friday

Our final day in Africa is a warm and sunny one , the nicest by a long way , but then last days often are !
We visited one of Kigalis district hospitals to meet the pall care team there, the doctor  had played for the Rwandad national rugby team , fly half ?,  the country only started  a nat team in 2001 and in spite of the final score vs S Africa losing 110-2  he gave us a blow by blow account of a magnificent run he made un challenged after he recieved a 'massive impact' so he took people by surprise , with great enthusiasm and pride !!  he made John Motsom seem laid back !!
We went to the ministry where the minister was delayed so we set off in search of a wheel chair. we had been told these were made at a charity orthopaed clinic but after 20 min drive across toen were told they no longer do them but that we could import one from Dubai!
we found another supplier ( the only other one) which was in a park connected to some African heritage charity. They had imported them  but they were quite rigid and we got a call that the minister was ready for us !
We returned, he was a very fierce and scary imposing man and im not sure he really grasps pall care or understands what is happening , but he had a very good strategic plan he told us !  We were a little down cast so took  the team here at the comm centre out for a buffet lunch
This afternoon I am . as you can see trying to write the report while Ruth contiues to look into a few things here at the centre.
Airport in a couple of hours

Thursd

We presented at the 7 am hospital meeting today showing a DVD of the Kenyan hospice that Ruth started  which was well received. My lovely pink lap top has done sterling work and fortunately the volume was just about ok for so many people as the Rwandanese speak so quietly they are use to low volume.  We had several emotional farewells from the clinical director and 'our team', they were terribly excited by the self timer group photo and I was quite relieved I worked out how to do it with out my trusty off spring to set it up! Everyone felt the trip had been a great success and I think so too although we still haven't persuaded John Baptiste to try his wheel chair but at least he's been moved from pall care to rehabilitation status and the staff have a plan! we were asked to see one of the prisoners before we left, all the prisoners wear baby pink 'scrubs' and there are heavily armed guards at the doors , i have to say the prison ward has done nothing to lessen my fear of prisons. The prisoners are allowed visitors in prison but not on the hospital wing ? fear of escape apparently but this chap wasn't running anywhere
We came up to Kigali this afternoon and then I went out on a home visit
Tonight we had supper with Ruth Evans who writes for the Guardian and is out here doing a documentary for the BBC, we had a lovely evening and she asked me to be in a series of debates she is doing on the 145 slot on radio 4 (thats how you refer to it apparently !!) in the new year , i think she was joking but Daddy would smile as it follows on from his favourite '40 mins of news and comments' that I hated at Vicarage lunches ! Tomorrow its 8 am at local hospital and then 11 am at ministry of health and then starting to tackle the report we have to submit of our trip. My Christmas cards have had a wasted trip I haven't even done the As!!
I'm completely out of comfort zone as the only way we could do on line check in was to receive the boarding pass to text on phone , I like a PAPER TICKET!!
Home via Nairobi , touch down for an hour, then change plane in Brussels

wednesday

We set off on our visit in the hospital transport as no private taxi would take us, only 1 hour later than planned, not bad for African time . We are going to use the money the taxi would have cost us to have Joseph's (the hospital soc worker) motor bike repaired as he has been unable to do visits for 2 mths waiting for it to be repaired! The journey started off smoothly enough and we had with us the physio, soc worker , Dr Alphonse ( who didnt want to miss out on the team outing!) , driver and a 'chap who knew the way', Rwamagana's answer to a sat nav! however this small counrty is not called the land of a 1000 hills for nothing  and as we left the main road we were soon  up and down with steep gradients on red earth pot holed tracks, side sitting in the back of the ambulance . The scenary was beautiful, views of the lake , contrasting foliage , smell of eucalyptus trees, goats , mud houses and groups of Africans sat under trees. On route we crossed into another district and had to stop and get paperwork permission to take a working vehicle through! Our destination was to 23 year old  Agnes. She lives in a mud house with her father and step mother. 3 years ago she had a caesarean section from which she woke up paralysed from the waist down , doubly incontinent and unable to sit other than for a few minutes to eat. her husband left and has a new wife but he does let the 3 year old daughter visit. For 3 years Agnes has lain on the floor being cared for by her stepmother and has not moved from there. Her smile was amazing , she was so pleased to see us and loved the English sweets I had and the perfume stick I gave her that was in my bag ,we took the food  for her parents. We were able to check that all her pressure sores were healed and managed to pull her to a sitting position although her waist and hips are v stiff. we asked her if she would like a wheel chair to be pushed outside her eyes lit up. A wheel chair is too expensive for the family. Ruth has some money that has been donated and I measured the door frome and while we are in Kigali we are going to the church firm that makes wheel chairs and hopefully buy one. This afternoon was an entertaining if not exhausting session on communication skills. at one point I was lying on the table in role play !

Tuesday

I gather a more cheerful post is required today ! Our presentation was well received and 1 doctor asked me to e mail her the slides and another asked to come to our afternoon session.
Hermon the german ( he's not german , congolese ) who is the deputy director of the hospital is rather shy and I think is probably hypothyroid , either that or he goes to bed far too late as he as a tendency to nod off- anywhere, so this afternoon I sorted  him , I gave him the pen to write things up on the flip chart , it was painfully slow but he didn't nod off once !! I think the box of miniature heros Ruth took helped, we have been sneaking one out at night and re sealing the box so no one would notice but thought we should take them today as the box was getting  suspiciously low, we still have my box for the last session!
Just flipped onto generator again !
Anyway, todays pictures are on the theme of  resourcefullness, 2 successes , wheelchair  from garden chair and man with oes cancer who has tied  his gastric feeding tube up with  shoe laces, the third is my shower apparently one has to stand in the washing up bowel which then wanders off round the shower tray at will and as the water spray is very small ones body often misses the water completely - polite helpful  suggestions only please
Last night Joseph the social worker joined us for supper and he is very useful for a potted history of Africa, unbiased of course. He was born in Congo , came to Rwanda to work for save the children  after the genocide
Off on a long drive tomorrow to visit a health centre and home visit so early start!

monday

Now Ruth has been into the kitchen and shown them how to make our porridge ( we are the only breakfast guests) the day starts well! Our day started with a trip to the market with Hawa to buy rice , flour etc for our home visit. The lady was a victim of the genocide losing all her family and being put out to prostitution by a step mother where she contracted HIV, she is now in social housing ( government provided) she gets a genocide allowance of 7000RWF per month for her and her 3 children , our shopping for her was 7000RWF (=£7). the 14 year old son is the main carer but lost his business of buying choc and sweets and re selling when his mother was in hospital and he had to pay up front for care (we are not sure if we she should give him re start up costs of £20 as he should be trying to go to school. The 6 minth old baby has been in foster care but the care was not good so she is home now and a benefactor gives the family 500ml of cows milk per day for the baby = 5 x 3oz day feeds for a 6 mth old !! although the 4 year old is delighted to have the baby back home and was playing peek a boo with her behind the curtain. There do not seem to be any toys around anywhere here and you will see the 2 children in the picture loved playing with the zips on my ruck sack , until one bit the other as he wanted it all for himself! It was a heart rending visit
This afternoon we helped Dr Hermon and Hawa discuss with son and daughter about taking their terminally ill mother home to die and removing the NG feed tube and IV. The family cannot afford to keep her in hosp any longer and I am sure it is better for the mother to die at home but the medical staff are not use to discharging people home to die ,they have both been on pall care trainimg but have never been brave enough to put it into practice. we then had to go over it all again with the ward staff
Quite an exhausting day all round
Tomorrow we present our presentation on pain assessment at 7 am to the whole hospital again !
We had the usual torrential down pour but at least it was dry for our visit as we walked there

sunday

Started the day in the dry so we walked to the large Catholic church and joined the service for about an hour , about 400 people there and fantastic singing . we then had a lovey walk around the back of the town and I will post some pics mainly for Elspeth project , wooden scaffolding , mud housing and interesting garden fencing . We had a very windy storm this afternoon and I have spent 4 hours preparing a 28 slide power point presentation in french from the french tool kit. This has been very slow and frustrating . We decided to try and cheer ourselves up with cinammon toast from the menu at afternoon tea time , this was a cross between eggy bread and burnt toast , we should learn and order one between two on untried dishes !!
Nothing else to report today
Home visits in the morning and apparently we need to take rice and sugar with us as a gift ?

me Dr Alfonz&Hawa/ me and ruth working@hotel.Dr Christian at hospice. Out patients at Rwamagana

saturday

we now really are the only guests in the hotel as no one stays here for the week end apparently, the staff outnumber us by about 8;1 and in spite of wearing Miss World type sashes saying customer service they are not big on it! It is not possible to get cold milk at all as they boil it from the cow and never cool it but its so sweet I am not thinking of tea as tea and then I'm not disappointed , its a sort of warm flavoured milk.
Did I mention I have not seen anyone smoking ? Apparently it is only done in the privacy of ones home so as not to upset anyone else, there is this pervading fear of not upssetting anyone else and being forgiving they say its the only way they can live together post genocide
This morning we took a 40 min taxi ride to the hospice of Pope Jean Paul 2nd, theres a very large painting of him in the chapel. Apparently they have to do a lot of trainig of the priests to be spiritual in their counselling and not religious. Its a beautiful place and I think the nuns must have had great fun choosing all different bedding and decore , it reminded me of sister margeretta and her midnight blue ceiling that she loved!
the building is absolutely state of the art from kitchen to family dining area to garden, all provided for by a wealthy German doctor. Dr Christian who is the country lead and the government champion of pall care was very welcoming and asked me to do a ward round with him to teach him things ( he has had a year in USA doing a pall care cert !!) Any way all went well and Ruth is going to help him get the bursary for 2 weeks at St Christophers and maybe he could combine it with a trip to stay with us and visit Mary Stevens
We had soup with garlic bread at lunch and at there was at least a garlic bulb (not clove!!) between 2 slices of toast , but as we said not planning on kissing anyone !
This afternoon we went for a walk, we came across the local market it was great fun , vegetables and second hand clothes , ex  european charity shops, we then thought we would take a short cut and had to be escorted out of an area by a guard , we ended up in some sort of hostel for men , good job we had had garlic!!

friday

A slower day today which has been no bad thing !
We spent the morning in the HIV clinic. Despite it being run totally in French we got alot out of it , the records being in english help
As with all Rwandan set ups it is very structured and protocol driven and no room for individualising for patient need and dare i say a little short on compassion . On paper all areas are covered . A very sad 82 year old gentleman came to clinic who is totally alone,  he contracted HIV from his wife who in turn contracted it from her daughter when she helped her through a home birth,  they all  now dead, but most had a sad tale to tell and a far cry from the lady at Hagley WI who , when I gave the talk there asked , how can we stop the black men having sex !
We went back to the ward to catch up on a couple of patients and have manged to arrange  meeting on monday with the family of the dying lady with the brain tumour to get her home . we  also went back to our young papraplegic , we got him sitting up in the bed . we established that the fear of getting him in a wheel chair as he once 'became unconscious' - presumably fainted after being flat on his back for so long. he is going to be sat up by his carer over the week end . Ruth and I then went into the shops to try and find him a soft ball for hand therapy - we tried every shop and the best we could do was 2 baby rattles. His face lit up when we took them back and he was very keen to practise and have something to do. It turns our the wheel chair at the end of the bed is his , we had been told there was no wheel chair , no one had asked !, We also went to a scrap yard to see if we could find something to make a back rest but no luck
Friday afternoon in Rwanda is national sports afternoon ( = wednesday afternoons in UK schools and unis) so nothing on our timetable
It has poured with rain all afternoon and been rather chilly so we have been at our computers in the dining area , light v dim , several power cuts and we had the last of our chocolate supplies!! and I have been updating my appraisal and recording info for our reports , we are about to try and post someting on our THET google group
2 rather well spoken young english boys on gap year passed through for a cup of tea and chips  on their motor bikes! they got a teapot , I have been having African sweet tea they just asked for English tea and it came in a pot -.............next time !!

me in the community, inside and outside the female ward

well thought I was on a roll there having successfully uploaded camera to laptop then to blogg but I can't seem to repeat the exercise so I will keep you in suspense ( and me )
this mornings presentation had an audience of 70 neither Ruth nor I slept much nor did our porridge (that the make especially for us ) justice but all went well and the french slides were a real help! I have to tell you all though that as they were using my lap top which was with the director , not in view of this pic, the guy at the front is Alphonse, the pall care lead, at the front it flicked to the save mode where it just rolls through all my pics ,,,,,,, this means that those at the front know you all well now and those at the back could see you through the screen curtains !! You all continued to roll round about 3 times, pics of BBQs at chapel st , inc the practice one , pics of croquet , new year fancy dress , you name it ... the director was far too interested in them to flick them off, mildly embarassing !! He loved the screen save at the end of Tower Bridge and explained to everyone how it open up to let boats through!!!
Ward round followed and we picked up some cases for this afternoons discussions , they were desperate for more role play!
They took us to one young man in his 30s who had caught his sleeve on a door handle fallen backwards and severed his spine . He is paralysed from the waist down and has been in hospital for 3 years. we spent the afternoon explaining he is not a pall care patient and hope to start to get him up in a wheelchair and rehabilitated, he has been waiting for 3 years for doctors to come from India and operate,  tragic but we are determined to make progress with him adjusting to life in a wheelchair  and start a discharge plan.
we took our usual end of the day unwind walk and went  behind the hotel tonight , it is a truly beautiful country with green rolling hills and a lake in the distance
supper soon but ordering is easy as we know the menu off by heart!!

wednesday

we have had a busy day , the ward round started at 8 and we saw some very  difficult cases which we then took to the meeting this afternoon. The IT man at the hospital has mended our lap tops and lent me a mouse!(I shared one of the choc orange bars Sue sent me with and he was very excited ,!)
This afternoons meeting was well attended by 4 doctors . a social worker , lab worker and psychologist about half the clinical staff, we also had an audience with the med dorector this am. We lead the meeting by discussing the case of a 77 yr old lady who has a large brain tumour and is in the last days of life but her family cannot take her home as she is being tube fed (pureed food), it was  a very difficult session discussing palliative needs and withdrawing feeding and respecting famly wishes etc . they have read the books but not use to applying pall care and the team is lead by a doctor just 3 years qualified. we introduced role play to them , their first experience and after initial hesitation they really entered into it and it stimulated lots of french/ english discussion, they were rather keen for Ruth and I to act out roles (Too keen we felt!!)
we have spent the evening preparing tomorrows presentation to the whole hospital (50 people) at 7am and i am very grateful to the Matthew to remotely making it look professional and Imogens distance IT advice , we have been e mailing french pall care power point back and forth!!
Our supper downtime was interrupted by the only other european face we have seen who turns out to be a german doctor living in Holland ( on her way to safari) and is a specialist doctor in euthanasia who was an evangelist for it , we were already not pro euthanasia and are now convinced we are right!!
We both thought we should wash our hair before tomorrow  and as we share a tank had to be quick , I also didint want to be caught out when the power went off. we have had several power cuts today as there have been electrical storms today , and tonight was a liitle chilly sat out side for supper ( hear it v cold at home!!)

I am in an internet cafe ! the very nice man thinks he has mended Ruths computer so \i will bring mine tomorrow
The drive from Kigali was beautiful , very hilly green and reminded me of the drive from Abersoch. All of the land was being farmed on a small scale , banans, maize cows rice , fishing. we are high here. althugh there is only really one main road itis very busy with people and local shops, don't think I will be able to find any presents ti bring Back
the hotel is 5 min walk from the hospital
the hotel is a series of outdoor buildings and the interior decor and plumbing is in need of update but the lunch was good - buffet
we had a meeting with the pallcare team at the hosp this am , they have prepared a timetable for us , a combination of teaching , case studies home visits etc days are 730 -5!
we had an interseting tour of the hospital this afternoon and things we could learn from , nearly everyone breast feeds, normal del patients are kept in for 24 hrs and umcomplicated sections 3 days- sig better than at home with the  6 hours and 24 for sections!
the prem baby wrd had no incubators but babies were strapped to their mothers who were resting and the babies had warmth and comfort
it is spotlessly clean
However facilities are v poor, no curtians for privacy anywhere, a child is diagnosed with a brain tumour after plain film and us scan no CT or MRIs, one x ray machine . the doctor that is our contact but is only 3 years post qualification does everything from obs and gynae to surg to medicine and his only post grad trainig seems to be collection of CPD points
There appears to be no other restaurant or eating place other than our hotel which saves us having to decide! No other tourists here, our hotel is just for conferences  really

Rwanda 2

In new room same hotel ! Tomorrow move onto Rwamagana . Spent 9 hours today on home visits hot and dusty but very worthwhile . Helped a family administer medication to their mother by showing them how to crush tabs on a spoonful of honey ,  dispensed medication from car boot , made some useful decisions but will spare you details in written form ! Shall never worry about driving on rough tracks as its am ordinary car that has taken us over very rutted sandy terrain ! Poor Ruth we shared what we thought was a cheese and Tom pizza but turned out to be cold meat lasagne , get the picture ! It was a picnic in the car ! We just been out to an Italian rest as we not convinced there will be similar opportunities in Rwamagana . Have an appt at the government ministry next week so will prob come back up to Kigali on the thurs night . Still can't get comp to work !

Neither Ruth nor I can get our laptops to work so again using phone ! Exhausting 12 hr day ! Moved hotels , Diane our link from rwanda pall care assoc said we had been put there as gov conference in town and all decent hotels booked but luckily found as one for tonight which is much better although prob homeless tomorrow . We attended a 3 hour African Anglican service on the 5 th floor of an office block ( no lift ) gospel choir amazing but interesting sermon on how Moses said it was a sin to be a vegetarian ?? Then we went to lunch with Diane and her family and spent hours talking about problems which I can't put on this site which is not private within pall care arrangements here . Exhausted we left to visit the genocide memorial and museum , harrowing would be an understatement  . After rooms on the Rwandan genocide it took you through similar episodes against Armenians , Jews , namibians , Cambodia  , Bosnia  . We were them accused of presenting a terrorist threat by an armed guard for waiting in the wrong place for out taxi . So in one day my mid 60 year old , 5 ft grey haired companion was accused of being a sinner and a terrorist threat !! We have just had supper with Liz and Mary from THET who have left us numerous tasks as they fly home tomorrow !! Eg hiring drivers to take us out to health centres , trying to speak to various people !! Still Elspeth I am really grateful for the dairy milk having one with bed time lemon and ginger tea provided by Ruth.

Rwanda 0

Ok after fog in Brussels delayed our London departure so we had a rapid run through Brussels , whty are we in EU , only British had to re do security check in Brussels so Ruth had her shower gel confiscated that she had bought after security in uk ! Apparently if we were not British wiykd but have happened
Met at airport by taxi man with sign ! Been brought to a very basic hotel , not the one promised bit it's clean and has mosquito net and cold beer
Group of farmers on plane coming over to help Congolese produce food with anticipated climate change , spoke alot about tractors !!

rwanda -1

its taken me over 90 mins to get back into my blogg so one must not only assume no news is good news but that no news is bloggers IT incompetence!! Had some remote IT help from Imogen
9 hours till I leave and we have just deposited the much needed heater to Elspeth in Reading on the way to Heathrow travel lodge
I hope to share rwandan experiences networks and capabilities allowing

Day -1

On our way to heathrow travel lodge via Reading to drop off much needed heater! And to eat ! Luggage at maximum weight due to large volume of paper resources that are packed but hey who needs to dress to impress ?
It has just taken me 90 mins to find how to get into correct place to write this requiring remote help from Imogen's IT support so no news from Rwanda is , assume,not only good news but the expected failed IT skill of said blogger .

departure-4

Interesting (or not) fact Nicholas has found on the foreign office advice on travel to Rwanda- plastic bags  are banned in the whole country and are confiscated with immediate effect. Highly commendable principle I hear our environmentalists cry but ................... what  am I going to bring my dirty undies home in , they cannot possibly roam freely in my case with any still clean un worn clothes??

departure - 5

with 5 days to go and in attempt to put off packing (which I always hate doing) I thought I  would attempt to set up a blog,  probably pointless as I  do not think there is wi fi where I am staying and power cuts are common place !
Michael tells me blog spots do not rate particularly well but I am looking at this as a sort of communal post card ???
I will leave this here for now send you all links , let me know if you can access it !