Congolese refugees, the Rwandan people, ARC, and myself. First I realize how fortunate I am to have had the opportunity to live, work and learn in a foreign environment. I appreciate that my wife, Martha, agreed to this experience as did my employer, Allina. The resources contributed by ARC such as food, lodging and support staff were essential to my success. Of course I will always compare life in a refugee camp with life in a developed country with many benefits such as running water, electricity, health care, security, etc.
The Congolese refugees have been in Rwanda five to twelve years and have little hope to return in the next year or two. They have few resources and no modern conveniences. They are unemployed or underemployed not by choice, as described earlier. They maintain some customs such as dancing and are adapting to the customs and laws of Rwanda as in the area of family conflict resolution. The people are patient, hopeful and eager to learn.
The Rwandan people are proud of their country, especially that it is a democracy, it is growing and is a law abiding country. They understand that education is important. About 30 to 40 % of the nurses are enrolled in college courses. They are eager to learn English and the use of computers. Several people invited me to their homes and were gracious hosts.
The American Refugee Committee proved to be a well run, hardworking and efficient organization. I learned about the many constraints that apply to ARC because of the nature of refugee camp management by multiple organizations and local laws. I have also learned that current funding reductions threaten to bring additional hardships on the refugees.
Working in a developing country has been a goal of mine for over fifteen years, so I was pleased to find that I could be successful teaching and practicing in Rwanda. I have found that new challenges are enjoyable and that I am able to tolerate uncertainty and the living conditions in a developing country. Fortunately, I didn’t experience any lack of security. I will return to my work in Coon Rapids August 25, 2008. I hope to work abroad again in a few years and to visit or work in Rwanda.
This will be my last entry to this blog, except that in a month or two, I may announce a time and place where I will show slides and speak about my experience in Rwanda. Thanks to those of you who wrote or spoke words of encouragement about this blog to me.
Tuesday, July 29, 2008
Wednesday, July 16, 2008
Last 10 Days
On June 29, 2008 Martha, my wife, joined me for my last 10 days in Rwanda. We were very happy to see each other after being apart for three and one half months. We visited the beautiful garden at the Mille Collines Hotel (of Hotel Rwanda fame) and the Genocide Memorial in Kigali where 254,000 people are buried. Next we visited the camps where I worked and stayed one night at each guest house. The staffs of the camps organized a farewell meeting with speeches and gave me a wooden mask, wooden map of Rwanda, carved milk bottle, woven map of Africa, woven basket and hand bag.
The last week we spent as tourists seeing parts of Rwanda I had not seen during my work. We traveled two hours from Kigali to the eastern border to see Akagara Park. Here we saw giraffes, hippos, water buffalo antelope, impalas, fish eagles, monkeys, baboons a few and other animals. This park has only a few elephants and lions due to settlement of refugees from Uganda and Tanzania in the park after the war of 1994.This created competition for land and poaching. The park is expanding the number of animals through protection and bringing in more animals.
The next day we traveled by taxi to Butare, the former capital and current university town. Unfortunately the king’s palace and national museum were closed due to a holiday. The taxi took us to the southwest part of the country to a large rainforest called Nyungwe National Park where we spent two nights. We hiked through bright green colored tea fields and the forest to a waterfall and viewed Colobus monkeys and a few birds.
The following morning we hiked four kilometers to a bus stop where we squeezed into the front of the bus for a six and three fourths hour ride on gravel mountain roads to Kibuye on Lake Kivu. Our hotel had a view of the lake though the water was barely warm. Nearby we visited ARC’s third camp in Rwanda, where I did not work as ARC is not responsible for health care. Here they have begun AIDS treatment in the camp’s health center. I had a chance to review the medical record they are using and found it to be comprehensive. The other two camps will be using this form in the next few months.
The night before our return to the US we were invited to the home of a Rwandan family whose son we had met in Iowa a year earlier. He is attending Iowa Wesleyan College there and had spent a holiday with my relatives. We learned of their living abroad for safety reasons, their losses during the war (genocide of 1994) and their assessment of and hope for their country. The mother, who is a former senator and current Supreme Court justice, explained that the constitution requires 30% of legislators be women and that now, after seeing the effects, nearly 50% of the legislators elected are women. This evening gave us a fuller understanding of the country.
We are now home. I must unpack and organize my things. I am working in the garden and fixing things around the house. In the next few weeks I’ll write a final entry to summarize my thoughts about this experience.
The last week we spent as tourists seeing parts of Rwanda I had not seen during my work. We traveled two hours from Kigali to the eastern border to see Akagara Park. Here we saw giraffes, hippos, water buffalo antelope, impalas, fish eagles, monkeys, baboons a few and other animals. This park has only a few elephants and lions due to settlement of refugees from Uganda and Tanzania in the park after the war of 1994.This created competition for land and poaching. The park is expanding the number of animals through protection and bringing in more animals.
The next day we traveled by taxi to Butare, the former capital and current university town. Unfortunately the king’s palace and national museum were closed due to a holiday. The taxi took us to the southwest part of the country to a large rainforest called Nyungwe National Park where we spent two nights. We hiked through bright green colored tea fields and the forest to a waterfall and viewed Colobus monkeys and a few birds.
The following morning we hiked four kilometers to a bus stop where we squeezed into the front of the bus for a six and three fourths hour ride on gravel mountain roads to Kibuye on Lake Kivu. Our hotel had a view of the lake though the water was barely warm. Nearby we visited ARC’s third camp in Rwanda, where I did not work as ARC is not responsible for health care. Here they have begun AIDS treatment in the camp’s health center. I had a chance to review the medical record they are using and found it to be comprehensive. The other two camps will be using this form in the next few months.
The night before our return to the US we were invited to the home of a Rwandan family whose son we had met in Iowa a year earlier. He is attending Iowa Wesleyan College there and had spent a holiday with my relatives. We learned of their living abroad for safety reasons, their losses during the war (genocide of 1994) and their assessment of and hope for their country. The mother, who is a former senator and current Supreme Court justice, explained that the constitution requires 30% of legislators be women and that now, after seeing the effects, nearly 50% of the legislators elected are women. This evening gave us a fuller understanding of the country.
We are now home. I must unpack and organize my things. I am working in the garden and fixing things around the house. In the next few weeks I’ll write a final entry to summarize my thoughts about this experience.
Saturday, June 21, 2008
World Refugee Day and case updates
Yesterday was world refugee day. In Nyabiheke Refugee Camp there were speeches of encouragement from refugee leaders, camp managers, UN officials local politicians and students. Dancers, music and a skit provided entertainment. The program was three hours. It was almost all in Kinyarwanda so I could not understand most of the speeches. Near the end the dancers chose people from the audience to join the dancing, and of course as I stood out in my pale skin, I was soon dancing.
Recent clinical cases
We are occasionally able to fit middle aged or elderly patients with reading glasses selected from a large box with glasses labeled with a US discounter’s label. Last week a 55 year old woman was so pleased she danced a little jig. A four year old started on Phenobarbital a month ago for seizures returned and her father reported no further seizures. Unfortunately we were out of the drug and they were told to return in a week to see if our supply has been replenished. Financial restrictions frequently lead to lack of supplies.
The child who I wrote about in May who had severe malnutrition returned to the clinic a week ago with shortness of breath, no fever or cough. He was transferred to the local hospital and died the next day at 10 months of age. The cause is uncertain, but I suspect infection or heart failure causes by malnutrition. His body was held overnight in the clinic’s isolation room awaiting burial the next day.
The newborn that the health team resuscitated about six weeks ago had a cold last week and I was able to examine him and talk with his mother. Later he received routine immunizations. He is doing very well.
Recent clinical cases
We are occasionally able to fit middle aged or elderly patients with reading glasses selected from a large box with glasses labeled with a US discounter’s label. Last week a 55 year old woman was so pleased she danced a little jig. A four year old started on Phenobarbital a month ago for seizures returned and her father reported no further seizures. Unfortunately we were out of the drug and they were told to return in a week to see if our supply has been replenished. Financial restrictions frequently lead to lack of supplies.
The child who I wrote about in May who had severe malnutrition returned to the clinic a week ago with shortness of breath, no fever or cough. He was transferred to the local hospital and died the next day at 10 months of age. The cause is uncertain, but I suspect infection or heart failure causes by malnutrition. His body was held overnight in the clinic’s isolation room awaiting burial the next day.
The newborn that the health team resuscitated about six weeks ago had a cold last week and I was able to examine him and talk with his mother. Later he received routine immunizations. He is doing very well.
Saturday, June 14, 2008
Laws and safety
Rwanda is a law abiding and safe country according to my experience and everyone I’ve talked to. People feel safe walking alone at night and theft is infrequent. Traffic laws are obeyed, although many drivers proceed after the light has turned red.
A month ago while I was photographing the green hills a policeman in civilian clothing asked me what I was doing and why was I here in the town of Byumba. We communicated in broken French and English and he became somewhat belligerent, demanding my passport. My driver’s license was not sufficient, so we walked a block to the ARC house where the guard and a manager talked to the policeman. After seeing my passport he thanked me and left. The next day a different policeman made an inquiry about ARC and me at the ARC office in Byumba. Speculation of my companions as to why he was suspicious include boarder security issues, as we are close to Uganda and threats made toward refugees by various foreign or terrorist groups who took refugee’s photos. Yesterday while walking home through the camp, I was stopped by the president of the refugee organization. He didn’t know me and inquired what I was doing. I explained my role as did a nurse who was nearby. He thanked me and I said I understood that non residents are not allowed in the camp without formal permission. J-walking laws are frequently enforced in cities, but luckily I have not been cited and am being more careful.
Today I’m finishing my work in the Gehimbe camp. Unfortunately I can’t get the projector to work for a presentation about using the internet for finding medical information. There is no active internet connection so all the information is in my computer. Maybe someone will be able to help. If I’m lucky my computer will be compatible with the projector, the correct plug adaptor will be available and the generator will work.
It is now the next day. The power was insufficient to power the projector, so I held up my computer anf moved around the room to give a partial view to the nurses.
A month ago while I was photographing the green hills a policeman in civilian clothing asked me what I was doing and why was I here in the town of Byumba. We communicated in broken French and English and he became somewhat belligerent, demanding my passport. My driver’s license was not sufficient, so we walked a block to the ARC house where the guard and a manager talked to the policeman. After seeing my passport he thanked me and left. The next day a different policeman made an inquiry about ARC and me at the ARC office in Byumba. Speculation of my companions as to why he was suspicious include boarder security issues, as we are close to Uganda and threats made toward refugees by various foreign or terrorist groups who took refugee’s photos. Yesterday while walking home through the camp, I was stopped by the president of the refugee organization. He didn’t know me and inquired what I was doing. I explained my role as did a nurse who was nearby. He thanked me and I said I understood that non residents are not allowed in the camp without formal permission. J-walking laws are frequently enforced in cities, but luckily I have not been cited and am being more careful.
Today I’m finishing my work in the Gehimbe camp. Unfortunately I can’t get the projector to work for a presentation about using the internet for finding medical information. There is no active internet connection so all the information is in my computer. Maybe someone will be able to help. If I’m lucky my computer will be compatible with the projector, the correct plug adaptor will be available and the generator will work.
It is now the next day. The power was insufficient to power the projector, so I held up my computer anf moved around the room to give a partial view to the nurses.
Saturday, May 31, 2008
Update May, 31, 2008
This week a building collapsed during deconstruction, killing one person and seriously injuring six others. I was not at that camp but was told the rescue and treatment went as well as could be expected. This reminds us of the suffering of the people in China and other areas of disaster. Also a twelve year old died of internal injuries after he was attacked by other young people.
More positive occurrences include the completion of a new building for labor and delivery. It is brick with a cement floor and a tin roof. It will replace one made of plastic sheeting on pole frames and mostly plastic floors. Running water will be piped in as soon as funds are available. The community health educators are receiving more training and soon will be visiting all newborn babies and their families weekly for the first few weeks of life.
Nyabiheke, the smaller of the two camps where I spend most of my time may expand in the next several months to accommodate 5-7,000 refugees currently in temporary centers called transit centers. The construction people are preparing to construct houses, roads, latrines and kitchens. The physician there has resigned in order to further his education, so ARC is looking for a replacement. I will be working only four more weeks, so will have some extra duties.
More positive occurrences include the completion of a new building for labor and delivery. It is brick with a cement floor and a tin roof. It will replace one made of plastic sheeting on pole frames and mostly plastic floors. Running water will be piped in as soon as funds are available. The community health educators are receiving more training and soon will be visiting all newborn babies and their families weekly for the first few weeks of life.
Nyabiheke, the smaller of the two camps where I spend most of my time may expand in the next several months to accommodate 5-7,000 refugees currently in temporary centers called transit centers. The construction people are preparing to construct houses, roads, latrines and kitchens. The physician there has resigned in order to further his education, so ARC is looking for a replacement. I will be working only four more weeks, so will have some extra duties.
Friday, May 23, 2008
Oh my aching mugango!
Mugango in Kinyarwanda means low back. It is one of a few words I have picked up because it is either the chief complaint or one of the “by the ways” of over one half of people thirty or moor e years old. Neck pain and headache is also very common. Of course these problems are very common in the US also. There multiple types of conditions and causes of these problems, however one notes many conditions that may cause the problems here. Transport of heavy objects on the head is very common, especially by women. Many people work stooped to wash, cook and work in the fields. People cut grass and weeds using machetes with a 45 degree bend at the cutting end. This saves gasoline and pollution but requires some back flexion.
In the clinic we are limited in imaging (x ray, CT, MRI) as I wrote earlier. We are able to see x-rays a few days later in cases that are more serious or resistant to treatment. The patient must travel by ambulance four to sixty miles to have the procedure. Due to budget limitations, we must select only the most serious cases to referee for x ray. We must think about saving resources for all other patient problems, especially those that are serious and amenable to treatment. Most cases of back, neck and headache pain receive ibuprofen or acetaminophen and posture recommendations.
This week we have been treating a fifteen year old boy with congenital heart disease using digitalis, spironalactone and low salt diet while waiting for approval of referral to a specialty hospital in Kigali for heart surgery. He probably has a ventricular septal defect and aortic insufficiency and possibly other problems. We are not able to monitor basic parameters such as the potassium level and became more uncomfortable as his shortness of breath increased and his pulse rose during the week. The UNHCR declined to fund the referral so we referred the patient to a teaching hospital in Kigali where surgery will not be possible, however better medical management will be possible, at least in the short term.
In the clinic we are limited in imaging (x ray, CT, MRI) as I wrote earlier. We are able to see x-rays a few days later in cases that are more serious or resistant to treatment. The patient must travel by ambulance four to sixty miles to have the procedure. Due to budget limitations, we must select only the most serious cases to referee for x ray. We must think about saving resources for all other patient problems, especially those that are serious and amenable to treatment. Most cases of back, neck and headache pain receive ibuprofen or acetaminophen and posture recommendations.
This week we have been treating a fifteen year old boy with congenital heart disease using digitalis, spironalactone and low salt diet while waiting for approval of referral to a specialty hospital in Kigali for heart surgery. He probably has a ventricular septal defect and aortic insufficiency and possibly other problems. We are not able to monitor basic parameters such as the potassium level and became more uncomfortable as his shortness of breath increased and his pulse rose during the week. The UNHCR declined to fund the referral so we referred the patient to a teaching hospital in Kigali where surgery will not be possible, however better medical management will be possible, at least in the short term.
Saturday, May 17, 2008
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