"Delicious 30"

    So I celebrated my 30th birthday in Africa. Not because I took a vacation, but because I live in Rwanda. If you had asked me a year ago what I'd be doing to celebrate the big 3-0, let me tell you... the answer wouldn't have come close to the truth. What is the truth? I'm glad you asked.

     A week before my birthday I was in Kigali attending the nursing conference hosted by the University of Rwanda. A few of us decided to grab dinner at a restaurant that Steph wanted to visit before her departure from the land of 1000 hills. Rhett, a visiting surgical resident from UVA joined us.  A few drinks later while discussing his vacation plans for the remainder of his time in East Africa, I more or less had invited myself along on a weekend adventure. To be fair, Rhett did say that I should jump on the opportunity and he was right. The opportunity that lay before me was extremely unique, fascinating, and a once in a lifetime experience. By the next afternoon it was all settled; I was headed to the Congo for the weekend.

     Now, you may be thinking to yourself, "Isn't that the country where there appears to be constant instability?" "Didn't one of the doctors on ER almost get killed there?" "Wasn't there just an article in the Washington Post when Alex was home for New Years about some rebel skirmishes in the northeast along the border with Rwanda?" "Didn't her father tell her not to go there?" And the answers to all these questions is, Yes. Now, mind you, when I first moved to Rwanda in August, I thought anyone who mentioned visiting the Democratic Republic of Congo (DRC) was a little off their rocker. Ok, to be perfectly honest, more than a little off their rocker. And yet, I had consented to stay 2 nights and 3 days in the country so I could go hiking.

Mount Nyiragongo (Wikipedia)

     It was no ordinary hike. Mount Nyiragongo is located in Virunga National Park in the DRC approximately 12 miles north of the city of Goma. It has an elevation of 11,382 ft with a crater diameter of 2 kilometers. Within the crater is a lava lake. Along with Mount Nyamuragira, which isn't far away (we could see it the following morning), the two volcanoes account for roughly 40% of Africa's volcanic activity (thanks Wikipedia!). Accordingly to our tour guide, Roger, the most recent eruption occurred in 2002 when lava flowed out of a lower elevation fissure and all the way to Goma. Over 9 feet of lava buried parts of the city, which have since been rebuilt, 9 feet higher. Apparently, the lava flow during eruptions of Nyiragongo is very fast partially due to the steepness of the volcano and I'm sure partially due to some geologic phenomenon of which I'm unfamiliar, but it can go as quickly as 60 mph. This is apparently quite unusual and what makes this particular active volcano quite dangerous. So naturally, I thought I'd hike it and camp at the summit in celebration of my 30th birthday.

     So let the adventure begin! It started with a long, interesting bus ride. In order for me to reach Gisenyi, Rwanda I had to take two busses, one from Butare to Kigali and then Kigali to Gisenyi. By no means is this the most direct route, but without a car of my own, it's the best way to go. Fortunately, Vanessa had a department meeting Friday morning in Kigali so she gave me a lift the first half of my journey. Once at the bus station (which is always a total and complete zoo) I discovered that our trusty bus line, aptly named Volcano, didn't run to Gisenyi. Fortunately, one of the Volcano guys walked me across the parking lot, dodging moving busses, people, vendors, probably animals as well, to Kigali Coach where at 9:29 am I bought my ticket for the 9:30 bus and ran back into the madness to get on the bus. I got the last seat... the jump seat right next to the door. Now the good thing about this jump seat is that you actually have room for your bags and feet. I very wisely dropped the dry bag with the three sleeping bags on the bus step and fit my day pack in front of me. I say it was wise for me to place the sleeping bags on the step because as I discovered about 15-20 minutes into the 3.5 hour drive the bus door tended to fly open at high speeds. The other people on the bus thought it was hilarious that the only muzungu (literal translation: crazy white person) was sitting there and every so often had to shove the door closed so that I wasn't flung off the bus when going around a crazy curve.

     I managed to keep my car sickness under control and by the time we reached Musanze (north of Kigali where Volcanoes National Park with the Rwandan gorillas is located) I was able to switch seats and grab my own. Between Musanze and Gisenyi our bus got pulled over for speeding. The odd thing about this traffic stop though is the two heavily armed police officers had everyone get off the bus. At first I thought nothing of this and then about a minute later I realized this was odd and whipped out my phone to text my ever trusty roommates who agreed this was weird. The officers then made us all get back on the bus to collect any baggage we had left on it. Finally, they let us back on and we continued on our way. I have no idea why we were stopped in that fashion. Maybe they were looking for something specific, maybe our driver had just said something to annoy them. I have no idea, but it's the first time since moving here I thought, "This is odd."

     Upon my arrival in Gisenyi about 1 pm, I was met by Innocent, the owner of Green Hills Eco-Tours, the tour company the guys and I had booked our trip through. He is very sweet and kind and was all set to drive me to the border so that I could cross into Goma. I was very excited. First, Gisenyi and Goma are located on Lake Kivu. I have learned in my travels that growing up on the East Coast of the U.S. has ingrained in me a need to be nearby water. I didn't grow up on the water, but we go to the river during the summer and it's just a 30-minute drive downtown to go sailing or walk along the harbor. I need water. So coming down a hill and seeing how big Lake Kivu is and how beautiful it is, almost took my breath away. I just love water.

Lake Kivu
Facing Southeast towards Rwanda

     When I was told that you walk across the border, I was very intrigued. I had these thoughts of grandeur of crossing the Rwanda/Congo border and feeling so accomplished, brave, and exhilarated. Perhaps this is how the Von Trapp family felt as they hiked across mountains, crossing borders and while I will admit the mountains of Rwanda are not the Alps, this thought did pop into my head...

Headed into the wilds of Congo

It was none of these things. In fact, it was completely uneventful and monotonous. I filled out my departure card for Rwanda, showed my passport twice, walked approximately 100 yards to Congo, showed my passport again, and I was in the DRC.

Newest stamp in the passport

That was it. The Congolese had a little trouble finding my visa that Innocent had given them the day before, but while waiting I went to the public health folks and had my temperature taken and showed my yellow fever card. Innocent stayed with me the entire time, walked me to my hotel, which was another 300 yards from the border, made sure I was checked in and the room was ok, gave me a lecture about not walking in Goma at night before heading back to Rwanda. The boys (I'll get to them) were still out on their gorilla excursion and were due back soon. I quickly settled myself in my room and then found myself at the pool, looking at the lake with a beer and new book in my hands.

Looking east to Rwanda

     It wasn't too terrible of a way to spend the afternoon. Very relaxing with the exception of the UN planes landing and taking off every half hour or so. We have an airstrip in Butare that is almost never used and I have grown so accustomed to not hearing noise from the sky that it surprises me when I do. The boys finally made it back to their hotel about 2 minutes away after a 3 hour post gorilla hike excursion to the Goma market to buy masks. Apparently, they were quite the bargainers. My hotel arranged a cab for me to take to their place for dinner (where I corrected the dish they had ordered me; they literally picked the only thing I wouldn't eat on the menu) and they regaled me with tales.

Mickey, Me, & Rhett

Mickey is a visiting medical student from McGill University in Canada. There is a program in Canada where you can enter medical school basically straight from high school (he explained the details but in all honesty I don't recall them all... must be the old age) and is just 22. He's ridiculously smart and talkative. Being from Quebec he speaks French and this lead to the three hour excursion in the market earlier in the day because he refused to be ripped off. Rhett, is a visiting surgical resident from UVA who tacked on a week of vacation to his rotation here. I'm sure he's heard all the possible jokes about his name growing up in Georgia, so during his few weeks in Butare we kept the Clark Gable and Gone with the Wind references to a minimum. He has traveled to more places I can recall and even worked on a game park in Zimbabwe. They are both very fun and personable... and also graciously allowed me to crash their bromance. I was informed that it was probably a good thing I hadn't spotted the volcano yet as according to them, it looked pretty intimidating. We all called it a relatively early night and agreed I'd let them know when I was picked up at the hotel by Innocent Saturday morning.

     The next morning after an awesome breakfast I was scooped up and then we got the boys. I met Roger, who was our guide on the mountain. Roger is awesome. So incredibly sweet, funny, and full of knowledge. We drove through downtown Goma and that's when I realized, I was truly in Africa. Rwanda is so incredibly different from other African countries. While the mountains and surrounding area of Congo was beautiful, Goma was a slum. There was a thick haze of volcanic dust and smoke as we drove. Trash burned in the streets and there were piles upon piles of it. Everything was gray and sooty from both the volcanic soil and fires. A child was going to the bathroom right next to the fruit his mother had spread out along the road to sell. I have no photos of Goma as the Congolese are not fans of tourists and photos, which I understand, and it's so vividly ingrained in my mind I don't think I needed a camera. One thing I did notice is that unlike Rwanda, Congo still has a number of trees. Most of the homes in Rwanda are made from red mud bricks while in Congo they're made from wood. For me, it painted a very difference landscape despite being within 20 miles of the Rwandan border. It's only when you leave Rwanda that you realize you're really living in Africa.

     It was still hazy as I finally caught view of Mount Nyiragongo. And the boys were right. It went straight up and the summit was lost in the clouds. I was certainly intimidated. When we got to the starting point, the sky had cleared and I was even more intimidated. The start of the hike looked to be 20 miles away from the summit.

Mickey and Rhett at the starting point.
Hello distant summit.

A zoomed view of Mount Nyiragongo from the start.

Then the other hikers started to show up with their gear and weren't hiring porters to carry it for them. All of my friends who had previously done this hike told me to hire someone. It costs $24 plus tip and I figured not only was it employing someone but it would also make my vacation way more enjoyable if I was carrying a water bottle versus a 25 lb day pack (I'm really good at packing). I told the boys that I might get shamed into carrying my bag as we sized up the UN crowd hiking with us. But in the end I hired someone and I really hope that the UN folks that stopped carrying their packs halfway up paid their porters appropriately.

    It took 5-6 hours to reach the summit. For the first 4 hours every time we stopped I think we all felt as though we hadn't made any progress whatsoever. The volcano looked just as far away as it had at the beginning of the hike. When it finally was noticeably closer I felt a little relieved.

Lunch break, complete with Mars bars.

Explorers

Our attempt at a Brady Bunch photo

I didn't think the hike was the hardest I'd ever done (that prize definitely belongs to the 14,000+ foot hike I did with my surrogate brother Chris in Colorado in July 2013) but it was pretty strenuous. I was not complaining when we took safety breaks to make sure everyone was still together. We took several safety breaks because I was in fact hiking through an area where the Democratic Forces for the Liberation of Rwanda (FDLR) hang. And of course, unbeknownst to me, the day before I arrived in the DRC had agreed to an offensive against the rebels with UN and U.S. support. So, yes, this is why my father had told me just three weeks before to NOT go to the Congo.

     But in all honesty, I felt incredibly safe. We had three Virunga Park Rangers with us who were heavily armed. As I've probably previously mentioned, similar to the machetes, I am completely desensitized to people in uniform (army, police, prison guards, bank guards etc.) strolling the streets with AK-47s and it was no different in Congo. One ranger in the front, one in the middle, and one in the rear and while I know the porters weren't armed with guns, I'm certain they all carried knives. I didn't think my 1" pocket knife gifted to me when I left the safety of Bucknell University for the wilds of the University of Maryland would do much good, but I had it on me. As we got higher up and passed the ranger station with another 5-8 park rangers they allowed us to spread out a little more. I stuck right behind the boys who were right behind our lead park ranger (the one with multiple magazines duct taped to his weapon). The last 30 minutes of the hike were ridiculous. I was climbing volcanic rock at, I'm not exaggerating, easily a 45˚ angle, maybe more. At this point, the boys took off (freaking jack rabbits). They were the first two to the top, even ahead of the ranger, and about 10 minutes ahead of me. I was the 4th to the top and the first gal by at least 15 minutes. I was expecting the elevation to get to me more, but I was pleasantly surprised.

Last 30 minutes of the climb... this is where the boys took off.

Looking down to the second crater as I
was roughly halfway up the last haul.

I made it!

     As I was still catching my breath, the boys informed me that 5 minutes before I reached the summit the crater was very clear and you could see the lava perfectly. As I peered over the edge I could faintly see it and a whole lot of steam. I was a little disappointed but, I'm not going to lie, I felt as though I had just climbed Mount Doom, minus the orcs and all (think Lord of the Rings for those who don't understand this reference). As the wind shifted and the temperature dropped it became one of the most mesmerizing and fascinating things I have ever seen in my entire life.

The initial glances at lava.

Steam clearing.

Amanda was a Dutch woman on the hike with us who also just happened to be a geologist. She was explaining all sorts of things to me. We could sit along the edge and watch the molten lava boil up, cool and harden (thus turning black) and then see and hear the cracks starting to form as it broke apart and another area boiling sucked the hardened pieces down. It was amazing to watch. We could feel a slight warmth from the rising steam when the wind was right despite the chill in the air.

Our hut is on the left, a mere 20 feet from the craters edge.

Roger and the lava lake.

After the sorting of huts, I changed into my thermals and Roger made us hot tea over a lovely fire. The wind was chilly but all in all I was fine. As Roger cooked dinner we had fun talking with Amanda and her husband Benjamin, goofing off, and simply looking down into the crater at the bubbling lava lake.

As night fell, it became more and more breathtaking with every passing minute. There was lighting bolting down in the valley and clouds illuminated above us. Below you will find a picture the boys captured of me with the lave glow from the rising steam and lighting in the clouds. It's fantastic.

      Roger made us a delicious dinner of rice, stew with veggies, sausage, beef, and fish. It was so nice to sit around the fire and eat and talk. He also shared with us the local alcohol of Goma, which is clear, tastes suspiciously like Children's Tylenol chewable tabs, and is packed in plastic pouches. You slit the corner and suck it out. We had a grand time. I finally called it a night about quarter to 9. I was exhausted. Roger made a hot water bottle which was great because I'd been hanging out in flats and not my gortex boots so they were a little chilled. Probably 30 minutes later the boys came in and I tried without success to pawn the hot water bottle off on one of them. I was actually hot. All my friends who have done the hike said that it's freezing, it rains, it will hail, it's windy... Rhett and I opened the tent (within the hut) door we got so hot. The wind was non-existant as we slept. I removed every layer I could and while Mickey snored to one side of me, Rhett tossed and turned on the other. We didn't sleep more than an hour and probably not in more than ten minute increments. So needless to say I wasn't thrilled when Roger knocked on the hut in the morning telling us it was time for breakfast, but I did want to see the sunrise, so once the boys were booted, I changed and went back to the edge of the crater to see. Again, it was very steamy and the wind had picked up so I scurried back to see what deliciousness Roger had for breakfast.

Roger cooking up a storm.

     We started our descent at 6:45 am. We were all a little nervous about the first section down. It was steep and all volcanic rock that you easily slipped on. If you slipped and fell forward, there was no way of stopping. I took my time and even the jack rabbits I was with took it easy. I slipped and fell on my bottom, which left a nice bruise, but otherwise we were all fine. One hiker in our group slipped and cut his hand pretty badly. Mickey, Rhett and I all agreed, there is no way they would do such a hike in the US/Canada without a twenty page waiver, if at all. It amazed us that only one person (that we know of) has died on the hike, and well, apparently thats because sections of the rim can undercut and the ledge crumbled beneath her. Thankfully, we all made it down safe and in one piece. As we hit the jungle section towards the end of the hike the rangers made sure we were much closer together for safety and at 10:45, we were back to the starting point. We wished the hikers who were about to begin good luck and Roger shortly had us in a car and on our way back into Goma.

Our lead park ranger, Augustine.
Photo credit Mickey on my camera

     Now, as previously mentioned, Mickey is Canadian. This means that his visa to re-enter Rwanda is different than Rhett's. I have a work visa so I already knew I wouldn't have a problem getting back in, I was more worried they'd confiscate my ziplock bags I'd packed everything in. Anyway, when the boys entered the DRC Thursday Mickey applied for his re-entry visa to Rwanda as he needs to be pre-approved. He received a reference number in return. I believe the process is for immigration to then email the approval directly to him, but this did not happen. As we were on the summit of the volcano, Innocent had called and asked if he had the email, which he did not. Immigration was to resend it, we would head to the hotel I stayed at on Friday night and print it, all cross the border together, and meet Amanda and Ben at the bus station and head back to Kigali together, where we were very excited to have some indian food and drinks.

     Well... things didn't go quite as planned. As it turns out, Rwanda's immigration website was down... There was no email sent and without the website there was no way to see that Mickey had in fact been approved to cross the border. Even his invitation letter from the University of Rwanda was not enough, so we decided to order some beers and wait it out. Afterall, it was just barely noon, how long could it possibly take? "We should order food guys." "But if we get approval we just want to go, we can get something in Gisenyi before catching the bus." By 2 pm I tossed my bathing suit on and we all jumped into Lake Kivu to cool down. It was lovely and not freezing as I was expecting. We were only in for 5-10 minutes since there was no beach but it felt great. A storm rolled in and we pulled out a deck of cards and started play Rummy. Roger thought we were all a little crazy for going swimming, but had fun watching us play and learned a little.

Storm rolling in.

     By now it was closing in on 4:30 pm and we were tired, hungry, and had just learned the border closed at 6 pm. We held off on ordering food all afternoon because it had gotten to the point of if we got Mickey's approval we really would have to leave immediately. We finally decided about 5:15 pm that we would all stay in Goma for the night and cross together in the morning. I didn't want to get on a bus by myself at that hour and none of us wanted to leave Mickey alone in Goma despite his protests that he would be fine. Then, I'm not really sure what happened. I think pure exhaustion and hunger caught up with Rhett and I and the cost of staying in Goma another night and all of a sudden at 5:48 pm Rhett and I were trying to cross the border. Right after handing my passport to the DRC official, there were some doubts expressed, but it was too late. My passport was stamped and I had to go, which meant Rhett was committed and despite thoughts that maybe Mickey should just try and cross he stayed with Roger and went back to the hotel for the night.

     As if that in and of itself wasn't chaos enough, we found out upon crossing that the busses stopped running to Kigali about 6:30/6:45. It was 6:15 by the time we finished at the border. Innocent finally showed up to get us to the bus station and as the taxi pulled up he jumped out to possibly stop the bus from pulling out of the station without us. It was halfway out when they stopped it and a Rwandan quickly ushered me to it. It had started to drizzle a little bit and I thought Rhett was right behind me. Then I turned around and he wasn't. He and Innocent were discussing something and then the bus started to move without him. I started to shout that he had to come with me, they started to slam the door close, I started to open it, the bus is now going down the street and I'm trying to grab my bags and jump off it, when Rhett comes jogging down the street and jumps on, just to ask me where his bag was. I had no idea where his bag was. Turns out the Rwandan who had ushered me onto the bus had already stored it, but it took another 15 frantic seconds to figure this all out. If the people on board didn't think we were crazy white people before, they definitely did now.

     By the time we both sat down, we just kind of looked at each other and wondered what the hell had just happened. We didn't get to properly thank Roger and Innocent and the last hour of our life had been just ridiculously chaotic. We had left Mickey and felt terrible, despite knowing he would be fine. We sent emails to Mickey and Innocent and of course while still on the bus to Kigali we learned that not only was the immigration website back up, but that Monday had been declared a holiday so that I really didn't need to race back to Butare. We finally slept and pulled into Kigali just passed 10 and while I told Rhett not to worry and that we'd be able to get a taxi (which we would have been) I was glad not only that he was with me, but that he had a taxi driver he knew coming to get us. The crazy zoo of a bus station was like a ghost town minus the taxi drivers hounding us.

     They dropped me off at my friend Becky's and that was our adventure. Becky made sure to leave the newspaper out for me to read while she made me the best grilled cheese sandwich of my life.

I finally made my way back to Butare Monday evening (Mickey having gone directly there arrived safe and sound from Congo about 1 pm) and Tuesday night the Butare crowd and I got Chinese for dinner to celebrate my actual 30th birthday. I have to say, it was an unforgettable one.

Lessons Learned:

1) You might regret not doing something, but you will never regret the money, time, and experience of actually doing it.

2) Life is an adventure, make it happen.

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