Our final entry

by Paul

Well this blog is ending for me the same way it started…typing it up while enjoying the privilege of sitting in a Star Alliance lounge waiting to board our flight.  It’s amazing: the difference in my perspective now versus just three weeks ago.  The time has gone incredibly fast and yet so much has happened that I can’t believe it all occurred in only 3 weeks.

Yesterday was a nice completion of the circle, so to speak.  We started the day off with a very good discussion surrounding ultimately a very sad M&M case.  After which we had the chance to go back to the apartment and pack up.  Rwanda proved to us both what the rainy season is really like, yesterday, and how incredibly lucky we have been with the weather during this trip.  The sheer amount of water that fell from the sky was impressive and finally justified to me why there are gigantic rain drainage systems all over the country.

We got to see Emmy one last time and as always he had a hand in making sure our exit from the country was as smooth as our entrance.  We also got a very nice phone call from Mary and got to thank her again for her wonderful hospitality.   Lunch we had at the hospital, one last time, with Rob and Sean.  We got the Special (not “Spanish” as we first interpreted it) Omelette, which was eggs, fries (or chips as they like to call them), tomatoes, onions, and something that was either meat or very hearty mushrooms (but I think it was meat).  We of course had, what I originally thought was going to be our last Fanta.

Getting back to my completion of the circle comment, the wonderful opportunity I had to come on this trip first truly came to be when I was at my first monthly teleconference with Rwanda, but on the UVA side.  I can’t remember now what the topic was, but I remember being there watching one of the residents give a presentation and trying to imagine what it must be like where they were.  My only view of Rwanda at that point was part of a room in some random building in a country I had never seen.  The end of our day yesterday was a fantastic way to finish our time here.  Here I was on the other end of the teleconference, now with a much broader view of where the residents here are, what their situation is like, and even simply where the teleconference room is in relation to everything else (to my surprise it is on the top of a four story teaching institution that handles the lion’s share of medical education for all of Rwanda- I, for whatever reason, assumed it was on the ground floor of likely a relatively small building somewhere near the hospital).  It’s funny how your mind builds a framework to surround what you see and it’s quite an experience when that framework is utterly shattered and replaced with the truth.

We had to leave the conference a little early to get back to our apartment, grab our stuff and hit the road.  The driver, provided for us by CHUK, picked us up in a minibus, which was great because it was my first experience in one in Rwanda.  Luckily for us, it was not packed to the gills like every other minibus in town, there were only four of us in there (including the driver).

We made it safe and sound to the airport and through customs.  We then saw what was likely the only restaurant in the airport and decided to pause before going through security (a good thing too, because I’m pretty sure we wouldn’t have been able to get back if we wanted too).  Our last meal in Rwanda was a surprisingly good panini with beef and vegetables.   Naturally we had to have one more Fanta to go along with our meal before getting on the plane.

Our flight to Brussels was nice and quick, especially given the fact that I slept most of the way.  We made a quick stop in Nairobi to drop off some travelers and pick up a few others.  Shortly after take off from Nairobi I feel fast asleep.  The last thing I remember is them saying something overhead about dinner (chicken and rice and some other option I didn’t quite catch) and thinking to myself, I’m really glad we already ate.  I woke up sometime later to find a blanket nicely folded on my lap, I opened it up and quickly fell fast asleep again.

It’s been an amazing trip, one that I will never forget.  So much has happened, I am not sure I have processed it all yet.  This blog, however, went a long way in helping me do that.  I hope you enjoyed this blog as much as I surprisingly enjoyed writing it.

I’ll end with a favorite quote of mine from J.R.R. Tolkien: “He used often to say there was only one Road; that it was like a great river: its springs were at every doorstep, and every path was its tributary. ‘It’s a dangerous business, Frodo, going out of your door,’ he used to say. ‘You step onto the Road, and if you don’t keep your feet, there is no knowing where you might be swept off to.'”

While it may be dangerous, it is also incredibly fun.  I hope when we next meet it will be somewhere completely unexpected.

A day of rest – sort of…

by Marcel

Today was planned to be a quiet day of relaxation prior to our final teaching sessions tomorrow morning and afternoon, and departure tomorrow night. We kind of succeeded. It would all have been well if Paul this morning hadn’t handed me an envelope that he had received yesterday from one of the residents. It contained a check from the University of Rwanda for our expenses traveling to Butare. We realized that we better get it cashed today, or it will never happen. I don’t think my Charlottesville bank will know what to do with a check for 60,000 Rwandan francs drawn on an African bank.

We hoped to get this taken care of at a local bank in Nyamirambo, but no luck: the check was issued by the National Bank of Rwanda, and can only be cashed there. And so our day of rest turned into a long (about an hour) and pretty hot walk all the way to the center of Kigali.

The National Bank is quite imposing, with tight security not dissimilar to an airport. To actually enter the compound you have to push through a rotating door made out of metal bars, which only turns when one of the guards holds a card to a sensor. Inside, though, the building looks more like the lobby of a large hotel than a bank: a huge high hall with seating areas and vines cascading down the walls. We found the right place for check cashing, and after long looks at my passport, and me writing pretty much my whole CV on the back of the check, we received our money.

Getting out also involved going through a revolving door, but this time they had hung the required card on a convenient hook, so that you could let yourself out…

Now flush with money, we decided to go spend it at the Serena hotel, the one true luxury hotel in town, and get a drink there. After the drink, sitting in plush chairs in the air-conditioned Sokoni Café in the hotel, we decided we might as well get lunch as well, and (taking into account Rwandan food prep time) the brief break turned into almost two hours. So we did get our rest after all.

The afternoon has been spent going through the presentation for the case teleconference with UVA tomorrow afternoon and answering emails. In a little while, it’s time to go check out one of Nyamirambo’s little restaurants.

The newspaper we perused in the Serena actually had an article about Nyamirambo. Probably to small to read, but the subtitle says it all.
The newspaper we perused in the Serena actually had an article about Nyamirambo. Probably too small to read, but the subtitle says it all.

PS 1: Just back from dinner at the Kaskito Pub, a tiny, dark place down the street here that makes the best spiced baked potatoes. Paul had his first chipsi mayai  (omelet with fries baked in), an east African favorite.

PS 2: The toilet still flushes! Christophe was right in removing the water tank.

PS 3: Rain pouring down outside, and a lot of power failures…

PS 4: (by Paul) Thanks, from both of us, to all our loyal viewers.  At some point we decided that it would be awesome if we managed to get 1000 views before the end of the trip and guess what?!?!? it happened today…thanks to all of you readers out there.  What’s more is that you came from 12 different countries!

1000 Views!!!
1000 Views!!!
12 countries!!!
12 countries!!!

Difficult Airways and the Military

by Paul

After our wonderful dinner at the Runnels last night, I was invited to go with Sean to the Military Hospital today to see a few of their difficult airway cases.  They have a very accomplished maxillofacial surgeon who works with a lot of patients with very advanced facial and oral tumors.  From previous global health work, Sean has some very extensive experience with difficult airways and knows how to deal with cases like this.  Therefore he has been working closely with Christian, one of the Rwanda anesthesiologists, in developing a good difficult airway algorithm and approach that will fit the system here well.

So my day started off heading to the hospital, CHUK, to meet up with Sean for 7am morning report.  They, as usual, discussed an interesting and difficult case from the night before.  Sean then discussed an interesting initiative that they are starting to improve interdisciplinary communication for the general surgery patients.  This will in fact be similar to a project that was started with the OB/GYN patients and has seemed to have improved the communication around those patients.  It was interesting to watch how he stressed the goals and the objectives and pointed out specific items that were left out in order to try and keep this initiative as focused as possible.  It was a good lesson is clear communication and since this project is all about communication it seems prudent to start it off that way.

So after that, we took a drive out to the military hospital. This was particularly enjoyable for me, since we were in Sean’s late 80s Toyota LandCruiser that has a 4 cylinder diesel engine, that generates all of about 85-90 horsepower but has absolute ton of torque (comparatively).  It is a thoroughly enjoyable car and would be fun to go romping through a Rwandan game park or mountain trail with.  He has had his fair share of issues with it, including the power steering failing recently, which in retrospect he is happy about because the car has just that much more horsepower now.

We made it to the Military Hospital without incident and got ready to start the day.  Due to availability of people, we ended up having quite a bit of time to ourselves until everyone was ready to go.  This worked out incredibly well for me because we got to discuss difficult airways and how best to approach them depending on the tools you have available. Sean showed me a rather extensive file of cases that he was accumulated over the years of different difficult airways that comprised tons of very advanced pathology that we never see in the US.  He also gave me his difficult airway lecture and we even had time to go over some of the tools that he has with him.

By and large what seems to work well for him is a combination of a videolaryngoscope (for visualization of the glottis) and a fiberoptic scope (to be used as an introducer of sorts).  This is a great technique, one that I have used with and is championed by our very own Dr. Randy Blank, home at UVA. The 22 y/o male that we were going to take care of today had what turned out to be some sort of fibro-chrondro-calcified tumor that was where his left maxillary bone (check bone) should have been.  It was large enough to distort his face pretty significantly and it was pushing up in to his left orbit (eye-socket).  Thankfully it was still a fair distance away from his brain and it was not invading or significantly distorting his palate or his pharynx.  There was the possibility that we could have secured his airway by simply taking a direct look like we do for any standard case.  But given the possibility that the tumor could still have gotten in the way and that we were worried about being able to effectively mask ventilate him, we decided to use the technique that I described above.  In addition to that, because of the potential for the difficult mask ventilation, we decided to slowly titrate in some propofol and halothane to get the patient off to sleep but keep him breathing on his own.  That way if we were not able to effectively mask the patient, we could have woken him up and found another way to secure his airway.  The most important thing about this is that this whole plan was discussed ahead of time, everyone in the room knew the plan before we started, and everyone had tasks to perform – this is all things that Sean has been trying to hammer home over the last several months to improve communication and prevent hesitation and poor outcomes when these situations get hard/scary.

Thankfully, we did not have a lot of trouble getting the patient off to sleep.  He was difficult to mask ventilate, which was first attempted by one of the anesthesia technicians.  She was fairly petite however and was having trouble making an adequate seal.  After a little while, I was given the opportunity to try and with my significantly larger hands I was able to make an adequate seal at which point we paralyzed the patient and then intubated him using the videolaryngoscope /fiberoptic scope technique.  It was an interesting case to watch and had lots of good teaching points which led to many good discussions.  It took quite a while to complete which meant the palate tumor case that was to follow needed to be rescheduled for another day.  Oh well, that would have been very interesting to see as well.

After work, Sean needed to make a pit stop at one of the cellphone places to get his wife’s internet modem reloaded with the monthly internet access plan and he decided to pick one up for himself as well.  This led to a very interesting discussion about how travelers or ex-pats often try and find the way to get the fastest internet possible here.  There is the misconception at first that it is likely or even possible to get internet access speeds that approach those that we have in the US.  It can apparently become an utterly all-consuming mission for a few hapless souls, which almost universally leads to complete disappointment.  There are all sorts of rumors about finding exactly the right person to talk to, who knows how to get hold of a device that allows you to connect multiple USB modems together thus quadrupling the speed, etc.  Needless to say this does not exist and short of buying/installing a satellite dish (which I don’t even know if it is truly an option), you will not have similar speeds to those that we see at home.  However, how much does this really limit you…overall not that much.  Streaming video is difficult, netflix or similar services is all but impossible…youtube works sometimes and somewhat slowly, but on a good day is pretty reasonable.  The question is, do you really need this?  For a short-term trip like the one we are on, absolutely not.  But for those people who are here for 6 months or a year, I can see wanting that connection to home for at least some of the time.  I am glad for now that my first experience here is short term like this so that I can avoid this issue, because I could totally see falling into this trap and wasting an inordinate amount of time trying to eke out every last MB/s that I could from whatever connection capabilities that I had.

by Marcel

(and me ? I spent most of the day waiting for arrangements to be complete for a meeting with the Human Resources for Health management at the Ministry of Health. Unfortunately, the Honorable Minister of Health had called an urgent meeting for the HRH group, so my planned 9:30 meeting eventually became 4pm. It gave me plenty of time to get some reviews written and deal with other accumulated stuff in my Inbox. But it all worked out in the end. The ministry sent a car and driver to pick me up at the hospital, we had a thorough meeting of the minds with senior HRH management, and afterwards they even dropped me off at the Nyamirambo apartment.)

“Former KHI”

by Marcel

This morning, after our usual breakfast of Rwandan yogurt with muesli and a cup of coffee to wash down the malarone pill, we took a walk down to the Kigali Health Institute or KHI. To be precise, it used to be called KHI. Under a complete revision of the university structure, however, it’s now the Divisions of Allied Health Sciences, Nursing Sciences and Community Health Development of the College of Medicine and Health Sciences. This is quite a mouthful, so it’s generally now referred to as “former KHI”.  It is a large building, full of people and classrooms, where nurses, physical therapists, anesthesia technicians, dental technicians, eye technicians, orthopedic technicians and others are trained. These are in fact the people who keep the health system in Rwanda running: outside Kigali and Butare you find very few doctors (no anesthesiologists at all, for example), and the 40 or so district hospitals function largely because of the people trained at “former KHI”. Their training is limited; the anesthesia technicians, for example, enter a 3-year program right out of high school. They often are not able to buy a textbook and have very limited internet access. Almost all they learn comes from paying good attention during lectures.

We went to “former KHI” to meet with Etienne Nsereko, who is the head of the anesthesia training program. In one of the conference rooms in the library (with windows wide open – the warm weather here is so nice!) we discussed for over an hour the technician training program and how we can possibly assist with it. We were happy to hear that he is planning to only take nurses (with 3 years of training) into the anesthesia training program. That will undoubtedly raise the quality significantly.  And then we spent a lot of time fleshing out how various groups teaching here can help him. Like so often, there are multiple groups working here, in a somewhat uncoordinated fashion: the CASIEF/ASA program that Paul and I are on, the Human Resources for Health program, a nurse anesthetist from the US who has been working on refresher courses for the technicians, Health Volunteers Overseas… Getting all those people to talk with each other and coordinate their activities is not easy. What Etienne wants most is some help for the people out in the district hospitals, who rarely get a chance to refresh or upgrade their knowledge. So we’ll try to move to a system where visiting anesthesia people can help with refresher courses, similar to what Christina Hayhurst and I did last year in Malawi.

After this discussion, we wandered downtown to Camellia, a  nice little restaurant where we had a croque monsieur for lunch, and then made our way back to the apartment. We took a  few little detours along the way. First to the Camp Kigali site where, at the very beginning of the genocide, 10 Belgian soldiers were murdered. I had not been there before. There’s reconstruction going on in the area, and we had to climb through some work areas to get there, but it was worth it. It’s a simple and stark memorial to 10 young men who had no idea what they were getting into when they got that job assignment. Most of them were married; about half had children, and one had his first child due the same month he was killed.

Then to the Nyamirambo market, where Paul hadn’t been yet. It’s only a few blocks from the apartment, but a completely different world: dark, cramped, packed full of rickety stands with women selling their (really good) fruits, lots of second-hand clothing, and some stalls on the periphery (the somewhat nicer ones) selling western goods like phone chargers and  school backpacks. As a sign of how different Nyamirambo is from the rest of Kigali: people in the market tend to greet you in Swahili instead of Kinyarwanda! This is because it’s the Muslim area, and so culturally more connected with the African east coast. We negotiated a good price for a fresh pineapple, which Paul subsequently expertly carved. Delicious.

A picture of Nyamirambo market taken on our trip in 2012. Not much has changed.
A picture of Nyamirambo market taken on our trip in 2012. Not much has changed.

We had a few hours in the apartment to get some work done. When we are at home, we are about every half hour interrupted by very soft knocking on the door: that is Christophe, who is paid by CASIEF to take care of the house, and wants to show us that he is doing his job. He’s the nicest person, and keeps the apartment spotlessly clean, but there always seems to be something for him to do when we’re home. He needs to check the garbage, he needs to replace a towel, he has found one of our shirts that – carelessly – we had left on our bed, and which he has therefore taken and washed, and which now needs to be ironed… Today he appeared with someone who came to repair our toilet. One of the two toilets totally has a mind of its own when it comes to responding to the flush lever. Sometimes it works, sometimes it works a few times in a row, and then it will fail for a long time. We have therefore, for the past month, been provided with an enormous water container to do the flushing manually.

The toilet and the manual flush system
The toilet and the manual flush system

But today Christophe introduced a person as “the technician”, and together they spent about half an hour in the bathroom, left for a while, came back, and eventually announced that it was fixed. In a sign of remarkable optimism, Christophe immediately emptied the big water container and put it away. So far the toilet has flushed twice in a row – maybe his optimism is warranted.

Talking about the apartment, it was fun to see the hotplate that Kristi and I contributed two years ago still there, albeit dusty and little used.

The Marcel & Kristi Memorial Hot Plate
The Marcel & Kristi Memorial Hot Plate

And, funny enough, it looks as if we’d started a trend:

We've started a trend
We’ve started a trend

The evening had a nice treat: Sean and his wife Diane invited us over to dinner at their enormous house on the other side of town. Hamburgers on the grill – we were sooo ready for that!

The last week…

by Marcel

The connection to WordPress is a-g-o-n-i-z-i-n-g-l-y slow tonight, so this will be a brief post.

Hard to believe, but it’s our last week in Rwanda already! Five more days and we’ll be back in Charlottesville…

We did the last of our academic days today. Morning report with the technicians and medical students was good, as always. Around 8 it started raining hard, with the result that at 9 only two residents had appeared: most don’t have cars, and were apparently waiting out the rain. So I didn’t start my lecture on head injury until 10.

The case presentation by the resident that followed was, I thought, really good. Nothing went wrong in the case, but it exemplified an issue that we also deal with on a regular basis: taking slow steps that individually don’t look bad, until you suddenly realize you’ve put yourself in a dangerous situation. This case was an abscess drainage on the ankle, done with regional nerve blockade in the prone position. The block didn’t work very well, the resident added some sedation, then some ketamine, then some opiate, and then some halothane, and then realized he was actually giving a general anesthetic in a patient with an unprotected airway in the prone position…

During lunch in the cafeteria, Damascene, the faculty member we are working with for the simulation sessions, was called urgently to go see a patient in the obstetric recovery room. We followed and found a patient who indeed had very low oxygen saturations. The obstetrician felt she needed intubation. Damascene, by suctioning her and making her cough some, managed to bring the oxygen saturation back to normal levels, and saved the patient an ICU admission.

Damascene and Paul’s simulation session today was about a meningioma resection, and I got to play the patient this time!

In the evening, Emmy picked us up for dinner at his house with Mary, his girlfriend. We also finally got to meet their little son, David.

David
David
Emmy, Mary and David
Emmy, Mary and David

Mary had cooked an excellent and very African meal: ugali (cassava porridge), tilapia in sauce, and mixed vegetables. It was also a good introduction for Paul to eating in Africa: from Mary coming around with a pitcher with hot water to clean our hands before the meal, to eating with our fingers.

All together it was a wonderful evening. We’re very happy to have friends like these in this country.

 

Waking up in Paradise then back to Kigali

by Paul

So I spent the night last night (and thus awoke) in the Paradise Malahide Hotel located near downtown Gisenyi on the shores of Lake Kivu.  I was in this great little bungalow where I fell asleep listening to the “waves” crash on the beach and woke up to the sounds of birds.  I had an excellent breakfast on their back patio (a patio not of cement but of volcanic rock) overlooking Lake Kivu.  I walked around a bit taking more pictures and then settled down onto one of their beach lounge chairs to read and just enjoy the scenery.

Breakfast view
Breakfast view
My bungalow
My bungalow

The beach

The beach
The view from the lounge chair
The view from the lounge chair

After a very relaxing morning, Emmy picked me up and we started our way back to Kigali.  But first we drove through the brewery that is in Gisenyi (where Primus, Mutzig, a few import beers, coke, and fanta are made/bottled) and over to a hot spring that is nearby.  We also drove up to La Serena Lake Kivu, which is the sister hotel to La Serena in Kigali (the nicest hotel in the country, as far as I know).  They let us inside to take a walk around and take a few pictures.  While we were there a huge storm rolled through, which caught us outside for just a second, but then we were able to watch it peacefully under protection.  Just before it let up, we headed out again and by the DRC/Rwanda border, which to my surprise was very open and not heavily militarized.  Apparently, here near Goma, there is fairly open and often travel back and forth between the two countries (but go about 300 km into the DRC and it is a very different story).

After those quick detours we worked our way back towards Kigali.  We made a few stops along the way to take pictures and once to pick up some supplies.  We, of course, stopped at the “obligatory stop” to get some goat brochette and fire roasted potatoes again.  :)

This country is very beautiful, even in the rain…

Truly the land of 1000 hills
Truly the land of 1000 hills

On the drive back, Emmy remembered that there was a huge football (soccer) game tonight between the number 1 and number 2 teams in the country.  Not  5 minutes after turning the game on via the radio, the number 2 team (the peoples team – the number 1 team is from Rwanda’s army) scored a goal and pulled ahead 2 to 1.  To which Emmy exclaimed “Oh no, Nyamirambo is going to exploded…I don’t think you are going to get much sleep tonight”.  Sure enough, when we got back to the apartment there were people lining the streets outside any establishment that had a TV (and thus had the game on).  Not long after I was settled in, we started hearing yelling and cheering, clearly indicating that the people’s team had won.  We walked out to the main street to see crowds of people running down the street wearing blue and white, waving flags of blue and white, and some making an incredible racket with these blue plastic horns.  Mototaxis, buses, and cars were streaming by, honking their horns and carrying ecstatic fans.  Every once in a while you would see and fan sporting the colors of the former number one team, black and white.  Impressively while they were clearly sad, they were not mean spirited about it and no one (absolutely no one) was giving them a hard time.  It was a very exuberant, but impressively peaceful celebration.  Even still, I wouldn’t want to be working in the hospital tonight.

Some of the oh so happy fans
Some of the oh so happy fans

Here’s hoping Emmy’s prediction is wrong and I am able to get at least some sleep tonight…I may have to breakdown and use those earplugs Marcel gave me at the beginning of the trip.

Gorillas in the Mist

by Paul

Here I am next to a blazing fire in the beautiful open air lodge of the Paradise Hotel here in western Rwanda on the shores of Lake Kivu.  To add to the ambiance a storm has rolled in, so there is the occasional flash of lightning and roll of thunder.  I am enjoying these surprisingly succulent deep fried tiny little fish, some peanuts, and a bottle of Mützig.   In a little while I will dive into some fresh tilapia and we will see what happens with dessert.  All in all a perfect end to an incredible day.

The day started, as many of our days here have, at around 0530.  Time enough to get up, get dressed, get breakfast (coffee, juice, bread with butter and jam, and a plate of fresh fruits), and meet Emmy to head out to the staging area for the gorilla trekking.  We arrived, along with maybe close to a hundred other people.  Then commenced the driver negotiation to get their charges into the best group possible that will best fit their physical capabilities.  I got paired with the Umubano group, the name meaning “Live Together”.  It was formed after the now dominant silverback, Charles, split from another group.  The family is around 15 members strong, including the newest member who is now 5 months old.  Our guide, whose name is Oliver, has been guiding now for 15 years, he was incredibly friendly and equally knowledgeable.  My group consisted of 7 other people also in their late 20s/early 30s.  We were a pretty eclectic group representing 5 or 6 different countries.  After everyone was settled, we all got back into our cars for a 45 minute or so drive to the point where we would begin our hike.  Emmy introduced me to the famous (or infamous) African Wake Up Road (the first level of off road) and then to the African Massage Road (now whether he meant the drive was a massage or that you will need a massage afterwards, I will never know).

African Massage Road
African Massage Road

We finally arrived at our taking off point where we were each given a walking stick (a very nice and very sturdy intricately carved affair).  So, backpacks strapped on tight, boots tied on tight, pants very stylishly tucked into our socks/boots, walking sticks in hand, rain gear at hand, and water in tow we were off.  Hmmmmm… remember me saying something just now about boots tied on tight… well most of mine were.  Some very good advice before going to a new and long trek is not to wear brand new boots that haven’t been broken in.  Some equally good advice that doesn’t usually need to be stressed is not to wear boots that are practically falling apart either.  All of about 5 minutes into the hike and whoops, there goes the rubber sole of my right boot.  Well I thought about it for all of about 5 seconds, I picked up the old sole and kept on moving.  At this point, all we were doing was walking along a path between fields, we weren’t even into the jungle yet.

A little while later, we make it to a stone wall that apparently surrounds most of the Volcanoes National Park.  This serves two purposes, to keep the animals in (the buffalo are notorious for rampaging through the nearby farm lands) and to keep people out.

The Wall
The Wall

After a quick rest and then a scramble over the wall, we are off.  Very quickly it becomes apparent why they suggest tucking your pants into your socks, the mud in places will swallow you whole up to at least your knee (at least that’s as deep as I got at one point).  We are scrambling up and down hillsides and through thick deep jungle.  It was an amazing hike.  But watch out for the stinging nettle, get to close and you are not going to be happy.  We moved steady in and out of deep jungle.  After a while we left the semi-beaten track to head off in a seemingly completely random direction directly through the thick of the forest.  Our guide was literally forging a new trail, because after all we were tracking gorillas and they are not inclined, nor do they need to, stick to well trodden paths.  Trackers had been out in the woods before us early in the day to find the groups and they were in constant communication with our guide to help direct us where to go.  I have no idea how long we trekked, but all of the sudden it was time to stop, put down our bags and walking sticks, and grab our cameras.  We were very close now to the gorillas.

Gorilla Trekking (i.e. blazing a new trail)
Gorilla Trekking (i.e. blazing a new trail)

The first gorilla I saw was a juvenile, a very cute little guy, sitting near a plant, chomping away. Shortly thereafter I saw my first silverback. He is the second in command, under Charles.  We were so close I felt like I could touch him.  Most amazing of all, he simply did not care that we were there.  He would make eye contact from time to time, but mostly stuck to eating.  Nearby there was one of the females, she too was enjoying lunch.  The next gorilla we saw was the man himself, Charles, the senior silverback.  He was massive.  At times they all seemed to make noise very similar to those we might make when we were enjoying a particularly good meal.  Our guide and the trackers would make noises at times in response to the gorilla noises that sounded very similar in nature.

Now while we were supposed to stay 7 meters away from the gorillas, they knew absolutely nothing about this rule and at times would walk right through our group.  One time, one of the juveniles even brushed up against my leg.  As the gorillas moved to find better food, we simply followed (as best we could – they moved through this area much better than we did). What was great, was that this was a relatively open area (compared to others), which gave us great views of the family and made it relatively easy to walk around.  I use the term walk around loosely because we were machete-ing our way through thick green growth and spent most of the time “walking” on the plants and not actually on solid ground.

About half way through our time with the gorillas we finally found the female who had recently given birth.  And with her of course was the absolutely adorable little 5 month old.  He like any 5 month old was bright eyed and curious, and seemed to delight in trying to climb all over his mother and copy her actions, including trying to eat some of the greenery.

Best of all, at the end of our hour with the gorillas they were done eating and it was time for an afternoon nap.  We followed the group to a spot that Charles had picked out to simply sprawl out.  One by one, the various family members started to settle down around him. The baby, quite a first decided now was a good time to use mom as a jungle gym.  Two of the juveniles decided that rough housing was the appropriate thing to do, and one of the juveniles, who clearly felt slightly left out, climbed over top many of his siblings and literally fell over into a pile with the rest of the family.

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This was an awe-inspiring experience and I truly feel incredibly lucky to have taken part in it.  The gorillas are amazing creatures, so different and yet so like us.

After we were done, we started our trek back to the cars.  We ducked, weaved, bodily pushed, and even crawled our way through the dense jungle until we found the final paths back over the wall and through the fields.  My boots made it almost all the way.  The leather on the bottom of my right boot held out remarkably well, though by the time I was back at the car with Emmy, I was no longer looking at leather but looking at the underside of the insole of the boot.  I was covered in mud almost up to my knees, I was exhausted, and I was extremely happy.

What's left of my right boot
What’s left of my right boot

This will be an experience that I never forget.

Volunteers for April 2014 with the CASIEF/ASAGHO anesthesia teaching program in Rwanda

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