Today will be an interesting day. I am hanging around the apartment while it is being cleaned. This will be our last night in it as tomorrow we move to a hotel and the apartment becomes home to the new doctor-professor. This afternoon I am invited to be a spectator of the Chamber of Deputies in the office of their Speaker. This is one house of their Parliament and the Speaker is a woman of whom they are deservedly very proud.
My contact is a young lawyer who works as a policy adviser to the Parliament. Sue and I took him out for dinner last night and reflected a bit with him as to the difficulty of maintaining the spirit of these wonderful people together with the demands and discipline of organization, accountability, participation, honoring of differences and eventually unity of purpose. This is a journey they are on and have not yet accomplished. However, the dream of building something of real value for their children from the wreckage of their parents is truly captivating. The genesis of the genocide at least in part was the past failure to fully appreciate and honor those organizational efforts toward inclusion however megere they may have been. Eventually the Hutus and Tutsis lost hope in those institutions and resorted to name calling, stereotyping, and eventually violence.
When it comes to these hard tasks the spirit is willing but the flesh is weak. We want to believe that somehow intuitively answers to our differences can just show up because we believe so strongly in the spirit. None of us like rules of procedure, committee work, submission to authority of leaders, agendas for discussion, etc. However, without the hard work of the flesh...the organization of ourselves to honor differences, debate viewpoints, so that all are honestly heard, not just those who like to hear themselves speak, holding each other accountable, and jointly finding unity of purpose...we seem to fall into the predictable divisions. Sounds a lot like our problems organizing churches, businesses, schools, and government, doesn't it?
God's love,
dlm
Thursday, March 31, 2011
Sunday, March 27, 2011
Habituated
This weekend we had planned to visit the Nyungwe Forest and hoped to see a large troop of "habituated" chimpanzees. But, alas, several things happened to prevent the trip; an appointment for Doug on Friday, (which was later canceled,) a bout of gastrointestinal rapid transit, and the RAINY SEASON! Nyungwe Forest is a rain forest, and the local people looked amused when I told them of our plan.
Instead we visited Lake Kivu at Gisenyi, close to the border with Democratic Republic of Congo. We stayed in a lovely hotel room with a view out over the lake, a good solid bed, and a "real" shower. The only glitch was that we had not gotten visas for the DRC, and today when we tried to cross the border into Goma, we were told we would have to go back to Kigali(a three hour bus ride)and speak to the embassy on Monday in order to qualify. Doug made a run at the official to stamp our passports, but she didn't budge. Oh well, we saw the Congo even though we didn't actually set foot in it.
On the bus ride home from Gisenyi, I was thinking about that word, habituated. Applied to the chimpanzees, it means they have seen enough humans to be undisturbed by them and to behave normally in their presence. I believe I have been habituated to several things while living in Africa these last six weeks:
1.Sleeping in a mosquito net and more importantly getting out of it to the bathroom
2.Smelling the pungent body odor in a bus loaded with damp human beings
3.Soup for breakfast in hotels, usually left over from dinner the night before
4.The 5 a.m. call of the muzzein for the local mosque
5.Saving napkins from restaurants for future use as toilet paper or towels
None of these behaviors seem unusual to me, although they took some getting used to. I suppose when I return to the U.S. I'll have to be re-habituated to America...
Instead we visited Lake Kivu at Gisenyi, close to the border with Democratic Republic of Congo. We stayed in a lovely hotel room with a view out over the lake, a good solid bed, and a "real" shower. The only glitch was that we had not gotten visas for the DRC, and today when we tried to cross the border into Goma, we were told we would have to go back to Kigali(a three hour bus ride)and speak to the embassy on Monday in order to qualify. Doug made a run at the official to stamp our passports, but she didn't budge. Oh well, we saw the Congo even though we didn't actually set foot in it.
On the bus ride home from Gisenyi, I was thinking about that word, habituated. Applied to the chimpanzees, it means they have seen enough humans to be undisturbed by them and to behave normally in their presence. I believe I have been habituated to several things while living in Africa these last six weeks:
1.Sleeping in a mosquito net and more importantly getting out of it to the bathroom
2.Smelling the pungent body odor in a bus loaded with damp human beings
3.Soup for breakfast in hotels, usually left over from dinner the night before
4.The 5 a.m. call of the muzzein for the local mosque
5.Saving napkins from restaurants for future use as toilet paper or towels
None of these behaviors seem unusual to me, although they took some getting used to. I suppose when I return to the U.S. I'll have to be re-habituated to America...
Thursday, March 24, 2011
LEADERSHIP
These days I almost always include a walk to city center for a cup of coffee at Boubon Street Coffee Company. On the way I commonly encounter a multitude of unfortunate souls asking for money. It is not uncommon for children to call out after me something like, "give me money." My ultimate role in both organizations I am striving to help is that of giving. The entire subject is difficult for me...to say the least.
On my return to the apartment today I had become steeled to the vendors of magazines, the people asking for money, and was pretty much inside myself when I heard someone say "How are you?" It was a very nice young man who just wanted my company during the walk. He shared his hope for the future of his country and his love of the people. I agreed on both points and then posed the question I have been dying to ask. In my few travels I have been exposed to a number of cultures and have never found people so loving and kind as those in this country. How can it be that this, of all countries, experienced the genocide of one tenth of its population in ninety days?
Augustine took his breath in and then said he believed it was the leadership of the country. He described how artfully the past leaders had stirred up those resentments we all have and how they simply created an atmosphere of hate between brothers. I thanked him for the explanation and in response to his question whether I understood I told him I really can't because I simply didn't live through their experience.
As I walked up the stairs a few moments ago I couldn't help but reflect upon some of my faltering efforts at leadership during the past few years. I do think the Rwandan experience is far more complex than even Augustine believes. However, it is truly a challenge when leading others to nurture and grow those positive qualities between ourselves and to avoid using our differences as a method of accomplishing personal goals.
None of us is perfect. That includes the Rwandans and those leading the orgznizations I serve. Can I devote my day to generous giving both of "my" money and whatever time and talent I have left? I guess the alternative is selfish ambition, deviciveness, hate, exploitation and ultimately what happened here seventeen years ago.
dlm
On my return to the apartment today I had become steeled to the vendors of magazines, the people asking for money, and was pretty much inside myself when I heard someone say "How are you?" It was a very nice young man who just wanted my company during the walk. He shared his hope for the future of his country and his love of the people. I agreed on both points and then posed the question I have been dying to ask. In my few travels I have been exposed to a number of cultures and have never found people so loving and kind as those in this country. How can it be that this, of all countries, experienced the genocide of one tenth of its population in ninety days?
Augustine took his breath in and then said he believed it was the leadership of the country. He described how artfully the past leaders had stirred up those resentments we all have and how they simply created an atmosphere of hate between brothers. I thanked him for the explanation and in response to his question whether I understood I told him I really can't because I simply didn't live through their experience.
As I walked up the stairs a few moments ago I couldn't help but reflect upon some of my faltering efforts at leadership during the past few years. I do think the Rwandan experience is far more complex than even Augustine believes. However, it is truly a challenge when leading others to nurture and grow those positive qualities between ourselves and to avoid using our differences as a method of accomplishing personal goals.
None of us is perfect. That includes the Rwandans and those leading the orgznizations I serve. Can I devote my day to generous giving both of "my" money and whatever time and talent I have left? I guess the alternative is selfish ambition, deviciveness, hate, exploitation and ultimately what happened here seventeen years ago.
dlm
Tuesday, March 22, 2011
African tenacity
Half my teaching time has passed...there is so much material and so little time! Monday we had our third of four "academic" days, with lecture/case presentation/discussion. I have become accumstomed to the individual approaches of the residents--one always questions my explanations, one nods approvingly, one falls asleep when the lights are down. I hope they are retaining what they hear, but more importantly I hope they can apply this new knowledge to patients. A patient in the recovery room developed post-operative acute renal failure just three days after we discussed this problem and how to avoid it in class. We discuss how to approach a particular anesthetic challenge, then a few hours later I watch as a different approach is used. And, I realize that I haven't even scratched the surface of role modeling for them, of getting them to reflect on their strengths and weaknesses, or of creating opportunities for them to practice specific skills.
So, like many experiences in Rwanda, teaching anesthesia is not as easy as I would like. Also not easy are washing clothes, keeping your shoes clean, driving to a remote village, finding a job after graduation, deciding how to deal with a street kid, avoiding traveller's diarrhea, or finding an entree' that doesn't feature goat meat. I am in awe of the Rwandans who deal with these inconveniences, as well as the huge burden of their past, and keep smiling, keep trying, keep putting one foot in front of the other. The least I can do is hang in there.
We had an experience Saturday of African tenacity in action. We were being driven to place where a local Rwandan pastor has organized widows to sew clothing and make jewelery to give themselves an income. The building is about three miles from the main road on a dirt track. Six people crammed into a small Toyota pickup truck, and a heavy rain storm--soon the road was only muddy ruts. Our truck had four wheel drive, but it wasn't working...The truck got stuck, spun its wheels, slid sideways and ended up firmly against a mud wall. People arrived with a shovel and a hoe and began chopping away at the mud. Several more attempts to get out of the ditch ended without success. A group of young men from the market arrived and offered to "lift" the truck out of the ditch, but only after a price had been negotiated. They proceeded to bounce on the bumper, directing the driver to "step on the gas." Finally, our leader proposed that we strike out on foot, and leave the driver and truck to the crowd to deal with. Soon, we heard a cheer from behind, and turned to see the truck sliding down the track with the group of men standing in the back waving and flexing their muscles. The driver actually picked us up, drove another two miles on the muddy, rutted road, and then while we visited the widows he drove back to town to wash the truck inside and out so it would be presentable to drive us home. In Rwanda you wash your truck with a wet rag, because there is no hose. Needless to say, he got a big tip...
So, like many experiences in Rwanda, teaching anesthesia is not as easy as I would like. Also not easy are washing clothes, keeping your shoes clean, driving to a remote village, finding a job after graduation, deciding how to deal with a street kid, avoiding traveller's diarrhea, or finding an entree' that doesn't feature goat meat. I am in awe of the Rwandans who deal with these inconveniences, as well as the huge burden of their past, and keep smiling, keep trying, keep putting one foot in front of the other. The least I can do is hang in there.
We had an experience Saturday of African tenacity in action. We were being driven to place where a local Rwandan pastor has organized widows to sew clothing and make jewelery to give themselves an income. The building is about three miles from the main road on a dirt track. Six people crammed into a small Toyota pickup truck, and a heavy rain storm--soon the road was only muddy ruts. Our truck had four wheel drive, but it wasn't working...The truck got stuck, spun its wheels, slid sideways and ended up firmly against a mud wall. People arrived with a shovel and a hoe and began chopping away at the mud. Several more attempts to get out of the ditch ended without success. A group of young men from the market arrived and offered to "lift" the truck out of the ditch, but only after a price had been negotiated. They proceeded to bounce on the bumper, directing the driver to "step on the gas." Finally, our leader proposed that we strike out on foot, and leave the driver and truck to the crowd to deal with. Soon, we heard a cheer from behind, and turned to see the truck sliding down the track with the group of men standing in the back waving and flexing their muscles. The driver actually picked us up, drove another two miles on the muddy, rutted road, and then while we visited the widows he drove back to town to wash the truck inside and out so it would be presentable to drive us home. In Rwanda you wash your truck with a wet rag, because there is no hose. Needless to say, he got a big tip...
Sunday, March 20, 2011
ISAAC IS 11 YEARS OLD
Today I went to church alone as Sue is recovering from a foot injury. I went to the store afterward and was returning to the apartment with a load of goodies on my back when I heard a friendly voice by my left elbow say in perfect English, "Where are you from?" I looked down and saw one of those classic children. Beautiful brown eyes. Open Smile. Matching me stride for stride even though about a foot and a half shorter. His name is Isaac, he is 11 years old; my name is Douglas and I am very old.
We struck up a conversation and I asked him where he was from. A small town just this side of Congo, where the gorillas live. Had I seen the gorillas? Yes, we both had. What is he doing by himself in Kigali? Walking. Is he in school? No, never. How did he learn such good English? Speaking to tourists. He can speak Spanish also. He can read and write very little and cannot do math, since he has never been in school. How did he come to walk with me through Kigali? Well, the flood gates opened. His father was killed in a genocide; his mother died shortly afterward. He has been raised by his auntie who beats him and refuses to use his father's money to send him to school. Most recently she called a driver to take him to Kigali. He did so and dumped him out, beating him to get him to leave the vehicle. On his back he carried a pack with all his earthly possessions: a stocking cap, two bibles, and some other unidentified written material, all of which had belonged to his mom.
Well, what does one do with that? I took him to the apartment, fed him some lunch, and called a friend who came over and interviewed him. I was told that the story had meaning. There have been outbreaks of genocide along the border when bad guys come from the Congo across the border, inflict injuries and death and then leave back into the jungle. We must take him to the police to report the crime involving his auntie. Off we went.
The scene changes to a series of mud brick buildings inhabited by uniformed police who take the story from the child time after time. He didn't miss a beat. Never saw a tear or a look of fear. Just trust and openness. When last I saw him he was in an officer's office along with two prisoners who possessed the worse case of body odor I have witnessed since the base camp at Kilimanjaro. Still not a falter. We wished each other God's blessing and I left. How brave can a child be? He is headed to his hometown to confront and prosecute his auntie.
I reflected on my blog this morning how overloaded this entire country must be when it comes to these orphaned children. Can you imagine what we would do if ten percent of our population was homeless, orphaned and under age? I guess it isn't a bit surprising if they engage in a fair amount of denial when it comes to this subject.
dlm
We struck up a conversation and I asked him where he was from. A small town just this side of Congo, where the gorillas live. Had I seen the gorillas? Yes, we both had. What is he doing by himself in Kigali? Walking. Is he in school? No, never. How did he learn such good English? Speaking to tourists. He can speak Spanish also. He can read and write very little and cannot do math, since he has never been in school. How did he come to walk with me through Kigali? Well, the flood gates opened. His father was killed in a genocide; his mother died shortly afterward. He has been raised by his auntie who beats him and refuses to use his father's money to send him to school. Most recently she called a driver to take him to Kigali. He did so and dumped him out, beating him to get him to leave the vehicle. On his back he carried a pack with all his earthly possessions: a stocking cap, two bibles, and some other unidentified written material, all of which had belonged to his mom.
Well, what does one do with that? I took him to the apartment, fed him some lunch, and called a friend who came over and interviewed him. I was told that the story had meaning. There have been outbreaks of genocide along the border when bad guys come from the Congo across the border, inflict injuries and death and then leave back into the jungle. We must take him to the police to report the crime involving his auntie. Off we went.
The scene changes to a series of mud brick buildings inhabited by uniformed police who take the story from the child time after time. He didn't miss a beat. Never saw a tear or a look of fear. Just trust and openness. When last I saw him he was in an officer's office along with two prisoners who possessed the worse case of body odor I have witnessed since the base camp at Kilimanjaro. Still not a falter. We wished each other God's blessing and I left. How brave can a child be? He is headed to his hometown to confront and prosecute his auntie.
I reflected on my blog this morning how overloaded this entire country must be when it comes to these orphaned children. Can you imagine what we would do if ten percent of our population was homeless, orphaned and under age? I guess it isn't a bit surprising if they engage in a fair amount of denial when it comes to this subject.
dlm
Saturday, March 19, 2011
BROTHERS AND SISTERS
Yesterday was March 19th. As it happens that is the birthday of my sister, Janet. Congratulations, big sister! I hope you had a great day. You will always be one of the most important people in my life and, though time and distance have certainly altered the landscape, the geography remains the same.
Yesterday also was a day to meet with the homeless orphans who are now positioned to complete their six month training. They have lived on the streets together as a large family unit looking out for one another in a world that has largely denied their existence. Ten percent of the population of this country can be described as homeless and orphaned. Yet, when asked, the staff members at PFR say they do not go to church because they have no home; their families are fractured or nonexistent; their government makes it a crime to live on the streets...the only home they know. Now they graduate with hopes and dreams and a few skills that may equip them for employment. I do pray it works for them.
These young men and women are excited but quite challenged. Where will they live, how will they acquire the tools of their new trades, who will accept and love them? Somehow those questions remain the same as they were a year ago when we began this effort to train them.
My time in Africa is coming to a close. I can feel myself moving back emotionally to America already. In America I am part of a church that is attempting to welcome people as they come out of jail and prison; it is attempting to reach out to kids from broken families (I heard the figure of 80% of the kids in some Portland schools are living without a father figure in their homes); and to be brothers and sisters in the lives of those less fortunate. The attempts are anything but perfect. Yet they are undoubtedly close to the heart of God. My hope is that somehow some of that energy could be found here. Why can't these young people have local families from churches and elsewhere that embrace them as they attempt the task ahead of them?
This next week I will meet with the administrative staff at PFR to discuss the future of the scholarship program and other issues. Please pray for God's continued direction. It would be wonderful if the practical needs of these wonderful young people could be found in the family of God. But we all need to see what is before us. These and those after all are our brothers and sisters.
dlm
Yesterday also was a day to meet with the homeless orphans who are now positioned to complete their six month training. They have lived on the streets together as a large family unit looking out for one another in a world that has largely denied their existence. Ten percent of the population of this country can be described as homeless and orphaned. Yet, when asked, the staff members at PFR say they do not go to church because they have no home; their families are fractured or nonexistent; their government makes it a crime to live on the streets...the only home they know. Now they graduate with hopes and dreams and a few skills that may equip them for employment. I do pray it works for them.
These young men and women are excited but quite challenged. Where will they live, how will they acquire the tools of their new trades, who will accept and love them? Somehow those questions remain the same as they were a year ago when we began this effort to train them.
My time in Africa is coming to a close. I can feel myself moving back emotionally to America already. In America I am part of a church that is attempting to welcome people as they come out of jail and prison; it is attempting to reach out to kids from broken families (I heard the figure of 80% of the kids in some Portland schools are living without a father figure in their homes); and to be brothers and sisters in the lives of those less fortunate. The attempts are anything but perfect. Yet they are undoubtedly close to the heart of God. My hope is that somehow some of that energy could be found here. Why can't these young people have local families from churches and elsewhere that embrace them as they attempt the task ahead of them?
This next week I will meet with the administrative staff at PFR to discuss the future of the scholarship program and other issues. Please pray for God's continued direction. It would be wonderful if the practical needs of these wonderful young people could be found in the family of God. But we all need to see what is before us. These and those after all are our brothers and sisters.
dlm
Friday, March 18, 2011
I HAVE BEEN TO THE MOUNTAIN
It is true. I made it to the top of Kilimanjaro. Just barely. Some people say their lives are forever different once they reached the summit. I seriously doubt that will be true for mine...it is pretty special though.
We have now been in Africa one month. The first two weeks were doing the photo safari and the climb. Sue then came to Kigali for her teaching gig and I took a series of buses through Kenya, Uganda, Rwanda and this week Burundi. Including Tanzania, our first country this year, I have now been all five of the East African coalition countries. What an amazing place and what a privilege.
This week I touched base with the staff at Prison Fellowship Rwanda and was greeted with about as much love as I have ever witnessed. Feelings run deep around here and everyone is so grateful to you all who helped fund the schooling project. Sue and I will visit the school tomorrow, then if time permits join Steven who is Kelly Bean's good friend. He is setting up a clinic with one of Sue's colleagues to try to help the women he serves who suffer from HIV/AIDS.
I went for a walk this morning along the route I jogged last year. A young man who cheered me on last year came up to me and asked if I was going to do "sport" again this year. I explained that I had just had surgery on both knees and had to be careful about sport these days. He broke into a big smile, gave me a Rwandan handshake and loudly proclaimed his prayer for God's blessing in my life. Can you believe that...these folks really do know how to love one another!
So, just to complete a thought...I wish God's blessing on all you who may read this. Whatever mountains you may be climbing He is definitely at the top.
dlm
We have now been in Africa one month. The first two weeks were doing the photo safari and the climb. Sue then came to Kigali for her teaching gig and I took a series of buses through Kenya, Uganda, Rwanda and this week Burundi. Including Tanzania, our first country this year, I have now been all five of the East African coalition countries. What an amazing place and what a privilege.
This week I touched base with the staff at Prison Fellowship Rwanda and was greeted with about as much love as I have ever witnessed. Feelings run deep around here and everyone is so grateful to you all who helped fund the schooling project. Sue and I will visit the school tomorrow, then if time permits join Steven who is Kelly Bean's good friend. He is setting up a clinic with one of Sue's colleagues to try to help the women he serves who suffer from HIV/AIDS.
I went for a walk this morning along the route I jogged last year. A young man who cheered me on last year came up to me and asked if I was going to do "sport" again this year. I explained that I had just had surgery on both knees and had to be careful about sport these days. He broke into a big smile, gave me a Rwandan handshake and loudly proclaimed his prayer for God's blessing in my life. Can you believe that...these folks really do know how to love one another!
So, just to complete a thought...I wish God's blessing on all you who may read this. Whatever mountains you may be climbing He is definitely at the top.
dlm
Tuesday, March 15, 2011
Rwandan hospitality
We have had many lovely experiences of Rwandan hospitality. On Friday, Cristof, one of the apartment guards, knocked on the door and told me that I must buy electricity. I told him that I bought electricity the first night I arrived, and he shrugged and said "you only have three left." Three kilowatts, three hours, three minutes?? I decided to take his advice. In small shops along the main road in our neighborhood, you can "buy" electricity. In exchange for francs, they give you a code that can be entered into your electric meter and this allows you to have power. As I walked toward the street, Cristof called after me "are you going to buy electricity?" "Mind your own business," I thought tersely. "You must have the paper with the account number!" He smiled sweetly as I trudged back up the stairs to get the necessary information.
I went to the place I had bought electricity before. The young girl with the laptop greeted me like an old friend. A woman I had not seen before was behind the counter, apparently the girl's mother. I murmured "bonjour" and was overwhelmed by a barrage of French. Young girl helped me out by translating. Her mother's name is Bertilde, and the daughter's name is Coretta. When I told them my name is Susan, the mother almost burst with happiness...her mother's name is also Susan. After some more small talk, Bertilde invited me to come visit them in their home, "nous habiton pres du ici," we live near here. We settled on Sunday for the visit.
Returning from the electricity store, a man walking with a crutch said "Good day." I greeted him in return. We began a conversation about what I was doing in Rwanda, and about America. He knows someone in Ohio. His name polysyllabic name in Kinyarwanda translates into "King" in English. He asked for my cell phone, then put his name and number in my contacts list. Apparently collecting contacts in a cell phone is the equivalent of Facebook here.
Doug and I were walking at midday Saturday, coming home with groceries. We were hot and his knees were tired, so we decided to sit in the shade of a large flowering tree by the road. An elderly woman wearing a royal blue knee length coat was sweeping blossoms and dust off the pavement. There are an army of these cleaners who sweep the streets, wet mop the rain ditches, and tend to roadside plantings. She looked alarmed as we sat on a concrete wall to rest. We thought she was about to shoo us away, but instead she retrieved two paper bags from her trash collection. Smoothing them out carefully, she motioned to Doug to stand up, and put it on the wall where he had been sitting, then did the same for me! We smiled and had a brief exchange in sign language. She grimaced and rubbed her stomach. I pulled out a liter of juice we had bought and offered it to her. What a smile!! She took it and carefully put it away inside a small shelter close to the road. After we finished resting, we waved to her and said au revoir. She replied in English "Bye Bye."
Sunday morning we were walking home from church and I decided to check out a little dairy shop we had seen along the road. We peeked in the doorway but only saw two women sitting in chairs, so we concluded that we had misinterpreted the sign. Just then a sharply dressed young man said "can I help you find something?" He introduced himself as Aristote, and explained that the two women were in fact selling milk. We were looking for cheese, and they had none, but Aristote told us we could get cheese in a small grocery down the street. He walked us to the store and introduced us to Eric, the shop keeper. Eric had run out of cheese, but he said he could call and get some in one hour. We said we could come back tomorrow, and had some other shopping to do. We needed an adapter for a certain type of plug on the coffee pot in the apartment. Eric pulled a box from under the counter and dug through cables, wires, remote controls for TVs and fished out a plug adapter that was attached to a cell phone charger. Would we like to have this one? Free for his new American friends. When we insisted on paying for it, he found another one.
Meanwhile Aristote wanted Doug's cell phone to get his number. I went back to the apartment to get the phone and we exchanged numbers and cards, and have now had two emails from him inviting us to visit Parliament, where he works researching legal issues.
We've traveled to many places around the world, but have never had the genuine hospitality that we experience in Rwanda. It isn't always lavish or fancy, but it is sincere. The sincere offer of a home visit, a plug adapter or a paper bag to sit on is a gift to be treasured.
I went to the place I had bought electricity before. The young girl with the laptop greeted me like an old friend. A woman I had not seen before was behind the counter, apparently the girl's mother. I murmured "bonjour" and was overwhelmed by a barrage of French. Young girl helped me out by translating. Her mother's name is Bertilde, and the daughter's name is Coretta. When I told them my name is Susan, the mother almost burst with happiness...her mother's name is also Susan. After some more small talk, Bertilde invited me to come visit them in their home, "nous habiton pres du ici," we live near here. We settled on Sunday for the visit.
Returning from the electricity store, a man walking with a crutch said "Good day." I greeted him in return. We began a conversation about what I was doing in Rwanda, and about America. He knows someone in Ohio. His name polysyllabic name in Kinyarwanda translates into "King" in English. He asked for my cell phone, then put his name and number in my contacts list. Apparently collecting contacts in a cell phone is the equivalent of Facebook here.
Doug and I were walking at midday Saturday, coming home with groceries. We were hot and his knees were tired, so we decided to sit in the shade of a large flowering tree by the road. An elderly woman wearing a royal blue knee length coat was sweeping blossoms and dust off the pavement. There are an army of these cleaners who sweep the streets, wet mop the rain ditches, and tend to roadside plantings. She looked alarmed as we sat on a concrete wall to rest. We thought she was about to shoo us away, but instead she retrieved two paper bags from her trash collection. Smoothing them out carefully, she motioned to Doug to stand up, and put it on the wall where he had been sitting, then did the same for me! We smiled and had a brief exchange in sign language. She grimaced and rubbed her stomach. I pulled out a liter of juice we had bought and offered it to her. What a smile!! She took it and carefully put it away inside a small shelter close to the road. After we finished resting, we waved to her and said au revoir. She replied in English "Bye Bye."
Sunday morning we were walking home from church and I decided to check out a little dairy shop we had seen along the road. We peeked in the doorway but only saw two women sitting in chairs, so we concluded that we had misinterpreted the sign. Just then a sharply dressed young man said "can I help you find something?" He introduced himself as Aristote, and explained that the two women were in fact selling milk. We were looking for cheese, and they had none, but Aristote told us we could get cheese in a small grocery down the street. He walked us to the store and introduced us to Eric, the shop keeper. Eric had run out of cheese, but he said he could call and get some in one hour. We said we could come back tomorrow, and had some other shopping to do. We needed an adapter for a certain type of plug on the coffee pot in the apartment. Eric pulled a box from under the counter and dug through cables, wires, remote controls for TVs and fished out a plug adapter that was attached to a cell phone charger. Would we like to have this one? Free for his new American friends. When we insisted on paying for it, he found another one.
Meanwhile Aristote wanted Doug's cell phone to get his number. I went back to the apartment to get the phone and we exchanged numbers and cards, and have now had two emails from him inviting us to visit Parliament, where he works researching legal issues.
We've traveled to many places around the world, but have never had the genuine hospitality that we experience in Rwanda. It isn't always lavish or fancy, but it is sincere. The sincere offer of a home visit, a plug adapter or a paper bag to sit on is a gift to be treasured.
Monday, March 14, 2011
Tough day
Thursday was a tough day. I was working with a resident in the Maternity operating room. We had finished two cases but an urgent C section arose in a woman with preeclampsia (toxemia.) Her blood pressure was very high and the equipment to do the medically preferable anesthetic was not available. I spent some time reviewing why the anesthetic we were going to do was not the best choice, then we went ahead and did it anyway.
After that we had a case of hysterectomy for cervical cancer. Things were going routinely when I heard the staff surgeon ask for suction. He asked three times urgently, and I looked over the drape to see the surgical field filling with blood. The surgeons couldn't find the bleeding tissues because the suction was not available, one of the lights was not functioning, and as they struggled, the patient lost a lot of blood. I called for help and two fine anesthetic technicians, the resident and I spent the next 90 minutes bringing this patient back from hemorrhagic shock. After things were better, the surgeon looked at me and said "We are struggling here, we have no light. I am sorry. Thank you for your efforts."
Next we were called to help start an IV in a young man who has sickle cell anemia. The resident and I together spent almost two hours trying every vein imaginable, including his scalp veins, but without success. This man had had multiple IVs and all his veins were clotted, inflamed or already used. In the U.S. we would have placed a special IV into a large central vein. But in Kigali they don't have the sort of catheters used for such IVs.
We were discouraged and about to sit for "lunch" at 3:00 pm when a nurse came running down the corridor asking for help in the Maternity ward. A patient 25 weeks pregnant was agitated and gasping for breath, in pulmonary edema. We placed a breathing tube, began treatment, and called to transfer her to Intensive Care. We were told there was no bed and no ventilator available. I ventilated her by hand with a ventilating bag for two hours, and finally we could move her to ICU. When we arrived, the ventilator was attached and nothing happened--it didn't work. I ventilated her again by hand for another hour as a different patient was removed from his ventilator to give to the new patient.
This is the everyday experience of doctors in Rwanda. Having second or third choice options for treatment, struggling with nonfunctioning equipment, lacking the one small medical item that would make a hard case simple, and having to choose between patients for a scarce ventilator or even deciding not to put an ETT tube in a patient who needs one because there is no ventilator available.
How can I even begin to understand these dilemmas? I think of myself as a "patient advocate" but I have never had to endanger one patient in order to treat another. How can I judge outcomes of care in Africa? I have always had the drugs and supplies at hand to give the best possible treatment. How can I teach the anesthesia residents to weigh their choices of anesthetic when they have no options? How can we review cases with poor outcomes when we don't have the vital signs or lab data to explain the downward spiral?
The residents are realistic about such experiences; they persevere in spite of difficulty and continue to care for the patients in adverse circumstances. I try to speculate with them: "What would be the possible causes of cardiac arrest in a patient with a head injury?" "How could we provide anesthesia for this very sick patient if we had any choice of drugs and equipment?"
Today I had lunch with Adolphe, a first year anesthesia resident. I asked him why he chose to study anesthesia. He told me that during three years after medical school he worked in a district hospital and saw "many deaths due to anesthesia." He wants to concentrate on anesthesia so patients can have a better chance of surviving their operations. I have a growing admiration for these doctors--I am amazed at their endurance, their buoyancy, their continued drive for improvement. I hope I can add something of value in my time here. The least I can do is to stand with them as we work and encourage their development. And, walk a mile in their shoes, even on the tough days.
After that we had a case of hysterectomy for cervical cancer. Things were going routinely when I heard the staff surgeon ask for suction. He asked three times urgently, and I looked over the drape to see the surgical field filling with blood. The surgeons couldn't find the bleeding tissues because the suction was not available, one of the lights was not functioning, and as they struggled, the patient lost a lot of blood. I called for help and two fine anesthetic technicians, the resident and I spent the next 90 minutes bringing this patient back from hemorrhagic shock. After things were better, the surgeon looked at me and said "We are struggling here, we have no light. I am sorry. Thank you for your efforts."
Next we were called to help start an IV in a young man who has sickle cell anemia. The resident and I together spent almost two hours trying every vein imaginable, including his scalp veins, but without success. This man had had multiple IVs and all his veins were clotted, inflamed or already used. In the U.S. we would have placed a special IV into a large central vein. But in Kigali they don't have the sort of catheters used for such IVs.
We were discouraged and about to sit for "lunch" at 3:00 pm when a nurse came running down the corridor asking for help in the Maternity ward. A patient 25 weeks pregnant was agitated and gasping for breath, in pulmonary edema. We placed a breathing tube, began treatment, and called to transfer her to Intensive Care. We were told there was no bed and no ventilator available. I ventilated her by hand with a ventilating bag for two hours, and finally we could move her to ICU. When we arrived, the ventilator was attached and nothing happened--it didn't work. I ventilated her again by hand for another hour as a different patient was removed from his ventilator to give to the new patient.
This is the everyday experience of doctors in Rwanda. Having second or third choice options for treatment, struggling with nonfunctioning equipment, lacking the one small medical item that would make a hard case simple, and having to choose between patients for a scarce ventilator or even deciding not to put an ETT tube in a patient who needs one because there is no ventilator available.
How can I even begin to understand these dilemmas? I think of myself as a "patient advocate" but I have never had to endanger one patient in order to treat another. How can I judge outcomes of care in Africa? I have always had the drugs and supplies at hand to give the best possible treatment. How can I teach the anesthesia residents to weigh their choices of anesthetic when they have no options? How can we review cases with poor outcomes when we don't have the vital signs or lab data to explain the downward spiral?
The residents are realistic about such experiences; they persevere in spite of difficulty and continue to care for the patients in adverse circumstances. I try to speculate with them: "What would be the possible causes of cardiac arrest in a patient with a head injury?" "How could we provide anesthesia for this very sick patient if we had any choice of drugs and equipment?"
Today I had lunch with Adolphe, a first year anesthesia resident. I asked him why he chose to study anesthesia. He told me that during three years after medical school he worked in a district hospital and saw "many deaths due to anesthesia." He wants to concentrate on anesthesia so patients can have a better chance of surviving their operations. I have a growing admiration for these doctors--I am amazed at their endurance, their buoyancy, their continued drive for improvement. I hope I can add something of value in my time here. The least I can do is to stand with them as we work and encourage their development. And, walk a mile in their shoes, even on the tough days.
Tuesday, March 8, 2011
Electronically challenged
Sunday evening when I got to the apartment, "Home Sweet Home" for the next month, the young man who guards the building informed my Rwandan driver that we would need to buy electricity, because the meter was low. Apparently whoever watches this had slipped up. We were directed several blocks away to a small cantina with a sign that says in Kinyarwanda, French and English "Buy electricity here." Armed with the number of the account or the meter, I never knew which, I marched into the cantina and looked helpless. That seems to work well, especially since I am usually the only "Mzungu", white person, in the place. I waved the paper with the numbers and said "electricity" in my best (and only) French accent, and they got the picture. I was directed to a girl about 15 years old at the corner table with a laptop and a printer. The Rwandan driver decided I might need help (I did!) and came into the cantina just in time to run interference for me with an intoxicated local who was practicing his English on me. We left in a hurry and presented the receipt to Venust, the guard, who did his magic and voila, the power is on!!
Then I was unable to figure out how to open the safe. It was the same safe I used last summer, but it now had a new door with a big combination lock, but I had no combination. That might seem like an insignificant problem until you understand that the cell phone and the "stick modem" were in the safe. A stick modem is a USB device that you plug into your laptop and it gives you dial up Internet access.
Always up for a challenge, I first began thinking of people I could call to ask how to open the safe. Oh yeah, no phone. Then, I thought I would email the coordinator for the volunteers. Oh yeah, no modem. Then, as darkness fell and I realized that I was alone, without a car, phone or Internet, and that I had no way to communicate with the hospital short of walking there, I began to feel some abdominal cramping. My infectious disease doctor friend Tom says that 50% of travelers to the developing world will become ill in the first week, then 50% of the remainder will become ill in the next week, etc. I had been in Africa for 19 days on Sunday, so you can guess what happened next.
Monday morning a driver miraculously appeared to take me to the hospital. I explained my situation to the local staff, and one of them offered his laptop to me. The Internet at the hospital is VERY SLOW, and I was only able to write a quick email to the coordinator before it gave up completely. Later in the day, I could never load messages from my Inbox before the connection "timed out," but I had seen a part of one message from the coordinator that helped me to open the safe Monday evening.
As I settled into bed with my antibiotics close at hand and my cell phone on the charger, I looked to heaven and asked God to bless the Rwandans who manage to greet me warmly, enjoy their friends and maintain their sense of humor in this electronically challenged country.
Then I was unable to figure out how to open the safe. It was the same safe I used last summer, but it now had a new door with a big combination lock, but I had no combination. That might seem like an insignificant problem until you understand that the cell phone and the "stick modem" were in the safe. A stick modem is a USB device that you plug into your laptop and it gives you dial up Internet access.
Always up for a challenge, I first began thinking of people I could call to ask how to open the safe. Oh yeah, no phone. Then, I thought I would email the coordinator for the volunteers. Oh yeah, no modem. Then, as darkness fell and I realized that I was alone, without a car, phone or Internet, and that I had no way to communicate with the hospital short of walking there, I began to feel some abdominal cramping. My infectious disease doctor friend Tom says that 50% of travelers to the developing world will become ill in the first week, then 50% of the remainder will become ill in the next week, etc. I had been in Africa for 19 days on Sunday, so you can guess what happened next.
Monday morning a driver miraculously appeared to take me to the hospital. I explained my situation to the local staff, and one of them offered his laptop to me. The Internet at the hospital is VERY SLOW, and I was only able to write a quick email to the coordinator before it gave up completely. Later in the day, I could never load messages from my Inbox before the connection "timed out," but I had seen a part of one message from the coordinator that helped me to open the safe Monday evening.
As I settled into bed with my antibiotics close at hand and my cell phone on the charger, I looked to heaven and asked God to bless the Rwandans who manage to greet me warmly, enjoy their friends and maintain their sense of humor in this electronically challenged country.
Monday, March 7, 2011
Security and Insecurity
I was walking down to the Western-style grocery in Mombasa a few days ago, and I had a strange experience. All along the way, people greeted me, calling out "Jambo", the Swahili equivalent of "Hi, how's it going?" Small three wheeled golf-cart-like vehicles called tuk-tuks whizzed by, honking a tiny horn and beckoning me to sit down and let them take me where I wanted to go. Some drivers even called out "Nakumatt?," the name of the grocery at the mall. (There aren't many Kenyans out walking in the midday heat, and we tourists are all headed to the mall.)
In spite of the heat and humidity, I was feeling good. The effect of looking at the ocean is calming, and we had been resting for several days. I smiled and waved back at the greetings, said "No, Thank you" to the tuk-tuk offers, and finally made it to the mall after twenty minutes dripping sweat.
My goal at the mall was the ATM. I wanted to withdraw some Kenya Shillings to pay off the hotel and get Doug a little cushion for his overland trip to Uganda. As I walked toward a group of ATMs I began to take notice of the people standing about, drinking a Coke or reading the newspaper. I began to wonder if they were watching me. I began to feel like a sitting duck. The first ATM rejected my card. As I crossed over to the second one, I caught a glimpse of two men watching me. I felt uneasy. All the 60 Minutes episodes about scams and cons in Africa were bubbling up in my mind. I quickly tried the second machine. Again, it rejected my card. By now I was a little shaken; part of me hoped to get the cash, and part of me was afraid to walk out through that crowd having just gotten the cash! The two men were just out of my field of vision, but I sensed them there.
Finally the third machine spit out a receipt, my card, and 20,000 Kenyan Shillings--it isn't as impressive as it sounds, only worth about $250. But it is definitely a wad of bills. I nervously stuffed them into my neck pouch, slipped it under my shirt, and turned to face the two men. Only then did I see their uniforms...they were security guards watching over people like me doing ATM transactions. At banks, hotel entrances, even in pharmacies there are often these guards, sometimes armed, but providing a very valuable hedge against being mugged.
My feelings of security or insecurity are sharper when I'm in a foreign culture. On the way home I couldn't help being a little more restrained in greeting the people by the roadside. That wad of Shillings represented for me a thing that needed protection--I was no longer free to relate to people without suspicion and reserve. What a clear picture of how possessions come between us!
This is not a simple subject and I won't give you some bottom line that I figured it all out on the walk home. It certainly has caused me to reflect on the meaning of security and on how I relate to strangers--and what is most important to me. The next day a man named Sultan attached himself to Doug and I as we walked on the Mombasa waterfront. He wanted to be our "guide" although he wasn't in his uniform because it was Saturday. He actually said "I am not a cheat. This is my job." He had a few facts, and he eventually wheedled his way into showing us a shortcut back to our bus stop.
As we said goodbye to Sultan and gave him a small amount of cash for his trouble, I again reflected on how money and money's worth can either divide people or bring them into relationship. One of my good memories of Mombasa will be of Sultan...
In spite of the heat and humidity, I was feeling good. The effect of looking at the ocean is calming, and we had been resting for several days. I smiled and waved back at the greetings, said "No, Thank you" to the tuk-tuk offers, and finally made it to the mall after twenty minutes dripping sweat.
My goal at the mall was the ATM. I wanted to withdraw some Kenya Shillings to pay off the hotel and get Doug a little cushion for his overland trip to Uganda. As I walked toward a group of ATMs I began to take notice of the people standing about, drinking a Coke or reading the newspaper. I began to wonder if they were watching me. I began to feel like a sitting duck. The first ATM rejected my card. As I crossed over to the second one, I caught a glimpse of two men watching me. I felt uneasy. All the 60 Minutes episodes about scams and cons in Africa were bubbling up in my mind. I quickly tried the second machine. Again, it rejected my card. By now I was a little shaken; part of me hoped to get the cash, and part of me was afraid to walk out through that crowd having just gotten the cash! The two men were just out of my field of vision, but I sensed them there.
Finally the third machine spit out a receipt, my card, and 20,000 Kenyan Shillings--it isn't as impressive as it sounds, only worth about $250. But it is definitely a wad of bills. I nervously stuffed them into my neck pouch, slipped it under my shirt, and turned to face the two men. Only then did I see their uniforms...they were security guards watching over people like me doing ATM transactions. At banks, hotel entrances, even in pharmacies there are often these guards, sometimes armed, but providing a very valuable hedge against being mugged.
My feelings of security or insecurity are sharper when I'm in a foreign culture. On the way home I couldn't help being a little more restrained in greeting the people by the roadside. That wad of Shillings represented for me a thing that needed protection--I was no longer free to relate to people without suspicion and reserve. What a clear picture of how possessions come between us!
This is not a simple subject and I won't give you some bottom line that I figured it all out on the walk home. It certainly has caused me to reflect on the meaning of security and on how I relate to strangers--and what is most important to me. The next day a man named Sultan attached himself to Doug and I as we walked on the Mombasa waterfront. He wanted to be our "guide" although he wasn't in his uniform because it was Saturday. He actually said "I am not a cheat. This is my job." He had a few facts, and he eventually wheedled his way into showing us a shortcut back to our bus stop.
As we said goodbye to Sultan and gave him a small amount of cash for his trouble, I again reflected on how money and money's worth can either divide people or bring them into relationship. One of my good memories of Mombasa will be of Sultan...
Thursday, March 3, 2011
"Chilling" out in Mombasa
Sorry about not posting anything recently, but we've been basically camping for the last two weeks, either in an airport, in the Serengeti or on Mount Kilimanjaro.
The safari was incredible, and we saw and photographed all of the "Big Five;" Lion, Leopard, Cape Buffalo, Elephant and Rhino. Our guide Pesa was quiet, persistent and very experienced--when we hadn't seen a rhino yet and it was our last day, he drove all over the Ngorongoro Crater and eventually found one, which was not at all afraid of the vehicles and even charged one of them. Doug has fabulous pics of all these animals, even the leopard in the tree. We were told it is very hard to see a leopard and so we were very lucky. I'll second that!
The trek on Kilimanjaro was an amazing experience, even though I wimped out and didn't make it to the summit. Doug did summit, and has a certificate to prove it! Seven days of slowly working our way up from about 5000 feet to 15000 feet, then a midnight push to the summit. Our Camelback water systems froze in the first hour. I was wearing five layers on top, three layers on bottom, and a ski mask, gloves, etc. and was still freezing! The temperatures got colder as we ascended, and finally a combination of nausea, headache and, frankly, fear made me turn back. I got to about 16500 feet. Doug and the assistant guide continued on and made it to the top just as the sun was rising! They turned around and hiked down hill a total of about 9000 feet elevation loss, total hiking time of 16 hours. Thank God his knees were tired but not injured. (He had bilateral arthroscopy in mid December.)
Now we're "chilling" in Mombasa, at sea level and about 100 degrees, watching the Indian Ocean on our balcony, and getting geared up for the next phase of the trip. As we travel through Africa we are again struck by the warmth and hospitality of the people, the many times they have helped us out, waived the extra baggage fees, allowed us to store things at the hotels, etc. I only hope I would be as kind and generous to strangers as the Africans have been to me.
Will be more regular about posting once I get to Kigali, which will be on the 6th of March.
Sue
The safari was incredible, and we saw and photographed all of the "Big Five;" Lion, Leopard, Cape Buffalo, Elephant and Rhino. Our guide Pesa was quiet, persistent and very experienced--when we hadn't seen a rhino yet and it was our last day, he drove all over the Ngorongoro Crater and eventually found one, which was not at all afraid of the vehicles and even charged one of them. Doug has fabulous pics of all these animals, even the leopard in the tree. We were told it is very hard to see a leopard and so we were very lucky. I'll second that!
The trek on Kilimanjaro was an amazing experience, even though I wimped out and didn't make it to the summit. Doug did summit, and has a certificate to prove it! Seven days of slowly working our way up from about 5000 feet to 15000 feet, then a midnight push to the summit. Our Camelback water systems froze in the first hour. I was wearing five layers on top, three layers on bottom, and a ski mask, gloves, etc. and was still freezing! The temperatures got colder as we ascended, and finally a combination of nausea, headache and, frankly, fear made me turn back. I got to about 16500 feet. Doug and the assistant guide continued on and made it to the top just as the sun was rising! They turned around and hiked down hill a total of about 9000 feet elevation loss, total hiking time of 16 hours. Thank God his knees were tired but not injured. (He had bilateral arthroscopy in mid December.)
Now we're "chilling" in Mombasa, at sea level and about 100 degrees, watching the Indian Ocean on our balcony, and getting geared up for the next phase of the trip. As we travel through Africa we are again struck by the warmth and hospitality of the people, the many times they have helped us out, waived the extra baggage fees, allowed us to store things at the hotels, etc. I only hope I would be as kind and generous to strangers as the Africans have been to me.
Will be more regular about posting once I get to Kigali, which will be on the 6th of March.
Sue
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