Wednesday, March 11

I must say, the Ob/Gyn team is doing amazing things.  They have visited numerous health centers, trained dozens of nurses, and have been well-received.  Their days are not much different from one day to the next in terms of what they actually do.  However, there is no standard of care in Rwanda, so they see how vastly different each clinic is from the next.  Some have electricity, some do not.  Some have water, some do not.  They all share a common theme:  "Please come back and train us some more.  We want to learn." 


One of the great paradoxes we see here is that there is a tenacity and determination in the people and its government.  They are determined that "the story of Rwanda" is not told through the eyes of the 1994 genocide.  They want it to be a story of "rags to riches."  Based on the amount of development that has happened in the nine months since we were here last, it looks like they are on their way.  The paradox is that they have 70% unemployment and they are still ranked as one of the 20 poorest countries in the world. 


Rwanda has much to teach us.  Recently, the US media ran a story about suicides related to the depressed global economy.  When this story was told to a couple of young Rwandans, they responded, “Try living in a refugee camp.”  A large percentage of Rwandans have spent a portion of their lives in refugee camps.


A few quick notes . . .  We had dinner with the wife of Rwanda’s British ambassador.  Great lady.  She is the only ambassador’s spouse who works in Rwanda.  We had dinner at the house of the Medical University’s Family Medicine program director.  The director, his wife, and their friends who joined all have hearts of gold. 


The meals and conversations were very engaging.  Our newest member, Catherine noted tonight that the genocide is the main topic of discussion at every dinner. 


Today, I visited Ecole Belge, a Belgian school, Kigali International Community School, and Greenhills Academy.  All three schools appear to be excellent.  Ecole Belge is French speaking, the other two are English.  Greenhills has the highest percentage of Rwandese students. 


The Rwandan government has decreed that ALL education will be done in English.  Ecole Belge is exempt from this law.  There are an estimated 45,000 teachers in Rwanda who do not speak English.  In order to retain their jobs, they must be fluent (yes, fluent) in English by January 2010.  Greenhills is already teaching in English (they used to be French).  I have a meeting with their director tomorrow over lunch. 


When I arrived at Greenhills today, the security guard spoke to my guide, Claude, in KinyaRwandan.  Then he turned to an errant Rwandese boy and corrected the boy in English.  This happened twice.  It takes discipline to do switch languages like that, especially since everyone around speaks KinyaRwandan.  I was quite impressed. 


Oh, by the way, we have now been without running water for three days.  We are down to the last 10 gallons of clean water in the holding bucket.  We are now planning and strategizing our laundry cleaning, our toilet use, etc.  Luckily, we have friends who are staying in a hotel.

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Oh Gosh!

Oh Gosh!

Tuesday, March 10, 2009

I have not had enough time to blog this week.  Last year we sat around waiting and waiting to get going.  But this year, things are definitely more organized.  We are up early and start our days by 8:00am. 


I have made a few observations lately.  There are clearly more muzungus here in Rwanda than there were last year.  Some of our business contacts have confirmed for us that the number of muzungus have sharply risen over the last year.  Unlike last year, we are not seeing so many kids yell and point at us, “Muzungu, muzungu, muzungu!”  I have also noticed more beggars, some of them children – even though begging is against the law.  I have noticed that there is a clear difference between our first experience and our second.  (Two members of our team are new.  They needed lots of time to adjust to the culture.  Admittedly, we neglected to properly educate and transition them.)  I have noticed that . . . how do I say this . . . there are lots of things I did not notice last time. 


Today I received some training in KinyaRwandan and then went into the ghetto with my friend, Claude.  Unlike the USA, there is virtually no violent crime here – not even in the ghetto.  It is funny how Rwandans look at strangers.  If you were in downtown Philadelphia, you would swear that the person was determined to have a fight.  Rwandans are areserved and serious people.  Their facial expressions reflect their seriousness and at first, looks like anger or disdain.  But once I say, “Muraho!” they smile and reply, “Muraho, amakuru!”  So, I was in the ghetto where muzungus rarely go.  I did not see any muzungus all day today, which was a first for this trip. 


Claude showed me the market and the house in which he was born.  That house is now a bar owned by Claude’s childhood friend.  I spent much of the afternoon with Claude’s friends, playing Dom, a game similar to Checkers.  I did not do very well, but I am determined to go back and win one.  We later shared some weak whiskey and goat bruchettes (skewered goat meat). 


Le spent her day teaching.  The Ob-Gyn portion of the team is doing VERY well.  They are visiting two clinics per day, training their nurses on delivery techniques.  In Rwanda, virtually all family health care is delivered by nurses.  In their system, birthing is considered a natural process, which means that nurses do almost all of the medical deliveries.  Considering all that we have learned about Rwanda’s system, which includes talking to the director of the medical university’s family medicine program, we are certain we are on the best track:  train the nurses in medical clinics because they need it most and because they are the ones doing the actual medical care.  (Doctors are in short supply and generally end up being hospital administrators.  There are currently a total of 400 doctors in Rwanda – only 11 of them are surgeons – serving a population of nearly 10 million people.)


By the way, we have been without running water for over two days now.  Our water reserves are seriously depleted.  We are being increasingly judicious in our use of the water.  It’s a little like “dry camping” in a motorhome.  At some level, we like the fact that it is not bothering us.  It makes us feel good. 


Tomorrow I go to visit some schools.  Thursday, we are supposed to visit the Minister of Health.  Friday, I check out USAID, WHO, Peace Corps, etc. 

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Safe Travels

“Safe Travels”


Today was a day that reminded me why we tell each other, “Have a safe trip.”  My lovely wife stayed in today with a migraine headache, probably a result of trying to do too much in the midst of being sick with the crud.  I stayed with her for a while and then spent the day making contacts and setting up appointments. 


Four of our group left for Butare, a town known as the education center in Rwanda.  Their plan was to meet with the director of the national medical school and visit the national museum.  However, their plans were drastically altered when they had a vehicle accident with a truck whose passengers were armed security.  I am thankful it did not create an international incident.  I am also thankful that it was a Rwandan friend who was transporting our team as opposed to one of our team members driving.  Based on their accounts, my sense is that there was great potential for serious consequences.  All are safe.  A couple of them were temporarily traumatized.


I had to ask Eddy, “Did we seem like spoiled Americans?  Here we are worried about an accident where the only bad thing that happened was a damaged vehicle and the inconvenience of missing an opportunity while also spending the entire day in a hot vehicle.”  I figure that any Rwandan who is more than 20 years old continues to deal with the trauma of genocide.  A motor vehicle accident probably sounds trivial to them.  But Eddy, in his wonderful wisdom just recommended that we take a day off from work, rest, and “recharge the batteries.  You cannot save thousands of Rwandans in two weeks.”  Funny, I didn’t think it was me who was saving them. 

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More Paradoxes

Eddy and Nadja’s house seems luxurious compared to what we imagined it would be.  However, there are some things that are very African . . .  We boil water every day and fill our large water jugs, then refrigerate them.  This becomes our drinking water.  There is no washer or dryer.  Le stayed home today to get well.  She has been sick since we left.  Somehow, the stress of getting up early and seeing patients and teaching clinical didactic was making her worse.  And somehow, doing laundry was exactly what she needed.  Here she is washing the clothes outside today.  She went and bought some rope to make a line dryer.  The only problem is that a couple hours later, we had to bring all the wet clothes in the house because the weather suddenly turned rainy and windy with thunder.  (Le specifically wanted me to put these pictures in for all to see.)
The other thing we deal with . . .  pretty much every day the water and electricity temporarily go out.  We ate dinner by candlelight tonight.  It was kind of funny to have Catherine tell her story and just as she hit her punchline, the lights turned back on.  Every faucet leaks.  Eddy and Nadja have buckets under them to catch the water.  We hear the drip drip drip of the shower all night long as it drips into a large basin.  It is actually handy since we often have no running water, in which case we use the water in the basin for bathing. 
This picture shows a portion of the bathroom.  There is a shower, which by the way, even when the water is running, the shower is not much more than a trickle.  The holding tank hanging on the wall is the hot water tank.  It doesn’t work, so every shower is COLD.  The cold water helps conserve water because you sure make it a quick shower!
The orange thing you see at the bottom of the screen is the basin into which the shower water drips.  It is about two feet in diameter.  Notice also that there is no shower curtain.  Water gets everywhere, but it is a cement floor, so it is not  a problem.  Besides, it evaporates quickly.
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Remnants of the Past

Remnants of the Past


Le, Catherine and I are staying with Eddy and Nadja.  We became so very close to Eddy on our last trip that he is now considered family.  Eddy’s mother died when he was young and he never had a mother-figure in his life.  So, Le has taken that place in his heart.  Nadja is Eddy’s fiancé.  She is from Belgium and, like Eddy, holds a special place in our hearts. 



Their house is far more luxurious than what one would expect, based on American stereotypes of Africa.  They live in a 3-bedroom, 1-bathroom house.  It is a cement structure, every wall and the floor are all made of cement.  Oddly enough, it is quite homey.  At the same time, there are these strange paradoxes that go with it.  The house is a virtual fortress, with a brick wall surrounding the property.  The top of the brick wall is made of broken glass and wrapped in barbed wire.  The windows all have bars over them.  Every entrance has multiple locks, including padlocks.  I suppose that during the difficult times in Rwanda’s past, this house was exactly what a person needed:  difficult to penetrate and you were pretty safe from drive-by shootings.  Here is a pic of the top of the brick wall.



The government has requested that homeowners remove the glass from atop the brick walls.  They have ordered that all new structures are to remain open, that is no more 10-foot high walls.  They want people to be able to see into the properties as they pass by.  It is part of their reconciliation program.  They believe that if people continue to live as if there is something to fear, then there will be something to fear.  They must begin living as if neighbors are trustworthy so that everyone will be trustworthy. 


The maximum penalty for being a “genocidaire” is 30 years, with half of the term served in prison and half served on parole.  As of this July, it will be 15 years since the end of the 100-day genocide.  This is the year when many perpetrators are to be released. 

 Can you imagine perpetrators and victims living side-by-side?  How does a perpetrator reintegrate into a community?  How should victims accept those who killed their families?  It makes sense that Rwanda’s religious community plays a big role in the unification of the people. 

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Respect the Elders

Respect the elders


In contrast to Joseph (mentioned in the previous blog), Vianney had a different answer to my question.  Vianney is a Rwandan-American.  He is working on building a non-profit, private medical school in Rwanda.  He has been living in the U.S. for two decades and lost family during the genocide of 1994.  In fact, he visited his home only four months before the genocide took place.  He told me he warned his family to leave Rwanda at that time because he could see how dangerous and oppressive it had become.  But just like frogs in boiling water, people could not see what Joseph saw until it was too late.


Vianney tells me that our elderly have so much to offer.  He does not like how Americans throw away their greatest resource.  I think many of us agree, but we cannot figure out a system that works well.  In Rwanda, there is great sorrow when an elderly person dies.  It is as if the entire wisdom of a community has disappeared. 


By the way, the median age in Rwanda is 18.  Over half of Rwanda’s population is too young to contribute productively to society.  It is a great burden to shoulder.  And Rwanda has the highest percentage of orphans in the world:  20%.  Wow.

 When we touched down, I nearly began to cry.  My lovely wife and I held hands very tightly.  We knew we were home.  What is it about Rwanda that is so magical?  It is so very beautiful here: the foliage, the sky at night, the occasional smiles, the smell of the air, the determination of the people.  Somehow I know that Rwanda has something to offer us all.  The spirit of Rwanda is unique.  And deep down, I know I need it . . .  Not just me – WE need it.

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Everyone Loves Their Own Culture

Everyone loves their own culture


Goodness, it has been nearly a week since we left Spokane.  I have had very little opportunity to write or blog, we have been so incredibly busy.


We had an overnight layover in Ethiopia on our way to Rwanda.  The airport in Ethiopia is very nice.  I somehow imagined it to be understated.  Not because of stereotyping, but because I had done some checking online before we left.  Ethiopia is interested in attracting more business, so their airlines offer free hotel stay for travelers who must overnight at the airport.  We all were given a free dinner that night, free transport to nice hotels, a free breakfast the next morning, and shuttle back to the airport.  Our hotel was rather grand.  I would say it was, by American standards a four or five star hotel.  On our way back to the airport, one of the other travelers was Joseph, a man from Angola. 


Joseph is an international business person.  We talked about his family and his country.  He told me the one thing he loves about his culture is that people all help each other, even strangers.  He said that you will see someone carrying a heavy load and a stranger will simply come up and help them carry the load without any question.  Usually, people help friends and family, but not strangers. 


One question I ask of people from other cultures:  if you were to pick one cultural value that is unique to your culture and that Americans do not have but would benefit from it if they did have it, what would you pick?  It is a difficult question for many people to answer.  I sometimes turn it around and ask them what one American cultural value would they benefit from if they would adopt it.  It is amazing the kinds of answers I receive. 


I have heard comments about communication styles, politics, social issues, Americans talk too much, Americans have strong individual rights and responsibilities, America needs national health care, Americans are too worried about political correctness, Americans offer true gender equity, etc.  Joseph offered this:  “Everyone loves their own culture.”  He refused to answer the question as asked because – and he is probably right – it is a mute point.  Who would adopt a different cultural value?  It makes some sense. 


No matter who I talk to, though, one thing remains the same.  Joseph said that people are people everywhere and that governmental systems do not accurately reflect the values of the people they represent.  So, no matter what the world thinks of the American government, and no matter what we think of the world, people generally do not have malice toward others but are more concerned about feeding their families, living with purpose, and practicing their faith. 


I wish I had given Joseph our blogsite so that he might see this.

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