Gisenye - Murara Health Centre

In the last week of my time in Rwanda I am lucky enough to get the opportunity to work alongside a fellow volunteer in a rural health centre. I am hoping to do this sort of work in my next volunteer placement so it will be worthwhile getting some experience. I set off by bus on a Tuesday afternoon, headed 3 hours North West to Gisenye, a sleepy lake side town right on the border of Goma, Democratic Republic of Congo. I have a backpack with 3 changes of clothing, and a pair of jandals. It is pouring down with rain when I step off the bus into the dark streets of Gisenye, but luckily a colleague is there to meet me with his motorbike. It means I dont have to walk alone, but does little to help me stay dry!
The following day we set off to the health centre on the back of the motorbike. The little red beast has been sitting in someones backyard for quite some time, and has questionable performance with one passenger let alone two! Nevertheless we eventually make it up the hill heading out of town and soon turn off the main road and begin negotiating the bumpy dirt track. The rain last night has left the holes full of water and despite our careful negotiation I end up with mud all up the back of my legs. We pass an array of houses, some very poor mud huts, but also some fairly nice houses with intact roof's and concrete foundations. Certainly not flash by any stretch of the imagination, but seemingly watertight and warm. The local children are wandering around, playing in the dirt and I hear the all too familiar 'Muzungu! Muzungu!'. Im gonna miss that!

We arrive at the Murara Health Centre at 9am and I get introduced to some of the team. As well as their local language - Kinyarwanda - they speak fluent French. Little help to me. So I smile and nod and try to look friendly and helpful. At exactly 5 minutes past 9 a nurse calls us over to the maternity unit, we have a baby on the way. I stand back and watch as a baby is delivered a couple of minutes after we arrive. I try to look cool and calm as I am secretly shitting myself. My colleague turns to me and says, "thats how it's done, next ones yours'. Mmmhh. We'll see about that.

I have a chance to look around the centre after the drama of the morning. Its fairly large, has about 4 buildings. From the street you arrive at a building that has a pharmacy and 3 consult rooms. The 'reception' is a desk situated on the porch outside the consult rooms. The pharmacy is a tiny room that has boxes scattered over an old desk. No sense of organisation and very little supplies. The consult rooms have a bed, a desk, and again, not much in the way of supplies. I see some iodine, a syringe and little else. The consult rooms don't yet have lighting, power was only installed this week and they are still completing the work. During the day the patient is positioned by the window to utilise natural light. Beyond the consult rooms are the wards where there are about 10 patients in a room. Beyond this is the lab, which is actually quite nice, I think it has recently been refurbished. Then there is the maternity unit, where I end up spending a lot of my time. It is a small building consisting of 3 rooms. The first room is the labour 'suite' I put inverted commor's on that because it really is hilarious to call it a suite. There are 3 beds side by side, but generally more women than that, so they share. There is no linen - the women and families must bring their own. It is dark and cold. Through from here is the delivery 'suite'. There are 2 beds in here, and I am told that at times they have had 3 delivering - one is on the floor. The first thing I notice about the delivery suite is the smell. Kind of like a butcher shop that has not been cleaned out in quite some time. At the end of the bed is a bucket to collect any mess, anything that goes on the floor is swept into a hole in the corner of the room. They sometimes use water to wash off the floor, never any disinfectant from what I saw. There is more in the way of supplies here than in the consult rooms. I see trays of scissors and clamps. A plastic stethoscope.    

Some syringes and viles of medication. Even a drip stand! The power has just been hooked up here so they have lights and the nurses are still very excited about that! I wander on from here to the next room which is the postnatal room. In here there are 7 beds, and the mothers will stay about 2 or 3 days after delivery. The family must come in regularly to feed the women and wash their laundry as they get nothing from the clinic. In the grounds of the clinic there is a large water tank with pipes into the clinics, the water was hooked up about a month ago. Prior to that they had to collect water and carry it to the clinic rooms. I am pleased I was not working here then! Unlikely to have been much hand hygiene going on. There is a toilet block for the patients, I dont even like to walk past it. I see a large furnace for the burning of hospital waste and a large covered well where they will dispose of the maternity waste. There is also a rabbit hutch and some vegetable gardens which are the beginnings of some community projects. As always, there are children running around everywhere, some local kids, some children of patients and also children of staff that have learnt to look after themselves during the day.

   

 

Later in the morning I get to return to the relative luxury of the new lab. To do some HIV testing. This morning we have 30 patients to test. The national average is 12% positive. Lets see how we do! I watch a couple of blood tests before stepping in to have a go. We have no tourniquet, so use a glove tied around the arm. I discover that the women are much easier than the men. Their skin is paler and the veins easier to see. Also their skin is much softer and easier to penetrate. Its quite nerve wracking as these people have never seen needles before. They are frightened. You have to be careful that they dont jump back as the needle goes in. Luckily it all goes smoothly and I get through a few of the patients. The testing is straightforward - a drop of blood on a test strip, results back in 15 minutes. We get one positive out of 30, not good but certainly not bad considering the national average. Today we are at 3%! I am pleased to know that all the patients receive one on one meetings prior to being given the results - regardless of outcome. They will receive education and advice, and if a positive result, they will receive further counselling and support.

The rest of the morning flies by, lunch comes and goes without my knowledge - to be honest the thought of eating here doesn't appeal to me. We do regular checks on the women in the labour suite and at some stage in the afternoon one is ready to go. My colleague tells me to scrub up, and there I find myself at the foot of the bed with gloves, gown and jandals in situ. Shit. Stop reading now if you are squeamish. I am sweating. My stomach feels as though it is slowly making its way closer to my mouth. I feel faint. My colleague tells me he is just heading out to check on someone else. I turn and say dont you fucking go anywhere. The poor woman is on the bed writhing in pain. There is no husband in here. No family. We have no form of pain relief to give her. Not even a panadol. The nurses lack even the most basic compassion you would expect of a fellow human being. One of the nurses here is known to slap the women that yell too much, one managed a difficult delivery by clamping her hand over the women's mouth so she would push harder. Thankfully I dont witness this first hand. I have learnt already that my protestations go unheard.

It seems the water's have not yet broken, yet the baby is coming so the nurse steps in to help out and break the amniotic sac. She tells me to stand back, but obviously I am not quite prepared for the torrent that follows. I get covered from the knees down in amniotic fluid. With my jandals on. Great start. Anyway no time to dwell - once the waters have broken the baby is on its way! I guide it out, turning it slightly to allow the shoulders to come out easily. I place it on the mothers stomach, a nurse clamps the cord and I cut it. I quickly take the baby to a table where I suction its mouth, nose and ears. Wipe it clean. Tie and cut the cord neatly and wrap it up to weigh and measure. It all happens so fast! I dont even know what it is. A quick check tells me I have just delivered a wee baby girl at 2.30 pm on Wednesday 30th March 2011. I breathe a massive sigh of relief before placing the crying bundle into her mothers arms.

The following day passes fairly quietly compared to my first experience of the health clinic. We do another 30 HIV tests. Zero positive today! We have a few consults and I remove some horrendous C-section stitches. We deal with the aftermath of a butchered circumcision. The young boys are encouraged to have it done here for sanitary reasons, and then deal with pain and infection for weeks on end. I begrudgingly learn how to do pelvic exams on the women in labour. Unfortunately a necessary part of the birthing process. The women appear shocked when I take the time to introduce myself and put them at ease before examining them. The nurses would never be so gracious. We check the foetal heartbeats with an ancient wooden bell, and take blood pressure with our plastic stethoscope. No babies are delivered today but we are to head back tonight when typically more are born.



We leave at 3 and have some dinner before heading back to the clinic at 8. Its freezing, dark and quiet. The staff quarters have 2 single beds for the four staff that are on tonight. There is a light in here now which makes things a bit more cheerful. There is also a light in the consult room, but it is necessary to wear head torches as well. The first patient of the night is a young lad with a machete wound on his wrist. He has cut deep and nicked part of a tendon. We dont have fine enough sutures to attempt suturing the tendon so we can only stitch the wound to stop the bleeding. Thankfully we have some local anaesthetic for him. My colleague hands me the needle to do the suturing, but as I watch the needle go in to administer local anaesthetic I realise that I wont be able to do the stitches. This guys skin is like leather and you can almost see the needle bend as it goes in. One of the nurses steps in and in the most brutal way possible, manages to stitch his wound. My every nerve fibre can feel this guys pain despite the local he has been given.

Next we do rounds of the maternity ward. There are four women in labour. On examination some are getting close so we stay on the ward to monitor. There are some spare gumboots so I decide to indulge in them for the next deliveries. I slide my foot inside, to a moist, slimy environment. On second thoughts, I remove my foot, give it a wash, and in true Kiwi ingenuity style, put some gloves on my feet before putting the gumboots back on. Excellent - clean and dry! We check the heartbeat of one baby and find it's a bit inconsistent, but a few of us listen and come to an agreement. We are soon to discover why there was a discrepancy. This women is close so she stays on the table in the birthing suite. My colleague does a pelvic exam and then turns away to get something. Next thing we hear a shout and we all turn to see the baby come.. literally.. flying out. I cant believe that 3 people can fit between a women's legs as we all dive in to catch the baby. Thank god for the umbilical cord which keeps the baby bouncing as though on a bungy. I get busy dealing with the baby as my colleague deals with the placenta - I decide that this is the way our roles will be - I have little interest in placenta. Although turns out - the placenta is another baby. Hence the discrepancy in heartbeats. This little guy also comes out fairly quickly, although we are there to catch it this time! No sooner do we get over this drama, then another woman is on the table wanting to push. Her blood pressure is a bit low and she's tired so we hook up some fluids. Im in the hot seat again. She's struggling. The head is crowning but she has a lot of trouble pushing. I suggest an episiotomy and my colleague kindly steps in to do it for me. We have no scalpel - just blunt scissors. I am soon to put into perspective how painful contractions are. The episiotomy is done in the throes of contraction, one large snip of the scissors. The women doesn't flinch. She may be writhing in pain from the contraction, but she doesn't notice the scissors cut through her. Fuck that. It still takes a couple of minutes for the baby to come out. I guide it out and go through the motions. As I am cleaning the baby I notice something strange with his leg. It looks broken. I take a closer look, check the hips. The problem is at the knee - it appears that the knee joint is malformed. The knee cap is at the back of the knee, and the foot is hence facing the wrong way. This poor woman who has been through so much is soon to discover that she has a disabled child. I also soon find out that the child will not go to the hospital, there is nothing that can be done here. This child will very likely end up a beggar on the streets. It seems so unfair when this tiny, beautiful, innocent child is in your arms.

We have a slight lull so get busy sterilising the equipment. We have exactly 3 sets of scissors and clamps. They get rinsed in the sink, placed in metal dishes, covered in alcohol and set alight. A few minutes later they are sterilised - as best as they will ever be here. We are lucky that they actually have alcohol at the moment. Soon enough we have another woman on the table and deliver another healthy baby. Before the night is out we have delivered 7 babies. One woman walked about 4 hours  in the pitch black from her home outside the village. Another woman was in Goma, DRC, and came across the border on the back of a moto taxi. One woman who was on her 10th baby had been labouring for 8 hours before disappearing, not to be seen again. We manage to get a few hours sleep in between and are so tired we dont mind sharing the single beds with the thin, scratchy woolen blankets. The following day we stay at the centre until 3pm, busy again with HIV testing and consults. By this stage I have lost some of my earlier enthusiasm. The excitement of delivering babies has worn off and all I can think about is a hot shower, and a warm clean bed.

Rwanda - Pefa part 4

 The bond with my children continues to develop. We have settled into a good routine which involves 'meet and greet' before morning tea. The children will all get some individual attention - the babies love their cuddles, the older ones get a thrill out of being hung upside down! Unfortunately I have somewhat 'created monsters' - they cry a hell of a lot more now when they know that I respond to it! However I am quick to identify the real from the crocodile tears. And all they want is attention. At times I feel like a human jungle gym with 4 or 5 children hanging off me.

After morning tea we will do some learning - alphabet, counting or reading. Initially I hold their attention for a maximum of 2 minutes but as the weeks go by they sit and listen for half an hour or so. After this we do some exercise as they have energy to burn! We will play soccer, or dance and sing, or play with balloons. Even when we are playing, the children are learning patience, sharing and discipline. By this stage I feel I must have a masters degree in patience myself! A few times I have had to put myself into 'time out' for a few moments!

 During lunch I will help the younger children to learn how to use their spoons as they all have one each now. After lunch the children will go down and I will often use this time to spend with River. I have been trying him on a bottle to see if this prevents his aspirating but his muscles are too weak. However the first time he tried it he took about 5 mls in half an hour, which progressed to about 40 mls in half an hour. He still needed to be topped up with the syringe so I taught the Mumma's how to do it slowly so he didnt aspirate or vomit. I worry that this won't be continued as it is so time consuming. I had felt when I first assessed River that he had visual and hearing issues, yet he now appears to respond to my voice and it seems to calm him. This is a great reward!

It is hard to leave my children when the time comes. There are about 5 I could take home with me quite easily! Its funny when I look back at my first week and I felt so overwhelmed. Now I am such a part of the place and it such a part of me. It has been a challenge, but so rewarding and I hope that I gave the children as much as they gave me.

Rwanda - Pefa part 3

As the days and weeks roll by at the orphange, faces, genders and personalities begin to evolve. I can distinguish the girls from the boys. I am starting to recognise faces and learn names. I am identifying personalities and sorting out the bullies from the bullied. This seems to be a big problem with the children aged about 8-10. I guss they are in that age bracket where they have evolved from being 'the young ones' but have not yet reached adolescence and joined the 'older kids'. The bullying is very subtle and is made even more difficult for me to identify considering the language barrier. I just see the older children talking quietly to the toddlers, before they hnd over their lunch or toys. Occasionally I would see less subtle forms when the children are in their rooms and I walk in to see them getting hit. Another common problem is the toddlers getting dragged along by one arm. The mumma's are guilty of this too - but instead of dragging them, they will actually pick the child off the ground by one arm. I spent a month trying so hard to discourage this to no avail. It almost had me in tears. The children were rarely punished for bullying, and if they were it was a decent whack. This type of punishment had little effect, they seemed immune to pain. I introduced timeout which worked well, but I fear it wont be continued as it is too time consuming. I wish that I could communicate with the bullies because I can unerstand that much of it stems from their upbringing. Imagine being one of 50, no individual attention, no-one to love you. By the time they become bullies they are clinging to any form of self control they can find. They get attention! In the form of violence but attention nonetheless. As angry as I get when they hurt the younger children I need to keep this in the back of my mind.

There are many more psychological issues at the orphanage and it is heartbreaking as I begin to identify them. One little boy - Pacific - is about 4 years old. He is an absolute sweetheart - loves to play soccer, loves to read stories with you, and shares amazingly well with the other children. He has a delightful smile which is ever ready. But he can withdraw in an instant. He will be playing one minute and the next he is in a corner, huddled up with his arms over his head. No amount of talking can bring him out of it, until he slowly comes back into himself. Another little girl Kezia is about 2 years old and rarely eats. I soon learn that if she is placed in a corner on her own she will eventually finish her lunch, but if anyone else is too close she will completely freeze. I once tried to help her with her spoon and she screamed and kicked and scratched at me. She wil then continue to freeze for about 10 minutes after she is left alone. Its frightening behaviour in a 2 year old. These are just a couple of examples of the psycholgical issues I identified in the later stages of my placement, and I hate to think the true extent of the issues at this place.

Rwanda - Virunga National Park

The mighty mountain gorilla's. Found only in the volcanoes of Rwanda, Uganda and DRC, and very nearly extinct only a few years back. It was for this reason that I took the opportunity to visit these majestic creatures whilst in Rwanda. It was not cheap - US$500 for a permit which allows you only one hour to spend with the gorilla's, but it is a once in a lifetime opportuniy which I felt could not be missed.
Natalie and I booked our permits at the ORTPN office in Kigali and were lucky enough to get them for that week, some people have to wait weeks for permits. So that Friday after work we board the 5.30 bus bound for the district of Musanze in the North. Ruhengeri is the main town  and we arrive close to 8pm. Its dark, and the town is still busy with hawkers and moto taxi's. Fingers and toes are crossed that we will end up somewhere safe as we have not organised accomodation or transport. The guest house we had in mind didn't answer the phone, and everything we read said there was no public transport to get there. So we are pleased to see dozens of competitive moto drivers. We eventually manage to barter a couple of fare's of 2000RWF (about $3), and soon we're racing up the mountain, freezing, on the back of the motorbikes with our packs on our back. We end up 12km away in the small town of Kinigi, and the moto drivers wait while we check availability. We also get their phone numbers in case we find ourselves in the middle of nowhere without transport over the weekend! We breathe a sigh of relief when we get handed the key for a room in Kinigi Guest House and we wave our drivers off with thanks. Kinigi Guest House is a quiet Alpine style lodge set at the base of the volcanoes. The alpine feel of the place is only enhanced by the climate. Its freezing! Natalie discovers that the showers are cold, and later on, the water stops altogether so that the toilets don't flush, and they slowly start to full up. Lovely. This is Africa! We take refuge in the bar with a beer by the warm fire.

At 7am on Saturday 19th March we set off for the ORTPN headquarters in a 4WD we managed to hire last night. We met 3 others in the bar who end up sharing the jeep with us and share the cost which helps! Our guide Fidel informs us we are to visit the Bwenge group which consists of 10 gorilla's. There is only one silverback which is the head of the group. Silverbacks are males over 12 years of age, and some groups have more than one, which means they will have to fight for the dominant position. Sometimes less dominant males will break off and start their own group. Blackbacks are males between ages 8-12, which there are none of in our group. However, we have a Tanzanian male trekking with us, so he becomes our 'blackback', along with 2 greying men in their 60's who become our 'silverbacks' - all in good humour of course!. 5 females and 4 babies make up the rest of our gorilla group. The life expectancy of the gorilla's is about 45 years and the males will grow to well over 200kg, with the females about 150-200kg. It was only a couple of years ago that the worldwide population was below 100 due to poaching, but due to the conservation - helped along by income from park permits - the population is now about 400.

We drive along rocky roads to the base of the volcanoe to begin our trek. The first hour is a steep incline through small mountain villages and land cultivated with potatoe and pyrethrum plants. Men and women working in the fields look up and wave as we pass. The tiny grass huts are deserted as everybody is out working. Eventually we reach the park boundary which is a tall rock wall spanning 75 km from Uganda to DRC. We are met by 2 more guides, one with a machete and one with a gun, before we scale the wall and land in dense jungle. There is a bit of a track punctuated by piles of fresh shit - we can thank the buffalo for clearing the path this morning, but we still need the help of the machete to clear the way. It is the rainy season so the thich, black, fertile soil is moist and we are in well past our ankles trekking through. The gardening gloves come in handy as we push through hanging vines, climb over fallen trees and look out for the stinging nettles.

Some trekkers had set out early this morning to find the group and Fidel keeps in touch with them by radio. An hour later, at an altitude of 2900m, we meet them and are told the gorilla's are nearby. Sure enough we round a tree trunk and a 150kg female is staring at us about 5 metres away chewing happily on a piece of bamboo. Hushed exclamations resound from all of us before we become silently spellbound. The brief acknowledgement the gorilla initially awarded us passes and she takes no further notice of us, instead concentrating on eating. She is completely unfazed by us being so close. Its mesmerizing watching her eat, delicately striping the branch with her teeth and fingers before eating the juicy flesh. She effortlessly tears off branch after branch with an easy strength.

The silverback is around the corner so we head off to meet him, and are pleased to find 2 of the babies are with him. He is about 4 metres away and pays us only marginally more attention than the female - glancing up occasionally to check we are not too close to the babies. One baby of 2 years is very shy and stays close to her papa. The other one is clearly enthralled with us, and comes closer to have a look before jumping to a low branch and performing. This one is about 14 months old and plays for ages swinging and jumping from branch to branch. Unfortunately the papa eventually calls her away and they head off to find shelter - apparently the rain is coming. The head trekker heads off slowly behind them with us following - he did not see an adult female hiding in the bushes and she jumps out and barks at him as we pass. It scares us out of our spell! Up ahead we watch a couple of females climbing a tree. They sleep in trees and we wonder how they manage with their size - clearly it doesnt always work as we soon hear a huge crash as one tumbles through the branches. We find the rest of the family under the canopy of a huge tree minutes before the rain pours down - they all knew the rain was coming a good 5 minutes before it did! All too soon our hour comes to an end and we head back down the mountain. Back at the lodge we change out of our soaking clothes and enjoy a bowl of hot soup to warm our bones whilst reminiscing about the day and sharing photo's. We retire early, exhausted, and with memories that will last a lifetime.

 The following day we phone our moto drivers and have them take us to a local cultural village. This is an ecotourism project that was started about 2 years ago to help the villagers, all proceeds go directly to the people. We find out later by talking to a Canadian woman working with the people that the founder is withdrawing his support as he has been subsidising their salaries and can no longer afford it. The villagers will soon be on their own, and hopefully they now have the knowldge to continue this venture and improve profitability. God knows they need it. It is fantastically run, and the enthusiasm and smiles on the faces of villagers show us that they love it. We dress in traditional royal costume and sit on the threshold of the large grass 'kings' hut, whilst watching the Intore warriors dance to the beat of the drums. The Intore wear head pieces of bark product which looks like long blond hair. They wear skirts and have bells around their ankles and carry spears and shields. The dancing is fast and rhythmical with grandiose head gestures whipping their hair into a blonde arc. I wonder if they're meant to look threatening. They don't today with their warm, wide smiles, and later we share the contagious smile and laughter as we dance alongside them.

One of the more entertaining villagers is a tiny middleaged man who comes from Rwanda's minority tribe of Batwa Pigmy. These people originated from high in the jungle and are known for their hunting ability which he proves to us with some bow and arrow target practice. Perfect score! Me? I managed to get one target after about 10 attempts! Much easier to go to the butchery section at the supermarket right? Of course, that is not an option for the villagers of Rwanda even today. Take bread for example. OK sure, some people make their own bread back home, but how many people grow the maise, dry it, grind it, and THEN make the bread? They do here. Another product they use is a seed called soghrum which they use for bread and porridge and we try our hand at grinding it between 2 smooth rocks - not too hard in isolation, but a hell of a process for bread! We also meet the traditional healer who shows us some potions for stomach complaints, nettle stings, respiratory complaints and, more amusingly, 'man power', which is demonstrated by the strategic placement of a large stick. The traditional healers are still very much used, and I have to admit, some of it really works and adapted forms of it are even used in Western medicine. Its upsetting however when HIV and cancers are ineffectively 'treated' by the healers , but more upsetting is that they actually dont have any other oprions of treatment. The morning is finished with a concert of dancers and drummers performing for us, before we again leap up to have a go on the drums and dance with the women. Ill have to be satisfied that I will NEVER be able to shake my ass like these locals can!!

Back at Kinigi we chat to a chap from Johanesburg, and in true backpacking form, end up catching a ride back to Kigali with him and his private driver. Much more comfortable than the local bus and much needed since I have run out of money by this stage and couldnt afford the bus fare back!! Had a sweet ride back, stopped at a pub and watched some street dancers, and delivered safely to our door. Excellent weekend!!

Rwanda - Pefa part 2

The orphans range from 6 months to 25 years of age. It is so much easier to think of the place as some sort of school or day care, rather than consider that this is where they live. In my first week the children are a sea of undistinguishable dark round faces. All heads are shaved so its difficult to even identify the girls from the boys. They are all dressed and all have shoes so they are better off than a lot of the local children. I spend the first couple of days becoming familiar with their routine. If you can call it that.
I arrive at 9.30 - all the children are up and dressed and amusing themselves while the mumma's do the washing. There are absolutely no toys or books to be seen. Half of the older children are at school, they either do 7 - 11.30 or 12.30 - 5. At 10 am morning tea is served for the toddlers only, it is a small cup of something they call porridge, but is the consistency of soup and smells disgusting. Occasionally they will get a small portion of stale bread roll. After morning tea they are marginally more settled for a brief time, and are again left to their own devices until lunch is served at 12. They have a huge lunch of cooked green banana's, potatoes, rice and round beans. Occasionally they will get some tiny dried fish, and even less often, a small banana. The older kids will eat at the 2 tables, and the younger ones under 5 (about 30 or so) will eat on the floor. There are not enough spoons to go around so the younger ones eat with their hands. I am pleased to see that they all wash their hands before eating. After lunch the rest of the older kids will go to school, and the young ones go down for a nap.

By 2 the place is quiet and still and the Mumma´s are busy doing the washing. They work tirelessly. There is about 4 mumma's on at a time and they are responsible for about 8 young children each. Most of them are also orphans themselves. You can tell that they do care about the children, but they are there around the clock without breaks and that would be too much for a saint to deal with! This is reflected in their motivation. The children are not played with, they're not hugged or consoled. They urinate on the ground and walk around in soiled clothing. Noses are not wiped, cuts and grazes not tended to. I notice that the children don't cry. I guess they have learnt not to. Whats the point?

 

I get introduced to River in the first few days. He is a wee boy of 6 years of age who was abandoned by his parents about 6 months ago. I get told that he is disabled but nobody knows what is wrong with him, so they ask me to assess him. He has cerebral palsy. Severe spastic quadriplegia. He is tiny. Looks about 2 years old. Arms and legs as thin as sticks, stiff as a board, and with visual and hearing impairments. Apparently he is in and out of hospital and its easy to see why when I watch him being fed. He should be on a PEG feed but thats is not an option here. Instead he is fed with a 5ml syringe which gets squeezed into his mouth all at once and he chokes, screams and vomits his way through the entire feed. Its horrendous. He stays in bed all the time, never gets taken outside.  He looks pale and frightened. This wee boy will be my special project.

Rwanda - Huye

The town of Huye was previousy known as Butare and is home to the National Museum and the National University. It is a 2 hour bus ride from Kigali and we decide it can be done in a day. Nat, Amanda and I arrive in the small bustling town in Southern Rwanda at 10 am in the morning. The streets are lined with trees and it is fairly tidy. There are a lot of young, smart adults around - owing to the nearby university. It is special to be able to visit the campus, as we know that in Rwanda it is a huge challenge to attend university and only a lucky few do. It is sad to learn that even a large proprotion of those with degrees will still struggle to get jobs. The campus is small compared to other universities around the world, but its lovely and tidy. Its interesting to see the classrooms are half full of people studying on their weekend, goes to show how seriously they take it. We stop and chat to a few people, with this level of education their English is fairly good. People are here from all over Rwanda. Popular classes are finance, business and IT, but many more are on offer here.

The national museum is on the edge of town, it is a large, beautifully designed building set in gorgeous gardens. There are 6 different rooms with displays of geography, people, food, craft, weapons, housing, clothing, politics and royalty. Its lovely to walk around and see a lot of the history of the country, but we're not allowed to take pictures and I have to confess my interest in, and therefore my memory of, such things is limited.



We try to find the Genocide Memorial, we have heard about one which has several classrooms housing lime preserved bodies from the genocide. There are thousands upon thousands of bodies on display. We can't find the memorial - although it was probably a good thing, because it may well have scarred us! There are many such memorials throughout Rwanda, one in Kiboye where it is estimated 90% of the population was wiped out. There are 2 churches just out of Kigali which have lots of bones, clothes and relics on display, with a backdrop of blood splattered walls where people were thrown against and killed. It doesn't bear thinking about.

Giving up on this idea we decided to try to find the coffee plantation which got a mention in the lonely planet guide. This is one of Rwanda's biggest exports and income generators. It turned out being a 15 minute moto ride out of town. Again we got their numbers just in case - they dropped us in the middle of nowhere! There was a large building with a tiny coffee plantation - I guess their crops were elsewhere. We walked in and asked if we could look around. A dozen ladies were busy sorting out beans and gave us very odd glances as we walked in. The language barrier made things interesting but they seemed quite happy for us to wander around. Not that there was much else to see. Just the ladies sorting beans. We figure there must be more so we refer back to the trusty old lonely planet guide. Apparently 1.5km down the road there is a lane and 1km down there we will find the coffee washing factory. So off we set in the heat of the day in the back end of nowhere. What seemed like ages later we find the lane to turn down. We walk along the muddy, bumpy road past the goats and get to a couple of sheds that look like they could have been a washing factory - 100 years ago. At first glance there appears to be nobody around, until many small children start to appear and flock around us. Its all very exciting for them it seems! Nothing much else eventuates so we make our way back to the road. The pied piper comes out again and the children follow us all the way back to the road. And then keep following us. We walk about another km up the road and they're still on our heels. We realise they're not going anywhere and its a long, hot walk up the hill so we decide to sit down and phone our moto drivers. It takes about 40 minutes for them to arrive and by this stage we have not only a dozen kids sitting around us, but also about 4 or 5 adults on their way home from somewhere who decide to just stop and stare at the crazy muzungu's sitting on the side of the road. We cant communicate with them so its all very awkward - although they dont appear to feel so! We mention that we feel a bit like fascinating animals in a zoo. When those 3 moto's came flying around the corner they were like our knights in shining armour! We managed to make it back to town 20 minutes before the last bus - time enough for a nice cold beer!

Rwanda - Mpore Pefa Orphanage

 I get settled into the orphanage over a few days. Day 1 I get driven there with Claire and Bosco, as well as 2 other volunteers that wont be working with me. I am to be working by myself. We stay here just an hour or 2 on this first day. Day 2 another volunteer comes with me for the morning which is fantastic because I have a chaperone to help familiarise me with the buses and shortcuts to get to work! We walk down the main road about 10 minutes to get to the bus stop. There are a range of large buses and also small vans which dont leave the bus stop until they are full. They have extra seats in the aisles which fold down, hiace vans will hold 20 adults. Each bus has a driver as well as an assistant who runs up and down the street trying to get people on his bus. You tell him where you want to go and if his bus is the correct one he will grab your arm and run you to the bus. Its quite scary to begin with! I will ask for the Gikondo bus. 5-10 minutes later we get off the bus, the assistant knows you want to get off when you knock on the roof or window. I always manage to get the back corner seat which means that when I want to get off about 5 people also need to get out of the bus. It costs about 150 Rwandan Francs which is 25 cents. When we get off the bus we walk in a sewerage drain to get to the street across. It smells disgusting and on a hot day I have to hold my breath the whole way. You dont attempt it after heavy rain. Once through here we pretty much reach dirt road and its about half an hour to the orphanage. We navigate by foot, avoiding the massive pot holes and half buried litter. The beginning of the track has a few stores. A small butchery (or boucherie) in a concrete hut with a window to serve. You can see large slabs of red meat hanging inside, a knife and an old scale. There are convenience stores that have all range of things within 4 square metres, everything is stacked neatly from floor to ceiling. There is a music store which is pleasant to walk past with Bob Marley or Shaggy blasting from the speakers. And there is a tiny 1 metre square hut with a chap that makes and sells shoes.
The area here is very poor. The housing much like that described earlier. Woman are walking around with huge loads on their heads. Baskets with 20 cabbages in them, pineapples, carrots, banana's. A lot of them also have a baby on their back, they are strapped around their chest with a blanket. Some woman need to put a hand up to steady their loads, but most don't. There are also a lot of men carrying loads in a similar way. I have seen someone with 3 double mattresses on their head. I have noticed that the men here are very short, some the same height as me, I wonder if this is why!
There are lots of children around, as there are everywhere. As you walk by you hear them scream 'Amuzungu, Amuzungu!!!!' This means 'white person'. I will always call out mwaramutzi! Or Good morning! They love to practice their English. So within minutes you will often have a trail of kids behind you, I feel very much like the pied piper.



We finally reach the orphanage. Mpore Pefa. It is tucked in behind a church, and the man who started it was the priest of the church. He died in 2007 and his wife took over the running of the orphanage while others took over the church. To reach the gate of the orphanage we walk down a dangerously steep dirt track for about 20 metres. We are walking past the fence of the orphanage on your right and the children suddenly come out of nowhere screaming 'Amuzungu, Amuzungu!'. When you reach the gate at the bottom the kids are already there waiting and they literally throw themselves into your arms, dozens of them. They have looks of such pleasure on their face it touches your heart.
It takes several minutes before we are able to make it through the gate. The bottom tier of the orphanage has 2 longdrop toilets and 2 changing cubicles for the older boys, as well as 2 open huts - one for firewood and one for cooking. The cooking space has a large open fire with huge metal cauldrons for cooking rice and stews. Off the cooking area is an enclosed hut which has the food - a few bags of soghrum (kind of a yeasty flour), a bag of round beans, a couple of branches of green banana's, and a couple of cabbages. This will feed the 52 orphans. From here you go up the stairs to the first dormitory. It has a central common room with a wing to the right and left. Each wing has 6 rooms. This level is for the older boys of whom the oldest is perhaps 26. If you walk straight through the common room you come to a thin strip of outdoor area where the young children are playing. There is no grass, just concrete and dirt. There is a flight of stairs heading up to the next dorm and at the top of the stairs is another strip of dirt. The children play on both levels and there is a 2 metres unfenced drop between each. The second dorm is for the younger children and identical to the first. There is a charming colourful mural on one wall. Two old beat up tables and bench seats, which are in disrepair and have nails sticking out of them. There is nothing else in the room.The bedrooms have 2 bunk beds each. The younger children will share 3 or 4 to a bed. There is only a handful of beds with mosquito nets, and I find out that the boys tend to get these. Beyond this dorm is another outdoor area where there is a tap and the laundry and washing is done here.Another set of stairs will lead up to another toilet block which stinks to the high heavens. The younger children will all navigate the stairs to use these toilets.
It amazes me how despite these appalling conditions, the children are all happy and smiling. It is hard to accept these conditions, but I just hope I can do something to help keep the smiles on these children's faces.

Rwanda - Culture shock

 I touch down in Rwanda on 28th February 2011 after 6 hours flying to Kenya, 4 hour stopover, and 1 hour flight to Rwanda. My first experience in Rwanda is of the not very friendly customs officials. My own fault really -  I have left my visa acceptance in my check-in bag. But instead of just letting me go down and fetch it he creates a scene. Half an hour later I go down to fetch it, pay 60 bucks, and I'm off.
I am here to do a month volunteering at a local orphanage. It has been organised through Global Volunteer Network (GVN)  and we are working with  Faith Victory Association (FVA) within Rwanda. Jean Bosco who woks for FVA is waiting to collect me from the airport. We hop into a rickety old 4WD landcruiser, wind down the windows for some airconditioning, wait while Bosco tries the ignition several times, then in a cloud of black smoke we are off!

The first thing I notice about Rwanda is the soldiers - quite a strong presence in the streets, all dressed in dark blue, with combat boots, all carrying rifles. They are certainly quite intimidating!
The second thing I notice about Rwanda is the driving - everyone is crazy! It is actually insane. I think they drive on the right hand side - although its hard to tell because they are often on both sides! They love their horns. I can never quite figure out why they actually use them? There are a lot of cars in Rwanda even though only a very small percentage of the population (the very wealthy) actually have them. It is even difficult for a lot of people to afford a bicycle. Most of the locals will commute by foot. So this means that along with the crazy driving, there are hundreds of locals walking on the roads. The drivers are rarely considerate of the pedestrians and I find later that you take your life in your hands every time you want to cross the street.

I am to stay in Kigali for the next month. This is the capital of Rwanda, and the biggest and busiest city in Rwanda. Rwanda itself is apparently the most densely populated country in Africa with a population of about 11 million crammed into 28,000 square metres of land. I would say that a big proportion of this population is in Kigali. As we make our way towards the guest house - my home for the next month - I get a feel for the living conditions of these people. I guess in a lot of countries that are densely populated you may see lots of high apartment buildings to fit everyone in. Not so here. The houses I see are tiny - maybe 4-6 square metres? I find out later there are often families of 6 or more living in them. They are made of mud, a lot of them have big chunks missing where the mud has dried and cracked off, they are certainly not water tight. Most of them have a corrugated iron roof - in varying degrees of disrepair. The huts are scattered wide across the dusty, dirty, muddy land. You can see people dotted around, children playing, and women - bless them - actually sweeping the dust. I have no idea why they bother but I think its a fantastic display of the pride of these people.
We arrive at the guest house about 10 minutes later and I am pleasantly surprised! We have passed through an area of houses which are actually quite large, concrete, have their own yards and gates. So it is not all slums thank god! Our house has a large gate which is always locked. It stands about 8 feet high and has spikes on the top. The rest of the wall is the same height and most of it has shards of broken glass embedded in the concrete to deter trespassers. This gives me a brief nervous sense of how dangerous it could be here. The house has a large deck with big white tiles which flow through to the inside. You enter into a large lounge area with a TV, couch and 4 one seaters. The furniture is very dated in mustard coloured upholstery with white doilies slung casually over the backs - however they look very comfortable. There is a large dining area to the left with table seating for 8. Off this is the kitchen which although large has nothing but benches, sink and a fridge. I later discover that the cooking is done in a rotunda hut in the back yard over fire. The hallway is beyond the lounge and this leads to 5 bedrooms, each with twin beds. There are also 3 bathrooms. I am suitably impressed! Although the showers turn out to be cold, and the water pressure so weak I could piss better I'm sure. There are only 5 of us in the house at the moment so we get our own rooms. My bedroom is the most gorgeous shade of bright green. I love it. We have mosquito nets over our beds which I discover gives it a very romantic feel! Pity I'm here alone.
My flatmates are lovely. Natalie from Canada, Amy from NZ (yes thats right!!) Cait from US and Amanda from US. We are all about the same age and get on really well. Some of the girls have been here for a while already and the help and advice that they provide in the first week is absolutely priceless. We also have Armani who I suppose is our 'house Dad' - don't see him much during the day but he's around at night for security and to let us in the gate when we get home after midnight! And Console who is our 'house Mum' - she's great - does the cooking, cleaning, dishes - I could get used to this! She speaks little English but is very sweet. The food here is much better than I had expected. Breakfast is usually toast with either jam, or avocado (amazing avocadoes!), and occasionally an omelette as a special treat. There is a large thermos of plunger coffee which we have with milk powder and sugar. Excellent coffee! One of Rwanda's biggest exports. Dinner is either rice or noodles, with hot chips, vegetables - either cabbage/beans/cauli/carrot, and a meat and gravy - chicken, beef, goat, fish, meatballs. All excellent except the fish. And there is always ketchup on the table. Now I can eat absolutely anything with my T sauce! Perhaps I wont lose all the weight I had planned to!

My volunteering begins with a day of orientation when Bosco returns with the landcruiser and brings Claire along with him. Claire is our co-ordinator here and is lovely. Speaks very good English too which helps! On the first day we learn a bit about the organisation, the country, and practice a few local words. Mwaramutzi! (good morning) Amakuru? (How are you?) Ni Mesa! (Im good!) Murakoze Chane (Thank you!) And another that I pick up very quickly once I start work at the orphanage - OYA! (NO!)
Orientation also includes a visit to the Genocide Memorial Museum in Kigali. Its very sobering to walk through and when we are there a school group come through. The students would be 16/17 and so potentially of age to have been around at the time of the genocide. One girl is sobbing uncontrollably and I could only assume she lost close family - perhaps parents and siblings.
The genocide claimed over a million lives. People killed in the most horrific, torturous manner. Young children and babies not spared. It was the Hutu tribe against the Tutsi. In Rwanda there used to be 3 tribes - Hutu, Tutsi, and the minority Batwa Pigmy. All 3 tribes lived harmoniously together until the Belgian settlers arrived and created inequality. They decided that the Tutsi were the 'superior' tribe, and basically regardless of education or intelligence, a job would always be given to the Tutsi over a Hutu. A lot of Hutu ended up being exiled because of this. Eventually I guess the Hutu had had enough. Who knows how long things had been plotting for but in April of 1994 the killing began and rapidly escalated. People sought refuge in churches, only to be mass killed when found. Some churches in Kigali had 4-5000 bodies. The famous Mille des Colline Hotel that amazingly managed to save some lives. Another part of Rwanda - Kibuye - lost 90% of its entire population. The museum holds mass graves where thousands are buried. Inside there is a room that has hundreds of bones. In one cabinet skulls of all sizes - a lot you can see fractures or complete holes. In another cabinet hundreds of femur bones. In another cabinet smaller bones. There are relics of clothing, you can still see blood stains. The worst part for me was the children's area which was right at the end. There are dozens of photo's of children from babies of 12 weeks to children of 12 years. Under each photo is a profile - Ill give an example - NAME: Elias AGE: 2 years LOVES: Icecream and his Mummy KILLED: By being repeatedly smashed against a wall. I know thats horrific but thats exactly what it was like. Dozens of these. Utterly devastating. It is a part of the history of Rwanda that is still so very fresh and raw and yet I am absolutely amazed at the resilience of the people. Although every single living person in Rwanda today has been directly affected by the genocide, they move on with their lives. They rebuild. They forgive. Its amazing.