Friday night I was in Heaven. Litterally, and metaphorically. The cheesy name of an American run restaurant lived up to its name during the one year celebration of a local contemporary arts studio. Ivuka arts was holding their celebration at Heaven, and we went to check it out.
Not only were the paintings beautiful, but there was also a group of traditional dancers. The Inhore dancing of Rwanda will never cease to amaze me – the rythm of the drums, their bodies, and the movement all stirs my soul. Especially because all the children dancing were formally street kids or beggers, and through the community of their dance troupe have earned money for school as well as a sense of belonging.
As I sat in garden full of paintings and music in the warm night air, I felt some much needed inspiration. Sometimes I find it easy to forget why I'm here, or catch myself frustrated or discouraged. This last week I was especially struggling with the idea of development, and wondering if making a better world was even possible anymore. These dancing children, however, reminded me of what I know is true. Although changing the world is a great challenge that will take time and patience, changing someone's world is far more achievable. And it is no less valuable. By showing simple acts of kindness, being a friend, or teaching a street kid how to dance, you make a person's life easier, their world better. And I figure if we do that enough times, eventually, some day, we can all live in a better world.
Sunday, September 21, 2008
Thursday, September 18, 2008
STAGE
Yesterday I had the opportunity to go to Rwamagana hospital in the Eastern Province, about an hour bus ride outside of town. I went with Yvonne, a clinical instructor, to supervise our students and make sure that there were nurses available to help them develop their skills and work with patients. I have not been in a hospital interacting with patients since my rotation in Butare in April, which was a really challenging experience for me. I was excited to go back with a new perspective, and to get out of the office for the day.
I climbed into a minibus at 6:45am, and as we sat in the fifteen (or eighteen, whatever) passenger van I had flashbacks to my own clinical rotations in Nursing School. The road east from Kigali is much straighter with far less hills, which was good for how crowded the bus was. The hospital was set up a lot like the hospital where I was in Butare, although here the wards are smaller, closer together, and had received some renovations. The wards are each a separate building, consisting of one large room with maybe some “office space” or nursing quarters near the back. The buildings are made from cement, but in Rwamagana they were at least painted a cheerful yellow. As you come into the ward two parallel lines of iron cots stretch down the room, and patients’ white eyes follow you silently from their beds draped in brightly printed fabrics, as there are no sheets supplied by the hospital. Each patient is responsible for purchasing whatever supplies and medications are prescribed for their care from the hospital pharmacy, and these supplies are stacked neatly on the small tables beside each bed, with buckets for washing and pots for cooking under each bed. Family members mill around, taking care of their loved ones, while nurses distribute medications and care for wounds. It is quiet, much quieter than any Canadian ward. There are no alarms ringing, no call bells dinging, no pagers beeping, no phones calling, and certainly no patients complaining.
My duties as a supervisor were not extensive. We conducted “rounds” and visited each ward. I was introduced to the nurses there, who were doing a really good job of pushing our students’ abilities, showing them new techniques, and testing their knowledge. In the Emergency Room, there were few patients, and I was able to have an interesting discussion with my student there. I was reminding him about the importance of assessment in the ER, as it is the point of entry to the hospital. He agreed, and was able to rhyme off the necessary assessments, but told me he was discouraged. He remarked that although it was good practice for him to assess the patients, there was really no point. There is nowhere for nursing assessments to be documented, and even if there was, no one would read it. Furthermore, if he did find something completely abnormal, it’s not as though he could actually tell the doctor about it, as his opinion has absolutely no credit. Not only is he a nurse, but a student. I said he could try to inform the head nurse, but he said even then, nothing is ever done with the information.
A prime example is that of pain assessment: in class, we had discussed a lot about the use of a pain scale and the importance of addressing patients’ pain because it has so many physiological and psychological consequences. But this student said he would not ever ask about pain, because it was an insult to the patient – with no medication to address the pain, he’d rather not bring it up to the patient in the first place. I couldn’t argue with that.
It was discouraging. Here is a student who has the theoretical knowledge behind him; he knows what must be done and has the empirical evidence to justify his nursing interventions. But he has no support, and no hard resources. He knows he should wash his hands between each patient, but has no running water to do it. He knows he should assess his patients, but no one will listen to his findings. He knows his patients need medication, but he has none. The education that KHI is providing these students is a great thing for the advancement of health care in the country, but the reality is that the resources are needed to back it up in a sustainable and equitable way. Donated medications and needles only go so far. True changes to the health care in Rwanda need government funding, and when that will come… who is to say. There are so many systemic players like political will, debt relief, and fundamental leadership that are abstract, but their consequences are visible in front of me every day.
Even more frustrating is the attitude of people (in general, including the public, doctors, patients, and other nurses) towards nursing. I can see the parallel between the challenges nurses face here to build a profession with the challenges faced in the past by Canadian nurses. It took many years for people to see nursing as a profession, with truly valuable skills, knowledge, and perspectives, and that nurses are not simply a “step down from doctors”*. My student voiced his concern that people do not understand that he will obtain a degree, and he actually knows what he is talking about. I told him that the challenges he faces will not be for nothing, and that his leadership will do great things for his profession and the health care in his country. I hope I am right.
[*side rant: my biggest frustration is when people think that nurses are people who couldn’t be doctors or are below doctors. I’m not a nurse because I couldn’t be a doctor. It is called a healthcare TEAM. We have a completely different skill set, and they are completely different professions. Like a firefighter and policeman – both emergency services, but different. Needed to get that out there]
Thankfully, I was encouraged in the next unit. Two of my students were working on an adult medicine ward, but were not finding much to do as there were not too many patients and most of them were walkie-talkies (nursing speak for not terribly ill). They had therefore taken the initiative to provide ‘public lectures’ on health topics, inviting the patients, their family members, and anyone else around to learn about disease prevention and self care. I was so proud of them! Although I couldn’t understand what they were teaching (it was of course in Kinyrwanda) I could see that they were engaging their listeners, asking good questions, and allowing for an open discussion. After, they were going from bed to bed teaching individual patients about their disease. I guess my own passion for patient-education rubbed off a little, and it was rewarding to see the direct results so eloquently delivered.
So, at the end of the day, I chose to take away a feeling of hope. There are so many frustrating challenges, especially when problems (like healthcare) must be addressed wholistically but there is a lack of collaboration. But I can see that the direction is positive. My students are thinking about these challenges, and they are learning. Patients are receiving care. Rwanda is moving forward. Positive change is positive change, no matter how slow or small.
I climbed into a minibus at 6:45am, and as we sat in the fifteen (or eighteen, whatever) passenger van I had flashbacks to my own clinical rotations in Nursing School. The road east from Kigali is much straighter with far less hills, which was good for how crowded the bus was. The hospital was set up a lot like the hospital where I was in Butare, although here the wards are smaller, closer together, and had received some renovations. The wards are each a separate building, consisting of one large room with maybe some “office space” or nursing quarters near the back. The buildings are made from cement, but in Rwamagana they were at least painted a cheerful yellow. As you come into the ward two parallel lines of iron cots stretch down the room, and patients’ white eyes follow you silently from their beds draped in brightly printed fabrics, as there are no sheets supplied by the hospital. Each patient is responsible for purchasing whatever supplies and medications are prescribed for their care from the hospital pharmacy, and these supplies are stacked neatly on the small tables beside each bed, with buckets for washing and pots for cooking under each bed. Family members mill around, taking care of their loved ones, while nurses distribute medications and care for wounds. It is quiet, much quieter than any Canadian ward. There are no alarms ringing, no call bells dinging, no pagers beeping, no phones calling, and certainly no patients complaining.
My duties as a supervisor were not extensive. We conducted “rounds” and visited each ward. I was introduced to the nurses there, who were doing a really good job of pushing our students’ abilities, showing them new techniques, and testing their knowledge. In the Emergency Room, there were few patients, and I was able to have an interesting discussion with my student there. I was reminding him about the importance of assessment in the ER, as it is the point of entry to the hospital. He agreed, and was able to rhyme off the necessary assessments, but told me he was discouraged. He remarked that although it was good practice for him to assess the patients, there was really no point. There is nowhere for nursing assessments to be documented, and even if there was, no one would read it. Furthermore, if he did find something completely abnormal, it’s not as though he could actually tell the doctor about it, as his opinion has absolutely no credit. Not only is he a nurse, but a student. I said he could try to inform the head nurse, but he said even then, nothing is ever done with the information.
A prime example is that of pain assessment: in class, we had discussed a lot about the use of a pain scale and the importance of addressing patients’ pain because it has so many physiological and psychological consequences. But this student said he would not ever ask about pain, because it was an insult to the patient – with no medication to address the pain, he’d rather not bring it up to the patient in the first place. I couldn’t argue with that.
It was discouraging. Here is a student who has the theoretical knowledge behind him; he knows what must be done and has the empirical evidence to justify his nursing interventions. But he has no support, and no hard resources. He knows he should wash his hands between each patient, but has no running water to do it. He knows he should assess his patients, but no one will listen to his findings. He knows his patients need medication, but he has none. The education that KHI is providing these students is a great thing for the advancement of health care in the country, but the reality is that the resources are needed to back it up in a sustainable and equitable way. Donated medications and needles only go so far. True changes to the health care in Rwanda need government funding, and when that will come… who is to say. There are so many systemic players like political will, debt relief, and fundamental leadership that are abstract, but their consequences are visible in front of me every day.
Even more frustrating is the attitude of people (in general, including the public, doctors, patients, and other nurses) towards nursing. I can see the parallel between the challenges nurses face here to build a profession with the challenges faced in the past by Canadian nurses. It took many years for people to see nursing as a profession, with truly valuable skills, knowledge, and perspectives, and that nurses are not simply a “step down from doctors”*. My student voiced his concern that people do not understand that he will obtain a degree, and he actually knows what he is talking about. I told him that the challenges he faces will not be for nothing, and that his leadership will do great things for his profession and the health care in his country. I hope I am right.
[*side rant: my biggest frustration is when people think that nurses are people who couldn’t be doctors or are below doctors. I’m not a nurse because I couldn’t be a doctor. It is called a healthcare TEAM. We have a completely different skill set, and they are completely different professions. Like a firefighter and policeman – both emergency services, but different. Needed to get that out there]
Thankfully, I was encouraged in the next unit. Two of my students were working on an adult medicine ward, but were not finding much to do as there were not too many patients and most of them were walkie-talkies (nursing speak for not terribly ill). They had therefore taken the initiative to provide ‘public lectures’ on health topics, inviting the patients, their family members, and anyone else around to learn about disease prevention and self care. I was so proud of them! Although I couldn’t understand what they were teaching (it was of course in Kinyrwanda) I could see that they were engaging their listeners, asking good questions, and allowing for an open discussion. After, they were going from bed to bed teaching individual patients about their disease. I guess my own passion for patient-education rubbed off a little, and it was rewarding to see the direct results so eloquently delivered.
So, at the end of the day, I chose to take away a feeling of hope. There are so many frustrating challenges, especially when problems (like healthcare) must be addressed wholistically but there is a lack of collaboration. But I can see that the direction is positive. My students are thinking about these challenges, and they are learning. Patients are receiving care. Rwanda is moving forward. Positive change is positive change, no matter how slow or small.
Tuesday, September 16, 2008
A picture is worth 1000 words
Demonstrating the ECG machine
Dinner under the thatched roof on Lake Kivu
Fishing Boats
Lake Kivu
Friday, September 12, 2008
Rain
The rainy season has started. I'm about to tell you something that will dispell all your current thoughts about Africa (as most of the time we tend to generalize the entire continent). I am wearing jeans and a light sweater in my office, and I am freezing cold. I would kill for a cozy sweater. Seriously.
Tuesday, September 9, 2008
Summary Article
Here is a copy of an article I wrote for the Xtending Hope newsletter. I hope it does a nice job of summarizing my experience thus far.
(NOTE: It has not been edited by Xtending Hope yet... so still all my own ideas and non of theirs)
Rwanda’s nickname, the ‘Land of a Thousand Hills’ is justified by the hills and valleys of Kigali that stretch far into the haze from cooking fires. Unfortunately, it is also known for the 1994 genocide, which, as a result of failures of humanity as a whole, led to the destruction of families, homes, and an entire country. Since then, the country has overcome incredible challenges to rebuild, forgive, and remember, but always move forward towards a future of peace and growth. Through my Coady Youth In Partnership / Xtending Hope placement I am very fortunate to have the opportunity to witness the astounding efforts and determination of this country, and see first-hand the power of forgiveness.
Following the genocide, the health needs of the population were compounded by increasing rates of HIV/AIDS. Reliable statistics are difficult to find, but it is evident that the disease has a profound impact on not only the health care system but the social capacity of the country. Many children have been orphaned by HIV, and child-headed households are not uncommon. Although preventative programs are increasing and ARV medications are more readily available, the truth is that HIV/AIDS causes suffering: suffering to patients, suffering to families, and suffering to the growth and well being of a country desperate to seek a new future. HIV is social disease that still spreads because of the stigma that remains attached to it.
In response to these health care needs, the Kigali Health Institute (KHI) was established in 1996 to increase the number of health care professionals in the country, and conduct scholarly based health research in Rwanda. A large educational institute, KHI is continually developing curriculum so that the health-care available in Rwanda meets international standards. As a new Registered Nurse, I feel very privileged to be in a position to learn about the process of educating health care professionals. My first task was to provide lectures for a nursing course in adult health, one that gave me valuable teaching experience and that I enjoyed thoroughly. I was able to lead a frank and honest discussion about the social stigma surrounding HIV, and provide information to nursing students on how to teach youth safer sex techniques.
The commitment and perseverance of my students with their desire to succeed was inspiring. Each and every one of them wanted to be a nurse to help others, care for others, or contribute to the well being of their country. These admirable goals, I know, will stay with me throughout my own nursing career. As my passion for and interest in education grows, I am increasingly convinced in its ability to enhance capacity, empower people, and ultimately lead to personal development. The sharing of knowledge and ideas has the power to achieve sustainable growth, and, as one student pointed out to me, is of utmost value because it can never be taken away. The education that I am giving, though, barely balances everything that I am learning about Rwanda, culture, others, and myself. It is a thrilling process that I am very grateful to be part of.
(NOTE: It has not been edited by Xtending Hope yet... so still all my own ideas and non of theirs)
Rwanda’s nickname, the ‘Land of a Thousand Hills’ is justified by the hills and valleys of Kigali that stretch far into the haze from cooking fires. Unfortunately, it is also known for the 1994 genocide, which, as a result of failures of humanity as a whole, led to the destruction of families, homes, and an entire country. Since then, the country has overcome incredible challenges to rebuild, forgive, and remember, but always move forward towards a future of peace and growth. Through my Coady Youth In Partnership / Xtending Hope placement I am very fortunate to have the opportunity to witness the astounding efforts and determination of this country, and see first-hand the power of forgiveness.
Following the genocide, the health needs of the population were compounded by increasing rates of HIV/AIDS. Reliable statistics are difficult to find, but it is evident that the disease has a profound impact on not only the health care system but the social capacity of the country. Many children have been orphaned by HIV, and child-headed households are not uncommon. Although preventative programs are increasing and ARV medications are more readily available, the truth is that HIV/AIDS causes suffering: suffering to patients, suffering to families, and suffering to the growth and well being of a country desperate to seek a new future. HIV is social disease that still spreads because of the stigma that remains attached to it.
In response to these health care needs, the Kigali Health Institute (KHI) was established in 1996 to increase the number of health care professionals in the country, and conduct scholarly based health research in Rwanda. A large educational institute, KHI is continually developing curriculum so that the health-care available in Rwanda meets international standards. As a new Registered Nurse, I feel very privileged to be in a position to learn about the process of educating health care professionals. My first task was to provide lectures for a nursing course in adult health, one that gave me valuable teaching experience and that I enjoyed thoroughly. I was able to lead a frank and honest discussion about the social stigma surrounding HIV, and provide information to nursing students on how to teach youth safer sex techniques.
The commitment and perseverance of my students with their desire to succeed was inspiring. Each and every one of them wanted to be a nurse to help others, care for others, or contribute to the well being of their country. These admirable goals, I know, will stay with me throughout my own nursing career. As my passion for and interest in education grows, I am increasingly convinced in its ability to enhance capacity, empower people, and ultimately lead to personal development. The sharing of knowledge and ideas has the power to achieve sustainable growth, and, as one student pointed out to me, is of utmost value because it can never be taken away. The education that I am giving, though, barely balances everything that I am learning about Rwanda, culture, others, and myself. It is a thrilling process that I am very grateful to be part of.
Friday, September 5, 2008
The Real Deal
The longer I am here the more I realize that it is entirely possible to come to Rwanda and never get a true picture of what the country is really like. There is a fair sized ex-pat crowd, north American coffee shops, a large new (and totally overwhelming, but with cheap wine) super-duper market, and plenty of hotels and restaurants just like ones you would find anywhere else in the world. Over the last couple of years the government has done a good job of “cleaning up the streets” so that beggers are few and open stalls no longer line the roads downtown. One boy who sells postcards told me he could go to jail for 6 months during a “street clean up”. I often see tourists in their safari vests (which, by the way, you don’t really need to wear on a safari) touting around town, and I wonder how much they are really learning about Rwanda, whether they really get to know the beauty in the people here, and the every day struggles that they face, let alone a true understanding of the culture and history.
Which is why I moved houses. The KHI guesthouse was lovely and all, but in the same neighborhood as the presidential residence and traditional colonial homes. The road was paved, the electricity worked, and there were plenty of other foreigners around. But I didn’t travel all the way to Rwanda to live like I do at home, and besides, another intern needed a room mate and found a good price for a place in Kicyru.
Our new digs are quite nice, after some challenges with moving in. It’s an apartment that is part of a larger complex which is secure and run by a senator, who is an excellent and responsive landlady. We have running water and electricity, but we pay extra for them so we are being very stingy (cooking by a solar powered lamp and unplugging the fridge make our electricity credit move down a lot slower). I could use a firmer mattress, but it’s nice to have my own space, cook in my PJs, and not have to drag my shampoo in and out of the bathroom. Best of all though, is that it feels more real. As I walk up the dirt road the dust comes up in little clouds that coat my legs as I dodge around the chickens and pot holes. MUZUNGUUUUUUUU choruses follow me wherever I go, and I wonder whether the novelty of 2 white girls in the neighborhood will ever wear off. There are little shops and internet cafes and many saloons (a commonly mis-spelled word for barber shop) just up the street, and people are everywhere. I get to take the bus more often, which is a true adventure best done with elbows up. Music from the church, the voices on the radio, and children’s shouts mix with the smells of cooked food and dust to fill the streets. It feels more authentic, it feels like “Africa”, and I really am way out of my comfort zone. It’s certainly not anything like home. Perfect.
Which is why I moved houses. The KHI guesthouse was lovely and all, but in the same neighborhood as the presidential residence and traditional colonial homes. The road was paved, the electricity worked, and there were plenty of other foreigners around. But I didn’t travel all the way to Rwanda to live like I do at home, and besides, another intern needed a room mate and found a good price for a place in Kicyru.
Our new digs are quite nice, after some challenges with moving in. It’s an apartment that is part of a larger complex which is secure and run by a senator, who is an excellent and responsive landlady. We have running water and electricity, but we pay extra for them so we are being very stingy (cooking by a solar powered lamp and unplugging the fridge make our electricity credit move down a lot slower). I could use a firmer mattress, but it’s nice to have my own space, cook in my PJs, and not have to drag my shampoo in and out of the bathroom. Best of all though, is that it feels more real. As I walk up the dirt road the dust comes up in little clouds that coat my legs as I dodge around the chickens and pot holes. MUZUNGUUUUUUUU choruses follow me wherever I go, and I wonder whether the novelty of 2 white girls in the neighborhood will ever wear off. There are little shops and internet cafes and many saloons (a commonly mis-spelled word for barber shop) just up the street, and people are everywhere. I get to take the bus more often, which is a true adventure best done with elbows up. Music from the church, the voices on the radio, and children’s shouts mix with the smells of cooked food and dust to fill the streets. It feels more authentic, it feels like “Africa”, and I really am way out of my comfort zone. It’s certainly not anything like home. Perfect.
Tuesday, September 2, 2008
Hands On Learning
Friday afternoon was my last lesson. It's hard to believe that the course is already over – the students were not given enough time to digest the material or study as they went. But they were off to clinical practice this week, so there was really no choice. There is a large focus on what the nurse DOES here. In my program, the focus was on theory, assuming that skills could be picked up during employment. One of my professors even said “monkeys can learn how to put in a catheter”. However, here, the students want to practice each element of theory; they want to practice how to take care of a patient with increased intracranial pressure, practice how to assess someone using the Glasgow Coma Scale, and yes, even practice how to teach people to use condoms.
This gave me a lot of anxiety. I was told that it was my responsibility to incorporate the practical part of the course, and that I could book the skills lab upstairs. The procedures here are very intracit, and I read about how finicky they can be while I was editing the english skills guide (over 300 pages of changing jewls into jewelery and intimacy into privacy). I've never even irrigated a real ear myself, let alone used a whole sterile trolley to do it! I thought there was no way I could pull this stunt off. Teaching proper nursing technique, which would be tested later by different instructors, was not something I could fake. The skills lab itself is well equipped with the most random things, including an ECG machine (that they want me to figure out how to use) and all sorts of manequins, but is lacking in basic supplies for the students to use in practice.
Thankfully Yvonne, a clinical instructor here, volunteered to help me out. On Friday afternoon we assembled in the skills lab for the demonstrations, and I was equipped with the “do's and don'ts” articles from my own nursing courses. Yvonne was going to demonstrate assisting with lumbar punctures (complete with the whole sterile tray, none of which was familiar to the disposible ones I'm used to) along with ear irrigation. That left me eye drops, ear drops, and how to teach youth how to use condoms, as part of our case study on HIV/AIDS, specially requested by the students.
And, after all that stress, it went great! I did it! I remembered how to do the skills properly (just like riding a bike?) and included the theory in with the demonstration. The best part of my entire week was putting a condom on a wooden black (of course) penis, much to the amusment of my students. I wasn't showing them how to do it, really, because a lot of them have had a lot of education themselves in school. It was more so about how to be a good teacher when it comes to public education on safer sex, and how you have to be comfortable with sexuality to talk about it. We talked about myths that they have heard (such as two condoms is better than one) and how to answer awkward, culturally or religiously sensitve questions that might come up. It was a frank and honest discussion, followed by sympathy for the penis when it was dropped on the floor.
The course evaluations came in that day, too. Today I entered the responses into a flow sheet for recommendations to the department, mainly about the need for adequate resources and time for the students. I felt fantastic when I read that “the lecturer was kind, intelligent, and a very good teacher. I hope she comes back again”. Knowing that I actually did make a contribution felt wonderful, and such a relief. Best of all, is that I felt like a real teacher. Haha, fooled them!
This gave me a lot of anxiety. I was told that it was my responsibility to incorporate the practical part of the course, and that I could book the skills lab upstairs. The procedures here are very intracit, and I read about how finicky they can be while I was editing the english skills guide (over 300 pages of changing jewls into jewelery and intimacy into privacy). I've never even irrigated a real ear myself, let alone used a whole sterile trolley to do it! I thought there was no way I could pull this stunt off. Teaching proper nursing technique, which would be tested later by different instructors, was not something I could fake. The skills lab itself is well equipped with the most random things, including an ECG machine (that they want me to figure out how to use) and all sorts of manequins, but is lacking in basic supplies for the students to use in practice.
Thankfully Yvonne, a clinical instructor here, volunteered to help me out. On Friday afternoon we assembled in the skills lab for the demonstrations, and I was equipped with the “do's and don'ts” articles from my own nursing courses. Yvonne was going to demonstrate assisting with lumbar punctures (complete with the whole sterile tray, none of which was familiar to the disposible ones I'm used to) along with ear irrigation. That left me eye drops, ear drops, and how to teach youth how to use condoms, as part of our case study on HIV/AIDS, specially requested by the students.
And, after all that stress, it went great! I did it! I remembered how to do the skills properly (just like riding a bike?) and included the theory in with the demonstration. The best part of my entire week was putting a condom on a wooden black (of course) penis, much to the amusment of my students. I wasn't showing them how to do it, really, because a lot of them have had a lot of education themselves in school. It was more so about how to be a good teacher when it comes to public education on safer sex, and how you have to be comfortable with sexuality to talk about it. We talked about myths that they have heard (such as two condoms is better than one) and how to answer awkward, culturally or religiously sensitve questions that might come up. It was a frank and honest discussion, followed by sympathy for the penis when it was dropped on the floor.
The course evaluations came in that day, too. Today I entered the responses into a flow sheet for recommendations to the department, mainly about the need for adequate resources and time for the students. I felt fantastic when I read that “the lecturer was kind, intelligent, and a very good teacher. I hope she comes back again”. Knowing that I actually did make a contribution felt wonderful, and such a relief. Best of all, is that I felt like a real teacher. Haha, fooled them!
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