University of Rwanda's 1st International Nursing & Midwifery Conference

     Last week the University of Rwanda hosted its first ever International Nursing and Midwifery conference. I think despite the hassles of trying to pull off such an immense project it was quite a success. There were approximately 40 posters, including three from CHUB and they all looked wonderful. My friend Becky did a lot of hard work, as did the rest of the committee, and I think it is really a great success for the school and the HRH program. Many of the US Universities sent representation and several of the program coordinators gave presentations. There were people who came from Uganda, Tanzania, Burundi, Kenya, and South Africa (not to mention the States). Not bad for the first conference ever!

     I will brag about Emmanuel and my poster, despite slight printing issues it looked quite impressive. The dean of the school of nursing and midwifery asked multiple questions about what we were doing and I think she was impressed! At least I hope so! Emmanuel fielded many questions (I may have kept a steady stream of ex-pats heads his direction) and everyone said that he did a great job explaining the details of our work. He worked very hard to be prepared for questions. He even had friends read the poster and ask him questions beforehand to practice. 

     Our poster was titled "Identifying Nurse Education Needs with Documentation Audits." It focused on how the ICU has been involved in HRH since Year 1 of the program, during Year 2 there was the development of new flowsheets for documentation and now in Year 3 we are using audits to identify focus points and educational needs. It was really well received and it's something that I can at the end of the year say, when I arrived the nurses were documenting only 40% of the information on the flowsheet. But now they are documenting 80%. It might not always be correct, but we are working on that and I certainly don't expect them to be perfect. I doubt that my documentation back home was perfect. But I did my best and I know that they are too.

     The Minister of Health even made an appearance at the conference, which I think the nurses truly appreciated. She is quite the spitfire and I enjoyed hearing her address the nurses. She believes that they really make a difference in saving lives and expressed that to them. I hope they remember that themselves when they are at work. I am happy that the conference was a success for Rwanda. I hope next year it's even more so!

The MOH addressing the nurses & midwives

Our glorious poster

Emmanuel answering questions from
one of the visiting US staff members

Melody with 2 of her twins

Jacques Update

     "Enfant a rendu son ame a Dieu." That is what I read in the nursing progress notes Tuesday morning as the porters rolled the 2 year old's body to the morgue. Translation: The child gave his soul to God. It is the most eloquent note I've ever seen written about a patient's death and it almost brought me to tears. And in seven years of ICU nursing, I don't think I've ever wanted to cry over a written note.
     The most terrible thing about Jacques is that his death might have been preventable. Had the neurological changes been identified earlier, were our CT scanner working, maybe we would have had a stronger case to transfer him to Kigali and neurosurgical intervention. It is beyond frustrating, but a lot of things I cannot change.
     What I can change is the education level of the staff here at CHUB. Please consider donating to our cause to ship over 3000 lbs of donated medical and nursing textbooks here to Rwanda. Any little bit helps. It has grown frustrating and depressing to see that over $12,000 can be raised for an injured dog in California, but I can't raise $6,000 for increasing education in East Africa.

Lessons Learned:
1) No matter how long you've been at it, there is always going to be something in nursing that makes you want to cry. It never gets easier.
2) There is a science to fundraising that I never understood before now.

Ianuarius: The Door to the Year

     The rain finally started tonight. It's been threatening for hours and the power was out earlier, but it just now started. It's been a few weeks since we had a good rain. I love the sound of the rain on the roof. It's very different than at home. Maybe because when it rains it pours here and for a long time. There is no such thing as a quick thunderstorm here. When we have thunder the entire house seems to shake. But the rain here is just big fat drops that pound onto the hard red clay and splatter everywhere. It's quite beautiful.

Knitted caps by my neighbor from home, Aunt Randy
put to good use in the NICU.

Dr. Théogène showing a new ICU nurse and GP Dr. Oscar how
to check fetal heart tones on our portable ultrasound.

     Last week was a little bit of a whirlwind. Jet lag finally subsided and I was functioning on a fairly normal level although I couldn't remember what the heck day of the week it was. Vanessa has a surgical resident from UVA here, Rhett, and we had him and Jim over for dinner one night, which was a lot of fun and a nice change from our typical weeknight routine. I also started a more serious workout schedule, where I quickly learned that two weeks at sea level completely wiped out whatever extra red blood cells I gained in my first few months here. I was huffing and puffing with just a small workout. But I went to my first yoga class here with Stacey and Jeff and I really liked the instructor. Joseph is really excited to share the practice of yoga with anyone, so it was a very refreshing environment for a yoga class. I am hoping to make it a Tuesday night regular activity.

These trees along the road to Kigali always
remind me of something out of Dr. Seuss.

     On Saturday we all made the drive up to Kigali to run errands and the most important one of all was picking up Rupert. At 15 kilos he's not much, but he's sweet, beautiful, kind, but knows to bark at strangers. Yes, we got a dog. We love him. He's pretty well trained, although terrified of the leash. We will have to work on that if we ever expect to take him for walks, but I'm sure that will come with time. Vanessa will probably stay for two years so she will keep him, but if she doesn't then we already have a good home lined up for him. We did discover the hard way that he tends to get car sick, so hopefully we won't have to take him on too many road trips to Kigali to see the vet.

So he gets car sick, but we got him safely back to Butare!

Rupert

Such funny ears!

He is very happy and healthy though, so my fingers are crossed. It's nice to come home to a furry friend, but he's so skinny sometimes I feel like I'm going to break him! Sunday was uneventful, yet productive. I went for a quick bike ride up to the market to buy some carrots and rice and was able to spend the afternoon cooking and relaxing around the house.
     Today started off with a bang. Rupert came into my room and cried about 5 am. Since I wasn't sure if he needed to go out I got up and took him out. Later I found out that he had come into all of our rooms and we each had done the same thing about ten minutes apart. Turns out he just wanted breakfast. We will have to do a little training about begging and waking up the humans when there is no intruder. Steph and I decided to be super fit and biked into work, which was a nice way to start the week. My staff always tease me though when I do this because my face stays pink for at least an hour after the fact. They find it so strange and funny at how red I get. Thank you Irish heritage. Anyway, the first thing I noticed when I walked onto the ICU this morning (this after I figured out how to access the unit as they've switched things around again due to the construction) was that all three of the patients from Friday were still there and somewhat stable! The second thing was that we had a little tyke in bed five.
     Jacques was admitted Friday afternoon just as I left. I didn't know his entire story until this morning. Here in Rwanda the mothers tie their children to their backs and go about daily life as if they didn't have an additional couple of kilos to carry. My favorite is watching the women balance baskets of fruit on their heads while they have a child on their back. I don't know why, but it's just a great image. Anyway, Jacques is two years old, and was on his mother's back when they were struck by a vehicle. His mother died instantly and he suffered from traumatic brain injury. According to the physician notes and a discussion with Vanessa, he wasn't too terribly off Friday afternoon, but Vanessa immediately filled out the transfer forms for CHUK (University Teaching Hospital of Kigali) since our CT is still not working and regardless, we don't have a neurosurgeon on staff in Butare, only in Kigali.
     Due to insurance issues he never left. He deteriorated until he respiratory arrested last night and was intubated around 10 PM. By the time I arrived on the unit at 7:30 AM, his vital signs were not looking good and I was worried, until I read the chart and examined him myself. Pupils were fixed, dilated, and there was no movement. Most likely his head injury progressed and he probably even had an intercranial hemorrhage and he was herniating, but we couldn't diagnosis it. Herniation, simply put, is when your brain swells too much. Due to our skulls the brain has no place to go during this swelling and starts to push down through the magnum foramen, or the hole where your head connects to your neck. As it goes, it compresses your brain stem, which controls your most basic functions and once this happens, you're brain dead. Jacques came into the hospital Friday awake. Now, he's brain dead. It could have been prevented were we just able to get him to Kigali. Or even have gotten a CT to make a stronger case for his immediate transfer to Kigali.
     This Monday was a little bit of a reality check. I always think how beautiful a place I live and sometimes, it's easy to forget all the hardships, hunger, and death that occurs. But often, I just need to step onto the ICU to get my head out of my dreamy state. Sadly, it sometimes leads me to not appreciate and enjoy the beauty that surrounds me in my simple life here.

Lessons Learned:
1. Determination can save lives, but you have to be a special type of person to want to change the system.
2. Beauty is surrounded by hardship and vice versa.

Hitching a ride up the hill.

Sunset

Sunset

Coming "Home" in the New Year

     Have you ever gone back to where you spent your entire childhood and curled up on the couch with a roaring fire, your puppy dogs, and lots of down/wool blankets and gear to keep you warm and just be glad you're home? Well despite freezing my bum off, I was able to pull off the ultimate surprise as a slightly early birthday surprise for my mom and went home for a week. Now she won't admit that she had no idea... But needless to say she was surprised to find me in the family room with just a few days left in 2014.

Jean and I had a full turkey!

Christmas luncheon in Ireland

     But when I last left you, I was on my way to Ireland to celebrate Christmas. It was cold, quiet, peaceful and lovely. Jean met me at the airport and on the drive to Ballybrack updated me on everything that had happened with Himself. I was glad to learn that it was truly unexpected and quick and there was no suffering involved when he died. We did everything that he wanted me to do, even down to using the Santa themed china pattern. He spent too much money on me picking out the most thoughtful gifts, including a very useful flashlight (that I used last night), an umbrella, and some fancy new perfume that I really enjoy. We had the most fabulous Christmas luncheon, all things that Mr. O'Hara wanted me to have. It was really quite delightful. It was good to be there so that Jean could relax a little. I know she appreciated me opening the door and chatting away with friends and neighbors that continued to check in on her. I believe I was also a good excuse to decline several Christmas luncheon invitations. She told me that she was tired of being minded and how one of her daughters hadn't let her drive for almost two weeks! I told her that since I still can't drive a stick the driving wouldn't be a problem. I met their son Sean and his wife, Lisa and their four children. Even they had bought me two small presents, which made me feel bad as I had been told specifically not to get them anything. I was very grateful for my mother's presents. She mailed me some new long sleeve shirts and a scarf with matching fingerless gloves. I'm fairly certain I had them on almost the entire time I was there. I met Mr. O'Hara's nephew, Jared and his family because Himself had specifically told Jared he must come and meet me. And we all toasted him with some delicious port.

Ironically, one day we all (grandkids included) went to the Dublin zoo. It's quite a good zoo, but I must admit I found it a little amusing that I was looking at giraffes, gorillas, rhinos, hippos, and lions for the first time in several years and I live in Africa. This will hopefully be rectified next month.

     After five days Jean took me back to the Dublin airport and I hopped my flight to JFK. I spent the majority of the flight devouring book six of the Harry Potter series that I had started just a few days before... how I managed to escape the Harry Potter epidemic before, I don't know. I blame my favorite children to babysit, the Griffith Boys... particularly Morgan. All I knew of Harry Potter was random chapters in the middle of the books I would read to him and the entire time I wondered what the heck these stories were about as Morgan corrected my pronunciation of names every two minutes. Anyway, I continued to enjoy Harry Potter while I devoured a Big Mac with extra pickles as my first meal back in the US and I chipped away the hours of my almost 6 hour layover. A six hour layer for a 37 minute flight. But finally, I arrived at BWI and my neighbor Aunt Randy scooped me up and took me home.

     My father knew I was coming, but my mother had no idea (despite what she may claim). And I wish I had captured the look on her face when I came around the doors into the family room where she was snuggled on the couch with a movie. I think it was quite the surprise ("And I usually hate surprises!") but a good one. The other part of the surprise is that I was hosting a birthday dinner for her the Saturday after New Years and her brother and his wife were coming down from Connecticut as an additional surprise. I already knew what I was going to cook, but just for good measure I thought I'd double check... sure enough I'd nailed it... surf & turf of lobster tails and steak. Aunt Sharon acted as my sous chef and made the broth for French Onion Soup while I made the crab dip and my Dad broiled the steaks while I steamed the lobster tails. It was a lovely dinner, despite seriously burning my fingers we all had a great time with family and friends who were able to join us. 

Who doesn't love lobster?

The table setting for Mom's surprise birthday dinner.

First course: French onion soup

     After dinner we all watched the Ravens play the Steelers in the wildcard playoffs. I enjoyed the first half but found myself dozing in the second half quite a bit. But it was fun to actually watch a game. I've been streaming 98 Rock (radio station) over an app on my phone the entire time I've been in Rwanda, which is pretty good. Overall there's maybe a five minute delay, but it's decent commentary and at least it's a part of home that I can have here. Unfortunately, the game tonight won't be on until 11:35 pm my time and I have tried so hard to get over my jet lag that I don't know if I'll stay up for it.

Friends since 2nd grade!

     Anyway, I was able to see many of my friends while home in Baltimore and DC and even popped up to Philadelphia for New Years to see friends whom I'd missed seeing before I left in August. It was a very relaxing week filled with junk food and good food (it's quite strange the things you crave when you live in a developing nation) and I'm glad I got home. I even got to speak to a high school class about my job when I popped in to say hi to my friend's mother. I only had one mild state of panic when my mother abandoned me in Wal-Mart. She was looking for Stevia for my dad. She went to check one area and I another... I of course found the proper aisle. This ginormously long aisle was 3/4 dedicated to sugar and sweeteners. I ended up calling my dad when my mother didn't answer her cell phone because I literally didn't know what to do there were so many options. I was completely overwhelmed.

Molly & I skating

New Years with Megan!

Drinks with Kathleen & Joe

Ice skating in Georgetown with Emily & Mark

     I was quite surprised to find approximately 3000 lbs of nursing and medical textbooks in my parents house as well. My social media campaign to gather the textbooks to bring back here for CHUB got a little out of hand, but in a good way! I am now tasked with trying to get the books shipped here to Rwanda, as my original thought of just bringing an extra suitcase back with me, clearly won't cut it. If you are interested in helping (every little bit helps) please visit my Go Fund Me page. I would really appreciate it and I know the staff who work at CHUB and the students who rotate through the hospital will really appreciate it. There is a lot of hard work that happens here and they have a thirst for knowledge unlike I've ever seen, so please help me make this happen.

Just some of the textbooks donated...

2 inches of snow before I left!

     Tuesday morning when I left Monkton the schools were closed and we had two inches of snow on the ground. It was beautiful albeit FREEZING. As my Uncle Rick kept saying, "your blood has thinned" and I wasn't tolerating the cold very well. I was impressed with myself that I had survived an hour and a half of outdoor ice skating with friends one night. Mom had me in the car obsessively early for the drive to Dulles, but this time we stopped at G & M for a crabcake lunch. 

COLD ALL THE TIME

Farewell USA lunch at G&M. Such good crabcakes.

It was perfect timing. By the time we got to the Washington Beltway, there was no traffic and we arrived at Dulles just as KLM started to accept baggage, 4 hours before my flight. Following airport tradition, mom and I grabbed some Starbucks before she said goodbye at the TSA checkpoint, the same spot where she had said goodbye in August. But this time was different. I really am not coming back for the next 8 months. I told her, "No more surprises." And of course whenever my mom starts to cry, I start to cry, to the point that when the TSA guy checked my boarding pass even he told me to make sure to call my mom when I landed. When my plane took off it felt so different this time. The excitement and novelty of moving to Africa has long since worn off and instead of being excited and scared, I just felt sad and a little lonely.

     My flights were uneventful, unless you count the screaming and therefore not so cute child who cried the entire red eye to Amsterdam. I landed in Kigali at 7:15 pm Wednesday and was welcomed by a lovely and breezey 70 degrees. My taxi driver was waiting for me and I arrived back home in Butare just before 10:30 pm. Vanessa and Julie had waited up for me and were very excited for the goodies I had brought back, which included face products, Berger Cookies, Oreos, spices, rubber cleaning gloves, new dish towels, Sirracha, and bug spray. It's the little things that matter when you live in Africa. I wasn't able to sleep until almost 4 am (perhaps because I was reading Harry Potter) so Thursday morning I slept in and got up about 10 am, where I promptly finished the final book of Harry Potter (all seven consumed in 1 month).

     I walked to work and felt odd wandering down our dirt road. I felt as though I was back where I belonged and yet felt completely out of place. I had the same sense when I was home too. Where is my home these days?

Lessons Learned:

1) True jet lag is truly terrible.

2) Even the briefest visits are well worth it.

Apparently Christmas Time is Here

     Having never spent Christmas anywhere that didn't have four distinct seasons and actually got cold, it's incredibly difficult for me to recognize that Christmas is less than a week away at this point. The short rainy season has moved on and we no longer have cooling rain every afternoon. Instead it has been getting hotter here averaging 80-85 degrees by midday. There are no carols on the radio, no decorations... I have to keep reminding myself that it's really December.
     Tomorrow night my roommates and I are hosting a holiday party before most people split for winter break. I almost feel as though I'm back in school with the conversation of winter break. But anyway, Joe brought back all sorts of goodies from the states on his Thanksgiving trip and I think everyone is looking forward to enjoying a nice night together relaxing. It's been pretty stressful this month getting ready for COHSASA's visit. They have been spotted stalking around the grounds this week, but they come to ICU today. It should be interesting to say the least. By no means do I think the hospital will gain full accreditation, but I think they are certainly on the right track to gain partial accreditation. And furthermore I can't help but laugh a little. I have never seen the hospital so clean, the beds made with fresh white linens, and everyone in perfect uniform. It is just like back at home. One of my managers at GW wanted to get rid of the tables we (nurses) used to sit and chart (back in the day of paper charting). Because they weren't Joint Commission regulated because then our hallways weren't wide enough. She  mentioned it several times and then noticed when the Joint Commission and/or the Health Department showed up, the tables... just miraculously disappeared. They were gone for the entire time the outsiders were around. And as soon as they were gone... the tables were right back in their normal positions like always. It is the same here. Though I'm hoping this time, things won't revert and we will keep moving forward.
     As for my Christmas, I will be spending it in Ireland with dear friends, the O'Hara's. Mr. O'Hara was a former patient of mine in GW in April 2011. I was his nurse for 8 hours, but because I mentioned my mother and I wanted to visit Ireland when I finished grad school, we formed a bond. This man was so funny that when I checked up on him when he was out on the floor the nurses were considering calling a psychiatric consult on him because he kept joking about the CIA. They didn't understand that he's Irish... and a whole lot of blarney comes out of their mouths. One year later, my mom and I did go to Ireland and the O'Hara's came to our hotel with a dozen roses for me and a box of chocolates for my mother and whisked us away for a nice country drive, lunch, and Guinness of course. They are lovely people and Mr. O'Hara (Himself as he often signed his postcards) and I have been writing postcards and notes to each other ever since. They are always highly amusing with him telling me about his failed attempts to become adopted by other couples they met while cruising.
     Having asked me many times when I was coming to visit again, I invited myself to Christmas, which of course was well received and I was really looking forward to it. However, Himself was misbehaving as usual and did not tell me how he was really feeling. On Monday I got two postcards that had taken awhile to arrive, which of course had me laughing and excited. He informed me that the Irish guards and a red carpet would be ready for my arrival, he just needed to put the final touches together. But, there won't be anymore postcards.
     Wednesday night Jean (Mrs. O'Hara) called me and told me that Himself had died and they had buried him. She wasn't sure how to tell me or if she should wait until I arrived on Christmas Eve, but I'm glad she told me now. I am upset. Originally I was hoping to visit in October and then I got this job and I pushed it back. I am absolutely heartbroken that I wasn't there and that I missed him. Jean has told me to put myself into work mode (i.e.- stop bawling my eyes out... which didn't really work that first night, but I tried) and to go get a hug from my roommates and she would see me Christmas Eve morning. I know she has much to tell me and I know that we will have many good laughs reminiscing and toasting to the lovable Sean O'Hara. Oh how I will miss him.

Quite possibly my favorite patient of all time

Me and the O'Hara's in Dublin April 2012

Hanging in the gardens of St. Patrick's

Showing off his dance moves for the ladies

Guinness stop

Last night in Ireland.
Himself & Mom

How could this guy not make you laugh?

Strolling through Dublin

The O'Hara's and Mom

      At the same time, yesterday was the anniversary of my brother, Kerry's death. Many of you reading this back home knew him, or spent the entire day with me when I found out, or I was at your house when it actually happened. It was sixteen years ago and not a day goes by that I don't think about him. I thought that this year maybe I would understand my brother a little more... he died when he was 29 and I was 13. Being the same age is odd and being older than he ever was will be stranger I think. This year hasn't changed much in my understanding of life and death and my brother, but it has been quite the unexpected year.

Kerry and Nora at his high school graduation from Calvert Hall

A rare photo of just the five of us together

     Merry Christmas everyone. Wish I could be home with my precious 10-12 foot tree with the lights glowing, but I think despite the unfortunate events, it will be really good to be away from Rwanda and in Ireland. Fingers crossed the ICU does well this afternoon.

Lessons Learned:
1) Never become complacent, life is bound to throw you a curveball
2) People come and people go in life, but those who are truly special will always be in your heart.

Kerry James Kling
March 3, 1969 - December 18, 1998

Accreditation: The Same Worldwide

     I have mentioned in the past that my hospital, University Teaching Hospital of Butare (CHUB) is going through the accreditation process. I love it (in direct contrast with how I felt about it stateside). Basically, accreditation has allowed me to make changes, while removing the blame and fault from myself. It's fantastic, plus it has really forced the hospital staff to take responsibility for the changes. I help, but I by no means lecture them every day on each and every little tiny thing. They have to make and enforce the changes themselves because I won't be here forever.
    Many of the hospitals here in Rwanda are making this leap with The Council for Health Service Accreditation of Southern Africa, also known as, COHSASA. In the United States hospitals are accredited through the Joint Commission (JC). Now as my healthcare friends know, there are many, many, MANY rules and regulations that the JC have, that during the normal year may or may not be strictly followed. Rules such as no material can be X inches from the ceiling, the width of your hallway has to be such and such, all sorts of documentation requirements, and so on. I had the great pleasure of being interrogated by a JC surveyor one year I was employed at GW. Of course it happened to be during the phasing out of physicians writing notes in the charts, but not all of course. It was lots of fun finding all the documentation (and reading out loud some very illegible handwriting) requested.
     Anyhoo... starting Monday COHSASA will be conducting a survey of CHUB. Let me tell you a secret: accreditation is the same worldwide. There is a vibe of absolute hysteria and panic racing through the hospital. I ALMOST feel at home. But the changes that have happened the past two weeks have been really inspirational. All of a sudden last week squirt bottles of alcohol for hand hygiene appeared at every ICU bedside.

  

Then the emergency trolley (aka code cart) checklist was actually being used and a hand washing station appeared outside of the ICU for visitors (we still have no running water).

  Yesterday I walked into this:

Cécile and the "mess"

Which looks pretty disastrous, but the end result was this:

 August 2014                          December 2014

I didn't say anything about the reorganization nor about checking every medication and material for an expiration date, which is what my In-Charge Cécile took upon herself to do yesterday. She has really stepped up and I am so immensely proud of her developing leadership skills. Meanwhile, I hung the newly revised assessment guides that Jessie and I had worked on together. It's amazing how excited I get over color printing and lamination. Maybe I missed my calling as a teacher.

      Meanwhile, we (the nurse educators) have been working with the Rwandan staff to certify 120 staff members in BLS. First, the other educators (I was still in Italy) put 12 staff members through an instructor training course. Then we essentially let them loose. It is amazing what they have done. While the powerpoint slides were provided by us, they have done all of the lectures, skills practice sessions, and only used us for the exam portion of the day and basically just for the sake of time. While we failed miserably at 120 people, we did certify 51 people in the last few weeks prior to the survey.

Newly appointed BLS instructor Emmanuel teaching

     Next week should be interesting. In 2012 when CHUB started the accreditation process the hospital scored a 40%. ICU scored 43%. Both of these scores are considered (marginally) partially compliant. I am so interested to see how they have hopefully improved over the last two years. Wish us luck!

Lessons Learned:
1) Sometimes people will surprise you with their courage and leadership.
2) Sometimes you will be surprised at how similar things are in completely different cultural settings.

The Truth About Machetes

     I have discovered that if I mention the word “machete” to people back home, they tend to freak out a little. I forgot that when I first moved here seeing them everywhere freaked me out, but I adjusted and I barely notice when someone is wielding an excessively long knife (typically 13-18 inches long) around.

      I couldn’t tell you where the machete originated. They seem to be all over history with machete-like tools dating back to the Bronze Age. But the machete is commonly used as an agriculture tool. Its long, strong blade makes it useful to cut through thick jungle and rain forest and to harvest certain crops (i.e.- sugar cane, coconuts, bamboo) and for other tasks such as yard work. Since moving here I have witnessed the machete being used by butchers in the market and around the hospital grounds to cut grass. Rarely does a day go by that I don’t see a machete in use in this very agricultural based society (or someone walking around with an AK-47 I might add… though I have not seen those in use). The most common type of machete here in East Africa is known as the panga or tapanga (Swahili). The blade widens on the backside more than those in West Africa and Central America and is generally longer at 16-18 inches.

       Because the machete is so common, it was the primary weapon used by the Interahamwe militias during the Genocide. I recall how much it unnerved me when I first moved here to see them everywhere. I associated machetes only with violence and I couldn’t imagine how the Rwandans felt to see them everyday of their lives after the atrocities many of them witnessed, had done to them, or even performed during the Genocide. As it turns out, the Rwandans kept the machetes around on purpose. Not only are they extremely important in this agricultural society, but also by using them everyday for non-violence, the population has been desensitized to them, very much like me. I don’t bat an eye when I see one… that was until early Wednesday morning when having just been awoken in the middle of the night by shouts I saw our night guard Charles run by with machete in hand.

     I returned from my relaxing weekend in Italy early Tuesday morning. I got to my friend Jessie's house at 2 am where I promptly napped until 5 am. Jessie and I then loaded up and started the drive to Butare where we gave our ICU nurses a retention exam on the ICU Specialization Course that Jessie taught them in the spring. She dropped me back at home just after 2 pm since I was looking very much like a zombie at that point. I showered, put my pjs on and worked on my computer. I skipped a group dinner and was in bed by 9 pm, lights out by 9:15 pm and I'm sure zonked by 9:30 pm. As I fell asleep I heard Julie and Vanessa come in from dinner, chatting and moving about the kitchen.

     The next thing I knew I heard a loud person and at first I thought I was still in Kigali (Jessie's neighborhood noisier compared to Butare) then realized that I was in my own bed and wondered why was a drunk disturbing my much needed sleep. It was just after 2 am. Then I realized that it was one word, incredibly loud, incredibly close, over and over again. I texted Julie and Vanessa, searched for my glasses, heard them in the living room and joined them.

     That's when I realized that we had been burglarized. The television, surround sound speakers, dvd player, stereo system, and some other small items were gone. Glancing out the open window with a broken handle I saw part of our veranda fencing (for lack of a better word) was broken and then I saw Charles run by, machete in hand. There was a lot of confusion, a lot of calling anyone and everyone we knew who could speak Kinyarwanda and translate for us. We finally got the complete story at about 4:30 in the morning, which was that 3 men had come into the house after breaking the handle off the window and went immediately for the electronics. Charles was able to chase them off and apparently even cut one of them with the machete as he was climbing over the wall. Charles was able to recover almost everything, but the tv is gone and I later discovered my battery power pack that Dan sent me a month ago was also gone. I had left it sitting on the coffee table when I climbed in bed. 

     There was no sleeping for the rest of the night and we were all a little nervous. For a second at the beginning of the confusion we thought they had been in my bedroom and taken my backpack, but then realized as Charles hauled it into the light, that it wasn't my backpack. I almost vomited though when I thought they had been in my room and I hadn't woken up. The scariest what-if though is that Vanessa heard them in the living room. She assumed it was jet lagged me wandering around and almost came out to the living room. She fortunately decided to just go to the bathroom and pop back in bed. But what if she had gone out there. It creeps me out but we are all fine, just a bit unnerved.

     Fortunately, the colonel has been pretty responsive. He sent Robert, our trusty handy man from Kigali on Wednesday to repair the window, he allowed a second guard to stay at night, and we now have shiny new razor wire on top of our wall. He has also said we could get a dog if we wanted... I am certainly going to look into this option. I didn't sleep well until last night, but I think that was primarily from over eating at our ex-pat Thanksgiving dinner. 

     I am glad that Charles is armed with a machete and that Vénuste keeps his police battalion on him and that the entire neighborhood is aware. Not only the neighborhood, but also the army is aware, the police, our HRH staff, University of Texas, the US Embassy, the neighborhood watch, and I don't even know who else. But I think it's safe to say that our house is being well covered and that no one would be stupid enough to come back. But I'm not going to lie... I might invest in a machete myself.