Day 300: Wrapping Up

     I'm sitting in my office at the hospital wondering how on earth I'm going to finish all the work I have to get done in so little time. I say this as I stare at the 3" binder that I've filled with material from the first three years of this program. There are very few HRH staff members coming to CHUB in Year 4, so I have been trying to make things as easy as possible for not only new staff, but also the Rwandans to take over many of the tasks that we've done. BLS has been successful, but there are always days I have my doubts.
     This 3" binder that I've essentially filled beyond capacity is all of our student nurse teaching session material. In year 1 of the program the nurse educators decided to teach the students all together once a week. Over the years this has continued and is primarily what we call TBL, or Team Based Learning. It's an interesting concept and one that really works well here as a teaching method. Long story short, the students receive an article the week before on the next week's topic. They are to read the article and be prepared to take a quiz when they come to class on that topic. The interesting thing is that we have them take the quiz twice. Once individually and then again in a group. It's pretty interesting to watch as they huddle in their groups hoping to be the first one with all the correct answers so that they win some bon-bons. The method allows the students to debate the answers until they all come to a consensus about why the answer should be A and not C (and sometimes ultimately why the answer ended up being B) and teach/learn from each other. It's a pretty cool process to watch.
     After all the groups are done and the quiz is reviewed and all answers explained, we generally give a lecture on the topic. Sometimes we give an article and no quiz, sometimes we do skills practice like with BLS. Regardless, the students really seem to enjoy it. At one point about a month ago we had five different nursing schools and roughly 75 students in the hospital. Bribed by chocolate, they all would show for class.
     This binder looks glorious and I'm excited to be done with it. But 95% of the time I wonder if the material will ever be used again. I have spent about 2 weeks emailing former HRH nurses for lectures, articles, and quizzes; then I've formatted everything to be consistent, written an easy-to-follow guide for each topic, including contact information for the Rwandans who perhaps taught the topic to the students before and reasoning for why the topics should be taught in a specific order. I have written or modified lectures on topics where PowerPoints were never recovered. Julie, Medie, and I have had multiple meetings with Désiré, the Training and Research Manager, about becoming more involved in the teaching sessions and how to organize the lectures for the students. And sometimes I'm extremely hopeful about the continuation of the once a week 2-hour sessions. Other times, I am left wondering.

Melody and I in March with some of the students

My twin, Emmanuel and I teaching Neuro assessment in March

The glorious binder than may or may not ever be used.
Fingers crossed.

Lessons Learned:
1) Sometimes your work ends up being fruitful, other times fruitless. But regardless of the end result, you have to approach everything with a positive attitude and hope for the best.

Seven Weeks

     Almost 300 days ago I arrive in Rwanda, bright eyed, naïve, and excited. Since then, I've gone through a bunch of changes that I can't even describe adequately. But my time here is almost over. It's shocking to me that this year has flown by. Back in October during my cathartic breakdown I felt as though this would be the longest year of my life. However, in exactly seven weeks, at 1:35 pm EST, my plane will land at Dulles International Airport, my dad will greet me, and I'll be home.
     I have no idea how I'm going to handle the transition home. In a good way, I won't have to deal with it immediately. After just a few days to handle my jet lag, I'll be back on a plane headed for Puerto Rico to stand up for a former college roommate and friend for his wedding. Then I'll only be around for a week before I fly to the midwest and see my nieces for the first time in two years. In case you haven't figured this out about me, I tend to not sit still very easily.
     I have no idea what I'm going to do next. As my mother informed me last night, I need to start making decisions about not only my career, but my life as well. For those of you who don't speak "mom," that's code for, perhaps I should think about settling down in one spot (in the U.S.) for more than six months, thus increasing my chances of meeting someone and getting married. The good news is that I have seven weeks until I need to start worrying (or start worrying more than I already am about impending unemployment). The bad news is that I will leave Rwanda in seven weeks. I still have so much work to do here. I'm not ready quite yet to be done.

Lessons Learned:
1) So this is what it feels like to be an adult.

Coffee & Cows (and of course Fanta)

     I was Facetiming with my good friend Steph from my DC days last night and she reminded me that she religiously reads this blog of mine and I realized that I had yet again gotten behind in my writing and perhaps I should give the mother of two (one of the friends who gave birth since I moved) something to read this week.

     About three weeks ago the hospital had Remembrance Days. The 1994 Genocide Against the Tutsis (and moderate Hutus) started April 7th. Sometimes referred to as the 100 Day War by locals, the violence started in Kigali and spread to the rest of the country. Butare was still a central and important city in 1994. It was still known as the intellectual center of Rwanda because of the University. The entire province was called the "rebel province" by the anthropologist, André Guichaoua during the International Criminal Tribunal for Rwanda. This is because Butare was the only province to be run by a Tutsi leader who openly opposed the genocide. In addition, there was a Tutsi minority in the province and the political group that dominated in 1994 was different than the political party from which the Interahamwe (Kinyarwanda translation: those who  stand, work, fight, attack together) or Genocidaires were recruited. Butare for the first two weeks remained peaceful and many Tutsis fleeing Kigali and other areas found haven here.

     The former Queen of Rwanda, Rosalie Gicanda lived on the main road in the northern part of Butare, most likely in the same neighborhood where I live. Her husband, Mutara Rudahigwa, had been the last king of Rwanda and despite the popular Hutu government for the next thirty years, primarily left her alone. On April 20th soldiers entered her home and took her and six girls who worked for her and transported them to a place behind the National Museum and shot them. Two days later, the soldiers returned to the house and killed the former queen's bedridden mother and the girl they had left to care for her. It wasn't long thereafter, the leader of the province was arrested and killed. Barriers were erected and became sites of murder. I have read about soldiers beating about 15 children at a barrier placed in front of Hotel Faucon and killing 8 or 9 of them. The hotel still stands and is also our grocery store.

Grocery Store portion of Faucon on Main Street. Hotel is to the left.

      April 20, 1994 also marked the day that the Interahamwe and militia were airlifted from Kigali to Butare. Political and intellectuals were targeted as well as the rich Tutsis and moderate Hutus. Many of the killings were done at the "slaughtering grounds" sites such as behind the National Museum and the Arboretum on the edge of the University campus; others were done in homes or on the main street in front of locations that I frequent. Many were shot, but others were beat to death with nail studded clubs or hacked to death with machetes. Women killed children. Civilians killed their neighbors. It wasn't just military, police and militia performing these horrible acts, it was college students and mothers and fathers. To me, it's as though the people of Rwanda had morphed into something horrible and not even human in 1994. A few of our colleagues have let a few things leak out over the past few weeks and it's just utterly heart wrenching and horrifying and brings tears to my eyes when I think about it. Over 600 students were killed at the University and their bodies exhumed in a mass grave on campus years later. Over 150 CHUB staff and patients were killed including one of the sons of Seraphine, the sweet older Francophone who sells me fresh milk (I met her other son at Akagera in February). The killings intensified with thousands slaughtered at a time, often in churches where they sought refuge. Overall, it is estimated that 220,000 people were killed in the Butare Province in roughly 85 days. Despite the two week delay, this was over 20% of the Butare Province population and the highest proportion of killings in any region of Rwanda.   
     So why have I just told you all of this? Two reasons really: 1) I haven't talked much about the genocide because it has been hard. I'm a trained ICU Nurse. I know how to separate my emotions from my job and thinking about what the staff witnessed and possibly even had to do to survive is too much for me. I have to separate myself from it in order to function. Reason 2) Cows.

HRH gifted cows

     About a week or so before the Remembrance Days, the HRH staff were informed of a tradition. Every staff member of CHUB is required to contribute 5% of their April salary to buy cows every year. A seemingly odd thing to do. The hospital then gift these cows to a community nearby. We had multiple translations so we still aren't clear, but those who receive the cows are either Genocide Survivors, the poorest of the poor, or both. We were asked to contribute to this tradition and when it was all said and done, the HRH staff purchased 2 cows to give and the hospital staff purchased 18 cows. I was impressed that there were a total of 20 cows to give. Fortunately, the cow giving ceremony was moved from a Saturday to a Tuesday afternoon, thus enabling everyone to attend.
     We all gathered at 1:30 pm two Tuesdays ago to attend the ceremony. As it turns out, the cows were actually delayed so Jean-Marie had planned to take us to a coffee station en route to the village to pass the time. I'm not going to lie, I wasn't so jazzed about this plan. It was hot, sunny, and I don't drink coffee. I was doubting that I was going to find visiting a coffee station interesting. As it turns out, it was one of the coolest things I've done here.

     We had so many questions that Jean-Marie asked if one of the men there could take us through the process. So with about 5 kilos of freshly picked coffee, he did.

Jean-Marie

The locals who grow coffee and pick it bring it to the station and first sort through the good and bad (there is a lot of sorting) coffee pickings. Coffee plants actually look almost like cherries before the bean is removed.

Good in front, Bad in back

Once the good coffee is sorted through, the fruit is weighted and then dumped into the first washing and second sorting station. Good coffee is all dependent upon weight. Once in the tank, the better coffee will sink and the bad coffee will float.

From this tank, the coffee is released down a shoot and into a machine that breaks the skin portion of the plant off and the coffee beans are revealed. Coffee beans that are not roasted are a pale cream color here in Rwanda.

Down the shoot and into the machine

The skins stay above and the beans fall below

From the machine, everything continues to based on weight and the beans are separated 3-4 more times. The best coffee is for export only (much like the tea here) and the level 3 coffee is sold locally. Level 2 coffee is a mixture. Regardless, everyone who drinks the coffee from this coffee station (that includes the 20 individuals in my family and friends who received late Christmas presents of coffee) raves about it and thinks it's fabulous. I wouldn't know since I stick to tea.

Using water and weight to separate the coffee for the 3rd time

Once the coffee is sorted into its categories, it's thoroughly washed in another big pit. A worker stands in the pit without shoes and moves the beans all around, so I'm not 100% convinced this is the most sanitary process, but I would assume the high temperatures of roasting would cure most undesirables.

    After this washing the beans are placed on the drying tables where they are (take a guess...) sorted yet again. This time though it is not done by weight but rather by hand. Not all the skins are necessarily caught by the machine so women sift the coffee to catch the remaining skins.

At this point the coffee is allowed to dry before the final sorting. Once dry the beans are either a nice cream colored or have a slightly green tinged to them. It was hard to translate exactly why they're green, is it because the coffee isn't mature? Or over-riped? No idea. But green coffee beans are not good. So at this point the women and men sort through millions of beans and toss the bad ones aside and keep the good ones.

The only waste 

It amazed me how they still sort and pick the coffee by hand just like you see in "Out of Africa." Things don't change much in Africa as time moves on I sometimes feel. There hasn't been the cotton gin equivalent to the coffee world introduced, at least not here in Rwanda. Coffee and tea are all still picked by hand. I love it.

     By the time our demonstration and few minutes of sorting through coffee beans ourselves was complete it was time to drive the remaining 5 minutes of so down the road to the cow giving ceremony. The entire village gathered for the event and of course, all the mzungus were looked at with surprise, but we were hospital staff and therefore part of the guests of honor and got seats under the tent.

I was seated next to one of the survivors and recipients of a cow, although I didn't realize this for quite some time. Apparently, the cows were still delayed despite our late arrival, so we were treated to a lot of dancing and singing as soon as we got there. This included an audience participation portion where Jim and I were both pulled up in front of the crowd and danced. While we were the only white people up there, the hospital Medical Director, Dr. Jules, and the matrons and in-charges participated too.

There I am in red and Dr. Jules is to the right

Eventually, the dancers were even able to convince the Director General to dance, which the hospital staff in attendance thought hilarious. Though I'm not going to lie, Dr. Jules certainly had some moves that surprised all of us. My performance was pretty lack luster. After songs and dances and naturally speeches, I thought it was going to be time to serve the Fanta. But I was wrong. To express their gratitude, the 20 recipients of the cows stood up and sang for us. It was truly beautiful.

Genocide survivors and cow recipients

     Then came not only the Fanta, but the cows! We were all very excited about the cows and while children cried over not receiving Fanta and the entire hospital staff giving their Fanta away to the villagers I snuck down to try and snap some photos of the cows grazing in the valley. It didn't really work since the cows kept running behind trees and grazing in the brush. There were 20 beautiful looking cows and 20 recipients, but how did they determine who exactly got each cow? I turned to ask Oswald, the CHUB staff member who had been translating the speeches for me when my question was answered. The two who had been selected to receive the cows gifted by HRH went first (how they determined who received our cows vs the other 18 cows I'm not sure). They each picked a piece of paper from Jim with a number on it. It was quickly explained to me that each cow had an ear tag with the numbers 1-20. Every recipient stepped forward and picked slips of paper and their cow would correspond with the number they picked.

The two recipients of the HRH cows

     I thought this was the end of the ceremony, but of course not. Now the recipients started to sing again, but this time it was similar to what I saw at the dowry just a few days before. They seemed to be chanting more than anything else. Oswald came to my rescue once again and informed me that they were each giving the names of the cows and thanking us. There was a little battle for attention as the recipients went back and forth. The distribution of vaccines for the animals is what stopped the battle of the names and then we were finally able to walk down and see them all get their cows!

Singing the names

Separating the cows one by one

     I received thanks from villagers who didn't even receive a cow as we wandered down to the field. It was very touching. After they were finally able to separate the first cow we headed out. The sun was setting and the bugs were coming out. It was probably one of the most interesting ceremonies I've been to here in Rwanda and I am so thankful that the date was changed and I was able to attend. This tradition shows the humanity that exists here and I'm grateful I got to witness it.

This little muffin just had an agenda of her own
the entire ceremony that kept me laughing.

Lessons Learned:
1) I don't know if cows will ever be enough, but it's nice to see that certain things will never be forgotten.
2) Coffee might be a little cooler than I thought before.
3) I am going to miss Fanta in glass bottles with straws at every special event when I get back home.