Two months in Rwanda and turning 30

Hello all,

As you've probably assumed, I am still without regular internet access, but have been so busy in the past 2 weeks that I haven't missed it...well not *that* much anyhow. It is my 30th birthday today and I am at a loss to explain how September 20 has snuck up on me (and 2 months have gone by since I arrived in Rwanda) this year much less 30 years worth of September 20ths.

I have travelled to Byumba today for a meeting with my Rwandan counterpart Dr. Moses, and yes... to be able to be in touch with friends and family today is important to me.

I have hardly had time to breathe since finishing August's monthly report and have not been faithfully keeping up with my journal. It's been a hard couple of weeks, "growing pains" if you will - any organization will suffer from bumps in the road especially at the beginning and I suppose when starting up a health center at a refugee camp in the Rwandan countryside, I should allow for more turbulence than other endeavors. Still I get frustrated and impatient because of how I *want* things to be and how I see that they *can* be... and most days nothing is easy - one has to follow up on every detail - not just say it and trust that it will be done. There's also the constant vigilance against corruption and misuse of funds that is so rampant in this part of the world (well any part of the world - I suppose but I'm just running into it more here with my managerial hat on). Fortunately ARC and Theodore (camp manager) and Barry (country director) have an absolute zero tolerance policy for any kind or corruption or misappropriation of funds - but it is exhausting to always be checking invoices and payroll sheets over and over. It's been such good training for me though - I tend not to prefer conflict but here I have to stand my ground each and every minute... good for me but exhausting nonetheless.

I received a call from the USAID representative today (great birthday present!) that our PEPFAR proposal for HIV/AIDS funding was approved for FY '06 which is wonderful news and so there will be money to start HIV prevention, testing and treatment programs!

I only have a few minutes left at this internet cafe before having to go to dinner but I will leave you with some pictures of the birthday party that Theodore threw for me last night... about 50 people - complete with a huge dinner, cake and lots of traditional dancing. I was touched that it was refugee and Rwandan staff alike- and most of my staff from the guards at the health center to my nurses, to the cleaners and nutrition center staff along with my drivers were there. Theodore presented me with a traditional dress from his home country of Benin in West Africa which you can see me wearing during the dancing!

The day yesterday started in such sadness, I attended a burial of Adeline, a 4 month baby girl who I'm sure had AIDS who we had managed to see through pneumonias and gastroenteritis and fungal infections and fever after fever the past 2 months since my arrival. I was at her bedside all weekend as she struggled not to drown in her own secretions from yet another pneumonia and suctioned her (our suction is a feeding tube attached to a syringe) almost every 10 minutes but despite all the "tricks" I knew, broad spectrum antibiotics, diuretics, steroids... couldn't save her. All of my nurses and I attended the burial - this child had such a will to live we had hoped against hope that she would make it through this episode, but it wasn't to be. The graveyard of the camp is in one of the most beautiful spots I've seen, surrounded by pine trees atop a mountain, there are half a dozen rough wooden crosses now - those refugees who will not see their earthly home in the Congo again... But as healthcare goes we had to return to the clinic where malaria is in full force now that the rainy season has started and there are stagnant pools of water... we admit 10 patients over the course of the day and our little hospital is bursting at the seams.






But night comes and as I enter my house I am greeted by this huge raucous party and speech after speech of such warmth that my emotions swing from sadness and exhaustion to joy and celebration...it takes away that bit of homesickness that had been festering a little the past few weeks with too much work and too little sleep and struggle after struggle to get even the smallest tasks accomplished. Such emotional roller coasters each and every day here but it reminds me of how fortunate and truly blessed I am to be here on this earth at this moment in time doing this work that I find myself so engrossed in .. I am keenly aware and in awe of being *alive*.

All my best,
Ann