the moodle is trying to kill me, or "what i did on my summer vacation"

Studying the trials and tribulations of underdevelopment is all well and good, but I never understood the importance of practice as much as when I had to use the moodle (the internal website for my graduate program) on a low-speed internet connection. 

The impatience I felt last fall for the global classroom (connecting the entire network of MDP programs around the world) from a Columbia user point-of-view is nothing compared to what it feels like to try to open a single page on the moodle from anywhere that doesn't have high-speed internet--even using the "low bandwidth" setting is not enough to keep my blood pressure from soaring and the vein on my forehead from popping out a little more. My sympathies go out to all those who were connecting with us during the global classroom.

Nonetheless, in terms of getting through the day, the Internet and its connection speed are the least of our worries, as rationing water and power come before we even begin to think about how painfully long it takes and how many tedious steps are involved in accessing the moodle.

The four of us working for Millennium Villages in Rwanda this summer opted to live in Nyamata, the "biggest" town near the actual MV village, Mayange, and where the MV Rwanda office is located. In the seven weeks since we arrived, the dry season has progressed and we are feeling it at home. 

We are supposed to have piped water at the house every Tuesday and Wednesday morning and every Friday evening—though I found out today that this has been cut to twice per week. For the last four weeks, we've had problems of not being able to fill the house's water tank because the water pressure was too low, or the water that was supposed to arrive on Tuesday morning at 7am didn't start until 5pm or 10pm or even 4am the next morning, which means Daniel, our house guardian, has to stay awake until the water is on so he can fill the assortment of jerry cans, 5-liter water bottles, plastic buckets, and cooking pots we’ve assembled to store extra water. We've had to buy extra jerry cans of water (at 150 RWF a pop) to carry us through to the next time the piped water came on.

I taught Le, one of my housemates, the phrase "if it's yellow, let it mellow," and we've all become very strategic about trying to use the toilet somewhere besides home as much as possible in order to avoid running out of water for things like washing dishes, flushing the toilets, and performing our own limited ablutions.

(Having grown up in Southern California during a looooong drought, I'm no stranger to water conservation behavior change campaigns and I'm pulling out all the stops in our house this summer. So, yeah, like thanks, California Board of Education, I, like, totally learned something, I guess.)

The sink in my bathroom is like the canary in the mine—each time I turn the knob is like a check on the gauge, I can tell by the water pressure how much is left in the tank and the smaller the trickle, the closer we are to running out; I’m always anxious that this turn will be the one that releases only a gurgle of air and perhaps a melodramatic final drop or two. 

This week we ran out of our last jerry can on Monday morning and the tank was completely empty by the next morning. The water came at 3am and today we woke to a full tank, a platoon of water containers at the ready, and Daniel fast asleep despite the late hour because he’d been up all night first waiting for the water to come on and then filling the containers.

Also, I don't know how or if this is related to the water problem, but for the last few weeks, nearly every night we have had a power outage that lasted anywhere from 2 to 4 hours. This is only inconvenient in that it usually happens right in the middle of our dinner preparations, so we've become connoisseurs of half-cooked pasta topped with olive oil and soy sauce (75% of us are East Asians, after all). When it happens in the afternoon and the back-up generator is out of gas, the office empties, and work grinds to a halt.

Bitch, moan, rinse, repeat. 

As annoying as the water and electricity problems we're having are, they are not really much more than that—simple (temporary--for us) annoyances. I remind myself that even complaining about these problems is a sign of the relative luxury we are living in compared to most of the people in the community we serve and the neighborhood we live in.

Every day, we see kids and adults pushing bicycles heavy-laden with full jerry cans up and down the inclines that give Rwanda its "Land of A Thousand Hills" namesake. Electric wires and poles crisscross the Rwandan countryside, but at night, houses are as likely to be lit by kerosene lamps as electricity as “cash-power” is too expensive for most despite their technically being “on the grid.”

All this has made me wonder, at the end of this summer, are these three months much more than just adult camping? Are we the ultimate summer poverty tourists,“slumming it” for the novelty of seeing development in action? I'd like to think not and I'd like to think that, just like with what CA’s Board of Ed taught me about water conservation, I'm, like, totally learning something along the way.

While the three months of summer initially seemed like they would stretch lazily across twelve long weeks, I can’t believe we’re already more than half-way through. It seems like we’re only now getting settled and it’s already time to start preparing for our goodbyes.

Professionally, admittedly, I’m not making a lot of progress. I've come to realize that given the language barriers and the heavy involvement that the CHW program has with the Rwandan Ministry of Health (read: bureaucracy moves slooooowwww) and the hesitation (read: we are explicitly forbidden) I have to "go rogue" at the Mayange site (read: strike out on my own with an interpreter in tow), I'm probably not going to get very much accomplished with my project this summer. 

To make up for that, I’m trying to learn as much as I can about Rwanda's culture and society (with some very interesting observations! More to come on that in a later post.) and how these influence the country’s development challenges. I do this by tagging along for site visits even for sectors that aren't explicitly under the health sector purview, talking to people I meet on the bus to and from Kigali, and asking people why they think things are the way are or work the way the work or what they would keep or what they would change about Rwanda’s development progress.

I still have hope that, ultimately, I’ll be able to produce and deliver something that the MV health office here will find useful, but, so far that seems as likely as a full tank of water on a Tuesday.

i was theeeeeeees close

It's a little difficult to see, but in this picture all three gorillas that we hung out with are there, including the silver back who is hiding in the bushes, sort of toward the upper right corner.

also this moment was right before...

I took this picture:

gorillas

For as long as I've known her (and I've known her since her beginning), my sister Emi has been obsessed with primates. When I told her I last week that I was going to Uganda to see the gorillas, she told me I was living one of her lifelong dreams.

For Emi

silverback traveling

lunch time

the emotional ups and downs of working in health this summer

For any readers who normally work in the health sector, what I'll be describing here is probably old hat to you and you long ago learned how to deal with the emotional ups and downs of just another day at work.

I don't normally work in the medical field, so while my experience this summer fulfills a personal and academic interest of mine, it's my first time to have any practical experiences working with patients.

the ups

Yesterday I finally got to do my first "ride-along" with a CHW, Alphonsine--though it was more of a "walk-along," as her bicycle was stolen and regardless almost all of the households we visited were within walking distance of her home (CHWs are recruited from within the community they will work in).

We visited four households--all were very low-income, but some were definitely struggling more than others. The biggest determinant of this seemed to be the number of children in a family.

All of the families lived in houses built from hand-formed clay cinderblocks with metal window-casings and doors; however, the windows of poorest family's house were mostly filled with clay save for holes the size of grapefruits to let in light and allow air to pass through. They raised no animals, their youngest child (22 months) was moderately malnourished (an improvement from her previous diagnosis as severely malnourished), and even the older children and the mother were thin and small. They were using their malaria bed nets, but the mother declined to let us into the house, her face turned away from us as she turned down our request.

Her next door neighbor's family was fairing slightly better and they could boast a pig, several chickens, and there were piles of soybeans drying in their yard. Still, buying milk more than twice a month is too expensive for the family of 6 (four kids and two adults), even at only about 30 cents per liter. Both adults were very thin, though the father seemed hearty. Their 2-year old baby was gigantic compared to the neighbor's child and was able to very loudly voice his demand for mother's milk.

At the other end of the spectrum was the mother we met whose 4 year old son was big and tall for his age and walked around the dirt floor front room smiling with confidence and energy. This mother, now expecting her second child after several years using effective birth control to manage the size of her family, described her recent food purchases--eggplant, potatoes, sorghum--giving important diet diversity to her family and noting that she had closely followed Alphonsine's nutrition counseling both during and after her first pregnancy. Her son was also playing with a large avocado full of vitamins and healthy fats.

In this house, the 26-year old mother and her younger sister who also lived with the family, were healthy and full-faced, signs that everyone was getting good, nutritious food. The mother was also diligently attending her antenatal care (ANC) appointments and getting regular visits from both Alphonsie and the maternal and child health (MCH) specialist CHW.

I took no photos during the first part of the day because I wanted the community to just get used to me being there since my role was to just to observe and note the amount of time the various CHW activities take. In any case, every time any of us muzungus step foot in the village, it's like a one-man variety show, but I still wanted to attract the least amount of attention possible.

Again there were, seriously, babies everywhere, but I resisted the urge to photograph them. Alphonsine's 5-year-old son, Sentia, had a million dollar smile that charmed the pen off me--I'm now down to one pen this summer after giving away my other two, one to Daniel and the other to Sentia.

the downs

Later in the afternoon, I sat in on a verbal autopsy* for an 8-month old who died on Sunday. The discussion was conducted entirely in Kinyarwanda, so I could only catch a little of what was going on. I just watched. Maurice (the MV CHW manager) filled me in on what she'd said after we left the house.

I learned about verbal autopsies in my global health practice class this past spring, but we didn't go too far into it since most of the students will never participate in one.

Grief and sadness transcend language, however.

I sat silently in a wooden chair in the dirt-floored front room of a better-than-average house for the neighborhood and listened to the grief-stricken mother's barely audible account of how her baby had died two days before.

Her eyes glistened, but she shed no tears.

Eventually the father joined us. He spoke some, wiping at his eyes as though it was just the dust that was bothersome.

The CHW for that household had accompanied Maurice and I and both she and another young woman of the house held babies they nursed as the mother spoke.

The mother's shirt, clean and white when she sat down, slowly grew small wet dots where her milk was still coming. The only time she looked somewhere other than the ground or Maurice was to watch the CHW shift her now sleeping baby to bundle onto her back.

As the visit ended, I joined the procession of people exiting the house. As is custom, I grasped the mother's hand with one hand and my forearm with the other and said thank you in Kinyarwanda.

I wanted to say something more than a woefully inadequate "thank you for your time," to give her a hug, but the awkwardness of death and mourning is unavoidable in any language.

The most I could do was hold her hand a little longer than normal and give it an extra squeeze. She looked up at me then.

But I hope she forgets that I was there and that her memories of her child's passing aren't marred by the odd appearance of an unspeaking muzungu in her living room.

post-script

I realized while we waiting for the mother to join us in the front room that it was totally unnecessary for me to attend another verbal autopsy. That will likely be my one and only verbal autopsy in Rwanda. Until or unless I become fluent in Kinyarwanda within the next two months (highly unlikely), I can't imagine how my presence can help and can easily imagine how my being there can hurt.

I think it was useful for me to see how a verbal autopsy is conducted from an educational standpoint and I noticed some things that I might do differently if I were asked to give some kind of feedback, but I don't think the educational advantages outweigh the potential negatives for the family. In a setting where at least there isn't a language barrier, however, I could think of more justification for my presence.

*Despite the definition at this link, this family had sought out medical attention for their child several times.

no electricy, no problem (ok, a little problem)

Last week, I learned the word ntakibazou, which means "no problem."

The most common response I get to almost any request I make is "no problem" and now that I've learned how to say it in Kinyarwanda, as Janice pointed out, I'll probably start hearing it everywhere in conversations around me.

We had no electricity at the office last week from Tuesday afternoon until Friday morning. Little mini-shutdowns that last for a couple minutes aren't uncommon at the Millennium Villages office, but usually either the generator kicks in pretty quickly or the breaker is fixed and we're back in business in no time.

But since Tuesday, we were out of "cash power," the prepaid system Rwanda uses for electric and water utilities. Wednesday morning we were running on the generator, but by the afternoon, the generator was out of battery too.

Most of the office was in Kigali last week for the Millennium Villages annual meeting/retreat, so the power outage wasn't too disruptive. Those of us left at the office already had a lot of downloaded research to go through anyway, but no electricity meant no wifi and no wifi meant no blogging and no blogging meant... lots of picture taking and processing.

Thursday morning, we had a surprise site visit from Jeff Sachs (of MDG fame), Sonia Sachs (health director for the MV project and J-dog's wife), and their family, so there was a bit of scrambling in the morning to get ourselves set up for their tour.

the agriculture info sign drew the attention of both young...

and old co-op members

me and the president!!! chantal is the president of the basket-weaving co-op board

this other president is popular here too

yes you can... be ready for your close-up

Once we had everything set up at the cooperative, we were able to socialize a bit with the women and men working there and worked more on our Kinyarwanda fluency and basketweaving skills.

"how's it going?"
"amakuru"

"good morning!"
"mwaramutse"

(photo taken by Malak Yusuf)

(photo taken by Malak Yusuf)

 

the co-op president formally welcomes jeff sachs

I talked to Sonia for a long time about the health system in Rwanda and at the site. I told her that overall I'm pretty impressed with how things are working here. I'm very interested in how the mutuelle de sante (national health insurance) system is working here and how that is incorporated in the community health system/policy that Rwanda's Ministry of Health has made the core of its national health policy.

can i help you? baboon etiquette

We visited Nyungwe National Park this past weekend and were greeted by a pack of baboons not long after entering the park. This guy was the last in the pack that we came upon.