Interim mini-project

It's been a quiet week here in Rwanda. All the data from our study is now at the Ministry of Health awaiting data entry. We're trying to hurry that process along - after all, that's what I'm here for (well, sort of) but these things can be a little political. So instead we found another mini-project for me to do this week. I went out into the field to look at what has been happening in some of the nutrition programs. These programs try to screen for children under 5 who are moderately or severely malnourished so that they can get extra help at the health centre (including extra food supplements for the children and nutritional counselling for the mothers).

(The one on the left isn't a mother, she'd just a neighbor girl who's helping out)

Other highlights:

- sleeping in the guesthouse at Ngoma and discovering that the rooster lived right behind my room. (Why, Why, Why is 3 am an appropriate time to start crowing?!)

- Being told by the entire medical staff (ten of them) of Kibungo hospital (all Chinese expats speaking difficult english, all male, all shorter than I) that I was beautiful and should stay and have drinks with them in the guesthouse restaurant - I gracefully declined (but it made up for the "healthy" comment from last week)

- visiting the Rwanda Genocide Memorial Centre. This was enlightening but emotionally draining as you might imagine.

More next week (and hopefully more pictures, I've tried to load more twice but all it does is suck up my precious megabytes and not post anything!!)

Interviewing is difficult if you don't speak the language...

For those of you who wonder what I've been doing... The program we're evaluating here is one that has community health workers (CHWs) treating children for a few specific diagnoses. There are approximately 60 000 CHWs of them here in Rwanda, one male and one female elected from each village (ostensibly). The diagnoses for the most part are diarrhea, pneumonia and fever, which is usually interpreted as malaria and treated as such rightly or wrongly. The CHWs also are involved in vaccinations and anemia screening (with de-worming medications as needed...your infectious diseases interesting fact of the day: the leading cause of anemia worldwide is hookworm infection - yep, may I point out once again, everything really is infectious diseases - love it!!). For those of you in the Global public health/pediatric fields - it's actually Rwanda's WHO IMCI program. So, the evaluation is to see how the process is working - not so much if it's really impacting the child mortality rate. It consists of interviews with randomly selected CHWs, revision of all their case files, and interviews with all the supervisors in over half of the health districts in Rwanda. (About 1200 interviews in total over the course of one week)

It was somewhat chaotic.

The teams got rearranged at the last minute so suddenly my boss and I were having to supervise a team of people we didn't know in an area that my boss didn't know. Plus there was problems with cash flow (as there often is) in order to arrange transportation and sundry other issues. Such is the fun of on the ground research like this. It's all about going with the flow basically and changing plans about 10 times a day. We pretty much accomplished our goal though. It was tricky as my boss and I could do only a handful of the interviews so we had to make the rest of the team work harder.

Interviews

Community Health Centre in rural Rwanda

The beautiful courtyard of the district hospital in Kibagabaga (which is pronounced exactly as written and is likewise my new favourite word. It sounds like it should belong in Bedrock)>

On our way to/from remote community health centres to do the interviews. I got the front seat because I was "the healthiest" (Rwandan description). A.K.A "the biggest". (This is apparently a huge compliment and I'm trying to take it as such - however, I have been somewhat brainwashed by negative aspects of western culture and had to do some mini-self-cognitive therapy with respect to body image.)

Fun week!! More later.

For all my nieces who want princess beds...come to Africa and you can sleep in a fancy bed just like this one:

Busy...

My first week in Rwanda has really flown by. After arriving late last Saturday night I spent Sunday settling in because Monday morning we (meaning my boss and I) left bright and early to drive up north to Musanze (previously know as Ruhengeri – name changed because of some political reason that no one seems to know or want to tell me: “It’s political”). This is coincidentally the same place that I visited in Rwanda the last time I was here as it’s the staging point for all the trips to see the gorillas (see previous post: "Uganda 5: Gorillas in the Mist"). This time I didn’t see the gorillas, or actually much of anything – in fact I didn’t leave the hotel grounds the whole 3 days I was there. We were too busy.

The Ifema Hotel is a very nice hotel if you ever happen to be in Musanze…

The reason for this visit was a training program for all the people that are administering the survey on which our evaluation is based. We had to talk about sampling and such as well as reviewing all the documents that they’d be using. It was tricky because of the language issue. The survey will be done in Kinyarwanda, the local language, so had to be translated. Kinyarwanda, like all the Bantu languages is apparently extremely complicated grammatically, and so there were numerous discussions about the language. Unfortunately mostly in Kinyarwanda so neither I, nor my boss, could follow them. We persevered however and organized logistics and actually did the random sampling. Busy, but fun - if you’re into that kind of thing, which surprisingly I am.

I did see some wildlife - in the garden beside the hotel…

The rest of the week was spent back in Kigali at the office working on more organizational stuff. We’re trying to computerize the data entry aspect somewhat so we’re going to trial a program on Pocket PC Creations, we’ll see how it goes. This next week is the actual survey week so we’ll do some trial data entry then as well. A lot of public health work is office stuff so not so exciting to blog about; in fact, here you can see my boring little office…
Yep, not very exciting but the whole point of this evaluation is to make sure that the program really is making a difference in the lives of Rwandan children – and I think that’s the really exciting part.

Saturday was spent wandering about the main part of Kigali and trying to find places to shop besides the big expatriate shopping centre. Due to the huge influx in development and aid money to Rwanda as well as the associated influx of large numbers of expat aid workers in the last several years, things are hugely expensive. Food, both at expat-type restaurants and at the expat shopping centre is as expensive or more expensive than in Boston. My roommate (another girl who’s working for the same organization) and I are finding alternative options.

Today, Sunday I went to church, which turns out to be about a 40-minute walk from my house. Well, in the interest of honesty, it was 40 minutes one way but on the way home I tried to take a shortcut, which turned into a very long and hot walk. It’s alright, probably the best way to learn the city is to get lost and then find your way home a few times. (It’s the only way I’ve ever learned my way around cities that don’t really have maps).