Susan Boiko, MD, Blogs From Rwanda: Final Lectures Before Returning Home

Sunday, October 23
Yesterday morning was the first time I had felt confident enough to try and get downtown without a companion or a taxi. It was a warm, sunny day, which made the 45-minute walk to the bus stop pleasant. Since it was Saturday, the streets were uncrowded.  I found what looked like the right bus and confirmed that it was indeed going to “mimouji” or “ville.” A 30-minute ride cost 40 cents. The bus dropped me off down the street from Kigali Tower, a 20 story edifice still under construction that will feature multiple shops, restaurants and, a first in Rwanda, a cinema multiplex. Already a branch of Nakumatt, the supermarket, is on the ground floor.

Three blocks away was the University Town Center, the first mall in Rwanda. Inside there are 3 levels of shops. The entire Center is about the size of a Penney’s in the US. Taking up the most space is Nakumatt, and next door, Bourbon Coffee where anyone who is hungry or thirsty and wants free wifi gravitates to. Luckily I got a table because 15 minutes later there was a line out the door. I had a strawberry smoothie and a bowl of chicken soup. It was advertised as chicken noodle but in reality there were only two or three threadlike noodles in the bowl which was a tasty broth with minuscule morsels of chicken but a nice garnish of diced zucchini floating on top.

I couldn’t get the wifi to work consistently on my Droid so I read “Sketches by Boz” by Dickens and then headed into Nakumatt. Claude had given me an invitation to Innocent’s wedding (the young soccer coach whose home my sister’s family and I had rented a few weeks ago) and I wanted to see what would be good for a wedding gift. I picked up apples and oranges for Betty, then realized I was still hungry. So off to the competition- Simba market a block up the street, which is less fancy but which has lower prices, a bakery, and even a café with a covered outdoor patio with normally a great view of downtown, but  the view was blocked by blue plastic protecting an adjacent construction site.

I decided on fish fingers with French fries and African tea. As I was sipping my tea a huge dust storm blew in, filling my eyes, nose and mouth with grit and toppling potted plants. I relocated inside with most of the other patrons, and shared a table with a young Rwandan woman who was eating her hamburger with a knife and fork. After eating all the fish, but giving up on the giant portion of fries, I made my way back to the bus stop and then to my destination, Kicukiro market. Since it was my husband’s birthday I called him to pass the time on my long walk back. It was downhill and I made it in 33 minutes, a new personal record!

This morning was overcast and at 1 p.m. I’ve been hearing thunder rumbling for 2 hours, with intervals of pelting rain. From the bed where I am typing I can look out the window and see a panorama of heavy gray clouds, neighboring houses, and if I stand up to look out further, the Kigali International Airport.

The bad weather cancels my last chance to go up to Bwiza and visit the people once more.

Karl Deringer, the kind volunteer whose wife works at the US Embassy and who spends so much of his time helping the Bwizans get on their feet, was going to give me  ride up, but with the bad weather the trip today is cancelled. Still, he shared some really good news with me. The Kwizera Dance troupe earned over $200 US for their performance, and the money has been deposited in the bank. Also, a $500 grant has provided the beginnings of a new industry- mushroom growing, which may commence next week.

I had hoped to take Claude and Solange ( a college student my sister’s family is supporting) out to dinner tonight and then shopping for a gift for Innocent’ s wedding, but with the rain we will probably go another time.  It will have to be soon. In 5 days I will be getting on a plane to Brussels and then on to Paris for 6 days, on my way back to the United States.

Saturday, October 22
Today is my husband’s 60th birthday. I called him at 6 a.m. (9 p.m. San Diego time so technically it wasn’t his birthday yet).

I had breakfast with Betty and Dr. Joseph. Betty’s car part has finally arrived after over a month and maybe Monday she will have her car back. It is impossible to shop for large amounts of groceries or to travel anywhere without a car here (just like Southern California!) and it can be a 2 mile walk to the bus stop, just as in San Diego. Even though I still have some computer work to do, I think I’ll put on my hat and take a walk to the bus to downtown, grab some lunch at Bourbon café, upload a few more books onto my Droid (I’ve already read Great Expectations and Alice in Wonderland and am working my way through Dickens’ Sketches by Boz. Somehow Dickens seems peculiarly appropriate here as 19th century London has a lot in common with 21st century Rwanda.

Friday, October 21
The original plan was to leave for the Rwamagana CPFK school at 8 a.m. We were finally on the road at 11:30 and arrived at the school after 1 pm, at which time all the primary students had left for the day, so I left most of the 200 + pencils my Kaiser nursing staff had so generously donated in the school office. The sewing program had moved to an annex a mile up the road, and I was warmly greeted by the teacher and students. They had made over a hundred small, medium and large cloth bags to be sold on the Coffee Rwanda website out of cloth I had chosen in the market over a month ago. The workmanship was top-notch. I gave out some small plastic rulers that I recycled from my practice. I use them once to measure skin lesions then normally they would be thrown away, but I had saved them. By then it was 2PM and with Mr. Kalimba’s sons in tow, we headed to the Dereva Hotel for a delicious buffet lunch. The COPORWA truck driver had filled the trunk with 4 huge stems of green bananas.
As a special treat we stopped at the Italian Grocery store where the drivers and sons of Kalimba had their first taste of gelato- they each chose strawberry and chocolate chip and really enjoyed the unique flavors. Then it was home to Dr. Joseph’s.

Thursday October 20
My last lecture at Nyamata Hospital got off to an inauspicious start. Josephine was ill so I was accompanied by Claude, who had never been there but recognized the pictures from  my posting on Facebook.

Dr. Stephen was to be away for training but he messaged me to arrive at 8:20. For the first time ever we were 10 minutes early and I used the time in the Administration office to ask that 20 Continuing Medical Education certificates be printed. One of the doctors frantically rushed into the office proclaiming, “We’ve been waiting for you since 7:45!” He was not appeased when I told him Dr. Stephen had told me 8:20. There were only a few doctors in the conference room, and the number dwindled further as the LCD projector was set up.  It needed a different extension cord, it wouldn’t project properly… Finally at 8:40 I began the first slide only to hear from that same doctor that the conference room was needed immediately for another meeting and that there was nowhere else in the hospital where the LCD projector could be used. At that moment I longed for the four conference rooms in the basement of Kaiser Permanente Zion Hospital in San Diego.

I packed up my computer and we adjourned to the doctor’s call room, with 2 iron beds and 2 desks. Somehow, more doctors had joined us and 8 crowded around my laptop as it actually sat atop my lap facing away from me and I gave the lecture trying to peek at the screen upside down. The subject was “Skin Signs of AIDS” and it was the most well received lecture yet. Dr. Olivier whipped out his camera phone and showed a patient with disseminated Kaposi sarcoma.

I don’t remember how it came up but at the end of the lecture I started talking about my own experience with breast cancer 3 years ago, the diagnostic process and my treatments. They stared at me, wide-eyed. No one in the room had ever seen a person who had early detection of breast cancer and successful treatment.  Their experience was solely end-stage, metastatic disease. They were thrilled to find out that Partners in Health is setting up and Oncology Service in their hospital in Butaro 3 hours north. I told them that they need to work with their hospital administration to invite more international doctors to Nyamata and that someday they will also have access to this level of care.

Wednesday, October 19
Thanks to the magic of Paterne, the class officer in charge of IT who rigged up Facebook so that he posts a message and it goes out immediately to 50 student cellphones, 20 medical students appeared at the stroke of 9 a.m. for my final 3 hours of lectures: Scars and Scarring Skin Diseases, Eczema, and Acne. In the break one of the students showed me mild keratosis pilaris and expressed frustration that the keratolytic cream prescribed by a dermatologist didn’t cure the problem. Just as in the US, many people don’t understand that we can treat problems but can’t always cure them.

Christophe, the medical student who organized my student lectures will be traveling to Jefferson Medical College in Philadelphia for 2 months starting in December along with two classmates. I hope my daughter who is at Bryn Mawr College nearby will be able to take them to a museum or show and then dinner on a weekend.

At the end of the lectures the students wanted pictures with me and I presented them with two texts that will eventually go in the medical school library- one large tome donated by Dermatology Certified Nurse Practitioner on Therapy of Skin Disease and one of my Pediatric Dermatology texts. Afterwards I heard that some of the students were interested in becoming dermatologists.
Tuesday, October 18
Josephine and I arrived at Nyamata Hospital where I presented the cases I had seen there and at the Christian Medical Fellowship outreach to Gakurazo. This was to be my last clinic with Dr. Stephen.  I shared with him my frustrating experience with MTN. His brother works in their corporate offices so he gave me his phone number.

I gifted Dr. Stephen with one of the bright battery operated lights donated by Kathy and Ted Scott and a battery charger, as well as American Academy of Dermatology pamphlets on common skin conditions.

After hospital rounds seeing both the recovered infant with staphylococcal pustulosis and a new infant with even more extensive pustules, we saw the mother with chickenpox improving- all her lesions were now crusted. We saw a  few people in the outpatient department with genital warts, tinea versicolor and then we returned to HDI for lunch. I began to work on my presentation to the University of Michigan medical students for my visit to Ann Arbor in November.  Josephine, Claude and I made plans to visit the CPFK Vocational School in Rwamagana to pick up the cloth bags the vocational students made for Coffee Rwanda to sell on their website. Students sew the bags and the school sewing program earns cash for each bag which they use to buy cloth and notions for other sewing projects.

Josephine called me at 6PM to say that due to mechanical difficulties the truck could not take us to Rwamagana after all. I called Christophe to see if they could assemble the medical students at the last minute for tomorrow.

Monday, October 17
Still pouring rain most of the day.  I spent the morning finishing the Great Cases at Nyamata Hospital presentation.

My internet flash drive failed the day before so I went to the MTN corporate store in downtown Kigali by a direct bus across the street from HDI. I went with HDI accountant Patrick, who had some other business to transact, and told him to meet me in the Starbucks- like Coffee Bourbon shop in the same shopping center. The experience in the MTN store was unpleasant. I had paid $70 for 2 months’ unlimited internet. It only lasted for 5 weeks because I didn’t enter the code *345*30#yes twice. I was never told to enter it twice, but the manager, “Fred” said I should have known that.  I showed him the receipt. Nothing on the receipt indicated the code needed to be entered twice. The clerk who sold me the package was only there in the evening, so Fred suggested I return then and see what she said. Disgusted, I bought another month of internet service even though I’m leaving in 10 days, because it is cheaper than a cab ride back and forth from Dr. Joseph’s home to confront a sales clerk who probably had no recollection of a transaction a month ago.   Poor Patrick! While all this was going on he waited patiently in the MTN waiting area.

I treated him to a cup of tea and I had an iced mocha. Suddenly 5 famous Rwandan National soccer players walked in. Patrick was thrilled beyond belief. I asked him if he wanted a photo with them- they obligingly posed, and it is now posted on Facebook. I told him in the US if we had seen football stars and tried to get a photo the bodyguards would have pushed us away.
After a short visit to my favorite Rwandan superstore, Nakumatt, where I bought an ice cube tray for the new office refrigerator which still hasn’t been plugged in yet, we returned to HDI for more presentation work

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