Goodbye Rwanda, Hello America

As I am writing this portion of the post, we are sitting on the plane somewhere over the North Sea approximately 9 hours from Houston. The past week has been filled with mixed emotions – we feel great happiness at the thought of heading home after two months away, but at the same time, we feel sadness for leaving such a wonderful country (and the weather!) and all the wonderful people we’ve met. There is still so much left to be done at the hospital, but we know that it is a process that’ll take much, much longer than the time allotted to us here in the program.

As we had quite a bit of paperwork to complete before our end-of-program conference, we decided (sadly) to reduce the number of pieces of equipment on which we attempted repair during the last week. Although we certainly take more pleasure in repairing equipment, there are also important things to be learned through the process of speaking with people to complete the necessary paperwork.

Nevertheless, we were able to wrap up all of our outstanding repair requests from the previous week, as well as fulfill a couple extra requests that popped up at the end of the week. Early in the week, we received an examination light that we had previously repaired. The examination light, however, presented a whole new set of problems, the most notable being that the light would not turn on at all. The first problem that we discovered was that the metal bar that serves as neutral was completely broken. We secured it as best we could, however, the repair was not as simple as this. Even with neutral continuous throughout the device, the light would still not illuminate. Dustin then dug deeper into the other side of the connector and realized the live wire had become detached deep inside of the plastic piece. Fortunately, he was able to solder it back together, and we applied epoxy to keep the wire from shorting against neutral. After this, the repair was complete, and we were able to return a working examination light again to the floor.

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A couple of weeks ago, we took an incubator from the room in the Pediatrics Department that houses broken and spare equipment (recall we worked on the two phototherapy lights from this room). As there were a number of repaired incubators sitting unused, we delayed this repair while we worked on more pressing matters. However, as we were trying to wrap up all of our loose ends at the hospital, we decided to take a look during our last week. By bypassing the switch and turning on the piece of equipment, we determined that the problem was solely the switch, which was always in the “on” position; even so, the incubator did not turn on. We took the switch apart, and we observed evidence of melting/fire. We used epoxy to hold the pin in the proper position and a soldering iron to melt the plastic to correct the position of the metal piece that makes the connection between the switch and the remaining circuitry.

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After putting the switch back together, we were able to turn the incubator on and off. After completing tests to check that the alarms were functional and whether the incubator could hold at the set temperature, we determined the device was repaired.

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Our final repair of the summer was a set of two negatoscopes (light boxes used to view x-rays) in the Pediatrics Department. The negatoscope on the right was plugged into an outlet in the hall, while the one on the left was hard-wired through the wall.

The first was a fairly easy fix; the power outlet into which the negatoscope was plugged was not actually supplying any power. We asked one of the BMETs who also happens to be an electrician to rewire the outlet to bring power from elsewhere. After repairing the outlet, the negatoscope turned on.

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The second negatoscope had far more problems, as it was indeed receiving power. In the end, we replaced all of the starters and bulbs; at this point, however, it only turned on intermittently, indicating a problem with the switch. After replacing the switch, the unit turned on every time… now the doctors have two working negatoscopes right outside of their offices (they had previously been taking x-rays to another building across the large hospital for viewing)!

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On our last morning at CHUK, we attended the weekly BMET staff meeting and brought breakfast to say thank you for all the BMETs had done to help us throughout the month. The BMETs surprised us with a card and gifts; they are truly some of the nicest folks we’ve ever met. Then, we walked through our favorite departments to say goodbye to and take pictures with our new friends.

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On Saturday, all of the students reunited for the end-of-program conference in Kigali. Each of the groups presented a summary of the second month at their hospital as well as information about their experiences in their towns. It was nice to be able to compare our experience at a large hospital with those of the students at the smaller, more rural hospitals – the challenges are certainly different. Here are pictures of the students in the conference room and our bungalow-style hotel room.

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On Sunday afternoon, we boarded our flight at Kigali International Airport for the start of our long journey home.

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After almost 8 hours, we landed in Doha and made our way (after several hours getting through the airport) to the hotel. When we finally made it to the hotel, it was 2 am, and the staff encouraged us to grab dinner (it was free; thanks Qatar Airways!), to which I immediately responded… “it’s 2 am! I don’t want to eat dinner.” He responded with, “No, go check it out and then come back, and I’ll have your rooms ready.” We finally agreed, and boy are we glad we did! The buffet was enormous with foods of every variety, and they had a whole section dedicated to probably 30 different types of desserts (for those of you who don’t know, I absolutely love dessert… it is the best part of any meal!). So, we each grabbed a plate and a sampling of the desserts, and that’s what we ate for dinner in the middle of the night (hey, how many chances do you get to eat free desserts in Doha at 2 am?).

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We were told that our shuttle would leave from the hotel at 6 am for our 9 am flight, so I set my alarms for 5 am so we could shower and be ready to go. They also indicated that we’d receive a 5:30 am wake-up call. Around 5:25, I woke Dustin up so he could shower; however, I soon made the realization that I had not changed my phone from Kigali time to Doha time, so it was, in fact, 6:25 am. After a few tense moments worrying that we’d miss our flight, we got a 6:30 am wake-up call from the front desk, indicating that our shuttle would leave at 7 am. It turns out that the reception had been an hour off earlier that morning, so we were right on time!

About 16 hours later, we happily landed in Houston, TX. After getting through immigration, baggage, and customs, we picked up our rental car (a VW Jetta!) and started on the final leg of our journey home, stopping at Buc-ee’s to pick up some much needed coffee and snacks. There’s nothing like coming home after a long time away! One downside to being away for so long are the massive weeds that greet you…

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We’ve been home for almost a week now, and we’re finally getting back into a rhythm. Mom and Dad brought Jetta (our beloved dog) back home to us this weekend, and we are certainly glad to see them all. We’ve been eating at all of our favorite restaurants, and I’ve spent a fair amount of time walking around my favorite supermarket (HEB, for you Texans). We missed a lot of things, like: our friends and family, our dog, shower curtains, cold cereal, cold sandwiches, driving, vacuum cleaners, decently fast internet, continuous water and electricity, getting free ice water at restaurants, etc. I know it sounds cliché, but we never realized quite how lucky we were until we took this trip. That being said, we do believe that Rwanda is an amazing place to visit, with plenty to do, see, and learn. We would highly recommend a visit for anyone who finds him/herself with the opportunity. We had an amazing experience and learned so much about ourselves and what we can do to continue to help. We will never forget this trip and the new friends we made. Thank you all again for all of your kind words and support – it meant the world to us to have you following our journey.

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Mount Bisoke

At the writing of this blog, we have less than a week left here in beautiful Rwanda! We have had an amazing time here and have learned so much.

We had another productive week working at the hospital and then hiked a volcano, but more on that later. We repaired two pulse oximeters, an infant temperature probe, two power strips, and the hand-held remote for a mobile x-ray unit!

We were called to the intensive care unit to repair their mobile x-ray unit, which was not firing correctly. Working with a technician and a second, working device, we determined that the problem was the remote. Although the unit could be operated by pressing buttons on the unit itself, the technician indicated that this was not a viable option because it would expose the technicians to excessive radiation, even with the lead vests.

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We took the remote back to the shop and thought about our options for a couple of days while we worked on other repairs. Finally, using a box cutter and brute strength (the hand-switch was glued shut on all sides), Dustin opened up the remote thinking that the problem was with one of the two switches (there is a preparation state and an exposure state). However, everything appeared to be working properly. We then moved onto the connector that allows the remote control to interface with the x-ray unit. Although by outward appearances it seemed intact, upon closer inspection inside, we determined that one of the wires was completely disconnected from the pin on the connector.

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After reconnecting the wire and reassembling everything, we returned to the ICU with the remote, where we were met by an x-ray technician to verify that the remote was indeed repaired. Using the remote, he took an x-ray of his phone and then printed out the x-ray for us! This was a big win for us because we had been dreading the repair attempt (hence we put it off for a couple of days) because we were not sure what we’d find when we took it apart. Luckily, it was a manageable problem.

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Last week, we mentioned that one of the CPAP machines in the Neonatology Department was plugged into a broken outlet on the power strip. We left our extension cord with them so that the CPAP could be plugged into a working outlet while we figured out how to obtain new power strips for them. When we returned with new power strips this week, we noticed our extension cord hanging on the wall with nothing plugged in… upon inspection of the CPAP, we realized it was not on, and again, it had been plugged into the broken outlet. We first decided to place tape over the broken outlets, but then we decided that we should just take the power strip with us for repair so they would not have the option to plug it into a broken outlet. Once we opened the power strip, we noticed that at least two of the switches (the strip has a switch for each outlet) had previously caught on fire. With this in mind, we decided to bypass the switches altogether, wiring positive and neutral directly to the series of outlets. Afterwards, we returned the power strip with six working outlets!

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The next day, three new power strips appeared in the shop for repair. One happened to be the same model as the power strip from Neo., so we decided to tackle this repair. Unfortunately, the power plug had been completely cut off of this one and was nowhere to be found. Dustin dug through the bucket of cords in the store room and found a cord with a plug. We soldered the two cords together to make an extension cord-power strip. Upon testing, we discovered that one outlet was not working, so we opened up the power strip to find that one of the wires had become disconnected. After resoldering, the device was good as new! As you can see from this picture (and others throughout our posts), we use heat-shrink tubing every where we can – it is one of the most useful items that we packed in our tool kits.

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While we were in the Neonatology Department (we spend a lot of time there!), the head nurse dragged us over to one of her pulse oximeters, which was not working properly – the LED was flashing rather than holding steady for measurement. We took the pulse oximeter and probe back to the shop to look into repair. Our boss encouraged us to request a replacement from the spares shop rather than repair it because the probes are so fragile and wires so small. A number of pulse oximeter probes were brought to us from the shop, but unfortunately, none would work with this particular pulse oximeter. We attempted all sorts of work-arounds to try to force the probe and pulse oximeter to work together, but nothing was successful. As this was the only available probe for the device, the nurses would not be able to use it at all! We returned the pulse oximeter with broken probe and explained that we would not be able to repair it. The look on her face was heart-wrenching! When we are unable to repair a piece of equipment, we feel terrible, especially when the root of the problem is spare parts!

A second set of items brought to our attention in the Neo Dept. was a pair of broken skin temperature probes for one of the infant warmers. Unfortunately, one of the probes was completely missing the temperature sensor. Dustin decided to combine the two, hoping that the one skin sensor combined with the connector of the other probe would make one working temperature probe. After cutting cords and resoldering wires, we returned the temperature sensor for testing, and it worked properly!

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Before we were able to fill out our paperwork and return to the shop, one of the doctors pleaded with us to fix the pulse oximeter than we had returned. We decided to give it one last shot, determining that we could do nothing worse to it than the state it was already in. Dustin opened up the sensor end and found a teeny wire disconnected but could not be certain where the wire should have been connected. After soldering the wire where we thought it should go, we were able to return the probe, working, to the Neo. Dept. We are always so excited to repair the equipment, especially when it means so much to the staff!

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The final item we repaired was the same power supply that we repaired during the first week. Although it was able to charge, the connection was fickle, requiring that you adjust the position of the connector to make proper contact for charging. We cut into the plastic connector to reveal the wires within, such that we could determine if anything had become disconnected. As with so many items here, one of the wires within the connector was completely disconnected. We resoldered the wire and reassembled the connector, applying a couple layers of heat-shrink tubing to hold everything firmly in place. Once inserted into the pulse oximeter, the probe made a strong connection – no fiddling required!

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On Friday, we were graciously invited to have lunch at the home of our boss, Jean Claude, and his wife. We had a great time visiting with them and getting to know his wife. We were even able to look through photo albums full of their wedding photos; it is very cool to be able to see the differences and similarities between American and Rwandan weddings. One thing for sure is that they have very large weddings here – at least 500 people in attendance is normal. The 80 people at our wedding is extraordinarily small to the Rwandans with whom we have discussed weddings. They also have several wedding ceremonies, including a traditional service (wearing traditional attire) and a religious service (wearing the same wedding attire as we do in America). As we’ve mentioned before, everyone here has been wonderful to us, and we always feel very welcomed.

After a late lunch with Jean Claude and his wife, we headed to Musanze with Ben and Jami to stay with Kristen so that we could wake up at the crack of dawn to hike Mt. Bisoke. Mt. Bisoke is one of 5 extinct volcanoes in the Virunga Mountains of Rwanda.

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At the peak, 3711 meters above sea level, there is a large crater lake – our prize for reaching the top. We arrived at the headquarters at 7 am to pay our fees and pick up our guides. We were accompanied by a family from Denmark and two guides, both of whom happened to be named Emmanuel. We took a 30 minute drive from the headquarters to the base of the volcano, most of which was driven over a very bumpy, rocky road (it’s known here as the pre/post-hike African massage). For reference, Ben said that this was the bumpiest road he’s ever driven on, and he’s driven on quite a few dirt roads in Africa. Here we are near the base of the volcano, looking very happy and excited (we had no idea what we were in for!).

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At the base of the volcano we were met by a number of security guards, who would keep us safe from any large animals we might come across (gorillas and water buffalo, for example). We never saw any animals, but we may have heard either antelopes or gorillas (I think they were gorillas, but I’m almost certain one of the guides said they were antelopes). By far, this hike was physically the hardest thing I’ve ever done; Dustin was much better suited for the hike.

Along the way, there were large sections of the trail covered by wheat sacks filled with dirt that served as steps. Other sections, however, were far less defined, and we passed through a lot of very narrow passages and otherwise very natural-feeling jungle.

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Along the way, we both had to take breaks to stretch. At one point, I got a charley horse in my calf, but after a bit of stretching, I was able to continue (for a minute there, I contemplated how long I would have to sit there while the rest of the group continued on and then came back down to retrieve me). Here’s Dustin stretching his hip right there on the trail. Also, here is a picture of us about half-way up the ascent, while we still had some energy left (and could still feel our legs). Our walking sticks came in very handy both on the ascent and descent.

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If it wasn’t for a couple of porters helping me up some of the more steep sections (and holding my hand for long stints over some of the rougher terrain), I’m not sure how I would have made it! At first I fought the help, thinking I could do it on my own, but at some point, I resigned myself to the idea that I’d be much better off with their help.

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As we made our way towards the top, we were greeted by increasingly heavy fog and a decreasing number of trees (apparently trees cannot grow at that high of an elevation). Our stopping breaks became more frequent the closer we got to the top. However, we got a boost of much-needed energy when we finally saw the sign indicating that we’d reached the lake at the peak. Dustin was so excited that he ran the final distance…dropping on all fours when he finally reached the summit (that’s him in the red… I know it looks like he’s throwing up, but believe me, he is not).

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We made it to the top in just under three hours to freezing temperatures (our fingers went numb in  a matter of minutes) and a lake hidden in the mist/clouds (somewhat disappointing). The guides assured us the mist would pass, and in a few minutes, the mist subsided long enough for us to snap a few pictures before it returned. In case you can’t tell, there is a crater lake behind us.

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After eating snacks, drinking Gatorade, and otherwise recuperating, we started the long descent back down the mountain at a slightly quicker pace than we ascended. We made it to the base in about two hours. Although the descent was harder on our joints, it was easier to handle, and I was able to take more pictures because I wasn’t in so much pain/out of breath!

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Along the way, several members of our group ran into a plant (both accidentally and purposefully) known as a “stinging nettle,” which causes a burning sensation at the site of contact. Luckily, the soothing salve is from a plant that grows alongside the stinging nettle. You just break off a leaf and rub the white liquid from the stem on your skin. Although it does not smell particularly nice, it certainly reduces the pain (Dustin knows from experience). The stinging nettle is on left and soothing salve plant on right. The last picture is Jami applying the salve on Dustin’s arm (Thanks Jami!).

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Finally, here we are back at the base of the mountain with the volcano standing behind us. We are all very happy to be back on flat land! Notice in the background Bosco, one of our porters, trying to wrangle a cow… this was just immediately after we witnessed a small child repeatedly throwing rocks and dirt at said cow.

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Saturday will be our end-of-program conference to wrap up our two months here. Then we board our plane back to Texas via Qatar on Sunday afternoon. We’ve greatly enjoyed our time here but are excited to get home. With all of the preparations for returning home, I’ll likely write our final post with some reflections on the plane and post once we’ve returned to College Station. We hope that you have all enjoyed our blog,­­­­­­­­­­­­ and once again, thank you all for your kind words and support!

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Musanze, Butaro, and Heaven

Less than 2 weeks remaining in Rwanda!

We’ve really gotten into the groove of working at the hospital each day. We’re finding new pieces of equipment to repair as well as new piles of broken equipment from which to scavenge parts.

Per EWH’s request, we maintain a running list of all of the equipment on which we work. The list includes the equipment type, manufacturer, and model, as well as the nature of the problem, solution, and whether it was returned to service. Aside from providing EWH with valuable information, this list serves as a reminder of what we have been able to accomplish (and occasionally, not accomplish) while at CHUK.

With that being said, during the last week, we repaired an examination lamp, heating plate, two phototherapy lights, a CPAP machine, an anesthesia machine, and the temperature probe on an infant warmer. We have also been in contact with the manufacturer of a suction machine to determine the proper filter for the device, at which point we will be able to return the piece of equipment to service. Some of these were quick fixes while others took considerably more time and effort.

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As mentioned in the last post, we met with the American doctor to discuss what he views as high priorities for equipment repair while we are here. He showed us to a room in the back corner of the Pediatrics Department that housed a number of pieces of equipment, which turned out to be a mixture of both working and broken equipment. He also took us to a field of broken equipment; unfortunately, this equipment seems to have been sitting outside in the elements for a very long time, leaving the equipment and spare parts on them essentially unusable.

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During the last week, we tackled several of the pieces of equipment in the pediatrics store room – the phototherapy lights and suction machine. When we turned on the two phototherapy units, only two of five bulbs worked in one unit and four of sixteen worked in the other (it was a 360° unit with eight bulbs on the top and eight on the bottom). The power supply connector on the single-sided (five bulb) unit was broken, so we replaced it with a connector scavenged from a different piece of equipment. After toiling with the 360° unit trying to find a complicated problem (we forgot to follow the KISS principle on this one), we determined that the issue stemmed from the fact that every two light bulbs share a single ballast and are connected in series. In other words, if one of the two bulbs in series is burnt out, neither will illuminate (not a very good design, in our humble opinion). We then went through the process of determining which bulbs were in fact working, and we ended up with 13 working bulbs between the two phototherapy units. Because there are no spare bulbs lying around and we aren’t sure when or if any will arrive, we decided to place five working bulbs in the single-sided unit and eight bulbs in the upper half of the 360° unit, which should still provide sufficient light output for the babies. After much cleaning, we then attempted to return the units to service. Although neonatology happily accepted the smaller, single-sided unit, they insisted that they did not have room for the larger unit. They told us to take it to pediatrics, because they sometimes have patients who need phototherapy. Pediatrics said that they didn’t need it at the current point in time…soooo we had to return it to the room from which it came. It was a little disappointing, but hopefully they will remember that they have a working phototherapy unit just around the corner if the need arises.

The smaller, five-bulb unit:

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The larger, 16-bulb unit:

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In the process of returning the repaired equipment to neonatology, we were called upon to fix a couple of problems that had developed and had not been reported (the nurse must fill out a repair request form for each piece of equipment). The first involved the humidifier on a CPAP machine that was no longer working; the baby was not being provided oxygen of the optimal humidity level and temperature. The nurses were not sure for how long the device had not been working. Initially, we were not sure what to think… the device was plugged in and the switch turned to the on position. To complicate matters, we were unable to troubleshoot too much because the device was connected to the baby and couldn’t be disconnected at that time (some of the device’s functionality was still being utilized). Just as we were leaving to investigate the device on the web, we decided to make sure that the device was getting sufficient power from the outlet on the power strip. Using a cell phone and charger, we were able to determine that the outlet into which the device was plugged was providing no power to the device at all (no wonder it wasn’t working!), even though all other devices plugged into the power strip were getting power. Because there were no nearby outlets, extension cords, or power strips available, we decided to use the extension cord that we had built in lab so that they could provide adequate care for the baby while filling out a requisition form for a new power strip, which we expect could take awhile…they don’t really like filling out paperwork around here. Boy, that extension cord sure does come in handy…but we’d love to have a second because we find ourselves needing it quite often now that we don’t have it in our possession anymore!

The second unexpected fix involved a temperature probe that monitors the skin temperature of a baby while under a warmer to ensure that the baby does not get too hot or cold. Our first clue to the source of the problem was that the machine did not even recognize that a probe was attached. Upon closer inspection of the probe, we determined that at least one of the connections (the ground) was broken inside of the probe. This was tough to fix because it was a stranded wire (lots of very tiny wires instead of one larger wire) that was connected to the insulation. After fixing the ground wire, we returned the probe to the unit (this unit had to stay in neonatology, while we returned to our shop to repair the probe) to test if it was now working; of course, it was still not recognized. We then returned to the shop and identified an area where we suspected that the wires were broken inside of their insulation. We resoldered all of the extremely tiny stranded wires within the cord; to try to keep it from re-breaking, we added considerable heat shrink, epoxy and super glue to the area around the resoldered wires. Finally, it worked!

On Tuesday, we took an unexpected trip with Ben and Pat to visit a couple of hospitals in the Northern province of Rwanda. The first was a PIH (Partners in Health) hospital in Butaro, which required that we drive over an hour down a dirt road along the side of a mountain with only trees to serve as a guard rail (in some places). Our driver, who shall remain nameless to protect his identity, drove the car (which was long overdue for a service visit) faster than it probably should have been driven given its sub-optimal condition. Even so, this was the most beautiful drive we’ve ever taken and our favorite part of the country to visit. What we find absolutely amazing is that the villagers are able to farm on the steep side of a mountain. The quilt-work patches of different plants and trees make for a beautiful view. We even passed several tea plantations, something for which Rwanda is known.

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We passed a couple of men herding a group of pigs down the road. We also came upon a man and his sons working to chop up a tree that had fallen (accidentally or on purpose, we can’t be certain) across the roadway, blocking our way.

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By far, though, the most magnificent sights to behold during the trip were a series of volcanoes seen along the way and from the town of Musanze, where we visited EWH students at the hospital. Even through the thick haze, the volcanoes were beautiful (we’re still holding out hope that we might climb one this next weekend!).

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The PIH hospital is one of the nicest hospitals that we have visited here in Rwanda and serves people in very rural communities. Although they have great equipment and offer important services, they still suffer from some of the pitfalls common to all hospitals here, namely lack of spare parts. Unless the needed spare part is very common, it will likely take months or even years before the part is received and implemented to repair the device. Therefore, important equipment can sit idly for a very, very long time because of a lack of spare parts (which can sometimes be very, very inexpensive!). After touring the PIH hospital, we got back in the car for a long, bumpy ride to Musanze. At the hospital in Musanze, we were able to visit some of the students, who, with the help of Ben and Pat, were able to repair an x-ray machine!

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Over the weekend, Dustin and I had brunch at Heaven, a very nice restaurant here in Kigali. We sat on the patio under a huge shade tree and had eggs benedict (Dustin) and heuvos rancheros (me). We then walked all over town (up and down the hills) until we finally ended up at the movie theater to enjoy some entertainment in a dark, air-conditioned room!

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All in all, it was another good week in Rwanda!  Until next time…

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Our holiday weekend in Kibuye

So much has happened since our last entry…

Monday was a holiday here in Rwanda, so we were unable to work, as much as we tried… and believe me, we tried. We arrived at the hospital around 9 am to find only one BMET on duty, and our tool kit was locked in the Supervisor’s office (he was not coming in for the day). While we were there, we tried to find doctors or administrators with whom we could meet, but no one was around. We settled for setting up a meeting the next day with the American doctor, whom we had met previously, to discuss how he thought we could help out around the hospital.

Tuesday and Wednesday were successful work days at CHUK. We were able to return 3 pulse oximeters to service, including the one that we started to repair on Friday. On two of the three devices, a portion of each screen was broken, and the only remedy would be replacement (one of the IC’s was apparently bad). However, going through the settings, we were able to find a display setting that would allow the user to still be able to read the oxygen saturation and pulse rate numbers. Although it wasn’t a perfect fix, we believe that it is more important to have some/most functionality than none at all.

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We then worked on a broken fetal monitor, a device that monitors fetal heart rate and contractions while the mom is in labor. A quick look at the power connection showed that only 1 of the 3 wires was connected.

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Upon further investigation, we discovered that the pins of the connector were also broken, similar to that of the pulse oximeter. Even with the wires connected, the device would not be powered because the power is disconnected from the board inside. After some deliberation, we decided to circumvent the connector altogether and solder directly to the pins inside. We then securely attached the power cord, and we feel confident that this problem will not occur again.

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Once we reconnected everything, the fetal monitor powered on, which made us very happy, but we were not exactly sure how to test the functionality, being that neither Dustin nor I is pregnant.

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We decided to go straight to the source… the nurse that requested the repair. The nurse actually took the monitor to the maternity ward and used it on a woman in the throes of labor. The fetal heart rate was displayed, and we were even able to hear the baby’s heart rate loud and clear. She then verified the heart rate with a working device to ensure that the monitor was providing the proper data, which it was! We were so stoked to be able to see with our own eyes the monitor returned, working properly, to patient use.

As we’ve mentioned before, the original plan was for us to spend time at the hospital in Kibuye during the second month here in Rwanda. Because Thursday was also a Rwandan holiday (oddly enough, July 4th is like an Independence Day for them as well), Ben took us to Kibuye for the disjointed long weekend to work at the hospital on Friday and enjoy the city over the weekend. We arrived in view of Lake Kivu just as the sun was beginning to set, an amazing scene to behold.

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We stayed at a great little hotel on the shore of Lake Kivu. Our room was literally feet from the water, as you can see from these pictures of the views from our porch.

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Here is Dustin sitting on our back porch, enjoying the sounds of the lake.

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We (Dustin, Ben, and myself) arrived early at the hospital on Friday morning to a very excited BMET (the only BMET at the hospital, who is responsible for all equipment repair and maintenance). He was excited to show us around the hospital, introduce us to the hospital director, and to work with us to repair some vital pieces of equipment. We first tackled two suction machines that had given the BMET trouble for the past two weeks.  We determined that the power connector (surprise, surprise) was broken on the first device. It seemed that something had gone awry, causing the connector to catch on fire. This was evident by the melted, blackened connection; inside, the wires had also become disconnected from the connector.

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Dustin and the BMET took an identical connector from a suction machine used for parts and resoldered the wires. Although the machine then turned on and provided adequate suction, the gauge appeared to be stuck, reading the same number regardless of the amount of suction. After removing the gauge, cleaning it, and otherwise tinkering with it, the suction machine with working gauge were returned to service. The second suction machine did not have a power supply problem, requiring that we dig deeper into the machine. After taking it completely apart and checking the tubing for leaks, we determined that the problem was within the pump. Upon further inspection, one of the valves on the pump had blown out and no longer fit properly. However, with a bit of epoxy, we were able to replace the piece (permanently we hope) and reassemble the suction machine. Luckily, the device and the gauge worked without any further incident.

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After repairing the suction machines that had been sitting in the shop for 2 weeks, we ventured to the surgical ward to look at two new surgical lights that stopped working a couple months into their use. Luckily, Ben had experience with these types of lights and after a fair amount of probing for continuity and voltage and such, we were able to deduce that a simple setscrew had not been installed properly, which resulted in an electrical disconnect near the bulb. We were able to reattach everything properly, which resulted in an ultra-bright surgical light. The problem with the second light was a little more difficult to diagnose.

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We checked that the voltage was correct in a number of places and verified that there were no broken wires inside of the pole by checking continuity. After much scratching of our heads, we finally noticed that when we tried to plug in the connector from the power supply/battery pack to the light source, the connector inside would move back, essentially disabling any chance of making a proper connection. After tinkering for quite some time, we were finally able to maintain the position of the connector long enough to connect the plug. Finally, let there be (bright) light!

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Having successfully repaired these important pieces of equipment, we were excited to enjoy our holiday weekend. On Saturday, we were invited to a 4th of July party with a bunch of other 20-something ex-patriots working at various non-profits in Rwanda. As a part of this party, we would be camping at the compound at which the party was held. So, to get camping equipment, we had to get to an island in the middle of Lake Kivu called Peace Island. We took a “boat trip” from our hotel on the edge of the lake to the island, which was about a 20 minute boat ride.

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Here we are standing on the coast, along with the boat that brought us to the island.

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The first cool thing we came across was a beautiful dog, who decided to follow Dustin across a very unsafe-looking bridge that connects the two small islands. Dogs are very uncommon here in Rwanda, and it is always a pleasure to see one (but it unfailingly reminds us of our dog, Jetta, who we miss very much).

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Then, we came upon a mom and baby cow standing in the middle of our foot path. Dustin was very adventurous, attempting to feed and pet the cows. When we asked Jean Baptiste (the guy who took us to the island) how the cows got there, he said that they swam… we’re not sure if we believe that!

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Then, on our way back from one island to the other, we came across a monkey hanging out at the beginning of the bridge. We watched him for a while, taking a lot of pictures, before he finally got up and began walking to the other island. We decided to slowly traverse the bridge as well; the monkey changed his mind, turning around and passing within a foot of us. Luckily, he was very relaxed and just wanted to take a seat next to Dustin.

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After picking up our camping supplies, we stopped by a shop to pick up goat legs that Ben wanted to grill for the party. While we were there, our friends asked about a sauce to go with the goat meat; the cooks invited Ben’s friend Betsy into their kitchen to cook the sauce alongside them. Apparently, the goat sauce turned out delicious, but I can’t attest to that, because I’m a vegetable (that’s what Costica, our new homestay dad, calls me instead of a vegetarian).

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At the party, there was more food (delicious American food) than you could imagine. The views from the compound, which happened to be atop a hill, and weather (for the most part) were amazing. We met a lot of interesting people with very exciting-sounding jobs and learned much about the opportunities for helping the people of Rwanda (and East Africa in general). It was a very fascinating group of people to have found ourselves amongst.

Here is a view of the sunset over Lake Kivu. The mound surrounded by orange is one of many islands in the lake. We were told that on clear days, you can see clear across the lake to the Democratic Republic of the Congo.

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Once the sun went down, the temperature started to drop, and in our little tent (and I mean little – Dustin could not even stretch out because his legs would be outside of the tent), it got very, very cold. Also, we had very little cushion under us, so it was definitely an experience. Here we are in front of our tent and Dustin curled up to fit inside of the tent.

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We awoke around 6 in the morning and just sat on the hill, watching the sunrise and Kibuye around us coming to life.

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We had an amazing and successful trip to Kibuye, but we are glad to be back in Kigali and to our hospital, CHUK, where we know we have a lot left to do.

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The second half of our adventure in Rwanda begins!

Greetings from our new home in Kigali!

On Thursday, all of the students moved (as groups of 2-3 students) from their home stays at the technical campus in Kigali to their new home stays in smaller towns throughout Rwanda. As we’ve mentioned before, we will be stationed in Kigali to work at CHUK with the possibility of moving to Kibuye on Lake Kivu if we cannot find enough to do at CHUK (however, this is now highly unlikely, as we’ll talk about later). However, we did pack up all of our stuff and move to a new home stay that is a little closer to the hospital. We’re living with a Rwandan EWH employee and his wife, who have both been extremely welcoming and gracious.

On Wednesday, we had our final exams in the language courses. Surprisingly, I think that we both did alright; although, I think the teachers could have been much tougher. Luckily, it seems that most of the people that we have come across in the hospital speak either French (which is easier for us than Kinyarwanda) or English (in addition to speaking Kinyarwanda, or course). Regardless, I think all of the students are excited to have completed both language courses and to no longer have to struggle for 4 hours each morning in language classes.

On Friday, Dustin and I had our first work day at CHUK. Here are a few pictures of the workshop and our work space:

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We found out that there is a group of electricity and electrical students from KIST (Kigali Institute of Science and Technology) that are also working daily in the work shop as a part of their course. They were very interested in working with us so that we could trade knowledge and skills. Initially, we were handed 3 broken pulse oximeters, which measure the oxygen saturation of the blood. One of the devices could not be turned on, while the other two had broken LCD screens. Dustin and I tackled the former, and we gave the KIST students the other two.

The device we worked with had three primary power options: a Li-ion battery pack, 3 AA batteries, or a 5 V wall power source. After taking the device completely apart and checking all power sources, we determined that there was an intermittent problem with the connection between the wall power source and the device. Once we were able to maneuver the connector in the right manner, we were able to turn on the device briefly. We then determined that the connector had two problems: there was a broken solder joint on the connector and the center pin of the connector was broken. As I believe we’ve mentioned, spare parts are a major problem here in the developing world. We first went through the workshop and store room to search for other pieces of equipment with the same sort of connector so that we could scavenge the part; however, we were not able to find anything. We then went back to the department from which the device had come earlier that morning to see if they had additional broken pulse oximeters that we could scavenge for parts, but they did not. Lastly, we asked one of the BMET technicians to take us to the part of town that has a lot of electronics. He took us down a narrow alley and into a tiny little workshop where there were amazing technicians repairing everything from power sources to shoes. We explained the problem, and luckily, he had an old device with the same type of connector. While trying to test the connector for output power, he determined that the cable on our 5 V transformer was broken, so he also fixed that. We left with a fixed cable and the spare part that we needed! On Fridays, all government employees are given the afternoon off to exercise or play sports, so the BMETs typically leave at 1 or 2 pm. Although a couple of the BMETs stayed with us so we could work for a bit longer once we got back from town, we still ran out of time. We’ll have to finish the repair on Monday.

Here is a picture of the new connector (the little black piece with red wires connected) that we purchased in town as well as Dustin working with great diligence to repair the device:

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As explained above, while we were in the midst of the repair, a BMET took us back to the department where he received the broken pulse oximeters. The department happened to be the Neonatology Department. While we were waiting to speak with the head nurse, a doctor from the U.S. came along to receive updates on the babies. While he and a nurse were speaking about one of the babies, the head nurse came along to speak with us. Although they had no additional pulse oximeters for us, this turned out to be a wonderful encounter. The doctor stopped his discussion to listen to our conversation. He then asked if we happened to be engineers. We answered yes, and he then asked… Do you happen to be biomedical engineers? His response to our affirmation was “I have so much for you to do!” He then proceeded to tell us of the broken equipment, such as phototherapy lights, that he would like to have repaired to save the lives of the babies in his department. He also mentioned that babies are dying because they do not have enough pulse oximeters, the device we are currently repairing! We also know of a number of pulse oximeters in the store room that we can also try to repair. Lastly, he told us that just one week ago, a baby died from hypoxia because the oxygen ran out and there was no alarm to let the nurses know. After speaking with the doctor, we are now even more motivated to repair as much equipment as we can. This doctor (and hopefully others) will be a wonderful resource for determining what devices to work on that will have the biggest impact. We can’t wait to get back to the shop on Monday!

Aside from the changes we’ve mentioned above, we must learn a new bus route for getting from CHUK to our home stay, which is in the Gikondo sector of Kigali (our previous home stay was in Kicukiro). In our previous location, we were spoiled because the bus stop was very close to our house and the bus stop in town was very close to all of our favorite spots (i.e., coffee shops and supermarkets). After work on Friday, the director of the Biomedical Engineering Department at the hospital walked with us to the bus stop. I think we must have walked many, many miles… and it was made worse because my feet hurt from walking such a long way to find the spare part in town at lunch. However, we eventually arrived at the bus stop and were amazed to find a line at least 50 people long waiting for the bus stop. After waiting for quite some time, we got a call from Costica, our new home stay host, who decided to pick us up before we boarded the bus. So, today, we had our first experience with the new bus route, catching a bus from Gikondo and departing in the downtown area. The experience was much smoother than expected, so the last new experience will be the ride from town back to Gikondo.

To end the post, here are a few pictures from Kicukiro, the area in which we stayed during the first month. On the left is a picture of the gates to the main entrance of IPRC, the technical school. On the right is a picture looking down the main road outside of IPRC.

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The picture on the left is of the area near our bus stop (notice all of the moto drivers), with the Kicukiro Market on the right-hand side of the image. The picture on the right is the bus stop that we used to get from Kicukiro to town.

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Here are a few pictures of town. On the top left is a picture of Kigali City Tower, where we go for movies and the Bourbon coffee shop. On the top right is the bus stop in town. On the bottom is an area in town with a lot of shops, including electronics shops.

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It was under the “Kazi ni Kazi” sign on the left (below) and through the narrow passage way that we found the spare part that we needed for the pulse oximeter. The picture on the right is a close up of the shops in that area.

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Our last full week at IPRC

Mwaramutse! (Good morning in Kinyarwanda)

We recently found out that we are staying in Kigali (the capital and largest city) for the second month of our stay here in Rwanda. We’ll be moving to a new home stay host that is closer to the hospital. Aside from fixing equipment, we’ve also been encouraged by EWH to do a bit of organizing of the biomedical engineering shop (for those of you that know me, I’m very excited about this!). We may still be able to spend a week or so in Kibuye (where we were originally planning to go) to help in any way we can.

This last week has been particularly tough because electricity and running water (and even buckets of water) have been scarce. We’ve eaten a number of dinners by candlelight… so I decided to take a couple of pictures of a typical Rwandan dinner. For this dinner, we had black beans with greens, fried plantains, rice, a stew with assorted vegetables, milk to drink, and an array of fruit for dessert (bananas, tree tomatoes, which are unlike anything in America, passion fruit, and oranges). It is customary in our house here to wait until you have finished eating to have a drink, which is almost exclusively milk (warm) or milk tea (a very hot, mild-tasting mixture of tea and milk). For completeness, here are some pictures of a typical breakfast – we split an egg pancake (thin omelet) every morning along with either porridge or oatmeal (sometimes both), bread (and sometimes beignets, which are much denser than ours back home), and tea. The porridge is the consistency of cream of wheat, and the oatmeal is made with milk, so it is particularly yummy. On this particular morning, we had some amazing bread that reminded us of Hawaiian rolls; I cut up the egg and put it on the roll as an egg sandwich. All of the bread here is made at one of many local bakeries; it is nice because the bread only has the few ingredients necessary for bread.

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Here’s a picture of our current host family, Gershome, Asumpta, and 6-month old baby Brianna.

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Last week, Dr. Cote focused his lectures on design because each team of students is required to develop a design for some need they discover while at their hospital. A number of BMETs also came to our design classes; these BMETs currently work at the hospitals, with some working at the hospitals at which our students will be assigned. Side note: Because our technical classes are immediately after lunch, we are typically very full and tired; so this week, Dr. Cote wised up and passed out hard candy to all of the students!

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We returned to CHUK for the final time as a group to complete a few more repairs. The undergraduates repaired a couple of surgery  lights and another incubator. Dustin and I worked on a projector that the head of the biomedical engineering department wanted to be repaired. When we initially turned it on, it started smoking, so we turned it off and opened it up. It was an extremely complicated piece of equipment with a lot of layers… it took quite a while to figure out how to get to the main components (power supply and fans). After spending a long time checking all the connections and measuring voltages at various points, we decided that we should reassemble it in the hope that it would magically work. We were able to put everything back together but ended up with 2 extra screws at the end (oops!). However, when we plugged it in, it started up and projected onto the wall! In disbelief, we power-cycled it again just to make sure it wasn’t a fluke, but it still worked! Sometimes that’s all it takes… we’re guessing it was just a loose connection! The director was very excited to have his projector repaired, and we were stoked to be able to fix it for him.

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On Saturday, we walked to Meze Fresh, which is an amazing Mexican food place about 45 minutes (with a lot of hills in between) from our home stays. I had a salad and Dustin had a burrito bowl; rice, beans, guacamole (free and delicious), cabbage, cheese, and pineapple salsa (incredibly fresh and tasty).

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After eating, we caught a bus (i.e., small van) to the Kimironko Market, which is a massive market about 30 minutes from our home stay. The market has everything… fish (available both dried and fresh but very smelly), fresh meat hanging from the wall, fruits and vegetables, clothes, shoes, jewelry, fabrics of every shape and color, and handicrafts. All of the handicraft vendors were very excited to show me everything that they had and to help me find a basket with the right colors for Mom. They were also very gracious when I said no and did not seem upset when I bought items from their neighbors rather than them. It was a cool experience. While we were waiting for all of our group to complete their purchases, we received free entertainment in the form of two small boys dancing to music. It was adorable (especially the little guy on the right… he was hilarious).

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On Sunday morning, most of our group walked for about 30 minutes with our new Rwandan friend (the one who originally confessed his love to me) to his church. The music was great and the sermon was in English, so we were able to understand almost the entire thing. The message was investing your time and energy in relationships rather than things, because at the end of the day, it is your friends and loved ones that matter.

After church, we headed over to the Hotel Des Mille Collines (which translates into the Hotel of a Thousand Hills), which is the basis for the movie, Hotel Rwanda. From the front, the hotel appears to be nothing special; however, the pool/cabana area is an oasis in the middle of Africa. We ate a very tasty lunch and chatted for over 5 hours, enjoying the view and cool breeze. We even sat about 3 feet from the actor Isaiah Washington (mostly known for his role as a doctor on Grey’s Anatomy), who was apparently in Rwanda for the annual Baby Gorilla Naming Ceremony (Kwita Izina).

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We only have a few more days at IPRC (the technical school at which we take language and technical classes) before we move on to the next stage of our journey here. On Thursday, all of the students will move to their hospitals, which range from 1-2.5 hours from Kigali. We will have 1 group in the west, 1 in the north, 1 in the south, and 2 in the east. We have our final language exams on Wednesday, so we will be spending quite a bit of time between now and then trying to prepare for those. However, we’ll still likely do less than stellar…

To end the post, a few pictures from around town:

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Finally, here is a picture of the building near to our home stay. They have spent the last few weeks putting in a new cobblestone walkway and painting the base of the flag, the base of the building, and the surrounding flower planters and holders. It’s been an amazing transformation! The left-hand picture is before; the right after.

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CHUK Hospital Part II and Akagera National Park

Bonjour, comment ça va? (Good morning, how are you? – in French)

Our language classes are still in full swing – we will continue with 4 hours a day of language until we switch to working in the hospitals on the 26th. French is going pretty well because, as some of you know, we studied the language with Rosetta Stone before coming here. It has really made all of the difference, and as we later found out in the hospital, a lot of the medical equipment has French labels. Kinyarwanda, on the other hand, is very difficult for us because it is less structured, has fewer rules, and many of the words sound the same (i.e., only one letter difference changes the meaning completely). We are able to exchange greetings with Rwandans, count, and tell time. We can use and understand some words, but it is quite difficult to form sentences. For the most part, however, that seems to be sufficient to get around. There seems to always be someone around who can translate for us if needed.

Our technical classes are completed, so we are now focusing on how to actually work in the hospital during the second month. How do we take inventory? How do we choose which equipment to work on? How do we communicate with the doctors and nurses? This is very important information that will ease our way throughout the second month.

On Friday, we once again visited CHUK hospital to repair equipment. Because there were only a few remaining pieces in the workshop, we ventured to the store room to look at the equipment that had been placed here. Based on the amount of dirt covering every inch of the equipment, I think it is safe to assume that much of the equipment has been sitting idly here for a very long time.

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Some of the equipment had tags to explain the problem, which is very useful for repair, but most did not. At the end of the day, the group had repaired multiple pieces of equipment (an incubator, an electronic blood pressure cuff, a suction machine, and a microscope to name a few).

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Some pieces, such as an infant warmer that we worked on, did not have any obvious problems and may have been placed aside for other reasons. When we plugged it in, it powered on and started warming;the alarms to alert when the temperature is too hot or too cold were working. However, there were missing components to test other aspects of the warmer.

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And yet others, such as an uninterruptible power supply, were broken beyond repair. The power cord on this piece of equipment had been completely cut off, so we found a new power cable and Dustin spliced it to the remaining power cable. After several hours of work, we were able to get the power supply to turn on and supply power at the three outputs. However, the output power was about a third of what it should have been and the same across hot and neutral, indicating a more serious problem that we’d be able to take care of in a day.

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Regardless, we are all learning a lot from getting our hands dirty (literally) working on the equipment. The technicians at the hospital seem very grateful for our help, just as we are for theirs.

After another long week in classes, we took a break on Saturday to visit Akagera National Park along the north-eastern side of Rwanda. Akagera was established in 1934 and is the largest national park in Rwanda. We learned that although lions were previously wiped out, 6 will be reintroduced into the park in 2014. However, there are still plenty of other big animals to see in their natural habitat. As with our previous two trips, we relied on New Dawn Associates to be our tour guides, and once again, we were very happy with the results. We boarded safari jeeps at 5 o’clock in the morning for a 2 hour ride to the park, with about half of the journey on red dirt roads. These “green” banana trees line the dirt road; their red appearance is due to all of the dirt!

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Our guide indicated that this was good preparation for the park, which would be far more bumpy. We were able to put the roof up on the jeep and stand up during almost the entire safari. Here is our jeep group during a midway break.

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This is one of the coolest adventures we’ve ever had! The weather was amazing – cool and crisp enough in the morning to wear jackets and warming up slightly later. The landscape was a little different than we’d seen previously, still somewhat hilly but with a more savannah-like appearance.

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We saw a lot of different animals and the most beautiful birds we’ve ever seen!

First, some of the birds (The Kingfisher, the one that looks like an eagle, is named as such because it dives straight down into the water to catch its prey. We were able to see it in action, and our guide said that the bird would be able to carry away a baby goat! Here’s a Youtube video of a different type of Kingfisher, but the one we saw dove into the water in the same way…it was awesome!):

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Second, the animals:

Baboons (these were very curious creatures and about 15-20 came out from all directions of the forest when we stopped the jeep; notice the baby hanging under the mother baboon on the left):

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Left: Giraffes and impalas; Right: Close up of impalas

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Left: Close up of giraffes; Right: A second family of impalas (these were very common)

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Left: Zebras (probably the most beautiful animal we saw); Right: Water buffalo (interestingly, very far from water)

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Left: Topi; Right: Wart hog (although his family had just run away, this little guy stayed because he had a itch that needed scratching)

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Hippos (these were one of our favorite animals… they are nocturnal so we were able to observe them for a while as they were sleeping in the shallow waters):

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The major downside was the presence of what Rwandans call “fire flies,” or basically what we call horse flies – flies that bite you; these were an ever-constant presence and could even bite through clothing. Also, since we were the second car in the convoy, we took the brunt of all of the red dirt that the first jeep kicked up… so at the end of the safari we looked like we had nice tans, but in reality, we were just covered head to toe in dirt!

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In other news, we had our first taste of non-local food this weekend. Because we typically eat at 9 or 10 in the evening and we had to wake up at 4 am for the safari, we decided to eat a very early (5 pm) group dinner Friday night. We went to a restaurant called Sol e Luna, and we each got our own pizza! As you can see from behind me, we had a great view of the city.

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Today, we ate at a place called “Mr. Chips,” a burger and fry joint that is a 20 minute walk from our house. I had a falafel burger, fries, and coke; Dustin had a hot dog (with all the fixings), fries, and a Fanta Citro (his new favorite drink here).

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After eating lunch, we tried a new bus route by catching a bus near the restaurant rather than walking to our usual bus stop. This story shows just a couple of examples of how helpful and nice the Rwandan people have been. We checked with one bus, but he was not going to town so we kept walking. About a minute later, a young man caught up to us and said “someone asked me to help you… the bus conductor.” So, we asked him where to catch the bus and he showed us the right place. We boarded the bus after asking the driver if he was going to town; he confirmed that he was indeed going to town, but then we heard the conductor saying other Kinyarwanda words after muji (which means town), but we couldn’t understand what he was saying… until much, much later. We passed most of the usual stops, but then, we just kept on going… out of the downtown area. I started to get very nervous, but then this nice woman next to us asked if we typically ride the bus and if we knew the route. We told her no and explained to her where we were trying to go. She immediately knew we were lost so she told us to get off the bus with her. She then took us to another bus stop and told the bus driver to drop us off in the correct area. If not for her, we would have been either stuck on that bus for a while or  dropped off in some far off area of Kigali. The kindness of strangers.

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