Butare, my new home

     It has been a busy couple of days here in Rwanda. Of course when I say busy, I mean African busy, which is really not that busy. As one can imagine, time is quite different here. It's much slower and almost european when you go to eat a meal. Unless you go to a buffet (which is common here) expect at least 2 hours for a meal. Before you know it, your sunlight is gone and you've had a very relaxing day of accomplishing one or two, maybe even three things.     Thursday morning Jessie picked Julie and I up in Kigali and drove us to Butare. As I said before, I am replacing Jessie at CHUB (the University Hospital of Butare) in the ICU as clinical educator. She is fantastic. I am so incredibly excited to work with her. During our drive she spoke of the program and the people and her successes and failures and just gave us fantastic advice. She is a font of knowledge. She is originally from Charlottesville, VA and worked at UVA before joining the program in year two. She has had so much success here that my job is going to be a whole lot easier. The drive was beautiful. 

Leaving Kigali

Rwanda is not a very large country (roughly the size of Maryland) but it has been highly developed. There is farmland but not woods. They grow rice, corn, beans, melons, and lots of hay for cattle and goats. It’s very mountainous and a little dusty, and overall I was surprised at the development. There are multiple towns that we drove through and here in Butare they are attempting to pave all the main roads (beyond the road to Kigali) before rainy season begins. Jessie indicated that much has changed since she has been gone for a few weeks. She gave us the 25 cent tour (apparently Rwanda has the best coffee in the world and Butare boasts an ice cream shop) before heading to the guest house that the program keeps for short term faculty and newbies looking for housing. I should mention here that every city/town/village in Rwanda has two names. One pre-genocide and one post, with the exception of Kigali. I believe it was an idea to try and start afresh after everything that had happened here. The interesting thing is that Butare is the old name and is also still very commonly used (for instance they didn’t change the hospital name), but the new name for Butare is Huye. It is more commonly acknowledged as the Huye district. I believe that Butare stuck because it was the colonial capital of Rwanda, but I’m not really sure.

Fresh eggs at the store

     The rest of Thursday afternoon was spent with Dianne and DeVon Hale, a social worker and Infectious Disease MD and our other roommate Vanessa, a general surgeon from Vancouver/Seattle. The house hunt really was not that exciting and it’s been a little complicated so I’ll explain everything once we move into our new home. The only other really interesting thing was that I ate goat meat for the first time Thursday. Our local guide to housing, Jean-Marie, gave me a piece of the goat meat from his kabob and said try it! SURE! I’m excited to do just about anything once. So when I picked the bite up with my fork I was a little surprised to notice that there were clearly two different pieces… and one was rather textured. It was so textured in fact it reminded me of the sheep tongue I ate in Mrs. Davidson’s Second Grade class at Sparks Elementary (do you remember that day Kathleen & Tori?). So I made the drastic mistake of asking, “Oh! Is that tongue?” “Non, it’s you know… (pointing to stomach area) stomach lining. Intestines.” GREAT… I had to eat it because I had so eagerly accepted it. The goat was fine. I desperately tried not to think about anything else.

     Yesterday was exhilarating. Here in the HRH program the United States Institution (USI) faculty have Rwandan counterparts, called our twins. Jessie picked me up and took me to CHUB to meet her old twin and my new twin, Emmanuel. He is darling. So sweet and nice and clearly expressed some ideas he had about what we can continue to work on in the ICU. Last year Jessie thought it would be a great idea to give the ICU nurses weekly lectures on basics since here the nurses are not provided with knowledge the way we are in the USA. What she didn’t realize is how hard it was to prepare lectures and teach particularly when some don’t understand English very well. Whether she realizes it or not, I may be employing Meredith (sister for those who don’t know) to translate some things into French.

The front of CHUB

     The hospital looks very small from the front, however it actually has about 500 beds, making it one of the larger hospitals at which I’ve worked. It’s very basic, as one would imagine. The buildings are all connect with breezeways, so you actually can spend a nice portion of the day outside. The ICU has six beds with potential to add another bed if we can get a monitor for it. Jessie was able to procure new beds that allow the staff to raise the head of bed (HOB… I apologize now if I enter nurse zone language skills and forget to spell out an abbreviation) up. Apparently when she arrived last year, all patient’s HOBs were in trendelenburg (or a negative tilt, feet above head), which is not ideal for an entire host of patients. But she has successfully taught them the benefits of keeping the HOBs raised and they have changed their practice. She also was able to get them new monitors, a central monitor, and new EKG machines. It’s awesome. Jessie worked so hard on obtaining equipment and lecturing though that she didn’t have a great implementation process (implementation also occurred in her last two weeks), so that is exactly where I am going to pick up, lots of low hanging fruit to start.

Equipment drying outside at CHUB

     I am so excited for work. It’s fantastic that Jessie is still here too because we can really work together with Emmanuel to create a plan for the year. I already know that in June I’m going to need to run a BLS/CPR recertification class because they were able to do that this past June. But the coolest part about my job is that Jessie would like me to help her improve her lectures. Part of the reason why she has moved to Kigali is to do the ICU Specialization Course in CHUK (University Hospital of Kigali). She really would like me to help her teach and perform analysis about the course already done last year. We are both so excited to work together and now that I actually have a clearer picture of my job, it’s just so fabulous. I have the sense that I won’t spend much time with the students, but Jessie said that she would often catch the staff nurses teaching the students the new knowledge they had gained, which is so ideal. I can’t wait to start.

     Last night we went to dinner at the Chinese restaurant in town. Yes, that’s right. Butare, on top of boasting an ice cream shop, also has a Chinese restaurant, called, The Chinese Restaurant. 

Soon to be my weekly go to

It was awesome. It’s actually owned by a Chinese man who is very nice. Apparently the ex-pats make an appearance weekly for dinner. There was a nice large group of us from HRH who all met there and for $7.25/person we enjoyed so much food and beer it was unbelievable. Back at the house four of us decided to play the card game Phase 10. I’ve never played and actually it was great fun. Perhaps it was more for me because I seriously kicked some butt while winning. We actually did not go to bed early, which impressed me because again I was up with the sun yesterday and today I actually slept in. It was fantastic.

Stacked mattresses at market

     We took it easy today, I read, enjoyed the beautiful weather, walked to the market where I found an Orioles baseball cap (though I didn’t buy it) and lots of fun clothing. I am convinced that we need to have an ugly prom dress themed party. There was an entire area of these old American dresses that were hilarious. 
This afternoon the electricity went out for the second time for about 3 hours. Previously it had only been for a few minutes at a time. I suspect that as rainy season progresses it will become less reliable. It makes me really wish I had bought one of those battery blocks that you charge and then plug your phone or computer into those. I can probably find one in Kigali next week when there for orientation thought.

Open air market

     We also spotted a total of six monkeys on the roof of the house across the street. They were super cute. I had no idea that there were monkeys here. I probably should have read more about Rwanda before I came. Right now we are having our first African thunderstorm and I’m enjoying the cool rain. I am practically a mile above sea level so the rain is nice and cool and it’s always breezy. It’s about time to figure out what we all want to do for dinner and I’m all blogged out. I’ve post more photos to Facebook, but a few here so you can understand everything. Hope all is well stateside.

Lessons Learned: 

1) Eat something before asking what it is.

2) It is illegal to walk on grass in Rwanda.

Baby monkey with parents

Arrival in Kigali, Rwanda

     Yesterday afternoon at 12:35 EST I landed in Kigali, Rwanda. It was 6:35 pm here and already pitch black. I told a friend I thought one of the strangest things that I'll need to adjust to is summer weather with winter darkness and I think that holds true. Kigali is only 134 miles from the equator so the sun shines for almost exactly 12 hours, every day of the year. The weather was beautiful last night as I walked down the stairs alongside the plane, across the field and into the airport. Kigali International Airport is clearly in the middle of some major renovations, but was lovely. By 19:20 I had all 4 of my checked bags, TSA had only broken the zip tie of one and sorry to report Mom, but one of your handles broke on that borrowed suitcase of yours. I waited inside for Julie, a retired oncology nurse also hired by UT and a Texas resident. She will be living and working with me in Butare and via email this summer appears to have quite the sense of humor. She landed about an hour after me and by the time we collected her bags it was just after 8 pm.
     Our hotel was about 15 minutes from the airport and I couldn't see much it was so dark. I was checked in and settled by 20:30 and Julie and I grabbed a bottled water before both just relaxing on our own. I had a nice hot shower, burned through one of my zip ties to access my much needed hair brush, and then gathered everything together that I wanted to take to bed...

Very hot lamp sufficed since all my knives and scissors were in my checked luggage!

Success!

Baby Tugs is here of course, my glasses, my book, my head lamp... all of this so that I could properly tuck my mosquito net into my mattress to save myself from mosquitoes! My bed looks beautifully romantic with this hotel white laced net cascading down from the ceiling, but I can see what a nuisance it truly will be and any feelings of royal grandeur will be quickly squashed.

Prior to the full tuck in.

Relaxing afternoon at Princess Status.

     This morning Julie and I had a lovely buffet breakfast of eggs, spinach, fruit salad, some meat and potato dish (reminded me of an Indian dish alongside the spinach) and incredible African tea served with hot milk and passion fruit juice. Then a driver was sent for us, Wilson, and he took us to the Ministry of Health where we met Sage.

Sage is part of our support staff and has been emailing us the last few weeks helping us get all our paperwork sorted for our work visas here in Rwanda. It has been quite the ordeal and of course we learned today that it isn't quite sorted. We are missing one or two things that will hopefully be taken care of by UT quickly so that they can get our applications submitted. Apparently this won't hinder us from starting work after orientation next week. After paperwork we ran a few errands and officially got SIM cards for our phones. If anyone attempted to iMessage me today, I did not receive it as I switched the cards out long before any of you were awake (unless you happened to be working night shift as I will say some of my friends do). I believe that iMessage will still be free to those of you stateside if I am on 3G network/wifi, but until I'm sure I still recommend Whatsapp/Viber/Voxer/Facetime/Email/ Facebook for communication. SUCH limited options my goodness!

     We took Wilson to lunch at a local place (well he took us and we paid), which was delicious. I don't really know what I ate. There was beef and chicken with rice and potatoes and fruit and sauces... whatever it all was it was good. And for $3.67 per person quite the steal. $1.00 USD is equivalent to about 700 Rwandan francs (RWF). Today with all the errands we ran I probably spent under $30 and the most expensive bill was paying Wilson for his time and then charging our phones. We got a decent sense of Kigali. It is a city of 1 million, with paved roads and a few cobblestones with traffic lights and circles. The city itself is in a valley surrounded by mountains and minus the fact it's lacking in water and collapsed buildings, it reminds me very much of Port-au-Prince. The people are smiling and the women are carrying fruit on their heads in massive baskets. School has started and the children walk to and from in their uniforms. There are motorcycle taxis everywhere and we have already been told a million times never to take them. It's a bustling city with a "mall" and supermarkets and surprisingly not many mosquitoes.

View of Kigali hillsides.

Cobblestone street of Kigali.

     This afternoon I have just relaxed at the hotel, which is very peaceful away from the hustle and bustle of the city, and sent emails, updates etc. 

My hotel building.

Julie and I will grab dinner and drinks in a bit and then probably hit the sack early. Jessie Silver, another RN who was in my position last year in Butare and has now moved to Kigali for this year will be driving us the 2.5 hours where we will finally meet Vanessa, our other roommate who has hopefully found us a gorgeous home.

Chez Lando Courtyard

     I am on my balcony right this moment facing due south and it is practically pitch black outside at 6:28 pm. The sky has some very faint pink to the west with dark clouds like the 9 pm sky at home. I suspect that I will turn into my father and wake up with the sun and start to go to bed with the sun.
     Well now the mosquitoes have come out despite my Deet, so back inside I'm 

headed. Will have to remind myself which mosquitoes are the night biting ones... malaria or West Nile. And suspect that I'll be requesting Benadryl spray or some super high strength cortizone cream for bug bites soon.

     Will write more when I get to Butare! Love to all!

Rwanda Cell: +250 781521965

And I'm Off!

     Currently I am sitting in Dulles International Airport waiting for my flight to board. There are two hours before boarding even starts. Never late to an airport when my mother is in charge. It has been a whirlwind month at home since returning from San Francisco.
    In case you haven't heard, I'm moving to Rwanda, East Africa for a year. Last fall a fellow RN that I met in Haiti after the earthquake messaged me with this job opportunity. She told me that she knew I had recently finished my MPH (Master in Public Health) and thought of me when she saw the job description. What is the job you ask? I am officially a Clinical Mentor for the Rwandan Ministry of Health (MOH) working on the Human Resources for Health (HRH) Program. I am an employee of the University of Texas Health Science Center Houston as full-time faculty, essentially contracted to the Rwandan MOH for a year. Several years ago the Rwandan government asked the US government for a change in funding. Much of US international aid goes to programs designed for specific diseases, like HIV/AIDS and malaria. However, Rwandan has been experiencing an issue with what is known as "brain drain." They are loosing their smartest and brightest to other countries because they cannot educate them and then the best of the best never return. So the US government agreed to provide funding for 7 years for health system strengthening by providing faculty to teach. Thus, I ended up with a job in Africa.
     I will be teaching clinical skills, not lecturing as far as I'm aware. Approximately 70% of my time will be spent with nursing students and their clinical instructors and the remaining 30% of my time will be teaching staff nurses. At this time I don't know much else. The program changes as it progresses so I've been told to expect the goals to shift and change as the year passes. Makes sense. The program is going into year three.
     I feel as though I should be more nervous or excited or anything, but it still feels very surreal. I was panicking about the weight of my luggage, but it all worked out well when I checked in. Four 50 lb bags checked, plus my carry-on, and my backpack as my personal item puts me in the 250-300 lb range of stuff I'm taking with me. That might sound excessive, but when you've been told to bring bug spray, sunscreen, and conditioner for a year... you'll learn how quickly your bags get filled.
     I'm contemplating now how one gets on the upgrade list as I notice some of the sleeper seats are still not filled. That would be pretty awesome, however I never seem to be that lucky. I am going to keep this post short as there really isn't too much else I can tell you. My layover in Brussels tomorrow morning is a few hours and then I will have a direct flight to Kigali, the capital of Rwanda. I should land roughly 12:30 pm EST and then on Thursday head to the town of Butare in the south where I will live. After a few days of searching (and hopefully finding) housing, I will return to Kigali for a few days of orientation and then finally start work sometime in September. I'll have more to report once there, until then, here's to adventure!