Mwiriwe Neza (farewell) Rwanda



(Favorite photos of Rwandan people above, click on image to view larger)

Things I like about Rwanda:

1. Rwanda is a baby wearing culture. Babies young and old ride around on their momma’s backs. (Or on the back of a bigger sister.)

2. Breastfeeding is the norm. Breastfeeding in public is also socially acceptable and expected. Extended breastfeeding is practiced and everyone (except perhaps some less educated foreigners), knows it is normal.

3. The people.  Rwandans in general are kind, reserved, tolerant and often polite to the extreme. Especially, I will miss the lovely A0 Advanced Midwife students. (See photos below)

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4. Some Rwandans are working hard to make their health care system better.

5. The weather is divine. Warm days and then it cools off at night. At worst the temp is in the 80’s, but humidity is low. We don’t have a fan or air conditioner because we don’t need them.

6. When you drop something, trip over your own feet or have some inconvenience…all the people around you, including virtual strangers will instantly say: “Sorry, sorry, sorry” in empathy.

7. Fresh sweet banana, mango, pineapple and avocado.

8. Rwanda is a cash society. You pay for what you use such airtime on your phone, internet (when it is working), electricity and water.

9. Colorful katenga clothing most women wear.

10. My daughters and I get to spend time with other families who are choosing to live outside of their respective countries.

11. Living in Rwanda allowed us to visit Uganda with my sister Kelley and that was wonderful experience. (Photos below)


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Things that amaze me about Rwanda:

1. Many castoff t-shirts from America have ended up in Rwanda. For example:

  • “Spring break 2013” (apparently had a short stay in the USA)
  • “Michigan Girls State Track Meet” (of course worn by a guy)
  • “I (heart) Iowa” then later that same day, “I (heart) Chuck Norris”
  • “Minnesota Twins”
  • “Ghostbusters” Icon (on an elderly lady, who had a color clashing African skirt).

What I would like to know where are the t-shirts from the rest of the world? Especially, France, Belgium, South Korea and Germany (as there are plenty of those folks here)????? Or is it really only us Americans who wear t-shirts?

2. Wildlife lives here: Elephants, zebras, giraffes, hippos, gorillas, chimps, etc.

3. There are many beautiful places and the thousand hills moniker is quite accurate. We wish we had more time to see it all!

 Things I don’t like about Rwanda:

  1. Taking the matutu or moto-taxi bus. Waiting for it to leave. Never being 100% I will get to where I need to go or get there on time. Dreading being squeezed in with other hot and crabby people. 4 people on a bench seat in a van, no room for your legs, your parcel, backpack and purse clutched to your lap.
  2.  Internet is slow and inconsistent. Wi-Fi that work is not common.
  3.  The assumption that every foreigner is “rich.”
  4.  Being hit up for money and goods. It has been overt: “GIVE ME MONEY!” “Buy me a computer!” “Muzungu give me food!” “Tell me how to get to America!” Or it has been: “I am an orphan…can you help me?” (Rarely by someone who was truly an orphan) “Can you give me a job?” “Can you sponsor my studies?” “How do I get someone to sponsor me?” “Can you sponsor me to America?” “You know the Genocide…”
  5.  It is expensive to live here. REALLY. RIDICULOUSLY. EXPENSIVE.
  6.  Women work harder than men.
  7.  Being called muzungu (which means foreigner). Do I whisper or shout: “Rwandan” when I see them??
  8.  Rwanda is very hard on your shoes: A) This may be because we walk a lot B) This may because of the uneven pavement or red dirt C) This may be because we left the US 10 months ago, and only brought a limited selection, which we wear over and over.
  9. I don’t believe Rwandans are free to say what they really think about lots of things…
  10. Not a photo-taking country, so it would have been inappropriate to take pictures in many circumstances. I would have loved to have shared more of what was seen.
  11. (Last of Uganda photos, below click on image to see larger)

Living in a Post-Genocide Country

So many things we have experienced in Rwanda. One of my biggest tasks here, the Advanced Midwifery students have finished their semester and thus I have a slightly easier schedule. What has not gotten easier is internet.

In early April the girls were off school for a week, due to the 20th Anniversary of the Genocide. “Remember, Unite, Renew” is the theme for memorial this year. There were many events, extremely tight security and VIP international visitors. One of our HRH colleagues found herself near former UK Prime Minister Tony Blair for example, during one activity. We participated in one event, the main remembrance walk, as there have been several. This one started from the Parliament building with its bullet hole damaged walls maintained to remember… and concluded at Amahoro Stadium. We got to the starting place of the event at the correct time, but then had to stand on hot asphalt for 2.5 hours waiting for the VIPs to arrive. We were hemmed in between tall wrought iron fencing on one side, and armed soldiers on the other. After tight security to enter and with thousands of people in front and behind us, were actually “stuck” for the wait. I could now understand how crowd “un-control” might happen with the possibility for serious injury if the masses became too frustrated.

Genocide Remembrance Walk

As we learned during Chinese New Year, which was several days of inconvenience for foreigners, Genocide Memorial week is similar…except no whining from us this time. I had read many articles, books, viewed films and documentaries about the Rwandan Genocide, which the government calls: “Genocide Against the Tutsis.” I had done all that research many years before this experience, due to my interest. I had been compelled to learn as much as possible, after seeing “Hotel Rwanda” a long time ago. I watched it for the second time, when my now, 23 year old son was in high school. Since he was a mere 3 years old when the genocide happened, he was shocked that something so TERRIBLE had occurred in his lifetime. Like most American students, he knew all about Nazis and the Holocaust, but was less educated on the subject of Rwanda.

When the girls and I arrived in the country, and the first time I saw an open truck loaded with Rwandan men carrying landscaping/farming equipment—which included several machete-carrying occupants, I thought about the images I had seen on film. Even now, as we travel around, I look at this small crowded country and think to myself, where did they hide? I study the faces of my Rwandan colleagues and think how could they tell the difference between Hutus and Tutsis? The key is that you can’t distinguish. Can you tell the difference between an US Native American and a Canadian First Nation person? Or someone from North European descent living in either of those countries?

The difference between being labeled as a Tutsi, Hutu and Twa was a legacy of colonization from the French and Belgians. Having 10 or more cows, you were a Tutsi. If you lost your 10 cattle due to disease or poor management, you could lose your identity and become a Hutu. Facial structure and bodily measurements were also included in the “scientific” analysis of tribal distinction.

Where I work, at the main hospital of the country, there is a medical unit for the aged and sick prisoners. I see them out on the hospital grounds and find myself thinking how I never see prisoners in America. The prisoners in orange are regular criminals but the prisoners wearing pink are the “genocidaires.” I look at their faces and see ordinary aging adults. They give no visible signs of the crimes they perpetrated. Once I saw a van of prisoners returning to the hospital grounds and a woman genocidaire was included. As she got out of the car, with her pink skirt, shirt and head covering, I was surprised and annoyed that she had a matching pink purse. It struck me as so odd, that seemingly inconsequential detail.

Female Genocidaire

Those affected by Genocide live amongst the perpetrators. Due to the large number of criminals and the anticipated time it would take to process through the criminal justice system Gacaca courts were set up around the country. It is a community-based criminal justice system that has some historical tradition. Perhaps this is better understood with information taken directly from the Rwandan website: The “Gacaca Courts” system has the following objectives:

  • The reconstruction of what happened during the genocide
  • The speeding up of the legal proceedings by using as many courts as possible
  • The reconciliation of all Rwandans and building their unity “

I do not know what it would be like to live, work, worship with those who harmed my family and friends, but it happens here with some success and some bad feelings on a daily basis. Many people say they had no options to leave or they did not want to leave their village, their country. People talk about starting from zero after the genocide. Which is what had to happen to the country of Rwanda. Not a single family was untouched by the death and destruction. What mattered was the degree of grief. “L” is one of the most educated Rwandans that I have met as she has taken an advanced degree in psychology. She mentioned that “Memorial” for her is not in April. I said, stupidly—“why not?” She looked at me with much sadness and explained because her mother was killed in May. That is when she and her family have their own memorial time.

L was in nursing school, whose academic campus was at a hospital. When the killings started, the Interahamwe (Hutu Militia) came and killed their teachers. They rounded up the nursing students and placed them in a room, planning to murder them as well…but then the Hutus were called to another place where fighting was going on. The students cried and prayed, knowing that the promise of death would happen when they Hutus returned. Amazingly, their lives ended up being spared. While the fighting was going on, several Hutus were severely injured and were taken back to the hospital for treatment. The nursing students lives were saved because some of the Hutus realized if they killed all the nurses, there would be no one to help the injured. L says that they treated injured Hutu and Tutsis equally, because that is how they had been taught as nursing students. Sadly, some of the recovering Tutsi patients would “disappear” in the night, being taken out of the hospital and murdered.

Recently, I talked to L about one of our post-cesarean section patients. One of my students had “rounded” on her and presented her history, physical and client teaching. The 28 year-old mother’s surgery had taken place the day before and she was doing well. I asked my student why did she have the first cesarean (in a country with about a 47% c/birth rate). I assumed it was going to be another sketchy reason, but was soon to learn that she had too much scarring. “Scarring?? Like from the first cesarean?” “No,” I was told, “in her pelvis.” Oh, my goodness, was she sexually assaulted, raped?” I tentatively asked. “Maybe, but she was shot. Shot during the war, down there,” the student explained. With stupefied silence, the other students and I did the math. She was 8 years old during the war. A little girl shot in the vagina. My stomach turned. I looked at my students and whispered, “I am so sorry.”

It has been 20 years and the stories come out when you don’t expect it. The thousands of Rwandan children, born after rape are about 19 years old right now. There are no special social services for them. Many are haunted by the stories of their origins. In a patrilineal society, they are the children of violent beginnings. Many of them grew up in single-parent households, their mothers were widowed during Genocide. For some of the mothers the child is a constant reminder of the trauma they suffered. Many of the women were systematically raped and tortured and deliberately infected with HIV. L has  stories…too many.

One student had to miss some clinical time. The reason: Rwanda is widening a particular road, and near the road is one of many mass graves. People who have family buried there were mandated to come help dig up the bones. They had to clean the dirt and clothing from the bones and set them in the sun to dry for a couple of days. Then the bones were re-buried. Picture that as a reason for an “excused absence.”

When my sister Kelley was here last month we went to the National Genocide Museum. The room where the children’s stories and photos were displayed made me the saddest. We took Beau and Mei with us. The museum also shares information about other genocides, WWII, Armenia…

I wrote this post a long time ago but thought it was too depressing to share. Plus, my thoughts and words are inadequate to describe the little that I know and hear. But then, this happened…My friend S is a physician here in Rwanda. Her father was an Auschwitz survivor. They are Jewish, but one should not assume that…as the Gypsies, Russian POWs, some Christians, Germans, mentally and physically handicapped were all victims of Nazi cruelty. Recently at a party, S mentioned that she went to mass and CCD every week for several years of her childhood. When she asked her father, why she a Jew was having to learn so much about Catholicism, her father told her it was just in-case it should ever happen again, that she be able to disguise herself as a Christian. Her father felt even living in America, that one could never know how a world could spiral down revealing the worst aspect of human nature.

Thus I share this post with you to remember the dead and living whose lives have been altered by genocide.

Birthday, Midwives and Orphan Boyzzz “World Salon”

I celebrated my birthday last week. Here is how I spent it: the first part of the morning was in the Skills Lab of the University of Rwanda, evaluating the A0 Midwife Students on Lower Abdominal, Groin and Bi-manual Skills. The students I spend two-three days a week with are practicing midwives in Rwanda. Some are even clinical instructors for A1 students. However, this group of women and three men were chosen to become Rwanda’s first group of Bachelor’s prepared midwives. The photo shows “my” clinical group of students this semester.

That same afternoon, we went to the REAL Midwife awards. “Save the Children” was giving an award to a Rwandan Midwife and a Community Health Worker for jobs well done to improve maternity care in the country. Some employees from USA Save the Children were present, they also brought along a reporter from the New York Times. One of those from STC was Mark Shriver and his 14 year-old son. So Beau and Mia, if you want to do a Taylor Swift and date in THAT family…he seemd really sweet and cute, and was clearly following his orthodontist’s advice, because this all-seeing mother noticed he was wearing his retainer.

The program

The program

What I enjoyed most about the event was listening to the midwives sharing their reasons for becoming a midwife. Two who spoke, were midwives that I am mentoring. One woman, C, shared that her two sisters died related to childbirth. One from eclampsia and one for delayed PPH (post-partum hemorrhage). Another student, A, had a story, but then afterwards she told me about the death of her mother, due to childbirth related complications, when A was 14 years old. She wore sunglasses when she read her public speech, because she was afraid she would cry, but it was too painful for her to disclose to such a large audience, about her own mother.

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Remembering when I was teaching in Pakistan, every “student” I spoke with had intimate knowledge of someone they loved dying related to childbirth. At that time, I was so taken off-guard by their revelations. Now that I have left the bubble of safety I usually practice within, once more, I am saddened to hear the realities of Maternal Morbidity and Mortality, and how families are affected.

Midwifery is improving in Rwanda, and it is the hope of their government, with the assistance of HRH faculty, we can help speed up the process, both in quality and quantity of midwives. I learned that after the Genocide, RW had only 5 midwives in the entire country. Now, 20 years later, there are 700 midwives. Some midwives have less education than an ASN nurse in the USA system. That translates to less than 2 years post-high school education. Which is why hopes are being pinned on this cohort of A0 students, who will become the midwife teachers, as well as clinicians. Promoting evidenced-based care is our mantra. We are here to upskill Rwandan midwifery…it is about helping create and support a self-sustaining system. The HRH program, is in the second year and by the 7th and final year, there will hopefully be a wonderful conclusion with many more qualified nurses, midwives and physicians.

Included are photos of some dancers who demonstrated historical dances of Rwanda. As you can see from the photos, that many of the midwives are wearing the traditional style clothing of Rwanda. Not necessarily the traditional fabrics, because most of us were wearing rented outfits. I learned that at weddings and such that the women wear this style, which includes two pieces of matching fabric. If I have a pained look on my face, it was due to my attempts to keep the shoulder sash piece on my shoulder. Originally, my outfit came with a “tube-top” that did not fit over my head, let alone my bosom. So I was given a replacement camisole, which of course did not cover the bra straps. I was also a wee bit hot, because all that shiny fabric did not breathe. However, if I was feeling the heat, it was the dancers who also were encased in a similar synthetic fabric, who should get the most sympathy points. During the dancing, there was drumming and and singing. All of the dancers wore several rows of bells on each ankle, so as they stomped, there was lots noise. The entertainment was reminiscent of attending pow-wows in the USA.

Drumming and singing

Drumming and singing



Afterwards, I caught a moto back to Gacuriro, where we live. The girls and I were meeting the E-R family for pizza. I had ordered a cake the day before. The kind gentleman in the bakery counter had asked if it was a birthday cake. I said, “as a matter of fact, it is!” But I did not tell him whose birthday it was. When I went into Woodlands Supermarket to retrieve it, I had a surprise. For a brief moment, I thought the girls must have walked down and told them to put my name on it. But then I remembered, I had given my full name and phone number, when I placed the order for contact purposes. Good thing the birthday cake was actually in my honor. 😉

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Since it was our first time going to the Pizza Inn, and we discovered it has virtually no place to sit inside its fine establishment, so the E-R family took us back to their home where we completed the celebrations. The best part was the ukulele birthday serenade. Fun fact: there is a Mzungu (foreign) Ukulele club here in Kigali. I have now had the privilege to attend one their practices. Mei was loaned a ukelele and is practicing “I’ve been working on the railroad.”

Also, recently, the Orphan Boyzzz held their hair salon. However, we must pronounce it “saloon” like in the wild-west days, because that is how it is said here in RW, despite the spelling. The young men are really aged-out orphans about 17-19 years of age from a local orphanage. There are some good folks who are helping these young men learn a trade. One of the volunteers is S, who is an accompanying husband to one of the HRH Ob-Gyns. The young men with their Rwandan instructor set up the salon at the house we lived in temporarily. That house has always been affectionately called the “Barbie House” due to its ostentatious characteristics, not a reflection on its inhabitants. So with the girls, I spent the afternoon at the “Barbie Saloon,” getting hair color, and a haircut and a couple ladies got style and blow-outs. At the last minute Mei wanted her hair cut too. That plan had to be tabled until next weekend. I was pleased with the results and would recommend them, and use them again (as long as their tutor, who actually works for Revlon, is present). Soon enough, there will be a link with photos to their facebook page.

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On a two hour walk/bus journey to get home from our afternoon at the “saloon,” while trudging up the final hill, one of the girls reminded us to look upwards. We were rewarded with an incredible night sky. As we gazed upon the beautiful stars, one of the kids said, “do you remember the stars in New Zealand?…Do you remember how we never saw the stars in China?” Then, the hardships did not seem so hard…for a few moments, we remembered how fortunate to be where we are.

Speaking of stars, Meili recently presented her Science Fair project on the Solar System at Green Hill’s Academy. Pictured with her group-mates.


Mei and Science Fair friends

Mei and Science Fair friends





Safari Summary…

Pinch me, I am living in RWANDA, AFRICA with my two youngest daughters!!!! That’s all I could think of a few weekends ago, when we went to Akagera National Park. We were invited by the lovely D, an Ob-Gyn, her husband S, an Anesthesiologist, both who are HRH Physician Mentors, where I work.  Also, along for the adventure was their three terrific kiddos who are 14, 11 and 8, and Meili and Beau, age 11 and 14.

 We saw baboons, blue-ball monkey’s, zebras, musk ox, hippos, some other kind of monkey, antelopes, warthogs, giraffes, birds and our collective favorite…elephants. S has a fantastic video which I will upload, when he gets if from his camera into a computer.

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We drove through the park in their land-rover up and around some crazy ruts. When we were in the plains, the kids got to ride on top of the land-rover,which they found extremely appealing. Especially, when one giraffe got curiously close. The parents were calm, but there was heard form the top of the vehicle some squeals of nervous delight. Tidbit: hippos do not like the rev of the motor and will come to the surface, preparing to charge. On our evening boat safari, as the sun was setting, we found a group of elephants down to the river for a drink and a bath. We could get pretty close on the pontoon, with only some brush between us. The elephant matriarch and the Aunties flapped their ears, raised their trunks and circled up around the babies and children. We had several minutes of feasting our eyes on the wonderful beauty of these majestic mammals. Then, the patient Matriarch had enough of our prying eyes and moved forward towards the boat, telling us it was time to back away. It was so exciting and I am so happy for my girls to have seen this.

We spent a comfortable night at the lodge.  The kids got some swimming in to cool off. Mei, Beau and I shared a king-sized bed. I got up early Sunday morning to take some photos of the sun rising over the Akagera River. While doing so, I was looking directly across at Tanzania, on the opposite bank. It was quiet with only myself, a couple staff and other photographers out at dawn. As I walked back to the room, in my PJs, a lone baboon raced through the lodge area, before my startled eyes.

After a hearty breakfast, we headed out for another self-driven safari and saw more animals and birds. We had hoped to catch the leopards, but that was a long shot in the daytime.  I wanted to see some crocodiles, but no such luck. I am sure they were there, watching us, but we did not spot any. Some time in April, the Rwandan government is  releasing LIONs in the park and we plan to go back for that. Camping is allowed at this Akagera, and even with the lions, it will still be allowed. You are advised to build a big fire and make sure that it does not go out at night. (!!) Now I need to watch “Out of Africa” and “Lions of Tsavo” again, in preparation. (Which is highly improbable due to the speed of internet.)

 We were happy to get away, and see more of the country than the city of Kigali. We have some time off coming up soon and so we are looking forward to a couple trips during Genocide Memorial week in early April. We think we are going to Nyungwe Forest for some rain forest trekking. National Geographic has this National Park on their list of suggested places to visit in 2014.

In our car-less state, most of the time, we have had to learn to take the bus. Confusingly, buses are called “taxi” and are rarely marked  to where their final destination may be. So a perplexed foreigner has to walk up to each “taxi-bus” and say the name of the location I want to go and hope someone speaks enough English to direct me. There is no website to tell you where the bus goes, or where to catch it even. Even more annoyingly the taxi-bus does not leave until it is full, which means the buses are always packed. Then I have a long walk either up or down the hill from where we live. If I take a moto, which I have done, because I want to get home…or somewhere a taxi-bus does not go…I ride with fear the whole time. Motos are dangerous, in part because of the loose interpretation of driving rules and obeying the lights or signs. Not to put the sole blame on drivers, because the pedestrians contribute to the traffic problems by crossing or walking in the street wherever they so choose. Our ED colleagues firmly believe taking the motos are a death-trap. However, regular taxis are ridiculously over-priced.  So what’s a budget-conscious worker to do? Either a 1+ hour bus ride, with changes each way to most places or a risky moto ride which will be directly point A to point B? Fortunately, the girls take a school bus which comes directly to and from our front door.

So what about the Rwanda people? They are mostly very kind, very friendly and smile a lot. Today when I was waiting for an AM ride with D and S, which is a sweet deal that saves me loads of frustration with the taxi-bus. As I sat on a step by a busy thoroughfare…children walking to school would shyly greet me. The braver ones would come over and fist-bump me. I am amazed by this, as I am used to be starred at in China. Here, there is usually a smile or a “muraho, bonjour, hello” to accompany the curious eyes.

Our African“hardships” include the electricity going out as a typed this post. However, I still had a semi-cold Mutzig beer and a candle, so I was able to continue writing until my computer battery died. Being in the city, means we have less power-outages than our colleagues living/working rurally. I was encouraged to look for housing near Parliament, American Embassy or Paul Kagame’s presidential home. It was suggested they have less inconveniences than the rest of the city-folks. We live by the defense minister, so perhaps we are safer, even when we do not have electricity????

I am sorry that I can not post very often. The internet is wildly erratic and when I am home, with my USB “internet” stick, I never have enough power to post. So I must do it from work, when I have time and access to internet. There is loads to share including some more photos.

Girls like school and have friends. Both are happy. They complain about how hard it is to learn another language, despite being bilingual! Mei has three different language classes, but is doing well with French, German and Kinyrwanda. Recently, at the midwife meeting, the Matron told the staff (while speaking in Kinyarwanda), that they needed to use English when giving report, so I could understand. This caused some smiling accusations when the staff pointed it out to her that she was not using English. The Matron, is also an advanced midwifery student, although I am not her mentor. However, I did mentor her, by coincidence today when we had a G4P3 have a standing birth, perhaps one of CHUK’s very first deliveries NOT on the labor table??  Much to the surprise and (possible unhappiness) of the other staff she gave birth in an evidenced-based “upright” position. Actually, she was sort of standing and leaning over as it turns out her IV line was wrapped around the bottom of the IV pole, so while she was giving birth, she could not stand fully up. I could see this, but could not explain it well enough, in tight quarters, while helping receive the baby with a tight nuchal cord. I was tickled pink and pleased as punch to get a momma off her back, but know to the others, this looked rather chaotic. Shout-out to my HealthEast Nurse colleagues who have worked with the midwives long enough to know, that we assist women in WHATEVER position works and not what is most convenient for the staff.

More later…

Report of this and that from Kigali, Rwanda

We have been in-country for 3 weeks exactly. The girls started  rec soccer over the weekend. A physician HRH couple and their three children took us there. We learned where to buy bagels and cream cheese. Mmmm.

We are moved to our new place. We will miss our temporary house-mates, but it was time to unpack those suitcases. Plus, the nice welcome committee needs their own place back.Good news: Some cleaning and repainting done. Bad news: No hot water, no water pressure. No stove, only a two-burner cook stove. We are supposed to have both, so this will have to change or I guess we find somewhere else to live? School bus forgot to pick up the girls this AM, so I had to use a taxi to get them to school at USA prices. First world problems.

I have been working all week at CHUK hospital. It is the teaching hospital and referral center for high-risk patients. Consequently, there are not a lot of vaginal deliveries. My midwife student and I witnessed a VBAC on Friday. Later, she got to do the newborn exam. Birth at teaching hospital means that there are many witnesses. Besides the two Rwandan midwives, there was a Belgian student nurse, French student midwife, two medical students, one resident, American midwife-mentor (me!) and Rwandan midwife-student. Oh, the mother giving birth and shortly thereafter, a beautiful newborn girl.

There will be a consolidation of two hospitals maternity units, and thus, I will be changing sites or sharing sites. The other hospital had 20 term newborn babies with low-apgars/seizures /neonatal  asphyxia, in 25 days last month. Six of those  babies died, and 14 were discharged with breathing and eating difficulties. Most will die within 6 months. Two mothers died this weekend at the hospital I work at. I was not on, so I do not know what or why. Today I saw a 14 year old with a germinal carcinoma. She may or may not get chemotherapy due to challenges of logistics and the advancement of her condition. She was painfully thin, and was diagnosed and had surgery in December. Somehow her pathology report was lost “in the system.” She has ascites that makes her look pregnant even though she is not. She can not eat or drink much. She has a hard time breathing and is in pain. She could be Beau or Mia…

Last week, I accompanied Gail, who is an HRH team member, and one of the most golden-hearted people I have ever known. She and I went to another hospital because, she was taking pillows to an orphan who had nose reconstruction. He was about 18 years old and had contracted leishmaniasis. His disease was not treated appropriately and it ate away his nose. He had a large open cavity in the middle of his face. He has lived this way for a long time. An American plastics team came to town and they were able to create a new nose with skin from his forehead. As an unaccompanied patient at the hospital, without a family member to bring him food or any comforts, sweet Gail made sure that some HRH folks were checking on him. Laying in a ward with open windows, no screens, full of other patients, a loose sheet, which did not completely cover the plastic mattress. Alone and in pain. But now, with surgery, a chance at gaining the confidence to re-join the world.

“Leishmaniasis /ˌlʃməˈnəsɪs/ or leishmaniosis (/lʃˌmnɪˈsɪs/ or /lʃˌmænɪˈsɪs/)[1] is a disease caused by protozoan parasites of the genus Leishmania and spread by the bite of certain types of sandflies.[2] The disease can present in three main ways as: cutaneous leishmaniasis, mucocutaneous leishmaniasis and visceral leishmaniasis.[2] The cutaneous form presents with skin ulcers, while the mucocutaneous form presents with ulcers of the skin, mouth and nose and the viceral form starts with skin ulcers and than latter presents with fever, low red blood cells, and a large spleen and liver. Leishmaniasis occurs in 88 tropical and subtropical countries.Leishmaniasis is found through much of the Americas from northern Argentina to southern Texas, though not in Uruguay or Chile, and has recently been shown to be spreading to North Texas.” from wikipedia.

The labour ward at the hospital I am currently at, consists of a row of beds, some with curtains, most without full privacy. The delivery ward is across the aisle and has with 4 delivery beds. The “room” is really sectioned off like office cubicles and is the size of a small medical consultation room…except the walls don’t go to the ceiling.  The beds are more like an exam table, the woman can not fully extend her body.You get one sheet and it does not even cover the bed. If you want anything to cover yourself, you better bring it with you.

Most places in the hospital have no running water. The toilets flush with a bucket. How does one expect aseptic technique when you can’t wash your hands or there is not enough sanitizer? So what is good? Most mothers breastfeed. Kangaroo care is the norm in the NICU when baby is stable. No epidurals. The RW Ministry of Health recognizes the need to train more medical staff and improve the quality of care provided in its health care system.

I should have remembered more of my French since many/most of the staff speak French and all speak Kinyarwanda. What I can say in French, I can say very well. Unfortunately, this will cause a paragraph length of a response and me standing there looking like an monolingual idiot. People were educated in the French language before the Genocide. After the Genocide, English. So the younger people are learning English. The Rwandans prefer British English instead of American English. A fake British accent does not help. (Not that I have tried!) Even our wash machine knobs and settings are in French. Oh Madam Schmeiling (sp?) from Pius X High School in Lincoln, Nebraska, I should have “ecouted” a lot more. Speaking of listening and learning, Mei and Beau are both learning French, Kinyarwanda and Mei even has German! I am so happy to hear them complain a bit about learning another language, because they had previously not been so compassionate about my poorly pronounced Chinese. Ha! Know they know how the rest of us mortals feel about learning another language.

Living with two of my children in Africa has made me braver and more cautious than I can adequately explain. It is physically and mentally a challenging environment and yet, we are happy to be here. It is a wonderful opportunity for the three of us. Tonight as Mei and I walked around our new neighborhood and watched the sun set over Mt. Kigali, we had a moment to think: how cools it this??? We look forward to some travels when time allows. Wishing/hoping for some company to share it with. Who has not imagined seeing elephants, giraffes and zebras in the wild? What about those famous Dian Fossey gorillas??? Who else grew up watching (bad) Tarzan movies, Mutual of Omaha’s “Wild Kingdom” and of course, read National Geographic cover-to-cover? Did you know the 60’s dance craze: “Do the watusi” was referring to Tutsi’s? Well, that bit of trivia relates to a whole other topic of the Genocide. The 20th Anniversary is next month. Some time, I will write about that.

For your enjoyment, some recent photos:

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Muraho (Hello) from Kigali, Rwanda

Beau, Meili and I are now living near the Equator in Kigali, Rwanda.

I have joined the Human Resources for Health (HRH) program as a midwife-mentor faculty from NYU.  I am committed here through July 31st, 2014. On the ground are about 100 other HRH medical providers. Our sponsor schools include:

Medical Degree

  • Albert Einstein College of Medicine at Yeshiva University
  • Rhode Island Hospital at Brown University
  • University Medicine Foundation at Brown University
  • University Emergency Medicine Foundation at Brown University
  • Columbia University
  • Duke University School of Medicine
  • Geisel School of Medicine at Dartmouth
  • Harvard Medical School
  • Brigham and Women’s Hospital
  • Boston Children’s Hospital
  • Beth Israel Deaconess Hospital
  • University of Texas Medical Branch
  • University of Virginia School of Medicine
  • Yale School of Medicine

Nursing Degree

  • Duke University School of Nursing
  • Howard University School of Nursing
  • New York University College of Nursing
  • University of Illinois at Chicago College of Nursing
  • University of Texas Health Science Center at Houston
  • University of Maryland School of Nursing

Health Management Degree

  • Yale University Global Health Leadership Institute

Oral Health Degree

  • Harvard School of Dental Medicine
  • University of Maryland at Baltimore

It is a pretty amazing group of people. Mostly, we are Americans, but throw in an Australian, Irishwoman and German and we are all working together to improve the quality (and quantity) of medical providers in Rwanda. I have been to my hospital a couple of times and met some of the staff. I will have a Rwandan “twin” who speaks English, Kinyarwanda and French. Historically, people spoke their main language and French, but those younger than 20 have been now educated in English. Some of the challenges will be language.

We have graciously been temporarily “homed’ into  a house-share group of HRH staff. One of whom, Rondi Anderson, CNM was a mentor to me, when I was trying to decide if I should go on for additional schooling and become a CNM. For you midwives, Rondi was a CNM attending homebirths for Amish, Old Order Mennonites in Lancaster, Co. Pennsylvania. In fact, Rondi had bought the practice of Penny Armstrong. Anyone remembering reading Penny’s book: “A Midwife’s Story?”

Everyone has been instrumental in welcoming us, orienting us and providing for much-needed support in how to navigate the confusion of moving to a developing country. Trust me, I have been despairingly lost, overwhelmed and tired. The heat, (although not as hot as Hangzhou), combined with the altitude (like Denver), combined with lots of walking on hills has taken lots of energy.

Today, we put our rental deposit on a duplex (multi-plex) where we will be living. It is the suburbs of Kigali, and there are other American families with children nearby. The place is located close to the girls’ school, but not close enough to walk. It has three bedrooms, which is nice, so that we can have visitors (hint, hint).

The girls will be attending Green Hill’s Academy, and international school which has children from 40 different countries. The cost is reasonable, which makes this schooling option closer to the “cultural exchange” we had hoped for in China. Speaking of China, we left Zane there to make his mark on the world. Mia went back to the USA directly from China before Christmas. We miss them both, as well as our other family members and friends. We are grateful for the friends we left behind in China and the new ones we are making on this great continent.

Why have I not included lots of photos of all the amazing things I have seen?? Well, it is more intrusive to pull out a camera here. There is much poverty. There are people who only eat once per day. Due to that, cameras, cellphones and computers are hot property and it is risky to take them out where they are seen. Also, it is has never seemed appropriate to take photos…although, I hope that will change. There is much to see and share!

Chinese New Year & The Grand Canal & Our Lady


Mei and Beau outside our apartment complex after we let off our own firecrackers

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CNY in China is exactly like what we heard…days and nights of firecrackers and fireworks. For the most part, Hangzhou has been shut down for the holiday, which lasts several days. By law the CNY holiday is a 3-day legal holiday which started on January 31, through February 2nd. All the little shops below our building, where we get our bread, milk, vegetables, mom’s favorite lemon drink (all found at different places) have been shut down for several days. Zane had to work at his place of employment, but I was off work for 5 days, because my translator was away with her family to celebrate. The girls and I went to my work for a delicious meal with co-workers that evening, then walked home to the tune of firecrackers. Unfortunately, it was a “bad” air pollution day already, so we did not have quite the view we had hoped. We went up to the roof of our 24 story building to look out. The weather was unseasonably warm to our delight.

Travel for CNY is the largest mass migration on earth and it happens EVERY year! We did not join the frenzy as we were cautioned not to, in part, because all the sites would be crowded or closed.

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Oh but some things never shut down…like Walmart and Starbucks. When walking behind the Walmart and mall, we were delighted to find the station for the “Aquatic Bus.” I have wanted to take a boat ride on the Grand Canal to soak up 2,500 years of the historic usage. I was even more delighted that we found the “locals” version, instead of the tourist boat. Our trip was a glorious one-hour ride, and the weather was 77 degree F; we ended up at the famous “Hangzhou Tower” area. That is the place where people go looking for Armani and Gucci-type stores. Name brands are very popular in China, if that fits your budget.

The Cathedral of Our Lady of the Immaculate Conception (圣母无原罪主教座堂) is a Roman Catholic Cathedral, located at 415 Zhongshan Road North (中山北路415号) not far from Wulin Square (武林广场) in downtown Hangzhou, China. Since it is the only Catholic church currently in service within the city of Hangzhou itself, it is also known simply as Tiānzhǔ Táng (天主堂) or “the Catholic church”. The current cathedral in Hangzhou, dedicated to Our Lady of the Immaculate Conception was originally built in 1661 by the Italian Jesuit Martino Martini, and is still one of the oldest churches in China. (wikipedia)