Wednesday, July 30, 2014

Newton's 3rd Law – To Transform and Be Transformed

It seems appropriate to reference Sir Isaac Newton here since after all, we all are affected everyday by some of his most famous work and engineers constantly use his principles. Newton's 3rd law states that for every action, there is an equal and opposite reaction. While this refers to physical actions and forces, Newton's 3rd law does a good job of describing my experiences this summer. Although I may have 'transformed' some broken equipment by repairing it, I've been transformed in so many ways by this trip. Over the past 9 weeks I've had some absolutely incredible experiences that I'm beyond blessed to have been able to participate in. Reflecting on these experiences as I wrapped up my time there on Sunday and arrived home on Monday, I'm extremely grateful for the ways that I have grown and the ways that God has been working in me and through me.

Volunteering at the Children Might Foundation was something that was lined up mid-way through my trip and turned out to be one of my favorite experiences. At the end of our fourth week in Kigali, everyone found out where they would be placed for the second month. When I found out I was going to be working in Rwamagana, I have to admit that I was slightly disappointed as I heard about how some locations had amazing scenery or interesting things to do while Rwamagana was a boring little town surrounded by only banana trees. As I packed up to move to our new home stay for the second month, I told God that I trusted He had a reason for sending me to this little town instead one of the other locations where I could be waking up with the volcanoes in my backyard or in a room that overlooked a beautiful lake. As always, He had some pretty good reasons. I was able to learn about the Children Might Foundation (CMF) and volunteer there for a few weeks which is an experience I couldn't have had at any of the other placements. Volunteering at CMF, I was able to become friends with some incredible people who provide a great example of what it really means to share God's love with the least of us. Through my time there, God's enlarged my heart for the impoverished and opened doors for future trips back to Rwanda.

My last night at CMF with everyone who works there.  From left to right, Didiae (he is the educational field worker and who I got to accompany on some home visits), Diana (a retired English teacher from Britain who is volunteering at CMF for 2 months, teaching English in the schools), Jacque (takes care of the cooking and cleaning, also helps to teach English to some women in the program), Ronnie (recently moved to Rwamagana from Uganda and will be helping with the farming program), and Joseph (the financial account and also helps out with the programs).  They even made a special meal for me that night and then we played 2 hours of Uno which were the most intense games of Uno I've ever played and my cheeks actually hurt from laughing so much!

One day while walking through the town on the way to lunch with our supervisor, a beggar woman whose face was severely deformed and appeared to have been majorly burned or scarred somehow came up to us asking for money. When we didn't give her any, she started grabbing our supervisor's pockets and was desperately trying to find some money. We all felt bad about not giving her anything, but said we didn't know how she would spend the money or if a few francs would actually make a lasting difference. A few days later as I was waiting in line at the bus station to buy a ticket back to Kigali, she came running into the bus station courtyard and begged from everyone. As I stood at the table getting my ticket, she practically tried to grab the change out of my hand. Again, I felt bad not giving her anything but didn't know if giving her a few francs was a good idea or not. The next weekend, I was at the bus station again since we traveled to Kigali every weekend. Once again, she was at the bus station, begging from everyone waiting to get on a bus and harassing everyone getting off a bus. As I stood against the wall, hoping that she wouldn't come up to me, she eventually came up to me and begged for money. When I didn't give her any, she grabbed my wrist and continued to beg. I'm ashamed to say this, but I was pretty uncomfortable being grabbed by this woman whose appearance was slightly horrific and was also minorly annoyed that she was so forward with begging from everyone coming and going at the bus station. On the bus ride back to Kigali as I was thinking about the beggar woman, God reminded me that no matter how repulsive she seemed to modern society, she still was a child of His which made her beautifully and wonderfully made.

The next weekend, Casey and I decided to head back to Kigali at night after work instead of in the mornings like we usually did. We bought our tickets for the last bus of the day and I found myself wondering if the beggar woman would be there since it was the last bus and after dark. I hoped that she wouldn't be so I wouldn't have to deal with her grabbing my wrist or pockets, but instantly felt ashamed for thinking that. In the back of my head, I kept thinking 'Laura, you know she's going to be there since you really don't want to see her and that God's trying to stretch you'. As anticipated, she was there. As each bus pulled in, she would run in front of the bus to beg from every passenger that came off the bus and even followed people across the bus station when they ignored her. As each bus filled up and prepared to leave, she was there pounding on all of the closed windows, desperately trying to get a few francs. I found myself against the wall again, counting down the minutes until my bus arrived and hoping that she wouldn't approach me in the meantime. Continuing the trend, she came up to me just like all of the previous times at the bus station. When I didn't give her any money, she spit next to my feet, grabbed my arm, and continued begging. I felt God gently telling me to give her my water bottle, but I tried to push that aside. As I was standing there being stubborn, God again told me to give her my water bottle, this time a little louder so I wouldn't have an excuse that I didn't hear Him. Somewhat reluctantly, I handed my water bottle over to her which she immediately grabbed and ran off to the next person while saying 'merci beaucoup' (French for thank you very much).

This little interaction reminded me of Matthew 25:35-40 and while I can take no credit for giving her my water, I'm thankful for God giving me a louder reminder when I ignored the first one. “ 'For I was hungry and you gave me something to eat, I was thirsty and you gave me something to drink, I was a stranger and you invited me in, I needed clothes and you clothed me, I was sick and you looked after me, I was in prison and you came to visit me.' Then the righteous will answer him, 'Lord, when did we see you hungry and feed you, or thirsty and give you something to drink? When did we see you a stranger and invite you in, or needing clothes and clothe you? When did we see you sick or in prison and go to visit you?' The King will reply, 'Truly I tell you, whatever you did for one of the least of these brothers and sisters of mine, you did for me.' ”

Many times while trying to repair a device, I would find myself thinking about how it would be really helpful if specific people were along on the trip with me because they would be a great addition. Ranging from teaching expertise, plumbing knowledge, remembering difficult names after only meeting the person once, creative thinking, crafty repair experience, to extreme patience, I thought of a lot of people whose skills I could have used. On another bus ride (I spent a lot of time on buses which gave me tons of time to think), I found myself thinking about another passage of scripture and it reminded me of how great the family of God is. Romans 12:4-8 reads, “For just as each of us has one body with many members, and these members do not all have the same function, so in Christ we, though many, form one body, and each member belongs to all the others. We have different gifts, according to the grace given to each of us. If your gift is prophesying, then prophesy in accordance with your faith; if it is serving, then serve; if it is teaching, then teach; if it is to encourage, then give encouragement; if it is giving, then give generously; if it is to lead, do it diligently; if it is to show mercy, do it cheerfully”. While I have some talents, I also lack many others, but in combination with others, we can have an entire skill set. It's a beautiful thing when many believers come together and share their different talents to work towards a shared mission.

Speaking of buses, God's evident there too. Two weekends ago, two of the other students in the group were going to stay at my home stay Sunday night. All of us had been at Lake Kivu for the weekend and it was a 3 hour trip back to Kigali, and then 1 more hour back to Rwamagana. Instead of traveling 6 hours in one day to get back to their home stay, they planned on staying at my home stay and then just leaving early Monday morning to complete the remaining 2 hours of travel. Once we got to Kigali, they reluctantly decided to complete the entire trip that night, and headed back to their home town. I thank God and everyone that has been praying for the group's safety this trip that they completed the trip Sunday night because Monday morning, a bus from Rwamagana to their home town flipped and everyone in the bus died. Had they stayed at my home stay Sunday night, that could have been them on that bus. Another time when everyone was heading to the rainforest, a dump truck was flying around the side of a mountain and almost collided head on with our bus except that our driver swerved off part of the road to avoid the crash. During the trip, there were multiple times that seemed like we should have crashed, but God was with us always and kept us safe.

I want to say a gigantic thank you to everyone that has incredibly supported me on this transforming experience. From continual prayers, to generous financial donations, to notes of encouragement, and simply following along with my trip through this blog, the support has been amazing and really provided strength and comfort. I hope that all of you have been able to get a glimpse into my time spent in Rwanda, learn a little bit about their culture, and see how God is working across the globe. Murakoze cyane! (Kinyarwanda for thank you very much)

As I finish my last blog post for this trip, I want to share a song with everyone that has been a prayer of mine and describes part of my journey on this trip. I took a leap of faith by deciding to go on this trip, not knowing how I would fundraise the cost or what I was getting myself into. On the trip, so many times I asked God what I was doing there and thought He was asking too much of me at times, but He always was with me. I'm not sure what He has planned for me next, but I'll walk by faith and wait to see what He has in store for me.

I want to live this live unsafe, unsure, but not afraid
What I want is to give all I got somehow
Giving up letting go of control right now

‘Cause I’m already out here, blind but I can see
I see the way You’re moving
God how I believe that

I can push back the mountains, can stand on the waves
I can see through the darkness, I’ll hold up the flame
Take me to the ocean I want to go deeper
I’m not afraid no, I’m a believer

And so I lose this life to find my way and come alive
They can try to deny what’s inside of me
But there is more, can’t ignore all the things unseen

Oh I believe I can walk on water with You, Lord

When I walk through the valley of the shadows
When I’m trapped in the middle of the battle
I will trust in You
‘Cause trouble comes, but you never let it take me
I hold fast ‘cause I know that You will save me
I will trust in You, I will trust in You

Oh here I stand all alone waiting on you, Lord
Waiting on You

Friday, July 25, 2014

Wrapping It Up

These past 2 weeks seem to have flown by!  Packed with lots of tasks to get done and trying to pack everything in before we had to leave, these weeks have been extremely busy but also extremely rewarding and memorable.  Last week we were finally able to get into the stock room to pull out some broken equipment that's been sitting in there and do a couple of repairs..  We also worked on a lot of documents for the hospital such as an equipment replacement plan and standard operating procedures which are needed for accreditation.  In addition to those tasks, we also had to work on our secondary project for the hospital which was making 'quick start guides' for several pieces of equipment and involved typing up 3 or 4 steps in English and Kinyarwanda on how to operate the device.  Besides our regular work at the hospital, we also needed to do several interviews with staff for a needs assessment and also create a presentation about our work the past 5 weeks for the conference this weekend.  Needless to say, it's been very busy between working at the hospital and still volunteering at the Children Might Foundation!  Time is a little tight as I wrap up everything for the end of the trip and prepare for the big conference tomorrow, so for right now I'll just post some pictures of what I've been working on but more details are to come!

One of the most fun jobs for me this trip, I got to install a new patient monitor on the ambulance!  They got the monitor out of storage, brought it into the workshop for literally 2 minutes to unpack it, and then we were off to the ambulance to install it.  I've never seen the model before and there were lots of extra probes so it turned out to be a puzzle that I had to solve of how to set it up and learn how to operate it in about 3 minutes as 4 or 5 doctors watched me and then asked for a detailed explanation of how to operate it.

One of the pulse oximeters that we found in the storage room and were able to get working again

One of the pulse oximeter probes was missing a prong and it's impossible to buy a spare probe in Rwanda without buying an entire new machine, so I cut off part of a resistor (it was the only wire we had of the right diameter) and soldered it back onto the probe.  With a little patience and a lot of focus to keep a steady hand, the make-shift prong works!

The otoscope needed a very specific type of bulb to replace the old one that was burnt out but we couldn't find a replacement after scouring about 10 shops in Kigali, so we improvised!  Using a $0.33 LED flashlight that we had in our toolkit and some electrical tape, we were able to modify the otoscope so it can be used again.  This new design even allows it to be portable and the LEDs will last much longer!

One of the fetal monitors needed a new thermal printing system and we also had another broken monitor of the same model, so I swapped the printing systems and the new one is working as it should!

After spending several days working on this fetal monitor and reading about 5 manuals on it, I was so excited to finally see this printing
Testing a patient monitor to check that the blood pressure, pulse oximeter, and ECG components are all properly functioning

A doctor or nurse said that the pulse oximeter probe on this patient monitor was not working, but after testing it, I learned that the probe is location-specific.  Since the outer casing had fallen off or broke off, there was no indicator to allow the prongs to only be plugged in the correct way.  I simply drew lines on the machine and probe which need to be lined up for the sensor to work and explained to the staff how it must be used.

The binder of Standard Operating Procedures (S.O.P.s) that we made for the hospital as part of our secondary project

Tuesday, July 15, 2014

A Child's Smile

Prior to the start of the trip, I knew that I wanted to find an organization or an orphanage near where I would be staying and try to volunteer at it a few times after work at the hospital. When I arrived in Rwamagana, we had the entire day free so I walked around most of the town to explore and to hopefully find an organization to volunteer at. After passing a few cooperatives and a women's education center that I was considering, I spotted a sign along the road for an organization called the Children Might Foundation (CMF). They even had a website listed on their sign, so later that night I looked into what their organization does and they have some amazing projects. I eagerly sent them an e-mail asking about any volunteer opportunities they had and after about 2 weeks of e-mails back and forth, I finally started volunteering there this past week! It's about a 20 minute walk down the road from the hospital and our home stay, so Wednesday after we finished at the hospital I headed down there for my first day. I had met Douglas, the director of the program, the previous Friday when we were lining up when I could start but I also got to meet Joseph, the accountant and office worker, and Jacque. They told me about the different programs they have, answered my endless questions, and we figured out a schedule for when I would volunteer there.

The organization serves 84 children and also supports women. They have a women's farming program on Mondays and Thursdays where they teach women various farming techniques and also how to save their money after selling the crops at the market. Wednesday and Friday afternoons and Saturday mornings they have a homework club where the children in their program can come and receive additional instruction. Tuesday nights they have an English program where women in the community can come to learn some new vocabulary and to practice their skills. Saturday afternoons they have a sports program where all of the children are invited to come and play football (soccer) or volleyball. During the week, they also do home visits once a month to every family that has a child in the program to check in on their progress in school and to see how the family is doing. For extremely poor families, CMF also gives them a goat which provides the family with milk and a source of income. The family must give their first female goat back to the program, but then they can sell the others. CMF also has a house building program and have built several houses in the local communities. In addition to these programs, there is also a child sponsorship program that helps to support children whose families cannot afford to pay for their uniforms or necessary school supplies. I highly encourage all of you to check out their website to read more about the amazing work that they are doing!

Thursday I had the privilege of accompanying Didier, their educational field worker, on 4 home visits which were heart-touching memories. On these home visits we were also delivering a few shirts; one for each of the sponsored children and one for the mother. The first home we stopped at was a widow with 4 young children. They previously did not have a house, then had a house but it was constantly flooding, so CMF helped to build them a house and also gave them a goat. The two youngest children in the family, Diana who is 5 and Bob who is 6, are sponsored through CMF and we had a shirt for each of them. Watching Diana get her shirt was such a simple act, but it was one of the coolest experiences and I wish I had it on video so everyone could share in her joy. Covered from head to toe in dirt, her face lit up more than I can describe when she saw Didier pull her new shirt out of his bag. Instantly she took off her current, raggedy shirt and Diedier put on her new one. For the rest of the time while we were there, she was constantly smiling and admiring her new shirt. I got to give Bob his new shirt and although he wasn't as outwardly excited as Diana was, it was still a really special experience.

Diana and Bob with their new shirts

Her smile when she got her shirt could have melted anyone's heart!
The next family we visited was a widow with 5 children, one of which was still crawling. Her husband had been killed by a grenade when he accidentally hit it while working in the fields. To get to their house, we had quite the off-roading experience, all while on a little moped with no gears. The next family we visited was a mother and 17 year old girl. The final visit was to a widow and her 16 year old son, Alex. The father had died from AIDS and the mother also has AIDS, but is taking medication so that she could continue working. Thankfully Alex is AIDS free. Even among her circumstances, the mother had one of the biggest smiles and most welcoming personalities. Visiting these families, it figuratively hits you in the face how overwhelmingly blessed we are in the States. Every morning I'm able to go to my closet and put on a clean shirt and pants, brush my teeth with clean water, eat, and have pencils and paper to use at school. After seeing how incredibly joyful and thankful each person was for receiving something as simple as one shirt, I wish that everyone could see that because so many times we become unhappy that we can't have the latest and greatest gadget while completely forgetting that we are still incredibly blessed.

Maybe some of you have heard of the song 'Kings and Queens' by Audio Adrenaline, but if you haven't, definitely check it out tonight. Simply go to Youtube and type in 'Kings and Queens by Audio Adrenaline' to find the song. It's one of my recently favorite songs and I've found myself frequently humming it the past 2 weeks. After going on the home visits, the song immediately popped into my head. Even though they are living on a dirt floor in a mud hut with 2 shirts and barely anything else, someday they will be kings and queens in heaven, dancing and singing with their Heavenly Father.

Saturday afternoon, myself and 3 others from our group played football (soccer) with about 40 children from their program which was so much fun! Although they are way better than I am and much more energetic, it was a lot of fun getting to interact with so many of them and simply enjoy playing a fun, yet competitive game of football. CMF even has a lot of jerseys, so at the beginning everyone changes into the jerseys and then returns them at the end. Complete with a referee and all, the game was pretty official!

Douglas is to the right of Andi and Didier is to the right of Katey.

Brett, Andi, and Katey were able to come to Rwamagana for the afternoon and join us for an awesome game!

Monday I shifted my hours at the hospital around a little bit so that I could visit the women's farming program in the middle of the day. After a good hike off the dirt path, we arrived at their fields where there were about 15 women and 7-10 men. They have a few cows, a donkey, chickens, a small storehouse that currently half-way finished mud walls, and an extremely small 1 room house that a family with 5 children live in to watch over the land. Their fields are a decent size, but they want to buy more land so that they can grow more types of produce and also rotate the land. With the money that they earn from selling the produce, they can pay for health insurance and other expenses. It's currently the dry season here, so they are mainly working on preparing the land, but they have some vegetables planted right now. On Thursday afternoon I'll be headed back there to work alongside the women and water the crops.

One of the fields they are currently growing crops in

Their storehouse for the harvested maize (corn) which they then grind up into maize flour

They've had to use tree branches and mud to construct the storehouse since they didn't have enough money for finished wood or concrete.  While I was there, they were mixing up mud (same way as they did on muganda in the Millenium Village) to work on finishing the walls.  Douglas is currently working with a builder to draw up plans for a larger storehouse and is applying for a grant for the building.

They even had Holsteins at their farm!

In the future, they would like to build 2 greenhouses like the ones in the distance so that they can grow more vegetables out of season which will help them earn more money due to the majorly inflated prices in the off season.

This afternoon I was helping Joesph and Didier to find some apps to download onto CMF's iPads, specifically for basic biology. Several iPads were donated to the organization and are used during the homework clubs as a way for the students to either learn or review, so we were working on finding new apps that pertain to what the students are currently learning. Tomorrow afternoon and then Saturday morning I'll be helping at the homework club which I'm looking forward to. Next Monday I'll be helping Joseph and Didier to learn Excel. Tuesday and Thursday of next week I get to go on some home visits again which I'm excited about since I get to experience new parts of the surrounding communities and see new families. Next Wednesday I'll be back at the homework club and then it's hard to believe I'll be heading home that weekend!

Monday, July 7, 2014

Joys and Frustrations

It's been a while since I last posted, so I'll attempt to catch everyone up to speed with what I've been working on at the hospital. After a few simple repairs early in the first week (refer to previous post), Casey and I began to take inventory of each department which included recording the manufacturer, model, serial number, and the hospital's code. Fortunately most machines had all of these, but there were a handful where the serial number was completely worn off or there was no hospital code. After taking inventory for the departments we had visited earlier in the week which was about half of them, we began our first real repair in the maternity ward.

Earlier in the week during inventory, Adeline, head of maternity and neonatology, had showed us 2 delivery chairs which were broken but still being used. The entire maternity department has only 3 delivery chairs for what seems to be one of the busiest departments at the hospital. All of the chairs are the same type and are supposed to be able to go from horizontal to partially angled, but only 1 of the 3 could actually do this. On the underside of the chair, there is a lever arm that allows the chair to go from horizontal to inclined but this was broken in multiple locations on the 2 chairs so the chair remained horizontal. Despite it being the worst position for a mother giving birth, the staff continued to use the chairs since a partially operational chair was better than no chair at all. After examining the functioning chair to see how the lever arm works, Casey and I began working on one of the chairs. It's hard to describe the mechanical repairs we did without you actually seeing the arm, but hopefully the pictures below will supplement my explanations.

The top part of the arm which connected to the back of the chair was supposed to interlock pieces, but the bolt and nut system was too low so we had to take the top section apart and adjust the bolt and nut. One of the bolts connecting the arm to the chair frame was missing and the other was broken, so we had to remove those and find replacements. Keep in mind this is Rwanda and not the States where Home Depot and Lowe's abound, so finding 2 bolts became a 2 hour process which involved going to 5 hardware stores to eventually find bolts of the right diameter which then had to be modified by the welders who cut them apart and added a piece in the middle so they were long enough. Now that we had the new bolts and had fixed the top section of the arm, it was back to the maternity ward to install the arm. Holding true to the past couple of weeks, what seemed like an easy process turned into several more hours of work. The plates on either side of the chair frame that the bolts needed to pass through were far from precise and did not align, so we had to have the welders adjust the holes in a plate for us. Finally we were able to force the bolts through after about 30 minutes of fighting with the arm and plates and re-attach the top section of the arm so that it interlocked. Add a little bit of WD-40 on the arm, and it was as good as new!
One of the new plates the welders cut for the delivery chair in maternity.

The interlocking parts for the chair.  When pushed down, the small metal button to the left of the block in the middle allows the chair to be raised or lowered.

The new plates and bolts installed!

During the repair process and what seemed like 10 trips between the maternity ward and maintenance workshop that day, we slowly acquired many curious eyes watching over our shoulders. I guess seeing a white maintenance woman fixing a chair is quite the spectacle! So many of the staff would periodically stop in the room to see our progress and were really excited that we were trying to repair the chair. Bringing some of the nurses into the room to show them how to correctly operate the chair once we had repaired it was one of the most gratifying experiences in Rwamagana so far. The excitement on their faces was contagious when they saw the chair working like it should and one of the nurses in her limited English told us we were very good technicians. That nurse has become our #1 fan and always waves at us, even if we are across a giant courtyard.

With one chair repaired, Casey and I began to tackle repairing the next chair. The interlocking mechanism on this one was also too low and the bolts to connect the arm to the chair frame had been bent into an elbow. Initially we thought this repair would be simple since we had fixed an identical chair the previous day, but we should probably stop expecting that since there's always something that comes up and complicates the situation. Using pliers and a wrench to hammer the bolts through and eventually break off part of it that was stuck in the chair frame, we removed the faulty bolts after an hour of work while inhaling the not-so-pleasant smells of the delivery room. Back at the workshop, we started trying to adjust the bolt and nut system but the nut was diagonally threaded and was impossible to twist. When all else fails, brute force sometimes pulls through. After several minutes of hammering, we got the nut correctly threaded and were able to fix the interlocking mechanism. Unlike the other chair, this chair was missing the plates for the frame which were necessary so that the bolts wouldn't slip through the gaping hole that had been formed in the chair frame so we made a template for the plate and had the welders make 2 for us. After another 30 or 40 minutes of fighting with the bolts to fit through the deformed chair frame, the third and final maternity chair was fixed.

After finishing the inventory partway through the second week, we began to attempt some more repairs but the equipment we've been working on has been very complex. The hospital here has maintained their equipment fairly well and practically all of the small devices are either working or completely broken, so we've been left to try to repair the large equipment like PCR cabinets, refrigerators, freezers, autoclaves, water distillers, ultrasound machines, phototherapy lights, and patient monitors. Unfortunately, I can't say that we've had very much luck fixing any of these yet. Last week became very frustrating at times because we would figure out what was wrong with a machine but we either didn't have the tools to repair it or needed a completely new part that we can't make. The PCR cabinet is fairly new but had a software error; the refrigerator's fan was disconnected so I re-wired that but one of the pipes in the back was broken and I was going to use oxygen tubing to replace it, but all of the coolant had previously leaked out; the water distiller needs a need relay; the ultrasound machine has a cracked screen; who even knows what's wrong with the phototherapy lights made from 320 LEDs; and the patient monitor needs a new spO2 board and ECG board.  Besides some of the big repairs, there are also little things that would be so simple in the States but are virtually impossible here but are crucial because they can literally be the difference between life and death.  The entire hospital has 1 defibrillator, but is uses electrodes instead of paddles and they have run out of electrodes which means that simply because of a lack of resources, patients can die from reasons that can be treated.

Among the many attempted and abandoned repairs, there have been a few small successes which help to keep us motivated. The hospital got a new fetal monitor but it wasn't printing, so after hours of troubleshooting and deciding it was the thermal printing system, I e-mailed the company and 2 weeks of e-mail tag later, they are sending us a new part since the monitor is still under warranty. Once the part arrives, hopefully it will be an easy swap and the monitor will be back in use. Cyprien, the Rwandan BMET at the hospital, found a 9V battery which we were able to use for an oxygen concentrator so that the alarm system now works. Next week, the hospital is being reviewed for accreditation which is a huge deal, so we have also been working on typing up some of the protocols and documents needed for the accreditation.

Finally, thank you so much to everyone for all of your support and continued prayers. In the good times and the tough times, it's comforting to know that I have so many people supporting me from back home!

Wednesday, June 25, 2014

Goodbye Kigali, Hello Rwamagana!

Well, plans quickly changed again late Saturday night/early Sunday morning.  On Saturday Casey and I were supposed to meet with the director of the hospital before he flew to Kenya Sunday morning, but his schedule was booked and we didn't meet.  Around 11 Saturday night, we received a text from him asking to meet at 7am before he caught his flight.  We found general directions to where we were supposed to meet him and so 6:30 Sunday morning we were traveling across town to meet up with him.  Well, so we thought.  The place we ended up going was Chez Robert when we were supposed to go to Chez Lando.  Thankfully Ben was able to pick us up and take across town to the airport where we were able to meet the director for 10 minutes before he boarded the plane.  During our meeting, our departure time from Kigali to Rwamagana changed from 10am to 9am so we quick rushed back to our home stay and hurriedly packed up.

The trip to Rwamangana is only 1 hour from Kigali, so we then had all of Sunday afternoon to explore the town.  We drove up to what seems like a small mansion by Rwandan standards and met the houseboy, Patrickq, who takes care of the house and also cooks all of the meals.  I feel like a spoiled American between having my own room and someone who cooks all of our meals for us.  It's nice for a few days, but it's a little bit of a weird feeling going from doing everything yourself at college and now someone is paid to cook your meals and wash your dishes.

When walking around Rwamagana Sunday afternoon, I was pretty sure the population of muzungus (white people) there was a grand total of 1.  Eventually Casey and I passed 3 other white people and we all were pretty excited to see someone else who spoke English.  In the afternoon we were also able to meet up with Cyprien who is the hospital's BMET but is actually in Kigali for 2 weeks taking some classes run by EWH for additional training.

Monday morning we reported bright and early at 7am to begin our 5 weeks at the hospital.  Before heading to class, Cyprien was able to show us 2 departments and then Casey and I worked on some equipment for the rest of the day.  Our repairs included fixing a loose connection in the tubing for an oxygen concentrator, making a new power cord for a suction machine, and fixing the wiring for an oxygen concentrator.  For the new power cord, one of the prongs on the old plug was broken, so we used the plug from an extra cord and connected it with the remaining part of the old cord, soldered some wires, and it's as good as new by Rwandan standards!  Unfortunately, none of these machines can be returned to the departments yet since they are still missing some parts that we hopefully will find or make this weekend.

One of the oxygen concentrators needs a new 9V battery for the alarm system which sounds like an easy fix, except we are working in a developing country.  After work, Casey and I visited 5 hardware stores to try to buy a battery which is going to cost us 2,500 francs ($3.50), but no luck.  After struggling to describe what a 9V battery is in Kinyarwandan, everyone said that we have to go to Kigali to find one.  Practically everyone back home takes it for granted how easy it is to replace a battery, but here it is a major scavenger hunt to find one and it's expensive.  The oxygen concentrators and suction machine also need new canisters for the humidification systems which is something that we probably will end up making since it will be practically impossible to find spares.

Tuesday we worked in the workshop again, taking inventory in the morning and then working on some un-interruptible power supplies (UPS).  One of them was a simple user error that we were able to fix once we took the UPS apart and learned how it worked.  In the afternoon, we attempted to repair a brand new fetal monitor that wasn't printing.  Luckily the user manual was still with it, so we read that in hopes of finding a solution but had no luck.  After reading 3-4 manuals, front to back, of how to operate the monitor and setup the printer, we decided the problem was with the thermal printing system which uses heat instead of ink to print the fetal heart rate (FHR) and uterine contractions (UC).  I currently am trading e-mails with the company of how to repair the thermal printing system and thankfully they have been responding and are being helpful.  Fingers crossed, hopefully this fetal monitor will be working by the end of my trip since the maternity ward could definitely use this addition to their current supply of 2 monitors.

While working on the fetal monitor, I saw a bunch of wires run up through the window from right outside the workshop where all of the welders work, plugged into the outlet.  I couldn't help but laugh a little bit at how crazy the sight was, but also take a step back from the outlet in fear of getting shocked.  Here they had 2 thin, loose wires connected to a welding torch, run across a walkway, run up through a window, and simply stripped the ends and stuck the bare wires into the outlet.  Of course I had to take a picture so all of you could really appreciate the sight.

Wednesday morning, Casey and I went on an adventure to the laboratory to begin taking inventory, since we had been waiting for the past 2 days for Batiste, one of the maintenance guys, to take us there.  Since Monday morning, he kept saying he would take us that afternoon, the next morning, that afternoon, etc., so we finally went on our own to get it done.  For a developing country, the hospital had some extremely nice equipment, some of which had been donated by various foreign countries.  From there we were able to visit pediatrics, surgery, physiotherapy, maternity, and neonatology.  Each place we went had their pieces of equipment that were waiting for repair, ranging from a broken freezer to an otoscope needing a new light bulb.

While taking inventory in maternity, I definitely had a 'TIA' moment.  Last month, some of the group would say TIA (this is Africa) when we saw something that you would never see in the States, like a goat carcass hanging in the doorway of a shop entrance.  Today definitely was one of those TIA moments as a midwife just took us straight into one of the delivery rooms where a mother was in the middle of labor and let us take inventory on a machine right next to the mother's bedside.  During the inventory process, the baby was born right next to us which was quite the experience; one that I'm ok with not repeating for at least a few more days here.  After that, we also got to visit the neonatal ward where we had to put on special shoes and inventoried infant incubators that were warming babies whose legs were the size of my finger.

By the end of the week, we hope to have finished the inventories for all of the departments and begun some of the repairs.  Over the next few weeks, we will be biomedical engineers, technicians, electricians, heating and cooling repairmen, IT, teachers, and many other random jobs.  Continued prayers for safety are greatly appreciated as the work poses some dangers such as being shocked and unsecured containers of oxygen exploding.

Saturday, June 21, 2014

Deployment Day

Sunday's moving day! After 4 quick and intense weeks of lectures on medical equipment, labs for repairs, and language lessons, our groups are heading to our respective hospitals Sunday morning. For the past 4 weeks, we have enjoyed a very plush life in Kigali, but it will be as if we are traveling to an entirely new country once we leave the lucrative city and head to the more rural areas. The nine groups will be spread through-out the entire country, from the northern mountain region bordering the Democratic Republic of the Congo (DRC), to the southern rain forest region bordering Burundi, to the eastern grassland bordering Tanzania. At lunch the one day, we were all joking that the first month has been our survival skills training, and now we are being deployed to our hospitals where we will be on our own for the next 5 weeks.

Casey and I will be traveling to Rwamagana, located in the Eastern Province and only about 1 hour outside of Kigali. We fortunately have a very short trip, but some other groups will be traveling 3-5 hours to reach their hospitals. Prayers for safe travels and safety during the next 5 weeks are greatly appreciated as these areas are not as secure as Kigali. One group will be traveling to Gisenyi which is located right on the border between Rwanda and the DRC and frequently has skirmishes across the border. Last week there were a few deaths there, but supposedly this is typical for the region and EWH is closely monitoring it. The other 8 locations will be safer than Gisenyi, but there still are possible risks as we leave the secure compound of IPRC in Kigali.
A map of where each group will be going to.  Currently, we are in Kicukiro which is around the 'N' in Rwanda on the map and I will be heading to the red marker directly to the east.

Although Rwamagana is only 1 hour outside of Kigali, it is a very small and rural town. The hospital is smaller than the ones we have visited in Kigali (CHUK and Kanombe) but is growing. During our time there, Casey and I will be staying at the hospital director's home which is only about 500m away from the hospital. Technically we are staying with a host family, but the director only occasionally stays at the house when he is traveling, so we will pretty much have the house to ourselves in addition to a houseworker and a guard at night.

For the first week, we will mainly be going to all of the wards to meet staff and to take a detailed inventory of all the equipment to see what needs repairs. Weeks 2-5, we will be working with 2 biomedical engineering technicians (BMETs) at the hospital to repair as much equipment as possible, as well as teaching the staff how to perform some of the repairs and about the importance of preventative maintenance. For the first 2 weeks we are there, one of the BMETs will actually be at IPRC attending some training classes so it will just be Casey, I, and the other BMET who pretty much only knows French. I better start seriously studying my French! In addition to the one BMET being in Kigali, the director will actually be in Nairobi, Kenya for the first 2 weeks we are there which makes things pretty interesting for Casey and I because we will literally be on our own. Hopefully on Saturday we will be able to meet the director before he heads out since when we arrive on Sunday he will already be in Nairobi. Without the director or the English speaking BMET to show us around, it's going to be very interesting the first week as we try to meet all of the staff and take inventory.

Despite being thrown in the deep end with minimal flotation devices, I'm very excited to head to Rwamagana and begin working in the hospital. Over the next 5 weeks, I hope to build some strong relationships with the staff there and be able to make a small, sustainable impact. As I begin the second month here and start to really delve into the intent of the trip, I ask for prayers for patience as that will be one of the main keys. Working in Rwanda is a completely different pace than working in the States, and sometimes waiting 1 hour for someone to bring you a part can become very frustrating. Patience will also be key as I struggle with Kinyarwandan and French while trying to teach some staff how to operate devices that I may have just learned how to operate a day ago. More importantly, pray for God's continued work at the hospital as the over-worked staff treat hundreds of patients with a wide range of conditions.

Thursday, June 12, 2014

Off to the Hospital!

Two Mondays ago we got to visit one of the hospitals in Kigali for the first time since we have been here. Abbreviated CHUK, this hospital is the largest teaching hospital in the country and one of the best facilities. Since it was only our first hospital day, our group simply toured the hospital and got to see the different wards, equipment that they use, and meet some of the staff. We were able to visit the different labs for diagnostic testing, the PICU, the biomedical engineering technology (BMET) workshop, radiology, pathology, hematology, and lots of other departments. For being in a developing country, CHUK had some great lab equipment, although there is also broken equipment everywhere with signs, just waiting to finally be repaired.

In the PICU, we were actually able to walk in the ward in small groups to look around and see the photo-therapy lights they use to treat jaundice in infants. In radiology, we saw their best CT machine in the country which is one of three total. We also got to meet an American radiologist who is working there and learned a lot about the medical system here. His wife is a pediatric trauma surgeon and wanted to do overseas medical service, so they moved with their two children to Rwanda for 1 year on a federal grant and have decided to commit to another year. Along with 138 other American nurses, physician assistants, and doctors, they are working on developing the residency program for health care professionals in Rwanda. All of Rwanda's doctors have completed their residency outside of Rwanda, so there is now an effort to develop the infrastructure to train doctors within the country. For a country of 12 million people, there are only 600 doctors which translates to 1 doctor for every 2,000 people!

This past Monday and Tuesday we got to go back to the hospitals again, this time for practical work experience. This week I went to Kanombe Military Hospital, and next Monday and Tuesday I'll be back at CHUK. Kanombe Military Hospital is also one of the best in the country, and is one of EWH's Centers of Excellence (COE) which means that it must meet certain standards. In order to even visit there, we had to go through lots of paperwork to get clearance and then more paperwork and diplomacy to be able to work on equipment there. Upon arrival, we had to pass through a military checkpoint to enter the hospital grounds. All around were people in military uniforms, whether they were working as guards, doctors, technicians, or administration.

Monday morning we worked at IPRC to take apart some equipment and learn its mechanics before heading to Kanombe in the afternoon. In the afternoon, Kostica showed us around the hospital and let us visit some wards. He works for EWH, designed the BMET workshop at Kanombe, and knows pretty much everyone at the hospital, so he was able to get us into most places, even though that sometimes meant we walked in and walked right out after the department head would tell Kostica we couldn't be in there since they were receiving an ICU patient or some other major thing.

Tuesday we went back to Kanombe and were actually able to work in the BMET workshop on some broken equipment. We worked alongside some of the BMETs there to learn the process of troubleshooting, the testing steps they go through, and how they fix the device. We started with an oxygen concentrator that just needed planned maintenance done which was fairly simple and only involved taking it apart, cleaning the filter, dusting off the motor, and checking the tubing and alarm. For that device, we got to work with a BMET who was in the military and even got a picture, so that was a cool memory! 

Some of the group then worked on repairing a broken dentistry chair and then others worked on a suction machine.  Mid-morning, the head BMET got a call that they needed some repairs in the dentistry clinic, so we packed up our tool bag and headed over. All of us in our group decided that we felt pretty official with our gloves and tool bag and being able to walk right into the clinic. When we got there, one of the dentists started explaining that the aspirator tool didn't have any suction and they also had a broken machine that wasn't shaking. Immediately I thought 'what am I doing here?' because I had never even heard of the machine before that he wanted us to fix and there was a patient right beside us getting her teeth cleaned. After a couple of questions, we learned that the device was a shaker, almost like a lab vortexer, to mix the dental cement used for cavity fillings. After taking the device apart, testing all of the wires, and dealing with several bad outlets, we decided the only problem was the dial which they had lost the knob for and had taped the case to the device which was causing the switch to constantly be turned on. With no spare dial, we couldn't completely fix the device but were able to repair the cracked case and make it so that the switch functioned again.

While in the dentistry clinic, our BMET got another call for a device in the ER. Walking right into the ER was quite the experience because there is no way in the States they would let a bunch of foreigners walk right in next to a patient being treated and just start repairing a device. One of the patient monitors wasn't turning on, so there we were 3 feet from the bedside of a patient in the ER receiving care. Luckily it was an easy fix for the patient monitor and we were only there for about 15 minutes. After testing the power cord and finding a break in the wiring, we exchanged cords and the monitor worked fine. I'm excited to be back in the hospital again next week for our last 2 days of practical training before we head out to our respective hospitals for the final 5 weeks!