Reflections on my first fortnight at the University Hospital

I’ve been going to the morning medical meeting 3 days a week for about a fortnight now, have done about 10 gastroscopies and a colonoscopy, and seen at least twenty referrals of difficult patients in the wards. Also the medical interns banded together and approached me about setting up a clinical teaching timetable, so I’ve spent a few hours in the last week teaching them. It’s still very early days, but I feel I’m gradually coming up to speed with how the hospital works.

Firstly, the hospital is desperately short of senior clinical staff. There are only 4 fulltime specialists in the Department of Internal Medicine, and of these, one is Head of Department and Professor at the University, one is Director General of the hospital (like the CEO), and then there’s one other and me. With the teaching and admin load, that effectively means only one specialist is usually available to supervise 100+ medical beds, 10+ junior staff, and 15 medical students, while also working in their subspecialty.

Secondly, the culture is mostly conducive to learning and teaching. Both senior staff and juniors seem highly motivated to teach and learn, gain skills and take care of patients. It’s just that they’re overstretched between competing priorities. In terms of physical resources, the medical school seems well resourced, and the hospital reasonably well so, at least compared with other African hospitals I’ve worked in. The interns approached me with a clear idea of their learning objectives that were not being met, and have worked hard with me in 2 hour plus stretches perfecting their neurological examination techniques.

Thirdly, the case complexity of the patients we see is often quite high. Many patients have been seen at District Hospitals prior to referral, and thus only the more difficult cases tend to reach CHUB. For example, I spent an hour today working out a treatment regime for a man presenting with HIV, active tuberculosis, and renal failure from his HIV. Treating any 2 of these is complex because of drug interactions, treating all 3 together with only limited drug options was a nightmare. Eventually we found a regime (efavirenz, abacavir, low dose lamivudine, rifampicin, low dose pyrazinamide, isoniazid, low dose ethambutol and pyridoxine for you medicos who care ) that might be effective we hope… So far in the ward I’ve seen Miller Fisher variant Guillain Barre syndrome, strokes, hepatomas, acute leukaemia, unexplained pancytopenia with PUO, haematemesis complicating dysentery, gastric carcinoma, a child with a pancreatic cyst, as well as the usual HIV, chronic liver disease, TB and heart failure cases. Of the gastroscopies I’ve done, at least two thirds have had major pathology (maybe 10% might in Australia) – duodenal ulcers, tumours, gastric outlet obstruction. As I was leaving at 6pm tonight I was asked to see a 21 year old girl with severe acute heart failure, sepsis, multiple joint arthritis and a rigid abdomen. Patients here can be VERY sick.

In conclusion, it really seems that God has provided an opportunity for me to work, learn and teach in an challenging but exciting environment. There’s much suffering and sadness here, but also much stoicism, hope and desire to improve how people are cared for. I met with the Dean of the Medical School today, Patrick, who is passionate about developing the skills of the next generation of student doctors and I’m beginning to share his passion. Today was frenetic; a 7.30 medical meeting, troubleshooting ward round of 4 medical wards, five gastroscopies, a quick trip to the District Office to work on paperwork for our (refused) visas, home for a 10 minute lunch then a 90 minute Kinyarwanda lesson with Catherine, back to take a 2 hour neurology tute and spend an extra hour with two difficult clinical problems and finally home just before 7pm, but overall it felt worthwhile. I’m currently typing in the dark near 2 sleeping children and a facebooking wife, exhausted but quietly content.

If we’re going to stay, however, sooner or later we’ll need a visa. Ours expired 5 days ago and our paperwork has been rejected 3 times so far, so we’re technically illegal in the country at the moment. Our certified copies of police checks, birth certificates and marriage certificate have all been rejected as inadequate, so we may have to courier the originals from Australia, at some cost and risk of loss. Also our moving into a (Diocese or hospital) house seems further away than ever, so we’re just psychologically settling in the Guesthouse, until something changes. Your prayers are appreciated!

William’s First Blog Post (dictated by William)

Today we went to French School. Down a little dirt path there’s something for cows to live in – a house. When we went into the classroom the children were eating snacks.The teacher gave me a chair and a book. I liked it. I want to go back.

 

CATHERINE’S EDITION:

I have not noticed any houses for cows anywhere, but other than that Will’s post is quite accurate. The first school we went to was English speaking, but won’t accept children until they turn three. The French speaking International School was set up by colonialists long ago, and has a French-born headmistress who has been in Rwanda for seven years. Will was pleased to spot swings and a soccer field in the midst of the classrooms, and I was pleased to spot a library.

The teacher of the youngest class (fifteen two-year-olds) speaks to them gently in French. Unlike the headmistress she does not understand English but the notices seem to be written in both languages, thankfully. Otherwise we’d be relying on Google Translator often! William was apprehensive about staying in the class without my presence, but I talked to him about it on our journey home and he quickly decided that he wanted to go to school. Now. I said he had to wait until after breakfast tomorrow, so he promptly asked me to serve him breakfast now. Always the problem solver. When Andrew questioned him about school later, saying, “I think you will cry for your Mum when you are there,” William replied confidently, “The teacher will look after me”. I was quite proud of him.

William excitedly helped me shop for the school stationery he needs; watercolour kids’ paint pallete, coloured pencils, textas, sharpener, grey lead and scissors. We planned his snack food together, and he packed his bag with a permanent smile. He even (I’m most amazed) caught a motorbike taxi home from town with me. He sat squeezed between the driver and myself, his head locked firmly facing the left, with Hannah on my back. Motorbikes are by far the cheapest transport option (300 francs compared to 2000 for a car taxi the same distance– 580 francs is AU$1) but Will’s been too scared before to mount one. It will make taking him to school and home far easier I think because even the four wheel drive seemed to struggle with the dirt roads leading there, while I hope a motorbike will be able to stick to the better parts of the road. We will see. Esperanse (the cleaner) has a brother who drives a motorbike taxi. He will drive us each morning this week; a trial week at school. I wonder what emotional state I will find William in when I pick him up at 12.45 tomorrow afternoon? It’s quite a long day for little ones, beginning at 7.45am. The same length as for the older kids. Picking them up early is discouraged, so if he doesn’t like staying that long he won’t be attending school just yet after all.

One excited little boy is falling asleep beside me in his cot. Yes, cot…and he will wake in it and then head off to school!

(P.S. Anyone else think it would be fun to tour France with a three-year-old as your translator?)

Will’s Comic Relief

Hannah has had a temperature for about a week, and her tooth still hasn’t surfaced. Yesterday morning it was high enough to make her a lethargic lump (after some paracetamol she smiled again). But I am very happy to report that last night she slept through, and we all got a good night’s rest. Meanwhile she is such a little girl. She spent quite some time blowing kisses at a group of young men on motorbikes and then moments later wouldn’t say goodbye to the Bishop’s wife. We are also quite amazed to hear some Kinyarwanda coming out of her mouth. “Bitte,” she greets people.

Will is at a delightful stage where he unintentionally provides great comic relief…

Will and I were cooking in the kitchen. Me, “We’ll have to go back to our room to get some matches.” Will, “We’ll need a truck.” Me, “Why do we need a truck?” Will, “A matches is on a bed. They’re big and heavy.”

Will had just done number twos on the toilet, and I was helping him afterwards. “Mamma,” he said quite innocently, “my bottom was talking French!”

Today, Tim is off to the hospital. Hopefully, the kids and I will visit some Nursery Schools (Kindergartens). Will is quite excited. We are also beginning more formal study with a language helper this afternoon.

The Swing

Yesterday my emotions swung hard and fast. We woke feeling relatively at home and set out in the morning to make a tyre swing for the children. Will has been asking to go to a playground, so it seemed like a good time to begin making one. I had noticed a corner of the market where a handful of men cut up huge tyres to make thongs and other items, and when we approached them it took several minutes with our dictionary and big hand movements to explain what we were after. One of the men somehow understood us, and went to find a smaller tyre that would suit the purpose. When he returned he spent quite some time cutting along our pen-drawn lines with sweat beading on his forehead, occasionally telling the large crowd of young men looking on to go away and let him work in peace. It was quite amusing at the end to see five grown men, including Tim, working together to turn the thing inside out.

The maker got a good wage and carried the tyre swing home for us, with some suitable pride I must say, explaining as we walked that he had two young children himself and another on the way. We thanked him gladly when he turned back towards the market at our gate, then began to scrub the swing clean in a shaded spot on the lawn. While we were at the task, the man returned with another in tow. The second handed me my mobile phone. I thanked him gladly and he waited, expecting a reward. As I walked inside to get one I noticed a text message, and opened it. “2000 francs have been transferred from this phone to the following number 078432.” I rang it, and behold, the man’s phone began to ring. Cross at the theft, I told him sternly that he had his reward and goodbye. He stayed. In fast Kinyarwanda I guessed him to be saying he expected more. Andrew returned from town and began to help, a local pastor became involved, and after quite some heated conversation I can sum up what had happened.

While at the market talking about prices, we had used my phone (as usual when we have trouble understanding) by asking someone to type the numbers in. Shop keepers have often used their own phones to do this for us. The man (not the maker of the swing but another in the crowd who sells mattresses) took the offered phone and typed. At the end of all the ta-do of tyre-making I forgot to make sure he had given it back, and so he quietly kept it. Then he turned up at our gate and pretended he had got it from another person who had ‘stolen it’, presenting himself as the hero. I noticed the text about transferred money, and on calling the receiving number heard his phone ring. His phone has two sim cards, and as the argument commenced he quietly removed the one he had transferred the money to (although Tim saw it done) and then tried to say it had not been transferred to his phone but to ‘the man who had stolen it’. By the end everyone was telling him off, including the maker of the swing, and he left in a huff.

2000 francs is not a lot of money ($4), but after all his deception and dishonesty I felt quite betrayed. Previously I had felt quite safe and able to trust the people I met. I needed to go back to the market to get some vegetables but felt too cross and hurt to return to the place where it had happened. After a few hours I regained perspective, remembering that we have met countless honest and caring people since our arrival, even at the market where locals warned us to be careful, and this was the very first who had betrayed my trust. Back at the market, I walked past the tyre section and was greeted with smiles (I am sure they had been told the whole story and was relieved to see friendly faces).

For the first time I was at the market with a local, Jane, and discovered that her capable presence made mine unnecessary. It is actually more fun muddling along on our own, trying to make ourselves understood. I am glad we have gone alone from the beginning, or I would have felt quite daunted by the idea if this had been our first experience!

At home again, the children had a wonderful time on their new tyre swing. They beamed from ear to ear and did not want to get off. They have made a constant beeline for it. Will is even consciously using it to make himself feel better when sad (he spoke to his best friend Amelia in the morning on Skype and was feeling very far away from her after saying goodbye). “The swing makes me feel better,” he explained after asking to be pushed yet again.

Pics From Here and There

Three of the staff here at Shalom Guest House: Frederick, Esperanse and Jane. Esperanse and Jane have very kindly been doing our washing since we arrived, which after asking Andrew I have learnt is not actually part of their job. So we are now employing them to do the washing and also in the afternoon for one of them to watch the kids for an hour while the other acts as our Kinyarwanda language helper. They are already teaching us outside of language helper hour! They have asked me to teach them some English as well.


Tim is very excited to have his first ever office! The bookshelves, I’m sure, will not remain bare.


The sign at the entrance of the hospital. Tim is looking towards the hospital itself, the building the to left of the sign in the blood bank. To the right is the dirt road that leads into the centre of town, where there are numerous shops and a market.


 This is the very back of the hospital. The view from here is spectacular.


And here (at the back of the hospital) begins the dirt road with houses along both sides, one of which will be ours one day! Our house is at the other end, right next door to the army barracks. Should be safe!


On seeing this puddle the day before I took the photo (when it was more wet), Will exclaimed excitedly, “Look Mum! A chocolate puddle!”.


An excited Skype video call to the children’s Oma (grandmother).

Other points of interest:

• Hannah, at 11 months, has started calling her father Tim. She is also enunciating William beautifully all of a sudden. She is still not 100% but slept last night (resettling herself a few times) and coped today without pain relief.
• William is seeming quite grown up, and has decided he's too old for The Hungry Caterpillar book (he'll listen happily while it's being read to Hannah). He's still sorting out his opposites so at the moment he says young instead of old, and long instead of short.Quite amusing at times!
• A cold front came in while I was at the market with Hannah on my back yesterday. The locals donned heavy jumpers. I was quite comfortable in a summer skirt and t-shirt whilst walking, but I must have had 100 people tell me in exuberant, highly concerned Kinyarwanda that Hannah was cold and needed her legs and arms covered. Today was quite warm and when it rained there were warm puddles outside our room. I stripped the kids off and let them play in them. They had a great time and a small crowd but again I discovered this was not warm by local standards. When I suggested it was cold in Holland today, at -4'C, I got a high five!
•  We think the Visas are nearly sorted. The trip to Kigali yesterday was fruitless but today the hospital director of administration went alone and we think (he speaks French and we have trouble communicating, particularly on the phone) that the applications were accepted today. Excellent! Thankyou for your prayers in this. Our entry visas expired yesterday.
•  Tim met our future neighbour at the hospital; a very lovely radiologist who shook Tim’s hand six times, is a grandfather and has already promised to bring his young grandchildren (8,6,4,2 y.o.) to play with our kids.
• I have become friends with a waitress at the supermarket cafe. She is a single Mum with a 3 y.o. boy. They will come to visit us on Sunday! She has been very thoughtful, including helping us to look for a house last week.

Rimwe Na Rimwe (Little By Little)

Hannah has been unwell for several days. We think the culprit is her first molar; that little tooth is causing a lot of pain, fever and possibly even her diarrhoea. Although Will has had the latter too. I’m very impressed that he has remained toilet trained even with an emotional transition to Africa and diarrhoea, a real answer to prayer! In fact, he and Hannah seem to be adjusting beautifully and are quite happy. They love the outdoors, for which the weather here is perfect, and they love people; finding Rwandans very friendly, especially towards children, has made them smile many times. They miss their family and friends from home, and are extremely excited to talk to them on Skype; a technology which we are grateful for.

Thankyou to all who have been praying about our housing situation. Before we arrived the hospital had agreed to provide somewhere to live and is in the midst of organising it. The latest is that the hospital’s Tender Board will ask various places to offer housing at their best price before deciding on a house for us to live in for the short term, while they fix up a house the hospital owns for us to live in for the long term. We imagine both these processes will take quite some time. We are not yet clear on how it will all work out, but are very thankful for a lovely place with lovely people to remain in while we wait, provided by the diocese guest house and paid for by the hospital. There are very big cultural differences in how the housing situation is being approached, and so we feel quite unable to decipher how it is really going. We are needing to continue trusting God and placing it in His hands. A good lesson.

Tim has gone to Kigali today to try and sort out the visas again. We will see what comes of it. It helped to know better what to expect when we were told the car would pick him up 7am, after our experience of waiting last week. We had breakfast at 7.30am and started to look at our watches at 9. At 12pm, when we were down the road having a nice relaxed juice, the car arrived. We are used to being late for everything in Australia, but it seems here we will have to work hard at it to cause much notice. Some things do seem to start on time; church and the hospital meetings for instance. So we will still have to practice some time-management and it is possible, I suppose, that we will have some punctuality left when we return to Australia. For the moment though, I’m taking great pleasure in finding myself on the other end of the time-management scale: all of a sudden I appear to be quite excellent at it! Let’s not compare where I sit on the relational scale here though. A little more adjustment needed first I think. What do you prioritise? People or tasks?

xx Catherine

Today

Today, William woke and began to use a new name for me; Mamma, with a French/Rwandan accent so the ‘a’ sounds more like an ‘o’. He has consistently used this name for me all day. Each time it leaves his mouth I pause for a moment as reality hits me; I am beginning to have a multi-lingual child who will correct me, be embarrassed by me in whole new ways and pick it all up naturally as I struggle to learn each word and cultural norm. I am excited for him, glad and relieved to see him adjusting so quickly, and also feel a little daunted.

Our second Sunday at the 8am English service took us by surprise, being even better than last week! Again there was an excellent message from the Bible, but with the addition of a wonderful choir (which I’ve been invited to join) who blitzed some Australian Hillsong songs we know well, ending with a moving, harmonised rendition of Amazing Grace. There were more people in attendance, including…drum roll…some other children! They happily sat in the centre aisle with ours sharing the colouring in and puzzle we had brought. Hannah discovered that short cropped African hair feels nice and kept rubbing a patient boy’s head while he solved the puzzle.

After church we came home (a short 50 metres down the driveway) as Andrew left for the Kinyarwanda service. “An hour?” he questioned, “M-m-m. I think it must go quickly through every part! You must come to the Kinyarwanda service!” Yes, we really should. Three hours would give much more time to each part, and it would help our Kinyarwanda. But at the moment, I am secretly quite glad the bishop suggested we attend the English service. It is wonderful! We are learning about God, can see ways we can contribute to the community, and are already building relationships in it. It is kind of amusing that we would attend the Kinyarwanda service for language study, and our service is full of Rwandans who attend it to improve their English! For the moment we are in the right place.

Shortly after Andrew left, he returned…with half a dozen kids in tow to play football (soccer) and frisbee with Will. They had a great time in the back garden! It began to rain but the kids kept playing, and as the rain thickened I was glad they were summoned back to church to keep them somewhat dry. Before long some of them were back, and played for a bit in the rain until we put an episode of playschool on. When Andrew came home they got in trouble; they had snuck out of Sunday School to come back!


Play School kept the kids out of the rain for a while.

After sleep time the kids and I went for a walk into town. It was a bit cold after the rain so for the first time I put on some jeans instead of a mid-length skirt. Traditionally in Rwanda women wear skirts and the thigh is more provocative than the chest. It was still so when we were here seven years ago. But I had noticed quite a few Rwandan women in Butare and Kigali wearing jeans and trousers, so thought it would be OK. As soon as I walked out the gate the men across the road (who know my name because we have shopped there) reacted. Hmmm, it was quite strange to be in jeans and feel like I was wearing a sexy, revealing top! It’s not really the look I was going for, I was just looking forward to wearing my familiar old every-day clothes from home. But they won’t feel the same to wear here and I think I’ll put them back in the cupboard for now.
In town, the kids and I sat down to a nice bowl of chips in a cafe, inside one of the little supermarkets where we shop. I made a discovery; requesting ‘lemonade’ produces an extremely tart homemade lemon drink (even after adding sugar I couldn’t finish it) so I must remember to ask for ‘sprite’. I made another discovery; it is much easier when two-year-olds do their number twos in the toilet at home.

“I’ve done a poo!” he urgently called out at the table. His wording never ceases to send my stress levels up. “You need to do a poo?” I replied, “quick, let’s go!”. I quickly put Hannah in the carrier and on my back without taking time to tie her in, grasped Will’s hand, and rushed through the turnstile into the supermarket and down to the back of the shop. The toilet is very dirty, smelly, has no seat to sit on or water for flushing. And it was engaged. Will stood beside me ‘dancing’. As soon as it was free, we rushed in. With Hannah on my back I lifted Will and held him over the toilet hoping the added height would not make a bigger splash that could get on him and me. There was already someone else’s poo in the toilet and wee on the floor I was trying not to step in. Try as he might, it wasn’t coming. Hannah was complaining and starting to climb out on my back. After a bit I put Will down, took Hannah off my back and handed her to a shop assistant. I turned to see Will’s shorts around his feet…in the wee. Desperate, I asked, “Will, can I put a nappy on you? You can do it in a nappy.” “No Mamma, I want to wear undies.” “Can you hold on until we get home?” I asked. “Yes,” he replied as he danced on the spot. He was not going to be able to walk 500 metres home dancing like that. “Let’s try one more time,” I decided. This time there was success. Then I had to try to clean him while stopping him from touching walls or floor as he bent over, with limited success. Finally, I got out four nappy wipes to wash our hands due to the lack of running water, despite their expense, then collected Hannah from a happily engaged group of shop attendants on the way back to our table. I handed Will a fork, which I was very grateful he accepted to eat the rest of his chips. A couple of minutes later I was disturbed to see him holding the head of it in his hands before stabbing another chip and putting it in his mouth. I told myself I would just have to get over it.

On the pleasant walk home, we passed the furniture shop where we had put in an order. Three days later it was ready! A high chair for Hannah. The men in the shop had never heard of one but I drew some pictures and we guesstimated some measurements with their tape measure, and three days later it was done! Meal times will be much cleaner now! It was $50 well spent I hope.


The kids eating dinner, Hannah in her new high chair!

After a dinner of bread, jam and little bananas the kids went to bed. I started this post. And now after some moaning and groaning in her sleep Hannah is awake with a fever. It's probably all that dirt she keeps eating. She’s quite perky after a drink and some panadol, so let’s hope for a good night…

She’s fallen asleep hugging me in bed. Time to lift our mosquito net and place her in the cot under her own.

Goodnight everyone.

Urogendo Ruhire! (Have a safe journey!)

Currently it’s 10.30am on Sunday morning and the rain is bucketing down outside. Hannah is asleep in her cot/tent on the floor beside me, and Will and Catherine have gone across to the kitchen at the guesthouse to sterilise and assemble our brand new water filter, so it seems like a good time to update you on Project Walkabout.

Hannah makes another new friend

We’ve had a busy few days, the highlight of which has been a trip to Kigali, the Rwandan capital, a 2 hour drive away. I spent Thursday at the hospital, attending the morning medical round and preparing paperwork for our visas and my medical registration. A hospital vehicle was assigned to us for the trip on Friday morning: departure time 7am. Catherine meanwhile visited the house where we will live to find beds made, the house tidy, and the garden being worked on. God’s people at the Diocese are looking after us! Unfortunately the hospital has not yet signed the contract with the Diocese, so we’re still in the guesthouse until they do.

We awoke 6am Friday, breakfasted early as pre-arranged, and assembled to await the driver. 3 telephone calls and 2 1/2 hours later he arrived; we made a 9.30am departure for a 2 hour trip to the Immigration Department and Medical Council, both of which were scheduled to shut at 12. It seemed unlikely we could get either task done, but we needed to shop for our house anyway, so off we went at breakneck speed, the children restrained in car seats for the first time since we arrived, and an extended Kinyarwanda lesson thrown in by the driver gratis.

The immigration office was packed, so we took a number and sat down to wait. 12 o’clock came and went, but the office stayed open. Eventually the staff took pity on our children, and, after checking with those still waiting, graciously served us ahead of our turn at 1pm. We thought we nearly had our visas … until we discovered one or two details were incorrect: we needed 4 visa application forms, not one; each visa cost $100, not $20 total; the letter of application from the hospital was insufficient as it only mentioned Tim; my notarised Police Check was unacceptable and we needed the original, currently in Australia; and we needed birth and marriage certificates to prove the relationships within our family. We had brought all eight things mentioned on the website, but as was politely explained, five were wrong or insufficient! Back to the drawing board…

The hospital driver arrived back from another errand and we forlornly decided to drop by the Medical Board, before meeting an old friend of ours, Dr Manzi from Gahini, now national advisor on new initiatives to the Ministry of Health, for lunch at “1pm”. Manzi kindly called ahead for us, and the secretary at the Medical Council kept the office open until we arrived. This time the paperwork was correct, only the payment was wrong, and this could be easily topped up at our local bank branch.

The day continued to get better. Manzi arrived with his 3 1/2 year old daughter, Ophrah, and she and Will became fast friends. Ophrah speaks English and Kinyarwanda fluently, and English is her preferred medium at home, which worked nicely for Will. Manzi took us to his lovely house, in a newly developed suburb at Kicukiro, overlooking Kigali. Two years ago this area was all bush, but Kigali is growing quickly and now the hill is mostly residential. The kids had a great time playing outdoors, and we sat down to a much appreciated late lunch. Talk revolved around the friends we had known from Gahini days, children, and what each family had been up to in the intervening 8 years. The boys talked shop for a while, with Manzi’s extensive insights into Butare Hospital, the wider Rwandan medical system  and its culture being most helpful to this newly arrived novice.

Hannah and Ophrah, at Manzi’s house

Manzi’s wife, Aimee, 8 months pregnant, was chairing a meeting for the day and did not arrive home until late. In the interim, Manzi took us into Kigali shopping for household essentials: bed and bath linen, kitchen equipment and a water filter being the priorities. Manzi kindly invited us to stay the night, so, after making a rendezvous with the hospital driver to ferry our new purchases home, we returned to his house and were reunited with Aimee, who had accompanied Catherine on our only previous soiree to Butare, in 2003. It was great for our morale to be the beneficiaries of the Manzi household’s kindness, hospitality, and cultural insights as well as to be reunited with old friends.

Manzi’s household helps illustrate the differences between Australian and Rwandan families. As well as his wife Aimee and daughter Ophrah, Aimee’s little sister Liz and Manzi’s little brother Bill also live with them, helping around the house and studying at university nearby. Two other house workers, a young man and woman, also live and work with them, receiving food and board as well as a good wage which they send home each month to assist  their parent’s families. Cooking, cleaning and washing (by hand) are all shared between these four, leaving Manzi and Aimee free to work long hours in their careers. Ophrah, at 3 1/2, attends Nursery School all day, being about to enter Nursery 3 (the school system here consists of Nursery 1-3, Primary 1-6 and Secondary 1-6, with Primary and some of Secondary being at least theoretically compulsory.) 

Will and Ophrah shared a bed for the night, with Liz kindly giving her spot to Will and sleeping on the floor beside them. Will announced his intention to marry Ophrah, after being informed that Daddy, his first choice, was not a suitable nuptial partner as he needed to chose a girl!

The next day, the kids had a ball and we relaxed, before a leisurely lunch with Alex, Manzi’s brother, who lives nearby and is financial controller for the World Bank in Rwanda, and his kids. Eventually we had to go, and after a detour to Nakumatt (a huge Western-style 24 hour supermarket) to complete our shopping, we caught the Volcano Express bus home to Butare, along windy roads through a rainstorm. The kids slept alternately on the way home, and our Rwandan neighbours in the bus took turns variously helping entertain the kids, cuddling them while they slept and generally being incredibly useful to and tolerant of us all. We arrived home at dusk to find our new purchases safely stowed, but still no word on when the hospital and diocese would reach agreement on our (temporary) new house. We all slept like logs for nine hours last night!

Hannah’s favourite pastime at the moment, when left unsupervised, is eating dirt. She makes a beeline for the door and is off into the garden bed to ingest as much good, nutritious African mud as possible. Impressive gritty diarrhoea has been the result. If perchance the door outside is shut, she heads for the bathroom, and contents herself with splashing in any water she can find. She’s walking more and more, taking up to 15 steps at a time, though still reverting to crawling for speed and stealth.

 

Hannah caught heading for the dirt

Will was found yesterday, soon after arriving home, with a gluestick in one hand, and his muddy sandals in the other. When I inquired what he was doing, and what the sticky mess on his left shoe sole was,  he explained, “I’m going to stick my shoes on the wall.” At least they needed washing anyway…

Will playing soccer with Alex’s sons

 

For those of you praying for us, thankyou! I thought I might update our prayer points now too, given things are changing fast.

Give thanks for God’s provision:

of a house;

of new friends for Will and Hannah;

and of the English language congregation at Butare Cathedral which has made us feel so welcome.

Please pray:

for the visa process, that it will go smoothly and the required documents will arrive;

for good and productive communication with the hospital administration, to enable us to move into our house soon;

for the many people in material need here, and that we might know how best to respond.

Please feel free to email us or comment on the blog – we love hearing from you all!

A busy morning

We’ve had an eventful start to our Tuesday. In fact I’d been on 3 separate expeditions by 12pm, and well needed the siesta time we often have in the early afternoon, after a fine lunch of sambusa (African-style samosas).

View from the Shalom Guest House

As kids actually slept to almost 6am for the first time since our arrival, it then was a mad rush to get me presentable and be out the door by 7.15am to attend the hospital morning medical meeting. About 30 of us, all white-coated (except for me), gathered in a meeting room at the back of the hospital compound to discuss the medical admissions of interest or difficulty in the ward. Dr Andre, the Hospital Director General, and Professor Joshua, the Head of Internal Medicine, presided over the case discussions, which encouragingly were conducted entirely in English. The medical students presented the cases, to a high standard I must say, and the junior doctor staff filled in any clinical gaps. It was nice to have my first real clinical input to these discussions, and the Professor seemed most welcoming and keen to have a gastroenterologist added to the team. I think I’ll try to get along to this meeting several times a week as a sort of “orientation” to the hospital.

After the meeting, I briefly met Francois, the sole part-time visiting gastroenterologist, who apparently is mostly very busy elsewhere. He’s on leave for February, so I will not get a chance to discuss what he has set up at the hospital until next month. The Director General seems keen though to significantly build the gastroenterology department, and wants me to begin training some of the junior doctors in endoscopy. Having yesterday met Charles, the University Vice-Dean of Medicine, who is keen for me to teach clinical examination skills, GI therapeutics and also tutor students in the wards, I don’t think I’ll be short of work after our language learning phase ends!

Dr Andre and I then discussed the housing situation. Thanks to the many of you who have been praying about this. The hospital house we are eventually to move into is undergoing renovations at the moment, and, while these will ultimately make it far more pleasant to live in, with sealed floors and a third bedroom for guests, this process is likely to take a couple of months. In the interim, Bishop Nathan has kindly offered us an empty diocesan house, and the hospital has agreed to provide a stove and refrigerator. There is some basic furniture, but we will need linen, crockery, cookware and so on, so I suspect a busy week is ahead of us…

Inzoze Nziza

After returning home, the whole family came with me to Inzoze Nziza, a local non-for-profit cafe run by a women’s cooperative, which was great and relaxing. Wonderful fruit salad, yummy cookies, ice-cream for Will and Hannah, and the chance to take stock of our first week here. Oh yes, and grab a quick happy snap of our resident blue-tongued lizard, who managed to rapidly find and consume some chalk:

We’re gradually getting over jetlag and acclimatising to the altitude (1750m), have made some good friends, acquired our first 50 words of so of Kinyarwanda, and begun bonds with the Diocese, University and Hospital. Will has walked 3-5km a day, balancing on the side of culverts and reluctantly holding our hand along busy roadsides, mostly without complaint, Hannah is taking her first unaided steps and remains as irrepressible as ever, and both our kids seem to be rapidly settling into African life, food and activities. God has been very faithful to us.

Finally we made a foray into the heart of town to fit our postbox with its shiny new padlock, and to begin pricing some of the household essentials we will need once we relocate to the diocese’s house. Many may be cheaper in Kigali, but it’s useful to know the local price for comparison purposes before you start!

For those of you looking to skype us, faster internet may be just around the corner. Both the hospital and the university are soon to be connected to the new fibre-optic network which is allegedly almost finished, and the red signs warning of buried cable in English, Korean and Kinyarwanda that run right along the roadside through town seem to verify this:

Thanks again for all your prayers, and messages of support. We feel very loved and cared for!

Searching through the rain. a capella Amazing Grace and a few musings

We’ve been in Rwanda 5 days now, and I thought that as it’s 9.30am on a Sunday and we’ve already been to church and Catherine has the kids entertained with a game, it might be a good chance for a bit of an update.

The long rains are underway here, and the last few afternoons it’s bucketed down, in the way it only can in the tropics (and Eastern Australia it seems!) We have a great view from the upstairs balcony in the guest house down one of the valleys surrounding Butare and watched one of the storms begin.  Great sheets of rain roll in, visibility drops to almost zero, lightning tears the sky, thunder echoes through the valleys, and the deep drainage ditches along the roadsides stream with water. William does NOT like thunder, but the rest of us rather enjoyed the show.This morning it was almost cold, and we all wore jumpers to church (maybe more to combat African concerns of our children developing sore flanks from the cold than from any real need).

In the midst of this storm, the appropriately named Aimable, a local businessman, arrived in his car to take us to show us the apartments he rents out. Catherine reluctantly succumbed to the children’s urgent desire for 5pm feeding, and I was left to venture out alone in my waterproofs. His apartments are at the opposite end of the town, near the Museum, and thus a bit of a trek from the University, Hospital and town centre. After solicitously escorting me round, we sat at the kitchen table, and got down to business. Out came the pen and paper, his manner changed, and we were debating rents and dates, utilities and gas bottles. My reluctance to commit to a rental before seeing what the hospital had found worked in our favour, and the price promptly dropped 20%. I was driven home with a promise to call on Monday after viewing the alternatives. We rang Zafa, the coffee shop waitress who had introduced us, to thank her for her help and to reassure her that all had gone well, before a dinner of pasta with capsicum and tomato which the kids inhaled as if they’d just run a 100 metre race, and a “late” 8pm lights out.

This morning we attended the English language Anglican service 20 metres away at the Cathedral at 8am. We were the only white faces, and had the only children present, which meant we had no reference frame for the acceptability of the kids’ intermittently exuberant behaviour. About 30 Africans, mostly students but also John, a paediatrician at CHUB, and several other older folk, worshipped following a traditional prayerbook service. Great classic hymns were sung, mostly a capella due to the PA being mostly non-functional for reasons unclear.

I was particularly moved by the opening processional rendition of Amazing Grace, and it stuck me what a powerful account of the transforming and uniting power of God’s grace was given by these word s, written by a reformed slave trader who had trafficked in African lives, and sung here, in the interior of Africa, by his African Christian brothers and sisters. The sermon ranged across Jeremiah 30 and Acts 6, from God’s care for his refugee people, through the appointing of deacons to serve the poor, and finally challenging us to be as suitable as those who were chosen: “filled with the Spirit and with wisdom.” We both felt very ministered to by all present. We were given the opportunity to stand as a family and introduce ourselves at the end of the service, and the worship leader even took charge of our children during the sermon to enable us to listen!

I feel I am beginning to reach even keel from the initial splash of landing. I’m under no illusion that our journey here has really even started, but as the jetlag fades and the basic pieces of life here begin to take shape, our perspective on the world is already changing. We have taken less than 10% of what we had in Australia, yet  we have maybe 50x as much as most people here. The sum the Australian government will pay me for a day’s work in Australia is an unimaginable one to most Rwandans, far more than they will ever see in their life. The injustice of this is striking and compelling; how to best respond is less clear. We pray that God will keep our eyes open to these contrasts over the coming months and years, even as we build relationships, and acquire the cultural understanding and wisdom we need, to chart our course here.

 

Our first ever Post Box!

Following pleasant walk to a amazingly-open-an-a-Saturday Post Office, we now have a Post Box! It's right at Will's head height and thus he can see right into the post office so he's already pleased with it. We don't have a padlock yet, but will do long before any mail to us can arrive!

Our new postal address is:
Tim and Catherine Walker
B.P. 663
Butare
Rwanda

Now off to the shops to buy shiny new padlock....

Culture shock, with textas too.

It is exciting being here, and we have been thankful for many friendly exchanges, yummy food, beautiful scenery and perfect weather. At the same time, we feel quite stressed and at times overwhelmed by everything being so different. We don’t know how to talk to people (even when they speak English we often miss communicate because the culture is so different – “Oh, Andrew is going to lend me the scissors I asked about and here they are brought by the cleaner; I thought by his response they must be at his home far away”), we don’t know what to expect (Do you help yourself in the bakery section or does someone serve you? We are welcome to use the kitchen to cook dinner so is Andrew in here cooking us breakfast or waiting for us to cook our own? Should we ask or wait and see? The ladies here are helping me do our washing; is that part of their job or should we pay them extra? Should we give them a tip even if it is part of their job especially because they’re washing Hannah’s nappies? They’ve used the wrong detergent on the nappies, how should I explain this without offending or seeming ungrateful? This man is asking us for money for bread even though he works as a church gardener, should we give him money or some of our bread or a job or nothing?). Constantly not knowing how to behave is stressful and we’re looking forward to every day tasks and exchanges feeling easy and normal. It will take time.

Yesterday afternoon while Hannah slept I sat with Will on the luscious back lawn. We were colouring in an activity book with his textas and pencils. One of the two cleaner ladies, Jane, came to watch intently. After a little while I offered her some textas and gestured to invite her to join us. She thanked me for the textas and walked away with a happy smile. Hmmm, that had not gone how I intended. Oh well, at least she was happy, Will didn’t seem to have noticed half his textas were gone and maybe her children would enjoy them. I noticed her showing them to those in a small staff meeting she had wandered from. The other cleaning lady came to hover and watch intently. I knew she was hopeful for some textas too but couldn’t give away all Will’s textas without asking him. After a while she left. When we were packing up I asked Will if he would like to give his textas to the lady, because she doesn’t have any, and that we would buy him some more one day soon. His reply, “Why doesn’t she have any textas?. I want to give her the new ones and keep these.” A few minutes later I raised it again, reassuring him that it was his choice but we would buy him some more if he wanted to give them to the lady. He said yes he did want to, and I placed them in his hand. When we found her, she was sitting quietly alone reading her bible. When Will held out his textas to her her whole face lit up with excitement as she thanked him. Will looked at the ground not knowing what to do. When we returned to our room I told him I was very proud of him.

I was feeling very good about coping with all the unknowns yesterday, until Tim got home and said that our house would not be ready for two months. Where will we live? Suddenly the whole day seemed terrible, and it was clear that I was quite close to not coping after all. William noticed I was feeling down. He came over with his drink bottle and said, “Here you are Mummy, I brought you a drink to make you better. A drink makes me feel happy.” That drink helped a lot.

Freefall in Rwanda

No, the above title does not apply to our moods, hopes or prospects. Or at least, not yet. It refers back to my feeling of the process of leaving Australia and our loved ones behind, which felt analogous to standing on an elevator, sawing through the cable a strand at a time. Except that sawing through each bond holding us to Australia was a source of mutual reciprocal pain to us and our loved ones. Until finally the cable snapped and we began the plunge into a new life in a new culture far away.

We arrived safely in Rwanda after a (relatively) painless 34 hour trip door to door. Indeed William got off the first 10 hour plane ride (for him: meal, 6 hours sleep, meal) and asked if we could go on another one … or six!!!  He did get somewhat less enthusiastic subsequently in the trip, of course…

About 33 hours away from Australia, two thirds of the way down the road to Butare, Catherine and I were both struck by what a foolish errand we would have been on, if we were purely doing this for selfish reasons or grand ideals. How fortunate then, that we felt God’s call so clearly to come to this place. His strength and our weakness have been reinforced at almost every turn.

The Diocesan Guest House is a beautiful and truly welcoming place, with staff who’ve taken great care of us, particularly as we were not fit for man or beast by the time we disembarked, 4 Walkers from the back seat (the one working seatbelt shared after some negotiation by Tim and William) and 6 bags, a pusher and a child’s carseat from under the ropes holding them onto the back of the hospital’s ute.

Andrew, the Guest House manager, has been easing our transition, culturally and linguistically, while acting as breakfast cook, guide book, mobile phone troubleshooter, and finding time to kick the soccer ball with Will. This has been a blessing, as the changes are especially marked for a two-and-a-half year old suddenly transplanted to a world without footpaths, where cars and motorbikes go past dangerously fast on the “wrong” side of road, where parents actually clutch his hand while he walks everywhere. Who continually amazes us with his ability to cope with so many new faces, all friendly, who call, smile and greet him incessantly. Who consistently accepts, processes and adapts to the new rules of the world around him (while sometimes describing himself as “feeling sick” because he is missing his friends).

Catherine’s pride, cultural prowess, and fortitude in successfully washing her hair with a litre of kettle-heated water after no hot water emerged from the hot tap, was a little undermined by turning around to spy a water heater hanging over the shower that merely needed plugging in!

Today I met with the University Hospital Director General, Dr Andre. He was warm welcoming and spent much of his afternoon showing me around and introducing me to the hospital’s many staff before driving me home to the guesthouse himself as the hospital car was busy. The hospital is impressive in size and scale, some 500 beds, with about 25 specialists on staff, including 5 physicians and one part-time gastroenterologist. The medical subspecialty areas have limited amounts of equipment but what they have is impressive – one each of an Olympus 160 series Gastroscope and Colonoscope for pertinent example (recent and impressive pieces of equipment quite dear to my heart as I’m likely to use them daily!)
The bad news is that apparently our house will not be ready to move into for at least 2 months. This leaves us in limbo a bit, especially as we’re unlikely to stay in the Diocesan Guest House beyond the end of this week, and comes as a bit of a blow, as we are looking forward to settling in a bit. I’m sure God knows what He’s got in store for this time, but as we’re both fairly tired and stressed, leaving it in His hands is taking some effort.

Mornings here are the most mellow and pleasant times of the day (at least when one sleeps overnight) and I snapped a couple of shots of the kids playing pre-breakfast this morning after the Muslim call-to-prayer woke us all at 5am: