolutely beautiful.

In Butare our time was well spent with teaching two of the first year residents. There are only nine residents in Rwanda and they are all our friends! They are bright, hard working people who struggle to do their best in horrific circumstances. They are without the most basic equipment - oxygen saturation monitors are hard to find, carbon dioxide monitors are nonexistant and even a blood pressure cuff may not be available. The anesthesia machines often us a working bit of one with a working bit of another. The residents know they need better equipment but still have to do their best in this situation.

We continue to find that people are very receptive and encouraging with whatever we suggest. It is so easy to set up meetings and there is wonderful receptivity and communication. It feels as though Rwanda is very open and has few obstacles. It is the opposite of all the burocracy and red tape we experience in North America. We had dinner with an brilliant Ugandan surgeon, Dr. Patrick, who is now chief of surgery and acting dean of post-graduate education at NUR ( National University of Rwanda). Dr. Patrick has experience with partnerships between universities in Canada and Africa. He helped set up one between McMaster and the university in Mbarara, Uganda. We told him we would be very keen to see something develop between Dalhousie and NUR. We also spent an hour with the Dean of Medicine at NUR, Dr. Herbert. He is an insightful man and was very encouraging.

Genevieve and I have found our thinking has shifted in the past few days. Instead of thinking we have ample time in Rwanda, we now realize we are in the home stretch. We leave on November 28. We both feel strongly that we need and want to come back. It seems we have barely begun.

Our driver to and from Butare, Terry, is a wonderful young man who was only 15 when he lost his father, aunt, uncle and brothers in the genocide. I felt like I had been stabbed in the heart when we drove by the graveyard where they are all buried. Everyday there are reminders of this tragedy and we have found people to be very open in discussing it. Today Terry is going to take us to one of the genocide memorials.

We are still shocked that this devastating event could have happened in a country where we find the people to be so warm and gentle.

Love, Patty

children

We live in a rather posh embassy neighbourhood but if you go a few hundred metres down our street the other direction there is an old neighbourhood of narrow alleys, dirt roads, mud houses with corrugated metal doors. It is completely off the tourist path. The children all smile and wave. They may call "muzungu" (white person) and laugh. Sometimes we get "bon jour, comment ca va?" other times "hello, what is your name?" in English. Yesterday some children came and held our hands and walked with us. Fortunately, we had some bananas, which they were very happy to receive as one little girl told us she was hungry. Some boys were playing soccer with garbage bags tied together.

I'm sure we will always remember the beautiful children of Rwanda who are so cheerful and friendly and have so very little.

Love to all,

Patty

Can we bring one home?

At long last we got to visit the gorillas! We visited the Susa group, which are gorillas that are descended from the ones Dian Fossey studied. The hike to see them is the longest, but so worthwhile. We were with about 25 gorillas and so close we could have touched them, if we had been allowed. It was absolutely thrilling to be with them and watch them play fighting, eating, moving slowly through the forest and caring for their young.

The group now has 41 members and is the largest gorilla group accessible to tourists. It is also the second largest family of gorillas in the world second only to a remote group of 65 members, considered to be the "research" group.

We saw gorilla twins, the only ones known to have survived. They are now four years old. They did survive because a young male, Sandy, became the mother's helper and always cared for one of the twins. The mother let Sandy care for the female and she kept the male. Of course, Sandy knew to bring the baby for feeding.

We heard that a gorilla group has moved from the Congo side because they are aware of the danger. Unfortunately, as of October 26, the Virunga Park Headquarters in the Congo, was overtaken by the rebel faction. The rangers, approximately 50, had to flee. Now the gorillas have no protection and are at the mercy of poaching as are many of the other animal groups including elephants.

The young baby in the picture is two years old. We saw three silverback males and one that will be a silverback next year. We saw many mothers. The number one male has 11 wives! He occasionally shares with the number 3 since number 3 helps him fight aggressors. Both number 1 and one of the females, Poppy, were alive when Dian Fossey was with the group.

After an absolutely fabulous experience with the gorillas we returned to our hotel and spent a wonderful evening with some fellow travelers; Edwin from England, his girlfriend, Melonie, from Australia, and Marleyse from the US. All 3 are extremely accomplished travelers! Marleyse has spent the last 11 months touring the world...solo!! She had the good fortune of winning a scholarship which mandated she not work!! and only travel (by herself) for 9 months minimum. To date she has been to 19 countries on 3 continents. Edwin, 34 years old, has now visited 60 countries!! on all continents. Melonie, 31 years old has visited 50 countries!! We felt somewhat humbled by their worldly experience.

Bon Soir, Patty and Gen

a vision for 2050

This was Rwandan dancing at a dinner we had during the conference on medical education in Rwanda. The conference has been excellent. We met some fabulous people who are doing interesting work in many areas to improve health care and medical education in Rwanda. There were representatives of organizations from USA, Australia, Belgium, Germany, Denmark, South Africa, Ethiopia, and, of course, Dr Jeanne (chief of anesthesia) and I presented on the CASIEF project. CASIEF is the Canadian Anesthesiologists' Internation Education Fund and it is through CASIEF that Genevieve and I are in Rwanda.

We met people who have spent decades in Africa and expressed opinions that Rwanda is one of the few countries in Africa where you can make a difference. Part of that must be because of the incredible openness we have found in the people. There is also a huge sense of goodwill and a desire for partnerships. Rwanda has a long term vision for development, which is quite comprehensive. There are goals for 2020 and 2050!

There are always signs of people's warmth: the residents all shaking each others hands before teaching rounds, the triple kiss, greetings and smiles on the streets.

We are heading to Virunga to see the gorillas this weekend and we'll be back on Sunday.

Patty

It's a small world

On the plane here we sat next to a lovely man who was accompanying a group of Rwandan senoir high school students returning from a math competition in Bangkok, of all places. He is the director of primary studies and teaches Math 10. We ended up talking the majority of the trip and he invited Patty and I to visit his school.

Yesterday, we had opportunity to visit with him and to see the school. It turns out that it a beautiful private school called Green Hills Academy. It is in Kigali. It has nursery school to secondary. It is situated on an amazing piece of land and landscaped beautifully.

We subsequently discovered that it teaches the International Baccalaureate curriculum and is the least expensive IB school in the world.

We also had the opportunity to meet with the Headmaster, Ron Wallace Again, I am reminded of the fact that we live in an incredibly small world. When we told him that we were from Canada, he appeared interested and inquired "where". When we said, "Halifax", he said that his mother lives in a nursing home there. Furthermore, he is originally from New Brunswick. He came to Kigali in September following retirement from his job as the superintendent of the Southern Alberta Catholic School Board. It gets better...he mentioned that a couple he knows will be coming to Kigali this winter. She is a nurse and he is a new doctor. I immediately thought of a friend of ours who is an Obstetrical nurse, recently married to a young doctor who has just finished his studies at Dalhousie University. I burst out, "Cathleen Connell?"

And it is!! Cathleen's father had, unfortunately, passed away this summer. As it happens, her father was this man's best friend. So, in the center of Africa, we have a Maritime connection!

Bon Soir!

PS. This is my first blog!

Genevieve

Mille Collines

This is a typical view of the route to Butare.

We made some friends who loved seeing their photographs and wanted us to keep taking more pictures.

Genevieve is doing a machine check in Butare. Nepo is giving us the tour. He is a clinical psychologist and trained in conflict management but is working as an OR nurse since there is no support for his other skills.

There are huge contrasts in Rwanda. Even at CHK ( Kigali Hospital), some areas are very modern and well renovated and other areas are in dreadful condition. There is a large amount of construction ongoing. They are building 6 new operating theatres as well as a pre-surgery area and a recovery room. We have seen the rooms, which are structurally built but still need a lot of finishing work. They are large, with windows and high ceilings. It will be a beautiful OR suite on completion. A large building is also under construction which will contain a new emergency department, step down unit, trauma bay, duty rooms, administration and clinics.

One of the most vivid experiences we had was walking into the surgical ward at CHK. I was raining hard as we passed through the surgical ward to get to the room for teaching rounds. The floors were wet from the rains and being mopped. The ward must have had 100 patients, of all ages. There were old people and children and babies. There were people lying on the floors and beds with many patients. Everyone was very crowded together and there was little space. As we walked through, a couple of children smiled and waved.

On Saturday we traveled to Nyungwe National Park in the south west corner of Rwanda. En route we passed entirely through rural Rwandan countryside, which is absolutely spectacular. They call this the land of 1,000 hills but it must be closer to one million. The hills are all terraced with crops like tea, coffee, banana, pineapples, sweet potatoes and corn. Every part has been cultivated even though the hills are extremely steep. The hills go off to the horizon in ever fading layers with mist in the valleys. It is unbelievably beautiful.

Rural Rwanda probably has changed very little in the past 100 years. Along both sides of the road, in the most rural areas imaginable, there is a constant stream of people, usually carrying heavy loads on their heads or pushing bicycles fully laden. Even little children carry huge sacks of potatoes on their heads. We drove through country, with a few little villages, for one hour and through the whole journey there was no point where one person was more than 20 feet from the next. The women wear colourful dresses, usually with matching headwear, and often have a baby strapped on their backs. There are children everywhere and they find us hugely amusing. They love to wave and smile and go into fits of laughter when we wave back. The only motorized vehicles on the roads are buses and trucks with very few private vehicles. Bicycles are fully utilized –even to carry loads of lumber or animals or a whole family!

Nyungwe National Park is huge and it’s great that Rwanda has preserved this area. It contains 20 % of all African primates. It is a rainforest high in the mountains near the continental divide that separates rivers flowing west to the Congo from rivers flowing east and north to the Nile. When we arrived there was another small group of people getting ready for the tour and they were Italian. Some heads turned quickly when I said, “Buon giorno. Siete italiani?” They were doctors and nurses from Italy working at a mission in a remote village north of the park. So, we ended up having four hour tour through the rainforest together. The guide spoke French because it was the best language for all of us (needless to say, he spoke no Italian). African French is fantastic. They speak so slowly and clearly we can understand almost everything they say. Our guide, Cumbogo, is extremely knowledgeable about the flora and fauna of the region so we learned a lot about the various trees – on which induces abortion, another is like a combination of Ecstasy and Viagra, and another has large seed that 14 year old girls used for bra stuffing. We saw blue monkeys swinging from the trees and old growth mahogany trees that reach 60 metres. It poured rain for a good portion of the trek, which took us down a huge descent to a waterfall and back up a very steep hill. The rain cleared leaving mists in the valleys.

Back to work tomorrow.

Ciao, Patty

Joy in Africa!

This picture is explained below.

Everyone here is thrilled about Barack Obama's victory!!! There is joy in Africa. Our house gathered together for a celebratory dinner. The two gentlemen on the left are Kenyan nurses and delighted with the news. Marete, on the left, told us the felt this was a profound change for the world like the fall of the Berlin wall. He believes this is sign that racism is on the way out and there is the dawning of a new era where we work together. Let's hope so.

The other young women are Belgian occupational therapy students who are volunteering for 3 months in Rwanda. They are 20 and 24 and extremely brave. There is only one occupational therapist now in Rwanda ( 9 million people). These women travel to visit children with cerebral palsy and to try to help the mothers find better ways to care for these children. Sadly, the incidence of cerebral palsy is very high.

We spent our first day at the public hospital (CHK). It is a study of contrasts. Some areas, such as the new maternity unit, are beautiful of a very high standard. There is a lot of construction going on and they are building six new operating rooms. Right now surgery is squeezed into a very small space. Genevieve is showing the male change room. The female change room is behind the sheet. (sorry, I can't figure out how to move the picture here)

I'm signing off now. There's lots more to tell but we are putting in crazy long days and not getting enough sleep. We leave for Butare tomorrow and may not be back to Kigali till Sunday so you may have a bit of reprive from my constant blogging.

scene of power point preparations

why aren't you girls voting?

Today we were mistaken for Americans but what the people wondered was why we weren't in the US voting for Obama. Believe me, we would if we could!

Today was our first day in the OR at the private hospital. It is quite well equiped and the staff are great. Still, there are lots of frustrations. Today we did two beautiful spinals but there was no effect whatsoever. The bupivacaine was not expired but must have been bad. How frustrating is that? We had to convert to general twice in one day for spinals that went in easily.

This is so amazing. There are a huge number of nurses and doctors here who are volunteers from Cuba. Cuba pays their salaries and Rwanda provides them with accomodation and a small food allowance. They volunteer for two years. If Cuba can be this generous we should be able to do more.

A few other things. The neonatal ICU is excellently equiped and run; it could easily have been in North America. We met fantastic nurse anesthetist, Janviere, who is as sharp as they come. We also found that orthopedic surgeons are the same everywhere.

We have been overwhelmed at people's gratitude for our teaching. They are so incredibly welcoming and warm.

We have spent the past four hours sitting out on our deck, listening to the birds, burning mosquito coils and working like fiends to prepare our power point presentations for tomorrow. It's great to be on line in paradise.

meeting the residents

It has been great to hear from some of you and if we don't reply to all the e-mails we are still very glad to get your messages. Thanks a lot.

We had a full day today of meeting the director of CHK (Kigali Hospital), a journey to the other end of Kigali to the Rwanda Medical Council, and meeting the chief of anesthesia and CHK as well as many of the residents.

We have found everyone to be gentle, warm and very welcoming. The residents had some excellent ideas as to how they would like to see the teaching done and we now have a program for the month.

There were some other exciting moments today, like when I couldn't find my passport. We looked everywhere and had a very frustrating visit to the Canadian Embassy. We did have to go there to register, which was fine, but replacing a passport is not easy. I would have to get a police report but neither of the staff members there could tell me where the police station was, what it was called or how to find it. They thought it might be near some other building of nebulous description at the edge of town. The whole discussion took so long we had to move on to our next appointment. Fortunately, the passport did turn up at the only other place where it could be - the tourism office where we picked up our gorilla permits yesterday. I was so ecstatic to receive it - mainly because the burocratic nightmare to replace it would be unthinkable.

So, here's the good things I love about Rwanda: gentle, delightful people; slow pace, no hurry; quiet city - a million people but few private cars, lots of people still on foot; mangos, passion fruit; lush vegetation and flowers everywhere; surprisingly few mosquitos; absolutely perfect air temperature; so much beauty.

These things are not so good: toilets!!!; the showers - you can take a cold shower, with low water pressure, or a hot shower but you have to hold the hand piece AND the switch for the shower at the same time as you squat because there is no where to hang the shower head; beds that are more like hammocks; prices that seem way higher than they should be considering the salaries of people here; things that just don't get fixed.

Genevieve and I are trying to laugh about the plumbing issues because we are very happy to be here and especially to meet the wonderful members of the anesthesia department. They are great folks.

Just last night we were talking to a housemate who will be getting married in four weeks. He invited us to the wedding and told us his family would put us up. They will have 500 guests, which is rather small in Africa as 2,000 would not be usual. This invitation was after knowing Haron for one day! We will be back in Canada by then....

I should add, and it must be obvious, that you cannot go anywhere near a TV or newspaper without seeing Barack Obama. They can hardly wait!!

Hotel des Mille Collines

Genevieve by the pool. They are building a nightclub, hense the construction.

first day in Kigali

This is the view from my balcony at the guesthouse. I woke up to the sound of many birds and otherwise quiet. Genevieve and I spent the day walking around Kigali to get oriented. We walked to the hospital where we will be working tomorrow and downtown. We had lunch at the famous Hotel des Mille Collines. It was so strange to be there, knowing the tragic history.

I am finding it slow to upload photos but will try a few more.

Arrival in Kigali

Genevieve and I have finally arrived in Kigali after what seems an eternity on airplanes. We had a 10 hour layover in London, but took a day room so managed a nap, swim and shower. The 6 hour layover in Nairobi airport was less luxurious but we immediately noticed how much slower the pace is. We spent an interesting hour chatting with a British gentleman who is a retired engineer working for Oxfam. He has been everywhere in Africa and just returned from Somalia where he was assessing a water program. The city he departed was bombed the next day. He was in charge of 350,000 refugees in Tanzania just after the Rwandan genocide. He's a wonderful man and was full of good advice and also praise for Rwanda.

Would it be a cliche to say that from the airplane Rwanda is green and hilly? The customs officer was without doubt the most friendly I've encountered. He was beaming as he welcomed us to Rwanda.

We are now getting settled into the guesthouse and I am far too tired to write anything more. I'm also in need of resucitation as my heart rate is 110 and my oxygen sat is 94.

xxoo Patty