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

Open heart

As I get ready to fly back to Canada tonight, I contemplate "what does this all mean?" and "why do I keep coming back?".  There are no easy answers but the most obvious one is that I have fallen in love with a country and its people.

The experience here is about enormous open heart; people radiate genuine warmth and kindness. It is nearly impossible to reconcile the current condition with the devastation that occurred in 1994. Yet the scars are everywhere, literally and figuratively. I am filled with awe by the culture of forgiveness and the vision for Rwanda to be the best country in Africa.

Nearly all the residents we work with were old enough to have memories of the tragedy but that is changing as each year the average age of the entry class in anesthesia gets younger and younger. Perhaps, even now, some of the younger residents have no personal memories of the genocide. Each year of stability allows more time for healing.

I come back each year for both selfish and altruistic reasons. Who wouldn't want to miss a little Canadian winter? Rwanda is spectacularly gorgeous and there is truly a culture of "no stresse". Ultimately, though, there are few things in life as fulfilling as helping people acquire knowledge to heal others.  I feel incredibly fortunate to have found anesthesia as a career and to have this opportunity to guide young people in becoming skilled clinicians and confident teachers.  This is as good as it gets.

I am grateful to all of the CASIEF-University of Rwanda former students who are now leaders: Paulin, Christian, Francoise, Gaston and colleagues. It is wonderful to see them flourish. I am grateful to the current group of residents who show up on time for academic day (having done all the pre-reading) and hungry to learn.  I am grateful to my good friends, Angela, Ruth, and Amélie who travelled a very long way for the Teaching and Learning Course and the Essential Pain Management Course.

But today, I am especially grateful to Kitt and Kyle. They worked their buns off always with good energy and cheer. They rose to the occasion, time after time, to meet our goals and challenges. Teaching in the chaotic ORs for complex cases, designing academic day teaching, running scenarios, helping with resident teaching, keeping me laughing, and nudging me on up some very steep hills on a mountain bike. Thank you Kitt and Kyle. Truly the dream team!

I have not forgotten Michelle, who could not come this year. Michelle, I need you back, my friend.

Lots of love from Kigali,
Patty

Up to 180!

It got more extreme.  Kitt jumped in and did 40 laps. Then Kyle joined her for another 40, bringing his grand total today to 100 laps. Both of them had rockets on their feet. So, the total for the three of us is 180 laps.  Way to go team!

100 laps between us

From Patty,

Our time is winding down in Kigali. It has been a rich and rewarding month, so we will be sad to leave. I've enjoyed sharing this experience with Kitt, Kyle, Ruth, Angela and Amélie. Truly, the dream team!

This morning Kyle and I did the "end-of-visit challenge".  Last year, Tristan and I swam 40 laps in the Serena pool.  Kyle and I vowed to achieve this goal again today. Kyle is a strong swimmer, male and half my age, so I jokingly suggested he should do 60 laps. Sure enough, we both met our targets: 100 laps between us.  This was followed by a huge breakfast. We are spending the day wrapping up loose ends.  Kitt and Kyle are excited about their upcoming safari in Tanzania. I will be leaving Rwanda tomorrow evening.

The two things I am happy about leaving are: 1.the noisy apartment and 2. Christmas music until at least the last day of January. If they play it again today, I might go quietly insane.

Last night we had an delightful evening with one of the HRH anesthesiologists and her family. It is certainly challenging to spend a year teaching in Kigali.

Here are a few random photos we haven't posted yet. 

Next question: Will Kitt try to achieve the new 60 lap challenge?

Gaston's daughter, Gwiza, heading off to school

Gaston, Florida and Patty

Flowers in Nyungwe

Nyungwe

Emmy in nature

The Dopest Shop (what do they sell?)

Kitt with her tailored African dress

So What Bar

Rooster, unwisely in front of chicken shop

Selfie at the Selfie Club

No Stesse Moses Couture