These are my experiences and adventures in Kigali, Rwanda working with WE-ACTx on research from a family needs assessment and shadowing at their local clinics.
Here is a quick tour of the wonderful house that WE-ACTx has rented out for us to stay in. It is located in Kiyovu, one of the fanciest, if not the fanciest place in Kigali. The President of Kigali, Paul Kagame, is basically our neighbor. My housemates include Lizzy, a pre-med undergrad from Pennsylvania, Kerrlene, a graduate student at Tufts (Fletcher!) and Cari, a Peace Corps Response volunteer.
Downfall of such safi digs? The moto taxis always try to charge way too much. Le sigh. #WazunguProblems
We were blessed enough on Sunday to be invited to WE-ACTx For Hope's celebration of African Child's Day (or International Day of the African Child, as Wiki calls it). African Child's Day is a holidy on June 16th that celebrates the rights and
importance of children in Africa. While it was started in honor of the children injured in the Soweto Uprising (in South Africa), it is celebrated all throughout Africa to bring awareness to the need for children's education and services.
We arrived just as the band was setting up (and rehearsing a phenomenal cover of “All of Me” by John Legend) and chatted with many of the Musicians Without Borders staff, including their community leaders that serve as teachers here and in farther villages. As the ceremony commenced, our eyes was blessed with an onslaught of singing, dancing, poems, skits and even a fashion show. The videos and pictures will do a much better job telling the story of the celebration than I ever could. Enjoy!!!
Here are some videos of the phenomenal dancing and singing that was performed:
On Saturday, Lizzy and I walked to the Kigali Genocide Memorial Museum. It was about an hour walk from our house but a great excuse to meander down the dirt streets that are so frequently avoided by wazungu in Kigali and snoop around MiniMarts that sell the million types of buscuits I was addicted to in Tanzania.
Upon reaching the museum, we were guided into a 5 minute movie with brief interviews of Rwandans who had experienced the genocide and their feeling behind the construction of a memorial. Kigali Genocide Memorial Museum(called Kigali Memorial by the locals) was built in 1999 to explain the
genocide, provide a final resting place for those who were victims of the
genocide and, serve as memorial that friends and family members could visit for
prayer and peace.
Although the museum is free to enter, you need to pay to
take pictures ($20) or listen to a guided recording ($15). Well-organized and staffed, the museum leads you step by step through the events and propoganda that brought about neighbors killing neighbors, friends killing friends and entire families being wiped up over a span of 100 days. The numbers are staggering - some 2,000 people per minute were murdered. The international community not only failed to act, but when they did, they inadvertently (or some may argue advertently) exaccerbated the situation. More than 250,000 victims are buried at the Memorial Museum.
As you move from display to display, you see quotes, pictures, stories, videos and remains of the casualties that lost their lives in the tradegy. One room consisted of hanging clothes, rows of skulls and piles of bones (not unlike the museum at Auschwitz) that provide even a meager glimpse into the sheer horror and magnitude of what happened in 1994. The current belief is that over 1 million people (mainly Tutsi but some Hutu's as well) were slaughtered during the genocide. Today in Rwanda it is illegal to say the words "Tutsi" or "Hutu" or identify people based on their ethnic group.
Family and friends gather around the coffins and pictures at a service of several
genocide victums who are about to be buried at the Memorial Museum.
Lizzy and I recorded our reactions to the museum in this brief video.
My day was spent shadowing our clinic lab technician,
Abel. Not only is he a phenomenal technician,
he is a great teacher and freely explained how he goes about testing for HIV
and malaria. Since today was Friday, the
WE-ACTx for Hope clinic conducts free HIV testing for anyone who wants to be
tested. Today there were 5 patients were tested. There are a series of 3 different tests that are performed, with the first being the most sensitivity and the last being the least. The Screening test is done is Rapid POC (point of care) HIV test labeled "CG" which stands for "Colloidal Gold". The Confirmatory test is a "Det" which stands for the "Determine HIV 1/2" test. Lastly, the Tie Breaker test is called "Unigold".
If the first 1 "Screening" test is negative, or the "Screening" and "Confirmatory" tests are both positive, then the third "Tie Breaker" is not performed. However, if there is a discrepancy after performing all 3, the samples are taken to the national laboratory and an ELISA test is done.
Abel, our lab technician, records the results of the HIV testing for today.
In 2014 and 2015, counselors from WE-ACTx for Hope administered a Family Assessment Survey to individuals who
were parents of a child under the age of 18 who was being treated at the
clinic. The counselors orally
administered a paper survey in Kinyarwanda, the national language, and the data
was input into an Excel spreadsheet for analysis and utilization. The clinic wanted to survey HIV positive parents about their
children who were 18 years of age and under to determine what familial or
social factors they find amongst participants and possibly draw correlations
between these components and ART (antiretroviral therapy) adherence.
I spent a large portion of Tuesday reviewing the data with 2 counselors at the clinic. It is compiled from a massive Excel spreadsheet into organized graphs based on different components of the survey, including demographics, family and income level.
Today was spent shadowing a nurse while she went through her patient consults (encounters) for that day. I'm finally starting to figure out the whole process! Here's what I've determined so far: 1. Patient checks in to the Reception area with their HIV Tracking booklet and insurance card. 2. Patient is given a number and their chart is pulled.
Each patient chart (Fr: Dossier) contains a colored dot that corresponds to one of the nurses. Each patient has the same nurse each visit (unless their assigned nurse is on leave).
3. Nurse is given stacks of patient charts in the order that she should see them. She then calls patients in one by one.
Depending on the number of nurses present (there are 4 but on average 3 are present each day) and the number of patients, nurses see anywhere from 20-40 patients per day.
WE-ACTx averages about 1,800 patients per month.
4. Nurse screens for TB and STI's and takes the patients weight to monitor BMI.
A positive screening for TB is indicated if the patient reports any of the following:
Productive cough
Fever
Weight loss
Decreased appetite
Vomiting
Fatigue
A positive screening for STI is indicated if the patient reports any of the following:
Gential discharge
Genital itching
Lower abdominal pain
5. Nurse evaluates patient's adherence and educates them if necessary.
6. Nurse records patients visit in their chart (Dossier).
7. Nurse also records current visit date and next visit date, in addition to any changes in medications, in each patient's HIV Tracking Booklet, Kubonana na Muganga (see below!).
This is where HIV positive patients track their current
medications (prophylaxis, ARV's) and appointment dates.
8. Nurse gives patient a prescription for their ARV's, Bactrim and any other complaints.
Patients today also complained of sinus infection, cough and possible pregnancy.
9. Patient goes to lab for any tests, pharmacy for medications (including ARV's) and reception to check out.
10. Patient completes a guided research assessment with one of the staff about their family members and whether or not they've all been tested for HIV.
