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.
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.
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.
And, funny enough, it looks as if we’d 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!