So long Shyira

The last couple weeks flew by. I knew all of December that I would be leaving Rwanda on Christmas day, but it wasn’t until around the 20th that I really realized I would not see Shyira again for quite some time.
Work at the hospital was pretty normal. The project I was working on, compiling data about patients with tuberculosis, was finally totally completed and gave me a feeling of satisfaction to produce work that would stick around longer than my 3 months. The last time I was in the OR it was hard to be overly meticulous, because I knew it would be a long time, if ever, that I would be doing this again. One of the hardest things to leave behind would be Caleb Jr., the 8-year-old son of Dr. and Dr. King. He had no other guys around other then his father to play legos, sword fight, and sit in the tree house with. I spent many afternoons after getting done at the hospital just pretending I was 8 years old again with Caleb Jr.
As the 25th snuck up, I was both excited and a bit sadden. I realized that I would be able to go socialize with people my age, make money, and have lighting in my room until whenever I pleased. Yet the life at Shyira was simple, predictable, and comfortable, and because of this I enjoyed it very much. As I packed up on the 22nd, I didn’t think about any of these things but just that I was moving on and now it was time again to get to the airport on time, with all my belongings, ready to deal with winter in the northern hemisphere. I had coffee with everyone at the Kohls’ house on Sunday and after exchanging phone numbers and hugs, I got in the ambulance headed for Kigali and said farewell to Shyira.
Christmas Eve was spent with a South Carolinian, who owns a solar power business in Kigali, eating Indian food and talking about this and that. We both had been away from home around the holidays before and it was nice to relax with someone before I headed to Paris.
The trip from Shyira to Paris was long, but nothing unexpected popped up. After 2 flights, 2 trains, and a lot of waiting, I was in Dr. Carole Soussain’s downtown Paris apartment. After a little walking around the city last night, I was happy to be in one place for a short while and be done with my travels. Although the two countries speak the same language, France and Rwanda are a little different.

Jocks 2-Dorks 1

AIDS day was recognized around the world on Saturday December 1st. To commemorate, Shyira hospital organized an event down in Vunga, where market is held every Wednesday and Saturday. Vunga is about a 25-minute walk down Shyira hill, which involves zig-zagging through small hillside gardens and passing by houses as children run out to shake our hands. The market is situated next to a river, which can be seen from Shyira, and for a mere 50 cents be crossed in a long, slender, wooden boat made from a single tree trunk with 10 other passengers.
The men at the hospital had been talking amongst themselves all week how we would adequately prepare for our soccer match against the military. Some time ago, the military stationed around Shyira, the hospital, and even the church all created soccer teams. To attract people to the AIDS day events, a match was scheduled between the military and the hospital. I was asked to play for the hospital the prior Monday and promptly agreed with visions of me having exuberant post-goal celebrations as the crowed screamed my name and my fellow players threw me on their shoulders. The coaches of the team had practices on the Wednesday, Thursday, and Friday before the match. Our training consisted of us scrimmaging any and all military men who were off duty at the time at the nearby field that resembled more a cow pasture than a soccer pitch. The combination of a fragile knee due to a unhealed ski injury, an elevation of over 6, 000 feet, and an opposing team of well trained military men brought me to panting, overheated state within 30 minutes of practice. Due to the French lessons I am taking three times a week, I was unable to make 2 of the 3 practices.
The first half started on Saturday a good hour and a half later then expected, but by the time the whistle blew, there must have been at least 2, 000 people watching. Two town officials were walking around with loud speakers playing the roles of commentators, and of course I heard my name, “Umuzungu” or rich man in English, plenty of times. As the only non-Rwandan on the field, I had much more attention on me than I ever wanted. Every time I would slip and fall or miss a pass, the crowd would explode in laughter. I don’t take myself too seriously, but this entertainment at my expense was not helping my confidence or pride. Even though I was aware the spectators’ hysterics were not malicious, I couldn’t help my contempt of their sadistic sense of humor. I played right striker for the first half and after running back and forth from the centerline to the opposing goal for 45 minutes, I was beat. The military and got 2 goals against us but our offence was slowly picking up. At half time, the coaches decided that I wasn’t adapted to their kick and chase method of offence and put me in at midfield to get some passes in between the defense and the strikers in order to save our energy and give us a little more time with the possession. It worked out well and even though we got robbed of one goal due to an off sides, the hospital team managed to put one up on the board before the referee blew the whistle to end the game. At a respectable 2-1 loss to the Rwandan military, I was fairly pleased with the outcome.
The game left me exhausted and in need of some peace and quiet, but there was a discussion panel between a couple of the Shyira hospital doctors and some respected Vunga people about the impact of AIDS in their society. The hospital bought a goat and made a meal of skewers and barbequed bananas that helped bring a little life back to all those that had participated in the game. There was also free beer and soda, and because I represented the hospital, I stuck to soda. The beer was fully taken advantage of and eventually diminished the local people’s hesitation to ask difficult and uncomfortable questions. Unfortunately, the loss of sobriety also led to blaming one another for the AIDS endemic and attempting to create harsh penalties for those who transmit the disease. By the end of the session however, it seemed like everyone had learned something that would help decrease the spread of HIV/AIDS. As I headed up the hill, I was ready for a soft bed, a cold shower, and a book to read. After a couple pages of reading, I had one of the best nights sleep I’ve had since arriving.

Where is Your Milk Moustache?

Cold milk. That is the answer to the question of what I miss most. I had been asked the question many times by people leaving Shyira to return to the States. “And what will you eat first when you get home?’ I would normally answer that I enjoyed the food here and there is nothing that I missed terribly. Sure, the convenience of a microwave and refrigerator were nice, but the gas stove and filtered room temp water were working out just fine. Even at Thanksgiving I didn’t feel like I craved the mashed potatoes or turkey the American Embassy provided for all the ex-pats.
I still had no answer to the question of what I would eat when I got home. It was over breakfast this morning that I found out. I was about to order juice or coffee as usual when my companion ordered some milk. I decided that even though I get fresh milk daily from the cows in Shyira, it had been a while since I had anything refrigerated and some ice-cold milk would hit the spot. I was a bit skeptical when the waitress brought out a square packet, snipped the edge off and poured the whopping 3.2% milk into my glass. I had never heard of milk coming in small half-liter plastic bags, only cartons or plastic jugs. But when that creamy goodness hit my lips, I knew that I had an exact answer next time someone asks what I will eat when I get home. I assume I’ll eat Oreo, or chocolate chip cookies, or anything else that goes with milk, just as long as I have milk. After drinking a liter to myself, I felt like a million bucks.
The weekend in Kigali has been a nice change so far. I enjoy how slow and rural Shyira is, but I’m 23 and need to get out do something every once in a while. I met up with a good sized group of Americans after the Thanksgiving dinner and we went over to Dr. King’s cousin’s house to socialize, play cards, and just hang out. Around 11 o’clock I realized what my small town living had done to my biological clock, and I headed home catch some sleep. Ill be going back to Shyira on Sunday and I have to admit I’m looking forward to a little peace and quiet.

A Little Retreat

Last week started just like any other. Monday was a busy day at the hospital, as usual, with an influx of patients coming in with countless ailments. The women’s area was so overpopulated that we had filled every bed and some patients were obliged to lie on the floor. Fortunately, there is nothing life threatening to any of the patients at the present, so after treating their infection, high blood sugar, or anxiety, most are happy to return to their family.
I am currently working with Dr. Louise King, alternating each day between the men’s and women’s ward. As I headed to meet her on Tuesday, she received a call from Dr. Caleb King asking if I would like to accompany him on his trip to Lake Kivu for a meeting. As one of the 5 great lakes of Africa, I was not about to turn down this offer. I must have gone back and forth from my apartment to the King’s house at least 5 times to assure I had brought everything I needed. Our first stop on the way to Lake Kivu was in Kigali so Dr. King could run a couple errands.
Things usually take longer then expected here in Rwanda. If someone tells you we are leaving in 20 minutes, feel free to get in one more chapter in your book and have a quick cup of tea, all with time to spare. Even in the hustle bustle metropolis of Kigali, the only thing you can set your watch to is the time in which people leave to go home. We stop at the immigration office to check on the status of some visas, then over to the offices of a couple non-government organizations to find money for our social fund at the hospital, and finally we chat with an architect about the design of a hydroelectric project Dr. King has been working on. All this takes a good four hours and we have a 2 and 1/2 hour drive to arrive at our final destination. Although the darkness came early on during our drive, the roads were in good condition and we made it safely to the guesthouse.
The next day Dr. King leaves early in the morning to his meeting and Caleb Jr. and I are left with a rented boat and a whole day to do as we please. The boat ride was beautiful and we were able to just see the silhouette of Congo in the distance. The workers at the desk warned us that the water was cold, but we are right on the equator and it was very refreshing even at 9 in the morning. Caleb Jr. and I wandered to the local market and bought a little candy to munch on while watching a movie on my computer. By the time Dr. King returned, we had built up a nice appetite and the lunch of grilled tilapia really hit the spot.
It was nice to get a change of scenery for a couple days from Shyira and do a little bit of sightseeing here in Rwanda. I plan on spending my Thanksgiving meal with my fellow countrymen at the American Embassy in Kigali and can’t wait to meet other people and hear their stories of what they’re doing here. I will be spending the weekend in Kigali and then back to the grind Monday.

In all my excitement about all the new sights and sounds, I completely forgot to inform my reader about the more mundane aspects of life here. While the work at the hospital is far from predictable, I do have somewhat of a schedule that I can rely on.
Each weekday I wake up at 6:45 to the sound of Clementine, my house help, banging around in my apartment kitchen fixing breakfast and getting ready for her day. My humble abode consists of a bathroom connected to my simple bedroom, a living room with a bed in case I ever have another male volunteer arrive in Shyira, and a kitchen consisting of a sink, gas stove, oven, and a shelf. I eat my breakfast of bananas, pineapples, and another bitter fruit called tree tomato along with some tea, the occasional fried egg, and bread. By 7:25 I bring my dishes into the kitchen, chug my tea, bush my teeth, and briskly walk the 5-minute commute to the hospital.
Every doctor is required to be at the Morning Prayer service starting at 7:30. Spoken in the local tongue of Kinyurwandan, a Bible passage is read out loud by the minister, which is followed by instructions as to how we can incorporate this lesson into our lives. The speaker is usually half yelling and this intimidating lecture is accompanied by an aggressive facial expression demanding the listeners’ full attention. A briefing in French follows the 30-minute bible study summarizing the events that took place while the various doctors were on call the previous night. There are a total of 100 beds in the whole hospital, so each of these updates can be just the same as the day before, or a new case inspires a comprehensive discussion between the doctors and nurses.
There are a total of 6 doctors here at Shyira. Doctor Caleb and Louise King are American and Harvard trained, specializing in pediatric gastroenterology and internal medicine respectively. Dr. Caleb King is the director of the hospital; he and his family have been here in Shyira for almost 5 years now. Matthias Kohls is a German OB/GYN who came a little over a year ago with his wife, an English teacher at the high school, and 3 little girls. Dr. Jean Luke, Dr. Dona, and Dr. Theonest are Congolese doctors each having been at Shyira for a varied amount of time, all trained in general medicine. I have alternated weeks assisting Matthias and Louise so far, but I hope to get a chance to work with Caleb when he finds time, and follow the other doctors as my French gets a little better.
I begin making the rounds about 8 a.m., which involves going bed to bed asking the patients how they feel, with the assistance of a translator. Although I always accompany one of the doctors, I do get to listen to the patient’s breathing and heart with my trusty stethoscope. Some people get right to the point and address their needs in a very matter of fact manner. Others come up with new symptoms everyday that elude the staff in how to diagnose the problem. In the maternity, a sick new mother or wailing young girl in labor demands our full attention. An elderly man with night sweats and weight loss or a young lady complaining of lack of energy and a cough gives us the impression that we have a new tuberculosis case on our hands in the internal medicine ward.
Around 12 noon I head to the little house inhabited by the only other current young foreigner here in Shyira, a 20-year-old German girl named Steffi. Steffi is working at the local kindergarten and tutoring the 2 oldest Kolhs girls. I eat lunch everyday with Steffi and her house help, also named Clementine, who is an outstanding cook and provides our meals every day. Lunch always includes red beans and rice, a potato dish, cheese covered cabbage, and carrots. Although this meal is generally very predictable, it is one of the daily events I look forward to most. The 30 minute long lunch is followed by a relaxing coffee break accompanied by reading time in the armchairs of Steffi’s house. I usually peruse one of the few U.S. News & World Reports or numerous girly magazines left by the previous inhabitants of the house. By the way, this winter’s Dolce & Gabbana line is hideous.
The first thing on my agenda during the afternoon is tutoring the second oldest King child in Latin. Sum, es, est, summus, estis, sunt. Ask her and I guarantee she can rattle those off for you. After our 45-minute lesson, I head back to my apartment to teach a local guy that is my age how to type. I usually use one of the few books I brought and have him copy it word for word. I recently got a hold of a typing program and he was over 15 words per minute last time I checked. The late afternoon is when I am left to read, have my twice-weekly 90-minute French lesson, or study my MCAT material. It is a time where I can usually sit outdoors, as long as our daily rain has already passed, and enjoy the warm air with a cup of tea. On Wednesdays and Fridays, all of the non-Rwandan people, 13 of us in total, and a couple Rwandan orphans eat together at either the King or Kohls household. It is nice chance to socialize and eat together a couple times a week, as well as give us a chance to talk about things other then the hospital, its patients, and its problems. On nights where we do not have a group dinner, I usually make a simple meal with the bread, rice, and cheese I have on my shelf.
My apartment, the King’s house, the Kohls’ house, Steffi’s house, one other doctor’s house, and the hospital are the only places in all of Shyira that have electricity. The generator goes on around 6 p.m. and is surely off before 9 p.m. The sun is down around 6:30, and unless someone is getting judgment for his or her involvement in the genocides by the community, almost everyone is in their houses getting ready for bed. The satellite is on while the generator is on, and I would say it’s a toss up between using the Internet and lunch as to what I love most outside the hospital. I usually get in bed by around 9 or 10, because I have a full day ahead of me.

Old Habits Die Hard

Everyday as I walk to work, I encounter a good number of children on their way to school, many of whom use their latest lesson in English to engage in a simple conversation with me. “Good morning”, “How are you?”, “Give me my pen”, “Give me my book”, these are the daily questions and commands I get from children as I walk around Shyria. Regardless of what time it is, I am always greeted in English by, “Good morning, how are you?” When I answer this question to a group of little girls or boys, they often smile and run away talking quickly amongst themselves. I was told that many of the teachers’ first lessons in English instruct the kids how to ask for school supplies or money from foreigners. This is no surprise, because some kid demanding I give him his pen usually confronts me as I walk to the hospital. I always slowly inform them that I do not have their pen and that I’m sorry, I don’t have an extra. The policy here in Shyira is that none of the volunteers can give money, food, or any other items away because it would cause problems and perpetuate an image that the doctors are really trying to shake. Although it would be nice to occasionally had out a couple sheets of paper or give a pen to one of the children, the fact is that there is no way that we can meet the demand of the entire school, and thus a simple act of kindness sparks an onslaught of jealousy and begging.
Mazongo is a term used by the Rwandans to indicate a person of wealth. I initially misinterpreted this as a racial phrase, but was clued-up to now know that it is given to any Rwandan or non-Rwandan that has a lot of material goods. The people here openly refer to all white people in Shyira as Mazongos, both to our face and in conversation between each other. I have had a hard time dealing with this even though I know it is not derogatory. As I walk with the doctors or alone, I hear Mazongo said between friends as they approach, and both parties smile and wave as we pass. I have tried to use some Kinyawandan, saying “Oya, Mazongo” (No, Mazongo), but this does nothing. It is a name I will learn to live with and I am now sure that I will never be able to shed the stereotype of being a white person in a lab coat, which is fine.
There are some customs that would be very difficult to pick up on, and I am sure that I have many more to learn. My latest humbling moment was when I realized that it is very rude not to walk your guest down the road when they leave your house. In the States it is good manners to see your guest to the door, wish them a nice evening, and that’s that. Here it is proper form to walk some of the journey home with your guest. When my French teacher hangs around my door for a moment after my next lesson, I now know to accompany him part way on his walk home.
One example of a deeply rooted practice is the fact that many people will take their sick ones to a traditional healer before coming to the hospital. The cause of all death and disease is poisoning by your enemies, a belief still held my many in our community. Older people stare at me as I walk from one house to the next carrying food for an evening potluck, because the potential of the food getting poisoned from those who want me dead is very likely. Today at the hospital I encountered the first death due to this mindset. A man with acute meningitis was admitted only 3 days ago. As his eyes danced wildly around the room and his shrunken body hardly resembled a man in his late 20’s, his loved ones told us that the healer had determined he was poisoned because he threw up after given the testing concoction. Immediately taking some spinal fluid to confirm the meningitis and giving him strong antibiotics, we thought we had a chance to combat this late stage infection. Yet this morning I was informed that this man had died last night, alone in isolation, because he did not receive care soon enough. As I sat in on the consultation with his family, the doctor informed them that whenever they thought someone was “poisoned”, they should bring them to the hospital. Although it was hard for me to see a family that had just lost a loved one who was in the prime of his life, I hope that they will tell other families to come get true medical attention when a family member is sick.
I love Shyira and the people so far, but there are some difficult aspects of this change that I am still adapting to.

Patching It Up

I awoke on Sunday morning to the sound of knocking at my door. Quickly glancing at my watch, I squinted a little when it read 5:42 am. I opened the door in my boxers to see Dr. Kohls looking alert and ready to go. “Do you want to assist me in a cesarean?” He asked me. Without thinking I quickly agreed. I put my clothes on, chugged a glass of water, and ran out the door.
I walked briskly down the dirt road to the hospital with Matthias contemplating my ability to stay on my feet for this procedure, as it was the first one since my little episode on Wednesday. We entered the changing room and the both of us put on our scrubs without exchanging any words of encouragement. As I entered the OR, the nurses put the sterilized
Surgical gown on me and I immediately washed my hands and put the two sets of gloves on. The woman had been in labor for almost 15 hours now and it was apparent that this baby wasn’t coming out on its own. After arranging his tools, Dr. Kohls made the first incision and we never looked back after that. My surgical masked drooped slightly about 10 minutes into the procedure, and I beckoned on of the nurses to help me out. Matthias immediately thought I was going down, so stopped everything to make sure I was okay. As I turned back around he smiled and said that I had given him a little scare, but I assured him I was feeling great. The baby came out great and we started to patch the mother up right away. Matthias give me the honor of doing the final stitching, which I did very carefully and enjoyed immensely. My confidence was back, and although it was only 7:00 in the morning, there was no way I was going back to bed.
I am now working with Dr. Louise King, an Internist here at Shyira, and the wife of the director of the hospital. Although this differs greatly from the OBGYN, I really enjoy the problem solving aspect of internal medicine, and I hope to learn a lot about her daily routine in the following week. The weather is getting a little wetter, but the sun still comes out for a good portion of each day. I start my French lessons today and I hope I can get to a level where I can have a simple conversation with the children before I leave. Thanks again for reading and I hope to get those gorilla pics up in the near future.