July 6

            Here in Rwanda we are celebrating Eid with a day off from work! This past week has been filled with holidays. We observed Independence Day on July 1^st, as well as Liberation Day on July 4^th. It has been 54 years since Rwanda gained their independence from Belgium in 1962, and Liberation Day marks the end of the 100-day genocide. No celebration activities were publicized, so my housemates and I decided to celebrate the Fourth of July our own way. We spent the morning making homemade banana pancakes (here’s the lovely video) and went to the Hotel des Mille Collines after for a day by the pool. Fun Fact: The movie Hotel Rwanda was based on events that occurred at the Hotel des Mille Collines.

Hotel des Mille Collines

Piña colada at Hotel des Mille Collines

            I also spent a good majority of the four-day weekend at Neo Café, which is located at the top of an industrial building called The Office. The other weekend, my housemates and I participated in a mural painting activity directly outside for Umuganda. On the last Saturday of every month, Rwandans participate in Umuganda, which is a day of service. Since it’s a legal obligation, most people do activities such as picking weeds and digging trenches for rainwater.  We decided mural painting was better suited to our skills than chopping tree branches with machetes (which we all tried and failed). Our neighbors took us to The Office, where we found a group of mostly foreigners helping their staff paint the mural. I can’t wait to see what adventure my next Umuganda brings!

Me, Kerrlene, and Stephanie in front of the mural

View from Neo Cafe

The Office steps

The Office

Eid Mubarak!

-E

June 27th

            

Stephanie and I with some of our co-workers last Friday. The woman holding the flowers is my supervisor.

            I drew my first blood samples at the clinic last week. I’m a certified phlebotomist in the United States, and my supervisor at WE-ACTx happily allowed me to join our resident laboratory manager in blood collection. From Monday-Thursday, blood is drawn from patients to observe their CD4 levels and Viral Load. The lab tech usually takes samples from around 20 patients a day. This process begins around 9 am and concludes around 12 pm.

            An average of two tubes are drawn for each patient, and the lab tech writes the patient’s Track Net (identification) number and the desired test (CD4 or Viral Load) on each tube. He then completes a request form for every individual tube. This form contains patient information along with the requested test. The samples are then driven to the national laboratory for examination. The lab is a short 5-minute drive from the clinic. This procedure occurs each weekday, except for Friday.

            Fridays are reserved for providing HIV tests to family members of patients and anyone else who wants to be tested. We usually see 5-7 individuals for the examination on these days. The procedure consists of a series of two tests: Colloidal Gold and Determine. The lab tech first draws blood from all of the patients in a red top tube, which doesn’t contain any anticoagulants. This means that the blood will clot, leaving serum. This type of specimen is preferred when testing for diseases. He then labels each test with the patient’s Track Net number so that the results aren’t confused. A pipette is used to extract the serum and place a drop on the designated spot. A drop of sample diluent is placed on top of the blood in order to carry it up the test. The test may produce two results: a top line and a bottom line or only a top line. The top line is the control and the bottom line indicates that a virus is present. Below are the results from the five people we tested last Friday.

The lab tech adding the serum to the Colloidal Gold Test.

Results of Friday's Colloidal Gold Tests. All are positive as indicated by the bottom line.

            Since all of the tests came back positive, the lab tech moved to the second test; Determine. This test is more accurate than Colloidal Gold, which is being discontinued in July because of its high inaccuracy rate. The same procedure is followed for Determine, however, a drop of sample diluent is not necessary. The test is let sit for 15 minutes to 1 hour. The bottom line provides the results and the top line is the control. If a line is present, the patient is HIV positive. In this case, the lab tech fills out a form and circles Positive in red pen. If negative, he circles negative in blue pen. (The nurse who discloses the information insists that they are labeled by color.) If the results come back inconclusive, then the sample is sent to the national laboratory to undergo the ELSA test, which is the most accurate. Once the results have been determined, a nurse sits with each individual and shares his or her results. Steps are then taken by the clinic to assure that each person receives the proper care they need. Since all HIV treatment is free in Rwanda, this process mainly involves determining which clinic is most convenient for the new patient.

The lab tech adding serum to the Determine test.

Results of Friday's Determine test. All patients, except for the center, were HIV positive as indicated by the bottom line.

-E

June 21

            Last Saturday, Stephanie and I walked for an hour to the Kigali Genocide Memorial Centre. I entered cautious and left speechless. There are no words to describe the tragedy that the Rwandan people went through during the 100-day massacre that occurred in the summer of 1994.

Kigali Genocide Memorial Entrance 

Kigali Genocide Memorial

            Upon entering, you walk into a very serene room to watch a short film that introduces the horrors of the genocide. After, there is a beautifully laid out exhibit that details everything about the genocide from the initial colonization of Rwanda to the horrific personal stories. After you read through the extensive history, you enter a dimly lit room with hundreds of photographs of victims that have been submitted by friends and families. This is eerie because the pictures were all taken fairly recently. Once you leave this emotional room, you can go upstairs where the memorial pays tribute to other genocides that have occurred in the world. This particularly struck me because of how supportive and conscientious Rwandans are of others who experienced the same grief and suffering.

            After, there’s a beautiful outdoor area where over 250,000 victims are buried. Stephanie and I witnessed a funeral procession occurring while we were paying our respects. The party was carrying two caskets containing men whose remains were finally recovered in order to be properly buried to honor their memory and life. This was unbelievably moving.

Section of the outdoor burial grounds

            Although it is impossible to describe my emotions after leaving, I can say that I felt an immeasurable amount of shame.  The extent to which the world cast a blind eye to the Rwandan genocide is inexcusable and deeply malevolent. Though I am not surprised in the least, it was extremely hard to read about the abandonment of hundreds of thousands of innocent lives.

            Another thing that struck me was that nearly every single person I pass when I walk down the street has a story. Not one individual was left unaffected by the genocide, and victims as well as genocidaires are everywhere. A person may walk past the individual who murdered their family every day on their way to work, and this is unimaginable. 

            I will undoubtedly be returning to the memorial before I leave Rwanda. What I learned has allowed me to gain a deeper appreciation for the work being done at WE-ACTx.

-E 

June 16

            Wednesdays are children’s day at WE-ACTx. In the morning, I work with our Musicians Without Boarders team to provide the patients with music therapy. WE-ACTx trains a group of young adults through Musicians Without Boarders called “Peer Parents” who help run support groups that occur on Mondays, Saturdays, and Sundays. A Peer Parent, Chris (head musician at WE-ACTx), Ali (secondary musician at WE-ACTx), and I have started Wednesday morning group therapy sessions. These sessions are designed to entertain kids while they’re waiting for their appointment. Our objectives are to help patients relieve stress, express themselves, and acquire coping skills.

            Yesterday was only our second time running the therapy sessions, and our success has increased drastically since our first try last week. The main obstacles we face are ensuring kids feel integrated when they arrive to the practices, as well as making sure they don’t miss their appointments. Our sessions include all age groups; so stimulating each child is sometimes difficult, as well. Next week we are trying a new approach where we will bring down one group for the first hour and a second group for the final hour. Hopefully this will make some of our challenges a little easier to manage.

            I attend the psychosocial meetings with the clinic staff on Wednesday afternoons. They discuss serious cases within the youth program. The staff typically sees adherence issues with children, so a lot of the discussion is around kids who have a particularly bad record. Some other topics involve complications in family life, as well as noticeably poor behavior. They devise strategies to help identify the best way to help the patient and get them back on a healthy track.

            Follow the link to a video of our cook, Serafine, and me that was filmed by Stephanie. She taught me how to cut a papaya, which we have growing in our backyard. Serafine is the sweetest woman in the world, and we think of her as our mom away from home:)

-E

June 12

My third weekend in Kigali is coming to an end, and I easily find myself considering this city home. This week, two new people joined us in the house. First, we welcomed Stephanie, a medical student who is conducting research at WE-ACTx until late July, followed by Susan, the founder of Hands of Mothers. Hands of Mothers is a local NGO that runs cooperatives to help women become financially stable. An example of a current program is Ineza, a women’s sewing group that creates beautiful products of everything and anything you could imagine.There are several others that I encourage you look into that can be found in the link. (They take orders!) I found myself buying several items from them including a beautiful bracelet, necklace, and bag.

Women of Ineza Sewing Cooperative selling products at Heaven Restaurant.

            The clinic was quite exciting this week. I was able to go to Rwanda’s National Laboratory to drop off blood samples, as well as accompany our psychosocial nurse to Nyacyunga to treat patients. There were two appointments scheduled for that day, however only one of the women showed up. The nurse explained how he keeps a file for each woman he meets in order to recall every detail of her life and her previous appointment. This is emphasized because of the fragile emotional state of the women. Many don’t understand that he has other patients, and would become upset if he didn’t remember everything about them. Some information he collects is a family tree, employment status, and living arrangements.

            The stories of the two women were devastating. The first woman was a survivor of the genocide, and she has had several traumas since. During the violence, she lost her husband and father, but her mother survived and has since remarried. Her mother is living with her stepsister, and the patient has recently moved in with them because she has no money. She remarried the man who hid her during the fighting, but he abandoned her to look for work in Uganda. In her last session, she was going to start a tomato business in the market in order to raise enough money to move out. She was worried that the stepsister would kick her out, but the nurse believed this was a result of paranoia. She didn’t show up to her appointment.

            The second patient was another genocide survivor who was sexual abused as a child. She was able to secure work as a housekeeper after the fighting, but her boss raped her. Shortly after, she entered an intimate relationship with the boss’s cousin and ended up marrying him. The story only declines from here because the boss was HIV positive and she was now pregnant without knowledge of the father. The status is still unknown because the two men never made it in for testing. This woman was also abandoned by her husband and forced to give her child to her mother while she looked for work. She has been depressed and suicidal throughout this process, but she said she was not feeling suicidal during her last appointment. She came in very sick this week with news that she was having suicidal thoughts again. Her business plans were falling through, and her landlord was threatening to evict her. After a very long session, they decided that she would have a friend help her create a business plan for selling onions or tomatoes. She would need this assistance because she cannot write.

Nyacyunga Clinic

Nyacyunga Clinic

            After a particularly emotional week, I stayed home and relaxed this weekend. Most of my free time was spent at Heaven Restaurant and watching The Devil Wears Prada and Eat, Pray, Love.  I also had the lovely pleasure of passing a man walking his sheep on my morning run.

Buffet at Heaven Restaurant complete with biscuits, grilled vegetables, coffee cake, passion fruit, Japanese plums, sausage, and cucumber pineapple juice. (Not pictured were omelets and banana pancakes). 

-E

June 8

       As usual, these past few days have been extremely busy. Things at WE-ACTx have picked up significantly since I arrived. Last Thursday I visited our second clinic in the countryside of Nyacyonga with our two doctors. Throughout the whole duration of the car ride I couldn’t help but think that I was in a movie. (Jurassic Park and King Kong were the first that came to mind). The mountains were breathtaking and topped with eagles soaring above the trees. However, my serene image came to an abrupt halt when Justin Bieber started playing on the radio... After the 40-minute drive, we reached the bottom of an extremely steep hill, which, naturally, we proceeded to drive up. With every wind and creek of the car I was almost certain we would start rolling back down, but we miraculously made it to the top where the cement clinic stood.

            

       Since the doctors only travel to Nyacyonga once a week, we saw the more serious cases. The first patient was a middle-aged man who was complaining of genital pain. The doctor performed an exam and discovered that he was infected with another STI besides his HIV. After, another gentleman walked in who was complaining of headache and stomach pain. We looked at his stomach, and the doctor felt that the man had one of two ailments: Typhoid fever or parasites. This system went on for a few more patients until a lively man walked in with a slight limp. The conversation immediately transformed into a lively banter, which was a relief from the somber tone of the previous appointments. After he left with a smile, the doctor explained that this man had been diagnosed with tuberculosis a few months ago and was paralyzed on the left side of his body. At the time, the doctor wasn’t sure if the man would regain any function, but he decided to prescribe medication regardless. This was the patient’s 2-month check-up, and he had regained his sight, as well as mobility. Once all of the patients were tended to, we went to the lab, which was a concrete room equipped with a sink, a few pipettes, and a very old machine that appeared to be a printer. They also had a small microscope where they were looking at blood samples. After the tour, we headed back to the clinic where I would begin to plan the two-week summer camp run by WE-ACTx at the end of July. Many patients are children, so the organization runs a camp for them. One of my housemates and I will be in charge of planning, so we have our hands full.

           

       My second weekend started off a little shaky when I started feeling a little sick, but it quickly passed after some plain noodles and rest. My big event was a hike up Mount Kigali in Nyamirambo. The views and two-hour trek were stunning, and I plan on returning soon. I will let the pictures below illustrate my experience.

-E

The Beginning

Since I last wrote, I survive my first weekend and began my internship with WE-ACTx!! My overall impression of Kigali thus far can be summed up as hectically relaxed. It seems ironic, but I have never met people who walk so calmly through chaos like Rwandans do. I’ll continue to elaborate throughout this post, and hopefully you will come to agree with my conclusion.

Me at an Italian Restaurant in Kigali

I’d like to start off by describing some valuable lessons I’ve observed since my arrival last Thursday. First, people will stare at your white skin no matter where you go. They like to touch you, grab onto the car you’re in, and ask you to take their picture. The man pictured below ran up to me on the street as I was on my way to the market and insisted that I take his picture. His face lit up when he saw himself and made me promise to tag him on facebook.

My pale skin also caught the attention of the head nurse at WE-ACTx. She began explaining a fantastical gel that comes from Europe and the United States that protects fair skin. She recommended that I bring it from my country since it cannot be found here. I told her this gel is a lotion, and it is called sunscreen. I reassured her that I had put some on that morning. Second, traffic laws are frequently “forgotten” here. Motos (little motorcycles) are the most abundant form of public transportation, and they like to weave in and out of cars. Taxis are also popular, and have a funny habit of turning off their engines as they coast down large hills. Not only really dangerous, but also very cost inefficient because restarting their engines takes up more gas than driving down the hills. Oh well, I wasn’t about to argue. Third, instead of squirrels running around, Rwanda has stray black cats. Finally, Kinyarwanda is an extraordinarily hard language to master. So far, I have learned how to say good morning: mirewe, thank you: marakozi, How are you?: amakuru, and good: ineza. Exercise caution when sounding these out, I mostly likely spelled all of them incorrectly.

Everyone at the clinic has been very welcoming. My first day was spent shadowing the head nurse. I sat in on all of her consultations in the morning. Every patient has a blue booklet that contains all of their health records that WE-ACTx keeps on file, and the patients bring in a white slip of paper to schedule their next visit. Although all conversations were in Kinyarwanda, I grasped what each person was saying because they’re very expressive when describing their ailments. After each patient left, the nurse would give me an overview of the conversation. Most patients are healthy and take their medication. She looks for warning signs like lower back pain, headache, and upset stomach. If patients express these symptoms, she sends them to the lab for testing because they could have typhoid or malaria. For example, one patient we saw had typhoid last week. The number of patients diagnosed with malaria varies each month, but 0-12 is the typical range.

After lunch I was able to work in the Pharmacy.  I packed Cotrimoxazole, an antibiotic recommended for HIV patients with a CD4 count less than 500. I sorted 30 pills into individual bags in preparation for distribution the next day. For a reference, it takes 4 years and roughly $200,000 to receive a pharmacy degree in the United States. I sat down as a pharmacist and began practicing with less than 10 seconds of instruction. Below are some pictures taken at the clinic.

Tomorrow is children’s day at the clinic, and I will be shadowing the youth director. I’m very excited to share my next experiences with you.

Signing off.

-E