Clinic-wide Meeting

Last week, we had our scheduled meeting led by Dr. Gilbert, Edmond and myself with all the nurses, Abel and the psychosocial team to discuss the Family Needs Assessment.  My main agenda for the meeting was to get clarification as to why this data was collected and try to tease out nurses’ and counselors’ ideas on what information could help them practice better.  I know that we could make correlations from the data that we already had, however, I wanted to gain the team’s perspective to better direct my analysis and suggestions.  They answered my questions patiently (although it was 2:30-4 on a Thursday, so people were ready to go home) and we were able to determine several areas of focus for small group sessions.  These areas included substance abuse, child abuse, HIV stigma and being an orphan.  Edmond presented an explanation as to the current state of the government-funded social services in Rwanda and we discussed whether or not WE-ACTx would benefit from using these.  Since it looks like the funding is limited and most social services are only for temporary problems, there is not much support.  One option is to search for NGO’s addressing social issues preventing ARV adherence in Kigali and forming relationships with them.

In addition, we discussed whether or not it would be valuable to organize small focus groups of children under the age of 18.  It was agreed that children are more honest without their parents present and asking them about our four areas of focus in this setting could be very beneficial.

We all agreed that the next steps for the remaining 4 weeks are to determine children for the focus groups and perform the sessions in Kinyarwanda.  To do this, we will need a psychosocial counselor, either Laetty or Henriette, present in addition to a translator. 

Since all the counselors are off work this week for a training, I spent my time composing a list of Focus Group questions, translating the remainder of the speadsheet data with Augustin and arranging a meeting for next week.  In the meantime, I began working with our data analyst, Jackie, to gather data on patients that we still need viral loads for in order to use it for any correlations or deductions regarding ARV adherence.

Happy Independence Day, Rwanda!

This is the agenda I composed for our meeting.

Laundry

I tried to wash my own laudry this morning.  Josie, one of our housemaids, was out visiting the doctor for her cough.  Going on a long hike this weekend, I needed my clothes washed and dried by tonight in order to pack them.  With the sun as the only form of a dryer, I knew that the clothes needed to be washed and hung by midday in order to dry in time.  As I paraded my clothes through the kitchen and dumped them into the cement basin, Serafine (our cook) followed curiously.  No sooner had I turned on the water and made my way towards the shed in search of laundry detergent than I heard my name repeated in haste.  

"Stephanie!  Stephanie!"  Serafine called out.

"Abey?" I inquired back in Swahili.

"I will do it."  She said and without asking her what, I knew exactly to what she was referring.

"No, no, no. I can wash my own clothes," I insisted.  "I know how to do it," I said as I wandered back over to the tub filled with my clothes.

"Oya!" she exclamed, switching to Kinyarwanda to emphasize the "no!"

"Serafiiiiiiiine..." I pleaded.

She went in search of the laundry detergent as I placed my clothes in the basin and let them soak up the cool water.  After finding no detergent, Serafine sprayed in dish soap instead and I swoshed it around with my undies, shirts and bras.

"Leave it.  I will do it," she repeated.

I tried again to wash my own clothes, begging and explaining to her why I wanted I was insisting on doing Josie's job.  As I began scrubbing one of my orange sports bras, she put her arms around my waist, pulling me in for a hug.

"Leave.  We will do it."  A victim of her loving embrace and relentless insistance, I pulled my hands from the soapy water and back away.

"Okay.  Thank you."  Slowly, I walked guilitily away.

She is certainly a wonderful mother and the most strong of women, so I had to respect her commands.  Later, when I asked her for a picture to add to this story, these resulted(per her idea...):

I promise that I'm laughing...not scared. :)

Climbing Mt. Kigali

On Sunday, Lizzy and I decided to be explorative.  We set our sights on climbing to the top of Mt. Kigali, a pretty little bump in the wavy landscape surrounding Kigali town.  Seen here in the background from our clinic, it was about a 20 minute bus ride from the bus station in the middle of town, Mimoji, which is about a 30 minute walk from our house.  After hopping off somewhere close to the base of the mountain, we began winding our way through narrowing streets, eventually walking next houses (or sometimes into them).  Children would wander after us and peter off after a few minutes.  Eventually a teenage girl jokingly offered us some of the corn that she was eating and, sticking my hand into her yard, happily accepted it.  Munching and meandering, we made our way up and up and up.  After about 45 minutes of attempting to find a path to the forest that topped the mountain, we came across a promising one.  Barely visible but still frequently trodden, we crunched our way through the leaf-covered ground, sliding backwards on the tiny rocks and layers of leaves. 

View just after passing by the last of the houses.

 As we climbed, the herd of children and teens following us morphed into only two boys (11 and 12 years old) and one kid named Erik (22 years old).  Between our blind intuition and the three of them, we pieced together a path to the peak.  As the top, we crossed a dirt road, passing by some guys leaned against tree trunks and another chatting it up on his phone.  After 50 meters, the forest opened up into a vast, cascading plain allowing glimpses of the mountains that sprung up between the road to Gisenyi in the West.  Barely visible along the skyline was a double peaked mountain that contained a volcano in Virunga National Park in the DRC.  We relaxed, shared some biscuits and took some jumping photos.  We are wazungu after all!

The hike down took about an hour and was punctuated by Lizzy's first taste of sugar cane.  We bought a whole branch for 100Rfr (15 cents) and gave some to the boys, Erik, and one of his friends that passed by.  The mama selling it laughed as we attempted to eat the sugar cane as readily of our Rwandan company and agreed to take a photo with these highly  incompetent wazungu.

The day ended with us exhausted, a bit sunburnt and hopping on motos as we waved goodbye to our new friends and sped home for water and libations.  

Worthwhile random adventure!

Umuganda

Saturday, June 25th, was my first (and only) Umuganda day in Rwanda.  Umuganda is a national-wide morning of community service that occurs on the last Saturday of every month.  You can read about the fascinating history and meaning of Umuganda here. 

John, our gardener, woke us up with his booming voice and fervent gestures that morning, insisting that we join in the work being done.  Happy to see another side of Kigali, I threw on clothes and harassed Lizzy and Kerrlene into coming with (just kidding, they actually volunteered quite readily).  We hiked down the winding road for 15 minutes, led by two Rwandans John had arranged for us, before encountering a group of 20+ Rwandans and wazungu lined up along a brightly painted wall outside a coop and one of our favourite cafes.  The wall was being painted with a massive with the more complicated portions already sketched or painted in.  We picked up plastic cups full of varying colors of paint and washed off some paintbrushes.  After a few hours of painting triangles, rhombuses and frilly swooshes, in addition to a plethora of conversations in Swahili, we hiked back up to the house.  In other places of Rwanda, people were picking up trash, shoveling clay and trimming bushes.

From about 8am until 11am on Umuganda, all buses cease running in addition to any form of transportion.  If you are caught on the road without a valid reason, such as catching a flight, you will be stopped and fined.  The city was mysteriously quiet as people either wandered down the road in search of work to do, or hid in their houses and performed the Umuganda for themselves and their families.

Lizzy, Kerrlene and I next to a mural that we didn't actually paint.
Our colorful, albeit basic, additions are further down the wall.

WE-ACTx Vs. WE-ACTx For Hope

After three weeks here, I was finally corrected on the difference between the terms that I'd been using interchangably: WE-ACTx and WE-ACTx For Hope.  Here's the difference:

WE-ACTx

WE-ACTx is an international NGO started in 2004 that currently raises money and awareness about HIV/AIDS in Rwanda.

WE-ACTx For Hope

WE-ACTx For Hope is a local NGO that branched off from WE-ACTx to serve as its own entitity and continue to provide clinical and psychosocial services to HIV positive patients in Kigali and Nyacyonga in Rwanda.

Ineza Cooperative

Ineza is a women's cooperative in Kigali selling handmade items ranging from backpacks to bookmarks, elephant dolls and table runners.  Their quality is amazing and these women really know how to work the foot pedal sewing machines like nobody's business!  Kerrlene and I went for a visit to their workshop in Remera this week after work.  Here is what I saw, including their room full of bags, purses and ties.  Kerrlene was even shown hwo to sew, since she recently had the women make her teddy bear a full outfit, hat included.  Now, she had a matching handband.  Yes, we are most certainly grown ups.  :)  Ineza cooperative partners with a local NGO, Hands of Mothers (Manos de Madres) to help sell their beautiful things at shops in Kigali and fairs in the States.

Wazungu buying some of the beautiful handmade stuff.

Here's their website: https://inezacooperative.wordpress.com/

Nyacyonga Again

Nyacyonga Clinic

Yesterday was my second visit to Nycoyonga, the slightly less urban clinic that WE-ACTx For Hope partners with to assist in providing care once per week.  I traveled with Edmund, our trauma counselor, and Dr. Gilbert, our clinic doctor.  It was my turn to shadow Dr. Gilbert was he finished some patient consultations.  He saw 6 patients in total, with concerns ranging from chlamydia to pelvic inflammatory disease (PID).  His adviced also ranged from giving antibiotics (Deoxycycline) to going to the closest hopsital for X rays and blood work.  

One of the HIV positive patients came in because he recently had a Rapid HIV test at a different clinic that came up negative.  This man had been HIV positive for 10 years and on ARV's for 8 years.  His wife was HIV negative, so they are considered a discordant couple.  He wanted to talk to the Dr. Gilbert because he wanted to stop his ARV's since he had now tested negative for HIV.  His wife was also encouraging this.  Dr. Gilbert was explaining the mechanism of action of HIV and why, even though he still have HIV and needed to take ARV's, the test had said he was negative.  Thus, he left choosing to remain on his medication and glad that he had consulted the doctor.  Smart man.

Dr. Gilbert setting up in one of the offices.

Edmund, me, Dr. Gilbert and Chantal.

Random fact about Dr. Gilbert:  While working in Partners in Health (PIH) in Rwanda before he joined WE-ACTx, he worked alongside Paul Farmer multiple times, who also taught him how to perform a lumbar puncture at one point.

Random fact about Edmund: Before becoming a trauma counselor, he was a self-taught professional photographer.  He used to photograph weddings and other events (which explains why the lighting on this photo is way better than my others - he helped us figure it out!).