Site Visit: Yeah I’m finally going to write about it

27 Jun

The good news is that I am excited about the work for me at the health center and to work with my supervisor. The trade-off is that I kind of wanted to cry when I saw my future home/where I stayed during my visit. If you’re not interested in the details then that’s all you need to know.

After arriving at the Health Center we headed to my supervisors office, dusted ourselves off and got down to business. I thought of a certain former coworker since the first thing we talked about was the center’s monthly targets and monthly reports related to government performance based financing. Part of my job will be to review the reports for accuracy (so cool for nerds like me and my former coworker). The indicators are numerous and quite interesting. This is the perfect time to boast about the organization I have the privilege of joining. Nyamasheke, the district my health center is in, is the number one district in Rwanda for meeting performance targets. My health center, ranks fifth out of 15 total health centers in achieving performance targets. Something to be excited about for sure. I also learned about the structure of the health center, the different departments, community health workers, and quality assurance mechanisms. Topics for other posts, suffice it to say that it is impressive.

After the meeting I experienced culture shock during a tour of the health center. First of all, pretty sure patient confidentiality does not exist in Rwanda. The first stop was a room where a nurse was taking a patient’s blood for an HIV test. I was happy to see they were wearing gloves but it freaked me out to see them shaking the vial and to feel like we had intruded on something I view as very private. My view of hospitals and clinics is that their environment and practices set them apart from other places in America with great emphasis placed on cleanliness. Not to say that the health center isn’t clean. However, with its concrete floors, open air design, and simplicity it is quite a divergence from the facilities I associate with medical care. I worried a little about exposure to biohazards, particularly during our visit to the lab. During my time there however, I never saw any inappropriately materials or body fluid which is a comfort.

We took lunch at my supervisors then went to the sector office where I met the Sector Executive Secretary and his staff who were all very nice. When I asked him what he would like me to help with, he informed me that they had a problem with electricity (the problem being there is none), and clean water. So maybe I could initiate some kind of project to bring electricity to the community. Dream big right?

Next we visited and had a tour of a secondary school. The majority of secondary schools are boarding schools as well. When I asked one of the nurses at the health center about the reason for this they said it was to help the students focus more on their studies. At home, most have no electricity and have household chores that take away from valuable daylight hours for studying. The headmaster of the school said that there is a shortage of universities since there are only a couple in Kigali they are expensive. As a result, many people attend university I nearby Burundi or DRC. The headmaster hopes to turn the secondary school into a university once electricity comes to the community.

The school keeps pigs and cattle, and even has a system for harnessing the methane from cow manure for biofuel. As we walked past a building still under construction I was struck by the utilitarian nature of the concrete and steel tin-roofed buildings. In my mind I compared this with the American notions of people friendly buildings and ergonomics. The made me a little sad for the students that they might never have the opportunity to appreciate the beauty in architecture or other flourishes I previously took for granted.

As I pondered Rwandan appreciation for beauty we climbed up onto a (unfinished) rooftop platform and I was treated to a panoramic view of my surroundings, Lake Kivu in front of me and the hills of my community above and below behind me. I asked the school secretary what this area was for and they said for taking tea sometimes thus restoring my faith in Rwandan ability to appreciate beauty. After we went to some special teacher building/lounge and had Fanta. There was some conversation which quickly turned into me listening and trying to pick out words I knew.  By this time it was approaching six as well as dark so we headed back to the health center.

By this time I was exhausted and welcomed the idea of being left alone, even if it was in my disappointing house. However that was not the case, two nurses showed up and decided to give me Kinyarwanda lessons. To be fair, in Rwandan culture it is customary to never leave guests alone, which is all I really wanted. They stayed until dinner. After dinner I finally got the solitude I had been craving, I read for a little bit and then fell asleep. Surprisingly I slept really well considering that my bed was basically a plywood platform with a three inch foam cushion that quickly compressed under my weight. By far the firmest bed I’ve ever slept on, I actually think I’ve slept on softer ground.

By now I’m sure you’re curious what’s so terrible about my house. First of all it’s got this post-apocalyptic feeling about it. Granted, it seems like it’s been awhile since anyone lived in it but every single window has some, or a lot of glass broken out of it. I can just see myself slicing off a finger or a major artery on the remaining glass. The walls are dirty and the paint is peeling. The worst part of all is the rodent problem. While inspecting the ‘kitchen’ I got to come nearly eye to eye with a big fat rat. There’s a tin false ceiling and I could frequently hear them scurrying around. Friday afternoon I was in my room and a mouse actually came under the door. Ewwww. Rodent carry disease and worst of all they attract snakes which is NOT something I want around. It freaks me out because they were around so much and there was barely any food in the house, just some fresh produce that the nurse who also lives there had. It’s a duplex and the other side is occupied by my supervisor and another nurse. My worry is that even if I work hard to limit rodent temptation that my efforts will be in vain if the woman I live with and neighbors do not follow suit.

My other concern is privacy. I’m not sure if it’s just because my new set up is different from my host family’s or if there are legitimate privacy concerns. At the very least latches will need to be installed on the doors to the toilet and shower since the doors are not inclined to stay closed on their own. At my host family’s place there is a mud wall that goes around the whole back along with a door we can bolt closed in the evening. Once it gets dark at six the door can be bolted allowing us to remain outside without strangers just wandering by. At my site, my prospective house is a)A duplex and B) Just below the health center right along a road that goes up to the health center. There’s a privacy hedge but no gate and folks have made it a habit to use my ‘yard’ as a cut through, to and from where I’m not entirely clear. I was in my room using the phone Friday afternoon and a woman actually came up to the window and tried talking/asking me for money. Telling her I didn’t have any money, ignoring her, and then trying the subtle cue of saying ‘goodbye’ did not work. I stopped short of closing the curtain in her face as that seemed incredibly rude. After I finished the phone call I opted to take my study materials into the living room where the curtains were closed. A few minutes later the woman walked to the back of my house where the door was open and said goodbye. Her actions still perplex me. Now you know why sheer curtains are on my wish-list. I really hope keeping the curtains constantly closed is not something I will have to resort to for privacy, especially since there’s no electricity for lights. Later when I went to pull the curtain back to put something on the window sill I was startled by a kid just hanging out by my window.

On a positive note, when my supervisor returned from Kigali we discussed my visit and house he was receptive to my privacy concerns. He mentioned there was a gate somewhere that could be closed to hopefully reduce the number of people walking through the yard and using my shower to fill Jerri cans of water. While wrestling with the issue of privacy during my visit I wondered how realistic it was to expect the level of privacy at my host family’s home in a country so densely populated.

As I mentioned, my supervisor had to return to Kigali early Thursday morning for a meeting, with some donors I believe. My health center was built by the Methodist Church. Thursday was spent observing different departments in the health center and learning the names of the staff. Additionally, I spent the afternoon with the supervisor of the Community Health Workers learning more about them and reviewing the diagnostic and educational tools they use.

The goal Friday was to get out and about in the community which proved a little difficult, mostly due to geography. On a positive note, I think I’ve found a running loop. My ‘community’ is in the hills and they really do use every area possible for farming and living. From the main that runs North to South along Lake Kivu there’s a road that winds maybe a quarter of a mile up a hillside to the ‘main drag’ where the shops and restaurants are located. Taking a right leads you past the bulk of the shops/restaurants, through the market and to the health center. Turning left the road splits, up one hill is the sector office and farther up another is the secondary school that I visited. Beyond that there’s not too much to the community without wandering into valleys or up large hills which seemed to be primarily houses and farm land.  After going through the market I attempted to pay a second visit to the sector office and was lucky enough to meet the head of Nyamasheke District, but he and most other people were headed somewhere else and the remainder of the staff were in a meeting of some kind. So I wandered back through the market to the health center.

The market is different from the two here and a little disappointing. There’s a lot of ‘stuff’ for sale, most of it you can buy every day of the week from the shops as well as quite a few clothing vendors. However, there are not many different food vendors. The large Saturday market at my training site has at least five different vendors selling the same kind of produce. At site there was at most two to three, but usually only one for most things. Except for the tiny fish. The good news is that they had most everything I could want and the prices were decent, from my limited experience. The BEST news is that every evening there are women selling big avocados for 100 francs, a good price for sure. One thing nice about this market is that the vendors are organized by what they sell which makes it easier to survey the quality of produce and bargain on the prices. I was surprised with so many tiny fish vendors and the sun shining down on them that the aroma of fish wasn’t stronger in the market. It was bearable until I made the mistake of walking past the tiny fish vendors which definitely triggered my gag reflex.

After lunch with my neighbor/future coworker I followed the road by my house down, found out it connected with the main road and talked to some people. The other thing I noticed was people, mostly men standing around various places in the community in groups based on what kind of animal they had for sale. I saw a group with chickens and a group with goats, a phenomenon I haven’t seen anywhere else.

After my walk I took some time to talk to connect with some other volunteers and study a little bit of Kinyarwanda, had the lovely interaction with the woman at my window. Friday evening I was again visited by my coworkers for some Kinyarwanda lessons.

Saturday, as much as it pains me to say was pretty boring. Tentative plans to visit people with a coworker fell through and I was left on my own for much of the morning. It was nice to finally have some downtime to blog and surf the internet but the battery on my laptop was running low, I had unwisely already finished the novel I brought, and I wanted to save the battery on my phone in case of an emergency on my trip back. So I was running low on things to keep me preoccupied which made me feel like a brat since I had finally had the down time I’d been jonesing for not to mention it seemed like a terrible waste to be bored in a new place.

After lunch I hung around at my coworkers and another came by with her baby. While I was holding him up under his arms and talking to him I felt something warm on my lap. He peed on me! Definitely a consistent danger of holding a babe in Rwanda since many do not wear diapers. I handed him back to his mom, used a towel to try to mop it up and excused myself to wash myself and my skirt.

Some other volunteers headed back from site visit Saturday because there wasn’t anything for them to do Saturday and Sunday and after getting peed on I questioned my decision to stay until Sunday. However, I felt it was important to see my supervisor one more time and it was too late to leave anyways. Luckily he arrived in the late afternoon instead of at six pm like he had originally told me. He stopped by my house to tell let me know he was back and would be in his office if I wanted to talk to him. Later I wandered up to the health center to visit with the weekend staff and talked with him about my experience and the house. I didn’t share too many of my concerns about the house because I wasn’t sure what was a personal concern vs a Peace Corps safety and security requirement. Which turns out was the right move since it’s best to leave such negotiations to my program director.

Saturday night we had a first rate thunder, lightning and rainstorm which I got to watch out my bedroom window from my bed then it was dinner and nighty night time since I woke up at the crack of dawn the next day.


2 Responses to “Site Visit: Yeah I’m finally going to write about it”

  1. leslierunsbham June 27, 2011 at 10:49 am #

    This is fascinating! I love reading this-I cannot imagine how different all of these experiences must be compared to what you are used to. It is so interesting to learn about the school’s methane fuel. Do they use generators in the hospital or just go without power? I have much more to say so maybe I’ll just email. Love you Heidi SUE!

    • Heidi June 30, 2011 at 7:17 am #

      Hey Lu, I might not have made it clear, the health center runs off solar power! They have a couple of solar panels at the center. My supervisor and the accountant along with a few other people even have computers they use. Cool stuff huh? I hope gmail works soon. I want to hear what’s going on in your life!


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