Wednesday, March 28, 2012

Drive By (Picture) Shooting: Ten by Ten

On our last trip out of the city on Tuesday I decided to take one more batch of pictures out of the car window. I was thinking about how I would like to show what I am seeing when I look out, and a video was just too impossible (and forget about posting it).

So instead I took ten pictures, each ten seconds apart and this is what I got. A bit repetitive, but I think you get the idea. This is in the 'burbs of Kigali.

Kigali is filled with these 'motos'. They are very well regulated and required to supply a helmet.

They are probably drying coffee or maize on these sheets

Its the 'authentic saloon'. Apparently original saloons gave haircuts. 

That sign is for a VCT sponsored by UNICEF

Can't decide if this one is creepy or cool.

When I saw the random (fake!!) giraffe, I knew I had to stop taking pictures. It was just too good. 

Last week?

It takes me almost exactly three weeks to settle into a new place, to find a rhythm, and to feel settled enough to branch out a bit and explore new places, really get to know people, and to discover the culture around me.

I hit my stride yesterday. Pretty much in time to realize I leave at the end of the week. Shoot.

And the last couple days have been particular stressful work-wise. It doesn't help that my co-worker returned home Saturday.

But we have taken the opportunity these last two days to hit up some lunch recs from our trusty translator, Alan.

The first was 'Mali food', as in food from Mali. It was really yummy, and there was a lot of it. A lot more spices than in Rwandese food, and a good chicken/pea/curry mixture to put over the spiced rice. This place was super hidden and super packed. The small corridor of stores and houses in a busy urban neighborhood was somehow packed with cars that came here just for this food.

If you want to find it, it is just here (as they say).

Across from this bar.

Then today it was Mr. Chips.

 A small restaurant, owned by a Canadian, in Alan's neighborhood that has cheeseburgers and fries. 

They actually also had bbq pork on the menu but I wasn't adventurous enough to try that. The burger was really actually quite decent.

Bon Apetit!!

Sunday, March 25, 2012


There is no hiding my skin color (duh). And there is almost no way to hide all the baggage that comes with having that skin color while abroad. It is simultaneously liberating (because there is nothing you can do about it) and isolating (because there is nothing you can do about it).

My co-worker told me during my first day here that I had obviously had "embraced being different". I don't know about embraced. But what the heck can I do about my skin color or how the kids react to it? Not much. So I just go with it. 

Because really I have significantly more experiences that prove how similar we are. And its hard not to smile at the earnest voices calling out from the banana trees. 

In Tanzania, I was followed by chants of "Mzungu, mzungu, mzungu!"

In Kenya, it was "Howareyou, howareyou, howareyou!"

Here, in Rwanda, its "givememoney, givememoney, givememoney!"

I am contemplating if all three chants are the same, or if I can read into the differences.

But really, nah, I don't think so. Bright, smiling kids cheering your arrival, many expectantly. I think most have no idea what they are saying. In Kenya, for example, they would pluralize 'howareyou' as if it was a noun in Swahili. 

I am still curious, after all these years, who teaches these kiddos to chant, scream, and chase after cars. Will it always be like this? Will I always be reminded that I am different, over, and over, and over again? (although I don't think that's the purpose of the chanting.) And will I always be asked for things? (I doubt that's the purpose either.)

Only time will tell. And hopefully I will be in 'the biz' long enough to update you down the road.

sidebar: I have been thinking a lot about this article lately, and think I will write a blog post about my thoughts later.So read up.

Saturday, March 24, 2012

Drive By (Picture) Shooting: Bicycle Edition

This series is again taken out of a moving car. There are bicycles everywhere. In the rural areas, there are bike taxis that take people up and down the hills and transport goods from one village to the next. The bikes seem to be longer than regular and often have a couple foot long pad to sit on attached to the back.

There are so many things you can do with a bike...

You can use it to haul some sort of green leafy plant...

Or you could take a friend on a ride...

Perhaps you can use it to get to work packing a truck full of sugar cane...

Or haul sugar or flour from the store back home....

You could drive your bike to work at the hospital and leave it in the archway...

Or use it to get home from school...

But be sure to give it a good bath at the end of the day.

Friday, March 23, 2012


I have learned a lot during my travels, some lessons more profound than others, I think this lesson is pretty profound.

On this trip we have seen a lot. We have been in functioning OR rooms, trauma rooms, wards stuffed with kids and wards that are eerily silent, seen lines of nervous young men waiting for circumcisions and lines of kids waiting to be vaccinated, seen neonatal units with impossibly small babies two or three to an incubator.

I am learning how to be professional in these circumstances. Unlike medical staff, we are not there to help the patients directly (although potentially our will work will impact them in the long-term), and it can be awkward to work our way between the beds, looking at the equipment, and trying to compartmentalize the pain or the sickness of the human next to us. I am ever curious so I am always guessing what the person is ailing from, although I am quite sure my accuracy is very low, having learned most lessons from George Clooney, news media, and my global health classes. I think it makes me feel more at ease to know (or convince myself I know) why the person is there.

Those who know me know that I have a hard time keeping a straight face, that I react quickly and visibly to my surroundings with my facial expressions (although I am getting waaaay better at this after all the travel).

At first, I was trying to keep a smile on my face as we talked with the nurses and doctors about the medical equipment, and I would flash my smile at those patients around me.

But oh man, then I started to stress out. Did I look totally goofy with a big old grin? (Yes.) How much grin was too much grin? (If you have to ask, its too much.)  Was a smile even appropriate? (Probably not) Would I want some goofy  person who could do nothing for me as I sat on a hospital bed smiling at me? (Maybe) How long do I smile for? (That's too long). What is the difference between a smile and a grin anyway? (Who knows)

So I took a lesson from Tyra and decided on the smeyes - smiling with your eyes. I am channeling all those lessons from America's Next Top Model, keeping a smile in my eyes (wait, what?), and trying to remain professional with the rest of my face.

I think it is working. I will be sticking with the smeyes.

Not quite smeyesing - all dressed up to go into an OR

Monday, March 19, 2012

Drive By (Picture) Shooting: Home Edition

So looking back through my pictures, 98.9% of them are of the scenery and 95% are taking out of a moving car. I will do better about (appropriately) capturing people and the work we are doing. My first mission was to take some pictures of the houses, again out of a moving car.

This is what I have collected in two days.

This one has a cow out front

Not a house, but it has a carrot on it. 

First building I have seen with a sponsor which is not a soda or cell phone company

Saturday, March 17, 2012

Up the Lake

 This week we drove from the southern tip of Lake Kivu, all the way up the lake to the northern tip. The road was not good, but we bumped and swerved our way up the road. And I was so thankful that we had a big land rover.

You know you are in for it when you ask "how long will it take to get there?" and the reply is invariably "what type of car do you have?"

It was an interesting trip though. Some days we traveled for many hours, some days only for a few. I spent most of the time gazing out the window at the scenery. Rwanda is very densely populated, meaning that you don't go for without seeing someone. It is also very cultivated. There are very few areas that appear to be undeveloped. It seems that almost all of the jobs are in agriculture here in the rural areas, as there are very few shops and many fields. We saw swaths of rice, bananas, tea, pineapples, carrots, and cabbages, and many other fields that I still have no idea what they are.

One new thing I saw were small wooden hutches set above small ponds, and the ponds are grouped 8-12 in a group. Turns out there are rabbits in the small hutches and fish in the ponds, and that the fish live off of the rabbit manure. Eventually both animals are sold at the market. Pretty inventive. (sorry, no picture).

Early morning drive
One morning we got up at 5 to take a six hour trip north to the next hospital. This was exciting because we got to see the school kids all going to school in big groups along the road, and then about an hour later, all of the workers headed to work in the fields, including women balancing hoes on their heads. The people emerge from the hills, having walked up or down very steep paths to get to the main road where we were traveling. The houses are built into the hills and seem to just pop impossibly out of the hillside as if they have been here as long as the hills have. Schools and churches are built on top of the hills on man-made patches of flat.

The kids are very quick to yell mzungu, although in these rural areas it was immediately followed with a plea for either money, pens, or water bottles (they know that mzungus are dependent on these and they are required to bring a water container to school).

The houses vary, but the landscape did not. Still with the up, down, all around. Really, the land of a thousand hills is a total misnomer. More like land of a bajillion hills. (think I will coin that phrase and sell it to rwanda for their next tourism campaign).

In the hospitals, we saw it all and met many interesting and earnest individuals striving to do the best for their communities but struggling with limited resources, old equipment, lack of educational resources, and enough staff. This trip was really my first chance to spend time in hospitals in my 'global health career' (whatever that means) and it has been very educational to learn about this avenue of healthcare, having spent more time in the educational and social parts of health. No big surprises, and many things are similar to hospitals in the states, although most details are to a more concentrated and stark degree that almost stops you in your tracks. Each hospital has crowds, smells, varying degrees of lack of materials and resources, trains of family and friends bringing lunch to the patients they know, mothers praying over their children, kids giggling and playing among the laundry. Hospitals are a unique mix of both desperation and hope. And the staff we meet are both aware of their circumstance and hopeful for both the institution and the population that they serve. We are seeing a lot of good work being done and in many cases I am impressed.

Our translator, Jean-Luc, and a hospital staff take us from one bloc to the next

In other words, this week was exhausting but very productive. This weekend we are taking a bit of a respite at a nice hotel and storing our energy for 7 more hospitals in the next two weeks.

So excuse me, I am going to go back to staring out at the lake for a couple more hours before the driver comes to take us away.

Wednesday, March 14, 2012

Food for Thought

We are currently winding our way from south to north along Lake Kivu. The road is "not serious" as our translator calls it. This means that it is bumpy, muddy, and otherwise just plain silly. We bump along from one hospital to the next and spend between 2-6 hours in the car each day. So there is time to puzzle over the things we see.

This is my current event I am pondering.

At one hospital, we saw a set of equipment in an operating room that the staff told us was only used when the mzungus, in this case Italians, came twice a year to perform surgeries. But other than that, the current staff had no idea how to use the equipment and just left it alone when the visitors were not there.

My immediate reaction was that this was not sustainable, and that the visiting doctors should have trained the staff on this equipment.

We asked the director of the hospital about these visits and asked why this training wasn't happening, knowing that the director must have thought this through already. He told us it was because if the local doctors were trained on this special equipment, they would surely leave this hospital in the middle of nowhere and get a job in a more urban area, or even out of the country.

That is what happened to the first three doctors that were trained on the equipment. So the training was ended, as it was hard enough to find doctors willing to serve this district hospital.

So what do you do about that? In terms of sustainability? Training? Brain drain? Human resources?

Its a puzzler.

Also puzzled? This guy. What is that crazy animal taking my picture? 

Sunday, March 11, 2012

Into the woods

So to make our schedule work, and we have very little room for error, we had to be about six hours away from Kigali by early Monday morning. This required us to travel during the weekend, so we made the best out of it and stopped by two museums and drove through the only national forest in Rwanda. Which again was green and hilly (sensing a theme?).

The drive from Kigali and then through the forest was incredible. The hills are continuous. You never reach a flat area. Up and down. Around and up. Down and over. And then repeat. luckily I don't get car sick and there is a lot to look at. Tea plantations that are built seemingly on the vertical, women on their way to a market somewhere, small kids on the side of the road who perk up when they see your white face flash by, random goats tied to trees, men on bikes flying down a hill with a mattress on the back. Banana trees, banana trees, banana trees. And then up and down, over and up, down and around again.

We stayed at the western edge of the forest, about an hour away from our final destination, on Saturday night. I have to say that this was possibly the most random place I had ever stayed at ever. Really. From the main road, (which is mostly paved, but hey, not really), we saw a small sign with the name of the hotel written on it. The only problem was there weren't any roads around, nor any hotels. Just a hill straight up the mountain and a mud path between the many small houses lining the hill. We asked someone walking around and they pointed up the path. There. It is up there.

See the sign? Now see that gap between the red and white buildings? Yeah. That.
Nuh uh. No way. At this point I had convinced myself that the website I had seen and the phone call I had made to the reservations desk was all a malaria-med induced dream. But up we went, at least one skeptical mzungu in tow (I can't speak for my colleague, though I am sure she had her doubts as well). The land cruiser snuck through the houses and straight up the muddy hill for about a kilometer. I thought about where we were going to have to turn around when we surely discovered that we had been duped.

When we reached the top, it was incredible. And incredibly surprising. Possibly the nicest rooms I have ever stayed in. And by far a top ten all time view - of the forest, Lake Kivu, and the green rolling hills all around. Really, just amazing. And refreshing.

When we had breakfast with the owner of the hotel this morning, he asked us what he could do to improve the experience.

Pave the freaking road! We said in unison. You are surely scaring away people at the bottom of the hill!

Ha, he says jokingly, we thought we would leave it as such. That way when people arrive at the top they will be even more pleased with the hotel.

More like they'll be in need of a drink, and that's a way to keep bar revenues up.

(apparently he wants to pave but has to wait on the government, who is building houses for those people living along side the road so that they can destroy the small homes to make room for the road and provide better housing)

View from my bed
So if you are ever in Rwanda, check it out. Top View Hotel.

It's really the tops. 

rain coming in over the forest as seen from the hotel

Rwanda Update #1

So what am I doing here anyway?

I got a new job with Duke in a department that is working on an assessment of a training program for biomedical engineering technicians. The training program, done by an associated NGO, aims to create curriculum and degree programs at many different levels to teach techs how to maintain and fix medical equipment, most of which is donated. More working medical equipment=good. Better aid efficiency =excellent. I am working on the program assessment and program planning for this project. It is a very new job but very exciting none the less (i.e. last minute trip to Rwanda). While in Rwanda we are collecting data for two different projects, both of which mean that I am traveling to 16 hospitals in 14 days all around the country. I am here with my colleague who has been here for three weeks before me. It is really great to have someone to be with and by the way things went at the first four hospitals, having two people is really helpful in completing the work.

It is a very beautiful country. I am learning a lot about Rwanda and what makes it different from the other East African countries I have visited. We haven't had much down time, but I take every chance I get to talk to the local people I encounter to get their story and point-of-view. From what I can tell, the Rwandan method of development is very different from Kenya and Tanzania, although some of the struggles are the same. From what I can gather, the development is both recent and happening quickly.
Rwanda Flag flies outside a health center

For example, one of the first things I noticed was that there weren't people on the side of the roads in Kigali selling things. I learned that there is an effort to restrict an informal economy. This was the most noticeable in the fact that the sidewalks were actually being used as intended, a new concept to me in this area of the world. There are constructed buildings used as formal marketplaces, and I am also told that there is government created housing for those who are either living informally or living in an area that the government would like to develop. (Still mulling over that one).

Also? It took me a full 24 hours to get called mzungu. And I have yet to only be harassed by kids less than 7.

Rwanda has only one native language and I have been attempting to learn a few words. The locals sometimes also speak French and Swahili, both languages I speak just enough to understand that I don't really understand.

The next week will be very hectic with lots of driving and early mornings, but it will also be a chance to see some of the rural areas which is a unique experience. So far, so good!

Happy Sunday!

Friday, March 9, 2012

Its Green Here

Our first hospital
I have been in Rwanda for three days now. We have been working a lot and haven't had much time to do any exploring or touristy things but I have had time to make one very astute observation.

Its green here.

And clean here.

But mostly green here.

Rwanda is officially the Land of a Thousand Hills

Can you believe I am in Rwanda?