Settling in (months 2-3)

Dear friends and family,

I continue to be AWOL, and I apologize for that. The longer I'm here, the more time I spend at work, exploring the countryside, and hanging out with new friends, both expatriate and African. Anyways lots of things happened these last couple months, so like before, lets walk through some pictures which depict some (but not all) of what's been going on

Wow, I realize how far behind I am. We went on a safari at Akagera National Park a while back, me and some other German and British medical students rotating at the hospital. This is probably the best picture I took there. Its "just" zebras, but on this safari we also saw baby leopards playing, 5 lions, and lots of the other typical safari fare. We also got completely destroyed by tsetse flies and rattled by the "African massage" of driving on the terrible road. So it was a mixed bag. The baby leopards were really magical, but we had no good cameras to get pictures of that from afar

Here is Chris, one of the Brits, blowing on our campfire. We spent the night camping in the Park, and it was beautiful. And far less terrifying than my past bush camping experiences, since the campground was surrounded by an electrified fence

 Campground in the morning. Funny thing was we actually bumped into the head American doctor in the ED at the campground. Rwanda is a very small place to work in as an expat.

 I wasn't working when this happened, but this bus rolled off a hill and about 15 of the 30ish passengers were killed as it crushed like a soda can. Everyone soon after ended up at the CHUK Emergency Department. I think mass casualty events are one of the things I most look forward to, being an ED doc in the future. For the record, Rwandan roads are normally super safe, at least compared to their neighboring countries. But when something does go off road in the land of 1000 hills, it tumbles far

 Did I mention Car-Free day in my last post? The main thoroughfare through the city closes once a month to encourage people to get out and be active. People run, bike, rollerblade, and at this plaza, what looks like thousands of people participate in a massive exercise class. Its really amazing to witness and be a part of

 A bike ride up Mount Kigali gets us some fans running along

 Chris and Robin, the 2 Brits, posing with an ambulance (in Kinyarwanda: Imbangukiragutabara) on their last day at the hospital

A final adventure with Chris and Robin and the rest of "Safari Crew" before Chris and Robin set off on their bike tour of the country. This is at Lake Muhazi, I posted pics from here before, but this time when we hiked we actually made it to the top, which was really rewarding

Don't tell Mom, I got a motorcycle. I figured, if the best way to get around the city is on the backs of other people's motorcycles, wouldn't it be safer to drive myself instead of trusting a stranger looking to collect as many fares as fast as possible? The even bigger reason is that there's so much of the country I want to see, and despite public transit in Africa being generally way better than in the US, its still nice to control your own trip and pick the paths less traveled. And its going pretty well so far

Another trip with the "Safari Crew". This is at Lake Kivu, on the border with Congo. Getting there on motorcycle was my first big adventure with it

So I got a message from Alex, an old friend I met in Tanzania when I lived there (we met on Zanzibar where he spent the year learning Swahili, spent Christmas together, had a visit from him at my old field site in Ifakara, but haven't seen each other since). He said "Hey man I saw your pics on Facebook, are you at Lake Kivu? I'm outside Kigali for the summer, lets hang out". So we've been hanging out every weekend since then! This is us walking along together during another Car Free day

Here's another Alex! This guy, Alejandro, was my roommate two summers ago in Uganda. He's back for a summer elective and decided to come spend the weekend. It was really a blast. I'm eager to be colleagues with guy in the future, its been exciting to see 

Here's the first Alex again! After Alejandro left to continue carrying the Infectious Disease department at Mulago Hospital in Kampala, there was a couple days on national holiday in Rwanda, so Alex1 and I went on a trip by motorbike to Byumba, the highest "real" town in Rwanda. It was a gorgeous ride there, and we pushed further off the beaten path to visit Lake Nyagafunzo. It was all good and fine, but the way back we meant to go straight to Kigali, got a little turned around, ended up on some difficult high mountain roads, and somehow found ourselves back in Byumba. Not sure how that happened.

A pig roast back in Kigali at Gardens for Health International, an NGO helping to grow and distribute crops to local farmers to help them diversify their harvests and diets. My friend Eric (who I actually sat next to on the plane to Kigali) was leaving GHI to work for One Acre Fund, and this was his farewell event. I put way too much hot pepper on my meal and my face melted off

These last two pictures are at "Zipline", an NGO that has started using drones to deliver urgently needed medical supplies (currently blood products, but with plans to expand to other things). They have a "nest" now that serves the Western half of the country. Planes go out and drop blood, plasma, or platelets at 12 different district hospitals, which parachute down as the planes return to base. They are expanding to have the planes reach more hospitals, and will eventually open up another nest in the East to cover all rural hospitals in the country. Hopefully someday they will expand to other countries too. The advantages are that not every hospital has reliable electricity to store blood products, some don't use them regularly enough to justify storing the many different blood types that would be needed, and driving the blood out would take hours. Instead, the maximum time for a drop from a Zipline drone is 45 minutes. So cool.

We got a nifty little "iStat" machine to measure labs in the Emergency Room. Unfortunately some times it gets too hot inside, and here Bernard it stepping out to let the machine cool down so we can keep using it. He is one of the senior residents, and I'm collaborating with him on a project investigating the epidemiology of chest trauma at CHUK

Found some new friends who love to mountain bike. This first ride with them was particularly beautiful, but grueling

The Sheetz vs Wawa debate rages on in Africa. Well, just kidding of course, but the more interesting thing about this picture is that this is a secondhand shirt that came from Pennsylvania one would guess. Secondhand clothing is now illegal in Rwanda: the government believes that stopping the import of poor quality charity clothing will encourage the local clothing industry to grow, making more jobs and enabling the country to be less reliant on giveaways from the west

First month in Kigali

Hi friends and family-

I know at least a few of you have been waiting for more contact than I've been giving- sorry about that. Our house just got wired for WiFi so it will now be much easier to put pictures on here, and to use Skype to chat live (funny story about the WiFi installation to come)

Compared with my last blog, this one will be primarily be pictures and brief anecdotes, not lengthy analyses of my thoughts and surroundings. Those find their way into my journal and I'd be happy to share in person.

Thanks for being interested and following along!

Notes:

• EM = emergency medicine
• ED = emergency department
• Kigali = capital city of Rwanda, where I am living
• HRH = Human Resources for Health, the Rwanda-USA collaboration that has sent many American doctors over many years to train Rwandan specialists, who will then, when the program ends, train the next generations of Rwandan doctors
• CHUK = the national teaching hospital in Kigali, where the residency training programs are based. (The initials are French)
• RECA = Rwandan Emergency Care Association. This consists of the EM residents, nurses, and ambulance corps
• Expat= expatriate. Someone living here who is from somewhere else. Most often refers to Westerners, but also people from other African countries

This is the beautiful view from the porch of the house I'm staying in. The neighborhood is Kiyovu, which is a nice quiet place near the center of town and walking distance from the hospital. The twinkling lights at night are beautiful, and lots of birds stop by in the yard

The city is just absurdly pretty

These are the Hash House Harriers. They joke they are a "drinking club with a running problem". Really welcoming fun bunch. Basically each week someone plans a route, and you can run or walk it, then afterwards everyone hangs out at a bar. There's lots of songs and traditions associated with the event, too. And its a cool way to explore on foot parts of the city you otherwise never would

This is Cliff, an internal medicine resident at Yale doing some teaching here in Kigali. On a day trip with some other friends to Lake Muhazi, he decided to ask the waiter for a fishing pole. Before we knew it, we had two bamboo rods and a local fisherman teaching us how to fish off the dock. We didn't catch anything

Even without catching any fish, it was fun hanging out and playing cards by the lake. Other than Cliff in the white shirt, there's John (housemate and medical student rotating in the Emergency Dept) and Alicia (housemate who is a political scientist who will be around for a while)

We also took a hike up into the hillside around the lake. I would credit Alicia with the idea more than anyone; we just picked a path and went, and it was a tough hike but really nice

Here's Alicia and John at a tough rocky part of the "trail" (there was actually no trail by this point)

Back at home, this is the house dog, Sumo, and one of the few cats wandering around. I don't remember her name but she is 17 years old and not particularly nice

This is the place where I bought a Giant mountain bike. The guy holding it is a semi-pro who was hanging out at this roadside shop. He's from Burundi and was telling me previously when there were conflicts, he escaped to safety by riding his bike

Yes, I'm doing work here too. For two weeks there was the EMIT (Emergency Med In the Tropics) conference hosted here with many interesting lectures and training sessions delivered to students and doctors from a number of different countries. In this exercise, we were using software that has previously been used with Olympians and other athletes to perfect their technique (for example, tennis serves); we recorded videos and then used the program to improve intubation technique. That's me on the screen putting a tube into a very sick dummy

One of the nights of EMIT, the conference attendees and EM residents went out to Kigali's bowling alley, Mamba Club. The interesting part about this one is that the pins are all set up manually by a dude at the other end of the bowling alley

On the last day of the two weeks that EMIT was taking place, there was the RECA (Rwandan Emergency Care Association) conference. It was a great mix of African and expat speakers. This is me and Vizir, who is one of the first year EM residents working on my research project here. He's a cool guy and likes to dance in Nyamirambo on the weekends (the part of town most known for Mosques and nightclubs, but I digress) 

I was asked to play cameraman for much of the RECA conference. This is Noah Rosenberg, the EM doctor who is actually heading the ED at CHUK nowadays (refer above for explanations of abbreviations). He's phenomenal. His lecture about the challenges of delivering care during the Ebola crisis reminds me of why I decided to stick with medicine as a career path. 

The Monday after the conference was the final day in Rwanda for Giles Cattermole, a British doctor who has worked here for the last 2 years. It was inspiring to see the EM residents and many other doctors come out to say goodbye, and one really got the feeling that they were appreciative for the role he played in training the first generation of Rwandan EM physicians. I couldn't stop thinking how exciting it must be to be both the residents and the expat doctors working to train them. HRH is truly groundbreaking. In this picture, he is asking quiz questions about the UK, and giving prizes away (by prizes, I mean stuff he couldn't fit in his suitcase) to those who get them right. He gave me a tour book of Rwanda

One of the fun social activities in Kigali is Thursday night Happy Hour at the Inema Art Gallery. Cheap cocktails, great live music, cool art, lively crowd. Later on in this set the older man playing the guitar shredded an awesome solo to Jimi Hendrix's "Hey Joe" with his teeth. Classic

Here's a traditional drum circle from the "Adventure Film Festival" this last weekend. It was unfortunately kind of lame (the Festival, not the drums). I was expecting cool GoPro-style extreme sports videos, but instead it was like home videos of people's travels around the world. Not even sure how it ended up being a big formal event

The Kigali Marathon is supposed to be a particularly brutal one. Kigali is at a pretty high elevation, and is hot and hilly. Despite that, these guys were wicked fast. I meant to do the 7k fun run (which oddly ended up being almost 10k), but so many roads were blocked off around the race course that I got lost and missed the start

This picture is from earlier today. Wednesdays at the hospital are training days for the residents. In this picture, the senior resident Gabin is teaching the intern, Pascal, how to do a cricothyrotomy. That's when someone's airway is compromised and you have to quickly put a hole in the neck

Lastly, remember how I mentioned there was a delay in getting the WiFi set up? Here is a picture of a bit of the fiasco entailed. All the workers were really nice but the process was a bit clunky. The climax of the whole thing was when one, trying to wire the cable through the ceiling, fell through the roof and onto the porch. Luckily he was fine, and now the net is working lickety split