Monday, June 30, 2008

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.

Thursday, June 26, 2008

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.

Wednesday, June 25, 2008

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.

Sunday, June 22, 2008

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

Friday, June 20, 2008

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.

Thursday, June 19, 2008

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.

Sunday, June 15, 2008

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.

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