A Blog is a funny thing

It's like reading a diary from back to front. If you haven't been following along the whole time you'll probably prefer to scroll to the bottom and read the posts in the order that they unfold. Otherwise, by reading from the top down, you get the end of the story first.

I've sent my reports to AIUM, SDMS & SVU. I've still got to send letters to some of the other donors. I've been invited to return and I'm in the early stages of working with KHI faculty, Lori Kimbrow and some other sponsors to return with a team of sonography experts in June 2009 to continue the effort of sonography education for the clinicians @ the district hospitals as well as any other persons who are interested in learning more about sonography.

If you've been following along, please add a comment so I can know who it was who was reading along from San Diego, Albuquerque, Ohio, Australia, Birmingham, Hanoi, England, Washington, New Jersey, Koala Lampur and all of those other places.

Wrapping it up - Final Report

The full report including issues and possible solutions can be accessed through this link. click here for full report in PDF format. The main jist of the report is found in the following:

Conclusion

• There is an immediate need for initial and ongoing sonography training of those who are currently performing the exams in the district hospitals. This could be easily coordinated through KHI and should be seen as an opportunity for Kigali Health Institute.

• There is a need to increase the level of training for the graduating Rwandan physicians. I am ignorant concerning the methods for change or ramifications for affecting this change but nevertheless see it as a very real and practical issue.

• There is a need to codify and ratify the professional description of a sonographer within the Rwandan medical delivery system.

• The medical staff will be accepting of individuals who are qualified and certified sonographers

• There are currently Rwandans who are capable of obtaining the training and appropriate certifications to practice sonography in Rwanda but not within the country.

• There is currently not a single acceptable clinical mentoring location within Rwanda.

• The question of will, national pride and long term resources must be considered prior to implementing a Rwandan Sonography program. Alternative partnerships and non-standard methods of training may need to be considered if there is a desire for sonographers during the next 5 years.

Wrapping it up - List of Tens, , , , well around ten :-)

Ten ways I know it's time for me to go home from Kigali:

1. I've decided to strangle the next person who calls me muzungu
2. In a conversation with an American I answer "Oi and merci" instead of yes and thank you
3. All the mulberries are gone
4. My food supply left in the cupboard/refrigerator consists of a bag of salt, some margarine, 5 tea bags, some stale couscous, and a box of hot breakfast oatmeal.
5. The water goes out for two days and I have a blow-out with the house boy - Philbert
6. My $10 of Skype credit is getting close to zero
7. Matatas - I can actually understand the Matata drivers, conductors, Can rapidly assess the quality of each matata, Look forward to the rides and The people (ticket agents and beggars) @ Atraco bus lines know be by name
8. I realize I haven't had a single solid stool in the past 60 days
9. I can walk up any hill without getting out of breath
10. I start making a top ten list
11. I'm able to quote food prices at @ Kimironko market

Ten Things I was most happy to have: (Either brought or acquired) (with input from Terry Loughnan)

1. Kodak EasyShare DX6490 Camera - With 2 Gb SD Card & docking station
2. My own pillow
3. A cell phone that worked in Rwanda
4. Laptop with wired and wireless connections, Skype with a headset and video camera on both ends of the earth.
5. Fresh, clean and crisp, 2004 and newer $100 bills
6. A nice large day pack
7. 2 Mb USB Jump Drive
8. Electrical Adapter Kit + Extra adapters
9. Storage trunks
10. Leatherman Tool
11. Audience Response system for teaching
12. I-Pod with speakers, my music and charge kit (Terry Loughnan)
13. A big Sudoku book (Terry Loughnan)
14. Light clothing and light hiking boots rather than heavy (Terry Loughnan)

Ten things I should have left home:

1. Inflatable Thermarest sleeping pad
2. Direct box for connecting autoharp to a sound system
3. PDA
4. Rolaids chewables - 3 packs
5. Spare batteries
6. $20 US bills (Terry Loughnan)
7. Jacket (Terry Loughnan)
8. Taste for coffee, because I didn't have a good cup whilst here (Terry Loughnan)

Ten things I really wished for while in Kigali

1. Having Shaloy with me
2. Petting a pet
3. My own transportation
4. Safe water from the tap
5. Water for showers
6. My kitchen and it's utensils
7. Better maps of Rwanda/Kigali
8. A smaller laptop
9. My church/Sabbath School support group/friends
10. French lessons before arrival in Rwanda

Ten Restaurant reviews in Kigali, Rwanda

1. Serena Hotel - The Mongolian Grill Buffet on Wednesday evening is the best value in Kigali. All you care to eat buffet with a salad bar, 1st drink, Mongolian Grill, hot bar with multiple choices, desert bar and fresh breads in the most upscale location in Rwanda. It feels like America for only 8,000 FRw or $16 US
2. Indian Khazana The atmosphere is exotic with a wait staff dressed in fantastic Colonial Indian garb. The menus is extensive with many options for vegetarians. The staff is attentive without being obtrusive. The food is delicious and authentic but you should expect to pay between 8 - 10,000 FRw or $16 - $20 US. A great place for a birthday.
3. KBC - The best lunch buffet in town is a hole in the wall on the north end of this complex of shops. Next door to the African gifts is a small shop with no external sign but from 12:30 - 2:30 some of the best lunch food in Kigali is served here. Expect to sit wherever there is a seat as the place will be packed. A great selection of well prepared local fare with multiple meat dishes which always had options of beef, chicken and fish. an assortment of salads, potatoes, greens rice dishes with some fruit and a glass of juice for 1,800 FRw $3.60 US. Food is cooked elsewhere but brought in for lunch only.
4. Africa Bite - In the Kimihurura district two blocks down from Rue 1. This is a hopping place at lunch time with a great buffet of tasty authentic African dishes for 2,500 FRw or $5 US. 1 drink and a fruit desert included. A good value @ lunch time it changes character in the evenings as a quite reserve from the hubub of a Kigali day. The quiet garden seating is a great place to spend a few hours quietly visiting with friends. A limited menu in the evenings but the kebabs are a great value and the weekend chef specials would be your best options.
5. Ice and Spice - Tasty Indian cuisine in Mumunge. It's a little less expensive than Indian Khazana but has none of the class. Expect to pay 6 - 8,000 FRw. ($12-$14 US)
6. KIST Canteen - The cafeteria service of Kigali Health Institute (KHI) and Kigali Institute of Science and Technology (KIST) provides a wonderful meal value to the faculty and students. Traditional African fair at a very reasonable price. Nothing fancy about the atmosphere but it's close, good flavor and cheap. The secret is that there are options but you've got to ask. These include Kinyomoro juice, fresh pineapple desert, chapats and African tea are all extra but you'll leave with having spent between 1,500 & 2,000 FRw ($3 - $4 US)
7. King Faisal Hospital Food Service - Hit and miss but mostly miss. Expensive for what you get. It's only saving grace is that you don't have to leave to eat. My suggestion, , if you have time , , leave to eat. There are a couple of small restaurant options on the road approaching the the hospital. They are all better and cheaper.
8. Flamingo Oriental Food - just down the street a few hundred meters from Africa Bite. Upscale dining hidden in a a neighborhood. You won't wander wander by and find this place by accident. Call ahead to get seating upstairs for a great view of Kigali by night. Service is above average with hot steaming, minted towels given before eating and to refresh you. The combination of atmosphere, service and good oriental dishes makes it a good option if you're okay spending 6 - 8,000 FRw ($12 - $14 US)
9. Karibu - Just down the street from CHK hospital and around the corner a couple of blocks from KHI is a good value for lunch. 2,500 FRw ($5 US) is a great lunch buffet with outdoor seating in a gravel courtyard. Drinks are extra (standard prices) but the fruit desert is included. The best part of this restaurant is the options. It's standard African fare but there will be around 18 different dishes prepared and available.

Getting Home - To Chattanooga

Even though it was after 2 a.m. when I crawled into the lower half of the bunk bed I awoke around 7 without an alarm. The shower was open and I revelled in hot water and plenty of water pressure. I quietly had all of my stuff collected and the room triple checked by 8:00 am. A few minutes later I was standing @ the ticket counter buying my one way into London Bridge station. Eight o five I'm on the train, moto in hand, pack on my back I'm on my way to Heathrow through.

I didn't have to wait for more than 5 minutes for any of the connections on the tube but it's almost 11:00 am by the time I arrive at the Heathrow. I don't know which of the 5 terminals to go to and first go to terminal 2. The guy @ excess baggage is helpful and I hurry back toward the correct terminal #3. I'm almost there when I realize that both my hands are free, which means I don't have the moto. That panic feeling quickly hits and I can't remember if I left it on the tube train or @ the excess baggage. I'm trying to get back before my 24 hours is up and they charge me for "each portion of a day". We've gotten this far without losing it so it's worth the retracing of my route. Run the ten minutes back to excess baggage to find it sublimely resting on the counter. Then hurry back to terminal #3 and excess baggage. The cost is 36 pounds because I'm 24 hours and 20 minutes. I explained that I'd gone to the wrong terminal and the guy drops the extra 20 minutes and 18 pounds of fee. It feels like it's going to be my day!!

Hurry to American Airlines ticketing and there are no lines. Yes there are three flights today and for $200 extra (Non-refundable) I can take my chances and fly standby. The first flight is not too full and I have a good chance (I'm standby passenger #8). The 2 p.m. flight is very overbooked and the so is the 4 p.m. Things are going my way and I want to get home so I pass the credit card and hurry over to baggage check in. They take my bags and only charge me overweight on one. Print the boarding pass and tell me that the plane is a bit late but is boarding now. . Not only is it a long distance between this place and the plane but I have all of British Air Authority (BAA) screening to pass through. I run up the escalator through pre-screening and then hurry through passport and boarding pass check, then through declarations, then wait for the X-ray, then personal screening and metal detectors then through immigration where they stamp my passport out of the country and into the huge duty free plaza waiting area. Past the food court and the throngs that are shopping and down the passage ways to boarding terminals into another que and they check my bag and boarding pass again. At the gate counter they ask me to wait in a special section with the other standby passengers. Boarding has just begun and there are eight of us hoping for empty seats. Had the plane left on time the last five might have gotten places, but with the delay other stragglers with confirmed seats were able to make the flight.

One of us already had a confirmed seat on the 2 pm flight. I'm number four on the standby list for that flight. They issue me a new boarding pass for that flight and assure me that my luggage hasn't left yet. Unfortunately we are not allowed to wait in these terminals and must recycle through security. It's after 12:30 and I haven't eaten yet. It's only an hour before boarding begins, so a trip back into the duty free area will give me a chance to grab a quick bite. Through customs, x-ray screening, metal detectors and I'm back in the lounge area and filling my empty water bottles. As I'm waiting in a food line for my sandwich, I realize my hands are both free. In the rush I've left the moto somewhere but I've only ten minutes to eat and get back to the terminal for boarding. Once at the terminal and checked into the standby area I ask the friendly counter staff to call back to American's ticketing and baggage area to see if it's been turned in but to they don't have it and there is certainly no time to check with BAA before this flight departs. American Airlines has overbooked perfectly and though they get reassigned seats every passenger with a confirmed seat who arrives in time gets on. But no standby passengers are seated. There is still the 4 p.m. flight but when they issue my new boarding pass for this flight they tell me eight new passengers are waiting standby for this flight and they all have priority over me.

At least recycling through customs again will give me a chance to check with BAA for the moto. This time through there is an American just ahead of me and he's being quite the pain to the BAA people. Loudly complaining about the process and how it's not this way in the U.S. @ home we take off our shoes here we can leave them on. At home the computers come out of the bags but here you leave them in the bags. He's being obstinate and no amount of encouragement from his wife can get him to comply without complaints of "they ought to all agree on the same screening!". We ended up next to each other in the final x-ray screening area. I don't know what came over me, but I commented to him that I had once had a boss who had two types of employees "flexible and former". IT startled him that another passenger had said something so he asked "What?" and I reminded him that adaptation was a key quality of the success of the human race. Based on his glare, I perceived that this was not a teachable moment for him and was glad he didn't punch me. The supervisors @ BAA had a whole heap of left items but no moto (it's gone, I hope whoever got it enjoys it). I had an extra 20 minutes in the duty free area to scope out where I might spend the night if I didn't get on the 4 p.m. flight. The flight is overbooked and 12 standbys seems pretty dubious, but I've got nothing else to do so I head to the terminal again.

The four of us from this morning are becoming friends. There is a young lady returning from volunteering in southern Africa. She missed her AA flight this morning when her South African Air incoming was delayed two hours. She is on her way to Fort Wayne and is out of cash. She's looking forward to getting on the flight for the food. There is a couple from St. Louis who have been touring Ireland. They had not planned for the long ques they encountered @ 8 a.m. and by the time they got to the ticket counter their seats had been given away to standby passengers. The other 8 standby passengers were the overbooked folks from 2 p.m. who had missed the flight.

The plane started loading first class and business class, no standbys called. Then group 1 and then group 2. A standby woman with two small children was called up. Group 3 and another woman with two older kids were called. We weren't surprised when the young lady from Indiana got a seat as she was #1 standby for the 2 p.m. flight. We cheered and clapped when her name was called. Group 4 was called and they called for couple from Missouri. I hooted for them and they wished me luck. There was another woman with two kids but luckily for me just one seat left and she wasn't going to send just one child or leave them both so that left the last seat, , on the last row open , , , , for me!!!

I'm @ Chicago's O'Hare International just after 7 p.m. I'm through customs by 8:00 pm. I call and leave a message on my wife's cell phone to let her know I'm in Chicago. I've heard there is a train I could catch to South Bend, Indiana. South Bend is just 30 minutes from my daughter's home and Shaloy is visiting her this weekend as well as attending the Thomas family reunion today. Someone recommends a bus to South Bend and shows me where to catch it. While I'm waiting I borrow a phone to leave a message I'll be in S. Bend around 1 a.m.. Shaloy, Tria and Ben are waiting when I arrive. Thirty minutes later we're at their house in Berrien Springs, Michigan. Although they both had work Monday we couldn't go to bed until after 3 a.m.

I enjoy another warm shower Monday morning before Shaloy & I start the 10 hour drive back to Chattanooga. We enjoyed holding hands and having nobody else to talk with. We didn't even care when we took a wrong road and added an extra 2 hours to the trip. I was only gone 8 weeks. It was busy and exciting and new for me but for Shaloy it was just a long slog of having to do her work and mine as well. We both agree that it's too long to be apart.

Going Home via London

Once I gave my goodbyes to Saidi, Betty & Abdhula I had a brief wait before being allowed through security. After Rwanda Air Authority x-ray scanned my two black trunks, looked in one of them and stickered them cleared, I duct taped them shut with the last of my roll of black tape. (the tape was still intact when I arrived home). Of course I was overweight on one of the trunks and had to pay extra. I'm carrying one bag about the size of a purse, my backpack (with all the clothes I need for the next four days, my pillow and the wire moto.

Inside, I've got a couple of hours before departure. In the lounge area I meet a group of Indian military officers. They are on their way home for a few weeks of leave. They've been assigned to the United Nations peace keeping force in Democratic Republic of Congo (DRC). A very nice group of men who offer to share their lunch (I decline because I'm still stuffed from KBC). It's a delight to be able to visit with them about their observations concerning DRC and mine in Rwanda. Individually and as a group they are the kind of guys with whom I could become instant friends. They like the wire moto.

The Ethiopian Air flight is on time and we walk across the tarmac and up the stairs. First class enters through the front set of stairs, economy through the rear. The plane looks new and I've lucked out and gotten the seat by the emergency exit (lots of leg room) and the man assigned to the seat next to me decides to move to an empty row further back. There is a movie screen that shows our current location and flight information. I'm reminded just how small Rwanda is , , , in less than 45 minutes we've left Kigali (in the center of the country) and we're out of the country. The meal was delicious and soon we arrive in Addis Ababa, Ethiopia.

I've got a 3 hour wait and take the time to get a accommodation reservations for London using hostelworld.com . I find a Queen Victoria hostel which has good reviews except for the location which is "Superbly located only 20 minutes from the world's most famous and historical bridge 'LONDON BRIDGE'". It's okay by me especially since I can't find anything else that's available for a price I'm willing to pay on a Saturday night. I book the reservation and write out the information as there is no printer. As I wander around with my two bags and moto, I find a cafe selling tiny cups of coffee and giving away popcorn. I'm not interested in the coffee but as I sit I see they have a juicer and I can get fresh squeezed orange juice @ $1 US per large glass. I'm on my 3rd glass when a couple of the Indian military guys join me. They want the coffee and had some from this place on their way in to DRC. They claim it is pure nitroglycerin, super charged. I'm not surprised to find that one of the doctors is a psychiatrist. Some of the things that the UN peacekeepers are forced to do (or not allowed to do) as part of their "Mandate" would really be disturbing to rational people. Things like: burying your left over food so that no one gets it and starts a riot (and then allowing the little boys to slip in at night to dig through the dirt down to where the food is).

At a bit before midnight we are allowed through security. Even though I have my boarding pass I have to go to the counter and get a special sticker. What's happened is that there are enough seats but many of us are assigned to the same seats and have to be re-assigned. Down to waiting buses that take us across the tarmac, out to the plane to climb the stairs. I'm at the back of the line and get a few minutes to enjoy the cool night air. The flight is good, stewardesses accommodating, food is great, plane is clean and new, I'm holding the moto in my lap, electronics all work and my digestive system chooses to have bout #2 of purging. I should have just switched with the man in the aisle seat next to me. He didn't get his full nights sleep as he was large and would have to get up to let me out of my window seat. My anti-diarrhea meds are in my trunks. Just after the sun comes up we arrive in Rome and the plane loses 2/3rds of the passengers while it picks up some fuel. A couple of hours later we're landing @ Heathrow.

I expected that as soon as I arrived in London I'd be able to understand all of the conversations but London is a cosmopolitan city and Heathrow a major international airport. I'm still hearing many tongues I'm not able to decipher. It's pretty quick through customs and I've got my trunks. I spend a couple of hours exploring my options with my 110 pounds of luggage. I end up using the obvious solution of storing them with Excess Baggage. As I'm getting ready to leave I realize I've almost forgotten the moto sitting on the counter.

Down to the "tube" I start the 1.5 hour trip into London. Someone in Kigali had told me to get an "Oyster Pass" and the helpful worker down in the Tube area confirmed I'd get the best rates and have the easiest time of traveling if I used the pass. I have to remind myself repeatedly that although I'm on a grand adventure the people around me are doing their everyday lives. The moto gets quite a few looks as it is quite unique. I have to change once to get to the London Bridge station where I'm to board a train which is to get me to Woolwhich/Arsenal.

It takes a while but soon I'm on the platform and 15 minutes later I'm leaving central London and on my way to my accommodations. Twenty five minutes and I'm off the station and walking through the suburb of Woolwhich. Five minutes later I'm standing outside the Hostel but the doors are all locked. I can see that the upper floor windows are all open so I stand on the street hollering "Hallooo" until a head pops out and says they'll let me in to wait for the proprietor. It's taken almost 3 hours to get here from Heathrow. The owner wants to know about the moto.

I'm given fresh linen for my bed but there are no towels provided. Once in my room I find that the bottom of one of the four sets of bunk beds doesn't have a backpack on it so I assume it's the one I'm supposed to sleep in tonight. My seven roommates are no where to be found. I stash the moto under my pillow and sort through my stuff. I've got no shampoo and head down the street to purchase some and get some food. Once back at the hostel I find the shower and all the warm water I care to enjoy (I could really get used to warm showers). It's 3 pm and I'm clean, I've made my bed I'm full and I want to see London.

Back to the train station where I enjoy the 25 minute ride back into London. At London Bridge I get off to explore the River Thames. I recognize some of the sights and although the area is packed with pale skinned people I hear only a few conversations that I can understand (lots of French, German and a smattering of Asian dialects). Lots of couples holding hands and getting their pictures taken in front of the sights and I'm suddenly very homesick for Shaloy's company. She is spending the weekend with our daughter who lives near Chicago and will be at her family re-union in Midland, Michigan tomorrow. Wander to the Tower bridge, wander to the castle, wander to some of the modern architectures and get some pictures, wander to the memorial to merchant marines who've been lost @ sea. As evening approaches the streets are filling more with couples and groups of friends. I get some food and find an Internet cafe. A search for Irish music and I find a place that has music in the room upstairs from a pub every Saturday night. I get directions and catch an evening bus in the right direction. I'm able to find my location on the map and walk to the pub. It's at the end of a dark street in an area I'd call "Little India" based on the number of hole in the wall Indian restaurants. The streets smelled of curry. As I approach the address an alarm starts to go off. The pub is dark and there is no on around. The alarm is coming from the business next door whose plate glass window was recently shattered by a heavy object. I can hear sirens approaching and decide to stroll away as the London police arrive to investigate. By now it's after 9:30 and I decide to go to the hostel. I'm starting to consider catching an early flight home.

My main issue is that Woolwhich/Arsenal is so far out that it is not on any of the maps that I have or find. I head in the general direction of Southeast London by train. At the end of the line I ask which street bus to take and I'm directed to the bus station down the street. Down the street is a 25 minute walk. The driver suggest I take bus #40, , , , , no bus #38 , , , , no actually you can take my bus to , , , , no , , , really you should walk back to the street and take bus #45 and let the driver know where you want to go and he'll tell you which connector will get you there. Back to the street I see the bus but it won't stop except at a bus stop. I follow it down the street and come to a corner where pedestrians are not allowed to cross. Instead of crossing, I enter a well lit "pedestrian subway" which takes me under the street (to avoid mixing vehicles and pedestrians) but under the street there are 5 options of tunnels. I take my best guess but when I pop up on a street I don't recognize it as being the opposite side of the street I entered. Now I'm really turned around and start to ask directions but the only guy I can find is from Brazil, is also lost and has been looking for the Chinese restaurant and his friends for the past hour (Do I have a cell phone I can lend as his is now dead?). I eventually find a parked bus and ask the driver who tells me to take bus #30 across the river and the driver will tell me where to get the connection. However, he doesn't know which stop #30 will stop at but there are lots of bus stops around the corner and just look at each one until I find one that says #30. I don't find #30 but do find the tube and decide that at least on the tube I can navigate back to London Bridge and catch the train home.

I arrive @ London Bridge station and the first thing I hear over the public address system in the tubes is "Last car on North Line is leaving in 2 minutes!" Great!#$! the tube is closing for the evening. Lucky for me I'm not riding the tube anymore, I'm catching a train. Up the stairs and I quickly see that the entrance to the trains is dark, quiet and obviously has been closed for a while. I'm not in despair as I know there is a system of night buses but which one?? Woolwwich Arsenal is off all the bus maps in central London. I decide #48 will get me in the general direction but where is a bus stop for that bus?? I see the bus and where it stops and dash the two blocks to jump on. "Yes, , , If I ride this bus to where #53 crosses I can get a bus to Woolwhich" It's now well after midnight and the ride takes almost an hour until we reach the crossing where I switch. We've picked up and dropped off many of the revellers who stagger onto and off the bus. They are loud, obnoxious and uncoordinated but they seem to find their way. Thirty five minutes later I recognize that we've just passed the hostel, ask to be let off and walk the few minutes back up the street.

It's close to 2 am and I'm happy to find my bed as I left it. Only four other sleeping bodies are occupying bunks. I assume the rest are the young people I passed on the way to my room. I'm done with London. In the morning I'll take a shower, grab my moto and head to Heathrow first thing and standby until I can catch a flight home.

Link to all of my London Pictures

Last few hours wrapping it up

There is no water when I get up but it comes on for an hour while getting ready (but only a dribble so I still take a bucket shower). All I have left in the cubboard are two petite bananas, some Nutella, an avocado and a bag of salt, some green olives in the fridge.

I'm out the door, on a moto with my backpack to KHI. I've got educational materials to drop off in the office, my final report to give to the Rector and some ties I'll give the the faculty later today. A quick walk downtown to work through my shopping list. A friend back home has asked me to pick up a pharmaceutical that he uses while I'm here. It's much less expensive (Terry warns me about using foreign drugs from a foreign country but my friend is aware and the drug is not illegal). Also, I'm looking for some oil that is appropriate for the barber clippers I've purchased for Mpore Orphanage as well as a spray bottle that can be filled with chlorine mix for disinfecting the clippers.

Next a moto to a consortium of shops I've passed many times but have never stopped at. There are about 45 shop keepers with the average stall about 10 x 10 feet. They are packed with art objects and tourist items that vary only slightly from shop to shop. Each owner wants me to make an offer on whatever thing I've shown an interest. But I'm resolute. I'll look in every shop making a mental note of things I'm in which I'm actually interested. I'm really only looking for those items that really strike me as unique in quality, price or style. The one thing I've really coveted is a very large mask in the shop under the post office in town. But it's $100 US and is too large to fit into either of my trunks. Shipping is possible but would at at least $100 more. I compare every large mask to the one I've set my heart on and none match up. I'll end up leaving Rwanda with only small masks.

After going into every store/shop I've found an African game that is better in quality than any I've seen elsewhere with a good price but I've already made arrangements to buy three from my friend Royce later today. I found some gorgeous scarves and I head back to barter. The price starts @ 5,000 FRw and won't budge , , , even when I offer to buy 4. I thank her and walk next door where they are similar with similar results 5,000 FRw, , take it or leave it. I left it. I know that Royce has a rack of scarves and though I've not looked closely at them, if I'm to pay full price I'll give the business to Royce. I found a moto about a foot long and 8 inches tall crafted from thick wire with the various parts wrapped in different colored banana leaves. It is quite unique and the wheels rotate. We start @ 5,000 FRw but it's in my hand as I leave for 2,500 FRw. Finally a piece for my work desk. Two carved hands holding a carved map of Rwanda. Each of the districts are outlined. I've seen a hundred of these but most of them add a clumsy etching of the key features for each district (a guerrilla in Nord district, a giraffe in Est District etc.) This one leaves those off and is much cleaner in appearance. The shop keeper started @ 10,000 but I'm getting on the moto having only spent 5,000 FRw ($10 US).

Back in town I visit Royce. She was not able to get the three games I'd ordered but her niece in the stall next door has two (and I pay less than I'd promised to pay Royce). Royce does have the scarves and they are as nice as the others. She wants 3,000 FRw and I get three. There is a reason for my soft spot for Royce. She is in her 50's and speaks excellent English. She translated a few weeks ago when I was being taught how to play the African game. Additionally, a few days ago I was shopping for a dress for Shaloy. Royce didn't have what I wanted so the two of us walked into town and went to 5 different shops. I'd say "This one is a nice material but wrong style" then next shop "Right color but wrong material" then as we passed someone on the street. "That style is good and I like the amount of embroidery but wrong color". We kept getting closer and closer to what I wanted for Shaloy until we found it. Then Royce bartered until I got the dress for less than 1/2 what I was planning to pay (which was half of where we started in muzungu prices).

Loaded with my purchases, I catch a moto back to the guest house and another moto to KBC (my new favorite) for lunch. After eating, a bus is waiting at the stop and only 1/4 full. a quick ride into town and another moto to KHI. The East Africa Summit is in full swing at the Serena and all roads are barricaded within 6 blocks which includes the normal routes to the school. I'm there 15 minutes early for our 3:00 pm "going away event". I've brought my 6 favorite ties to Rwanda and I give away all but my very favorite. They are in excellent condition and you'd have thought I picked them for each person as they matched their outfits perfectly. I did insist on showing them how to tie the ties in the current U.S. fashion (extending down so it just hits the belt). The current Kigali trend is a huge knot that leaves the tie only extending halfway down the shirt (which looks fine when sitting but a bit odd when standing). For Matilda I let her choose a scarf (She has excellent taste and picks the one I had intended for Shaloy so I'll have one quick piece of shopping in the a.m.).

We walk to Karibu and find a table off to the side by ourselves. It's a lovely time to speak kind words to each other and enjoy each other's company. Four of our party are bachelors and we have a grand time talking about marriage, it's attributes, the perfect wife and the perfect time in life to get hitched. I'm given a nice shirt (although I don't know where they found a 2xl in Rwanda) and a "Thank You" shadow box with the Rwanda basket. After an hour the waiter tells us it's time to wash our hands (a new one on me) so I comply. John has ordered a fish for every two of us and a plate of chips (French Fries) and salad for each of us. The fish has been cut in two to the spine but is till connected and has been fried on both sides (sort of looks like a huge fried butterfly fish). I'm waiting for the silverware but the others are not. I wasn't fazed to see people eating the fries with their fingers but was startled when John started eating the fish sans silver. The salad (a type of cole slaw) was a bit harder to take. I just let my mind wander back to how I might have eaten at 2 years old and dug in. The fork, knife and spoon where missing on purpose and were never delivered. After eating we went and washed our hands again. It certainly adds another sense to the act of eating.

It's 5:00 pm and time to scatter to each person's next thing. Hugs and goodbyes and confirmation of schedules. Benard is catching a bus to Nairobi @ 5:00 AM, Patrick is flying to Nairobi later in the morning. Patrick & Benard are disappointed to not have had the last lecture and ask if they can come over this evening after supper to receive it. John is going to accompany me to the Airport @ 1:30 Friday. I call Terry who is coming back from Butare and I catch a ride home with him.

When we arrive at the house there has been no water all day and none is promised for this evening. I'm sad to say I "lose it" with Philbert who has known all day but not gotten any back up plans. There isn't any water to flush the stools, drink or cook with. It's all gone and what we had in the reservoir was used today to clean the sidewalks and do laundry. I insist that even though it's past 6:00 pm he Bosco and have enough delivered so we can have water to boil for drinking and to flush the toilets. After the call he's non-commital as to when/if it'll arrive. He used my phone to call so we call right back and I speak with Bosco insisting that they deliver water tonight. I walk with Terry to Africa Bite. I'm still full of fish but enjoy an African Tea while he eats brochettes.

When we arrive back at the house there is water in buckets to get us through the night. Terry had piled up the materials he'll take to the new guest house in the morning. We are both quite surprised to find Philbert agitated about what was being claimed as property of the Canadian Anesthesiologists. There is a long, loud and heated discussion about what belongs to whom. It's not my fight though & I retreat else I may find myself exploding. Terry will certainly capable to sort it out in some fashion. Patrick and Benard arrive around 9:30 pm and we do that last hour of lecture. One more set of hugs and I work some more on packing the last bit of stuff. I'm trying to leave or sell anything I can replace in the U.S. so I give some clothes and sell my cell phone, computer camera and two jump drives to Dubali.

Friday morning the mood is not much better in the house. Terry and I catch a ride with the CHK driver to the new guest house to deliver the stuff. We can only get into the kitchen as the rest of the house is locked up tight and only "Claire" has a key. Off to CHK to leave a computer and cell phone for the Canadian Anesthesiologist with the local coordinator (Terry is not being replaced for two months so there is no other secure place to leave the two most valuable items) Back to KHI to find "Claire" and Abdhul. Back to the new guest house with a key and now we can properly lock Terry's stuff into the cupboards of the suite assigned to the anesthesiologists.

On to Mpore to deliver the clippers and give instruction on their use, cleaning, oiling and disinfecting. We stop at a store to get some bleach and I'm astounded to pay 7,000 FRw ($14 US) for 2 liters. I'm so amazed I ask Terry to come in and make sure I've not misunderstood but the man insists 7,000 FRw. Gotta have and no time to comparison shop. On to Mpore. They are delighted to receive the electric clippers and promise no more loose razor blades for cutting hair. I leave my triple head razor and a pack of blades as well. We spend 45 minutes and 5 hair cuts are given by three different people and we're very comfortable that they know how to use them and will oil them, "2 drops after each head". We visit for a little with the lady who runs the orphanage and I'll share the contact information if you feel inclined to help directly with a place that could really use some assistance.

On the way home we pass the Consortium. I run walk in and buy the game that I'd spotted yesterday and the scarf (at full price) for Shaloy. Back to the house to pack for an hour and then lunch @ KBC and it's time to go. Saidi and Betty have come to ride with me to the airport. John is late and a call to KHI finds he hasn't left yet. Shake hands goodbye with Philbert and safe journey goodbye to Terry. Another call to John to let him know we're going and it's off to the Airport.

Yesterday, when there was still a bit of time I almost got emotional about leaving my new friends. Now when there is only a few minutes left, I'm too excited to be on my home to cry now.

Kibilizi - The last official work

This is my last official work for the trip. I'm to visit Dr. UYISABYE Innocent @ Kibilizi Hospital which I've been told is about ten minutes outside of Butare. It's Wednesday and I've been looking forward to a repeat buffet @ the Serena hotel one last time before leaving. So when I get my ticket I get a 7:00 am departure which means leaving Kimihurura @ 6:30. It's not an issue of getting up early though as I'm back into that cycle of tired early in the evening so that I'm going to bed early and then waking up @ 3:00.

I haven't given myself much margin today and the bus pulls out just a few minutes after I arrive. We've only 5 passengers but I'm relatively sure we'll stop at the lower station on the way out of town. We load up but don't fill the jump seats. I'm getting low on Rwanda money and I don't know where I'll find a Forex in Butare. So when I see one right by the bus station I take a chance and run inside. There is another customer in the booth next to mine and I'm a bit surprised by his greeting. In perfect English with little accent "Good Morning Muzungu." Since the man was obviously well spoken I asked him a question which surprised him "Then is it okay for me to respond with Good morning African or Good morning Rwandan?" He was quick to try to tell me that the term isn't derogatory but I think it made him think. No time to discuss the semantics any further so I dash back to the bus and reclaim my seat before I get left.

On the ride I find myself staring at the country side and think to myself "you're here for the people not the scenery" and I look back through the bus at my fellow passengers. The Rwandese are a beautiful people and I feel quite comfortable in their midst. I no longer feel foreign even though I'm reminded daily when I'm called a Muzungu. A young man comes up and puts the jump seat down beside me. He wants to visit in English for practice. During the conversation I learn that he is going to visit his home but not his family. They were killed fourteen years ago and he grew up with people he's going to visit in Giterama (about halfway between Kigali and Butare). Now he lives in Kigali and works in the textile industry. He wants to know if I'd like to have him as a son. I don't know what to say and act as though I can't understand what he's saying until he decides to change the subject. I guess it's a self defense thing.

Once I get to Butare I ask about a moto to Kibilizi and when the first driver quotes 3,000 FRw I start to wonder about the ten minute business. So I go inside to ask the Atraco man what a reasonable rate should be. He misunderstands and quotes "20,000 to Kibilizi". He thinks I want to hire a taxi but even a taxi shouldn't run $40 U.S. for a ten minute ride. Once he understands I want a moto he says 2,000 is about right. Back outside the moto driver quotes 2,000 so I'm on and we're going. South through town, out of town then left on a gravel road that turns to a dirt road and through the country side. I later see a sign and the village of Kibilizi is 11 Km from Butare (thus the 10 minute thing) but it takes about 25 minutes to get there from Atraco.

Kibilizi meets all of the things that my mind sees when I use the term village. We pass through to the far side and here is a lovely looking facility. Pay the man, walk into the courtyard and call the good doctor. "Hallo, Hallo, yes Doctor Innocent, yesss this is Leif Penrose the echography instructor, , , yesss where am I?? I am in the courtyard of your hospital, , , yes and you are where??? I see , , , , Kigali!! Eh? Eh? Okay they are expecting me and go find the radiographer, , yes, , ,yes thank you." As I walk to the hospital buildings and a man who appears to be a physician another young man in a lab coat comes to me. Doctor Innocent has called the Radiographer Emma and the physician is Dr. Guillain Luesso (I don't know which is his first name). They take me to the ultrasound room and we flick on the light which decides not to cooperate. On, off, on, off, off, on a bit, off, flash on, off, on, off. It's a good thing I'm not prone to seizures...

I let the doctor know I'll need some time to get to know the ultrasound unit maybe twenty minutes, , and He leaves to see patients. A trip to the loo and then to meet the hospital administrator. Emma warns me that the staff speak primarily French and to please speak slowly. Back in the echography room the light has decided to behave. The machine is a Pie unit with a 3.5 MHz curvilinear and has a 5 MHz Transvaginal transducer. I sit down to become acquainted when another doc pops his head in for introduction. I let him know I'll need some time to figure out the system but in twenty minutes or so I'll be ready to do an inservice. Back to the buttons at least it's in English when doctor #3 pops his head in for introduction. I let him know I'll need some time to figure out the system but in twenty minutes I'll be ready. Okay how to do the left/right switch, okay where's the Obstetrical package when doctor #4 pops his head in for introduction. I let him know I'll need some time to figure out the system but in twenty minutes I'll be ready. Back to the Obstetrical package when Dr. Guillain pops back in. It's been twenty minutes but with each new doctor I've had to introduce myself and explain that I'll need a few minutes so that I've really only spent about 5 minutes total so far in between introductions. Emma shuts the door and runs interference for me. There are 7 doctors at this hospital which is around 2 years old. I think they are all here except the doctor who invited me. The unit is pretty straight forward and I'm soon ready. The room is very, very small and it's difficult to get more than three people around the unit but there are 4 doctors and myself plus Emma trying to see. We crowd in African style.

The doctors are anxious to learn but it's quickly apparent that they don't have a base knowledge of sonography. I switch gears and terminology to my beginners talk. I decide that I'll make sure Emma knows the buttons before I leave and perhaps he can help when they use the machine. I'm told the printer doesn't work but it's a simple fix of showing them the right side up of the paper. I asked repeatedly for the manual and get a consistent answer of "they took it back with them after they delivered the machine" Even with repeated questioning, I'm not able to figure out who they are, why they wouldn't leave a user manual or where they would have taken it. The physicians are happy to learn about the obstetrical package and I show them how to print a report. We scan a few volunteers but there are no patients who have pathology they want to examine. Repeatedly, , I'm told they do only obstetrical and no GYN or abdominal work. The time flies and I realize we're past 1:00 pm. I've made Emma miss lunch (though the doctors have periodically slipped out) and the interest has wained visibly as it's just Emma, Dr. Guillain and I left (no more volunteers and no patients). It's thank yous and goodbyes and Emma will walk me to where I can catch a moto.

Out the front gate I find a sight I've been hoping to catch during my stay. I've told Terry I'd be willing to pay to get a pictures of a boy with his stick and circle playing. There are a lots of variations but I've seen the sight many times. The circle is sometimes an old, small bicycle tire, sometimes a rim of plastic, sometimes a wooden circle. The stick is sometimes just a stick, sometimes the stick is attached to the circle with a string so that the child pulls up on the back and let's it roll on the front half of the cycle. Sometimes the stick has a stiff wire on the end that can be used to "hook" the circle. I've tried to catch the image riding past on a bus and have seen in it in crowded situations when I didn't feel comfortable but today I have just one boy and his smaller playmate, on an empty street, and I'm with a man who can tell the boy I'd like to take his picture while he plays and in return I'll give him a coin. Well the boy is certainly delighted. I get my pictures, the boy gets the coin and there is no mob to mob me afterwards. Off to find a moto.

The station where we wait has 4 others who are also waiting. There are a couple of Rwandan police officers who are checking the driving permits of the cars that cross this dusty country intersection. A UN vehicle goes by and is flagged down. After Emma explains I need a ride into Butare they refuse and drive off. The Africans are incredulous that they won't give the Muzungu a ride. Thirty minutes of waiting and not a single moto in sight and matatas which are heading in the opposite directions and I ask if it's okay to walk. No I can not walk, , I ask if they don't walk me to walk or I'm not allowed? They will call me a taxi, , , No a taxi will be expensive, , , mes but may I walk, , , yes but you don't want to because it's a far distance, , , , yes but may I walk (It's a beautiful day, the road has not turn offs or branches and I'd rather walk and flag a passing matata than stand here just waiting. The Africans are again incredulous as I thank Emma, shake his hand and start down the dirt road to Butare. As I leave Emma is explaining to the police officers and he heads back to the hospital.

The road is nice and at least half of it is down hill. The weather is in the low 70's and there are sky has a few clouds. The sign says 11Km but I'm pretty sure I'll not have to walk it all. I'm never alone as there is a constant presence of some adult walking somewhere or some child who wants to see the Muzungu. I don't even break a sweat until about the 4th Kilometer when the road starts uphill and the tress aren't shading the road. About an hour into the walk a small pickup stops and gives me a ride the last ways into town. A lovely man who has also given a ride to a man (riding in the back) and a woman who I saw earlier waiting for a moto (riding in the front). I'd like to get to Butare in time to catch a bus in order to get back to eat at the Serena tonight. I'm back @ Atraco by 3:15 and get a ticket for the 3:45 bus.

Off to the grocery store to get a drink and sambosa then back to wait for departure. I'm surprised when the man tells me it's time to board as the only vehicle is a Hiace van & I thought the expresses all used a full size bus. I soon realize that the expresses do all use a full size bus and I've gotten onto the local to Kigali. It's all good in that we'll be back before Serena starts the buffet @ 7:00 and I get to enjoy the local people one more time up close and personal instead of whizzing past the bus stops @ 60 Km per hour. Thirty five stops and 3 hours later we pull into town. The only other person who was originally in the van in Butare is the van driver. At times we've only had 5 people and other times we've been max filled. It's all good because tonight we're eating at the Serena.

I called Terry who is having soft drinks with the anesthesia residents in town. I meet them and we visit for about 45 minutes until it's time to excuse ourselves and walk to Serena. Walking down the street we wonder where the East African Summit on Economic Development which begins tomorrow is meeting. Six blocks from dinner we find out. . . . . . When an officer with a machine gun wants to know our destination. . . . We politely tell him we are going to the Serena, , , , He wants to see our badges and is not satisfied with my drivers license.... The Serena is closed to the public, , , the conference has already had dignitaries arriving (we see a motorcade go by in the distance) and you may not proceed further down this street unless you have proper papers, badge and documentation. There is no arguing with a military officer who's packing heat.

At this point none of the regular places we know have any appeal. We decide to try a third Indian restaurant that Terry has spied. Ten minutes later we're in and have ordered. Serena will just have to be a fond memory.

Kibagabaga - Monday and Tuesday

My last week in Rwanda. I've got two more hospitals to visit. Kibagabaga Monday morning is a suburb of Kigali and Kibilizi on Wednesday is supposed to by close to Butare.

I'm scheduled to visit Dr. Gatsinda @ 9:00 am until noon Monday. I'm able to leave the house @ 8:30 catch the matata to Kimironko market then a moped sized moto out to Kibagabaga hospital and I'm at the gate right @ 9:00 am. This is a lovely new facility, just a couple of years old. beautifully landscaped with modern style doors, rooms, fixtures and equipment. We head to the "Echography" room and I meet Dr. Benard who is introduced as the gynecologist.

The ultrasound unit is a French Kontron Sigma 330. I'm not surprised to have never heard of it. Of the dozen ultrasound units I've seen in Rwanda I've not seen two by the same manufacturer. This one adds an additional challenge in that all of the buttons, soft keys, user's manual are in French. The nomenclature for the abbreviations is also a bit foreign: Biparietal Diameter which we abbreviate BPD is "BIP" and Head Circumference is "CP" (Circumference Parietal). The unit has Doppler and Color Doppler but only a single curvilinear transducer and no printer. I'm able to show how to use the obstetrical calculations package and to retrieve the report. Up to this point each time they did a measurement they'd write the values on a piece of paper which would later be transferred to the referral slip. An inexpensive thermal printer and they could print the entire obstetrical report including ratios, estimated date of delivery based on averages and each of the measurements with associated plus minus ranges.

We scanned 4 near term obstetrical patients in a row. On all 4, head measurements came out about 4 weeks younger than the rest of the measurements and last menstrual period dates. The calipers are measuring correctly but the associated dates added to the calculations is incorrect which skews the expected date of delivery and estimated fetal weight. One of the Doctors confirms that it's pretty routine that the babies are bigger than expected based on the ultrasound measurements. I've got another appointment to teach the Anesthesiology residents about ultrasound guided vascular access so I can't stay longer but asked to borrow the manual and return tomorrow (Tuesday) with an answer. I'm pretty sure that there are a number of options in the calculations package and if I can find the right sequence of button pushing I should be able to get into the system setup and see which has been chosen and then reset it for a more appropriate one.

Throughout the time I'm here Dr. Benard is in and out but we're joined another Dr. who also attended the Physician's conference and a couple of other doctors who are interested in learning more about their machine. Then Dr. Gatsinda brings in a a couple of Americans. Dr. Hal Goldberg is a Cardiologist here with a team of physicians, ancillary staff and other volunteers who are working with the docs @ Kibagabaga hospital. I get an invitation to supper and ask that Terry can join us as well. They've brought their own ultrasound unit a portable GE unit (although the Kontron unit has a cardiac calculation package there is not a cardiac transducer).

No wild and crazy findings today, but I've got to split @ 12:00 to make my next appointment. In all of the hospitals, the docs I've worked with are on duty and have their normal case load plus the time they are trying to spend with me. Three or four hours is really the max that they can carve out of their packed schedules in one day. Dr. Gatsinda takes me to meet the Medical Director and gets me a ride back to town in the ambulance. I'll try to get a picture of one of the ambulances for my Paramedic friend Randy Pierson.

That night, I find that only the first half of the manual is in French. Sections 5 - 8, which have the calculation tables information, is in English. I'm pretty sure that the tables can be changed and I've got a good idea how, but it'll still take a bit of playing to get the right sequence.

The ambulance drops me @ Kigali Business Center "KBC" where I'm to meet Dr. Terry Loughnan and his Anesthesiology residents for lunch. Afterwards we'll walk to King Faisal hospital where I've made arrangements with Seth to use the ultrasound unit for a couple of hours. Terry has found this "hole in the wall" lunch buffet restaurant. He has repeatedly mentioned the quality of the meal and afterwards I agree that it's a real jewel of a place were a meal and fruit juice is $3.60 U.S.. The place is packed and you can choose to stand and eat or sit at a table with strangers (which actually doesn't seem very strange at all in Rwanda).

When these five residents graduate and join the Rwanda health care system there will be 16 Anesthesiologists in the country. Currently, full anesthesia is only administered @ CHK, King Faisal and the hospital in Butare. Dr. Loughnan has an interest and a lot of experience in ultrasound guided access to jugular line placements as well as upper extremity nerve blocks. Today we're showing the possibilities (not training for competency). This two hours session is very low stress for me and the residents are obviously intelligent and anxious to learn how they might use this tool. As a bonus, I get to see my friends @ King Faisal again.

Terry & I catch a ride to mumunge, swing by a forex, search out a place to by hair clippers and then realize that the restaurant where we're meeting the American team is back in Remera and not in town. Down to the matatas but we're here @ rush time and the scene is close to anarchy. For this trip we can take a Remera bus but are unsure how close to our destination we'll get (as we've never taken that route before) and don't want to get stuck walking a couple of Km. The more sure option is a Kimironko bus but we can't find one. As we ask the drivers and bus porters they keep pointing to the one ahead. Terry later says that the pointing doesn't actually mean the one ahead but rather "not me, , , , but you might try the one ahead, , , , it might be". The taxi to Chez Lando will be expensive from here and we know the matatas and just keep trying. The crowd of individuals who are also looking for a Kimironko bus keeps growing in size and tension.

After 15 minutes, I spy one of the Hiace vans rolling in with a sign that says Kimironko. Hopeful riders grab the open windows as it slowly cruises in. They are running along side to ensure a seat when the slider opens. The driver purposely pulls in so close to a parked bus that it effectively skims off all of the folks hanging onto to the side. I'm able to obtain a spot in the qeue near the back of the bus but it's a pure melee to enter as there is another merging qeue at the front also trying to get into the sliding door. The attendant is trying to block a path so the current riders can get out but that effort fails and 4 people get stranded in the back until the attendant gets the word and redoubles his effort to finally get them out. In the midst of the scrum an old woman says "Pardon" in French as she hits me with her elbow to try and gain advantage. (Terry later tells me I shouldn't feel special as she had already elbowed him as well). Teenage school girls duck their heads and try to go under the outstretched arms and when they get their bodies in the flow are basically swept into the van. The woman in front of me hopes to secure a seat by passing her bag in through the window to hold a seat. When I last saw her, the doors where shut and she was standing outside (Terry thinks the bag was passed back out the window but I didn't see it happen). I'm pretty sure I could have found a spot but there was no way that Terry would have made it so I bailed out of the line (to the delight of the old woman who was able to weedle past the woman in front of me who was smaller). We decide it may be time to grab a taxi.

I snuck this video Sunday. It's not a melee, but captures a bit of the atmosphere of a slow day.

Supper with the folks from Spokane @ Chez Lando. The group is on their first trip and are trying to figure out the system and the opportunities for service. They are a pretty sharp group of people with a Neonatologist, Cardiologist, G.I. Oncological Surgeon, Psychologist, Medical Oncologist and accompanying staff members plus some family. Logistics and some of the prepratorial details have them with some questions and they hope we might be able to share some insights. Gradually more and more of the team arrives but by 9:00 we're both tired and excuse ourselves. They insisted on paying for our meal and we caught a taxi to Kimihurura.

Tuesday morning I say goodbye to Dr. Konn who is flying out this morning. I reviewed the Kontron manual again, send the company an e-mail asking for an electronic version in English and head back to the hospital. In fifteen minutes I've got the unit calculating using Hadlock's tables and I'm on my way back for lectures @ KHI. I run into Benard & Patrick in town and we walked together back to the KIST canteen. Dr. Konn has had ticket problems and was forced to buy a new ticket on the spot for the flight from Kigali to Kenya. She had been issued a paper ticket but only had the boarding pass and they wouldn't let her on without both. After lunch there are issues about time and not having a room available when we were scheduled to begin. Today was originally scheduled as a day off so I could wrap things up but I've added the trip to Kibagabaga and the lecture so the pressure is mounting. If the lecture isn't high enough on the priority list to have a room I decide I must have been mistaken about how much it was desired. It's already past time to start and no room, so I cancelled and went to try and cash the re-imbursement checks (which I've been warned repeatedly must be cashed before leaving the country). It ends up only taking 45 minutes to convince the National Bank Rwanda to cash my two checks.

On to get a few more presents and then back to the house where I'm meeting Said for supper. I chilled out for about 45 minutes playing my autoharp when Patrick & Benard arrive. Soon Said gets here and the group of 5 all decide to eat together @ the Chinese restaurant. We spent quite a bit of time discussing the advantages and disadvantages of marriage. Terry takes the tack that the three of them should wait and not hurry. I take the tack that life is too short not to have a best friend to share it with. The whole thing is a bit mute though, as none of them has anyone they are even dating. (though I've repeatedly pointed out that the cashier girl @ KIST canteen really blossoms every time she sees Patrick)

Things are starting to wind down.

Gisenyi - Lake Kivu full posting

Thursday evening I purchased tickets for Terry & I to travel to Gisenyi leaving Kigali @ 1:00 pm. I'm getting the travel arrangements and Terry is getting the lodging. We'll be there Friday afternoon/evening and return Sunday Afternoon.

Friday morning's lecture go well but I didn't finish the obstetrical section before it's time to leave. We agree that I'll come back Tuesday afternoon at 2:00 and finish the last lecture. At tea time I had a bowl of the banana stew. I know I won't have time for lunch as I hurry from KHI to the bus station and I didn't eat breakfast before leaving. Even though I know the shape and color is banana, it still tastes like boiled potatoes to me.

When I get to the bus station, Terry is waiting and the bus is just loading. We are able to get two window seats in adjacent rows but this vehicle has jump seats and we get the feeling we'll be crammed in. At least we each have control of the air flow. Life is looking good as we leave the main station in Mumunge as our window rows have only one seat and then the aisle. None of the jump seats were being used and there were a couple of other empty seats as well. On the other side of the aisle is a large woman who has brought quite a bit of luggage that is in the aisle area up front. On the way out of town I commented to Terry how glad I was that we didn't have to stop and catch the bus at the lower station on the way out of town (Large, dusty, dirty and confusing). He asked me to point it out but there wasn't a need because we turned in to pick up the rest of the passengers.

From the get go there seemed too many onboarding passengers for the remaining seats. About a dozen people wanted to get on and 5 of them were white girls with huge backpacks. It may have seemed as though there were more because there were bus company staff assisting the girls. The where able to get two of the backpacks in the cargo area but the other three had to come inside. The jump seats started going down as they entered but the large woman next to me is insisting that the white girl can't sit next to her and she won't let the jump seat but put down. She waves an extra ticket and we assume she's bought two so she doesn't have to sit next to someone. The loading process grinds to a halt because no one seems to understand why the dumb Muzunga won't take the seat. Many encourage her to take it any way and in her confusion she attempts but the woman firmly places her hand on the girls butt as she tries to sit and pushes her back up (to which the girl gets loud and irate about being touched in that location). The bus staff are telling her to sit back down and we finally help him to comprehend that this woman won't let her sit. Loud and fast paced discussion in Kinirwandan and we find she has a friend coming and she's trying to hold the seat for her. Five minutes of tense waiting with lots of loud words when an equally large woman arrives and is let through to cram into the jump seat and overflow onto mine. Everyone tries to takes a seat when they realize they've oversold the bus and a very unhappy man is forced off by the company. The extra three backpacks and extra luggage of my row mates is blocking the doorway so that every time we stopped to let someone off there is a moving of luggage so the door can be squeezed opened. We depart.

I'm fascinated by the bee hives. They seem to be made of banana leaves woven into a a mat about 5 feet long that is then rolled loosely into a tube. This "Roll" is then placed in the notch of a tree anywhere from 20 to 40 feet up in a tree. Some one would have to climb the tree to place it and then climb the tree to retrieve it. I've not seen many bees but there is so much stuff growing they must be around to keep things pollinated.

The ride seems extra long today. Maybe the one bootleg tape that played through 6 times during the trip, the close quarters with my bulky neighbor. We left @ 1:00 and arrived in Gisenyi around 5:15. We warned the girls that they might have a time finding accommodations as they had not pre-booked and there is supposed to be a big party tomorrow evening after the gorilla naming ceremony. We want to be well situated before dark and decide to take a taxi rather than walk. The driver seems a bit confused but agrees to take us to "Hotel Du Lac". After a couple of minutes he asks us for directions. Terry calls the phone number and hands the phone over so that the hotel and driver can communicate directly in Kinirwandan. The driver then tells us we've got reservations @ the hotel but that our hotel is in Cyangugu 10 hours south on Lake Kivu not in Gisenyi on Lake Kivu. Two hotels, same name, same lake, one still operating the other closed for the past two years. A call to Paradise hotel in Rabona 6 Km south , , , they've got a room for tonight but not tomorrow. We take it but have to raise the cab fare because the hotel is 30 minutes further away on a very rough and beat up road.

The Hotel Paradise is quite lovely and sits right on the lake. Most of the units are small bungalows mimicking the shape of the traditional houses. We end up in a double for $25,000 FRw and split the cost. They start to find us accommodations for the next evening and by supper time have found the house two doors down has rooms, is not occupied except for the house staff and the owners have agreed to let us stay Saturday evening in single rooms for $15,000 FRw each. We can still take our meals and enjoy the grounds of Paradise (though the guest house also is lake front and has beautiful landscaping as well).

Next morning after breakfast and moving our stuff to the guest house we decide to walk the 6Km back to the edge of Gisenyi. The weather is pleasant and we're up for the walk. At the end of the road is a brewery for the local beer. It is at least partially powered by an electricity plant that runs off of methane gas that is emitted from Lake Kivu. We can see the tower of the methane rig about a kilometer off shore but are unable to see the power generation unit as the road is closed and guarded by RDF military with automatic weapons at both ends (which is too bad as the road along the shore used to go to gisenyi, seems in perfect condition, not nearly the elevational rise and fall and would have a lovely view of the lake during it's entire distance). We are accompanied by various groups of urchins who delight in some muzungus to walk. They are persistent in trying to get us to converse and some are very persistent in trying to relieve us of some Faranga (money) by either repeating "Faranga?!?" repeatedly with outstretched hands or using their English with "Give me money". Of course you can't give them money for a number of reasons. First the giving to one could not happen without others seeing which would produce an immediate onslot of demands to give money to each and secondly we don't want to encourage begging as a means/option of supporting yourself. Periodically we hear a cry for "give me pen" which actually would be okay if I had a pen to give, but then again you'd have to have a whole box of pens if you gave just one. We know that Dr. Konn has been here previously and when we returned we jokingly accuse her of encouraging the kids to beg for money (which she firmly denies doing). Then in jest we accuse her of teaching them to beg for pens at which point she looks quite sheepish and admits to doing.

Each group seems to know there boundaries end but as soon as we lose a group we're passed on to the next pack who have heard we're coming by the distant cries of Muzungu and Bonjour. As we get close to town we cross a small Hydroelectric plant. Town is quiet and the streets pretty much empty. The guide books are totally inadequate for information. The Palm Beach Hotel which comes highly recommended appears abandoned as do a number of other establishments. There are a number of places we pass by and have never read about and ones we expect to find that are either absent or under new ownership with new names. We see a huge crowd of people congregating in one spot of the public beach and see that the 5 white girls from the bus yesterday are swimming in bikinis and have attracted probably 1oo male African spectators who want to have a watch. It's annoying but safe for them and we walk on to the border with Congo which is a sister city of Goma DRC but don't enter (we've been told that the return visas would run us $60 US). We're hot and stop to get something cool, wet and sweet. I have to learn another repeat lesson when they charge me $2,000 each for my two lemon Bavarias which are a 0% alcohol malt beverage. But they've already been consumed and though I protest that I paid only $750 yesterday the server simply states that the charge is $4,000 in Gisenyi please. The place was a converted lake home and we had enjoyed the gardens, birds and lizard but it didn't seem nearly as pleasant with $8 of soft drinks.

Before leaving we asked if there was a "Hotel De Lac" and find that it's been renamed and is the next place down the road. We stopped in to see it and decide it looks like a nice place to take a meal. It also is a converted home, with equally nice gardens and we sit under a cabana while we await our meal. Again the birds are exquisite and many lizards are running around. We realize that we're the only guests there and after 1 hour and 20 minutes walk to the kitchen and enquire if the food will eventually be served. The proprietor assures us it is coming now and we rest for another ten minutes when Terry's coffee is brought. Twenty minutes later the food begins to come. Afterwards we can say it was worth the wait but it we'd have simply left had we been in Melbourne or the states. Before leaving we enquire about room availability and find had we arrived last evening, we'd have been able to to get rooms at the expected price.

After lunch we decide to walk back to the guest house. Nearing the halfway mark Terry mentions the lack of juvenile presence. Within 1 minute of mentioning the absence of youthful escort they arrive en-force. Terry takes a ploy of hanging back acting as though he speaks neither French or English and letting them surround me. I feel like pig-pen in the Peanuts comic strips but with a cloud of children rather than a cloud of dust. By the time we reach the house we're both quite tired of the throng. We'd seen a boat that is marked "Taxi" and go to the lake to investigate the possibility of a boat ride today or tomorrow only to realize the taxi is sitting on the shallow lake bottom with a couple of feet of water in it's hold.

We decide to cool by taking a swim in the lake and the temperature is perfect. After the 17 Km of walking it is the perfect recipe for getting rid of acquired, dust, sweat, grime and heat. While we're relaxing we start to hear rhythmic responsive singing. The fishing boats are going out for the night to fish for the petit poisson (little fish). The boats are three boats connected together with poles. On the way out they are close together but once out fishing the poles are spread so the trimaran setup covers almost twice the distance. Long poles extend from both ends of each of the three hulls for dropping the nets and the boats are paddled to their destinations. Later in around dusk the lanterns will be started. We aren't sure if it's to attract more of the sardine sized fish or so they can see to sort them. Dinner @ Paradise where we're joined by a British woman who is traveling alone and has come to see the guerrillas,, sit by the lake and attend the naming ceremony. She is delightfully oblivious to many of the typical concerns of foreign travel and is having a marvelous time. There has been a cancellation and she's allowed to move back into her room from the tent. She's a bit disappointed in that the tent was to be free. My heater kicks on warning my it's time to call it quits for the day. I'm in bed by 9:00 and asleep by 9:00:30.

Morning comes with rhythmic responsive singing of the returning fishermen through my open screened window. I throw on clothes and grab my camera as Terry and I hurry to the beaching area to see the catch. As the second boat comes in the middle pole hits the bluff and the tip of one of the poles breaks. I hurry to grab one of the other poles and pick it up enough to clear and Terry grabs the other side. The fishermen are happy for the help and allow us to hang around and take pictures. I'm surprised by the apparent absence of fish. For an entire night of fishing there doesn't appear to be appropriate amount of fish. An older woman is working a hatchet on some branches to make a fire and cook some of the catch for breakfast. We head back for our own breakfast and then back to town to try and change our tickets for an earlier ride. To my shock Terry suggests we ride motos back to town as the matatas look as though we might have to wait an hour or more to reach the requisite 18 passengers.

We're delighted to find an empty bus waiting and they are happy to change our tickets. Terry gets the coveted front passenger seat with the window & I'm in the next one back with a window. The bus leaves and nobody occupies the jump seats and the driver confirms there will be no other passengers for the express run to Kigali. The road between Gisenyi and Ruhengeri is under construction and many of the homes that are too close are marked with an X indicating imminent domain and ultimate destruction at some point in the near future. Past large banana and tea plantations. Another cool thing I've seen are the egg baskets. There is a section of road where the local people bring baskets made from banana leaves to the side of the road. Inside are 30 eggs. If it wasn't the last week before departure, I'd beg the driver to swing in and get one of these egg baskets but I know if we have eggs every day I won't get them all eaten so I settle for a picture.

Back in Kigali by 12:30 and down to another Indian Restaurant I've located called Ice and Spice.

They warn us that the food will take almost an hour but it's on the table in 30 minutes. I think you'd much rather be told a longer time and have it arrive early than a short time and have it arrive late. We split up and I do some afternoon shopping before returning to Kimihurura. I'm starting to sort my stuff for the return and to get more detailed in what I'm leaving/taking and working through my gift list.

Before dark I walked to the local convenience store (Hah!) for a few critical items (T.P., some juice concentrate, eggs for 5 more breakfasts, a 500 ml container of full cream milk and bunch of bananas) Supper with Terry in the cabana of the left over food in our cabinets (pasta with tomato paste, microwaved potatoes, and cabbage salad). Dr. Konn had planted some collards and I cooked a batch for about an hour and then left for a few minutes to start the blog, , , , , forgot the collards , , , , , and scorched them (I ate most of them any way).

Dr. Konn arrived after and had been to the orphanage for one last time. She witnessed one of the older staff ladies with an old fashioned two sided razor blade (no handle) chopping at the children's hair for hair cuts. She was holding them down with a leg thrown over them as they screamed. Now we know the source of all the head wounds. Some of the kids are HIV+ and using the same razor blade on kid after kid is an instant source of transmission. Tomorrow I'll find an electric Razor.

Link to all my Gisenyi pictures

A week of Lectures to KHI Faculty

Monday, Tuesday, Thursday & Friday, I'm lecturing about Sonography to the KHI Radiography faculty. We start @ 8:30 and lecture until 10:00 when we break 30 minutes for tea. Then again from 10:30 until 12:30 when we break for 1.5 hours for lunch. Last lecture goes from 2:00 until 4:00. In total there will be 6 physics lectures, 3 abdominal lectures, 1 pelvic and 1 OB/Gyn lecture. The medical Imaging Program Director John Ndahiriwe, plus Radiography faculty Patrick, Benard, Benjamin and Matilda all attend. The Rector of KHI Dr. Ndushabandi also attended Tuesday afternoon lectures.

Wednesday was a faculty Senate meeting so I went on to Kiziguro hospital. The stress level is quite low for this series as I know the material very well and I'm presenting the same basic presentations that I've given before here in Kigali with a few modifications. I'm getting more used to the projector and realize that there is a specific order that it must be connected and turned on in order to operate properly. The only stressor is that the power supply for the computer is starting to get flaky and works only if it's in the right position.

Thursday John, Benard and I go to eat at the military barracks around the corner. I was surprised to hear that it was open to the public and wanted to see. The food is typical African lunch and there are probably 3:1 public to military ratio of customers. The men in uniform go straight to the front of the line. The price is reasonable $2 U.S. and it's just around the corner from KHI, KIST, CHK hospital and the national lab so there are quite a few possible sources of customers.

It's also right next to the Camp Kigali which is a memorial to the 10 Belgian Soldier / UN Peace keepers who where murdered during the start of the 1994 genocide. Outside is a garden with 10 vertical monuments. Each has the initials of the man killed at the base and horizontal cuts into the stone indicating how old he was at his death. Many of these cuts hold dried long stem roses that have been left. Inside the building where they died is a semi-circle of ten candles and more long stem roses on the floor. The shrapnel from the grenade pock marks the wall. In an adjacent couple of rooms are posters about genocide and a brass memorial with a picture of each man and a brief biography. Though much briefer experience than the other memorials it is no less disturbing. I have walked past this place a half dozen times and did not realize that it was. On the way back to Campus John tells me that KHI - KIST used to be a military school and that where we ate lunch is the military hospital (but is currently used for administrative functions only). To see all of the images from Camp Kigali click here.

Thursday evening is a farewell party for Dr. Konn and her African students. It runs on typical African time so when Terry & I arrive late @ 6:30 we find there is only Patrick has gotten there before us. The location was a complex at the bottom of our hill (a bit over 1 Km from the house) called "Car Wash". Dr. Konn had warned me that it although advertised to start @ 6:15 we wouldn't be eating until after 7:00. Eventually the students showed and the food was served. Then came a speech by one of the students followed by a song they had composed. After each chorus one of the students would step forward, present a card/gift and make a mini-speech while the chorus was being hummed. Then the chorus was sung again followed by another speech and gift. Lots of tears but it couldn't go too late as the students begin their semester finals tomorrow morning @ 8:00 am.

Friday, Terry & I are going to Gisenyi on Lake Kivu in N.W. Rwanda. No updates until I return Sunday.

Kiziguro Hospital - Wednesday June 18

The ticket people, drivers and beggars @ Atraco are beginning to recognize me. They smile when they see me coming and want to know where I'm going today. I hand them the card that Dr. Emmanuel Kanimba had filled out for me and they direct me to the correct ticket agent. Yes the bus will leave for Kiziguro I can leave @ 6:30, 7:30 or 8:30. "Which will have me arrive by 10:00 am?? Yes, then I'd like a ticket for 7:30.... Oh , , , no advance tickets??? What time must I be here to get a ticket for 7:30??? Okay then I'll be here @ 7:00 am Wednesday... You are sure I will be able to get a seat?? Yes then 7:00 am"

I had to leave the house by 6:45 to get the ticket... I plan to take a matata but after 2 pass without a spot available I grab a moto. It isn't until after I've made my deal about destination and price that I see this is one is in poor condition. There is no visor on either helmet, and there is a single seat for the driver with a luggage rack and the luggage rack has no padding. But he's a careful driver and we arrive @ Mumunge in one piece without incident. There is a ticket and we'll be departing in about 20 minutes. Here is the bus and the front passenger seat is empty. I take a chance and leave my lab coat on the seat to mark my spot and go to look for food. There is a restaurant @ the Atraco station and I went to see if there was something for breakfast. With the talk about moving I've let my supplies drop @ the house and I'm out of breakfast stuff. They have a large bowl of stew for $6oo FRw. I looks to be boiled potatoes in a tomato based sauce with a few chunks of meat. I'm half way through my bowl when I realize the potatoes are actually bananas. The bowl of food is so hot it takes me about 15 minutes to eat most of it before I decide to go back to the bus. There is one other passenger sitting in the front seat between my coat and the driver's spot. Three minutes and the driver jumps in and we're off , , , just the three of us. We're on our way to Remera station (on the way out of town about 15 minutes distant). Here the rest of the bus fills up in short order and we're on the same road I took twice last week to the other two hospitals in the side of the country. Slowly the bus empties at various stops until by the time the driver drops me @ Kiziguro there are only three other passengers. He points to some distant buildings and says "Hospital"

I start to walk through the village and can hear the children through the open windows of the elementary school doing recitations en masse. Past the large Catholic church and I don't see anything resembling a hospital. I ask a pack of teenage boys and they are very amused at the funny sounds that I make. I showed them the card with the information in English and it's equally odd to them and they have no clue where to point me. A quick call to Dr. Kanimba and he's on his way to escort me. Meanwhile the boys find a man who speaks French who is able to point me in the right direction. Dr. Kanimba meets me and we continue on to the hospital. There are 6 doctors assigned to this facility but only two are here now, the rest are @ meetings or have other business. I'm introduced to Dr. Jean Paul and shown the ultrasound unit. In the corner there are the remnants of their old unit which no longer functions. On a cart is a Chinese manufactured portable unit with a single 3.5 MHz curvilinear transducer. I need some time to explore and Dr. Kanimba needs to see patients. The buttons are in the right places and it's not long before I've got it pretty much figured out. I open the box under the unit and find a transvaginal transducer. They must have just forgotten to mention it to me. Dr. Jean Paul comes by with some paper for the printer and a user's manual.

This is a nice little machine that can store 32 images, has a good obstetrical package. I take a few images adjusting the printer and change the hospital name in the memory and set the date/time correctly. By the time Dr. Kanimba is free I'm ready to give him the in-service. He is quite surprised to see the T.V. transducer as none of them knew it was here. Dr. Jean Paul says they can find some condoms. He is equally surprised that we've gotten the printer working and that they can produce an obstetrical report using the calculations package. The M-Mode works as well and now they can calculate fetal heart rates as well. Additionally the transducers are both broad bandwidth and have a nice wide range of possible frequencies. He's also quite happy to find they can store and retrieve images. After the in-service we start scanning patients.

First, a couple of obstetrical patients. It's the same here as elsewhere, they want to know how to tell the sex of the fetus and then how to do the measurements (one fetus shows us she's a girl and the other obstinate one never did expose it's genitals). A pelvic ultrasound but the bladder is not full and we ask her to start drinking. Then a patient with a large epigastric mass. The mass is plainly visible extending from the umbilicus about halfway to the pubis. Sonographically it's too large to measure, fills the pelvis and lower abdomen and is mostly solid with some areas that are quite bright and shadowing and some hypoechoic regions as well. First we check to see if it's attached to a kidney or liver (as expected, it is not), no ascites and I can't define a separate uterus or ovaries. They think it may be a fibroid but I'm leaning more to an ovarian mass. I suggest that this may be a time when the transvaginal transducer might help. If we can see a separate uterus then we can tip the differential diagnosis towards ovarian. They talk to the patient and I showed them how to prepare the transducer. Almost immediately we can see that the uterus is completely separate but dislocated by the mass. There has not been an abdomen radiograph but if they see a tooth in the pelvis that would be consistent with a large dermoid.

An elderly man with possible chirhosis is next. The liver brightness appears normal when compared to the renal cortex but there is significant ascites (which they've drained twice already) massive splenomegaly and a splenic vein measuring 14mm (even larger portal vein).

Next is a an adult woman who has never menstruated. On pelvic exam the physician feels a possible imperforate hymen. Based on the apparent age of the patient, an imperforate hymen and never a menstrual cycle she should have a huge fluid collection in the distal vagina. She has developed breasts and has some pubic hair. But the patient's bladder is empty and we're hesitant to go directly to T.V. exam. By now it's close to 2:00 and the doctors want to take some lunch. I'll wait until the patient has filled her bladder and rescan after eating. The day is quite pleasant and the local restaurant serves goat brochettes with banana. Back to the hospital and the patient is moving quickly (as full bladder are apt to do) but there is a similar amount of bladder filling. But I don't see any masses or for that matter a uterus. We decide to do a T.V. exam and even though we look in every corner of the pelvis there is no apparent uterus. All we see beyond the vagina is peristalsing bowel in every direction. No ovaries either. I don't understand the discussion between the doctor and patient but the patient seems not happy about the results.

Another physician arrives who had attended the seminar. He has a patient who has had an abortion but they are concerned about retained products. The uterus is large and we can plainly see there is quite a bit of retained products and they plan a curettage procedure. There are no more patients and it's about time to go to the bus station. I've got an appointment to meet Terry @ the Serena hotel for supper this evening @ 7:00 pm. All three doctors walk me to the station and after purchasing my ticket, wait with me for the Hiace van (bus). Again, I'm impressed that these dedicated young physicians are a real sign of a bright future for Rwandan medicine.

The bus and driver are the same ones that dropped me off 7 hours earlier but this time the bus is max full. They've over-sold by one and a young man has to get off to make room for a woman who had an earlier reservation. When we get to the next village, someone who was in the front seat disembarks and I'm back in that front passenger seat by the window. It's dark by the time we reach Kigali. A quick moto to the Serena through the gate and I'm back in America. This hotel could be any 5 star facility in the U.S. Terry has found a group of Australians congregate here each Wednesday evening and I've been invited to tag along tonight. The food is outstanding with a buffet including the first drink, a selection of appetizer soups (I had leek) a wonderful salad bar that has the first cheese I've put in my mouth in 7 weeks, a Mongolian grill (Rwandan style but still tasty), an additional hot bar with a great selection of Indian cuisine (It was all fantastic) and a desert bar that was just decadent. Plus there was frequent resupplying of fresh warm breads/rolls. I had decided I would stay away from this place as I wanted to experience Rwanda and not a substituted American experience but it was definitely a very nice supper. Although the price was a bit high I've been to other places in Kigali where I've spent $8,000 FRw and not been treated nearly as well or to as high a quality food.

Home by shared Taxi and I'm back where I started by 9:00 pm. The generator is running as the power has been shut off. Philbert has been busy with other things and the bill didn't get paid. I'm tired and go to bed not thinking about what the power situation will be later. When I wake up to Blog Thursday morning, the house is dark and quite. In the morning we find that they also ran out of diesel for the generator. Luckily, there is still water in the hot water heater and there is water pressure so the shower is pleasant if brief. We managed to get 3 people showered with the warm water. Around 7:45 am a call to Abdullah reveals that if I wait I'll be made late so it's off by moto.

Ruhengeri Guerillas

It’s a bit over 2 hours to go from Kigali to Ruhengeri. When I picked up our permits I was told repeatedly, "You must provide your own driver into the park." and "you must be at the Park Entrance @ 7:00 am and provide your own driver" and "The park entrance is at Kinigi not Ruhengeri.and you must provide your own driver". So I went to town to get the bus travel tickets while Dr. Konn went to take care of ordering dresses to be made for family and friends from a seamstress @ Kimironko market. We want to get to Ruhengeri early enough to make those driver arrangements but the buses are full and the earliest I can get a ticket to leave is 4:00 pm. Which will get us to our destination around 6:40 and then we’ll find the hotel and still have to find a driver. Rwanda pretty much shuts down for business after dark which is a constant 6:00 pm every day of the year. Dr. Konn calls the hotel and they have a driver they use and they assure her that for $60 we’ll have our driver for the day.

Rwanda is playing a football match against Morocco. The match started about 15 minutes prior to our departure. We were not paying any attention to it but knew instantly when a point had been scored by Rwanda. The cheer literally could be heard across the city. The din of the bus area is replaced by the din of jubilee. People were shouting, horns were beeping, arms thrust in the air in victory with smiles were on every face. The bus arrives 5 minutes before departure time and there is the mad dash to get in the door and grab a seat. A window seat gains control of the window, a surface to lean your head against while sleeping and you only have to hug the person on one side instead of the two person group hug of the est of the seats. It’s a beautiful drive, on a pretty nice bus. We’re packed in already but there are a few empty seats as we leave. But we aren’t done yet as there is a 2nd bus station on the way out of town. We stop here to finish the canning process and they’ve over sold the bus by one. There are three seats plus the one that folds down to eliminate the aisle. We’re seated five across, which already one more than there are seats and now the seat behind us is 6 people in 4 seats. But everybody seems happy because the game is being blared over the bus radio and Rwanda is winning. Dr. Konn gets out some tissue paper to plug her ears. The speakers in the front of the bus aren’t working and the driver has it cranked so he can hear clearly from his front seat location. I don’t have a clue about what’s being said but don’t need to. The rhythm, pitch and timbre of the Rwandan announcers’s voice is the universal. Rwanda has the ball and the pitch goes up, Rwanda gets closer to the goal and the pitch rises some more with the speed increasing a notch and each sentence is left hanging , , , with a rapid fire if a goal shot is attempted and an blast off acceleration if there is a score or a rapid descent of disappointment if the shot is missed with a quick re-grouping to tell what’s happening next. I don’t understand a word but can easily follow the game. We’re out in the country side when they score another point. Villagers we’re passing begin pumping their fists into the air and the bus is honking at them in Rwandan pride. Now the same progression but the bus gets quieter. Morocco must have the ball near the Rwandan goal but when the announcer does the blast off part there is a collective moan (Morocco scored the point). In the mountains we periodically lose the station and the driver instantly tries to find another station. There is nothing else on the radio but he still has to find a station that reaches that particular stretch of road. Sometimes the radio lasts for 5 minutes and other times for 15 before a switch. At each village you can tell where the radios are located as there will be a clump of 5 to 15 people at a doorway listening. Sometimes they carry the radio to a spot on the road where there is reception and they’ll sit at that spot in a huddle encouraging their team to win for them. Once the halftime is reached there is quiet music for the intermission and most of the passengers sleep until the 2nd half. Same thing over again but now we hit stretches of time when there is only static to static as the ready searches for a signal for 5 minutes before we get 20 seconds of fuzzy broadcast. They all strain to hear whether a goal has been scored during our absence. Another goal, another collective cheer on the bus with more fist pumping villagers dancing around. The game finally ends and the entire countryside is celebrating. I’m a bit confused about the score as I know we’ve heard 4 cheers so far but the insistent sign language between passengers shows a score of Rwanda 3 Morocco 1. It might well have been super bowl Sunday back home.

At Ruhengeri the bus driver physical blocks the doors so that the departing passengers can get off. It takes quite a bit of effort on his part to hold back the mob on his back until the last passenger gets off. If he didn’t do this the passengers still on board would be swept back to the seats in the back of the bus by the oncoming tidal wave. When he releases the dam, every seat is claimed within 90 seconds. You could easily be trampled in one of these scrums.

It’s very dark and we have about a Kilometer to walk along the road to get to the hotel. It’s a constant calculation for your safety. Is it safer to walk on the nice smooth road (and take a chance getting hit by a car, lorrie or bicycle) or safer to be off the road (but perhaps twist your ankle or knee in some unseen pothole or crater). The vehicles have a light so you can see them coming but none of the silent bicycles have illumination and you have exactly 1 second from the time of sensing them until you feel their air as they blast past. We’re happy to reach the safety of the hotel Murhabura. The man at reception has two singles reserved and yes the driver will pick us up @ 6:00 am and we must pay him $60 U.S.. Hotel and continental breakfast for $40 each. There are no other restaurants close but this is supposed to be one of the best in town so after checking out the rooms we head for supper. Normal African fare with a few French specialties. We were hungry so we both ordered an appetizer of fresh cream of mushroom soup, entree of goat skewers and chips plus a desert. The serving bowl of soup that arrived contained at least a half gallon of soup. It still contained enough to serve 3 or more people when they took it away. It could have easily been the entire meal as they brought toast out as well. I canceled my desert order as I was full before the entree had been served. At the table next to us was the coach for the Rwandan Cycling team. I’ve seen one of the riders in Kigali and we chat for about 20 minutes. Supper over, it felt as though it was after 10:30 but the clocks said it was only 8:30 - Regardless I went to bed and had no problem falling asleep with the alarm clock set for 5:30.

The promised 5:30 continental breakfast is served on African time @ 6:00 so Pascal the driver waits while we shovel our food in. The ride to Kinigi Park office is nice but the roads are already crowded @ 6:10 on a Sunday morning. I guess if you go to bed when the sun goes down you are ready to get up when the sun comes up. We pepper Pascal with questions and he assures us he’ll be our driver all day and that he’ll be willing to take Rwandan Francs as he doesn’t have any change for the U.S. bill I’ve brought. Once @ Kinigi we register, have tea and get assigned to one of the 7 guerilla groups that are being visited. Dr. Konn repeatedly asks to go to the group with the shortest walk. Pascal is quite excited when he asks if we want to go to Susa group. It’s the largest group and has the famous twin juveniles. He assures her that it’s a "medium walk" so we find ourselves with 6 other trekkers receiving instructions from our guide Olivier. Our group has three Australians, a couple from South Africa, a young lady from Vermont Dr. Konn and myself make 8 (which is the max per group that visits a family). I know that many people desire this particular guerilla family and I’m pleased but seem to remember that this is supposed to be the farthest hike (sometimes taking 4+ hours to reach the family) Pascal assures us that yesterday they were close, , , just a medium walk...

The guide, Olivier, rides in our 70's model Land Cruiser at the head of the convoy of 4 wheel drives vehicles. But we head in a different direction than the other 6 teams of trekkers, back to Ruhengeri past our hotel and then down the road to Gisenyi which is being repaved. Each of the villages has a crowd of people getting their pictures for their I.D.s. I’m not entirely sure but it seems that it’s census time and everyone is supposed to go back to their home village to register. After 40 minutes of driving we turn off onto a washed out road through the village, out of the village to an even more washed out road, onto a washed out muddy track until our 4 wheel drive won’t go any further (4 wheel drive doesn’t work when the tires don’t have adequate tread) Into the back of one of the other Land Cruisers until it can’t go further and we start our walk early (not being able to reach the planned parking area). We’re joined by a military escort packing automatic weapons and a group of potential porters. Some had planned to hire porters. My pack is light and I don’t want to spend the extra money, , , , the young couple are also carrying their own packs. Four porters grab the other folks packs and a 5th man comes along just incase. We’re told that the military is there to "scare off buffalo or elephants" and that they will be very unhappy if they are included in any pictures. (During the trip there was always one in front and one at the rear)

The climb to the edge of the park is very, very steep and along or through the fields. A few cattle, sheep and goats are seen periodically and there are homes almost to the border of the park. It takes over an hour and two rest stops to get to the stone wall marking the edge of the park. Dr. Konn has hired the extra porter and is ready to see the guerillas now. After we’ve caught our breath we’re given our next set of instructions. And told that the family is about a 90 minute walk once into the forest. The guide puts on a 2nd set of pants, an extra jacket and a pair of leather gloves to guard against the stinging nettles (which he promises to point out so we can avoid them).

If it were not for the bamboo, this walk could be almost any trail on a wet spring day in the Appalachian mountains back home. The plants look quite similar with mint, nettles, blackberries and clover. The trail is narrow, steep, muddy and prone to frequent roots. We proceed slowly and are encouraged to keep close together and quiet as we go. We can tell when we’re getting close to the trackers as the radio reception has less static and is getting clearer as we approach them. Another hour and finally we reach a point where a tracker meets us and when we’re told to drop the packs and walking sticks. Take everything we value out of the packs (so that there can be no accusations if something later is missing) and no food or water past this point. If the packs need to be moved the porters are to carry them (even if we didn’t hire a porter). Another 20 minutes walk and we’re ready to begin our hour with the Susa family.

Shhh, around a corner and into a thick patch of stinging nettles and we can hear the various individuals eating. Slowly we approach with the trackers grunting our presence. We come close to the 2nd oldest silver back. He’s big, very big but the most impressive part is the size of his hands. He doesn’t really turn to ignore us also doesn’t acknowledge us either. It’s as though we were simply a flock of birds that are part of his normal background. He decides to take a nap and I catch it on video. The family group starts to move and they head up the hill with us following quietly but quickly behind. The pattern seems to be five minutes of vigorous climb followed by 5 minutes of sitting, munching on nettles or bamboo until they start climbing again. Olivier explains that the bamboo shoots contain a bit of alcohol which they enjoy and are searching to find. But it’s the end of the season and they are having to look a lot to find a few pieces of bamboo shoots.

At one point we climbed past the family and position so that we can see them as they pass. We don’t move fast enough and Olivier is urgently encouraging us to get off the path and Shhh and "no pictures now!". A couple of black back males are waiting for us to get off the path so they can go past. My trekking pants are not thick enough to guard against the stinging nettles and I didn’t even think about gloves. I’m stung close to 600 or 700 times. My arms, legs and hands are letting me know that I should have read up a bit more or payed closer attention about what to bring. A number of times I put down my camera and just try to absorb it all. I’m concerned that I could easily spend the entire time staring through the back of a camera and miss the magic of the moment. We only get one hour and Olivier has a clock that he keeps checking to make sure we don’t spend more than our allotted time. From first sighting to last picture we climbed close to an additional Kilometer. Olivier tells us later that we stopped following the family @ 2,975 meters (by GPS). It takes almost 20 minutes of sliding and mud surfing to get back to the porters and Dr.Konn. She had stopped after the first sighting but had gotten to see the twins (which we missed). When she sat down and the mother and both twins had come and sat next to her before heading up the hill to rejoin the group.

The group is pretty jazzed but all are tired from the climb. We got lots of great photos. We’re told that many other times the family is resting and there is very little climbing once the group has been reached but today we arrived during one of the moves. Bye to the trackers (who will spend the rest of the day following the family until the guerillas make their evening nests) and we’re on our way down. Forty minutes and we’re back at of the park rock wall border. While we rest Dr. Konn receives a phone call from the hotel. They’d told us we could leave our stuff in the rooms until after the trek and where are we? We’d expected to be back by noon but Olivier says it’ll be close to 3:30 before we’ll arrive back (we have the only keys?!?). A bit more rest and 40 minutes more walking through the fields and we leave the military escort and 10 minutes more to the waiting 4 wheel drives. The whole community is there to see us off. Dr. Konn has words for the driver Pascal who had told her "medium walk" and I have words for him when I discover that by convincing us to come to this family we’re now charged an additional $20 because of the increased distance.

A call on the way back to town and we are told that the buses are filled until Monday. At the motel I hurry to grab our stuff from the rooms while Dr. Konn hurries to get the receipts. Hurry to town where Olivier (who rode with us again) helps me at a different bus company to obtain the last two tickets to Kigali on the next bus out @ 4:00. We hurry to a store to grab something to eat as our 6 am breakfast is long gone. Hurry back to the bus area and within a few minutes are scrumming for seats again. This bus has four individual seats on each row, with no aisle jump seats and only four passengers per row. Back in Kigali by 6:30 back at the house by 7:00 and supper of spaghetti with Terry. We’ve obviously not moved and he reports there was no activity toward moving the entire time we’ve been gone. Which has only been 27 hours since we left.

The speed to load the video below will depend on your connection.

To see all of the photos from my trip to Parc National Volcanoes and the Mountain Guerillas click here.

Rwinkwavu Hospital -

I’m up and out of the house before 7:00 am. I’ve finally connected with Shaloy over the skype this morning. I realize how much easier it is since we’re able to see and hear each other almost daily. A quick moto ride and I’m waiting for my bus @ Atraco by 7:10. The crush of people, the people wanting to divert you to another company, the sellers of candy and sellers of mobile minutes are all becoming routine. I’m even getting used to sitting next to a complete stranger for a couple of hours, touching ankle to shoulder with my bag on my lap the entire trip.

I visited for quite a while with a very pleasant young man who works with Atraco. At the appropriate time he walks me to the van and I get that coveted front passenger seat. I’ve shown the driver where I want to go and he nods but doesn’t speak any English. I showed a fellow passenger who also doesn’t speak English but nods approvingly as though we’ll pass that place. After an hour and half of driving my phone rings and It’s Dr. Irenee who I am going to see today. There is a spot at the hospital where they are able to get one bar of reception. She asks to talk to the driver to enquire about the time of my arrival and to instruct him where to leave me. I am thus deposited and to the dismay of the flocking moto drivers quickly picked almost immediately by Dr.Irenee and the Rwinkavu bus.

It’s a lovely 20 minute ride down the dirt road toward Akegera Game Park. Rwinkwavu Hospital is a joint effort between Partners in Health (PIH) and the Rwandan Ministry of Health. The people who I've talked to in Kigali refer to it as the "Clinton Hospital" as the Clinton Foundation has provided some funding, I recognize the road and the scenery from our trip with Dr. Konn and her students a couple of weeks ago. Dr. Irenee tells me that there is a sonosite unit and a new ultrasound unit provided by the Ministry of Health. We find it still in the box and she says it has yet to be used. The unit is made by a Chinese company I’ve not heard of. We take it to an exam room for me to explore how it works. It has a 3.5 MHz curvilinear transducer and a basic OB calculations package. There is no memory so once a measurement is obtained you must write it down. There is no ability to Cine back to a missed image, no Doppler and it won’t store any images. But it does work and provides an acceptable image and we can do measurements. The Hospital director and Dr. Gilbert join us as I play with the unit.

The first patient has a supra-umbilical mass that is visible just under the skin. And extends to the costal margin. It connects to the inferior margin of the left lobe of the liver. Additionally he’s got two other heterogenous masses within the liver both with significant anechoic areas and with a thick rind. They have a similar appearance to the large mass and I suspect they are related and are some sort of parasitic abscesses. Then Dr. Gilbert turned on the Sonosite to show me a case they had saved. Splenomegaly with a very large anechoic area with a large echogenic mass within the apparent fluid. The still images are quite confusing but the patient is in the hospital and within a few minutes we’re scanning him in his bed on the ward. The apparent fluid is totally contained within the splenic capsule and I can see normal splenic tissue around the edges of the fluid with an echogenic mass floating within the fluid. There is no history of trauma and they say they’ve stuck a needle in it and gotten back tomato juice fluid (which they’ve sent to Kigali for pathology analysis). I can describe it but I don’t know it’s cause. A couple of other patients using the Sonosite and one normal and one with a liver mass that is extrinsically compressing the biliary ducts.

Back to the exam room where we scan some OB patients and volunteers. The first question as always, show us how to see the gender of the fetus. Off to a delightful lunch in the employee cafeteria and then back for a few more patients. Dr. Damascene joins us for most of the afternoon. A few patients, a few quick pointers a mini physics lecture on angle of incidence vs angle of reflection and we’re done for the day. Pictures, thank yous both ways and I’m out waiting for the bus.

The Sonosite unit is fantastic, three transducers, Doppler (Spectral and Color), memory for storing images, a full calc package, slots for memory storage devices to attach. I encourage them to use it and promise to e-mail the Sonosite folks to let them know how valuable their unit is to the patient care in Eastern Rwanda.

The Rwinkwavu bus goes to Kigali every Friday evening @ 5:00 pm and returns Sunday evening. While I’m waiting I got a chance to visit with some of the American PIH volunteers who are taking the two days in Kigali. When the bus comes to load us up it seems there won’t be enough seats (and there wouldn’t be in the U.S. but this is Africa and we just put another person in each row and head towards Kigali. Dr. Irenee is on her way to visit a sister in Butare. We sat next to each other and where able to visit. Every so often we reach a worker’s home and we stop to drop them off. By the time we get to Kimihurura the bus has about 1/3 rd of the original occupants.

This second visit to a district hospital has confirmed even more the need to have more sonography training during the physician training at the medical school in Butare, regular scheduled on going/in country training seminars and one on one training with their equipment on site. The physicians are intelligent, hardworking, dedicated professionals who could use a few more tools in their tool bag as they care for the people of Rwanda.

Thursday June 12

I’ve been needing a day like today to write my report. I don’t have any set appointments, no specific place to teach, just a day to get caught up on those things you occasionally need to catch up. That’s today. Catch up day. I missed Shaloy on the Skype and decide that I’ll move to the computer closet where I get a better connection.

The report is my observations and recommendations concerning Sonography training in Rwanda and covers the question of the training of those currently performing the ultrasounds (general practitioners @ district hospitals, the deliberate assignment by the Rwandan Ministry of Health of a recognized para-professional sonographer and the outlook for training sonographers in Rwanda.

I’m done by 1:00 pm and walk for a bite to eat and then catch a moto to KHI where I’ll print the report. I want to have a couple of other eyes look at it before I submit so that I get it in the right format, to the right people with the wording that is locally common. I also trust Dr. Konn’s opinion on the local conditions and don’t want to be offensive or pushy. John is very accommodating with the printing and helps me get a driver to go to the new guest house. I’ve got the time and all we’re going on is rumors about moving preparedness. I grab some pictures and I’m sure that we’re not moving Friday (tomorrow) and doubt seriously that we’ll be moving Sunday. Link to all pictures of new guest house.

Dr. Konn is leaving in 1 week and I’m gone in 2 so it’s time to try and get our reservations for Rhurengerhi for the Guerilla trekking. Terry doesn’t want to join us as he’s promised his wife they’ll go together and he’s heard that it’s magical once but not twice. We’ve been calling, e-mailing and stopping in @ ORTPN periodically and keep hearing that there is a single slot tomorrow, or next Monday there is a single spot. We keep waiting for two openings but will take individual ones if we don’t find something in the next couple of days.

At ORTPN I put on my best face of a poor, pathetic, polite and kind Muzungu who just doesn’t understand that when they tell me there are no openings when I desire to go that I should leave. I ask again are there two openings on this date, , no?? Okay please look at this date, , , ohhh nooo that’s too bad... How about this date??? I’m realizing that the tour operators have direct access to the reservation system and are constantly adding and dropping reservation slots. What may not have been available ten minutes ago may become available 5 minutes from now. Those slots become available to either the ORTPN office or to the other tour operators (whoever spies the opening first). We working also with Dr. Konn’s schedule, my schedule and really only have a couple of options for when we can go. I asked her to look again at this Sunday and now there are two slots open for Sunday!! Although it takes another 40 minutes to complete the paperwork and do the credit card transaction I’ve got our tickets. The bonus is that we don’t have to adjust schedules since we’re going on a weekend.

I was done by 4:00 and had some time to go tourist shopping and get my bus reservation for tomorrows trip to Rwinkavu hospital. I have a list of people for whom I want to purchase memorabilia and I’m looking for the right things and right prices from shop owners who’ve treated me kindly. I have a great trip in town and end the day waiting for Abdullah to pick me up at UTC, since he’s already on his way to the guest house. I know I stand out as a Muzungu. I had not considered the number of stares a Muzungu with arms full of African items might attract standing on a street corner in downtown Kigali as people are leaving for home. I think the most welcome site I’ve seen in Rwanda so far was that tan Corolla swooping in to my rescue from the city of a thousand stares.

Rwamagana - Greatest immediate impact thus far

I've been invited to go to Rwamagana hospital today by Dr. Etienne Amendezo (or as the Rwandans write it Dr. AMENDEZO Etienne). Rwamagana is about half way between Kigali and the border of Tanzania. It's supposed to be 45 minutes from Kigali (and it is if you drive directly there without stopping). I get to the matata station in Mumunge before 9 but the Atraco bus company sign that I'd located the day before was not the place to get tickets or catch the bus. By the time I walk to the correct location I've missed the 9 am bus and have to wait for the 9:30. One fortunate side effect is that I'm the first person on the 9:30 bus which means I get that coveted front passenger window seat.

The trip is very pleasant. We made a stop @ the Remera bus station and I see that it has it's own little market of all the things that a traveler might need; Sun glasses (or as my Aussie friend terry says "Sunnies"), tissue paper, small packs of cookies/crackers, gum, 2 piece suits, belts, shoes etc. . . The suits on a rolling rack are the oddest of this eclectic assortment of offerings. Dr. Etienne and I phone each other a couple of times throughout the morning first confirming that I'm coming and the time and later my progress. The hardest part of reporting when I'll arrive is that neither the driver nor the other passengers seem to speak any English so the pantomimed question of "When will we reach Rwamagana??" creates much discussion and comment in KiniRwandan but no answer for me. Along the way I see a trench being dug for what appears to be telephone or power cables. I arrive just about 11:00 am.

The hospital is directly across from the bus station and I walk into the courtyard and await Dr. Amendezo. A tall handsome Dr. Eric comes to greet me. He speaks English very well and is going to join us in learning more about their ultrasound unit. Soon the Director of the hospital comes to say hello as well and then we are joined by Dr. Amendezo and we head towards the Maternite Ward.

The ultrasound unit is a biosound unit that looks as though it might have been an early portable model. I've included a link and if you have any information you can share especially a users manual. There are a couple of stickers indicating that the unit was donated by Pie Medical and I'll e-mail them so they can know that their donation is being used (and to ask for a user's manual). Since there is no manual I ask Dr. Amandezo to give me about 20-30 minutes to explore the buttons and figure out how each of the controls works. Ultrasound units are similar to cars , , , , once you've driven one and learned all of the "car" controls you should be able to drive just about any car. The buttons may look different, may have another name and will likely be in another location but they are all still there. This unit is relatively intuitive for me and I've got most of the major controls figured out by the time the other 4 doctors arrive for the impromptu inservice.

The biggest thing I discover is inside the transducer case that was stored under the machine. I looked inside for a manual or printer cables and found an endovaginal transducer. The physicians were as surprised as I was to find it. Their primary use for the ultrasound unit is obstetrics and gynecology. Having an endovaginal transducer can significantly improve the quality of the sonographic information available to them. The other thing that I discovered is that when calculations are entered appropriately it calculates the standard fetal biometries including heart rate, expected date of delivery and estimated fetal weight based on the averaged biometries. I showed them how to start an exam with "New Patient", how to select an exam type from the presets, once scanning how to change the overall gain, depth, TGC, dynamic range. We spent quite a bit of time reviewing how to enter calculations and make measurements. I wasn't able to quickly figure out how to delete errant measurements, but know there must be a way. I also can't answer if the unit averages all of the measurements for a specific biometry or only the last measurement of that specific biometry. Hopefully someone from PIE will be able to help me.

After the basic inservice they have patients lined up with specific questions that they want answered. First an OB patient and a demonstration on a live patient on how to do the calculations and show a report. They are wistful for a printer that they might be able to easily document the report sheet quickly. I can sense that they want to ask me about the gender and are trying hard to be polite, so I can finish showing them how and where to do each of the measurements. Finally the question comes up and all affirm the desire to see the baby's bottom. Luckily for my demonstration, the gender is quite obvious as we can plainly make out the labia. Next, there are two patients who are questionable for retained products of conception after miscarriage/abortion (one positive, one negative).

Another patient has a pelvic mass found during physical examination. They want me to scan the pelvis and abdomen. Her bladder is not quite full enough for a standard transabdominal and is too full for a routine transvaginal examination. On the preliminary scan I see that her uterus is significantly retroflexed and the tansvaginal should be much more helpful. She attempts to void but is unable even though she has close to 300 cc of urine. I note subjectively a thickened bladder wall. I look around the abdomen before switching tho the T.V. transducer. The right kidney is enlarged with massive calyceal dilatation and a right ureter diameter that measures almost 17mm. I can trace it from the renal pelvis all the way to the uretero-vessicle junction. When I check the left kidney it is not quite as dilated in the renal sinus but the left ureter is basically the same diameter as the right and can be traced by it's large size down to the same basic location of the bladder trigone. Additionally, she has large bilateral pleural effusions, a peri-cardial effusion, splenomegaly and a very large Inferior Vena Cava (which they confirmed as congestive heart failure). This lady is very sick. The T.V. exam showed bladder wall thickening in the are of the trigone and an indiscrete mass in the cervical area. All of this is consistent with her dilated ureters and inability to urinate. They knew she was quite ill and suspected each of the things we found. The sonogram was able to clarify the gravity of her situation. This patient helped to clarify for me the value of a good ultrasound unit with trained individuals operating them.

Finally an HIV patient who has a pelvic mass which they would like to evaluate as possible fibroid. They also want to look through the abdomen for other pathology especially lymph nodes. I've had Dr. Amendezo scan the last couple of patients with help. The other physicians have been paying attention and are able to quickly point out which button to push for measurements and image correction as he scans. I'm very encouraged that the few hours I've spent here today have had the most immediate impact on direct patient care in Rwanda thus far.

Like other busy days, the next thing you know and we've almost missed the lunch hour (it's 1:30). I went with four of the young physicians to the local hotel a few hundred meters down the road. It's a lovely setting and serves a fantastic African lunch buffet. After lunch I sat down at the unit by myself while Dr. Amendezo does an emergency, exploratory surgery for soft tissue neck trauma and possible carotid transecting/bleed. I find how to change the name on the machine to say Rwamagana Hospital, the steps to delete those errant measurements, how to change which transducer that is selected with exam start up and how to adjust the other imaging presets. We scan a couple of volunteers with three of the physicians. They are delighted and I'm relieved when this baby also proudly displays his genitals for the expectant and grateful audience. After surgery, I'm able to show Dr. Amendezo the steps I've discovered. He walks me to the bus stop and we visit while waiting for my 4:30 ride back to Kigali.

The future medical care for Rwanda will center around physicians such as the ones I've interacted with all this week. From my perspective they have a hill to climb to get where they can see they need to be, but I've seen the will, the energy and the commitment to be successful in these men and women. Link to all of my Rwamagana Pictures

Physician Seminar - June 9 and 10

Monday I was up early as I thought of changes I needed/wanted to make, questionnaires, evaluations, certificates. I've got enough materials for an 18 month course and I've been paring it down asking myself repeatedly "What is most important? Do they really need to know that? Is that too deep?". I go over my list of items to take again and again (Computer, cables, power supply, business cards, books, docking station, glasses, tape for cords on floors, questionnaires, pens for the flip charts, audience participation clickers, USB extension, audience participation receiver, evaluations, camera, water) Check and double check spread on the bed then into the big backpack. I don't want to forget anything today. The pack is very full and very heavy and as I pick it up I remember one of the straps broke on the last moto ride home. A quick repair and good morning to others who are up. As Dr. Konn is getting ready to go I notice she has a projector so I ask about which I'm supposed to use. She makes a call and we discover I'm supposed to use the one she has. Abdullah is at the house this morning @ 7:30 but is unable to give me a ride to King Faisal so I'm out the door, on a moto and at the meeting room by 7:45. The physicians are supposed to be here by 9:30 so I've got plenty of time to get everything right.

The conference room is locked. Of course they aren't expecting the meeting until 9:15 so they won't be open @ 7:40. One by one King Faisal physicians come by checking the door and milling around the entrance. They have a staff meeting from 8 to 9. I got to visit with many of them and they are happy to here that Kigali Health Institute is helping the General Practitioners with Continuing Medical Education opportunities. Once the secretary comes I slip in and try to set up as much as I can while the staff meeting goes on. As a busy mouse in the corner it was very encouraging to overhear snippets of their discussion. They are a dedicated group of professionals of the highest order. Treating each other with respect and expressing the types of high ideals and morals that we would want all physicians to hold.

Once the staff meeting is over I can re-arrange the room and make final preparations. I'm ready by 9:10. @ 9:25 I decide to give a call to John so I can assess when they should arrive. They are just leaving so I have a bit more time. Benard & Benjamin both come with the physicians and have brought my box of materials from the school. The physicians are young and bright. They represent Rwanda's best. Most went to school together and are assigned to hospitals around the country. During introductions I find that all but one are general practitioners, they all have ultrasound units that they are using to different degrees. Most are performing obstetrical and gynecological sonograms and only a few are dabbling in the abdomen. All of them speak primarily French (and to them I have a very strong accent).

I shared who I was, what I was doing in country, the various organizations who had worked together, the societies that had helped and the companies who had donated educational materials. Physics first , , , we're starting late I've got too much stuff and not enough time. By the time the first session is over I know I'm going too fast. During the morning Tea, I delete half of the stuff I'd planned to include. After the 2nd session I decide I'm still going too fast but were done with the basic physics. During lunch (which is outstanding) I look at the afternoon talk on knobology and delete some more. We are @ the hospital so that I can take them to the machine. If I take too long lecturing there won't be time to get to the sonography lab. So I delete some more and try to slow down. We get through the lecture and down to sonography by a bit after 3:15. Before heading downstairs I pick up the surveys and all but a few join me at the machine for a good session talking about the various knobs. Finally I start to get the feedback that shows a teacher has their interest. I'm concerned I've given them too much theory.

Back at the house I go over the surveys and find notes indicating they'd like to concentrate on Obstetrics and Gynecology tomorrow, , , and almost every note asks me to slow down. I rework my plan for Tuesday dropping the abdomen lecture entirely, deciding to do a lot more writing on the flip charts instead of depending on the Power Point to keep me on time and moving. I know I go slower if I'm writing instead of pointing to a drawing already done. Plus, , I delete more things that I decided are superfluous in this setting.

Tuesday morning I'm at the door @ 8:00 and all goes well until the projector won't electronically talk to the computer. I lecture every day and know almost every trick to get them to collaborate but none seem to work. I start the secretary (Mary) on the path to acquiring a different projector. Benard suggests turning everything off and starting over and that finally does the trick. I'd planned to start @ 9:30 and I've finally got all of the electronics going @ 9:28. Good thing I'd planned some margin!

I assure them that I got the message and I'll slow down a bunch today. Also there's a lot less theory and the lectures today will focus on Obs and Gyne. We start off with a lecture that Nee Barnor our CVTC Clinical coordinator has given to me. Today is much, much better from my vantage point. More interaction, more questions, more head nodding, more correct answers when questions are asked. I love to teach and on a good day like today the teaching energizes me. By the end of the day, I'm fully charged and feel like an energizer bunny on caffeine (inside but still presenting slow on the outside). I gave out some of the items that had been donated. We took a hand poll and those who scanned the most I gave luggage tags from Sound Ergonomics, those who said they had mice, , , I gave mouse pads from SVU, all received a OB calculator wheel from SDMS and the person with the highest accuracy rate from the audience participation I gave the nice bag from SVU. I've got 12 working days left in country but I'm only scheduled to do a specific activity on 4 of those days. I offered to come to each of the doctor's hospitals and work one on one with them for a half day. Five of them take me up on the offer.

Wednesday the 11th I'm off to Rwamagana to work with Dr. Etienne Amendezo. Friday the 13th I'll go to Rwinkworu Hospital near Akegera to work with Dr. Irenee Umilisa. Monday the 16th I'll visit Dr. Emmanuel Kanimba @ Kizigura Hospital. Monday the 23rd I'll be with Dr. Melence Gatsinda in nearby Kbagabaga. I'm scheduled to be with Dr. Innocent Uyisabye @ Kibilizi Hospital in Butare. That leaves 3 days for tourist stuff if nothing cancels.

Back @ the house I meet up with Terry and we head to town for a visit to ORTPN to check out the possibilities for getting to the gorillas @ Ruhengeri, change some American money, do a bit of shopping and grab a bite to eat. We were successful on all fronts but to varying degrees. The Gorilla slots are all filled. I have an okay chance of getting a cancellation slot because I'm one, can go in the middle of the week and except for four days next week can re-arrange my schedule on short notice. I've been good about my expenses and I think I've got enough to be able to go. The mask I've looked at 5 times now I took down to measure, weigh and get a better look at in the light. I do like it, a lot, but it's quite large (though relatively light) and I don't know if it will fit into my trunks. Terry introduces me to a new restaurant that some Belgians had shown him. I tried a new drink, , , , tomato tree juice. The waiter assures me it is sweet so I order a glass. I recognize the taste as Kinyomoro fruit juice and it's confirmed when they bring one of the fruits to show me. We take a matata back to the house.

At every opportunity, Terry does his best to bring to my mind different aspects of why I shouldn't be riding the motos. I think he's up to 6 reasons that he's shared so far. His latest one is that the most dangerous part is the helmet. It's been on probably 500 heads without a cleaning. Hmmmmm , , , , , , It's so easy though, , , they are everywhere, you don't have to wait, you don't have to cram in, they take you right where you want to go, and they are pretty cheap. The thought of lice has got me scratching my head!

I promised to include links to the various organizations and resources on this web page and will try to have them all on before I go to bed tonight (Wednesday).

Sunday June 8, 2008

I got up early but couldn't raise Shaloy on the skype so I went back to bed and slept in until 7:00 am. Terry and I need to re-stock. We'd let our supplies dip in preparation for a move this weekend but now hear it may be next week. So we're off to Kimironko.

The first stop is to get some sewing done. My shopping bag ripped last trip, my ASE bag that I use daily has 2 places that need mending before disaster strikes and I have a pair of trekking pants with a zipper stuck shut (I had to slit the seam to get my room key and wallet out). We found a sewing booth open and are able to communicate my needs even though they speak only French & KiniRwandan. The seamstress consents to having her picture taken. While waiting we go to order our fish fillets but don't have to wait today as the fillets are already done and just have to be bagged. No haggling over the price and the fish man also agrees to a photo.

On to some other supplies. The egg lady just smiles, , gets three eggs and waits for her $240 FRw. The routineness of it is feeling grand. Potatoes have gone up from the last couple of times to $150 per Kilo ($0.15 per pound). We went to 4 different vendors but that was the price today. We were surprised that the price of peanuts went from $1500 FRw to $1000 FRw (until later when Dr. Konn tells us she never pays more than $800 FRw for the same sized bag). I'm able to get hot peppers, cilantro and green onions for making salsa tonight. Back to pick up our sewing $5 US for a new zipper installed and 3 mendings. We get the last few softer items and walked a mile to a store in Remera advertising "European Foods - Best Prices". The eggs in the bottle still cause a lot of local questioning. In the store the lady asks how much I paid? pointing to the bottle with 3 eggs. I tell her $240 FRw and she is amazed telling me that she can sell them for no less than $2500 FRw. Terry and I are sure she must think they are something else but can't figure it out.

Back to the house before 10:00 and I cleaned the majority of the dirt off the potatoes, start some rhubarb stewing, clean some pinto beans and start them cooking, clean the green onions and cilantro. a Tuna fish sandwich for lunch and I caught a quick nap. Then I started to work on updating the talks for the physicians tomorrow.

We did take some time to have a Mexican meal of spanish rice, refried beans, Tortillas and chips (that Dr. Konn had stashed since she came in January), fresh Salsa, guacamole and fresh pineapple for desert.

I'm not nervous because they are physicians. The thing that makes me nervous trying to hit the right level for the group. I've spoken with John and he says they will be general practitioners who are currently using sonography but want more skills. The other thing that seems to challenge me is getting the content down to an amount that is deliverable in the time allotted. I worked until almost 11:00 pm on trying to get it right and still don't feel like I've pared enough away. I woke up @ 4:30 with my mind whirling about paring away more and the need for a survey plus a certificate when we're done. I got in a skype visit with Shaloy until she went to bed and then finished up. Ready for Monday

All pictures of Kimironko market

Sabbath #6 Kigali Memorial Centre

Kigali Memorial Centre. Terry and I decide that we’ll try to find the Kigali Memorial Center this morning. We’ve got a road name from the Bradt Guide. We’ve got the web address from the Lonely Planet guide. We’ve looked on a map of Kigali and think we know where it is but decide to go to the ORTPN office first and confirm then go, but the ORTPN office is closed on Saturdays. Back to the bus drop off and we asked a policeman (who seems quite surprised that we wanted to walk that far). He pointed us in the direction we thought we should go. It was around a 3 mile walk from the city to the Centre. We had to be careful walking down the hill as the sidewalks were quite uneven. I was surprised to find the shurtliffs has made it Rwanda but changed the spelling to protect the innocent. It started to drizzle as we arrived. Although not as shockingly brutal as Murambi the experience was just as intense.

We had to be wanded and have our bags searched before entering. No photography was allowed inside (outside only), cell phones were to be checked to ensure that they were off or silent. Just outside the entrance was an eternal flame. The inside of the building reminded me of a sea shell in that you circled around a couple of times but never intersected the entrance until the exit. The lower level succinctly chronicled the events that built up to the genocide and then chronicled the actual events and aftermath through photos, displays, video kiosks and a small theater. There were snap shots of the victims in life (donated by relatives) hanging around small alcoves of the theater. Two beautiful stained glass windows and a series of glass figurines added to the atmosphere of concern, respect, presentation of fact and thoughtfulness to those still living with the loss. Once we completed the downstairs section we were guided to the upstairs which is dedicated to the remembrance of genocide victims through the ages. Each room chronicled a different genocide, Some I'd never heard of and others I'd known of only obliquely. By the time we walked up the stairs Terry had had as much as he could handle and he went for coffee. I continued on and then through the section showing photographs and stories of the children who were massacred.

The grief is overwhelming, but once I was able to evacuate from the building, I found that there are a dozen small and private gardens surrounding building. The now continual rain seems quite appropriate. The beauty of the flowers and the gardens relieved a great deal of the crushing weight of the place. Then I came to the cement vaults of mass graves. Over 250,000 people have been buried in this site alone. I went to find a cup for myself. We pondered how these things happen and the inhumanity of man to man. we discussed our own issues with thoughts of exclusionism and dehumanization that we keep under control but nevertheless express in quiet moments. It makes me wonder if I'm capable of such an evil thing and I suppose I am but I can't conceive it. I give up, it's too big and I can't get my mind around it. I finish my tea and we leave. Anyone alive here over 3o was a teenager when this happened. How did they let this happen? The people I've met who are over 30 are kind and sweet and nice... I can't get my mind around it.

We walked the mile back to the bus stand with the raining slowing and caught the matata making a big circle back towards the house. Instead of walking directly to the house I showed Terry the large roundabout park (The Peace Park) and the government ministry buildings that abut the guest house property. I took a nap and got up in time for the Realife Sabbath School Lesson Live and Interactive from Collegedale. I don't know how, but it relieved my homesickness and increased it at the same time. Ken Willes had it all set up and I was able to hear and participate in the discussion. Truly the highlight of my day.

This evening I went with the Terrys to the Indian restaurant again. Crammed into a matata as though sardines, we quickly smelled the aroma of petrol. Then the man next to me (who was a pleasant drunk) started to talk. Now Dr. Konn and I can't figure out if the odor is truly petrol or fumes from this man's consumed or spilt banana beer. He was sure that we were his friends and greeted us as such introducing us to the other passengers (who I never could decide if he really knew). Finally we reach our stop and walk to Indian Khazana.

The first time I went here was on my birthday and the waiter asked if they could sing for me and I insisted that I would not enjoy it. Tonight we got to witness a birthday song. The lights went out and the entire African staff lined up in a congo line and very loudly began singing as they snaked from the kitchen,through the tables towards the object of their myrth. First a version of happy birthday with 3 verses and the last one asking "How old are you now? How old are you now?", this was quickly followed by a couple of songs that were super joyous and African but not recognizable to me as birthday songs. A couple of the singers had wild masks on and one kept blowing a large horn which gave some rhythm but not a specific identifiable note. It seemed to take about 6 minutes from lights out to clapping of the restaurant patrons at the end. I was happy I hadn't consented a couple of weeks ago.

A taxi ride home and in to bed. Kimironko market in the AM with our cameras and I've got to work on my presentations for the physicians for Monday.

Click here for all of my pictures from Kigali Memorial Centre

King Faisal Day #10 Last Day

As I walked into King Faisal, Betty was walking out. She said that she had worked the night shift and was going home to sleep, Said was scheduled to work the night shift and wouldn't be in (He'd told me that already) and there were only 3 radiographers scheduled to work. So I know the opportunities to teach today are going to be few. One of those scheduled was the Chief Radiographer and he's kept hopping doing administrative things throughout the day. Christopher is scheduled to work in CT which leaves Diogene to work with the radiography students. The first exam of the day Christopher and I almost get completed before he's needed in CT. Diogene stepped in but by the time we finished he was being called for other exam. During the next case one of the radiography students came in and I worked through the study letting him scan explaining as we went.

We've been moving in baby steps and it's time to take another step. The exams we've been doing have had a verbal report to the radiologist. I've posted to the SDMS "Discussion Forum" a request for help with sonographer worksheets. A great response with Dea Shatterly, Chris Schara, Kelli Gohrs, Suzzane Swindell and an offer from Viki Patsdauter. So I've got some variety and today I've brought my laptop so I'll create worksheets for King Faisal. I went to the King Faisal website and grabbed the logo and went to work making a complete set of worksheets for the common exams. It was not long before I had first drafts for the Radiologist to review. He would like normal values to be listed and we spot a few errors, I realize I've left off a couple of exams and they don't look as similar/uniform to each other as I'd like. So as is common with projects like this, it took longer to "get it right" than to produce the first round of originals.

I was optimistic about how much time it would take and didn't bring my power supply for the computer. At lunch time it's a quick ride home to get the transformer and then a walk down the cobblestone street to Afrikabite for lunch. Terry and I both were concerned about the long term viability of this lovely restaurant based on our view of the evening crowd. But I see that they have a steady stream of customers during lunch. On the way back I caught a ride with a man from Fiji who saw me waiting for a moto and went out of his planned path to drop me at the door of the hospital. He had his little dog in the back seat and the three of us hit it off immediately. His wife works with the reconciliation work and they've been here for 4 years. It was too cool to pet a pet.

The imaging department has been receiving a "sprucing up" this week. New desks, chairs, cabinets, an intensification of cleaning, and removal of items that weren't in keeping with a patient care area. The results are quite nice. It was good before but is now quite sharp.

I get a chance to visit with two of the three Obstetricians today. They share use of the ultrasound machine and probably perform more sonograms with it than the Radiology department. I showed them the three OB/Gyn worksheets and asked each of them the question "If there was a trained sonographer, , whom you trusted, , , would you be in favor of receiving images and a sonographer's worksheet report rather than scanning every patient yourself??" both were quick to say they'd love to have someone else actually performing the majority of the studies so they could concentrate on other issues and perhaps get done each day at a reasonable time. I've observed these two physicians scanning and they are doing great studies following all of the standards that I'm used to seeing in the U.S.. If there are to be sonographers in Rwanda, the support of the Obstetricians will be key.

Near the end of the day there are a couple of ultrasound patients and the department is already slammed with other cases. They've been going all out since the morning and I decided to not make the patients wait and just did the exams and showed the results to the Radiologist. I'm happy with the finished worksheets and leave them both hard copies and electronic versions on the radiologist's computer. As I leave, only Diogene is around. He's going on leave after today and won't be around during the remainder of my stay.

I'm out the door feeling blue and the rain means a wet walk/ride home. I remind my self we're taking baby steps and there will be others behind me to help the process get further along. Back at the house I'm feeling down so I got the autoharp and played for about 40 minutes in the cabana. The music and the words really lifted my spirits and when I'm done I'm good to go. Philbert arrives from cleaning at the new house and tells us there won't be moving this weekend "maybe next week". I don't think he's in too much of a hurry to switch to the new digs. I'm fine here or there. . .

I visited with Shaloy by Skyping her cell phone (twenty minutes for $0.43!) just before bedtime. She'd just gotten back to Georgia after a whirlwind trip to Phoenix. My niece Bailey got married Thursday. Shaloy and my mom hooked up together for the event. Tomorrow, I'm going to spend the morning at the Kigali Memorial Centre (another genocide memorial here in Kigali) and then in the afternoon my buddy Ken is getting my place ready to participate in Sabbath School again.

King Faisal Day #9

Terry is also working @ King Faisal today so we decide to walk together. He has a skype visit scheduled with his wife @ noon and he discovered that his headset isn’t working so I set up my computer, signed him in on his Skype account and gave him a key.

When I arrived there I found that there where three King Faisal radiographers who were unable to come the other evening because of work. They are quite wistful about missing and so I invited them for next week (presumably at thenew house) on an evening when they would be free. It looks like next Thursday will work. We’ve been told that some time soon we’ll be moving to a different guest house but the communication has been mostly hearsay and rumors. A bit of my hesitancy about picking a date is that I’m not sure which house we’ll be in and when. I’ll confirm with them where next week.

I worked with Pascal and Said today. Of all the radiographers and students I’ve worked with, Said has put in the most effort and has made the most advancement. He’s been taking one of my books each evening and by comments he makes during the day, I can tell that he’s been reading and comprehending. For the past few days I’ve been concentrating on having the radiographers give the report and review the images with the Radiologist. I’m trying to get them used to the process and the level of detail that they should be using so that the Radiologist will have confidence that a full study has been completed.

When lunch time came I realized I hadn’t brought my billfold or any loose money today. I caught a moto back to the house, handed the driver my cell phone (so he knew I’d come back), asked him to wait, ran into the house and got my money and paid him. My forgetfulness was fortuitous because Terry was having some computer issues that we were able to work through. I ate lunch at home and he got his Skype visit with his wife. Hearing a person’s voice is such a cool thing. Another cool thing is that I’ve received my birthday card from Shaloy. Even though we talk daily, getting the card was nice. Mailed May 13 Airmail delivery got to me June 3. It’s cute and I’ve got it on my desk in my room and I smile each time I spy the silly thing..

When checking my Yahoo e-mail account I got ready to delete all the "spam mail" and somehow decided to check what was there before doing my normal "delete all without looking". I was glad that I did because there were a number of comments from the blog that had ended up there and would have been lost without going back through every posting. A couple from Shaloy about the orphanage one from Tria and one anonymous. In response: I haven't asked about the countries willingness to allow outside adoptions but will ask. Also, Shaloy was concerned about the orphanage kitchen facilities and I'll re-investigate about what can be done to improve them. My friend Kelly Pratt asked if I could set the picture links to open in a new window. I can not, but , , f you don't want to lose your spot do this.. before going to the pictures (or whatever other link), click once on the adress bar for your search engine, click "CTRL and N" simultaneously (which should open a new Internet window). Then select one of teh two pages you now have open and when done just close it. Your original page should still be available.

There is a large black like bird who is black with a white chest - they look as though they are crows in tuxedos.. I’ve asked what they are and was told they are "Igikona". They are cool in that they have a very wide range of interesting vocalizations, from the typical crow "caw" to some that I’m unable to describe.

Terry lent me a "Bradt travel guide" for Rwanda that had an interesting section regarding the Rwanda Flag: "The old flag contained red, symbolizing the blood shed for independence. But in today’s peaceful Rwanda this is seen as inappropriate. The new flag is blue, yellow and green. Blue to signify peace and tranquility; yellow to signify wealth as the country strives for economic growth; green to symbolize agriculture, productivity and prosperity. There is a sun in the top right hand corner, against a blue background, representing new hope for the country and it’s people. The flag was designed by Alphonse Kirimobenecyo, a Rwandan artist and engineer"

I’ve not been happy with my Rwandatel phone. I checked Tuesday and had over 3,600 FRw credit. I made one call Tuesday evening for less than a minute. Now I’m trying to call Terry it tells me I don’t have enough credit and gives an error message when trying to check the amount of credit. The phone wouldn’t work at all on Wednesday but Thursday morning I received a call but couldn’t call out. So I decide to go to the place where I bought the phone after work on Thursday. It takes a ride across town into Mumenge and then a ½ mile walk. I decide to be just as sweet and helpless as I can and not to do the upset routine. The lady informs me that the entire Rwandatel system was down Wednesday but it’s up today. She says her computer is down and she is unable to check my account but she used my phone and now my phone acknowledges that I have time. She is able to use my phone to call her phone and shows me that her phone can call me. I walk out and try to call Terry "not enough credit" checked my credit "3,695 FRw". I’d seen another Rwandatel office on my way and decide to confirm what I’ve been told. I got an additional piece of information that made sense. "Rwandatel has had a problem and was down Wednesday. They are up now but can only call land lines and Rwandatel customers. We can receive calls from MTN network but are unable to call an MTN customer. The companies are trying to work out an arrangement" Hmmmm....

While in town, I did some comparison shopping at a different set of craft shops and then went back to the bus area. I don’t think I’ve been here at this time because the crowd is probably twice as big as I’ve seen before. As a full bus comes in to drop people off , , , people who are waiting grab the windows and run along side trying to be the first in the scrum once the current passengers depart. Diogene had warned me about it but I hadn’t witnessed it. I did not feel like participating today and caught a moto back to the house.

Terry & I walked down to Afribite for supper. What a delightful place and a great couple of hours visiting, comparing experiences, discussing, enjoying the food and atmosphere. The prices are great and the food was outstanding again. We both had vegetable samboas for appetizer, fish brochettes (like a kebab) with chips and a salad and passion fruit juice. Afterwards I had some of the hot african tea with hot milk mixed in. The tea had a delightful amount of fresh ginger added. There was a strong smell of perfume that wafted periodically past our outside table and I had to get up and find the source. About 20 feet away was a gardenia type bush that smelled fantastic. Ohh, , , and it's inexpensive!!

A nice walk back to the house, using my headlamp to keep from twisting an ankle or knee on the intricately designed, cobblestone street that climbs the hill or the pot holed road in front of the house. In bed before 9 p.m.

King Faisal Day #8

Standard morning. Dr. Konn is going to Kibuye for the rest of the week, Duvall is already there, Zachary is gone but I don’t know where, Philbert has been gone a lot to the new guest house (cleaning), I haven’t seen Philip in a week. That leaves Terry and I as the only ones still here and we make plans to go out for supper tonight. Thursday I’ve invited the radiographers from King Faisal hospital to come for supper. Terry has volunteered to help me cook.

I waited until 8:00 am and when no driver came I started towards King Faisal and caught a moto. The morning was slow with just two renal studies by 11:00 am. I worked with Said and I showed him how to use the siescape feature when viewing large areas. We both worked more with the 3D feature trying to become more adept. Said tells me that tonight will work much better for the group to come and eat with me @ the guest house. I know Terry will be flexible so we’re on for tonight.

Next week I’m doing a two day seminar for general practitioner physicians from across the country. We were scheduled to hold it @ KHI but there is no ultrasound unit there so we’ve made arrangements to have it at King Faisal. The radiography program director is supposed to come this afternoon to confirm the arrangements and check on food possibilities. There are quite a few resources @ KHI that were donated by AIUM, SDMS, Pegasus Lectures, Gulf Coast Ultrasound, Society of Vascular Ultrasound and Sound Ergonomics. I need to audit that they’ve all arrived, sort them by category and choose the ones that may be helpful next week. Additionally I want to have a visit with the director to discuss my observations and opinion about the long and short term options for training of sonographers in Rwanda. So @ 11:30 I bid adieu and catch a moto across town to KHI.

The audit goes well - everything has arrived except the box of materials from Sound Ergonomics and John tells me there is a box waiting at the post office. We walk to eat lunch @ Karibou which serves upscale African fare. Over lunch I shared with him my observations, concerns and the options for training. He seems open and grateful for the outside perspective. He asks me to prepare an official letter of finding for presentation to the KHI president and we discuss possible dates. After I have it prepared and presented I'll share it on the blog. Afterwards it’s back to King Faisal to confirm those arrangements with the head of catering services and Seth (chief radiographer)

After those meetings it’s pretty apparent that it’s not picking up in volume as the two morning studies are still the only ones in the log book. So I head to Kimironko market to get supplies for tonight. I’m getting quite comfortable with the bus system. I’m no longer dreading the squeeze as we pile in 4 to a row. I’m finding I have favorite vendors at the market who recognize me and there is less haggling over prices. I know where each of the items is located so I’m on my way back home with 2 Kilos of potatoes ($0.40), 2 fresh pineapples ($1.60), 3 large avocados ($0.60) 2 purple cabbages and 2 onions ($1.40) a very large bag of shelled red peanuts for ($3.00). The only part that was a bit expensive was the fresh Tillapia Fillets but they are much less than I’d pay in the U.S.. Tonight we’ll feed ten people well for less than a dinner for two would cost back home.

Back at the house, Terry is already here and roasting the peanuts, , He is great, , , working to help prepare the salad and fry the chips. The group of ten arrives right on time @ 6:30 and we’re eating by 6:45. The food turned out good and after clearing away the dishes we had a lovely evening with music and visiting. They haven’t seen an autoharp and seem very interested in how it works. I brought out my whistles and recorders as well. One of the house guests, Phillip has come home for the evening and he joined us. Phillip was Seth’s Biology teacher in High School and they enjoyed visiting a bit. Too soon it’s getting late (after 8 pm) and everybody has to work tomorrow so we take a few pictures and lots of hugs and I let them out the gate promising to have a link to pictures on the blog tomorrow.

When I get back into the house, I’m pleasantly surprised to see that the John (one of the house workers) has got the cleanup almost done. I’ve been working hard to be extra friendly with John as I’m trying to get him to use some English and he’s trying to get me to use some KiniRwandan.

King Faisal Day #7

Monday evening I tried to post to the Blog but couldn't get a connection. Terry had mentioned a country wide outage, perhaps it was the normal bandwidth issues in the evenings so I wrote the blog but didn't post. When I awoke @ 4 a.m. and couldn't connect, , and decided to move to the closet where the computer router resides. Sometimes a direct connection to the router will work. No go direct connected...... Hmmmm Rwanda wouldn't be down for this long, , surely, , so I started looking at the router and although there are two green lights I think there are supposed to be three. I start searching the rats nest of cords and see a plug unplugged and re-plug it , , , no change. Then I see that the power strip has a switch for each individual plug and I trip the individual plug switch and two lights turn on at the wall socket for the Internet connection and a third light turns on on the router. No country wide outage, no bandwidth issues, , just a plug - unplugged. As we're getting ready each of the house guests ask if anybody got connected yesterday and we had all assumed bandwidth issues nobody had checked further.

Monday we had over twenty patients with a dozen of them Radiology patients. Today only 2 by lunch time. Unlike yesterday, I was wondering if it was lunch time when it was only 10 a.m. I worked with Seth for a bit preparing for the Physician seminar that's planned for next Monday & Tuesday. It was originally scheduled to be held a@ KHI but we really need an ultrasound unit and there is none at the school. I'm pretty sure if we can find a conference room @ King Faisal we could have access to the ultrasound unit. Seth takes me to see Nadine and in just a few minutes we've got a lovely conference room on the 3rd floor for both days. A quick call to John to confirm dates/times/attendance levels and it's a done deal. Now I'll just need to review the course content from the syllabus and modify my presentations to match this audience.

We scanned a couple of volunteers to keep the morning productive and talked about more theory. We reviewed a case from yesterday who was a return patient from my previous time here two weeks ago. At the initial study the kidney was indistinguishable as a discrete kidney but rather appeared as a large mass. The rapid onset of symptoms and patient fever made me suspect it wasn't a tumor mass but some infectious process but I hadn't been able to follow up. now 10 days later he's back for another ultrasound and he's had a CT. This time I can see a kidney with thick fluid surrounding it and the fluid appears totally contained within Gerota's fascia. The Radiologist believes it's a resolving hematoma and that would certainly be consistent with the ultrasound findings. Additionally I noticed a large diffuse bruise in the area of the kidney. I questioned the patient concerning trauma during the first exam and then again today and both times he denied any type of trauma. In later discussions with the Radiologist and Terry they both say it's likely the patient just doesn't want to admit to being beaten. Hmmmm

We'd made some arrangements to work with the OB/GYN doctors using the 3D but I haven't seen them either by 3:00 so Said and I go to CT to review anatomy. After an hour I'm ready to pack it in and say goodbye, , but what is this?? the OB Dr. has slipped into the U/S room and has 7 patients lined up to scan. Plus he's anxious for the promised 3D session. Plus there is now a Radiology sonogram which can't be done until after the 7 obstetrical studies....... This is a typical hospital :-) It's all good though because the Dr.s are very pleasant and engaging, , , the radiology staff are equally pleasant and what else will I do this evening anyway?? We stored the 3D acquisition data and I'll work on it after the patients are gone. We finally get to the Radiology patient who is positive for DVT which I can document from the external iliac down to the calf. It has all of the characteristics of sub-acute thrombus. When I sit down to do the 3D image manipulation we'd saved the images but not the data.... A call to the OB/GYN Dr. and he says he'll bring another patient down in a bit.

The sun is about to go down, , , the day is beginning to cool off and I walked out to one of the balconies of the hospital to look over the city while I'm waiting. I can hear a group of youngsters off in the distance playing soccer. I finally spot them about 1/2 mile away but I can tell when something good has happened by the shouts of happiness which travel clearly. I can also hear the occasional officials trilling whistle. Out this side of the hospital I can also see most of Kigali's beautiful golf course. On the surrounding hills I can see a series of construction projects of new homes and upscale housing developments. This could easily be America , , , except for the cry of a worried goat whose been staked out to the grassy area next to the hospital for it's evening feed, the sight of the hospital laundry folks taking the sheets off the lines at the back of the hospital for the evening and the typical low income housing interspersed wherever there is not development. It's a study in contrast. Now the Dr. is here and it's time to do that 3D. I've gotten faster and it's not long before I've got his image and have dissected away the extraneous tissue from the face. I'm still not thrilled with the quality of the final product and I'm not sure how much is me and how much is this specific ultrasound unit.

A nice walk home and an easy going evening with the other house guests. I enjoyed comparing experiences with Terry while we ate in the Cabana. Then we both had computer work to do and I was in bed before 9.

King Faisal Day #6

It’s my second week but there has been a week in between. I’m genuinely happy to see Diogene, Said and Betty. It feels like I’ve come home. I haven’t worked with Pascal much before but we’re working together today. First thing in the morning I met with Dr. Sanoga and we went to see Dr. Innocent Nyaruhirira who is the Executive Chariman of King Faisal hospital. I/we want his support for having sonographers and his advice as to best approach the Minister of Health. It was a good and productive meeting.

Once back in the department, I see Pascal and we visit as a group together. They want to get the web address for the blog and I spend a bit of time showing them pictures. They seem to be interested in seeing pictures of my family. Pascal and I are going to be the primary team for sonography today with others coming in as they have time. Pascal held down the fort last time I was here so the others could learn and now it’s his turn. We take care of a couple of patients and get a bit of time to do some book work. Then another couple of patients and the OB/GYN doctor has brought 7 patients and he wants to "borrow the machine and room".

It took a bit to finish the exam but we eventually get done and move out. After his second case I asked him if I could observe. He was happy to let me and I was able to show him a couple of minor items where he could be a bit more efficient with the machine. I really enjoy performing OB exams. He seemed honestly happy to have another set of eyes. Pascal came back in and we would change the sheets and tried to help things along. The room setup isn’t very good for good posture and the Transvaginal exams really need a table with stirrups and a drop away bottom. I promised to bring him some of the information stuff that Sound Ergonomics had donated. He’s doing between 10 and 15 ultrasound exams per day and is certainly a candidate for Muskoloskeletal injury.

Once the first wave of OB/GYN patients were done we had some radiology sonography studies waiting. I was quite surprised when Dr. Sanoga suggested we should go to lunch as I thought it was a bit early. He assured me that if we didn’t get down to the cafeteria soon they would close as it was already 2 p.m.!! I’d been having such a good time scanning, working, teaching, helping that I’d totally lost track of time.

After lunch, Said managed to be in the room the majority of the rest of the day. We spent about an hour with one OB patient trying to become proficient with the 3D transducer and it’s surface rendering mode. We are able to make it work but the final product is not outstanding. I’ve brought the manual home to read up on it tonight. We saw quite a few pathologies today. (Pancreatic carcinoma with invasion to the IVC, a couple of cases of chronic DVT, ovarian mass, possible ectopic vs very early intrauterine that we couldn’t resolve but will watch).

I had supper alone with Terry. He was finishing up his supper when I arrived but we visited while I prepared mine and he sat with me under the cabana while I ate. His bag has arrived!! In one piece with all of it’s contents. I know his stress has dropped significantly. I’ve really enjoyed visiting with him. When we were in Kimironko market yesterday, we found some raw peanuts. He’s shown me how you can roast them in a fry pan with a bit of oil and salt. They are quite tasty.

After cleaning up my supper dishes I played the autoharp under the cabana for about 40 minutes. No Internet Monday since noon. Terry said he thinks the Internet is down across the country , , Could be!?!

Sunday June 1 - Half Way point

I really don't try but seem to wake up spontaneously around 4 a.m. each day. This makes me tired early and I'm ready to hit the sack by 8:30 which is probably why I'm waking up @ 4 a.m.. Terry Loughnan is such a change from our previous anesthesiologist. He likes to visit and go and explore and visit and compare and is completely happy with adventure. From my perspective the quality of daily life just increased by 20 dB.

He and I head to Kimironko market @ 8:15 am by matata (city bus) and had a grand time shopping today. The people in the market are quite fascinated by my bottle of water that I bring to get my eggs home. I don't want to contaminate my water bottle again, so I've cleaned out a mayonnaise jar. Last time I was afraid that the eggs would still break rattling around in the jar. My friend, Kelly Pratt, suggested that I could fill my egg jar with water. That way I could check to see if the eggs were bad (bad eggs float) and the water would serve as a cushion against breakage. I place my egg jar in the outside of my pack and the people can see the jar with a fluid and eggs inside. I've had a number of people stop me and demand to know what's in the bottle. Which seems odd for people who seem to be actively passive about so many other things.

I keep taking my camera and wanting to get pictures of the market but I'm quite concerned about offending people and getting proper permission. Terry comes up with a brilliant plan. Next time we go together, we can take each others cameras and take pictures of each other, which people will be fine with, , , but we'll include all of the things we want to show.

Back home before 10 and time for a nap. Dr. Konn got back to the house and said that a couple of students would be joining her painting at the orphanage. Terry & I have agreed to go and paint as well. So up from my nap before noon, a quick lunch with the students (Remy & Clarisse) on the back porch and we're off in a taxi to go across town to another burg of Kigali. The taxi isn't up to code and has 5 passengers when it should only have four max. So the driver takes every back road possible to avoid the Police check points. Dr. Konn doesn't know the back-roads and we spend a fair bit of time wandering about through some very very poor neighborhoods.

We do finally find the right road and are on our way to the Mpore Orphanage @ Gikondo. Dr. Konn's students have been here and have done most of the painting but there is some sections that didn't get done and four of us are here to finish it while Dr. Konn paints some murals. We had to wait a bit while the children ate before we could start. I had brought the autoharp and a couple fo recorders so Clarisse sang while I played (many of our praise songs from the U.S. are well known here). The orphanage is stark to say the least. There are fifty children here in two dormitories across from the house of the woman who runs the facility. She and her husband started a church here before the genocide. After the genocide they started to gather the children and built the two dormitories just below the church and across the path from their house. The husband died 18 months ago and the whole thing ekes out a way on a wing and a prayer. The cooking area is under cover but outside. It consists of three large stones with a fire built underneath. A pot of food is cooked and then served. I never saw it, but a number of times I heard their cow which provides the daily milk. I've taken a picture of their protein source.

The children seem between 5 and 18 years old. Most are in the younger category but there are definitely some that are needing to find a way to become independent. I see a couple of older women who are helping. Some of the older boys immediately come out of their rooms and help with the painting. We ran out of paint before running out of walls. Wash the brushes and rollers and we play some music and Terry plays a bit of indoor soccer. Both of us have a good bit of body hair and the kids are apt to want to pet or tug on it. The murals came out nice, one is of a vehicle, on another there is a wall with the kid's hand prints and a couple more of flowers that Dr. Konn completed after we left. On each she added an inspirational message. When I allow myself to compare between this and what I have back home the comparison seems obscene.

We leave Dr. Konn to finish her murals and have some alone time with the children to whom she's become attached. Back at the guest house I use the skype to call Zach on his way to work in Seattle, talk to my mom in Colorado, try to visit but miss Triandra in Michigan and visit with Shaloy for about 45 minutes in Georgia.

Supper with the Terry's, write the blog and one last visit with Shaloy (three in one day - What a treat!!) and now it's time for bed. It's raining now, God is washing the city so it will be clean tomorrow.

It was a lovely day.

To view all of my images from Mpore Orphanage click here.

Sabbath #4

I was really tired when I got home Friday evening and was in bed asleep by 8:30. I awoke @ 3:30 a.m. and checked the Skype and found that Shaloy was online so we chatted for about an hour. She got to bed before 10 p.m. and I went back to sleep from 4 until 8 am.

A nice leisurely morning with a breakfast of toast on a plate while I grazed on the mulberries fresh from the tree. I meet the new Anesthesiologist. He arrived through Nairobi yesterday and Ike is leaving today. His bag hasn’t arrived and he’s working to track it down. Now we’ve got two Terrys in the house, but this one has an Aussie accent and the original Terry has a New Jersey accent. Dr. Konn warns me that I might have a difficult time with a ride to church in that it’s community service day across the country. Everybody is strongly encouraged to work in their community making it a better place.

I walk the 1/4 mile to the corner and don’t encounter a single moto. The city is quiet and seems to be sleeping, , , where have all the people gone ? ? ? I don’t hear trucks, matatas, motos and only a few personal cars. I don’t see people everywhere, , , It’s almost 9:30 on a Saturday morning I’ve not seen the streets this empty ever. The quiet is so peaceful. I guess they take the once per month community service day seriously. I take a seat at the pull-out where people wait for the city buses. A single moto goes by after 5 minutes and I wave indicating I want a ride. He wants 4,000 FRw ($8.00)to take me to Kimironko and I still would have to walk the last mile to the church. I decide to wait for the matata which will only cost 170 FRw ($0.35). So I wait , , , and wait , , , Three little boys go by with a home made soccer ball and cross the main thoroughfare half way and then stop and have a consultation in the middle of the road. I’m more interesting than whatever they were planning so they come back to where I’m sitting and touch me to see if the white will come off. William, Dick and Anan speak varying levels of English but are quite happy to sit next to me and occasionally utter different words. I enjoy their company even though none of them is over 8 years old. Gradually more and more people are on the streets and many are carrying machetes. In a country where a lot of people were hacked to death with these huge knives their presence is a bit un-nerving. I soon see that they are using the machetes to cut the grass along the side of the road. A couple of teenagers come by and although I ask several times concerning the eventual presence of a matata, I can't seem to comprehend whether there will or won't be a bus. After waiting about 40 minutes another empty moto comes by and for just 1,000 FRw he'll take me to Kimironko. Each time I mention Kibagabaga the price doubles so I'll just walk the last mile.

Sabbath School is almost over when I arrive and I can see that there is a baptismal tank set up for use outside today. A couple of songs for church and we go outside to watch 8 people get baptised. We sing constantly between baptisms and then go back in for the rest of the service. After church I walk back to the matata station @ Kimironko but I've got a friend. A little boy about 8 - 9 years old wants to walk with me. I'm quite concerned about where his family is and won't they want to know where he is. Later in our walk up the hill, I pass an Adventist teenager and I ask him to enquire about the boy and he assures me that all will be well. A half block before the matata station the boy waives goodbye and heads down a side street. I head for the guest house. The city has woken up and seems to be back to normal.

I enjoyed a quiet afternoon of music and visiting. Terry, the new anesthesiologist, is a musician who plays guitar, banjo and mandolin. He has not seen an autoharp and is fascinated with it and it's sound. When I put it down he picks it up and almost immediately makes beautiful sounds come out of it. So I get my whistles and recorders. We spent the afternoon under the cabana. He's traveled quite a bit and it's very nice to have a deep conversation in English. I miss Shaloy, Ted Porter, Nee Barnor, Jennifer Stephenson, Mark Layne, Sharon Vaughn and so many others who I can talk with about concepts, theories, current events and such. The language barrier is probably the most tiring aspect of the trip. Terry has a lost bag and I'm glad to be able to lend him some clothes. After Sabbath we walked to a nice restaurant that I've wanted to try. The food @ "Afribite" was delicious, plus filling in a casual and super atmosphere. The service was spectacular and the food was a great, tasty and traditional. Two of us ate for less than half of what it cost at the Indian restaurant.

During the day there was a football match between Rwanda & Mauritania. The House staff were watching on the television and would come out to tell us each time Rwanda scored. We did not need for them to do it because the game was being watched around the neighborhood. There was a yell that seemed to echo across Kigali everytime Rwanda scored. Happy mood when Rwanda won 3 zip.

I've used the last of two of my favorite things. I am out of Dr. Bronner's pure peppermint castille soap. In past times I've only used it camping but I've been enjoying using it as a body wash here in Kigali. I have no hope of finding it locally. I've eaten the last of my horehound candy. :-( On a positive note I found Rhubarb in the market. Philbert has never seen it before and doesn't know how to cook it. I don't make pie crusts, but can make a dynamite rhubarb pie filling which I've enjoyed for the last three days. Philbert approves. HMM GOOD!

KHI - Student Lectures 4 & Test

It’s been years, but today I’m administering a paper test as I write the blog. I’ll post and add pictures once I get home. Fifty seven questions covering the twelve presentations and 25 hours of lecture from this week. I created a 2 page sheet of stuff to study and then another study sheet with 66 of the more important power point slides. We made copies and distributed them last evening. I’ve also brought almost all of the books that were donated and the students are referencing them throughout the day.

I’ve tried to take the basic questions and especially concepts that I had covered repeatedly. I also took out any questions that used subtle English language variations. Still I’m finding that there are some words/terms they don’t know. They don’t know the term stretcher (So I tried the word guerney, still blank stares then bed, continued stares and finally table , , , Yes they know table). I should have known not to use ETOH abuse. I was surprised that in regards to menstrual cramping they didn’t know the term cramping. And, although I’d used the term a couple of times the word onset had to be explained as well.

The books, , , it reminds me of when I first picked up my kitten Ariel from the side of the road. She was very, very hungry and scrawny. Food, , she eats, , she walks away, 3 minutes later , , ,Ohhh , , , more food and she eats more, , then walk into another room , , , , Ohhhh!! And here’s some more food let’s eat some more. It seems the same with the radiographers, physicians and students, , , Books , , Lets grab them and read, , , Got a break, , , here is a book, let’s read, , , the students want to grab them and read as fast as they are produced. It is as though they are ravenous for material that they can read at their pace. Their English comprehension is much better when read rather than heard. They don’t have to deal with my accent. I felt like a heel asking them to leave the books when they finished .today.

This building is very noisy. Every car on the nearby street, every person on the three balconies
who is talking penetrates into the room. The windows are open to provide ventilation and even if we closed them there are gaps and they are only single pane. After the test I stay to grade them right away. I won’t see some of these students again and I want them to get their grades and to be able to review the test. After grading them all I decide to throw out 6 questions which the majority of the class missed. Many of these are the questions with misunderstood words. The grades make a nice bell shaped curve with one 100%, most in the 80's or 70's and 2 below 70%. I’m happy that they’ve had a thorough introduction. The top five scores received rewards (three shirts donated by SVU & two ball caps I've brought).

Today, since it was my last day, I decided that perhaps we could enjoy tea together. If I take tea in the faculty tent it costs me $200 FRw max. I’m told that the students take theirs elsewhere because it is cheaper. So I figure, , , no problem , , , It’ll be a bit since there are 30 of us but, let’s see if we can take tea together. I ask Benard if it can be done and he assures me yes. He’ll take care of it. And good as gold at the break I’m told they are expecting us but at KIST Canteen. Not the teacher’s tent or the student’s area. Okay, , , we walk over and there is a room they have prepared for 30.... Tea is wonderful, , we talk about examples the students have thought up to describe motion that occurs because of Pressure gradients that exceed the sources of resistance and the subsequent motion that occurs from high to low. All while sipping the African milk tea and eating Chapats and Sambas. So delightful, , , I send the students back to the classroom and search out the person to pay. I’m sure that I’ve misunderstood because the man says 30....Hmm now that is a great price!!! only 30 FRw for each person Wow!! Now 30 x 30 FRw is 900 FRw, , which would be great but he meant 30,000 FRw. How can this be!! And he writes it down, 1,000 FRw for each person x 30 persons is $30,000 FRw (sixty U.S. dollars). There is no arguing at this point because I didn’t make the arrangements and never asked the price, , , the room was provided and the tea and food have been consumed. Later it’s explained that tea in the faculty tent is subsidized and tea for the students is subsidized and that I’ve only been charged the normal full price... $400 FRw for the tea and $200 each for the 30 Chapats, 30 Samboas, and 30 Taquito type things. When I consider it’s just $2.00 each and it was a delightful time I’m still glad we did it. Nobody was increasing the price because I’m white, , , In my ignorance I just didn’t play the system right. . . . Knowledge is Power!

KHI Days 2 and 3

Two Great Days,

We’ve had water since Monday and with plenty of pressure. This is Ike’s last week with us. Saturday he’s on his way back to St. Louis. His replacement is supposed to arrive tomorrow and we’ll add an Australian accent to the mix. I used to make cracks about Ike eating fish each evening but I think he’s on to something. I can get a Kilo of fresh fish fillets @ the market for $3600 FRw. There’s nothing to clean and there is no waste. Plus, , I get at least 4 meals from that amount , , , and it’s not tough!

The ride situation has been a bit sketchy. It’s not consistent or dependable. I know I’ll eventually get picked up, but the exact time is a guess. So if I’m on a schedule (like teaching class) where I’m expected to be there at a specific time, it ads a lot of stress. Tuesday I’d made arrangements to be picked up @ 7:20 so when there was no driver @ 7:20 I walked down the street and took the moto. It’s awfully hard to insist that students be on time if I’m not. On the way home, it's not such a big deal to be a bit vague on the pickup time.

The students were on time and back on time today after each break and stayed for the entire day. The classes go quite a bit slower than they would back home because of the language. But we managed to have some fun and cover most of what I’d intended. I switched gears a bit. These students are not expected to pass board exams and most of them will be performing Radiographic examinations, not ultrasounds. So I slowed down with a lot of the detail that is necessary for registry and added more pictures and more interactive questions with the audience response system. Today we talked about attenuation and decibels. I don’t know why but what normally takes over an hour too explain with comprehension only took about 20 minutes. They definitely have an advantage when converting from various units of the metric system (which is always a challenge for my American students)

I've enjoyed the 10:00 - 10:30 tea break each day this week. This also runs on it's own time schedule though. I've released my students for break @ 10:00 and then walked to the tea tent and they are just barely ready. I noticed something today that may be very telling. I've yet to find a clock on the wall, either in a classroom or in an office. This week the look of the faculty canteen has gotten upgraded. Yesterday there were lit candles on many of the table, the food area was decorated quite sharply with cloth and fresh cuttings of branches with leaves. There was a man who I'd not seen before who was dressed in black and white with a vest who appeared to be in charge of keeping it looking good. It felt more like a nice restaurant than a cafeteria.

I felt like I needed to do something to connect with the students better, so today I took my autoharp to class. I was casual about bringing it in and I don’t think any of them saw what it was. During the first break I quietly got it out and started playing. It worked. I’ve made found some fellow musicians and music lovers in the students. I’m trying to learn they’re names and I’m starting to see some of their personalities coming through as they get more used to me and start to understand my accent.

I've gotten e-mails from most of my Coosa Valley students this week. They each expressed their desire for my return which makes me feel guilty for leaving them. Most of them talked about how wonderful their clinical experience has been but a couple are struggling and I'm too far away to effectively help them. The blend between student needs/expectations and clinical site needs/expectations is a delicate balance. Sometimes the issues need thorough exploring from many perspectives before a conclusion is reached as to whether a student is in the right clinical setting. Many times the student is best helped by being encouraged to "hang in there" but you can't tell about the nuances of the situation from the other side of the world. I mentioned my American students to Ezekiel today and said that they were anxious to have me back. He was quick to tell me that he and his classmates are my students as well and that they also need a teacher. I'm torn again because he's right. But I know before I've really begun that this will end.

Tomorrow is my last day with the students lecturing. I've been asked to create and administer a test for them, covering the materials we've reviewed. The class captains come to me and ask If I'll give them a copy each of the notes. They'll then dsitribute to the class members.

I mentioned that Benard had had his clothes stolen off the line during the night. They’ve been returned!! Wet, but he got them back. The night guard had taken them for some unknown reason and then had held on to them for a day and a half. There is a language barrier so neither Patrick nor Benard have been able to figure out why the boy took them, what he did with them during the brief hostage situation or what prompted the return. They report that there’s been some other shady actions on his part so he was they’re prime suspect from the beginning. However the explanation works out, he’s glad to have them back!

Radiography Students - New Challenges

Today I started four days of lectures with the 10 Senior G3 and 19 Junior G2 Radiography students. I miss my classroom. I've gotten very spoiled and familiar with the technology @ Coosa Valley Technical College. Benard is here early today to help me get the classroom set up before the students arrive. The students seem anxious to learn and are attentive. There is definitely a language barrier. English is not the first language for any of these students and I have an accent that is different from the English they've heard spoken before. They also speak very quietly, which is a challenge because of my hearing loss (too many years of loud Rock and Roll with Headphones turned up too loud).

My standard jokes get a blank stare because humor has a lot to do with nuances of shared culture. By the end of the day I'm totally skipping them. We have three class sessions 8 - 10 then a 30 minute break for tea. 10:30 - 12:30 with a 1.5 hour break for lunch and the final session is 2 - 5 p.m. That gives me 7 hours x 4 days - 28 hours. My main issue isn't that I have enough but that I have too much. The classroom has more chairs than are needed. The chairs are not stackable so they pile them along one side of the room. The students are used to moving the chairs that are being used are moved into whatever order the they want which ends up being no rows. but random clusters most as close to the back wall as possible.

That 30 minute mid-morning tea break could be really addicting. I've got to talk with my Dean Frank Pharr and see if that could be worked into our day @ CVTC. There is a tent set up outside and tea (Hot with milk) is provided for the faculty. For an additional $100FRw ($0.40) you can have a warm flat bread with our without a filling. The 1.5 hours for lunch drives me nuts though . At lunch time we have to take down and lock up the laptop and projector. After lunch we set it up again. I found out at lunch that Benard had his clothes stolen off the clothes line during the night. He is trying to be pleasant about it, but many of the things taken were his favorites (kind of like losing old friends).

The American students are leaving this evening and the Rwandan students want to go say good bye at the airport. After lunch, we negotiate an early departure today @ 4:30 with a class time extension tomorrow to catch up. I lectured until 3:00 and gave them a 10 minute break. At this point more than 1/2 the class decided they needed to transact business with the accounting department. 25 minutes later I've only got about 7 students who have returned. So after consulting with Benard I disconnect my stuff and close class for the day. My time is being wasted by waiting for whatever is happening in accounting. I call Abdullah to see if I can get a ride to the guest house and I'm told 15 minutes. 35 minutes later I call again and he tells me he's right here - now. 20 minutes later another driver asks if I can be taken by him to the guest house Abdullah is somehow indisposed. During the wait for Abdullah I visit with Nick and a couple of the other American students who had a bit of free time before their flight and are hanging @ KHI. Many of the Rwandan students come and appologize for the mass absence.

By the time I get home I'm about as cranky as I get. I spend the entire evening (until 1 a.m.) trying to pare down and spice up the lectures to get them to a more appropriate introductory level. Tommorrow is another day and my bed is calling loudly.

Memorial Day

Memorial Day in America - The day to remember those who have fallen in service to our country. The traditional beginning of the summer season.

Skype doesn’t work this morning even though Shaloy & I try repeatedly. I hear Ike talking about getting a shower this morning but the water was off 15 minutes later when I got to the bathroom.

Today is a preparation day for four days of radiography student lectures. I’d hoped to say good bye to the American students but I’ve got too many things to do and don’t make it there. One of those things is going to the post office to see if my package from Shaloy has arrived. It has not but we did a test run with the projector and it worked okay so I’ll cross my fingers for tomorrow. These lectures are not high stress because I have the material already done. The hard part is knowing how much to delete. I plan to use the audience response system clickers, which has the interest of the KHI instructors.

I also need to stock up on groceries as I’m getting low. I get my bags and head to Kimironko for shopping. At some point I decide that this is fun and start smiling more and laughing a bit whenever I think something is absurd or funny, which completely changes my attitude and seems to change the attitude of the folks I’m bartering with. I took my camera fully intending to add pictures of the market but having read so many warnings about pictures and Rwandans, I’m hesitant to get it out. I have two images of Rwandans smiling, even though they smile frequently and laugh quite a bit. But the moment a camera shows appears it’s serious business.

I’ve spent way too much time getting caught up on the blog from the weekend, So that’s it for today.

Parc National Nyungwe Forrest - Full Post

After leaving Gikongoro I’m approached by a moto driver and I agree to a ride to the top of the hill. At this point I just want to get away as quickly as possible. I forget that Athanas had told me that I must go back to the matata place. After a couple of them go by totally full I realize he was right, but there are no motos or bicycle taxis now so I walk back through the town. When I get there they are anxious for me to get in the van-bus. I’d have liked to get on one of the big buses but none are in sight so I squeeze in. I ask how much and they want to know how much I want to pay. I protest quickly and loudly that bartering is for taxis and motos not buses on routes, , , they should tell me what the price is & I’ll pay it. Athanas had warned me it might be considerably more than the $400 FRw I’d paid to get this far. After a huddle they decide I should pay $2500 FRw. I protest again loudly, $2500 is more than the fare from Butare to Cyangugu and I’ve already traveled a considerable part of the route and I’m getting off 65 Km shy of Cyangugu! "Well how much will you pay??" I complain again about fairness and set prices. They drop it to $1500 FRw and if I won’t pay that amount I must get off for they want to leave. I give them the money and pout. Later that night I’m embarrassed that I fussed over two U.S. dollars when I really did need a ride of about 50 miles. I decide I was hungry, disturbed, hot and just plain cranky, , , regardless, I’m now embarrassed.

It’s not far and we enter Nyungwe Forest. For only the second time since I’ve arrived in Rwanda, I look at country side and do not see a house (or for that matter any cultivation). We stop a couple of times to drop people off and pick up as many as we drop off. The next day the ranger tells me that sometimes they come to wait for a bus and are never able to board and end up walking back home after spending an entire day waiting. After a bit, the porter dude begins a conversation and I realize that though the bartering bothered me greatly they were over it and wanted to be friends. We see many military men carrying automatic weapons and patrolling the roads on foot.

The ranger station - Entry place is called Uwinka. I’m happy to get out of the bus because I was sitting with my feet crammed against the engine cover and my feet were as hot as I could have possibly stood. A short walk and up some steep stairs & I’m here!! The rangers seem surprised to see a visitor @ 3:30 p.m.. They direct me to registration.

Isaiah is a tall, handsome man who speaks English very well with a really cool accent. He says Yes we have camping, You have no tent , , , No problem , , , we can rent you a tent and even a sleeping bag. God is good!! I’m so relieved to not have to go elsewhere to find a place. The fees for foreign visitors are quite a bit higher than for foreign residents which are quite a bit higher than for Rwandans. Once we’ve added park Entry fees, hiking fees, tent rental, and guided Chimp tour it’s an even crisp $100 bill (in US currency). The guide book had warned me about the price and the US currency so came prepared. One hundred U.S. is a lot of cash and if I’m willing to forego the Chimp tour I can knock it down to $50. But I don’t know if I’ll ever get to see chimps in the wild and I’m here so... Suck it up and plunk it down and stop brooding cause I’ve worked hard to get here!

The tent is a quite nice modern two person tent. I get to choose between any of the four camping spots, as I’m their only guest. The rangers insist on setting the tent up (which happens quickly once I’ve decided which site). In no time flat I’m settled and eating my lunch. Then out for a walk down the trails which are immediately adjacent to the camp sites. There is a mountain monkey visiting nearby. The rangers had warned me /asked me not to feed it and to keep my food stuffs out of sight.

The trails are steep and very shaded. There is a profusion of flowers and I feel like my friend Eric Tanner as I take close up picture after close up picture of the various flowers. I can not seem to capture the steepness on pictures. The effect evades me. I do not see very many butterflies or any bees (though I’m told that chimps enjoy eating honey using sticks). I’m cognizant of the time and try to stay relatively close to camp taking care to remember that all of these easy steep down hills are going to be accompanied by an equally difficult steep uphill return.

I get back in time to have a relaxing supper before dark and to play my recorder for a while. The rangers offer to setup and start a campfire for me but I decline. I’m supposed to be in my boots ready to go @ 6:00 am for the chimp trekking. I spend about 30 minutes after dark reading the guide book again with my headlamp before heading to bed. I’m getting ready when I receive two phone calls. One from Diogene (from King Faisal) checking on me and the other was the promised call from Athanas making sure I wasn’t stranded. I felt all warm & fuzzy that someone was concerned for my safety. Sleep was good with a perfect temperature. It rained several times in the night but I was dry and warm and snug as a bug in a rug.

My phone alarm went off @ 5:00 am. So I arranged my stuff, ate my breakfast and was in my boots ready to hike @ 6:00 am. I think that they sent two guides because if they needed to haul that fat muzungu out, , , they’d have more help to do it. But they said that Antoine was accompanying Isaiah to learn to be a guide (he’s been a ranger now for two months). I’m given a walking stick which I try to refuse but am politely insisted to take. We walked very quickly down the road I’d driven up on the bus the day previous, past two of the bus stops. The whole time Isaiah was on the radio with the trackers (who kept urging us to hurry lest we miss the chimps)

The trackers live in the woods with the chimps. They carry charts where they log activity, interactions, food consumption and movements. I’m told that they move when the chimps move and once the chimps go to sleep they make camp and then must be up following them at dawn. I’m also told that they love their work and they have an additional function of habituating the chimps to human contact. We hustle about 6 Km down the trails to the first tracker and chimps. Shhh please no sudden movements ,, ,shh please your camera, , , shhh no flash please, there about 200 yards away is a chimp in a tree eating the flowers. With the camera zooming as much as I can the chimp is a black spot in the middle of a fuzzy tree. I use the walking stick to help the camera motion and I do get a few pictures where you can tell that the primate does not have a tail and thus is a chimp. More talking on the radio and we walk quietly down the trail to a location where a blue monkey and a mountain monkey are both in a tree also eating flowers. They are about 120 yards distant. A bit bigger black spots in camera lens.

A bit further down the trail we meet a different tracker who starts us down the hillside. I’m happy for the stick now because this is really steep. Soon we stop and about 50 yards straight out is a chimp 150 + feet up a tree eating flowers. Although the chimp is quite high in the tree we are almost the same height just 50 yards away. We stay here for about 45 minutes and then the chimp decides to search elsewhere for flowers. During that time we hear the rest of the group hooting in the distance. Isaiah says they are too far to walk to. As we prepare to leave a blue monkey takes the place in the tree of the chimp and we stay another 20 minutes observing him moving around eating flowers. I have a 4:00 pm ticket from Butare to Kigali so we need to start back. It will take longer to get the 12 Km back than it did to get here because it’s almost all uphill.

Pictures with the trackers and they are off to spend the rest of the day with the chimps and up the hill we go. Many times during this chimp trek I’m reminded of climbing a hill/mountain with my brother Matt in the Seattle area a couple of years ago. The reminder comes from my sweating and hard breathing compared to the guides who I never saw sweat. . . at all... not a drop... Isaiah is kind and periodically stops to tell me about flora, fauna, traditions, cultures, medicines and then we continue until he perceives I need a break and then he finds something else we need to stop and have discussed. We do see some monkeys in trees and more flowers that need photographing. Back on the road we meet more of the military guys and some folks hoping to get a spot on a passing bus. (Which is what I’ll be hoping for in about an hour). Antoine has been very quiet mentions that I am walking just fine, , Isaiah explains that they didn’t expect me to be able to hike as well as I have. My knee is talking to me and reminding me that it’s down there. I probably should have taken some Ibuprofen prophylactilly. Overall I’m feeling great and we see a few more monkeys along the road.

Back at the ranger station they get warm water for me and take it to the shower house. The water is too hot and Isaiah says there is a container of cold water for mixing. I didn’t understand that the container was outside so I used the containers in the shower which turned out to be paint thinner. So I just showered with the cold water which isn’t any different than I’d have had at the house in Kigali. I get my stuff and I’m out on the road by noon. Once there I eat my lunch and await the ride. Two other men are also waiting and then two rangers join us. They are all concerned about my ride situation. The buses coming from Cyangugu will not leave until they are full so my hope is that someone wanted off so that there is a spot for me to get on. The rangers are quite amused and a bit astonished when I tell them that God helped me get here and He’ll help me get back.

About 12:30 a petrol Tanker truck comes by with only a driver and stops. The ranger had flagged him without my noticing. We ran to the truck and after a moment the ranger asked if I could "Help with gas money?" I hopped in quickly and down the hill we went to Butare. Brite is a Ugandan Truck Driver who travels between Kenya, Uganda & Congo delivering petrol. He seems happy with the company and speaks English very well. I’ve got a comfortable front seat near the window & I’m happy as a lark. He’s returning empty so we move right along. Now if only the pedestrians will stay off the road to not get hit and killed. Out of Nyungwe, through Gikngoro and on to Butare before 3:00.

I walk back through town and stop at the kind grocers store. They’ve got warm little pizzas for cheap and I get one. There is a eating area which I had not realized was a restaurant. I’ve already got my little pizza and a drink so I ask for chips (thinking French Fries). The waitress is quite surprised and shows me the menu and makes sure I want chips only.... Yep Chips!! So I get a plate of home made potato chips. Very nice thin and salted. Not French Fries. I laugh out loud at myself. I got what I ordered but not what I wanted.

Back to the Horizon bus station to catch the express. Neither of the two 3:30 buses will allow me an early departure. The one 4:00 pm bus leaves without being full. Did I mention that this bus is called the express?? Normally I’m concerned for the safety of the pedestrians, , this trip I’m concerned for my own!!! This guy should think about driving NASCAR. We’re back in town a little after 6 p.m.. I call Philbert...If there is no water I’ll eat out. I ask "Is there water??" I hear "Yes!". The city bus to Kimihuru wants me to board right away. Dummy me ,, that puts me in the back & I get off at one of the earlier stops which means 5 or 6 people will have to get out so I can get off. I'm berating myself for not being smarter and then mis-communicate where I want to get off and we’re already stopped and the 5 people have gotten off when I want to say NO!! Let me off at the next stop, , ,but I get off and start the walk up the hill. It starts to rain and I finally get to use the super duper rain jacket that Zack got for me. I decide to eat out anyway but after walking to the restaurant it’s closed.... I’m tired, hungry and my feet hurt when I get home and Philbert says no water. He hadn’t said Yes he said "Yesterday". Yesterday they had water - none today.

Then I start to think about the great adventure I’ve had and there is enough water to flush the toilet twice tonight and enough water to take a cold bath in the morning.

You can access all of them from this link.

Gikongoro - Murambi Genocide Memorial - Full Post

Sabbath morning there is no water, which makes me want to hang here @ the house even less. I was able to enjoy an extra long Skype visit with Shaloy (almost 1.5 hours). Then it was time to hurry to catch my buses.

I was the first of the passengers to arrive for the express to Butare and get the front passenger seat near the window. YEAH!! Definitely a favorite location for me. We’re not totally jam packed for the 7 am trip so there are actually a few empty seats. While we’re waiting I see a lady in a blue uniform. She is using what appears to be a home-made broom to sweep the entire street and both sidewalks. She is sweeping the trash, bits of paper, etc into little piles. I assume that either she or somebody else will come along later to collect the little piles.

The drive is pleasant and I recognize many of the houses, fields, and other sites. For the first half of this trip we follow the same road that I traveled a couple of weeks ago to Kibuye but once we hit the town of Gitarama, we turn south. Some of the trucks move so slow up the hills the the bicycle riders catch a ride by grabbing onto the back of the truck to get towed up the hill. It looks really dangerous to me. We arrive in Butare a bit after 9:00 am and the town is just waking up. The company I’ve ridden with does not proceed further on my trip. They suggest Atraco, the guy @ Atraco doesn’t speak English but tells me they don’t travel that way either. I walk to a hotel which I’ve read about in the Lonely Planet Guide and meet an American. He says that it’s about a two hour trip but he’s only done it by hired car. I’ve yet to see a road that doesn’t have matatas (local service taxi buses), so I’m relatively sure if I can find the right road I’ll be able to get a ride. I go to a supermarket and there’s an English speaking man who seems to be the proprietor. He tells that if I walk down the road there is a special bus stop where the buses will proceed to Gikongoro and Nyungwe once they fill up.

So down the road and I do eventually see an area with minibuses and buses waiting for passengers. But not before passing a large group of bicycle taxis. I ask for directions to the buses and three insist that they can take me to Gikongoro. I know it’s over 25 Km and I certainly don’t want to go that far on the back of a bike, so I walk on to the buses. I ask at the first bus which is big and old and parked under a tree for shade. Yes they’ll be going that way and only $400 FRw to Gikongoro This one will leave even before they fill up, as they will be picking up all along the way. A small child is fascinated by me and the parents let him stare and touch. I’ve brought my Tenor Recorder and quietly slip it out and start playing for the child. The kid still doesn’t do anything but contemplate my skin but the adults on the bus seem to like the music. After a couple of songs I put the Recorder away and a man invites me to come sit next to him.

Athanas is a dentist working with an NGO. He told me that he is working quite a bit with the pigmy population. I asked if I would recognize them by look or stature and he says that they simply look like all impoverished people. He is on his way home which is just a few miles outside of Nyungwe Forrest and before Cyangugu. We eventually get enough passengers or hit the right time and start to proceed down the road. We stop frequently picking up local people who pay differing amounts based on the distance they intend to travel. There is a man traveling along as a porter collecting monies and giving receipts. With the ebb and flow of people coming and going I’m amazed that he can keep track but he does. I think that the people are also honest about paying their fares.

Athanas is a bit concerned about where I’ll stay the night. I’ve read that there is camping @ the park but that you have to have your own tent and sleeping bag. However, on one web-site there was mention of a recent addition of a couple of rooms that might be rented if you’re otherwise prepared to camp (bringing food). If that doesn’t work out there is a ORTPN guest house some 18 Km down the road. If neither of those work out I can catch a ride on to Cyangugu or back to Gikongoro. My hope is to find some way to stay at the forest. I’ve got food and warm clothes for the night. This plan doesn’t sit well with Athanas and he promises he will call this evening to make sure I’m not stranded. We reach Gikongoro but Athanas wants me to stay until we’ve gone the last bit by bus. The road to the memorial is a couple of Kilometers on the other side of town and the bus will drop me there. We exchange phone numbers and he introduces me to a new fruit - Imbuhu - that they peddlers are selling to the bus passengers at the stop. It is small about the size of a walnut with a paper skin and when you feel it there is a fruit the size of a marble. It is sour and seedy and I get a quart bag for $400 FRw.

Almost as soon as we leave, we come to my stop. Immediately there are motos and bicycle taxis who want to take me the 2.5 Km to the memorial. I turn them away because I want to walk and contemplate the enormity of this place. I’m denied my solitude as one small group of youngsters after another run to walk a ways with the strange muzungu who is walking. But I can smell the fertile ground and the growing plants and the cooking fires. I’m content to walk. Finally the last 100 yards to the entrance all of the local people drop away and I can walk slowly through this place which at one time was a well known technical school. It is totally quiet except the crunching of my boots on the gravel. A huge dried out wreath and banner arch across the entrance. I know that in April there are remembrances and based on it’s state of decay, I’m pretty sure this is a left over from a month ago.

There are some tour buses so I’m sure it’s open, , , I quietly walk inside the former administration building and a group of Rwandans are just finishing a tour. I don’t know what is proper so I wait until they finish their talk and then they go outside to the burial site to sing hymns. Still no one comes and the signs are a bit confusing and as I start up a stair case the man who has been giving the talk comes and asks why I’m here. I try to explain that I’ve come to the memorial to see what is to be seen and he asks me to wait. After a bit he brings a lady to "Show me the bodies". We quietly walk outside and around the admin building and start walking toward a neat set of tan brick buildings with glass-less windows and open doors. The first is quite startling. A set of racks has been constructed about 2.5 feet high and these are covered with the bodies of victims.

The bodies are covered with lime to slow the decay process down. There are also mothballs in every room and on the some of the corpses. The smell is unique, deeply penetrating, and quite powerful. I have never smelled it before and will likely never forget it either. Sunday while uploading and titling the pictures I could vividly smell it again even though I know I had none of it on my clothes or materials. I have had a similar smell experience in Waveland, Mississippi after Hurricane Katrina. The smell of rotting food, vegetation and gulf muck is permanently imbedded in my brain as the smell of destruction and ruin. Now I have two of those references.

The silence was equally penetrating. The countryside around the site is peaceful and serene and you can scarcely believe that an atrocity of this magnitude could have occurred here, the report says fifty thousand died in a matter of a few days, but here are the bodies. As macabre as the sight seems I suppose that sometime in the future there will be people who will deny that genocide occurred and there must be places like Murambi to make us remember that it did occur. Equally disturbing are signs showing the location of the French flag and another indicating that French soldiers were playing as the massacre occurred.

The rooms go on and on. There are over 950 bodies preserved for viewing. There are more than 50,000 buried in mass graves. Some where shot, some died by grenade, some were bludgeoned and some were hacked by machete. It doesn’t take a forensic scientist to detail these methods through the wounds on the corpses. I walk from room to room silently filled with remorse for the families who were slaughtered together. It is so overwhelming that I can not cry but another group is walking through and one of their members is wailing and is having to be carried away. Later, I see that this must happen often enough that they have a room prepared in the administration building where she is recovering.

I’m told that many of the worst massacres occurred in churches and this school. The two institutions where I spend most of my time, in this country, 14 years ago, became places of murder. I can not fathom. As I’m walking back I come to a group of teenagers from a school in NE Rwanda who have come to see. As I pass them, one quietly asks me if I have an explanation for this. . . I do not. There is a place with a high water spigot and people are washing their hands, faces and heads.... It seems appropriate to try and wash the odor away but I do not see how it can be erased.

I sign the guest book, walk out the gate and back to the noise of Rwanda.

here is the link to all of the images.

King Faisal Day #5

The morning routine was pretty uneventful. The water pressure seemd a bit low so I filled some of the containers. You know, , just in case, ,

It was a very slow day @ the hospital. We had three patients today. Said was scheduled to be with me and Diogene came in on his day off (That's the 2nd time this has happened) Benard the student also was there for much of the day. We had basically the whole day for theory and practice/practical application, then more theory and practice/practical application, then more theory and practice/practical application.

There is a very pleasant German woman from Butare hospital who is in Kigali evaluating available services, fees and referral options. Her English is excellent and she joins us for one of the lesson sessions while she awaits for time with the Radiologist. She tells me there is a German cardiologist who does Echocardiograms in Butare and He's been trying to teach the other physicians how to scan abdomens. But he returns home in a month and they'll not have anyone to do the Echography. She seems very interested in having a sonographer @ the hospital. As intelligent and knowledgeable as she seems I'm getting a bit leery of other folks evaluations of usage patterns.

At his request, I spend about 30 minutes explaining and demonstrating renal artery scanning to the radiologist. I encourage him to consider the amount of scan time necessary to correctly perform renal exams. I think it finally struck him how meticulous one must be when I demonstrated the dramatic differences in reported velocities with just a 20 degree variation in angle correction.

At lunch time it was raining and we waited for the rain to stop so we could walk to lunch. Then one of the senior radiographers (Pascal) who has a car offered to drive us to the restaurant. It was back to "New Life" Restaurant by day tavern by night. A normal African lunch again but today I get brave and ask the proprietor if I can take some pictures. The food is tasty and filling and must be loaded with calories.

The afternoon is spent alternating between theory/practice and reviewing prior cases. We try to see the CT on the renal patient from yesterday but he hasn't had his CT yet. Financial issues I'm told. The CTs are pretty expensive for the average Rwandan. I may have to come back and correct the figure but I was told a while back it was around $150 US for the exam and interpretation.

I can't bear the thought of sitting around the house this weekend. Ike is taking off for Gisenyi, Dr. Konn, Patrick, Benard and the American students are in Kibuye and I've not made any friends @ the church, , , So I'm going to one of the genocide memorials and a park. Diogene went with me to Mumenge (town center) and after visiting three bus services I purchased a ticket leaving @ 7:00 am for Butare. Diogene has been a great friend and help today. We now go to find a small daypack for my weekend. The first place we find a pack that might work but it has basically no padding on the shoulder straps and the first two they get for me bust the zippers. They want $10,00 FRw which I think is okay for a pack that I consider disposable but we leave and look for better wares. We find another shop with a better pack. self healing zipper, thicker material, more padding. The guy wants $15,000FRw I offer him ten and he sticks to the fifteen. We leave but he comes to the street entrance and comes down to $12,000 ($24 U.S.) I'm happy and have a pack I think could take the place of my damaged carry-on.

Diogene walks me to the bus area and makes sure I get on the right bus to Kimihurura. He encourages me to take the bigger buses and I'm wondering why I didn't catch on to this one sooner. There is a single seat on the left near the window and a double seat on the right with room for only two. I grab a seat and don't even have to touch the other passenger. The bus slowly fills for about 5 minutes and I'm wondering if all these other people are going to stand. Then I see that what I thought was my right arm rest is a folded up "jump seat". Once the back of the bus fills these jump seat fold down to make a bench from one side to the other. Two people now join each row, making 5 across and we are full on touching both of the other passenger's sides from ankle to shoulder. I think I'm getting used to it in that I know that this is everyday for the folks I'm riding with.

Tomorrow I'll go to Butare and once there I'll get a local bus to take me to Murambi Memorial Site where some 50,000 Tutsi were killed in Gikongoro. Once I've visited the memorial I'll go on to Nyungwe park. The highlights of this mountainous rain forest park are 14 species of monkeys and chimpanzees, orchids and butterflys. It is between 5,600 and 9,700 feet elevation. I'll play it by ear about where to sleep but I'm taking food just in case I'm able to stay at the park.

When I get home , , , , the water is off. Supper is the fruit that's ripe and won't keep two more days, A large mango and three avocados. No updates until I'm back Sunday evening.

King Faisal Day #4 - On a roll

This morning for breakfast I had a new treat, Nutella. It's made from hazel nuts and it tastes like a creamy mixture of peanut butter and chocolate (heavy on the chocolate). I had it on a roll and it was pretty tasty. With a glass of the "Full Cream" milk it seemed quite fattening. Shaloy has commented that I should be losing weight but my clothes don't feel any looser.

Everything else is as it should be; Warm water for a shower, driver was on time, my daily Skype visit with Shaloy. All is well in who-ville. At King Faisal, I have Betty and Deogene assigned to be with me and Said comes in on his Day Off!! That's what I'm talking about!! someone who wants to learn badly enough to go an extra bit. It's quite encouraging. Dr. E also seems quite satisfied to have us bring some images and a report. He's hopping to keep up with CT & plain films much less scanning the patients who need sonograms.

Today's cases included a focal fatty infiltrate within the liver that had a mass like appearance. Another was an in-patient whose right kidney had gotten so big that we could not identify any internal structures, It was hypoechoic and the patient was febrile with a lot of pain in the area of the kidney. It looked inflammatory but the Radiologist thought more likely malignant, I'll follow-up on tomorrow's CT scan.

I went to lunch with Deogene and Said to a local restaurant just about 1/4th mile from the hospital. There were tables and a young lady brought us drinks. The food was buffet of the typical Rwandan lunch, cabbage salad, chips (thick French Fries), cooked bananas (not sweet), cassava, rice, greens (with some sort of bitter seedy green tomato that today I decided might be some variety of eggplant), thin gravy which is appropriately called "soup" and one cube of meat. As much as you can get on a plate (except the meat which is limited to one cube) for $800 FRw ($1.40 U.S.). I've never seen anybody go back for seconds. They get enough the first time. We do a lot of visiting about culture variations and they are surprised to find out that you don't get any money when you marry off your daughters.

I asked Said about a scar on his forehead. He shows me another on his arm and I come to understand he is a survivor. Deogene explains that there was a lot of "cutting". We talk about the reconciliation process and the "Men in Pink". (I'll try to get a picture soon). Their prisoners wear pink pants and shirts that look sort of like scrub suits. And most that I've seen have an interesting knitted cap/hat as well.

We did about a dozen studies and had plenty of time for theory sessions between patients. All three of these people can learn sonography if they get a bit of encouragement, are aggressive in getting their hands on the transducers and go over cases with the radiologists. Our day ends with a renal transplant patient for possible early rejection. The resistive index in all of the poles is less than 0.6, kidney is 10 cm with a tiny bit of collecting system dilatation and otherwise unremarkable 2d findings. The arterial anastamosis has some turbulence, but the angle corrected velocities are around 70 cm/sec.

I catch a moto into Mumenge to go to the forex and exchange dollars for francs. I decide to wander a bit and find that there are quite a few stores selling African and especially Rwandan arts/crafts/pottery/baskets/carvings etc. I look but won't buy until I've looked multiple places, on multiple days, compared prices and see who is consistently friendly and not trying to gouge because I'm white. After looking in a half dozen stores I see that this place also has people wandering the streets asking for money and selling some of the stuff I've seen in the stores. I put on my stone face and walk past but one woman is persistent and when I hear that she is offering me two small african drums for $500 FRw (1$ U.S.) I decide to buy, , , but I've only got a $2,000 bill and she quickly wants to just have me buy something else that she has and not give me any change. Others realize that the muzungu has slowed down and might part with some money and there is soon a small crowd of women thrusting their crafts at me, competing to be heard along with a couple of women who have nothing to sell but keep asking for money. I try to focus on the woman I'm buying from and she finally gives in and asks someone for change. I make my exit as quickly as possible without running and within a block the last one gives up. I do not enjoy that type of shopping!

I remember that I saw another restaurant nearby that advertised Indian cuisine & I'm up for more of what I had last night. I'm there in ten minutes but on closer inspection, , they advertise Indian, Chinese and American food. I walk in scope out the restaurant's menu and don't see anything resembling Indian. They've got a market though & I find a treasure. . roasted peanuts. . . I plunk down my money and get the nuts and two packets of Koolaid stuff (I'm getting tired of drinking boiled water or Fanta). On the walk back, I'm on a tree lined street and the pavement is pretty much painted white with bird droppings. The birds are circling overhead and in the trees and I wonder if I should cover my head. These are big crow like birds with the markings similar to a magpie. It reminded me of that old Hitchock movie "The Birds". There were literally thousands.

Home by city bus. During our lunch time cultural exchange we had discussed "personal space" and the lack of that concept with the Rwandans. It was re-inforced on the bus ride where there were four adults in three seats. It was impossible not to touch the entire side of the person on each side of you. One real absurdity is the driver's insistence that whoever is in the front passenger seat wear a seatbelt. The drivers frequently just drape theirs over them so that it appears they are wearing but they aren't clicked. Additionally there is always someone sitting between the driver and that front window seat (riding the hump), and it's fine that they don't have a seatbelt nor any of the other passengers. The last of my tilapia filets and cabbage salad for supper. The koolaid - "pineapple with ginger" tastes like medicine.

CVTC News: All the boxes that MaryAnne shipped have arrived without damage. Thanks! I've gotten many very positive comments about my name tag. I wear my CVTC name tag every day and they are uniformly impressed with the appeareance. I've had multiple comments: I guess kudos to the marketing folks who picked or designed the name tag. I do check my CVTC e-mail daily.

King Faisal Day #3,

I'm woken wide awake @ 4:30. It seems that my intestines have decided they no longer want to be part of me and my escapades and they've decided to pack it up and leave. . . . via the nearest exit . . . . . Now!! I'm just glad I stocked up on soft paper. In between times, I visit with Shaloy on the Skype. At this rate I'm pretty sure there won't be any going to work today. I take a dose of 1 charcoal tablet and two Loperamide. . . Finally about an hour later they change their mind and decide to stay. I go back to sleep and wake up a bit later as though all is well with the world.

Okay, get up and start to clean up and who is this??? but the driver is here to pick us up @ 6:30. Ike and the driver have mis-communicated the pick up time & the driver is ready to go now. I'd rather walk than rush now and be there over an hour before the rest of the staff. I ask them to leave me. So, , , another leasurely morning (warm shower water and a bit of pressure :-) ) breakfast with white scrambled eggs and milk that tastes like half and half for breakfast. I walk to the corner, catch a moto and I'm there before 8:00.

Seth is the chief Radiographer and he provided me with a "clinical coat" today. My lab jacket that Shaloy sent hasn't arrived yet. I worked with "Said". This guy is sharp. Already understands the physics and can explain it to me without prompting. Understands the associated math and is pretty good with anatomy and great with understanding the terminology. A slow morning with just a few cases before lunch and a couple after. We had time to scan each other and discuss the functions of the various buttons and the actions of various pathologies on the ultrasound images. We did have a couple of cases that looked like malignant liver lesions. One that looked like gall bladder sludge (definite fluid/solid interface that you expected to be parallel to the floor but instead was vertical in orientation) but it was attached to the wall and would not move regardless of patient position. I also worked with an OB/GYN doctor as he evaluated a set of twins.

Dr. Konn brought the American students to the hospital and I visited with 1/2 of them while the other half toured and then switched and visited with the 2nd 1/2 while the first half toured. Much of my conversation each day is limited by my limited amount of French & Kinyrwandan. I depend on the local folks to be able to speak English or draw or I sign. This doesn' t give much opportunity to have deep conversations. It was nice to visit with native english speakers for a while.

Diogene joined us just before lunch and then again in the afternoon. We scanned different people in the department, did a couple of other cases, reviewed the CT of one of our morning patients and scanned a few more of each other. I walked home again but called Abdullah to make my own arrangements with a driver I know, so that there is less confusion and mix up. I wave to the seamstress lady and am going home at the same time as the school children who enjoy daring each other to talk to the muzungu or shake my hand and say "hello".

The house is empty and Philbert says everyone is gone or gone out for the evening except me. I do some CVTC e-mail work, start a download of some software that Nee has sent and look up that Indian Restaurant I read about. Down to the corner and catch a city bus to within a couple of blocks. One of the people on the bus, Julius, gets off at my exit and walks me to Indian Khazana. The Lonely Planet guide of East Africa gave it great marks and I would as well. Quiet, attractive, attentive service, not outlandish prices, huge selection (including a lot of vegetarian). I have an appetizer of lentils and spinach that are rolled into balls the size of a racquetball and fried. Some of that great Indian bread and goat (the first tender meat I've had in Rwanda) in a thick brown sauce. The masala tea with milk was outstanding for desert.

I walked about a mile before I could flag a moto and now I'm about to crawl into bed and hope that this night will not have any conflicts amongst my innerds. I've gotten two e-mail birthday cards, a happy birthday song from Shaloy, a number of other e-mails with birthday wishes, and I've enjoyed my presents of a French-English Dictionary from Tekoa, Autoharp from Shaloy and anti-rain jacket from Zach. Other than noticing that I keep my reading glasses close @ hand I don't feel much older.

King Faisal Day #2

A long night last night as my ileum and colon were actively peristalsing resulting in increased motility and decreased transit time with a resulting insufficient amount of fluid absorption. I had a nice Skype visit with Shaloy this morning and hear that I'm a Great Uncle by my Nephew Phillip Thomas and his wife Loraine. Alivia Thomas born in Boise, Idaho a few days ago. Phillip has this truly wonderful habit of calling us on our birthdays. We had a memorable time @ their wedding a few years ago on Orcas Island in the San Juans off near Seattle. I actually thought of them Sunday when trying to capture a picture while the hippos were up (We had an equal challenge trying to catch images of the breaching Killer whales on a whale watching trip)

My ride (new driver and I don't know what happened to Abdullah - Phone says not working)showed up @ 7:00 am and I wasn't anywhere close to ready and didn't really want to get there that early, so I relaxed, ate a mango and got ready, , , leisurely and caught a moto to the hospital arriving @ 8:00 am. Today I worked with Betty (a radiographer) and Benard (the KHI radiography student). I scanned a few and had her back scan but most of them I walked/guided/helped her to do the exams. We worked with the Radiologist Dr. E today. He was trained in Belgium and I could tell that he was used to and expected to scan the patients. It a bit of a trial for him to sit back.

Some interesting cases today: A 9 cm mass that was seen between the stomach and liver on CT, they wanted to evaluate whether it arose from the liver tissue or was encapsulated and was pushing into the the liver. A case of sub-acute DVT with constant flow, veins that would not coapt, flow had returned but was tortuous through the hypoechoic residual thrombus.

At lunch time I took a moto to KHI to eat lunch with the Radiology staff, inventory the mailings that have arrived (all the boxes sent from CVTC have arrived with only one CD case damaged but no materials damaged or missing) and also to return the processor manual to Leonard @ CHK. I've visited with the Chief Radiologist @ King Faisal today and review the conversation with the head of radiology @ KHI. I've repeatedly heard radiographers say, , , "It doesn't help to learn this because we will not be allowed to practice later". If this is true, they are right & I need to evaluate how I can best help. If it's not true, I'd like to be able to say so. After discussion, we plan to see how to best approach the Minister of Health in the near future, and to see if we can get an official answer about the practice level for trained/certified sonographers in Rwanda.

Back to King Faisal after lunch to work with 4 students and Betty until a patient arrives when I scoot the extra three out of the room. The OB/GYN doctors periodically bring their patients and use the machine. So at 4:00 pm we're asked to vacate for them. After checking to see who I'll be with tomorrow I start the walk home. I've brought the case for my autoharp because it needs sewing/mending and there is a lady who sits next to the road with a pedal sewing machine each day. I stop to see if she can fix it and she is happy to do so. Fifteen minutes and $1,000 FRw later my case is repaired. I'm happy and she seems quite happy as well. I've probably overpaid her but it was worth $2 U.S. to me to have it fixed well.

While walking home I see a familiar sight. There a bunch of people in blue sitting on the public grass areas across from the ministry buildings. Sometimes they are sitting with nobody around and others are sitting in 2s. On closer inspection, I think they are weeding by hand, I don't know what the blue signifies (civil servant or criminal). In Georgia, the prisoners are frequently out on the sides of the roads cleaning but always under guard and I've not seen a guard with these people. Perhaps a Rwandan can leave a comment and help me out.

Home to a supper of fish and chips which are helped along when I see that there is some red vinegar that I can use for seasoning. (tasted similar to the malt vinegar that I like at Long John Silvers). I sit and eat outside under the gazebo and play music for about an hour (autoharp and recorders).

Philbert comes to see me later and I let him try out the autoharp. I'm hoping to get to bed early

King Faisal Hospital - Day 1

I'm pretty proud of my eggs. Benard (pronounced Ben erd) from KHI had told me that it wasn't safe to buy the eggs @ Kimironko market. When I asked why, he said "You wouldn't get them home without breaking the shells" (they are given to you loosely in a thin plastic bag - no egg carton). But I needed/wanted eggs. My large mouth water bottle and these small eggs might make a pair. The eggs fit in and I get them home without any waste. When I made my omelet this morning, I'm surprised to see that the egg yolk is not yellow but much closer to a white so my omelet is white instead of the yellow I'm accustomed to seeing. They still taste fine. Ike tells me that he had to adapt to the color and that there is nothing wrong with having white yolked eggs.

A new driver and vehicle drops me @ King Faisal Hospital which is no more than 2.5 miles away. I tell the driver to not worry about me this afternoon, as I intend to walk home. I'm in before the rest of the staff and wander around the outside of the facility a bit. The difference could not be more stark. This is a thoroughly modern facility, with the only CT scanner in the country. The ultrasound unit has six ways of recording - BW printer, color printer, video cassette, hard drive, 3.5 Floppy and CD. It has Doppler and 3D/4D. There is a changing room and enough linens for the entire day. The main department is using all digital imaging. They plan to upgrade the CT unit, add MRI & Nuclear Medicine within the next couple of years.

After a discussion with the Seth and his staff I go to orient myself to the location of the various knobs on the Siemens G6 Ultrasound unit. I know what they all do I just need to learn where each button I want/need is located. By noon my fingers are moving automatically to the right spot. I work with a Radiographer "Deogenes" and a student "Benard" (also pronounced Ben erd). Dr. S. is the Radiologist and he is quite pleasant and accommodating, sharing the vision, introducing me and accompanying me to lunch and then paying for it today. Throughout the day, he encourages the radiographer to keep his hands on the transducer and scan. I work one on one and have Diogene scanning most of the patients or at least back scanning.

The workload is a bit slow and we only do ten patients between 8:30 and 4:00 pm. Two of them are portables in ICU. I see about the same percentage of pathology as previously. The biggest difference is that they have Doppler and are interested in doing more and better vascular studies. The first two today are DVT venous leg exams. The patients are not the poverty level patients of CHK. At 4:00 we begin reviewing some cases and the pathology we'd documented and I walk home around 4:45.

I cooked some of my multicolor beans for 3 hours while adding to yesterday's blog. We tried but had much difficulty with the Echo students skype session @ 8:00 pm. I think that it's mostly bandwidth issues. We were able to say hi and wave at each other & I shared for about 5 minutes.

There many avocado trees along the public roads. I've asked two different people what would happen if somebody picked one of those avocados?? They both responded that it would "Be no problem, yes, sure, fine, no problem" So I ask, , , If they are free on the trees in the street why do they sell them in the markets?? They both told me that they wouldn't use them from the public streets and that they buy them.

The hit counter is very intriguing to me. I can see the cities of people who are reading the blog but don't know who it is who is following along in Cincinnati, St. Mary's - Florida and Albertville - Alabama.

Akagera Game Park with Dr. Konn's group - The full posting

Alarm went off @ 4:30 am. I've convinced Dr. Konn that they can pick me up along the way. It will help Philbert as well because he is picking up their laundry to wash it while they are out today. I may not have mentioned that there is no washing machine here. I've not found any Laundromats. So about every six days I pay Philbert around $2,000 FRw to wash my clothes by hand. He air dries them on the line outback and then irons the shirts.

RATS!! not real rodents but shoot!! not a gun, but dang!! No water. I forgot to mention yesterday one other Great Thing!! Not only was there water but the shower had water pressure!! and not only that but the water was warm!! Hot Dog!! The shower is one of those hoses with a shower head that you hold in your hand and point in the direction you desire. However, the pressure is such that if you hold it sideways (or up) the water only goes down, , , not out sideways for a while before turning down. And though we have hot water in the sinks it never seems to have any positive thermal qualities when dribbling out of the shower wand. But I'm not complaining, because I had a bucket full of water saved for just such an event and I'm getting to see Giraffes, and Baboons today!

So Philbert & I meet the buses at the corner. Once they have given him the eleven bags of laundry I have a seat. Everyone seems in excellent spirits. I never hear an exact head count but there are ten American Students, One faculty member (Bianca), Dr. Konn, three people with the tour company, about 25 Rwandan students and me. So close to 40 people in two buses. Kigali is roughly in the center of the country. Last Sunday I traveled around 2.5 hours basically west to Kibuya and was at the western border. This Sunday we're traveling about 2.5 hours basically east and we'll be at the eastern border. A 2.5 hour drive doesn't' get you nearly as far on these roads as it will in the U.S.. The main roads seem well maintained but are heavily used be all sorts of traffic (buses, trucks, taxi vans, motos, the occasional bicycle (frequently carrying some commodity or another person) and people walking, always, people walking.

We move from the main paved road to a dirt road @ the town where Bill Clinton's Foundation has donated monies to build and outfit a hospital. The further you get from the main roads, the lower the quality/standard of the housing. We pass many community water supplies today. I see yellow 5 gallon containers collecting that water which makes me seriously doubt the information given me last Sunday when I was told that the yellow containers were all for milk.

We get to Akagera Park and proceed to check in where we can stretch legs, empty bladders, pick up the guide for each bus, sign in and meet the first animal. There were a number of baboons around the ranger station and they seemed adjusted to people. One in particular, was quite happy to mill around with us and was interested in anything that might be eaten. We could get quite close to him without any apparent nervousness , , , , , , on his part. The temptation was great and just before we got ready to leave he was sitting in a bush about 2 feet off the ground , , , , and his feet looked so soft and touchable, , ,, and he'd been sooo friendly so far , , , , , so I got closer (and he ignored me) , , , , , reached out (still ignoring me) , , , , , and touched the bottom of his foot. He must have been ticklish , , , , , for he jumped to grab my hand, grunting loudly and ran off past me. The others nearby hadn't seen what had caused the incident but were startled as he ran past. . I tried to act non-chalant and kind of meandered off around the corner. Shaloy has already scolded me. I know, , they're wild animals....

Into the buses and within 15 minutes we see the Giraffes. They were pretty close by and two of them were hitting each others necks with their heads. I've seen a video of this but the ranger tells us they are just playing around... In the previously mentioned video it didn't look like playing but at the park today it did. We see some antelope which aren't on my side of the bus and I don't hear the name clearly and some Zebra. The ranger tells us that there are about 15 lions. They are seldom seen by the tour buses and primarily eat the zebras (the Giraffes can kick pretty hard). We leave too soon for me but on to find the buffalo.

It's a long drive and the first group is about 1/3rd of a mile away under some trees, barely visible and we don't try to get closer. Another 20 minutes and we see come to zebras standing in the middle of the road. Just standing, , , waiting , , , , after a few minutes the bus driver revs the engine and the Zebras take off running, , the African students really liked that and there was quite a bit of hooting and hollering. A few minuted later, another small group of Zebra and a lone bull under a tree. We're about 70 yards away when the other bus splits the distance between us and the Buffalo who is now paying attention. Quite quickly he puts his head down and charged. They quickly put it in gear and as soon as they started to increase the distance he stopped. It was only about another 1/2 mile to a group of over 50 buffalo. They seem wary and we don't get very close. On the way back we see almost all of the same family groups of animals as on the way in.

Another rest stop @ the ranger outpost. The faculty member Bianca was quite happy when we were able to locate a couple of Cokes (she hadn't had her coffee and was getting a caffeine withdrawal headache/migraine). On to the Hippos. The lake is the 2nd largest in Rwanda and we stop at a "fishing project" and catch a pictures of some Egrets, Maribou Storks (Which I think are some of the ugliest birds) and a pair of beautiful Egyptian geese. A little bit further and we stop at a camping site where we are told there are hippos. We're allowed out here and we pile out scanning for a huge animal but see only a small disturbance on the water surface about 30 yards out from the shore and a small partial head with nose, eyes and ears. The hippos poke their heads up for 5 - 10 seconds. The rangers tell us that each submersion lasts about 5 minutes and if that is so there were around 5-8 individuals in this herd. as we would see a head once every 45 seconds but never so enough to be able to actually identify different ones.

It's getting close to lunch time so we go to the park lodge. A very nice modern facility with a fantastic view, top notch service and a very nice pool. If you want a place to go and relax far far very far away from it all (and be treated well with great accommodations, food and service) I can highly recommend Akagera Game Park Lodge. We made lunches with Various kinds of sandwiches (tuna or PBJ or Nutella), fresh pineapple, biscuits (cookies), water and 15 plates of "chips" (thick French Fries) fresh and hot from the restaurant. Everybody ate until they were satisfied. Afterwards many people swam.... Dr. Konn had told me at one point that there would be swimming today, , , But I had spaced about it and hadn't brought my trunks, , , but I was hot and the water was cool and I did have on solid black boxer briefs which were quick drying, wicking so , , , , (no I didn't swim in just my underwear!) I unzipped the the trouser legs of my pants and jumped in. About 3:00 pm we packed it all up headed for Kigali.

Same trip in reverse, with a brief pit-stop for those with small bladders or who had consumed much fluids We were back in town by 5:15. I asked to be dropped off in Kimironko near the market as I was getting low on some supplies. The market was beginning to shut down as sundown was approaching and there are no lights. I was able to get a pineapple, 2 mangos, 0.5 Kilos of mixed beans for soup, 6 eggs, two 500ml containers of milk, a Kilo of tomatoes, a cabbage, carrots, onions and a Kilo of those strange Kinyomoro fruits. I'll get pictures of the market next time I go.

I took over 300 pictures today and the Internet speed isn't very fast. When I got home I couldn't access Blogger & I needed to let my computer churn through the images and some software I needed to load in order to sort pictures. I laid down for a nap and didn't wake up until 4:30 am Monday when I started the process over, , , So the complete regular blog about Sunday is just coming now Monday evening.

The students who were on the trip asked for me to send them e-mails of any pictures I took of them. However that would be waaayyy tooo time consuming of a process and I might not send them the ones they wanted. Soooo, If you want a picture or pictures here's what you do. Go to my Picasa album. When you see a picture you desire right click on it. Tell your computer where you want it saved and BINGO. You've got the image. Of the 300 pictures 54 were blurry or of no interest at all and I've deleted them. Some of the pictures have captions but it'll take me a good part of an evening to add captions to the rest (which I intend to do - eventually) .

Tomorrow I start @ King Faisal Hospital.

2nd Sabbath

It was nice to sleep in. I didn't get up until 5:30 today. But I wanted to visit with my sweet heart over the Skype. A lounging type of morning with fried onions and scrambled eggs plus a whole avocado and a glass of milk.

The milk here is similar in taste to my childhood in Yerington, Nevada where we drank cat milk. The local dairy farmer was a family friend who was not allowed to sell raw milk for human consumption but could sell it for pet consumption. We would take a clean glass gallon jar to him and he would exchange it with a gallon jar of milk which was for consumption by our cats (we didn't own a cat and that would have had to be a lot of cats because we got a gallon every 2 or 3 days). Besides being unpasteurized and non-homogenized, it had all of the fat content and we would let it separate to make home made cream, butter, butter milk and whipped cream. The fat content was close to 20%. In the U.S. what is termed whole milk is only 4%. Low fat is 2% and skimmed is near 1% or less. If you're going to drink water, , , why would you run it through a cow first??? Anyway, , , The Rwandan milk in 500 ml paper containers says, "Full Cream" and it tastes like it..... Man it's good!! Ready to go to church by 8:30.

I walked to the corner to catch the city bus to Kimironko terminus and then walked the last mile to Kibagabaga English Church. I figured I was getting close when I saw four little children wearing their Pathfinder scarves. I don't think they must use the Pathfinder song here because there were only quizzical looks when I started singing it to them. I thought they'd recognize the tune. Crazy Muzungu! They just wanted to touch me. Again I was struck by the stark contrast in the quality of the church structures across the street from each other. But I was able to participate in Sabbath School and worship in a language that I understood. We had a dynamic speaker who preached in Kinyarwandan and was translated into English. Which seemed a bit strange because most of the people understood before the translator translated and sometimes the translator just let it go because everybody had already gotten it. I'm almost done with this cold but I got a coughing fit and had to leave the sanctuary or disrupt the service, so I stood outside and listened because the speaker was so good. Walked back to Kimironko and then a City bus back to my street and home.

I had cabbage salad for lunch and then took a nap until my special Sabbath Treat!! I played the Autoharp for about 45 minutes until my treat was ready!!. 3:30 our time, 9:30 East Coast time, ,I Skyped my buddy Ken Willes who had set up his laptop, a camera and microphone @ the Collegedale Community Church, Collegedale TN. I got to have Sabbath School with my Realife class!!! Live!!! What a treat!!! I muted my microphone while we were singing and I played my autoharp because the time delay would have put my sounds about 0.5 seconds behind theirs. I'm sure the other house guests were wondering what was going on in my room. They set the laptop up on a chair and made my live image full screen. They forgot to bring the Hawaiian shirt though. I sat between Allison and Kelly. Periodically Kelly would turn the camera so I could see who was talking. I tried to look towards the person who was talking. That is when a person on Allison's side would talk I'd look at the wall to my right and when a person on Kelly & Shaloy's side would talk I'd look toward the closet and someone across the room talked I looked at the camera. I was trying to fit in :-) Thanks to my friends back home for going to the effort so that I could be included.... Wow that was nice!

I had gotten on Google Earth a while today to see if I could find our guest house and did. I noticed that around the block (that's really a country block), there appeared to be a park in the middle of a huge roundabout. So before it got dark I went for a walk around the block and found a very very nice park. Until I learn the real name I'm going to call it "Roundabout Park" They have built and are building some beautiful modern buildings around the periphery which must have started after Google Earth took this image. The park was quite nice and I intend to make a regular place to walk to and enjoy.

I got back to the house after dark and made supper. There were three of us (Duvall, Philbert and I) trying to cook on a tiny 4 burner stove but it was all quite friendly and suppers were eventually made (mine was fish and fries, Duvall was making spaghetti for 4 and Philbert was cooking for Ike). I tried to call Dr. Konn about details for tomorrows trip. I'm supposed to meet them before @ 5:00 am and I don't know what to bring, the costs, or really any other details other than the starting time and ultimate destination. Her phone says no service so, , , , what else will I do on a Saturday night?? I catch a moto to the Iris Guest House and start to wander around looking for Muzungus with American accents. I spot a room in the restaurant with about 5 young ladies who sound American. I play dumb and ask them in my worst Southern accent if they might be from America. The ruse doesn't last long because one of them, Shayla is from Albany Georgia and doesn't believe the accent for a moment.

We visited for about 45 minutes while they dribble in one by one. They had spent the morning either @ church or the Kimironko market (their choice) and then met @ 12:30 to go to an orphanage to paint the walls and the kid's faces and entertain the kids. They had called and ordered their food before they left the orphanage, then drove back to the Iris, and most took showers (the reason for the dribbling in, , , as each finished getting cleaned up) and then the food came. Good thing they had called ahead!! That was over 1.5 hours from ordering to on the table!!

Dr. Konn asked if I could get supplies to add to what they have for Sunday's lunches and I go to get 10 cans of tuna, two loaves of bread 2 very large boxes of biscuits (cookies) and deliver it all back to the Iris and then catch a moto home. I think that when Jesus fed the 5,000 it might have been tuna fish, "'cause tuna goes a longggg waaayys, " Back at the guest house I get the other supplies; four large avocados, a bowl some salt a knife and a can opener. We've decided that they will be passing directly past our corner so I'll meet them there @ 5:30 with Philbert who will be getting their wash done while they are at the Akegera game park.

CHK - Day 8 - Last day

Woke up @ 4:30 without a rooster or an alarm clock, so I decided to Skype Shaloy. I think/hope
she appreciated talking earlier. I also visited with my mom for a little bit. She fell off of her scooter and has broken her right wrist so she has been pecking out short notes during messaging sessions. Now she has her camera and microphone which she found from back when Triandra was in Peru, , , so we can talk away.

Morning routine was pretty routine. The radiographer I had class with this morning has an unusual name, "John of God" at least that's what I heard him say and what I had repeated back and what I said back and he said yes. We were already scanning patients when my other scheduled student "Gaston" arrived. The first few patients in the morning John of God, Gaston & I scanned and then reviewed the cases with Dr.s L & M. After Dr. Landos arrived Venant came and retrieved John of God but Gaston stayed for at least 90 minutes maybe a couple of hours, observing and helping. I tried to slip over to him and explain what we were seeing whenever it was possible.

There was some crazy pathology today. A lot of patients in a lot of pain. A woman with a 10 cm peri-umbilical abscess two years post surgery. A young girl who had massive dilation of the gut and I'm pretty sure had perforated and was on her way to surgery via sonography (There are no images taken so this ultrasound image is a similar case off the web). A baby whose neck was almost the size of his head on the right from a neck mass. The baby was crying audaciously and also having a hard time breathing from the mass in his neck. Every time he strained to cry or breathe the mass bulged out to three times the size and when he would relax or between cries the mass seemed to move down into his chest. It was a complex cyst with septations. Another patient with a large liver abscess in a tremendous amount of pain.

Another 35 patients for today and the crush is over. I'm I saying goodbyes to Dr. Landos (we've exchanged phone numbers and he's invited me to his hospital in Nyagatre plus I'm supposed to get him an OB calculator wheel when that box arrives). Dr. C seems happy with my visit, I promise to come back and see Dr. M. and Dr. L promises to show me where I can get a beautiful African dress for my sweetie Shaloy. I know Dr. L will know to go, because she always is dressed sharp. Venant says we'll make more arrangements with John, Dr. Konn and I for additional training before I exit Rwanda.

This afternoon I've been asked by the KHI faculty to go to Muhima Hospital and see what might be done for their broken processor. It's been down for 2 weeks and they are hand dipping films. Supposedly it's a Pro-Tec processor similar to the one I've been working with. I go by to see Leonard in maintenance and borrow the manual in case they don't have one. We talk about the parts order and he's taken apart the defective motor and thinks he may be able to get it going in case they need it before the replacement arrives. I also received an e-mail from Doris Tontsch @ Pro-Tec with suggested prices (in euros - minus shipping) for the parts that they need.

It's off to KHI and lunch with Patrick and John (the Radiology Program Director). The canteen told me I could take pictures of the food today. So here's lunch: rice, cooked bananas (not sweet at all) potatoes (very large cubes that look to have been boiled and then baked), casaba, bitter greens (which I've eaten every day and have now come to enjoy), red beans, a cube of meat (and they mean a single cube about halfway between a dice and a Rubik's cube) and a red gravy/soup that you pour over it all. It's a ton of starch which they seem to pile high and eat without gaining any weight. All this, as much as you can keep on a plate, for $1.60 U.S. These folks are the thinnest population group I've encountered (speaking from a sonographer's point of view).

When I've seen hits on the blog from Kigali I've assumed they were all from me, , , Over lunch I realized that some of the Kigali hits are from others because many of the things that I've written about were quoted back to me by the Medical Imaging Program Director. I hope I've not written anything that will offend any of the local folks here in Kigali. Patrick tells me of at least 4 words I've misspelled. I've been adding an a on the end of Muzungu, added an o in the middle of Kimironko (the market town), the town where there is church in English is spelled Kibagabaga and finally that strange fruit is called Ikinyomoro.

We wait, wait and wait for Abdullah to take us to the hospital and finally give up. (He's been delayed while having a flat repaired). It's about 150 yards of driveway between administration and the Health buildings. I've walked this parking area/drive a half dozen times and have picked up no less than a dozen nails. When they fill a pothole, they bring in dirt from the construction areas and the dirt contains nails. No wonder Abdullah is constantly getting flats! When I was a kid my Grandpa Penrose would insist that we look for and pick up any nails whenever we walked about the drive or yard at the ranch.

So we are taken by a different driver over to the hospital and wait @ administration for permission to proceed. Then we are accompanied down to Radiology, films outside drying in the sun but now suspended in manual dip racks which I haven't seen used in 25 years. A few minutes later and we're in the radiography room. The processor is in a corner, upside down, no racks, no chemical tanks hooked up, with parts obviously missing from it's belly. The Director of the hospital arrives and tells us that a repair person has come and removed the Power Control Board (I'm guessing some other parts as well) and has promised to return it (the PCB) repaired and fix the processor next Monday. The only thing I do is to confirm that it is a Pro-Tec processor. It looks very similar to the one I've been dealing with for the last week.

So, , , , that's it for this mission. If they need help once the PCB board arrives back they say they'll let us know. . . . So we're dropped off at the town buses and catch the one back to the guest house for me and on to their apartment. We wander through the melee listening for the Hawkers shouting Kuchira (the route we want to get us home). This is a two person operation in that there is a driver who drives and a "Hawker (my term)" who urges the people to get on this particular bus and not the next one down going to the same destination. Or maybe it might be another destination. Benard warns me to ignore what it is written on the bus because they swap them out if a bus breaks down. Of course the next one down has a "Hawker" trying to get you on his bus instead of the one you were about to get on to. It's loud and confusing and the craziest part is that they all seem to be run by the same company "ATRACO". There is an ATRACO official who keeps in contact with the drivers by hand signals and keeps/moves/directs the buses in and out. We pick an empty bus and get on to wait. It is crowded, I get warm and sleepy and could have easily closed my eyes for a nap while we waited for 15 more folks to get on our bus. Patrick tells me we have to wait until we get 18 passengers before they'll leave. Eighteen in a standard Toyota mini-van!

Home without incidence, I treat myself to a two trips around the mulberry tree picking and eating the fruit. I start on the chicken and dumplings, nibbling some of my pineapple while I wait. Check some e-mail, send some files and have a lovely meal. The second cooking softened the bird a bit, , but not a lot. Tastes great though. I've got a tupper ware container of leftovers in the fridge and still have a fair bit to share with the house staff.

Skype visits with Dan Pratt and Ken Willes. We're trying to set it up so I can participate in Sabbath School tomorrow. School business Skype with Dawn Irwin (I'm going to visit with the echo students next Monday @ 2:30 their time via Skype). Then I set up a Skype to phone service so I can call U.S. landlines and cell phones for 2.4 cents per minute. I call Shaloy's answering service and sing her a song, call Tria's answering service leaving her a message and figure I'll skip leaving a message on Zach's answering service.

Sabbath I plan to attend the English Church in Kibagabaga and Sunday I'm going to the game park with Dr. Konn's American Students. I'm supposed to get to see giraffes, baboons, warthogs, hippos and antelope.

Any image that is too small to see/read on the blog , , , If you click on it, , , , will open a new page and be viewable in original size. Also a couple of folks have told me that they're having issues publishing comments. I've changed some settings to see if that helps. You're comments have kept me encouraged to keep blogging.

CHK Day 7

I'm back again before the rest of the staff. The patients are already lining up outside waiting for the floors to be cleaned. They take a bucket of water, and poor it all over the terrazzo floors and then squeegee it out the front door. I noticed today that one wall of the waiting room is made up of a grate which has no way of closing. That is to say that all year round and 24 hours a day the waiting room has one wall that is open to the outside. That speaks volumes about the constant temperate temperature.

I worked with Jean Paul & Terreza again from 7:30 - 8:30 this morning talking about the concepts of how to perform a scan in a systematic fashion and reviewing images to understand the sonographic terminology. These are two very intelligent people and they are quick to grasp even though their primary language is French.

At 8:30 the regular crush of patients but really not too bad we (Dr. C, Dr. Landos & I) scanned 35 patients between 8:30 and 12:00. Today I saw two patients who had malignant looking lesions on both mammography and ultrasound with axillary lymph nodes, a liver that was full of tumor mass that had infiltrated into the p