Recalling Addis

It's been a month and a bit since I came home from Ethiopia. Now that I have hi-speed internet, I might finally be able to finish this blog. Since I spent many minutes staring at blank computer screens loading up web pages in multiple Ethiopian internet cafes, I figured Internet blogging just wasn't going to be a part of my Ethiopian travels.

I arrived in Addis Ababa (New Flower) accompanied by an Austrian nurse I had previously run into in Rwanda, Christine. We got our tourist visas in the airport and proceeded to the luggage carousels, where we got the first taste of Ethiopian airport etiquette. Our luggage came without incident, but the procedure for going through customs was slightly unfamiliar to me. It involved the following: Line up, in the loosest sense of the phrase, in front of the lone functioning x-ray machine, then try to wedge a corner of your luggage cart into a clump of unyielding travellers with similar luggage carts. Push harder as the person behind you is pushing their cart into your heels, and then try to step over your own luggage cart as you try to help the woman in front of you pick up her luggage which has fallen onto the floor. Shout "HOLD ON A SEC, PLEASE" as you realize that people are trying to push through three abandoned empty luggage carts on their way to the x-ray machine rather than trying to get them out of the way. Struggle to navigate three empty luggage carts through a crowd of people while making sure your luggage doesn't get pushed out of the queue. Place your luggage on the x-ray machine conveyor belt making sure that you don't get hit by another piece of luggage which is flying through the air and hoping to land in the same spot that you would like to place your luggage. Realize that you need to become a baggage handler person for a few minutes and help others place their luggage on the belt in a somewhat orderly fashion so that you might possibly place your second piece of luggage on the belt. Run to the other side of the x-ray machine, throw your luggage onto your luggage cart and run away to save your ankles and heels from the people behind you who are pushing their luggage cart into you as if you weren't there.

I emerged 45 minutes later, grateful to see my friend Niki's face in the greeting crowd.
"Man, Niki, that was insane over there..."
He grimaced knowingly: "Yeah, with all those flights arriving at the same time, I expected you'd get caught in the x-ray machine rush."

We walk out into the fresh night air and we are accosted by taxi drivers right away. Niki barrels through them and explains to me that those were the yellow taxi drivers who are to be avoided because they are rip offs. We head towards the blue taxis in the distance and the process of bargaining begins the second that the blue taxi drivers realize we are heading towards them. They asked us for 3 times the actual fare to get to Niki's house, Here was my first exposure to the Ethiopian principle of "if you don't ask, you don't get." Over the next eleven days, it became a common theme of my interactions with the Ethiopians I met, and it is definitely a very pragmatic way of looking at life.

The next four days I spend in Addis Ababa with Niki and his friend Kunal's family. During the days I went exploring on my own, walking downtown, taking minibuses and taxis to various sights. In the evenings I met up with Niki and indulged in the many hidden luxuries that are available to the large number of foreign workers in Addis. Being the diplomatic center for Northern Africa, a wide range of cuisines are available if one ever gets homesick.

Addis Ababa

There is only one internet service provider in Ethiopia. One page takes a good 15 minutes to load if you're lucky. I'm lucky today, except that I think I'm supposed to be at the airport checking in at this exact instant, so wish me more luck in getting to the airport in one piece. Hopefully in more peaceful surroundings I can explain why my Ethiopian experience has been CRAZY.

xxoo.

Leaving and having left

To be honest, this post has been the most difficult to write. I have started about five times and stopped because I wasn't sure what I was actually wanting to express about leaving Rwanda. I mentioned that I had mixed feelings about leaving. After a few days of rumination, I think it's not so much mixed feelings, but rather an uneasy feeling of having started something important without having finished another very important thing. While I know that I've done the best that I can with what I had, I strongly believe that my four weeks was not long enough to teach the Rwandan residents in a way that they deserve to be taught. I would really love to come back and spend some more time really settling into the environment and to appreciate the subtleties that never surfaced. Yet I know that I can't commit to something longer until I come home and put the finishing touches on Janius the Anesthetist. I look back at these four weeks as a thought-provoking introduction to what believe I want to dedicate a large part of my career to exploring.

After I get those five letters after my name (FRCPC), I know that I will want to explore other intellectual avenues and start addressing all the "why?" questions that popped up in the last four weeks. Questions like "Why is it so difficult to get appropriately-sized tubes for pediatric anesthesia?"or "why do they run out of painkillers on a regular basis?" or "why can't the patient monitors be serviced?" have complex answers in the developing world and I want to understand these problems better. It's not enough just to go in and say hello & goodbye; I believe there needs to be committment, patience and insight for lasting change to occur. To avoid paving the road to hell with good intentions, I'm seriously considering international development studies, or working in an environment where project management skills are taught, so that eventually I might be able to manage and fund a development project.

The professional epiphanies aside, leaving Rwanda had its sweet moments as well. Avi and I discovered the best indian ever cooked in a restaurant (Indian mother cooking is sacred, not available for fair comparison) at Indiana Khasana. We went two nights in a row, and if it wasn't for our having to leave, we'd probably have gone back regularly until our wallets groaned. Also, it was time to indulge in guilt-free consumerism!

I filled my bags with Rwandan basketwork, coffee and tea but the best purchases were the huge bouquets of flowers that we got. After having passed up Les Rois des Fleurs (Flower Kings), I finally saw them again on the roadside with a few days left to spare. Avi picked up three amazing bouquets of flowers for the equivalent of $5USD. I think I really did squeal, jump and clap my hands when he showed up with them. Please don't tell anyone.

I'm off to Ethiopia now for some exploring and tourism. Hopefully there will be some semblance of a connection there. A plus!

Leaving Already

I am getting ready to leave Rwanda. I'm having mixed feelings about leaving because I'm finally feeling like I am settling in. On the other hand, I am looking forward to leaving because I need to finish the business of completing residency, get some experience & solidify my knowledge more before coming back.

Paradise???

I realized how much of an internet junkie I've become after eight days of not being connected. So in fifteen brief minutes, I am just going to rave about one of the most beautiful places I've seen in my travels.

Last weekend we hopped on a Sotra Tours bus and went 2.5 h westward towards Lake Kivu, the big pond straddling the border between the DRC and Rwanda. Our destination was Kibuye, one of the major Rwanda towns on the shores of this huge lake. It is an up and coming resort town and we caught it before the crowds did (hah!). In fact, the potential is such that all the Kibuye lakeshore properties have been bought up in the space of 12 months.

The place was stunning. No exaggeration, I must have looked like I was walking around with my mouth slightly held open because I’d be muttering “wow” to myself over & over again. Looking one way, I’d see emerald-green mountains rising up around the lake in waves, one range after another. The other way, I’d see this silver lake with some definition of "picturesque." For example, two fisherrmen in a wooden canoe paddled out onto the water during the sunset. They cast their net into the water with the sun setting behind thunderclouds in the background, so that they were silhouetted against the water. I took a walk in the morning and just wandered along some dirt paths lined with eucalyptus trees, flowering jacaranda trees, palms, laurel bushes, bougainvilleas, etc. and then the view opened up so I'd see Lake Kivu in blue, green and greys framed by all this blossoming. All this with no cars, no air pollution, just a quiet clean breeze and chirping birds. I could have been in a travel commercial, it was so perfect.

The perfect hotel/resort we chose to have breakfast in also offered the obligatory boat ride to some islands. They took us to a small island with a small restaurant and a huge sound system blaring happy Ugandan music. Since it was a small island, there's not much to do there except eat, drink, take pictures, splash in the water and watch the resident pet monkey chug orange Fanta. We were joined by a boatload of Kigalionians, who took a great deal of group photos all around the island. I walked by and was promptly mobbed and roped into the middle of the picture-taking frenzy. In the flurry of Kinyarwanda, I catch on that they wanted a picture with the 'mzungu.' So that makes 15 times since the beginning of the trip, Christine.

I reluctantly boarded the bus back to Kigali on Sunday afternoon, really wanting to feign sickness to stay in Kibuye for another few days.

Weekend Wilderness

I must be long-winded, becuase I still haven't even talked about my weekend. It was great since my friend from days of yore flew down from Beirut for 48h to visit me and see Rwanda.

I am kinda falling asleep as I'm typing so for now I'll be short with the breath...

Friday afternoon we went to what the locals call Gisozi, the Genocide Memorial Center. A powerful experience especially because it's almost impossible to reconcile today's clean & peaceful Kigali with the images of horrors that were posted up in the exhibit. I struggled not to cry openly at the video testimonials. It was especially difficult when I entered the room that contained thousands of photographs that relatives donated to the center in memoriam of their loved ones who died so senselessly. The center's gardens and its views overlooking the other hills of Kigali are fabulous; it was fitting to have the multiple large stone burial vaults there. Some had flowers strewn on top from loved ones who came to visit. It hit me that each vault must contain thousands of victims each.

That night we balanced things out a bit by opting for frivolity. Elias, Chief and Herbert wanted us to go to the Executive Car Wash for food, then hit the hottest place in town, the New Cadillac. The Car Wash had great roasted goat & pork, but the chicken was the best. I have never before tried to bite into a piece of meat and had it bounce off my teeth. That chicken did exactly that and I am very sure that it was not made of rubber as a joke. Needless to say, the chicken was left pretty much intact. The meat was great but unfortunately the service was silly. We asked for salt at the beginning of the meal and got it with the bills. When we checked the tab, we found charges for things we did not order, and the charges for the two dozen beer that we did order weren't there. I can only hope that they just gave us the bills for another table...

I must say that the highlight of the New Cadillac was the glow-in-the-dark carpet and the black light. Black lighting in African clubs are an interesting visual phenomenon since you saw mostly teeth and light shirts grooving & grinding away but sometimes you couldn't really make out the person that belonged to the teeth and shirt. It was trippy, especially when drunk and tired.

Four hours later, we dragged ourselves out of bed and heaved ourselves into a jeep for a mini-safari at the parc nationale de L'Akagera. Although the guidebook was not particularly excited about the wildlife scenery there, I still got to see animals that I'd never seen in the wild before. During four hours of bouncing up and down dirt roads in a 4x4, we were lucky enough to spend some time watching giraffes, various antelope species (Impala, Waterbuck, etc...), hippos, baboons, warthogs, Marabou storks, egrets and a fish eagle.

My favourite animal encounters in that brief time have got to be the giraffes & the hippos. Up close the giraffes were beautiful and huge, but my favourite thing about them was that same characteristic unimpressed ruminant look that I recgnize in the cows from back home. Somehow they remind me of a bubble-gum chewing attitude-laden punk teenage girl. The hippos I didn't get to see in full glory as they stayed safely in the water. That may have been a good thing since it muted the smell that they are supposed to have. We parked the car next to where we saw them surface a little, in hopes of seeing them actually come back out of the water. They didn't, but I got to see them do this crazy ear spinning thing which I assume is the best way for them to get water out of their ears. I think humans should also be able to windmill their ears at high rpms as it would be such a useful way to get water out of your ears after swimming, and it'd be a great trick to impress at parties. I'm glad there were no repeat incidents of angry animals charging at us (Ecuador 2007.)

The weekend was good fun, it was fabulous to see my diplomat friend David again and see more of Rwanda.

Days in Rwanda

Already in the blink of an eye half of my stay in Rwanda has passed. I think, how will I describe how it has been so far??

After two weeks, I am finally settling into a routine. During the weekdays I wake up around 5 am (because people start to stir and because of the rooster calling) and sometimes I actually get up and go for a short swim in the pool. Other times I roll over and sleep for another hour until I really need to be up. By around 6:45 am, the hospital transportation arrives to pick us up and take us to the hospitals in which we are supposed to be teaching. Mondays and Wednesdays are spent at the CHK (Centre Hospitalier de Kigali), Tuesdays are at the King Faisal Hospital without fail. Who we get as the morning driver is always a nice surprise, as it seems that the Faisal and the CHK have difficulty communicating with each other about who picks us up on what day.

Thursdays & Fridays are a bit more variable. It depends whether or not we are in the south of Rwanda at the university campus. If we are in Kigali, we spend one more day each at the CHK & the King Faisal. This Thursday & Friday we will go out to Butare, the university town in Rwanda.

I start my day by giving short 30-45 minute presentations in French to various groups of nurses who work closely with anesthetists. These are the ICU, Recovery room and nurse anesthetists. After finishing those, I suit up and enter one of the operating rooms to teach the residents.

The type of operations done at the CHK, the main public hospital in Rwanda, are similar to those I would expect to see done in a community setting. As expected, all the operations are done with stainless steel equipment that has been re-used many many times since the sixties, in simple rooms that often serve more than one purpose. For example, the ladies change into their scrubs in a small 5' x 3' area at the back of the anesthesia office. While the techs upload Rwandan music videos or English TV shows dubbed into French on the computer, you change behind a green drape that is the partition for the ladies' changing area. Hung at eye height, everyone can see your head and figure out you're changing, but that's not a big deal. It's simple and it works.

After donning the green habit, I now have to find myself an appropriately sized pair of white (why white i don't know) OR clogs. Most of the time the women's clogs are gone because most of the anesthesia techs are women, leaving me the large men's size 8 white clogs. Thankfully it doesn't really pose a problem because I don't do much running around anyway. The pace of the day is such that there is no need to do so. Hats and masks are not disposable and made of the same heavy green cotton that the OR scrubs are made of. Since no one can breathe through them, most people just cover their mouths with the masks. Some just don't bother pulling them over their faces. I gave the masks a trial period of one week and after feeling suffocated after two days, I gave in and used the disposable ones brought from home.

There are usually 3-4 small cases or 2-3 big cases booked per OR per day. The anesthesia technicians usually see the patients beforehand and fill in a patient information sheet the night before. The pink info sheet often has good information but curiously all patients end up with the same summary assessment score even though they're not in the same state of health. Also, everyone's physical examination is remarkable in its unremarkableness. It seems that no matter how many health problems you have, your bravery alone will make the you healthy enough for surgery.

The patients enter unclothed by wrapped in a large dark green sheet that also is made from thes same material as the scrubs. Most of the time, I am flabbergasted and impressed by the calmness of the patients who have no idea what to expect from a general anesthesia. An intravenous goes in, a mask is put on, medications are given, and off they go, just like they do here.

The intra-operative teaching goes on until noon, when I leave to get some lunch with Avi and we get ready for afternoon teaching, either a lecture session, or return to the OR. When we're at the CHK, we indulge in a superb restaurant called Karibu ("Welcome!" in Swahili), which has a great lunch buffet for the equivalent of $5 CDN. They often have French news channel on the TVs, so while eating it's a chance to catch up on world events important to the French. After finishing, we roll back to the hospital, fighting the onset of the post-prandial coma. The King Faisal provides us with hot lunches in their cafeteria, a definitely nice perk.

The afternoon teaching sessions are interactive and we've focussed mostly on basic airway assessment and management. These sessions have lasted until five PM, then the day is done. We call a hospital transport and often get them to drop us off at one of the major grocery stores before we head home.

That is how the first half of this month has flown by. I can't believe that this upcoming weekend is already the last one I can spend here!!!

The KHI Guesthouse Part 2

Ok, now that my magic fingers have repaired the internet connection, I can continue with the people in the KHI guesthouse.

Larissa and Veronique, the Flemish Belgian occupational therapy students. They're here for 3 months in total, both younger than 25. They have my respect for coming out here and doing the best they can, from trying to make fries to trying to provide occupational therapy to cerebral palsy kids without any guidance at all. Apparently, I share a roof with 66% of the number of occupational therapists available to Rwandans. To add to their experience, they don't speak a word of Kinyarwanda or French either, so their work has been made even more difficult with the language barriers. Despite all this, they supply the house with giggles and warbles everyday; you know they've come home because you can hear characteristic Flemish warbling and then a bunch of giggles and laughs.

Larissa is the older one, a bit more reserved but has a great sense of humour and her laughs are the ones I hear the most. We cooked dinner one evening and they were hanging around for some conversation. Larissa was leaning against the wall on her right shoulder and just listening to Avi, Veronique, and I chatting. Suddenly, I see her slide and recover from the slide-fall and then she pushes herself back up with her left hand, like you would put back a book or something heavy. If my description is hard to understand, it's because what she did was rather hard to understand. I just stood there looking perplexed for a second and then started to laugh at her because it really just looked so hilariously retarded. She joined in.

Veronique is the motorcycle & horse-riding-Scout leader-kinda badass-smoking-ACDC-lovin' 20-year old of the duo. She's the one who told us that she spends five nights a week at a pub, but only drinks two of those five nights because she's the designated driver. She's sweet-looking enough that I believe her. I haven't seen her do anything retarded, I suppose she's just too cool to do anything like that while sober.

Finally, Rose is a nursing and midwifery instructor from Kenya. She is an older lady whose frizzy hair is an indication of her frizzy personality. Her frizziness keeps her from socializing with the rest of the house as she becomes easily overwhelmed when things depart from the routine she is familiar with. It also doesn't help for her to be born with a voice which borders on screeching while she voices her discontent about the state of the kitchen, when she phones home at midnight and yells into her cell phone, or when she reminds Herbert that he should go to church with her on Sundays. Thankfully, she has a good heart and isvery courteous when she wants to use my computer to check her e-mail. I don't think the house would be the same without her.

So, there you have it, my housemates in a nutshell. I now must seek shelter from the mosquitoes...

The KHI Guesthouse Part 1

I have to say that so far, one of my favourite things about this trip is getting to know the people who live, come, and go in the guesthouse. There are a total of eight rooms, most of which are occupied by people who have been here for more than a week. I am gradually getting to know them and they are quite the colourful bunch.

Dr. Dibal Wendali, or 'Chief.' I kept calling him Wakari, which means 'hiker' in Swahili until one day I heard his friend Herbert call him Dibal and I had to ask him again what his name was because I was sure that he wasn't called "Hiker." The Chief has been here from Nigeria on and off for the last two years. He teaches medical laboratory science at the Kigali Health Institute and is the veteran amongst us. He is aptly named 'Chief' as he carries himself with stature and poise even as he comes down the stairs in his Nigerian nightgown and blue plastic flip flops. Although he can look severe, even bordering on grumpy, he's actually quite generous and open. I find his frankly-stated opinions the most entertaining of all.
For example, after our mishap with the drivers, we spoke to him about what happened, and in authoritative tones, he gave us a breakdown of costs that he incurred on the same trip that we had wanted to do. Seeing as he was quite knowledgeable about travelling in Rwanda we started asking him about other trips, especially what he knew about gorilla trekking. His response was: "I don't understand why you would pay $500 USD of good money to see some apes eat and scratch themselves in the forest. This gorilla business, it's all a bunch of bullshit to me." Avi & I looked at each other and grinned.

Dr. Herbert, physician lecturer from Zimbabwe. Slight in build, friendly and polite in nature, but seemed to be reserved and be quiet. That opinion changed over the last few days. Over the weekend, he and Elias (see below) brought their women home and partied continuously. I didn't see him on Monday, but we did see him on Tuesday when we had our first guesthouse communal dinner.

As he came down the stairs with a lost look on his face, we invited him to sit down and eat with us. After I asked him how his day went, he said: "We had to administer our first practical exam to 50 students today. It lasted for six hours. and I had such a HORRIBLE hangover." I started to giggle, and I said, "hey, I think you need some more beer now as you know that it is a cure for your hangover." Of course he took some. Over the course of the dinner, we started making fun of one of the young Belgian girls for being at the pub all the time. She defended herself by saying that although she was there, she never really drinks because she's the designated driver. Herbert pipes up, "Well, in Zimbabwe, we all drive when we're sloshed. I don't even know how I even manage to park the car half the time. It's really common in Zimbabwe, we all just learn to drive drunk."

Elias, another health professional who is lecturing for the Kigali Health Institute. He only stayed a weekend, en route from Butare to the Kibuye campus up north. You could tell he was around by listening for a high-pitched, full-bellied giggle-chuckle that matched his round, grinning face. He kinda reminded me of a Care Bear.
During the weekend he was here, the only real interactions I had with him were just brief "Hi, what are you up to today?" type exchanges as he passed by me studying furiously in the living room. Nonetheless, my lasting memory of him will be the time he burst into the study room in which I was reading, dancing away like James Brown. With a ball cap pulled over his eyes, a bright lemon yellow TANZANIA soccer jacket on with complimentary dark sports pants, and prominently gleaming white ear plugs, he sidesteps over to me at the desk. He stops dancing for a few seconds, pretty much yells: "I am SO happy, I love this music from my country!" and jams one of his earplugs into my right ear. "Isn't this such GREAT music?? It makes me feel SOOO good!" as he's bopping his head up and down next to me, snapping to the beat and just grooving for the both of us combined, as if he was in the middle of a dance club. For me, who had been sitting for several hours in silence and concentration trying to understand more anesthesia, it was a mild sensory overload. I saw him later on that evening with the ear plugs, a leg draped over the armrest of one of the sofas in the living room as he waited for a friend to go out with him.

Vivian the physiotherapist from Zimbabwe. She was the first person I met when I arrived October 5th, completely sleep deprived and confused. I can best describe her as a female african version of Santa Claus complete with mischevious smile, a hearty, jolly laugh, and lots of rolypoliness. I didn't get to know her much because she was evicted from her room at the end of the maximum stay of 3 months at the house, but it just seemed that all was well when she was around. Even while she was complaining, she was still smiling and laughing infectiously. Hopefully she'll be back for a visit.

Next installment: the Belgian girls & Rose

Mzungu!

Prior to leaving, my good friend Christine had asked me to keep track of how many times I was called "MZUNGU" during my travels. "Mzungu" from what I understand, is Swahili for "white person," and I believe that it has the mildly derogatory connotation kind of along of the lines of "ooh-look-at-that-clueless-little-white-foreigner." Or maybe it doesn't. It's the first time in my life I've actually been referred to as 'white' and probably the only time. I'm not comfortable being singled out because of what I look like, but then again, I guess there is no harm in being honest and calling a mzungu a mzungu. In any case, as an apparently rich mzungu, you live in a special financial universe in which prices for all things are inflated by 20 to 8000%.

The most striking example of this came yesterday morning. Avi and I were thinking we should get out of town for a short day trip somewhere. We had not had the time to do the proper sleuthing, but we had heard from previous volunteers that it was not too difficult or expensive to hire a driver. Through chatting with hospital employees, we found someone who was willing to take us this weekend even though it was quite last minute. So at 8 am on Saturday morning, the driver and his employer show up to pick us up. They park the car, get out, and start to chat pleasantly with us about whether or not we should go to Kibuye or Gitarama, both of which are around 130km away. We decide that maybe Kibuye sounds like a nice quiet place to spend the weekend, so all that's left is to find out how much it will cost.
"So, how much will this cost?"
The employer looks at us and says, "$500 USD."
I think Avi and I dropped our jaws at the same time. I ask "For the weekend??!?"
"Yes, well the fuel alone is $100 USD."
"Ok, so what is the additional $400 USD for?"
An awkward silence ensues. That pretty much said all we needed to hear.

After some profuse apologies for getting them to wake up so early and for underestimating how high the gas prices and cost of living is in Rwanda, we say goodbye to the drivers. As they drove off, we shook our heads and wondered whether anyone else had fallen for that. It's too bad their greed had gotten the better of them; had they proposed something like $150 USD we might have gone for it and they still would have made a profit on us. Anyway, I'll be sure to put out a subtle gentle warning out on this dude for the CASIEF volunteers who come after us.

Mosquito vs, Janius 82 to 1

I hate mosquitoes. I hate them more now because I have bites on my big toe joint, the underside of my thigh and on my boob. Freaking hell, I have a bite on my BOOB. I've never had one there before and I never want that to happen again. AAARRRRRRGHGHGHHG.

Visitor & Teacher

I am nearing the end of my first week in Rwanda, and I am on the steep part of the learning curve of not only how to live here, but how to be a teacher. It's been challenging for two main reasons. First, I am an R5 nearing the end of my training and feel compelled to convince myself that I am able to run my own room. Thus coming to Rwanda as a visiting resident teacher, I have had to hold myself back from doing things I have come to do pretty automatically once I step into an OR.
Second, I've realized that by being a teacher you come to see your 'knowledge-territory' clearly. Having to answer good questions or explain a concept in a different way in fact showed me what I myself understood. In essence it's been an exercise in patience both with others and myself. Difficult, but definitely a welcome challenge.

While at times draining, the best part about being a teacher is seeing those light bulbs light up, hearing those gears mesh & start turning inside the students' heads. In addition to teaching the anesthesia residents, Avi & I have also been asked to give short teaching sessions to the anesthesia technicians, the recovery room nurses and the ICU nurses. On Friday, I gave a 30 minute talk to the ICU nurses about the basics of resuscitation, the famous "ABC" algorithm. For the non-medical personnel, this scheme is considered to be the basic tenet of resuscitation, where in order to prevent someone from passing away, you need to establish an Airway, assess and support the patient's Breathing, then assess and support the patient's Circulation.

After I started, it was clear that the nurses had read about assessing the ABCs but only as an esoteric curiosity in a book. However, once we started to discuss an imaginary case, I saw that most of the nurses already instinctively understood what the algorithm meant. It was just a matter of helping them to organize their thoughts in a manner that would be practical and useful for them. We worked as a group to manage the imaginary case, the nurses managing the patient and me making choking and snoring noises while scribbling on the whiteboard. At the end of the half-hour, the grateful sincere smiles and the repeated requests to come again tomorrow morning were all I needed to be on cloud nine for the rest of the day. I felt like I had shared superbly delicious chocolate with them.

Living in Rwanda = more patient, smarter, happier

I believe that living here makes you a better person in the end. Why? Because the way things work here requires you to 1) laugh about everything, 2) not expect anything to work in the way they might appear to work, 3) be creative and resourceful, and 4) to practice the art of waiting.

For example, returning to my house requires that I convey a set of instructions to the driver instead of just giving him my address. The guesthouse actually doesn't have an address, so I have to memorize how exactly to get home because sometimes the drivers don't know where I live. So, I live in Kiyovu Rich, on the right-hand fork of the road with the MTN kiosk and large series of potholes. It's past Thousand Island Expeditions, across from the European Union houses, but near the French embassy. That's my address.

Once I get home, I fill the kettle with water from the tap and manage not to get soaked because I know that turning the faucet any more than 3/4 of a turn will result in a sudden increase from a trickle to a major splattering torrent. To make a cup of Rwandan tea (which is superb), I begin a quiet bonding session with the kettle. Basically if I leave, the kettle stops functioning. I need to hold the "ON" switch down with my thumb until the water boils. Sometimes I'm lucky enough and the switch sticks so that I can step away to gather the ingredients for dinner. I have to go to two fridges, because I have food stored in both the refrigerating fridge and the not-so-refrigerating fridge. The whole guesthouse has to share both fridges and the cold fridge is getting full, so we have to put some of the stuff in the warmer fridge. To use the microwave, I need to grab a universal adapter from my neighbor so that the three-flat-pronged plug for the donated microwave can be plugged into the two round outlets. Needless to say, things take a bit longer to do than I am used to, so now I have to go 'pole pole' (pronounced polay polay, means slow slow in Swahili). THankfully the internet connection works without a hitch.

Newly Potted Plant I am

Have you ever seen a newly repotted plant? If so, it looks sort of awkward, with dirt on its leaves, a couple of stems bent, mildly limp and conceivably shocked. You know, however, that it's going to be ok in a matter of days. After approximately 48h of arriving in Kigali, I am feeling what I imagine a newly repotted plant might feel like if it had the ability to feel. Thankfully, I am assured by all my housemates that these sentiments are quite normal.

That being said, the people here in Rwanda are unparalled in their grace and kindness. I have yet to meet a rude Rwandan. Everyone including random passengers picked by the hospital car driver reach over to shake your hand, introduce themselves and wish you a wonderful evening even though they have just met you five minutes ago. I especially love their smiles. Even more exciting was meeting the Rwandan anesthesia residents over the past two days. It's only been two days, but it's obvious that they are all thirsting for challenges, wanting to know more, and ready to have fun doing it. Moreover, they are wonderfully generous, warm, humourous, grateful and open. Meeting them makes me feel so privileged to be a part of this initiative, and I know that I have a ton to learn from them as well.

The country is beautiful. For a person who loves flowers and colours, the abundance of hibiscus, jacaranda trees, rhododendrons, bougainvilleas, and other unknown and exotic flowers is amazing. The horizon is layered with misty grey outlines of hills. Terraces of tan and light brown buildings drape over the Kigali city hills, and all this is visible from our guesthouse. The cleanliness of the streets and the well-paved roads puts Montreal to shame. I am really looking forward to seeing more of Kigali and Rwanda in the next few weeks.

As well as getting to see more of the country, I am looking forward to getting used to some of the idiosyncracies of living here. These idiosyncracies are both the source of laughs and tears...

Frodo-like, perhaps?

Instead of trying to give you a play-by-play of the Kilimanjaro ascent, which would really just involve descriptions of walking slowly with tiny steps, I'm going to do it in concise heading form a-la-anesthesia style.

1) Challenging, but not as much as was the Cotopaxi ascent: (As I write this, I think, "I voluntarily paid large enough sums of money to subject myself to subzero temperatures and low-oxygen air just for...bragging rights???)

Reaching the summit of Kilimanjaro was thankfully a slow hike on gravel and stones as opposed to wading up a snow-covered glacier. It made the ascent easier but the thin air was still thin enough that I started to notice that I had to actually coach myself aloud on how to walk properly, that I was somewhat more light-headed and irrational than normal, and that the breathing muscles that I never noticed started to protest from the effort I demanded of them. This time around though, these sensations weren't surprises. I just accepted them like you would a grouchy elderly neighbor that visits at bad times. I had already experienced the shortness of breath, the biting and icy winds, and the frustration of losing your headlamp light already while on Cotopaxi. In fact, if these things weren't present I would have started to think that something was wrong with the whole experience of summit-bagging.

The eight-day Lemosho route was perfect since we only hiked a maximum of 6-7 hours on any given day and rested for the remainder of the time. This was a comfortable way to acclimatize and in fact I was lucky enough to have only a day of altitude headache. Actually I was lucky enough to not have any illnesses, altitude, musculoskeletal or gastrointestinal. I highly suggest sacrificing a small rabbit to the mountain gods before embarking on a similar expedition as it worked well for me.

2) Lots of people, especially Norwegians.

Kilimanjaro has become a very popular mountaineering route for many people and so on any given day, there are probably more than 1000 people camped out at various campsites on the wide flanks of the mountain. This was especially evident on summit night, when the final stretch from 4600m to 5896m looked like that scene from Lord of the Rings when the Elves decide to vacate their country. During short pauses, I looked up and saw the glow of hundreds of LED headlamps snaking up the slopes looking like strings of while Christmas lights. It was beautiful for about 15 seconds, after which all tendency to reflect and enjoy the scene was smooshed by the chills that set in from inactivity.

Among all these people, it was mildly eerie that the vast majority of people with whom I ended up having the chance to socialize were from Norway. Avi and I shared a bus with a group of 10 from Oslo and ended up camping close to them throughout the trek. At the first campsite, we camped next to five other Norwegians whose hoots and shrieks and cheering during card games made Superbowl parties sound lame. Then Avi ran into another group of seven Norwegians that were on the same airport transfer bus that he took, one of which can brag about having had a doobie on top of Kilimanjaro. Then after perusing the campsite registers, I noticed at least 20 more had passed through in the last three days. That begs the question: in a country of 4.5 million people, who's doing the work in Norway if most of them are hiking Kilimanjaro???

3) "Duuust in the wiiiind/All we are is dust in the wind" - Kansas

I have never been so dusty in my life. I could have had a dust-cloud competition with Pig Pen by Day 3 of the trek. While it was mildly annoying to my OCD personality component that my hands were dirty AGAIN within five seconds of washing them in water, I would much rather wallow in dust than in mud. On similarly positive notes, the dust made washing very satisifying, as you could wipe away that dust from your skin like those women did on those Lysol commercials from the 90s. It also made blowing your nose quite the interesting experience.

4) 4-star Camping Experience.

Despite all the complaining, the trek was definitely organized to maximize the comfort factor as much as they could. First, we had porters to carry our gear, a kitchen tent, a mess tent, and fresh (read: Heavy) foods such as eggs, tomatoes, oranges, avocadoes, meat, etc. It's hard not to be in awe of the physical strength and endurance of the Kili porters who came up with us. You really can't complain about being tired when people carrying 6 foot wide loads weighing at least 20 kg on their heads run by you on the hill whether or not the slope is going up or down. These guys generate a breeze as they come by so you have to get out of their way. I can see how momentum might play a part in helping the porters get from one place to another.

The only major difficulty marring the 4-star experience were the outhouses. Let's just say that going to the bathroom became a precision art. There were new outhouses constructed for the tourists just to lessen the stress, but even these were not really any different from the "Porters Only" outhouses. If anything, the ones reserved for the porters were probably less disturbing since those guys have a had a few more years of target practice in the loo.

5) I DID IT!!!!! I climbed Kilimanjaro!!!!

At the end of the day, I don't regret a single moment of it, especially when I reached the summit at the exact moment that a sliver of red sun burst over the horizon. Although my sides, throat and stomach were burning from breathing hard, I had to let out a huge long yell of relief and pride after pushing myself to the limit. Of course, my limits were REALLY tested during the descent, which consisted of 4.5 more hours of hiking downhill...

Low battery, will return soon...

Too much beer

This is about the fifth time I've attempted to close Firefox down so that I can nap a little and recuperate some of the sleep I lost last night. Note the attempts were unsuccessful because I am still writing.

I just wanted to say that I am happily sitting in a bed in Room 3 of a guesthouse on the hills of Kigali somewhere surrounded by: 1) gated embassies, 2) Radio voices speaking in Kinyarwanda, 3) whoops of laughter from the Vivian, the zimbabwean physiotherapist living in room 7, and 4) little bird chirps.

Since I'm trying to stop blogging, I promise that stories about the Kili ascent, Norwegian invasions, the imprecision of Precision Air ("Tanzania's Finest"), and the arrival and first day of teaching at the Centre Hospitalier-Universitaire de Kigali at 7 AM will follow in the next few days.

Moshi Moshi

Hello from Tanzania!

I am here safe. I thought it wasn't going to happen after having stood in line for 2 hours waiting for KLM to deal with a delayed plane arrival, but I am here, intact although slightly sleep-deprived. Perhaps the sleep deprivation prevents me from accurately describing what it feels like to be here in Tanzania, but I think it has more to do with feeling very keenly like an alien.

It's not that these experiences are new, but rather it's the shock of rediscovering it all, this alternate universe that everyone lives in except us. I thought to myself "here we go again" as I 'rag-dolled' in the front seat as our wagon careened over bumpy dirt roads to the hotel last night, struggled with the non-existent hot water that barely made it out of the shower head, and I inhaled the oh-so-healthy smell of exhaust and dust while walking into town this morning. Despite it all, I was grinning like an idiot, loving the smiles, the waves, the flashes of bright colourful garb of women and their children, the glimpses of everyday life occurring around me at every moment.

Sleep deprivation from jet lag isn't all bad; I couldn't sleep this morning, but it was almost like I was treated to something new just because I had been awake. After the rooster started singing at 4 AM, the muezzin started his ethereal call to Friday service for the devout Muslim. I had to put down my book and listen; its sacredness had to be respected. After a little while longer, the strange orchestra of the hotel staff beginning another day replaced the muezzin. I got up since sleep was no longer an option and wandered about the hotel complex, smelling the multiple flower scents that floated around the gardens. The gate staff said hello and motioned me to come outside. I followed and was greeted by the rising East African sun casting its white light on the slopes of Kilimanjaro. All this before breakfast!

More to come hopefully. The next few days I'll be trudging up the slopes of Kili. Mike and Dups, apparently Zara is now bringing a portapotty specifically to spare their guests from the horrors of Barafu's bathroom...Lucky me!!!