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!


Tuesday, June 10, 2014

The Power of Forgiveness

The first Saturday here our group traveled to the Millennium Village as a way to learn more about Rwandan culture and to see more of the country.  Prior to the trip, we didn't really know what to expect of the trip except that we would be visiting a village and their local genocide memorial site.  The day turned out to be magnitudes more than that and was certainly filled with many impacting experiences.

The Millennium Village is an initiative that was started in 10 countries throughout Sub-Saharan Africa as a means to lift a village out of poverty.  Goals such as reducing extreme poverty and hunger, improving education, health, gender equality, and environmental sustainability are set and are supposed to be achieved within 10 years from the start of the program.  Mayange was selected as the village for this program in Rwanda.  Before the genocide in 1994, Mayange was mostly a jungle and was the most fertile area in the country.  In 1992 when turmoil began, thousands of Tutsis were sent here as the government's attempt to quietly kill them, hoping that they would die from natural causes in the jungle.  When fighting broke out in 1994, tens of thousands of people were killed there.  During the aftermath when refugees were returning to the country from Tanzania, many people went there to re-start their lives.  As a result, heavy deforestation occurred and the area went from the most fertile to the most infertile.

Since the start of the Millenium Village in 2006, Mayange has had several school buildings built, their health clinic underwent major improvements, multiple cooperatives have been established, their village as a whole has seen major improvements, and they have built one of the most amazing communities that I have ever heard of, let alone experienced.

Our guides first took us to the school area to show us the classrooms. The school buildings were built by various organizations, including World Vision and another relief group.  Although it was Saturday, some kids still flocked to the schoolyard and were eager to tag along with our group.  The principal at the school showed us around and told us that the school teaches 1, 035 students with only 16-17 teachers!  That's about 62 students per teacher which always makes me think of how teachers in the States would probably go on strike if they had that many students in their classroom during elementary or middle school.  After seeing the school, our group participated in muganda (see previous post).



Once we finally cleaned ourselves up from being a muddy mess after muganda, our group visited Mayange's health clinic.  Here they had several nurses on staff, but no doctor since it was only a village health clinic.  Entering the health clinic, the waiting room was overflowing with dozens and dozens of people waiting to be seen.  At most hospitals in the States, there are 1-3 people per room, but here there were about 14 people all in one giant room with no curtains to serve as dividers.  Walking from ward to ward, there were people everywhere, including sleeping in the middle of the courtyard.  We got to visit the PICU and check out the equipment in there and even see some patients being treated.  Going to the maternity ward, they showed us this one room that was the size of a large bedroom in the States and told us that was the old maternity ward before the Millennium Village project started.  For all of you mothers out there, imagine sharing that size of a delivery room with several other mothers!  Since the project began though, they have built a new maternity ward which is much bigger and can better accommodate the village's needs.


I didn't really think about Rwanda having health insurance before the trip, but during our visit they explained that most people buy health insurance so that they can actually afford medical care.  Through the government, anyone can buy health insurance and then they only have to pay 10% of any care they receive which is typically the only way people can receive medical care.  Also, mosquito nets are given out for free to anyone to reduce the amount of malaria cases.

After the health clinic, we visited a local farmer who showed us his animals and crops.  The stalls for cows and pigs were really interesting because they were just constructed from bamboo.  Walking through the banana groves was a pretty awesome sight and we even got to see how they harvest cassava roots.


As part of the Millennium Village project, several cooperatives have been established to provide income opportunities for groups of people.  One of these is a women's basket-weaving program that involves about 120 women and allows them to sell their baskets in a store and at some markets.  Their store there was packed with beautiful baskets made with intricate details and each basket included the name of the person who made it.  Afterwards, they even showed us how they make the baskets!  Using a small bundle of straw, they just continuously wrap embroidery thread around it and sew it through the previous circle of the basket.  I only did 2 small loops and I'm amazed at how they can make the baskets, let alone add designs to them.




From the cooperative, we visited the Nyamata genocide memorial site which is by far the most intense place I have ever been.  Prior to 1994, the site had been a large Catholic church but due to the events that happened there, it is now a memorial site.  During 1992 when some fighting occurred, Tutsis fled to the church to seek protection and were able to remain safe.  When the genocide began in 1994, thousands of people again fled to this church since they heard how people were protected there and also because they thought people would respect the holy space and not kill anyone.  Unlike in 1992, soldiers  broke into the church where 11,000 people had taken refuge and killed everyone there.  To honor everyone who lost their life there, survivors gathered the victims' clothes and brought them back to the church.  Unlike any other memorial I've been to, they showed you every detail.  Walking through the doors of the church, you could see the grenade marks in the concrete where the soldiers broke in.  Inside the church, there were piles of clothes laid on every bench, hundreds of bullet holes in the roof, and blood stains on the walls.  Walking past the piles of children's clothes was definitely the toughest part.  Outside, they had 3 mass graves for the 45,000 people who were killed in the area.  To the group's surprise and horror, they actually let us walk down into the graves and look around.  Walking down the stairs, there were shelves and shelves on either side filled with skulls and bones of all the victims and you could see how they were killed.  I really don't know any other way to describe the sight other than it being a real-life scene from a horror movie.


Our final stop of the day was at the village of unity and reconciliation.  Here, survivors, perpetrators, and refugees of the genocide live next to each other and serve as a living testimony to the power of forgiveness.  We were welcomed with singing and dancing by girls from the village and it seemed like everyone in the entire village was there.  After that, we listened to a perpetrator talk about his experience during the genocide and then listened to a survivor tell her story during the genocide about how she hid after both of her parents were killed.  The head of the village then told us how after the genocide, 2 American pastors sat down with both sides and helped each other discuss what happened.  The perpetrator who shared told us how the pastors worked with him and eventually he asked God for forgiveness.  Just the concept of living next door to someone who killed your family would be considered insane by most people, but the people in Mayange are actually living it.  At first it was far from easy, but they said that through prayer and asking God for forgiveness, they now live as one community and can ask anyone for help.  No one is identified as Hutu or Tutsi, and all of their children grow up together being taught they are all equal.  Simply experiencing their love was definitely a life-long memory.

So many times at home, I hear someone saying how they were wronged by another person and want to get even.  It's my prayer that everyone would be able to experience a fraction of the forgiveness that the people in Mayange have because the world could be flipped upside down from that.  It's definitely not any forgiveness that us feeble humans are capable of, but rather a forgiveness that God delivers through us if we choose to allow him.

Sunday, June 8, 2014

Muganda

Translated from Kinyarwandan to English, muganda means reconciliation.  After the 1994 genocide, the country wanted to make sure that people learned from it, never forgot it, and grew from it.  To help do that, the last Saturday of every month is dedicated to muganda and everyone, whether 5 years old or 75 years old, is required to participate.  Each village does this together and from around 8am to early afternoon, everyone works together on a specific project to better their village.  In the city, it tends to be road maintenance or trash clean-up and in the more rural areas, it tends to be construction.  Some people aren't a fan of muganda since they lose a free Saturday, but I think it's an amazing program since the whole entire community comes together as one to work on a common goal and regardless of any income, ethnicity, or cultural differences, everyone is working side-by-side to better their village.

Last Saturday our group had the opportunity to participate in muganda with one of the villages, Mayange, in the Eastern Province.  The current project in Mayange was working on building 5 houses for refugees that were returning from Tanzania.  The walls and roofs of the houses were made, but they still needed to be 'insulated'.  We arrived at acres and acres of open dirt fields with hundreds and hundreds of people ready to work.  There were dozens of wide, shallow holes dug near the houses and by a giant water tank truck that was being operated by the military.  In order to make the mud for bricks, water was emptied into a large 'reservoir' hole and then distributed to other holes which people hoed dirt into and then others would stomp around to mix the dirt and water until the correct consistency was reached.  Once this was made, another group of people would carry by hand the mud to individual houses where another group would take handfuls and literally throw the mud onto the houses until all of the walls were covered.

When our group arrived, it felt like there were 1,000 eyes questioningly staring us down.  Soon after we got there, the military men on top of the water tanker truck distributed the water and the entire process began.  At first, all of us stood around just watching how the process was done, but eventually some of us hopped in the mud pit and helped to hoe dirt or stomp around to mix the mud.  As soon as we did that, all of the locals started cheering and laughing.  Some people in our group even started to dance around while mixing the mud and chant while hoeing which made everyone there laugh.  Some locals even joined in with them and many people pulled out phones to videotape the spectacle.  Once the first batch of mud was made, the enormous group split into smaller work groups and went to individual houses to carry mud and to plaster the walls.



I foolishly wore a skirt that day since the group thought we would be walking around in the heat all day, but I still hopped in to join the mud-mixing brigade.  All I could pick up from their kinyarwanda conversations was 'muzunga' which means white person, but I'm sure they all got some entertainment out of watching the white girl in a skirt stomp around in the mud.  Swap the hot African sun for the cool mountain climate, and it was like mixing cob for the natural oven in Guatemala 3 years ago.  After mixing some mud, I got to put my softball skills to use and have fun chucking mud at the house walls.  In order for the mud to stick to the walls, you had to throw it really hard, which meant that you inevitably got a nice back-splash of mud of you. Most of the time it felt like target practice because there was always that one little spot you still had to cover and sometimes you would hit it and sometimes you would just keep circling it.



One of the interesting stories from muganda happened when myself and another student in our group took a short break to talk to one of the locals there and practice our French.  We might have been there for 10 minutes when one of the other workers from the area we had previously been at came over and told the local that he needed us to come back to work for 15 more minutes.  I'm pretty sure we didn't help that much, but it was really neat having them want us to work with them.

Something that really stood out at the end of our time at muganda was the change in how we interacted with the people in Mayange.  At first, we were the typical white people who just stood around and watched and they seemed to expect that.  Then they let us hop in and help out some and occasionally laughed at our techniques or just stared at the muzungas working .  Once they saw we really did want to work, they would show us their proper technique and teach us some.  By the end of the morning, they were calling us back to work from social breaks.  Although we were only there for about 2 hours, it was amazing to experience their sense of community.    Getting to work alongside someone who could be my grandfather's age and then 30 minutes working alongside someone my age, I got a glimpse into what it's like to have an entire village spend time getting to know each other and work to make an impact on their community.


Tuesday, June 3, 2014

Land of a Thousand Hills

Sunday night I safely arrived in Kigali after 22 exhausting hours of travel.  Since Rwanda is practically on the equator, the sun sets around 6pm so it was completely dark when I landed at 7, even though it felt like 1pm due to the time change.  After passing through customs with two of the other program participants, we met up with Ben who is our On the Ground Coordinator (OTGC) and drove to our homestays that we will be at for the next 5 weeks.  The entire group of 19 participants are all staying with host families on the campus of the Integrated Polytechnic Regional Center (IPRC) which is a secondary and technical training school that students from all over the country attend.  It's comparable to a really small college campus and has awesome facilities, partly due to equipment donations from Korea.

When I met up with my host dad, Avit, Ben asked him if his wife had their baby yet and Avit said early that morning they did!  I was pretty amazed that even though they just had a baby less than 24 hours ago, they were still opening their home up to 3 college girls for the next 5 weeks.  I didn't really know what to expect for my homestay, but their house is much nicer than I anticipated and could be considered a nice rancher in the States.  I'm sharing a room with 2 other girls in the program and our room is extremely nice, larger than I expected, and we even have an indoor bathroom!

All of us sleep under mosquito nets since they are terrible at night, but the first night I was so worried about suffocating in my net since I sleep on the top bunk and my net was too small so it was right against my face.  Thankfully I got a new net after the first 2 nights so it has been a little better but still challenging since the net is off-centered overhead and touches my skin.  For the first week, I kept waking up with dozens and dozens of mosquito bites on my arms and legs since the mosquitoes can bite through the net if it's in contact with your skin. At one point, my entire left arm was swollen from mosquito bites and looked like I was diseased.  While desperately fighting the urge to itch them, I counted the bites and had 50 bites just on my left forearm, not to mention the countless ones on my legs despite wearing 20% deet bug spray.  Since then, I've resorted to wearing long pants and long sleeves at night which is extremely hot in Africa without any breeze, but it's been a successful solution to the buffet that the mosquitoes have been making of my skin.

Monday morning everyone had to meet for class at 8am, despite suffering from some serious jet lag.  Right away, we jumped into 4 hours of Kinyarwandan language lessons with only a 10 minute break.  After about 3 hours, my brain was pretty well saturated and trying to focus on learning new vocabulary during the last hour was a challenge shared by the entire group.  Kinyarwandan is the native language spoken in Rwanda and while some words are taken from French, it was a completely foreign language with difficult pronunciations.  Monday-Thursday we had Kinyarwandan lessons from 8am-noon and then on Friday we started our French lessons which we will have for the next 3 weeks.  English became the national language in 2010 and while some people like my host parents speak it, French and Kinyarwandan are still dominant in the country.  In the afternoons, the group has lectures taught by a professor from Texas A&M University and labs to help us prepare for working in the hospitals.

Monday was just a basic introduction to the program, but starting on Tuesday we dove right into the work.  Before working in the hospitals, we need to have a basic understanding of electrical engineering principles so there are about 12 labs we will be completing.  All of the labs are completed with our assigned partners for the trip who we will be working with during the second month when we disperse to our separate hospital assignments.  My partner is Casey, a bioengineering student who attends the University of Pittsburgh and is one of my roommates during the first month.  Tuesday we constructed an extension cord and also learned how to solder components into a soldering board.  As an electrician's daughter I feel that I should have known better, but my partner and I committed a rookie mistake and ended up stripping our wires too much so that when we wired it to the plug, some were touching and created a short so we had to disassemble and re-wire the entire extension cord.  At least a lot of learning happened!

Wednesday and Thursday everyone was paired up with some of the Rwandan biomedical engineering technology (BMET) students at IPRC and we worked together to make an ECG simulator.  I was paired up with Jhon who just graduated from the program and Carpaphore who just finished his second of 3 years for the program.  Trying to communicate was sometimes difficult, but their English was pretty good which was a huge relief to me since I had retained pretty much only my name, basic greetings, and numbers from my 8 hours of Kinyarwandan lessons.  Building the ECG simulator with them was an awesome experience because we got to share parts of each others cultures and they also taught me some about circuits.  Once completed, we even got to test out device on a machine and Jhon was able to keep the device which can be a valuable tool when troubleshooting equipment in the field.

The first week was pretty exhausting between recovering from finals week and jet lag, having class 8-5 everyday and having homework assignments at night, but the group still found time to hang out and socialize with some of the students at IPRC.  Thursday afternoon we got to play basketball with some of them and despite our terrible skills compared to theirs, they were always eager for another game.  We played 3v3, half court, and to 3 baskets.  Once one team scored 3 baskets, regardless of 2 or 3 point sots, the losing team rotated out with a new team.  Soccer (futbol) is huge here and there are always teams practicing every afternoon on the campus's very nice field.  Thursday morning we also got to experience some of Kicukiro (chi-choo-chiroo) by visiting the market across from the school to practice some of our Kinyarwandan skills.  We were only there for about 45 minutes, but it definitely was an experience walking past shops with entire animal carcasses hanging in the doorway as butchers tried to sell us meat that was sitting out in the heat with bugs everywhere, piles of produce next to piles of rotting produce, and women sewing clothes or grinding up flour from casava roots.

Tuesday night, Avit and his wife, Agnes, had to take their baby to the hospital for a check-up and ended up staying overnight since the baby had jaundice which is fairly common in infants here.  There the baby received phototherapy via blue light to neutralize the yellowing of the skin and eyes.  Thankfully, the baby is doing well and returned home late Thursday night/early Friday morning and is extremely cute!

Saturday our group took a tour of the Millennium Village to learn more about Rwandan culture and history which definitely proved to be a vivid experience which no one will be forgetting anytime soon.   The day was packed full with experiences, so I'll be creating a separate post just for that day, hopefully within the next day or two depending on the internet situation.

Overall, the country is absolutely gorgeous.  It's know as 'The Land of a Thousand Hills' and is just breathtaking scenery wherever you go.  One interesting fact is that no plastic bags are allowed into the country, which definitely helps to limit the garbage situation.  Even compared to the States, Kigali is extremely clean and it's hard to find trash anywhere on the streets.  The country takes great pride in Kigali and presents it as their showcase to other countries.  A few times our group has been walking around the city and a young child will come and ask us for 100 or 200 francs which is the equivalent of about 25 cents USD.  If an older person, maybe 30 or older, or a soldier sees the child asking us, they approach the child and the child takes off running, I guess in fear of getting in trouble.  I haven't been to the rural areas yet, but at least in Kigali, practically everyone takes great pride in how their country is presented to foreigners.  Several of the host families have told us that we need to gain weight while we are here so that when we go back to the States, people will know that we ate well in Rwanda.  The group isn't really a fan of that idea, but the hospitality here is amazing and the sense of community is heart-warming.