Maternal and Child Health Abound

This week seemed to have a recurrent theme; maternal and child health. By coincidence, I happened to be in Kigali at the same time as the 2nd International Maternal and Child Health conference and I was able to talk myself into being an attendant. The two day conference was held in hopes of discussing the Millennium Development Goals of reducing child mortality and improving maternal health, and featured presentations by representatives from the WHO, CDC, prominent international NGOs, as well the Minister of Health himself. I wish there had been a few more days and the presentations had been a little more spaced out as the information was incredible. Everything from case studies mapping current health trends, to the most common causes of maternal and child deaths, to affordable and practical innovative technologies were presented. It really was an intriguing conference and I was glad to be able to participate.

I returned back in Rubengera on Thursday to a fairly uneventful day however Friday proved to be exciting enough for both days. I have been working most of my hours in the Maternity Ward at my health center, mainly because they also look after the patients there for 3 days hospitalizations so there is typically something to do. I was lamenting the fact that I had not attended a birth yet when I arrived on Friday to a full maternity center. One mother had recently given birth and was still in the delivery center and I understood the reason for her still being there, a retained placenta. Luckily she was able to be transfered to the Kibuye hospital before too long, but it gave me a chance to look after the tiny infant that I'm sure was premature.

While filling out some extra paper work, the other nurse Helene and I heard one of the women call us, saying her water had just broken. So, we moved her into the delivery room and prepared for the birth. I was amazed that it was only Helene and I that were there. Rwandan women have an incredible understanding for how their bodies work and know how to work with them. Helene encouraged the mother to push with the contractions and she delivered the baby in only 3 pushes. Instead of putting the baby directly onto the mother's chest or into a waiting blanket, Helene suspended the baby upside down so she could clamp and then cut the cord, and then handed him to me. Thankfully there were no complications, either with the birth or the baby. Helene was able to help the mother deliver the placenta and I was charged with cleaning and weighing the newborn, and then wrapping him for the mother. It was not as bells and whistles as some of the other births I've seen, but it was still encouraging to be present. When we were back filling out paperwork, I was even able to bring up the idea of Kangaroo Care with Helene, and promised I would bring in more information about the benefits. Maybe I can even convince her to teach mothers about using KC.

Life from the past month

Since I have neglected my blog for so long, I figured I would give a brief overview of some of my activities. My time thus far has been split between working and living in Rubengera, attending economic development trainings throughout the country, and hanging out in Kigali with friends.

In Rubengera, I have been continuing to work at the health center. Every once in a while I head out with my counterpart to attend a meeting or training to a new cooperative or saving and lendings group. These trips typically involve a long difficult journey on the back of a motorbike, long meetings in Kinyarwanda, and a lot of forms noting who has attended the meeting and how much they need to be reimbursed. The organization I work with, CHF has a lot of ambitious goals to greatly increase the number of parents and guardians who are in savings and lendings groups, which is the primary poverty reduction strategy of the government. It is pretty cool to see how just getting people together and encouraging them to put aside some money every other week can result in them making huge progress in improving their own economic situation. I have also spent a lot of time working at the health center. Granted I am still unable to do much more than sit and watch the nurses however, I have had a few days where the nurses allow me to participate in some of their activities. Taking blood pressures, weighing and measuring babies, and recording patient data have all helped make me feel somewhat more useful than a fly on the wall. I have also been able to ask more questions about healthcare in Rwanda, however even though I can ask the question, more often than not I cannot fully understand the French reply. I have greatly enjoyed learning about my health center and even seeing areas for improvement.

Tranings have been met with mixed feelings so far. I have been to an ISLG (internal savings and lendings group) training in Musanze and a cooperative development training in Butare. Despite the gracious accommodations CHF provides for us, it seems slightly extravagant, especially when they reimburse me 15,000 RWF when my bus ticket to the site only costs 2,200 RWF. The hotels feed us well and typically there is hot water and wireless internet which is always welcomed and appreciated. The amenities are typically what make up for the long days on incomprehension. I understand that having the trainings in Kinyarwanda is most beneficial for the greatest number of people, but translating entire days of presentations is virtually impossible. Colleagues with sufficient English skills are assigned to sit next to us and give us a play by play, but as anyone that has ever tried to do this can testify, an entire day of keeping up with repeating everything just doesn't happen. They soon are engrossed in trying to pay attention that we are forgotten. As well, having 10 people trying to translate at the same time creates quite a raucous, much to the displeasure of everyone else. I am at least comforted with the fact that my counterpart is able to get information from there trainings.

Many weekends now I have found myself either willingly or unwillingly in Kigali. Luckily there always seems to be someone around to hang out with and enjoy the good, albeit expensive dining options. It's always fun to be able to speak English in whole sentences and just enjoy being American. These weekends are unfortunately much to easy to get used to, which is why it is a relief to be back in Rubengera this weekend. The 4th of July was a fun occasion celebrated by most. By some bad luck I encountered my first real "African" sickness that same weekend. For anyone that has never had amoebas, hope you never get the chance to experience it. Mostly it involves a lot of you curled up on your bed, swinging between wanting to sleep and throw up. Thankfully, with the wonders of modern medicine, the amoebas are long gone, I hope, and my weekends in Kigali can once again be enjoyable.

Healthcare in Rwanda

Such a weighted topic. I know studying and working in America has made me biased as to a very high standard of care, however it's still difficult to see some of the common practices here. I understand that for the majority of practices, there is legitimate and logical reason, but part of me still wants to claim that there needs to be another way.

The largest difference between care of patients in Rwanda as compared to America is the treatment of privacy. In the States, HIPAA rules all. You cannot speak show or transport patient records, speak of another patient, or let slip in any way any possible patient identifier. Individuality and privacy are as fundamental as breathing in the American healthcare system. In Rwanda though, patient confidentiality is non-existant. Blood is taken by going efficiently down the row of waiting patients, ARVs are passed out and advised upon to two or more patients at the same time, and the idea of private records is laughable. In other words, everyone knows why everyone else is at the health center. It is a reflection of the difference in cultures I understand, but after 5 years of having HIPPA drilled into me upon fear of failing or losing my license, it is a shock to see the openness people have.

Another startling difference is the lack of safe and proper procedure. Though there is still a lot of emphasis placed on the safety of the patients, using sterile needles, cleaning the skin, and aspirating before injecting, there is an apparent lack of regard for nurses' safety. Gloves are not routinely worn and when they are donned, the same pair is used for everyone. Also, recapping is a common practice. Thank you Luther and Caregivers for instilling in me such high educational standards; it still makes my heart skip a beat whenever someone goes to recap their needle. Like I stated before, I do understand the reasons for these practices. Lack of supplies and funding makes it impossible to use a new set of gloves for every person that passes through the center. I know this is not an appropriate way to provide care, but I also know that unless a suitable alternative is presented, it doesn't do any good to try and enforce the standards I am used to in America.

Rwanda, while still woefully behind in technical skills and available resources, has an interesting health care system overall. Kigali has the largest and most advanced hospital, King Faisal, which hosts some of the only medically advance equipment in Rwanda such as ventilators, CT scans, and MRI machines. I might be mistaken but I believe they also have a mental health hospital as well. Rwanda is split into 5 provinces (North, East, South, West, and Kigali), which is then divided into 31 districts, and all but two of these have hospitals, however these are in the process of being constructed. From there you get down to the secteur level are the health centers which offer services such as Maternity, Prevention Mother to Child Transmission (PMTCT), ARV distribution, VCT, as well as a lab, pharmacy, and 3 day "hospitalization" wing. This is where I work. Secteurs are broken down into cells, and then further into umudugudus, which would be the equivalent of a large neighborhood. In each umudugudu there are a minimum of 2 health workers, the majority having at least 3; one for men, one for women, and one for pregnant women and small children. These health workers have the power to give out basic medicine, refer people to health centers, and do basic diagnostic work, such as detecting Malaria. I find the expansion of the healthcare system to be extremely encouraging and can see the ambition to provide the population with care. Amazingly as well, Rwanda's major health insurance provider Mutuelle covers nearly 80% of people. With all these steps however, Rwandans still have low rates of treatment owing mainly to inability to access health systems due to atrocious roads as well as lack of resources in the health centers and hospitals. There is so much promise in this country, but unfortunately ideas first have to be adapted to Rwanda's many obstacles.

The quiet life

Integration starts and ends with language. I know that's what they told us, and I do believe that for full integration, it is necessary to be able to speak the host country language, but Kinyarwanda has proven to be an elusive and difficult desire. For someone that was quiet and didn't talk much when everyone around me spoke my same language, it has proven to be an abrupt transition to be placed in a situation where I talk even less. I do make an effort to say hello to most people I pass, which is nearly as far as my conversational Kinyarwanda skills take me, but the fact that any further questions inevitably lead to conversation topics that I really have no ability to comprehend makes me hesitate. There are a fair number of people in my area that have marginal English skills, which always comes as a relief. The health center basically runs in French as all the records as well as many forms and diagnostic tools are written in French. Since all the workers at the health center are educated people, they also know French, which makes it unfortunately, conveniently easy to revert back to my basic French instead of bumbling along in Kinyarwanda. Obviously I understand the importance of being able to speak in Kinyarwanda, especially as most patients that come though the health center know that as their only language. I am able to get along with the basics of asking for prices, figuring out where my bus is headed, or asking where people are going or coming from, but beyond that I am lost. As my French is nowhere near the conversational level of my colleagues, I tend to remain quiet. In an already quiet world where only a select few know my primary language, not being able to speak or ask questions proves frustrating. I've found a few times where I have nearly gone an entire day speaking only a few sentences. It probably doesn't help that I live alone either. Everest tries his few English phrases, and I try with my Kinyarwanda, however we don't typically get past polite formalities. Though I can see it would be possible to go through my 2 years service and survive with my limited language skills, I think the quiet might get to me before anything else. It's amazing how much you rely on basic human interaction, and in most scenarios, you never have to deal without it however, it is one of those things that leaves a gaping hole when it is gone. My goal will be to come back fluent in French and with a good grasp of Kinyarwanda, so here's to hoping the quiet life is an adequate motivator.

Mbabazi: to have grace, compassion, or pity

I figure I have lived up to my namesake fully when I receive the same name in another language that means that same as my English one. In most Peace Corps countries, language teachers or coordinators bestow upon the new and naive volunteers names derived from the host country in order to include them in a small part of the culture and to ease the transition into the community. The thought is that if the volunteers have names like the others, they might be perceived more like everyone else. That's the theory at least, although it doesn't help when you forget to introduce yourself with your new name, or forget the name when people try to call you by it. In either case however, most volunteers from my health group were no different and were given Kinyarwanda names, myself included. The name the language coordinators decided best suited me was Mbabazi. Although I got many different translations for what this name truly meant, as Rwandans tend to have many explanations and versions of a solitary thing, the general definition of mbabazi came out to be; one who has compassion or pity, grace.

In most cases this would be an honored and respected name. Our given Rwandan names were based on the characteristics the coordinators saw most in us. In fact, most Rwandan names in general have a similar idea, encompassing a religious theme but also taking on the description of the family. I am glad my coordinators found such characteristics in me, but I find it slightly more curious that they happened to choose a name that is almost identical to my English name. Even though Rwandan names tend to carry more actual meaning and English names seem to be more symbolic about their origins, the idea that my two names matched seems ironic. My English name, Kerry, supposedly means one who has compassion. Call it coincidence or my true nature showing through, who knows really. Now I just have to remember to introduce myself as Mbabazi Kerry, and remember to respond if they call me.

Apology

I apologize first and foremost for my lack of updating the blog. I've always been a great starter but apparently have trouble with the whole continuing bit. I will try to write more but I feel as the months progress, my work and life might become repetitive, as many jobs tend to do, at which point I might resort to making up wild and absurd stories. Hopefully it won't come to that, however I will inform you if it does.