Saturday, May 20, 2006

"Not all who wander are lost" JRR Tolkien

One of my favorite quotes of all time.

Leaving this time around is still hard, but it's with a real sense of security that even in an extremely unpredictable part of the world - and with a population even more unpredictable still - that the programs started will continue and the knowledge taught and learned will not be wasted.

I fly out of Kigali tonight. Thanks to everyone (too many to list here individually) for all the support and love and encouragement this whole year! I definitely would not have been strong enough to have kept going without you all. I'm looking forward to catching up with everyone back home where I'll be planted for at least a year before off and wandering again...

lots of love,

Monday, May 08, 2006

Out of survival mode...

One of the most gratifying things about returning this time around is that the sense of desperation that was my constant companion from July to December is notably absent. The problems are there, it is true - but things have stabilized - the Nyabiheke health center hospital had *3* patients total for most of last week - and two were chronic (femur fracture in traction and arm wound with daily dressing requirements). It's such a luxury to be thinking about things other then basic survival, things like nutritional supplementation, HIV prevention and treatment, Income Generating Projects, Schools, Vitamin A supplementation, mass de-worming...

Here are some of the scenes from the past two weeks:

Vitamin A / Mebendazole distribution:

Community health workers distributing Mebendazole & Vitamin A

Vitamin A deficiency is one of the 5 leading causes of blindness in the world - and preventable by a 10 cent capsule... Intestinal worms are endemic and can contribute to poor growth, decreased cognitive function and anemia ... and are also easily and inexpensively treated... things were going so smoothly at the health center that I went along with our community health workers house to house to find all children under 5 and help administer the Vitamin A & Mebendazole capsules

HIV Educational Campaign "Extravaganza"

One of the skits illustrating the importance of getting tested for HIV

As part of starting up a comprehensive prevention and treatment program for HIV/AIDS, community mobilization with educational activities especially focusing on decreasing stigma and encouraging testing are underway. Gihembe camp's anti-AIDS youth club who has been active for a few years now - came to visit and support Nyabiheke's fledgling club "New Hope" and jointly they put on an afternoon of dancing, skits and music for the kids and adults at Nyabiheke.

Dancers from the Gihembe anti-SIDA group performing to a crowd literally packed to the rafters

Income Generating Projects
I've mentioned it before but I have to say it again - the difference in the camps since Louise came and helped people start their own businesses is palpable. To have an occupation while in such a tough situation - not able to return home, not able to work in the regular local economy - it truly transforms people's lives and attitudes.

Our hospital was so empty that the IGP bagmaking group took over one of our wards! (Exactly the way it should be in my opinion)

Another group enjoying a reprise from the heavy rains on a sunny afternoon

People go to "work" each day at their tailor stations or bagmaking or soapmaking stations. For those of you in Boston who'd like a handmade nylon bag (they're selling for 5000 Rwandan Francs - roughly $10 US, materials cost about 2400 and it takes about 2 days to make each bag) let me know and I'll bring one back for you or put a bunch in the mail!

The local tailors' co-op sewing a tear in my overworked and shabbier-by-the day white coat (costing the equivalent of 50 cents which I thought was a pretty good deal, but one of my nurses informed me was "muzungu price" (white people's price) telling me she would have only paid the equivalent of 10 cents!)

Outdoor School
My version of outdoor school in elementary school was going to the woods for a day and learning about building shelters and making fires and basic survival. Here the children know all those things from an early age - their outdoor school is going on while they await the construction of proper schools with walls and roofs to attend.

At school finally, under the shade of the pine trees

The compromise made between the Rwandese Government and UNHCR is that there will be a preschool and K-3 school (plastic sheeting and poles) constructed in the camp, and extensions to 2 local schools will be built to accomodate the rest of the children grades 3 and up. It's not a perfect solution but at least the littlest ones won't be walking 2 km to get to school. Funding for these projects is jointly supplied by UNICEF and UNHCR and the materials the children are using as well as the blackboards are donated by UNICEF. The teachers are refugee volunteers, serving their own community.

A Morning for Art

Ryan and Ryan are two U Wisconsin Madison students studying in Kenya for the semester. Through a connection of a connection (as these things often happen here) they stumbled onto our doorstep in Nyabiheke for a few days last week eager to learn and help in any way possible.

After observing the Vitamin A distribution and HIV activities, and being instant favorites of all the camp kids - they wanted to design a project to bring back to Wisconsin with them to educate their campus about the ongoing humanitarian crisis in the Congo and the lives of the refugees it has caused.

The children took their tasks very seriously and there was little of the mugging for the camera or gawking at the 3 muzungus that I had been expecting

With just a half day of planning we were able to gather 30 children ages 6-17 together from all parts of the camp to spend a morning coloring pictures of their lives here, what they hope for, or what they want to be when they grow up. The morning was an incredible success (I just have to mention at this point that over 50% of the children said they wanted to be nurses or doctors!). Ryan and Ryan will be putting on an exhibit of the drawings at their campus in Madison sometime this fall.

This young man drew a picture of the camp and his life here (left) and on the right a picture of the Congolese flag and himself as a politician in the future. He wanted to be a politician to make Congo safe so that he and his family and all of the refugees can return home someday.

I've been reflecting on the difference between staying alive and living these past two weeks. It's the things like education, dance, drama and art and even yes having a job, being able to have an occuption - these are things which restore dignity and allow people to live - very different than the staying alive of airway, breathing and circulation we focus so much on in the medical world (yes without this there couldn't be the other) however the stuff of living, of diginity, it's happening slowly here even in a refugee camp even in the middle of Rwanda.

This last photo is of one of our other young artists. He drew a picture of a football player (soccer for us Americans) which he wanted to be when he grew up. But on the back of the page he wrote a message which at this point, given the situation in Congo may be even more difficult to achieve than becoming a star footballer...

"My hope is to be able to go home to the Congo someday, thank you."

We hope so too...


Monday, May 01, 2006


I'd somehow forgotten how beautiful Rwanda is - being back in the countryside at the camps this past week reminded me - especially now that it is rainy season - everything is so green and alive. It makes the grey of London seem very very far away!

I've forgotten my cable to download pictures so those are coming next time I get in email range, I promise. Being back at Nyabiheke, with the nonstop greetings from the children and their choruses of "Doc-tor An-na" and the elders with their more restrained "Mahoro" and the hugs and kisses from my staff - it feels like home. The health center is running without a glitch - the atmosphere is so calm, so organized, none of the desperation that I had remembered. Malaria cases are down 50% since net distribution in December, daily educational lectures have continued and I wandered into a mass Vitamin A and Mebendazole distribution being done by the Community Health workers from tent to tent for all children under 5 (Vitamin A being one of the leading causes of preventable blindness in the world) as well as a new startup anti-AIDS club meeting.

The IGP groups started by Louise have definitely had a profound impact on the atmosphere of the camp - the sewing group in one area, the soap makers, the handbag weavers - people are joking and laughing together while they work. Makeshift school have been set up under the trees so the children are occupied during the day and many adults are volunteering as teachers in these schools. Classrooms are being built, a nursery school and K-3 to stay in the camp, grades 4 and above will be attending the local schools as soon as extensions to them are built. Meanwhile they are doing what they can (and I happen to think it is quite a lot!)

The nice thing about having been here near the beginning, then being away for a bit - is the ability to see significant change - in a good direction. I am so happy to be back - and realizing that my time is far to short. I really only have 3 weeks left before headed back to Boston. The HIV paperwork draft is finished - will be reviewing it this week and even though it all can't possibly get done in the next 3 weeks - what I have seen of the programs that have started and continued in my absence gives me much confidence that this will hold true with the HIV programs as well.