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).

Rwanda introduction...for mom especially

Greetings from the land of a thousand hills! Many of you know that I'm here in Rwanda doing a public health internship for a few weeks. I'm here helping with a monitoring and evaluation project of a program that uses Community Health Workers (translation: lay health workers or those who have received only very limited health care training) for implementing a series of protocols to treat children (less than 5 years) for the most common childhood illness - and the ones that kill the vast majority of children worldwide. I'll leave it at that for now as I'll likely be talking a whole lot more about it later.

I flew into Kigali on Saturday evening and I just want to assure my mother (and father) that all is well. Really, I have this really nice apartment and things are fabulous. Here are some pictures to show you...

My bedroom with fabulous sleek fuschia bedspread

Bathroom - no hot water but it's always quite temperate so no problem

Living area - I haven't actually tried the TV, although I'm fairly certain the only thing on right now is World Cup games and World Cup related broadcast

Kitchen (the fridge is almost, but not quite as small as our fridge in Boston Cami)

The Laundry room

And this is my favourite part!! Looking out from my room this is what I see!!

View from the balcony - looking out over the valley towards the main centre of the city (Rwanda is basically hills and hills)

I've been up north over the last three days helping out at the training meeting for the people who are actually doing the survey for the evaluation - more next time!!

Nothing for months - and now a turkey!!!

Apologies to all of you who thought I was really going to blog something about my actual life. I have the best of intentions all of the time but by the time I get around to blogging things, it all seems so over and done with. I made a promise however, to a certain small friend of mine that I would prove to her via photographs that I do have real, live, wild turkey living in the ravine in the back of my house. This is for you Anya!!

P.S. He is really much bigger than you

The Adventures of Rajah (and notes on an up-and-coming artist of my acquaintance)

Meet Rajah, a well-loved friend (so well-loved that the outer layers of his nose have rubbed off):

He's an important part of everyday life for a certain young friend of my acquaintance. In fact, this certain young friend INSISTS that Rajah MUST be present for proper bed time protocol to be followed. Unfortunately Rajah is almost invariably missing when it's time for bed. He has an almost uncanny ability to be present minutes before bed (eg during bed time story reading) but then suddenly disappear when the actual moment of getting into bed arrives. It's quite a talent!! (Perhaps he takes after his namesake - a tiger from a Disney film).

Usually a house- wide search for the missing "tiger" ensues involving my young friend, his siblings and any hapless adults who happen to be present. Rajah is usually eventually found but sometimes in the oddest places:

Sneaking in from a quick trip outside:

Tigers love warm laundry

Hiding out underneath the couch cushions (a frequent spot):

Hanging out with a bunch of other toys

Attempting a 60's revival

Rajah has famous friends!!

He's very tricky, sometimes he hides in the bed, where he's supposed to be all along!

Sometimes he's actually been tiger-napped

And sometimes he just wants a bedtime snack

But after all is said and done, Rajah usually finds his way back where he's supposed to be and he and my young friend (FINALLY) get to bed as happy as ever.

Notes on an Up-and-Coming Artist:

Actually, Enoch took most of the photos you see above. I told him what I wanted to do because we'd had so many Rajah sagas when I was living with them that I felt it deserved a blog entry. Enoch loved the idea and wanted to use my camera. We discovered that he actually has quite a talent for it. He took a bunch more but here are 5 of my favorites - fabulous for a 4-year old!!

I call this first one: "Still life in shades of blue"

Next: "Sunday Feet":

I actually stuck this one in because I rarely like photos of myself and I liked this one
Next: "Surprised sisters"

Finally: "Portrait of the artist as a young boy"
Kind of fun eh?

Updates - my (apparently) semi-annual blog

My cousin Sara was quite right to not hold her breath while waiting for the next edition....it's been a really long time since I've blogged. I always use the fact that I don't have any kids or pets to take cute pictures of as an excuse for not blogging regularly. That's part of it but mostly I just always find other stuff to do...but, for those of you who have been wondering (I'm sure very few!!). Here's a summary of the last few months:

March : Work, interspersed with a fun cruise with Mom, Dad and Alita. Embarassingly enough, I hardly took any pictures. Dad always takes so many that I didn't feel the need. Please see their blog if you really want to see the pictures. (I personally didn't feel the need to add any more pixels involving me in a bathing suit to cyberspace)

April: More work, interspersed with packing up my house, getting rid of the vast majority of my furniture and stuff and moving the rest to Mom and Dad's house (My net-worth now consists of 12 boxes of books, 4 boxes of kitchen stuff, 8 boxes of other assorted stuff and 4 suitcases of clothes + 13.5 years of post-secondary education)

May: Living in Toronto, Ontario for a month doing a rotation at the Tropical Medicine Clinic. (Very fun (although my definition of that word might vary from other peoples') - all kinds of weird infectious rashes, malaria and LOTS of people complaining of diarrhea) I got to do a bunch of fun things - ran into and got to play with a bunch of old friends. It was great!!

Here's a picture of the Toronto Skyline from Leslie Spit (the name of the little peninsula we'd ridden bikes to)

And, here's a picture from the CN Tower looking out over towards Leslie Spit

This is me rappelling down the CN Tower....just kidding, of course this is the classic glass floor picture

AND, this is why you shouldn't agree to let strangers take pictures of you at tourist venues

June: Final month of work as a resident - HURRAY!!! Amazing! (I can't believe I'm actually done!!!!) Fun too because I got to live in Paul and Heather's basement. A photo of the kidlets and me playing with the "Photo-booth" feature on my beloved Macbook:

July: For the middle two weeks of July I actually worked as a staff physician at the hospital I trained at (ironically I have NO pictures of the University of Alberta Hospital despite spending at least 65% of the last 7 years there - no joke, at least 65% - there might be some deeper meaning in that) I think I worked WAY harder than I ever did as a resident, averaging about 12 hours a day for 14 days in a row - you can ask Heather and Paul and the kids - they were hardly aware I was living there. Ah well, it's now going to finance the next 6 months of my life so all is well.

Prior to that I did get to the Lund Family Reunion. Tons of fun, and enough of a "baked beans, KFC and jell-o salad" fix to last me until the next one 2 years from now. (Aside: One of the recurring questions of my life: Why is is called jell-o SALAD??? There's absolutely no vegetables involved....) You can only see 2 containers of KFC in this photo - I promise, there was 10 on the table, I opened them myself.

Some cute pictures of various festivities that weekend (note how I get around the "not having cute kids or pets of my own" barrier - yep, that's right, BORROWING them)

Later in July I got to take a quick trip down to Seattle, Washington to attend my cousin Kjarsta's wedding reception. I hadn't seen my so-called Seattle cousins in way too long a time so it was such fun to see them and catch up. They looked stunning!! (And Grandpa and Grandma Salmon look pretty cute too!!)

August: (Whew, this is getting pretty long!!) Spent trying to get everything ready for the big move to the great US of A. Dad and Mom and Alita and I took a fun road trip to Chicago, stopping at such highlights as:

Custer National Battlefield Park (or whatever it's called)

Mount Rushmore

Needles Highway

We stopped at Winter Quarter's and then got to Nauvoo, where we dropped Alita off for EFY and went to see Scott, Sue Ann, David and Lydia in Chicago. What fun!! We went back to Nauvoo and toured around there for a couple of days. I then said farewell to the folks and went back to Chicago so that I could take a flight to BOSTON, my new home. (Disclaimer: my camera battery has malfunctioned so there are really no more pictures after South Dakota but I promise to try and get it working so that my family can see where I live in Boston). YAY.