Out-takes

Dear Folks:

This is the last posting-we decided to treat ourselves tonight and stay at the Serena Hotel where we can wake up to a wonderful breakfast and spend the day relaxing. It sounds decadent but really it is so neccesary to decompress before long flight.

For the last post thought it would be nice to put some memorable moments up. Last night we hosted Paulin and his family with his lovely kids and we played dressup with the OR greens that we had stored at the apartment.

We played hide and seek, and had crayons. There were squeals of laughter, and Paulin layed down on the floor while the kids tried to resuscitate him!!

Louise has been trying to take pictures of bicycles and so here is the

ultimate shot of chickens-some alive, some dead. It is incredible how important bikes are for survival-used for transporting everything from bananas to water. Some towns you cannot get married unless you own your own bicycle and of course pay the parents of the bride with a ceremonial cow.

Then there is Theogene our wonderful driver-we spent many special moments with him, including Louise changing out of her wet pants in his back seat, as he covered his eyes in the front seat-(very shy). These white women have no modesty.

As you can see we have been hugging people and have been embraced in return. We have been so enriched by this experience. We will be coming back as better people. having gained much more than given by our stay in Rwanda.

Love Jennifer, Louise and Lynn

We well see you soon. I think we have all learned a lot about many important things in life, the meaning of family, and supporting each other.

winding up

Well we are in to the last few days of our stay. The traditional going away dinner occurred last night which also coincided with the welcoming of 3 new residents into the program-Gaston, Eustache, and Benjamin.

Speaches were made including a speach given by Jennifer in Kinya Rwandan which Theogene our driver helped me prepare. The sentiment was right -although the words were very scrambled.

Lynn and Louise had a very good meeting with the CHUK pain management committee and are preparing for their grand finale-on Thursday which is a pain symposium, for nurses and doctors, where Perpetua and the hospital pharmacisit will participate.

Monday-was the last teaching day, and I gave the residents their exam which they did fairly well on-. Now it is just a matter of filling out their evaluations and marking the exam.

We have confirmed out tickets home

Perhaps there will be one more blog to come. I think the three of us are ready to come home-.

See you soon

Love Jennifer, Louise and Lynn

Heaven exists in a corner of Rwanda

Dear Folks

I am sure there are many heavens, but for sure one of them exists in the corner of Rwanda where we spent the week end.

Our wonderful Rwandan friend Theogene has been our chauffeur, guide, mentor and support . Our bumpy and adventure filled ride through Akagera park is over but the sights and sounds of Africa can't be erased. We saw impala, zebra , giraffe, water bucks, buffalo, baboons, wart hogs, topi, and were very fortunate to see elephants . The plain teemed with wildlife , and the trees were filled with too many species of birds to remember.

Then we got the flat tire...........and the skies opened..Technically you aren't supposed to exit the car because of the animals ,but they ignored us long enough for Theogene, our guide Tito, and a bus driver who happened along to replace the tire, then we resumed our trek on a deeply rutted, soggy road blocked by trees uprooted by elephants. There is a solitary male elephant( Mutare-which means chief) the guide was praying we would avoid. (He is known for charging the cars. )That wish came true . The elephants we saw ignored us completely. No one was insulted.

The hotel was a sanctuary......with comfortable clean rooms , a BATHTUB!!!! , and a lovely out door eating area where the night sounds were magical. The very early morning was filled with mystical , haunting calls, and a haze over the lake left the divisions between land, water and sky unclear. I think we have been so busy that the opportunity to stop , savour and wonder is a gift , and one we used to full advantage .

We had a very charming and engaging waiter at dinner and breakfast who delighted in teaching us Kinyarwndan , and took great care of us as his welcome guests. This is the Rwandan way, and we could take some important lessons from their attention to people around them , their politeness and respect. We may be strangers in a foreign land but care is always given to ensure we are made welcome. In fact whenever we thank someone they say" YOU are welcome "in the most heartwarming way , with the emphasis on'YOU".

I stepped out onto my balcony at around 630 AM to savour the view, when I looked up into the face of a very large and curious male baboon, hanging like an African gargoyle off the roof of our room.Rapid re entry . That's when the lizard ran over my foot!

We booked a boat to see hippos , crocodiles and birds. The sky was looking ominously dark in the distance so we went back for our rain gear. If we thought we had a deluge on Saturday , this was Armageddon. The sky turned completely black , the wind whipped up big waves and the sky opened. Remember this is the place for hippos and crocodiles! We were soaked to the skin, our faces stung by the horizontal rain, with thunder and lightening surrounding the boat. Our guide thought he could outrun the storm in his little metal boat . ( Oh what fools we mortals be!)

Then it stopped just as suddenly as it started, after turning the red dirt road out of the park into a river. Enough drama for one day ......we thought. The drunk looking motor bike with 2 helmetless idiots weaving along the road in front of us ploughed face first into the back of a truck ahead of them , and fell over. Both men stood up ( thankfully) looking dazed, blaming the truck driver for braking too quickly! Jennifer , still soaking wet in the front seat had been watching with growing dread in anticipation of what was coming. Yes, she has the gift of prophecy . Who knew?

Anyway folks, we are firming up our final days' agendas, writing our reports and will spend next week end travelling again. Enjoy the photos .

From Jennifer, Louise and me......see you all soon.

Fun time at the Credo Hotel and Multimodal Wake UP Management

Hi to everyone!

We are in Butare again , with 80 degree temps, sunny sky and plenty of activity, Our driver Joseph and the hotel staff welcomed us back as if we were long lost friends. Hotel Credo, ( Jennifer writes)- is a special hotel-possibly 0.5 stars, with one very frightened black rodent cowering in a corner after Lynn let out an amazing cry when encountering it in a hallway-I now carry my umbrella as a weapon. A notice in the bathroom reads as follows: Notice: Credo Hotel Management would like to remind its esteemed guests that it is strictly forbidden to use towels to clean shoes or dirty legs. Musungo ( a white person) have been known to have seizures in the bathroom due to the flickering neon light. However the goat brochettes are excellent! We have 2 towels for three people as one is stuffed under the door as a bunger for rat invasion as well as mosquitos. Louise has chosen to sleep with Lynn-(I am upset-Jennifer again).

However now that I see Louise wearing her nasal expanders to prevent snoring I am somewhat mollified by this. (again Jennifer)) Terry you lucky man you.

Patients and staff at the hospital stop to extend their hands , ask our names introduce themselves and find words of welcome in a mix of French, English and Kinyanrwandan .

Our work has included teaching pain assessment to surgical nurses and a dinner journal club for the residents hosted by Jennifer pool side at the Credo Hotel.

The residents are very engaged, working hard on English, supportive of each other , interesting and varied backgrounds.

Our message of multi modal pain therapy has an interesting echo in the Butare style of wake up call .At 4 AM the adjacent mosque calls believers to prayer on a PA system, repeated at 5 AM for stragglers. Not to be outdone the now wide awake rooster starts his unrelenting serenade, then the cell phone alarm sounds at 630..to the strains of the Mission Impossible scheme . By the time our coffee receptors are saturated we have been awake for hours.

We say good bye to Butare tomorrow afternoon and will head for Akagera game reserve on Saturday. By Monday Louise, Jennifer and I are all heading separate ways with community hospice, hospital based teaching and committees, OR and preparing for a public lecture. We are into the home stretch and see you all soon.

Love Lynn, Louise and Jennifer

Journal Club By Candlelight

Dear Folks-true to schedule the power went out in the midst of journal club tonight at our apartment-and so a romantic tone was set to a lively evening of discussion of morphine usage. The residents came over after work, snacked and then got down to some serious discussion about the barriers that exist in treating pain in Rwanda. Bona calls himself MORPHINE MAN, and Christian was wearing a t-shirt that said Jesus. On top of that we are going to a restaurant next week called Heaven for our farewell dinner.

As a very touching finale to the evening speeches were made paying tribute to Justin-who all agreed has been an amazing teacher. Justin responded in with a heartfelt tribute to the residents, who work incredibly hard under very difficult conditions with little in the way of supplies and supervision.

Tomorrow we are heading off to Butare again-a 2 and a half hour drive from Kigali-and Lynn will be writing the next blog-regarding one of her pet beefs-which we will be experiencing at 0500 and 0600 in the Credo Hotel.

Take care folks

Love

J

I am handing over to Lynn-who has a particular beef to get off her chest-

So on to Lynn

Nyungwe Forrest

Once again I have been coerced into writing the weekender blog. This time I am locked in the car on the way back from Nyungwe National Park. I have promised that this blog would not be used embarrass anyone. For instance, I could write about how on a crisp Saturday morning on our way to take a tour of a local tea factory Jennifer announced to everyone that it was she and not the hotel staff that had cleaned all the monkey poo out of the bathroom that morning.

I could also tell you about how Louise thought it was a good idea to exit her room holding a banana in front of her with a troup of monkeys waiting outside the door. And then tell you that she was surprised when one came and grabbed it out of her hand.

I could describe the sound of the laughter emanating from the backseat as three grown women spent the ride over from the tea factory to our canopy walk swapping stories about male genitalia and muskrats. I could tell you all these things but I am much too mature to give into such childish whims. I could spin tales about the origins and myth of WHITE Jennifer and her reputation amongst various kitchen staff throughout Rwanda. I could try to relate the beauty of the Shepherd’s song and the African magic contained within that made each Inyambo cow pee in succession followed by Louise, Jennifer and myself.

Lastly, I could tell you about the four hour waterfall hike whose final two hours were uphill and the legend of the white tourist who was left behind never to be seen again. They say that amidst the rush of the waterfall you can still hear her crying “Ou est l’acenseur?” I could talk about all these things…. But I won’t. Instead I will tell you about the wonderful hotel we stayed in, the amazing traditional Rwandan dinners served within and beauty of both the canopy walk and the majestic rainforest.
Addendum: I also won’t tell you about the time I could not stop giggling after taking the picture of a monkey who was perched outside Lynn and Louise’s room staring intensely (very intensely mind you!) with the brightest, bluest scrotum I have every seen.

Love Justin

Its not all work!!

Dear folks-in case you thought all we did was work-we hate to inform you that the end of the day in Kigali we can often be seen poolside at the Serena Hotel. We have all joined the spa for 200.00 per month, which is god's gift to help us unwind and clean the grime off after a days work. They also offer amazing massages very cheaply. It really helps rid ourselves of any tensions, and Justin is exercising regularly and has an amazing 6 pack. He has lost at least 10 lbs on this trip due to early morning workouts!!

Of course everywhere we go we have been dogged by power outages-so Louise who always carries her handy headlight saved the day when we were in black out mode in the change rooms-here she is looking like Darth VADER- with headlight and towel.

We are having a lovely time staying in Nyungwe-already have seen monkeys jumping through the trees as we drive through this huge rain forrest. Justin will blog on this tomorrow-the plans for the weekend are a canopy hike and a walk to a waterfall.

Will let you know what animals we come across.

Love to all

J

Progress, Step by Step

Progress-Step By Step-

So many encouraging things happening on many fronts. Louise, Lynn and Perpetua are collaborating on an advisory document to the minister of health on pain management.

Olive is a proud anesthesia nurse standing in front of a stocked drug box, for which she has the key and is responsible for replenishing it every morning. The box is divided into sections for resuscitation, local anesthetics etc. This is a huge improvement compared with the past where people were scurrying around looking for supplies, with no thought as to what would be needed for the day.

This coming Wednesday there is a meeting to establish standards for the operating room. Based on an excellent international guideline we will look at what standards can be realistically set, and what needs to be achieved. This is huge progress compared to my last visit where there was no consideration of standards at all. There is a lot of discussion re establishing the surgical safety check list and Bona is working on this. The Ors have finally received infusion pumps, so that the management of pediatric cases will be much improved.

Justin got an ovation from the nursing anesthesiologists this morning based on his clear teaching on transfusion triggers. Once again he was able to describe a concept clearly, and now we know why-His MOM is a wonderful teacher, and has obviously passed on her skills to him.

All I can tell you is that I AM THRILLED AND GREATLY ENCOURAGED by what I am seeing. We are passing a few days in Butare and then on to Nyungwe forrest to hike and do the canopy walk-(I suspect that this will be a few feet off the ground) and both Justin and I have a fear of heights-yikes!!!!

Hope all is well with you. We feel we know Justin’s MOM-and want to visit her in Montreal-Next time you have to come-you could do some volunteer work in an orphanage!!Then Justin would have 4 MOMS with him-WOW. (good thing he is not here reading this).

All the best

Love Jennifer

My turn

My original posting just got deleted and I have to try to remember what I said. We are all exhausted and my memory is definitely impaired. Tomorrow we are off to Butare , and I will have to be the straight guy to my funny travelling companions.

We are loving the warm weather and mild evenings. Today must have been close to 30 degrees and the pool at the Serena hotel was our late afternoon sanctuary. Louise and I were enjoying a glass of wine when Jennifer arrived with her OR case of the week: a bowel obstruction due to Ascaris. Mountain gorillas are not the only wild life we are unlikely to see again.Jennifer has the pictures , though she will not be posting them on the blog.

Last night we were hosted at the home of Theoneste and his wife Jeanne d'Arc. He gallantly escorted us in the dark and we all had falls before being crammed into a bus bursting at the seams. The full moon is " the poor man's electricity " and we all were glad to have it last night.

We have a canopy walk scheduled for this week end in Nyungwe National Park , and then will head back to Kigali.The time is flying by, and we will be happy to get home but until then our best to all our faithful followers.Keep the feed back coming....we like to hear from you too.

Lynn

How do women breathe?

This week was filled with many spontaneous teaching opportunities. This question was asked to us seriously which led to a presentation to the anesthesia nurses on respiratory physiology. Justin was able to draw simple diagrams to show concepts such as why it is important to give oxygen prior to putting the patient to sleep, Of course there was a prolonged discussion on the weight of women’s breasts, and Justin made a joke that in Canada men have big boobs also and made them all laugh. It turns out that there is no time given to formal teaching for nurse anesthetists!-so this was a first for them and you could see light bulbs going off.

Lynn and Louise were busy doing a teaching blitz with recovery room nurses, and nurses in various wards. Most nights they can be seen peering at the computer trying to put a talks together on the fly!! They have already had to do multiple revisions as they start to comprehend their target audience and the preconceptions of the caregivers.

Small group sessions, teaching on the fly in the operating room, and doing regional blocks-its been great.

So here are some more pics folks.

Take care

Jennifer

More Gorillas

Dear Folks-Here are a few more pics of gorillas-When the silverback charged I hung on to Louise (behind her) and shook-Totally scared. By the way gorilla poos are very big because they eat 30 kg of plants per day-something to consider if you suffer from constipation. I successfully stepped in one-wow it went over the top of my boots.

Lake Kivu was gorgeous-this time took my bathing suit-so no embarassment to my friends, and no Rwandese guys hanging out in the bushes ogling.

Janice-the email for the guy who

is driving for us and arranging weekends is Theogene-

email themurekezi@yahoo.fr. Maybe he can organize your trips for you.

Take care

Jennifer

Take care

Love Jennifer

Back from the gorillas.

We are all safe and sound and back in Kigali-here are a few pics of gorillas-Janice-my email is not working --there is one set of crocs and boot covers-Bring lots of batteries-and head lamp.

We are organizing our trips through a driver-Theogene and I will give you his number in next blog-we stayed at Kinigi Guest house before gorilla tour and Malihide Paradisus in Lake Kivu near Gisenyi.

Today was beautiful-we all slept well and I did not shine any light in Justin's eyes this morning.

Teaching day tomorrow-so take care all

Love Jennifer

Justin's blog

I am currently trapped in a hotel room with only one door which is locked from the inside and I don't have the key. That is not to say that the key isn't here it just means that I don't have it. The key is the possession of Dr. Jennifer Szerb, my captor. My freedom is reliant upon writing my first and what will most assuredly be my last blog. Therefore...... October 8, 2011. It is currently 19:04 PM and I am sitting in just the loveliest hotel room on the edge of Lake Kivu gazing at the water through glass doors which I can't open. The day started with an early wakeup at the Kinigi guest house where Jennifer, Lynn, Louise and myself gorged ourselves on African spiced tea, pineapple and and some sort of African plum whose edible parts were not entirely clear. We were then driven to the Volcanoes National Park where we divided into our gorilla tracking groups. Our particular group consisted of 3 matriarchs, 2 adolescent females, 2 adolescent males and a subservient older male. The group of gorillas we were tracking consisted of 3 silverbacks, 2 male blackbacks, 3 females and 3 juveniles. Within 10 minutes of starting the medium "plus sportive hike" one of the adolescent males, a Brazilian Australian, twisted his knee and Louise announced that she in fact was missing a kneecap. Using my belt to tie around the Brazilian Australian's knee, I did my best Steve Erkel impression by tucking my shirt and fleece into my waistband to keep my pants from falling down. This was how the day started. But the day only looked up from there... about 1950 feet up. We huffed and puffed and made several stops but eventually reached the zenith of our trek. Suddenly we were upon them. They were much larger than I had expected and frankly was a little intimidated. It turned out, about 8 seconds later, that my intimidation was greatly justified as the largest of the three Silverbacks charged our group in a terrifying display of bravado. We all cowered in his presence which seemed to satisfy and pacify the great leader. As soon as we realized we were all safe and had not soiled our underwear the sound of snapshots being taken filled the crisp mountain air. We proceeded to track this group through dense vegetation and trails freshly cut by machetes and the nimble men yielding them at the front of our group. The gorillas were magnificent. Such noble and family oriented creatures. They glided effortlessly through the forests often stopping along the way to munch on bamboo shoots. We were told to maintain a distance of 7 meters from the gorillas at all times. However, the guides clearly forgot to notify the gorillas. They would saunter wherever they pleased and if that meant brushing up against Lynn's leg then so be it. We followed them for about 3 hours before we made our way back down the mountain. Safe and mostly sound we were all jubilant at having just witnessed the majesty of the Rwandan gorilla. We collected our certificates of completion (which Lynn has promised to hang by her Medical diploma by the way) and headed towards Lake Kivu where we will spend a very relaxing day tomorrow. The day will be well deserved after the arduous climb. I am extremely proud of Jennifer, Lynn and Louise for making the climb look easy. Jennifer has promised not to set an alarm or shine her headlamp in my eyes at 5:40 in the morning to check if I am still sleeping.

Justin

Helps God

Lynn Louise and I are hoping for divine intervention-with no hairdryers, and multiple power outs they have taken to praying for cosmetic interventions-

Kids are gorgeous here-another of many pics taken of school kids in uniform

Finally it turns out that Lynn has a great jugular venous pulse-who knew-the Africans have never seen anything like it-Way to go Lynn

So for people who are reading this-namely Lori Cormier and Ray Roberts I have yet to hear any comments from you-please write as I have no access to personal email on the comments section.

We are off to Ruhingeri tomorrow so next set of pics will be of silver backs and Lynn being carried off by King Kong-help. Louise is so sweet she keeps hugging everyone-please don't hug the hairy guy Louise.

To Justin's Mom-he is doing great. He is a wonderful guy-you have done a great job as he is fitting in with us old ladies.

Take care all

Jennifer

Louise's perspective

Dear Bona-Smiling always and working hard

Out on the town Jennifer after Beer

What an incredible experience. I was told that the people here are fantastic, and this is proving true. On my first night a very kind manager of a hotel that was filled to capacity, took me to the Gorilla Hotel and got me completely organized. Met a couple from Victoria, exchanged info etc, and I later realized that they were the people who wrote "There's a Boat in my Baggage" -or something like that. The first day in the hospital we were graciously welcomed by Perpetua , the Head Nurse of the hospital, and Antoinette who gave us a full tour. Lynn and I organized a talk for 0700 Tuesday for peds, and were totally amazed that the night nurses [after a 14 hour shift]stayed an extra hour and a bit, I don't think that would happen in Canada. We are definitely finding that less is better when it come to presenting information to folks whose first language isn't English.

Last night we had a very unique experience-finding a restaurant on a dirt road in the dark, which Justin had been to once in the dark so didn't exactly know where he was going. It proved to be worth the effort. a large fish, of unknown type, served head and all.The from dinner group consisted of some very entertaing folks, 2 from Germany, 1 from england, Justin and Jean Martin from Quebec, Lynn and Jennifer from halifax and moi from Vancouver. Ruth-our apartment could use some loving care from you.On that note - I was told that the power frequently goes out-i just prepared for how often. Jas your headlamp is awesome, and Carrie & Steve, your backpack is my constant companion.

love Louise

The mornings come early -we're picked up around 6:30-Terry i do miss you bring me coffee in bed!although Lynn does take care of our java needs. This am we presentd an interactive talk to Recover nurses-again I'm impressed that so many attend. lots of work to be done.

First day in the OR

Dear Folks. As expected first day in the OR was a culture shock, but it was great to recognize familiar faces, and to work with Bona and Christian again. Our first patient was a 2.7 kg infant born with an intestinal malformation-so very challenging as pediatrics is definitely not my area of expertise-yikes. \however after many moments of terror from my point of view the surgery went off well and we were able to extubate the baby in the end.

Then on to a young boy with HIV and a huge tumor coming from the side of his neck-he was very good, and had waited all day patiently for his operation, unlike Canadian kids. It is so busy-supervising more than one room, that we ended up not eating lunch until about 2:30. However shortly after that I exited to go pick up the gorilla tickets and to sign up for the Serena Hotel which is God's Grace to me as it has a fantastic spa and I had a whirlpool, swim and long shower so that I now feel finally like the grime of the trip has washed away.

Justin stayed late-he is a real keener, and Lynn and Louise gave their first set of pain talks to the nurses but I haven't had a chance to talk to them to find out how they went.

SO far no cockroach sightings at the apartment, but the kitchen is full of traps.

I can't access my email so anyone that wants to communicate with me needs to sign up on this blog and write comments to me.

Hope all is well at home.

Take care

Love Jennifer

Here are some more pics

First day

Dear Folks:

The intention was that we were to be picked up at 800 and we were to have breakfast together with Justin but CHUK driver suddenly appeared at 715, and there were at least 2 hair disasters, as one fried hair dryer and several people did not eat breakfast-Loiuse is bitter. She also missed lunch but drank a cup of tea thanks to Perpetua who is the head of nursing. Lousie is doing fine now thanks to a large beer and snacks.

So Lynn and Lousie are inspired and fell in love with Perpetua and Antoinette, who took them on a full tour of the hospital, and gave them their job for the month which is to do lectures and help with the development of pain policies and guidelines. This also includes giving lectures to nurses on every floor, as well as making sure that the policies are implemented and do rounds with the patients.

Justin and Jennifer took off for an all day teaching session. Thank god for Justin who perceptively was able to see when I was talking above their heads and bring it down to earth for them, as well as Paulin who sat in on the lectures and explained some of the concepts in French. Justin has had some challenging experiences the first week, so we are glad to be able to support each other. He also has managed to keep track of my sweater and my umbrella, as well as find me some bandaids for an impending blister on the heel.!!

We tried to do as non didactic lectures as possible so did an airway scenario and had the resident do a history, physical and discuss the options for airway management, as well as 3 cardiac cases. There is so much to cover, but I think they really appreciated the day.

Wonderful to see everyone again. Paulin and I had lunch together at Kariboo..

Here are a few picks of the ladies relaxing,

Love Jennifer

we have arrived

we are reunited with lousie, lynn, justin, Jean Martin who is a pediatric surgeon who is provding us interesting patients and internet expertise.

Justin started last week, and he is full of stories and has been exercising at the Serena hotel. JM has been here 5 days and has been operating at CHUK

Louise her trip was smooth but no one to pick her up at the airport and so she befriended a researcher from Bolitimore and so was taken by there dirver to Gorilla Hotel-good name!! The room was 150.00 but was discounted to 80.00

We tried to communicate with Esperance and Bona to make sure that Lousie was picked up, but there was denial of the fact that there was three people coming. However Justin thought Lousie was coming at 10.00 am and spent day in the apartment waiting for Louise.

So Lynn and I were met by Bona and family and Esperance and children and flowers and big hugs and so all wonderful, and so far we have experienced one power outage since being here 1 hour.

SO head lamps are being used already. We have had many torrential downpours becuase of rainy season.

Love to all and we will be in touch -Our internet is working slowly.

Don;t worry we will be safe!!!