Rwanda-- Week 3 and 4

Update: We spent our third week at the hospital in the maternity unit, and this is by far my favorite unit to be in. Claire says the same for herself as well. It is an exciting unit with something always happening.

Roughly seventy percent of women in Rwanda give birth in health centers in this country (as opposed to in their homes), and there are about four hundred if these facilities nationwide. If a woman is high risk or is experiencing complications, she is transferred to a district hospital, and those are the patients that we see here.

During the week Claire and I observed quite a few births (about three per day). Compared to the US, the equipment here is very limited, but they do their best with what they have, and the nurses’ and midwives’ education is increasing with teachers like Leslie.

Felix is the student midwife who became our designated supervisor for the week, and he is always sure that Claire and I are not only learning, but also practicing what we learn. There are a lot of midwifery students on this unit so it is a good learning environment. We also sat in on some of Leslie’s midwifery lectures which we enjoyed very much. She is a great professor!

In the morning, we spend time with the mothers who are laboring if they are struggling to remain calm, and we make sure to give much attention to mothers who may be ready to deliver a stillborn child.

The labor room is small and full of beds, so it gets hot quickly with many people in this small space, especially with no fans and no breeze through the opened windows. Despite the heat and smell of sweat and urine, it is good to be with these women to massage their backs or give them a drink or hold their hand (or catch them as they are passing out, as I had to do our second day on the unit!), since they are otherwise alone to labor in a room full of other laboring women as families are not allowed to be with them except to bring food and water.

The nurses and midwife on duty continually do rounds to keep check on the fetal heart rate and the progress of the mother. The first day I was having trouble hearing the fetal heartbeat through the fetoscope, but I was very excited the next day when I counted accurately the first time listening to a heartbeat.

When a women is ready to give birth, she goes across the hall to one of the three delivery rooms. It is common here in Rwanda for many complications to occur in childbirth because there is a lack of antenatal care. Because of this we have witnessed a variety of situations. Some things we observed and learned how to do this week are:

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•      Under what circumstances to put the mother on oxygen during labor
•       When a mother needs an episiotomy (far more episiotomies and C-sections are performed in Rwanda than necessary, so this is a point of needed education here)
•       When a baby needs to be assisted in birth by a vacuum suction
•       How to get a baby to start breathing if it is not doing so immediately after being born
•       How to do a full infant examination after birth
•       How to apply eye cream and give a vitamin K injection to the infant
•       How to deliver a placenta and check that it is all in tact and no pieces have been left in the uterus
•       What medicine the to give the mother to prevent and stop hemorrhaging

Highlight of the week: Doing a lot of hands-on learning in the maternity unit this week, and learning a lot from the students and Leslie.

Leslie took us down the street to the Rwamagana School of Nursing and Midwifery for a tour of the campus. There are about three hundred students, two hundred of which live on the campus. It is a beautiful place, and they even grow their own food in big gardens, and they have cows which the milk to make chai tea and they also sell it.

On our second to last weekend we went to lake Kivu in Gisenyi with Emily, Shami, and Babu. It is so beautiful and relaxing there, and it was nice to be in the fresh air and get out of the city for a day!

Our last weekend, we went to the rainforest at Nyungwe National Park to camp overnight and go hiking. No wonder it was named one of the top twenty places to visit in the world! Breathtakingly beautiful, high up in the mountains, we were completely surrounded by forest for miles and miles. Sounds of birds and chimpanzees echoed in the forest. We were so happy to have experienced this beautiful part of Rwanda.

Challenge of the week: Passing people on the sidewalk! I was laughing about this with Emily and Shami, because people don’t walk on the sidewalks here the same way they drive on the road. People tend to walk in crowds on the sidewalk and don’t move out of the way or make a single file when people are passing in the opposite direction. Even when one or two people are walking towards us, they usually walk down the middle of the sidewalk or even on the correct side, but quickly switch sides before passing. It makes for a very attentive walk anywhere, as you are constantly dodging people at the last step or passing crowds on the road. You’d think it would be simple enough to use the sidewalk the same way you drive, but for some reason that doesn’t work here.

Humor of the week: Claire and I spent our last day in Rwanda in Kigali with Babu, wandering around town exploring and getting things that we wanted to bring home. It had been such a successful trip with no casualties, but of course, on the last day, we lost two important things: Claire and my iPhone. Thankfully, at least we got back the more important one!

At the end of the day, we were taking motorbike taxies from town back to the bus station to go home. Babu told the moto drivers that we would stop at one store along the way, but only my driver and his heard the message, Claire’s did not. So we stopped, and when Claire kept going, my driver said that he told him where to take Claire (our final destination). Well that wasn’t the case, so Claire’s driver began looking for us and finally came back to the store where we stopped, after we had already left. When Babu and I arrived to the bus stop and didn’t see Claire, I slightly panicked but realized that Claire had my bag with my phone in it. Babu called her and although she was in a slight frenzy, Babu calmed her and told her to get a moto and tell him to bring her to the Eco Bank where we were waiting. After some confusion with which bank and six motos all surrounding her, Claire jumped on one and hoped he would bring her to the right one. Babu and I had a great laugh at this now that we knew she was safe. I tried to get out all my laughter before she arrived. That didn’t work. I’m still laughing about it.

We got on the bus, and somehow by the time we got off and walked the rest of the way home, my iPhone was gone. It’s totally gone, and I have no idea how. But that was our only casualty this trip, so I’d say it went pretty well!

Claire and I are so thankful for this experience we had in Rwanda— in Rwamagana at the hospital, in Kigali, at Lake Kivu in Gisenyi, and in the rainforest at Nyungwe National Park. We want to again give a special thank you to all of our friends and family who supported us and made this trip possible. It is a time we will never forget!

I have pictures of our last week at the hospital with Leslie and the students we worked with, but they are on Leslie's camera and I have not obtained them yet!

Shami and Emily keeping it cool at the lake

cloudy day a the lake

the library at Rwamagana School of Nursing and Midwifery

personal cellphone holder for the midwife (Felix here) when sterile or soiled gloves are on during a delivery

Outside the house with Giselle, our new Rwandese sister 

Claire and I on the canopy bridge high above the rainforest!

Emily and Shami enjoying the view from the canopy bridge

Rwanda-- Week 2

Update: We are spending our second week at the hospital in the C-section unit. This unit has twenty-four beds, and it usually stays full, sometimes two women having to share a bed. This week we have been taking vitals as we did in the pediatric unit last week, but we also are taking blood pressure which we could not do last week since they do not have child-sized blood pressure cuffs. We are also learning how to clean the incision wound of the post-op mothers and how to check if it is infected or healing properly. The head nurse is very good at teaching us how the nursing care in this unit works, and one nursing students, Vincent, has been particularly kind in showing us what to do and explaining to us what he doing, whether writing a report, drawing blood, starting and IV, or giving an injection.

Highlights of the week: I’ve learned many Kinyarwanda words now! Well, I know thirty-five words/phrases, which is not enough to really communicate, but I can do such things as greet and thank people and ask the bus man where the bus is going. I began learning when I came in December and since then have been practicing. Babu has been my faithful teacher and Mama, Emily, or Shami help when we are confused with spelling and such (yes, it’s a hard language that even fluent speakers can’t always spell it…). But each new word learned is great excitement for me.

Leslie is also a highlight of the week. She is a midwife from the US who has been here in Rwamagana for a year now, working as part of a team doing a seven year program to bring better education and care for the mothers and babies of Rwanda. She has taught us a lot about the conditions of the medical care in Rwanda and how she is working to improve them.

Challenges of the week: Getting on the bus. Yes, just the act of getting on it! Local buses which remain in the same city or town are no problem. However, buses that go from city to city are another story. For the weekend, Claire and I took a bus from Rwamagana to Kigali, and the problem is that the bus companies sell more tickets than seats. I did not realize this, nor that the seating is not a first come, first serve. It’s a crowd of people literally pushing and shoving each other over in order to get into the bus. I’ve never intentionally pushed a stranger out of my way before, and at first I was conflicted. As I saw Claire disappear onto the bus, I knew I had to push as hard as I could or I wasn’t getting on. I don’t know why they do it this way, but they do, and it only took me one time to learn how it’s done. I’m now becoming an expert at stranger-shoving at the bus stations, while being conscious of my backpack due to the fact that bus stations are the prime location for pick-pocketing.

My watch. In order to hold the stethoscope with my right hand and look at my watch at the same time, I have to wear my watch on my left hand. Even though I’m right handed, I’m a weirdo and have always worn my watch on my right hand. A minor change, but I am not quickly becoming used to it.

Our water bottles reek! Something in the water here in Rwamagana makes them smell so badly that I have to hold my breath while I drink, and this is with washing it with bleach regularly. At least we’re not getting sick from whatever it is that is making them smell so badly.

Humor of the week: this is actually something that happened last week, but it is a story that we are still laughing about. The first day of work it was pouring rain, but we had no choice other than to walk, so out in the rain we went. Not five minutes later, we heard someone running up behind us but we attempted to ignore him. He came up to the left of Claire and it seemed as though he was grabbing for her bag. Claire jumped towards me and shouted very sternly at him. He stepped back quickly and began explaining to us something in Kinyarwanda and he was pointing towards the house. We smiled and told him that we are fine to walk in the rain and that we are just going down the road to the hospital. All three of us were confused but Claire and I assumed that he was offering us a bike taxi or an umbrella or raincoat and went on walking.

Later on that day when the house boy let us in, it was he who was the one chasing us that morning! Our host mother, Odette, had sent him after us to let us know that she could give us a ride.

Odette owns a restaurant in town and she took us there for lunch that day. We were walking from there to the house before going back to the hospital, and on our way we noticed someone chasing us down again. This person knew English and told us that we have gone too far and pointed to the road we had just passed. He was a server at the restaurant and told us that Odette had seen us walking the wrong way and sent him to redirect us. These poor people chasing us around, being so kind and caring for our wellbeing!

Last Friday after morning rounds, one of the med students told us we were going to a “nursing ceremony” and that Claire and I were to come… we tried to inquire what this ceremony was about, but we didn’t get any clear answers. So we walked for about thirty minutes to the health center, which we found full of doctors, nurses, and midwives. We saw Leslie there, and she told us this was a gathering to celebrate nurses and midwives, and to talk about the history and future of their roles in Rwanda. We sat through speech after speech (all in Kinyarwanda) which were each separated by a few minutes of traditional Rwandan dancing. They had told us the ceremony wouldn’t last long… the room was hot and crowded, and we had not a clue of anything being said. About three hours later it was finally finished, and we got to walk all the way home in the mid-day heat. At the time it was not comical, but looking back now it’s quite funny!

     Our walk to the hospital from the house. The buildings ahead on both sides of the road are bilingual schools, and the children like to shout greetings to us each time we pass

 The center courtyard of the hospital. the wards surround this area in a circular configuration 

The bright sun shining into the pediatric ward. I am in the back half of the ward, looking into the first half, with the nurses office behind the yellow walls on either side

 The medical students we worked with during the first week. From left to right: Francis, Everest, Claire, Leonet, myself, and Franc. We learned so much from these students and enjoyed working alongside them

 

 Operation Laundry

Once a week we are becoming better and better at hand washing our clothes.

The picture on the bottom right is of Claire pretending to have to beat her white uniform "clean" against the dirty rocks... it was a joke with a friend before we left that we would have no way to clean our clothes properly so our white scrubs would be brown when we returned

Rwanda-- Week 1

Muraho! Greeting from Rwamagana, Rwanda.

Claire’s and my first week here has been an adventure. Each week I hope to share a small update, a highlight, a challenge, and something comical that has happened from our experience here.

We arrived Thursday night and spent the weekend in Kigali with my sister Emily, her finacé Shami, Noel, and Mama Nyanja and Babu (our friends with whom we stay while in the city). We were able to adjust to the time change quickly (really no jet lag at all- we are becoming experts at this!) and we enjoyed adventures around the city to exchange our money into Rwandan francs and go to the outdoor market to buy vegetables and fruit. I was also so excited to go back to Emily’s church which I very much enjoyed while visiting in December.

On Monday we were ready to go the Rwamagana Hospital (about an hour from Kigali) for our first day to become orientated and see where we would be doing our rotations. This is a government hospital and it has an ER, a pharmacy, a mental health ward, an outpatient ward, a physical therapy ward, a surgical ward, an internal medicine ward, a maternity ward, and a pediatric ward.

Although they mostly speak Kinyarwanda and French, the doctors and medical students know enough English to communicate and they are very welcoming. We learned that this is one of the four teaching hospitals in Rwanda, and we are thankful to be in this learning environment where the nurses and doctors want to help us learn and achieve our goals.

Update: This first week we have been working alongside three Rwandan nursing/ medical students who are on rotations in the pediatric ward with us, and they speak English very well. They taught us how they fill out the nursing care plan for each patient on a daily basis, how to take vital signs, and we learned what it sounds like through a stethoscope when a patient has pneumonia or asthma. We also learned how to read an x-ray to check if a patient has tuberculosis.

The most common illnesses that the pediatric patients present here is malaria, malnutrition, and pneumonia. Cases of cleft lip and palate are also present.

Highlights of the week: Rwamagana is beautiful! It is also very safe so we can walk around the town without needing a Rwandan to accompany us, even after dark. We both agreed that we could live in a place like this. 

The people here are very friendly and we are enjoying learning how hospitals are operated in countries of limited resources. The staff are very welcoming and we are learning a lot about the common diseases found in in children here and the proper treatments.

Challenge of the week: Both Claire and I have new Dansko shoes for nursing, and we are currently breaking them in (we will be ready to start clinicals at school in the fall!) but because we leave to walk to the hospital at 7:45am and get back for lunch at 12:45pm, then go back from 1:45pm to 5:00pm. This many hours of standing and walking for multiple days in a row is making for very hurting feet! Claire also has problems with her left foot and right knee, and I have problems with my lower back, so we are in much pain while getting accustomed to standing for so many hours at a time.

Humor of the week: on our first day of work, I poured salt instead of sugar into my coffee! I missed out on a great cup of coffee (and caffeine). The next day I skipped attempting to put sugar in altogether.

Also the toilet clogged this day, and by the time we acquired a toilet plunger, it was after dark and the electricity had also gone out! How Claire and I have both gone our whole lives without having to plunge a toilet, I don’t know, but it would be a first for both of us, and somehow I was elected to do it. Thankfully Claire brought her headlamp (so glad I gave that to her for her birthday a couple years ago—it certainly comes in handy so often for us!) so headlamp on head and plunger in hand I went into the dark bathroom without a clue as to what I was doing. But whatever I did worked! On my first try, I successfully plunged a toilet (and good thing, because clogged toilets are becoming a daily theme). As I washed my hands afterwards, the sink started to leak. Nothing the bathroom floor rag can’t clean up for now. 

Another funny was that Claire and I have started a small running club… here in Rwamagana the neighborhood dirt roads are great for running, but every day after coming home from the hospital when we go out for a jog, the neighborhood kids think it’s a great idea to join us so as we go, we collect a small pack of kids jogging behind us, and they think it’s hilarious! 

the road outside Mama's house in Kigali

Africa Bite! Lunch with Shami and Babu for authentic Rwandan food in Kigali 

Spending time with Emily and Shami before leaving for Rwamagana for the week

At Mama's house before leaving for our first day at the hospital 

Rain clouds coming over the beautiful hills on the way from Kigali to Rwamagana

African tea with ginger.. a favorite

toilet plunging 

Sophomores no more...summer is here!

Today is a big day... Two years officially in the bag. By the grace of God I am now going to be a junior! Big congrats to everyone in my nursing cohort for all the hard work that has brought us to be official nursing students now! What a blast it has been learning with each of you these past two years... I look forward to two even more exciting years! Our official EU scrubs will arrive any day in the mail now and it will be one more way to look forward to next year. 

Today I bought my white uniform and Danskos and am ready to leave for Rwanda tomorrow to spend a month interning at a hospital with my dear friend, classmate, roommate (and let's be honest, sister) Claire, and spending time with my sister Emily, her fiancé Shami, and friends!!

Please follow our blog if you are interested for (hopefully) weekly updates! THANK YOU to everyone who has been supporting me and  as I work my way through becoming a nurse, and for those of you who are praying for me and Claire and have financially supported us to make this trip possible. We can't say THANK YOU enough!

Happy summer everyone! 

Enns on Ecclesiastes

Dr. Peter Enns was my New Testament professor during my first year of college. This year in chapel, he did a three part teaching on Ecclesiastes. The timing was perfect, because just this summer I found that this book is one of my favorites, but I was puzzled by it. Imagine my surprise when Enns, one of the professors to has taught me the most, and has taught me to think, the most, was going to speak into the book that I wanted so much to understand.
These are some of his words that I captured on paper.
_________________________________________________________________________
Week 1

Why have a job?
Meaningful life
Buy a house

What does all that matter? I'm gonna die anyway.
That's a summary of Ecclesiastes.

Enns loves this book. Because it's more honest about things than we sometimes dare to be.

Nothin matters. Everything is meaningless. No matter what all your efforts, you'll have nothing to show for it because you're gonna die. God is to blame because he set it up this way.
The authors wants this sour note.
Totally stupid. Everything is stupid.
What do we gain for our toil?
He's punching you between the eyes and grabbing you by the throat. He won't let you go. And don't write him off.
For him nature does not declare glory of God. He's having a bad day. Nature tells of the meaninglessness.
Nothing new. Don't hold on to anything because it's nothing new and nothing that will last.
Verse 11. People are not remembered after they die and this cycle won't end.
Don't find comfort too quickly.
Even family is quite forgotten! I [Anna] don't even know my paternal grandmother's name.
He wants you to be depressed and shift to this uncomfortable state.
Steve Jobs has affected a lot of us. Do we remember when he died?

Are you depressed yet? If yes, mission accomplished. And this is in the Bible. Where do you find honesty like this?
No wiggling out, no quick answer. He keeps you there for 12 chapters.
It might be surprising to learn what he says to get you out of this. 

Week 2

Maybe the Israelites didn’t always have it all together. 

Martin Luther- “Love Him? Sometimes I hate Him.”

Honesty that sometimes we don’t embrace.

We play church.

God understands.

We expect the wrong things when we read it.

This book is not telling us how we should think, it’s telling us how we do think sometimes.

It's a mirror and we look and see ourselves in it.

Ch 12 --> Cohelet is done talking and narrator will evaluate what he's been saying for 12 chapters

1. Cohelet is wise. You can't blow him off. 

2. Wisdom hurts. Not there to make you feel good.

Words of the wise are like goods, like firmly fixed nails.

Don't baptize your lack of organizational skills in a Bible verse. 

At the end, what do you do? 

Fear God. Keep the commandments.

It's dark, you want to give up, you don't want to be an Israelite. 

Solution?  It's not a quick fix. It's a path. Keep walking. Be and Israelite.

That was their solution.

I don't feel like it, it makes no sense -- it doesn't matter. Keep walking.

For the Israelites the "path forward" was being an Israelite anyway, even when they didn't want to.

Week 3

In a faith crisis. Absent in his life, he feels God is downright mean.
We all have cohelet moments. We are disappointed or angry when God is a no show.
What does it look like for us to keep going in these moments? What diff does it make? What diff does Jesus make?
These moments are part of our journey and communion with Christ.
Three things Enns has learned:
Whatever it is, be honest with God. We are conditioned to put on make up and pretend everything is ok for God.
Enns was a great father except for a 25 year period when he was just winging it. Hard to believe that his daughter went through a time when she didn't like him at all. What a blessing that she could be honest with him! She trusted him enough. Do I trust God enough? Do I trust his love enough to be in his face the way chohelet was?
Second thing: when God seems absent, maybe he is actually teaching you something. One of the paradoxes of the Christian faith- when he seems most distant is when he is most present.
You are not leaving God behind, you are leaving your thoughts of God behind.
Mother Teresa said no, she will not pray for clarity.
Clarity is the last thing you are holding onto and need to let go of.
Mother Teresa: "I've never had clarity, I've had trust."
Maybe he is teaching us to let go.
Third thing: hardest one to explain. It's a grand mystery. But it's a key to the Christian life. Our God is a suffering God. Jesus suffered for us so we don't have to, but that's only PART of it. It's something that he does WITH us, not just FOR us.
"I know what the Bible says I just don't always understand it"
God suffers with us. No matter what we are not alone.
We also suffer with him. It is how he meets us and how we meet him. Cohelet moments may be allowing you to connect with God is a way no other thing can.
Phil 3:10. Becoming like him in his death. It's a package deal. Can't have one without the other.
His life is a pattern for us.
Cohelet is not the problem child of the Bible. He is our hero. He is not broken, and neither are you. He doesn't need to be fixed. There is no quick fix. There is only walking with God daily, trusting, no matter what you feel like. You almost can't lose. 

Litany of Humility

A prayer that I need to remember daily.

O Jesus! meek and humble of heart, Hear me.

From the desire of being esteemed, Deliver me, Jesus.

From the desire of being loved, Deliver me, Jesus.

From the desire of being extolled, Deliver me, Jesus.

From the desire of being honored, Deliver me, Jesus.

From the desire of being praised, Deliver me, Jesus.

From the desire of being preferred to others, Deliver me, Jesus.

From the desire of being consulted, Deliver me, Jesus.

From the desire of being approved, Deliver me, Jesus.

From the fear of being humiliated, Deliver me, Jesus.

From the fear of being despised, Deliver me, Jesus.

From the fear of suffering rebukes, Deliver me, Jesus.

From the fear of being calumniated, Deliver me, Jesus.

From the fear of being forgotten, Deliver me, Jesus.

From the fear of being ridiculed, Deliver me, Jesus.

From the fear of being wronged, Deliver me, Jesus.

From the fear of being suspected, Deliver me, Jesus.

That others may be loved more than I,Jesus, grant me the grace to desire it.

That others may be esteemed more than I,Jesus, grant me the grace to desire it.

That, in the opinion of the world, others may increase and I may decrease, Jesus, grant me the grace to desire it.

That others may be chosen and I set aside,Jesus, grant me the grace to desire it.

That others may be praised and I unnoticed, Jesus, grant me the grace to desire it.

That others may be preferred to me in everything, Jesus, grant me the grace to desire it.

That others may become holier than I, provided that I may become as holy as I should, Jesus, grant me the grace to desire it.

-Rafael Cardinal Merry del Val