Ana's last day in Rwanda

Since arriving back to Kigali last Sunday after the wonderful weekend in the rainforest and on Lake Kivu, Jaime and I have really enjoyed being tourists.  I worked on Monday teaching and orienting the new volunteers from Cornell University.  We went to Republika for dinner, which is owned by a stunning Rwandan woman serving local fare on the upscale.  Jaime joined us there.

Tuesday was a day of tourism around Kigali covering the National History Museum (live snakes!), The Genocide Memorial, Kimironko open market, a coop where Rwandan widows of the genocide make amazing items out of the beautiful textiles, more Mutzig, brochettes and chips, and then a return back to the hotel and farewell hugs to Amy.  Wednesday we had a spa day at the Serena with coffee scrubs, massages, and workouts.  We ran into Tommy and Amy having a coffee after their last day rotating at the hospital and then met them at the indian restaurant for dinner.  There were more farewell hugs to follow again.  We really like those guys!

Thursday I met with Paulin to discuss some issues with the program and to say goodbye.  We met at the brand new Ubumwe Grand Hotel on the roof top lounge/bar next to the pool area.  It was definitely on another level!  An open rooftop area on the "sky high" level allowed for amazing views of most of Kigali.  It was fancy.  Jaime joined me there and then I sowed her the Mizungu market, Nakumatt and the well-known Bourbon Coffee store.  We made our way back to Heaven in the late afternoon after walking around Kigali.  For dinner we went to the Mille Colline Hotel, which is the hotel in the famous film "Hotel Rwanda."  They had live music playing the best of 80's and 90's soft rock salvaged only by the intermittent reggae songs they mastered.  This lovely bar area is set outside on a large open lawn with an impressive and tall  thatched roof bar area complete with corporate hookers and dirty old white men.  The latter was new to the scene from my past experiences at this hotel and very disturbing.  Jaime and I made it home just in time to avoid the sky opening up with torrential rain.

It's Friday morning and we are just waking up for our last day in Rwanda.  Our flight is at 1:45am tonight/tomorrow so we are planning to make the best of our time today complete with exercise and lounging.  I am definitely sad to leave Rwanda but that sadness is blunted by my excitement to visit one of the most beautiful sets of islands on the planet.

I hope you all are well!!!

Ana

Ana paradise to heaven

We spent the morning cruising around on a small wooden motorboat with our guide Seleman. Cruising past several little islands in Luke Kivu, each had its own name and features. Like the first larger island was called Napoleon's Hat because that was its shape. Unfortunately I remember it more for the thousands of bats flying and swarming and darting and flapping. For those of you who aren't aware, I have an irrational fear of bats and this sight led quickly to nausea and panic. It was disgusting. Seleman was poised to dock the boat so we could hike to the top of the big hill, but I put a quick stop to that plan. Heeebie geebies.  After cruising a bit away from the island, the shape became more obvious and we all took photos "wearing" the hat. Pretty funny stuff.  The next island we stopped had lemon trees (which are actually green) and vervet monkeys. The monkeys are definitely cheeky wee things and little thieves. Most remarkable are their bright blue....umm...errr...yeah, they have really bright blue balls. It's impressive.  We stopped in another island known as peace island, or Amahoro. It had a nice path all around the island so we walked around for a bit eating guava fruit from the trees. Beautiful!  We made a couple other stops on Seleman's recommendation that he thought were funny photo ops. He left three of us on a tiny island and pretended to leave us behind. He was my kind of prankster.  

Next we went back to the hotel to check out and collect our things before jumping back into the boat to head to the Cormoran hotel for lunch. Wow! The Cormoran hotel was something else! Sitting on the top of a huge hill rising up from the shore of the lake, the views were stunning. The grounds were covered in perfectly manicured flowers, succulents, cacti, and unusual trees. Just stunning. The restaurant was beautiful and I had tilapia caught that morning.

After lunch we took the 2 and a half hour drive home to Kigali. We dropped Amy and Tommy off at their apartment with big hugs. We all made each other laugh so much we've grown quite fond.  Next Emmy took us to our old apartment in Nyamirambo where we had to pick up our big suitcases.  I was hoping to meet the Cornell team, Sheida, Gunisha, and Eric, but they weren't home. I will see them this morning at the hospital.  Emmy then drove Jaime and I to Heaven. The restaurant I've eaten at so many times in the past now also has a boutique hotel.  It is lovely and perfect for the time we will be here. We had a lovely dinner of fish tacos and passed out with a wine buzz.  I'm just up to get ready for academic day at the hospital and looking forward to another week in this magical place.

Lots of love!

Xoxo

Ana

Ana on the boat

Lunch at Cormoran

Heaven

Ana Nyungwe and Kibuye

The last few days have been packed with unbelievable fun and new adventures.  Cynthia and I went to Khana Kazana, the favorite Indian restaurant for valentines dinner. We had Italian tapas at Brachetto with Amy Wednesday night. We completed successful and satisfying days teaching and lecturing at the military hospital. Jaime arrived Thursday night. Unfortunately Cynthia left Saturday for the states. Friday Amy, Jaime, Tommy and I left Kigali for Nyungwe National Forest with Emmy. We did a beautiful waterfall hike yesterday. We've seen three different types of monkeys. Saturday afternoon we drove to Kibuye, which is a place I've never been. Now we are staying at a lovely hotel on the shore of Lake Kivu called Moriah Hill Resort. We've all been laughing tons and really enjoying each other. Today we are headed out on a boat ride to cruise some small islands on the lake.  

My love for this country and its people grows every year.  I love and miss you all!

Ana

Ana hike to Dian Fossey's tomb

Sunday was the anticipated day that Cynthia, Amy, and Tommy were able to trek gorillas.  It is always so fun to see how amazed and excited people are after spending time with gorillas.  They all have uncontrollable smiles and an obsession with reviewing the gorilla pictures on their phones or cameras. It really is a surreal indescribable experience.  I did a new hike to Dian Fossey's tomb, which was a lovely nature hike half way up the hike Ive done the past two years to the crater lake at the top of the Bisoke volcano.  It was a good test and metric of my cardiovascular fitness because I found myself way more fatigued than the past two years.  I guess that's what happens when you quit running long distances.

Monday was another successful academic day including lunch with a resident and his faculty mentor to discuss their research project design.  In the afternoon after teaching, we met with four of the residents chosen for US rotations, and the program director, Paulin.  We spent an hour discussing how to succeed in the US Embassy Visa interview.  After the meeting, which was held at the Serena hotel, I made use of the gym (to improve my volcano hiking endurance) for a run.  

I decided to grab dinner at the Serena so that I could hang around the good wifi until 9pm in order to call (FaceTime) New Zealand on a phone interview for a possible job starting this summer.  It would be a temporary job for 3-6 months, but one where I would be able to do anesthesia, ICU, and teach.  It would also allow me to learn more about another healthcare system which would inform my opinions at home, and my global health perspective.  The distraction will also be nice while I figure out what I want from my next job at home.  Unfortunately I couldn't make the phone call work on the cellular network, on FaceTime, or on Viber.  I guess I will just have to wait longer - not my forte.

This week we are working at CHUK and then Kanombe, which is the military hospital in Kigali.  Most importantly, my best friend since childhood, Jaime arrives this Thursday!!!!  We are planning to go to Nyungwe national park which is the rainforest.  I can't wait to share Rwanda with her.  

Lots of love, big hugs, and yummy chocolate for you all!

Ana

Ana Lake Kivu

This might have been the perfect day.  Waking up to birds singing seems like the most relaxing and natural alarm clock possible.  After having breakfast outside on the water, Cynthia, Amy, Tommy, and I decided to walk to the hot springs about 1 km up from the hotel.  We knew that we had to be back at 11:30 when Emmy would pick us up for lunch, so we went straight after breakfast.   We practiced our Kinyarwanda as we walked along passing people on the roads, and I even got to practice my Taekwondo moves with some cheeky young boys smiling as they acted like martial arts masters trying to engage us in combat.   They finally conceded while running away smiling and laughing as my trained white-belt form degraded into the last ditch strategy of a crazy white woman wide-eyed screaming while kicking and punching.  It was hilarious and they were clearly amused and shocked that I engaged and played with them. 

In years past, you could walk right up to the hot springs and see the locals bathing and washing things in the steaming hot water as it bubbled up through the ground.  I’ve even heard about, but never seen, that people will bring potatoes to cook in the boiling puddles.  This year was different.  In the true spirit of entrepreneurship, the community has developed a co-op, built a bamboo fence around the hot springs, and has begun charging 1000RwF (Rwandan Francs) to visit the site.  

We gladly paid for the visit since the money goes back to the local community, but were also pleasantly surprised to find four local Rwandans ready to receive us and put our feet in warm mud, sit us down for foot and arm massages, and rub medicinal herbs all over our exposed white skin.  It was quite the amazing experience rivaling a recent trip I paid hundreds of dollars for in Calistoga, California for the same treatments.  They were enthusiastic to pamper us with their treasured local resource and they actually did a fantastic job exfoliating and massaging.  We all agreed that we were perfectly relaxed afterward and gladly paid another fee for their services.

We walked back to the Paradise Malahide and met up with Emmy who planned to take us to a California inspired local restaurant called Calafia.  The food was welcomed familiarity with amazing salads, sandwiches, and fish tacos.   After lunch we found ourselves in a local bar lined up in plastic chairs amongst many local men facing a large but solitary television set airing the Arsenal v. Hull City soccer game.  We were all so full and heavy from lunch that we left at halftime with half empty beers left on the table. 

Again back at the hotel, we debated between taking naps and doing a lawn yoga session led by a San Franciscan yogi via a podcast on Amy’s phone.  Thankfully we all chose the latter.  It definitely made us all less tired and heavy and somewhat energized to shower and come back to hang out for drinks and dinner.  Sitting by the water, we chatted while drinking beer and wine in between a red and grey sunset and the full yellow moon.  The food was great and we are all in our rooms early preparing to get up early in the morning for a 5am departure so the three others can start their gorilla treks in the volcanic mountains of Ruhengari.

Ana

Ana at American Embassy and Paradis

On the heels of the US immigration ban strike down I am visited the US Embassy in Rwanda for the first time. I am advocating for visitor's visas for the Rwandan residents I have invited to rotate at Stanford.  This year we are starting programs for them at Stanford, Cornell, and Penn State.  It is a huge improvement in their education to have a bi-directional exchange exposing them to the countless resources we have that they do not.  Only then can they determine for themselves what works for their healthcare system and their patients.  It also exposes them to a more effective healthcare system to which they can aspire.  As you can tell, I have been working on this exchange program for some time and am motivated to see it through.

Last summer four of my colleagues/residents were planning to attend the ATS conference in San Francisco. Fortunately, two of them had their research accepted for presentation, but unfortunately two of the four were denied visas.  The rules around issuing visas are opaque and nebulous and both times I have emailed the consulate offices to gain a greater understanding of the process I have received tangential jargon without clear explanations. So, I am here to put my face in front of another human's.

The embassy is intimidating, of course; thick, high, grey concrete walls, doors that are excessively heavy, obvious procedures to make you wait in different chambers before finally gaining access to the consulate office.  After having to wait until exactly 8:30 and navigating the two security stations I finally was able to speak to a very pleasant Rwandan embassy worker through a thick pane of glass with a phone and speaker to hear each other and a slit under the window in case we needed to slide each other objects of interest. It was all very prison-like.  He was the most pleasant part of the experience and I found him full of good advice.

After the meeting, I asked the front reception/security desk to help me call my taxi driver, another Emmanuel (Emmy).  They were all very interested in my limited ability to speak Kinyarwanda and humored when I introduced myself with my Rwandan name, Kanyana. It means baby cow and apparently is flattering for a nickname. Next, I went to the most western styled shopping area that houses the popular Bourbon coffee and the Nakumatt grocery store. 

After meeting Emmy and Cynthia back in Nyamirambo, we hopped in the car to head to Lake Kivu in Gisenye.  We shared the ride with two medical students Tommy, and Amy from Dalhousie University in Halifax.  It was a fun ride to share with three first-timers to Rwanda and fun to catch up and chat with Emmy more.  When in Gisenya, we drove past the Congo-Rwanda border, and stopped to look at a nearby active volcano, although it is relatively unimpressive during the hazy daytime light.  We finally arrived at one of my favorite places, Paradise Malahide, an amazing hotel on the water of Lake Kivu.  

We settled in, then sat by the water drinking Mutzig (my fave lager), eating dinner and chatting.  At 9pm we went up to the open air lounge/lobby to sit by the fire and were surprised by traditional dancers and drums.  It was awesome!  Even their faces dance with bright white wide-toothed smiles and blinking eyes.  The dancing men have elaborate outfits of white long skirts with chevron designs, long blond headdresses, bells around their ankles and intricate beads hanging cross their bare chests.  Their ankles stomp the bells in time with the drums as they move their arms in elaborate ways, swing their long blond straw hair, and then jump repeatedly higher than Ive ever seen.  They pulled several of us up to join them which was super fun and exhilarating but embarrassing for highlighting how Mizungu we really are.

I slept soundly in my private bungalow under my mosquito net until waking at 5:30am to the singing of birds and the water lapping the shore.  It is a much better alarm than any I can find on my iPhone.  I am now again in the lobby to finish my emails and am listening to the nearby church singing before heading down to sit by the water for breakfast.

I love Rwanda :)

XO

Ana

Paradis - everyone's favourite

Ana and Emmy

Mutzig

Ana Feb 9

Hello again and XOXO

We asked Christophe to buy a few food items from the market and he returned with the most gorgeous vegetables.  I have been really loving sautéing peppers, onions, tomatoes and zucchini in the morning and then throwing an egg on top.  I have also been drinking a ton of Rwanda's amazing tea.  Impressively, I've only had one coffee since I arrived.

Tuesday was spent at King Faisal hospital, which is the private hospital for people with money and extra insurance above the mandatory governmental sponsored program.  The hospital itself is vastly different from the public academic centers because of the resources available for patient care.  Certain labs, X-rays, medications, and personnel not available at CHUK (public-Kigali) are readily available at King Faisal.  In fact, because these resources are available, they are over used.  I rounded in the ICU with the team and several times recommended that stop checking certain labs and stop certain medications that were unnecessary.

The team of residents and students were different from the team at CHUK, so I again gave a talk about mechanical ventilators, which everyone always likes because it is a topic that confuses most trainees, and some faculty.  Not all of the trainees do an official rotation in ICU and when they do, they are taught by faculty who are not specialized in ICU.  So, I am in high demand, and loving talking about and teaching some of my favorite topics.  It's gratifying.

After work, Cynthia went to an art gallery that was started and features mostly the work of two Rwandan brothers, Emmanuel Nkuranga and Innocent Nkurunziza.  They re pretty famous around here abroad.  They have a a few galleries around town and do some interesting work.  

Check them out: http://inemaartcenter.com

I went back to the apartment to meet up with Francoise, who graduated the anesthesia program last year with the highest marks of her class.  She is an amazing physician and is now doing well as a faculty member in the department. She just had a baby two months ago, so I delivered some donated items to her (Thanks, Annie!).

Afterward, I went again to the Serena hotel to force an interval workout but I...am....sooooo...tired still.  I'm guessing it will take a few more days.  Cynthia met me in the Serena lobby lounge and we headed to Heaven.  Heaven is a restaurant own by some San Franciscans that sits up on a hill and has a lovey view.  The dining area is essentially a huge covered outdoor deck and is very well done.  The food is creative and good and a perfect mix of Rwanda and the US.  Heaven also has a boutique hotel that I will be checking out after my friend Jaime arrives on the 16th.

Ok, that's the most of it!  We are headed back to King Faisal again this morning for more ICU and teaching.

Love you!

Ana

Ana Feb 7

Howdy friends and fam!

Turns out I think there is something fun about sleeping under a mosquito net every night.  Now I equate it to building forts as a kid, but that was not the case the first few years I was here. In the beginning, I was more focused on the creepy, crawly, buzzing, biting, nightmare bugs that were undoubtedly trying to get in.  In fact, I have found myself more relaxed regarding just about everything. The people, the language, the culture, the insane traffic speeding through the winding streets; none of those things seem as foreign to me now.  Now it is comfortable, and I am again imagining I could live here for quite some time.

It's hot and humid.  Around 60 degrees at night, the days are heating up to over 80 degrees with around 95-100% humidity (that's Bama hot, ya'll ;).   After work yesterday Cynthia (the Stanford anesthesia resident I am mentoring) and I headed to the Serena Hotel so I could join their gym and spa and we could lounge around on their big comfortable chairs and couches siphoning off their wifi.  I attempted a pathetic workout but was really short of breath just walking around. I am clearly still jet lagged and affected by the altitude. We ate dinner at the hotel, one of the only places I trust eating a salad without getting sick.

Monday was our first academic/lectures day which might have been the best yet.  Every year there are huge improvements in the teaching methods and this year is no different.  I supervised a Rwandan anesthesia resident but he did such an excellent job preparing and leading the discussion, my contributions were confined to writing the pertinent information on a white board.  Most impressive was that he didn't use a single powerpoint slide.  Two years ago we would have all been put to sleep by the monotonous tone of some resident reading from their slides.  

We had an hour and a half for lunch which is pretty standard here. We went to the Camelia Tea House with my friend Paulin who is the residency director here.  Some of you may recall he stayed in my apartment in Sausalito this past summer during is first visit to the US for a conference.  He raved about his stay when he was introducing me to the new residents.  Paulin remembers my big brother, Gregor and his big truck.  He always laughs and says he is a "real American man."  In the afternoon Cynthia and I led two stations in the simulation center.  One station Cynthia simulated a patient with airway problems and the other station I gave a chalk talk on mechanical ventilators.  It's thrilling every time you see comprehension spread across the students faces.  I miss teaching.

Today was a clinical teaching day.  Cynthia went to the operating room to work with some residents there, and I spent the day rounding with a team of residents and medical students.  We had 7 patients in the ICU and 3 patients in a step-down, or lower acuity unit.  All of the patients except two had brain damage after being in a motor vehicle accident.  That is actually most dangerous thing about being in Rwanda, and most low-income countries actually.  The lack of organized traffic flow and laws puts cars and busses and bicycles and pedestrians and mototaxis all in a big pot together to fend for themselves.  I have even seen the mototaxis come up on the sidewalks.  Pedestrians definitely do not have the right of way.  One of the patients coded and died while we were rounding which is more rare in the US, but unfortunately all too common here.  The ICU is the one place which sees only minimal improvements over the years, and where I will be spending most of my time these next two weeks.

Last night I went to bed early, but woke up at 2am.  Tonight's plan is dinner at the Serena followed by a yoga class with Cynthia at the gym.  I hoping for better sleep tonight.  

I miss and love you all, but am enjoying my team here as always.

XO

Ana

Ana Feb 5 arrival in Rwanda

Dearest friends and family,

I made it safely to Rwanda :)

I think this may be there first time I have arrived to Kigali during the daylight.  I know it was my first time to fly Ethiopian Airlines.  Let's just say, they're not my favorite airline and the food was worse than any school cafeteria in memory.  Think bland gristle and guar gum.  I had significant layovers in both Washington D.C. and AddisAbaba, so I am pretty exhausted.  Plus, since I was delayed a week (after being taken out by that nasty stomach virus that is going around), I missed my friend and colleague, Patty. So, instead of having a few days to adjust and hang out with Patty to plan the program's next year, I will probably just crash tonight to be up bright and early for a full day of teaching tomorrow.

As always I was greeted warmly by my friend Emmy, but this year he had his wife and two small children in tow.  Luckily I had a San Francisco snow globe and a toy trolley car wrapped and stuffed in the bottom of my bag.  I had bought them in the airport for just these two little guys.  For Emmy and his wife it was refurbished Samsung phones from Amazon, and for Christophe (the house boy our program sent to college who then kept being the house boy), a Golden State Warriors ball cap.  I also handed out sunglasses donated by my baby brother, Rhett.

Every year I come, this place has changed.  This year is no different.  Developments in infrastructure, new businesses, and an increasing number of white people piling through the passport lines herald the rapid economic growth here. On the drive from the airport Emmy and I do the same recap every year now: how much we like each other as friends, where he got his newest watch, how many times I've been in Rwanda, which of the previous residents that have joined me did we like the best, which famous Americans have been in Rwanda, etc.  This year it was Leonardo DiCaprio apparently.

Emmy drives me to the volunteers' apartment in Nyamirambo (affectionately called NyamiramboVegas by Emmy) so I can get settled in.  The noise is minimal at this hour (3pm), but it will be at a soft rage tonight and every night thereafter.  It is a neighborhood that attracts young people, mostly men, to drink, play loud music, play billiards, and show off that their cars have anti-theft alarms.  I avoid the scene mostly but have found it appropriate in years past for watching soccer while eating goat on a stick.  Apparently that is a strange thing for a woman to do, but I get away with it because I'm a muzungu. 

I usually go with Emmy to the airport to pick up the Stanford residents that join me on these trips, but tonight I will hang back at the apartment.  Cynthia arrives around 7pm but there are two others Emmy needs to collect, so the car will be too full for me to tag along.  I'm trying to stay awake but feel like I've been drugged after such a long travel time.  I'm definitely dreading the morning alarm already.  The apartment feels comfortable, kind of like a second home.  I halfway unpack my suitcase, drink some cold, whole, milk from the fridge and plop down on the bed to write to you good folks.  It's always so nice to be back.  It's comfortable.  On my eighth year, as I watch the confusion and anxiety on the faces of those passengers who are clearly here for the first time, I realize how second-nature this place has become.  

XO