Saturday, January 16, 2010

Nyamata Genocide

Warning - disturbing post about the genocide and the memorials.

Saturday - another nice sunny day in Rwanda. The cleaners came round and washed our floor by hand and made our beds with clean linen, while I did some work for a presentation I have to give on Wednesday.
Good english breakfast of bacon and eggs to set us up for the day.
Wandered along the local main street further away from town, past the court offices, then turned into some back streets and headed to the Nyamirambo market. Wondered how safe it was but decided to look inside. In fact there was enough room to preserve some personal space and it was very interesting. Mangoes, potatoes, dried beans for sale, a couple of meat counters I did not want to get too close to, hardware stores, places selling clothes and all sorts of fascinating things. For $4 I bought a new backpack as the zip is comong loose on my old one. Don't know if my new one will survive the trip!
Bought a few overpriced groceries at the local Merez gas station - have to find a cheaper place to buy stuff.
We had arrange with a highly recommended English-speaking guide for us to be picked up at 2 pm to go to the genocide memorials at Nyamata. The time came and went. After ten minutes I texted, and again after 30 minutes. He called back, claiming we made plans for Sunday, not Saturday. We are sure he is wrong, and he says he will try to get to us as soon as possible. Its now 3 pm and it gets dark at 6. Greg has the number of a driver who we used before. He calls and they have a difficult conversation, as his french is as bad as his english and its a poor connection. He seems to know where to pick us up, but there are major roadworks which make life more confusing. A third driver sees us looking lost and offers to take us, but then Gregs driver shows up. We set off in what seems to me to be the wrong direction - the roads in Kigali are very confusing because you have to go round the hills. It was suppossed to take 30 mins but after 20 we are still trying to rush thru Kigali traffic. Eventually we get onto the Nyamata road, which is new and fast. The scenery becomes spectacular, rolling hills, swampy rivers, banana plantations, people pushing overloaded bikes, women with baskets on their heads. All the stereotypes of Africa.
We arrive at Ntamara (excuse spelling errors) and I wander into the old church. Somehow I did not think this was one of the sites with bones. Immediately taken aback by a shelf full of skulls. Pelvises below, then femurs, as if arranging things by anatomy made it better. Along the church walls were clothing from the victims. At the back is a small schoolhouse, The kids notebooks are still there, along with the remnants of a funeral pyre. At first there was just the two of us, then an armed gurad joins us. Our driver gets out, as there is no guide. At first he had not wanted to go near the site. He shows us a paper saying he is exempt from paying medical bills because of a genocide injury. We have to stop him showing us his scars.
On to Nyamata. The church is larger, there are more clothes on more pews. In the basement there is only one glass pyramid of bones. It does not seem so bad.
Then the guides take us to the back. We have been talking French and realize all four of us speak English better. At the back you go into crypts. Coffins line each side. As you go further in they give way to boxes of bones (the guide opens one). Then there are open shelves of bones, all in order again. We get taken to the second crypt. One side the coffins are draped and some are named. We look over at the other side. The guide says its more of the same, we need not go on. I am relieved.
We are about to take our leave when one guide says that the other was one of seven survivors of the genocide which killed 10,000 at that site. He tells us of those days in April 1994, when the living hid amongst the dead and the interhawme stuck spears into the heap to ensure they had not missed anyone. The guide ran into the jungle and hid in a swamp.
Etiquette question: Given that there was no fee for admission or for the tour, what is the appropriate tip for someone who relives that experience for you? At random, I decided on 5,000 R Fr, which is about 8 dollars, quite a lot of money locally.
The drive back as the sun set and a gentle rain came down was also pretty. Got back home and had a beer.
It would be nice to believe that the Rwandan genocide was a one-off event, that somehow people could only be that brutal in Rwanda, but I don't think its true. Similar genocides are happening now in the Congo and not getting publicity. Then there is Darfur, Sarajevo, the Nazi Holocaust. The slogan "Never again" seems so empty. Its so easy for Clinton, or anyone else, to say "Its not in our interest to get involved".

Friday, January 15, 2010

Second case in Kigali

I am in the Anesthesia Team Lounge at King Faisal Hospital in Kigali.
Its the partly private hospital which has the best equipment in Kigali and does the big cases.
Its a beautiful building, with a large central area open to the breeze.
I am working with two residents - a third year from Kigali and a second year Canadian who joined me from Winnipeg.
The Rwandan resident wants to do the big cases with me. After declining to do the 3 day old baby yesterday I decided I should do the neuro case with him today. We are draining a chronic subdural haematoma on a blind 15 year old kid who weighs 20 kg, has a VP shunt and will have surgery for a craniopharyngioma next month. The kid seems very pleasant and cooperative despite all her problems, She only speaks Kinyarwanda but seems to have no neurological deficit apart from the blindness.
The surgeon only booked the case last night so we were delayed three hours waiting for bloodwork. So far everything seems to be going well, but we are doing the case without monitoring temperature, urine output, neuromuscular blockade, or end-tidal CO2, and the ECG is very temperamental. I hope the kid wakes up well when the operation is over. We are flying by the seat of our pants here.

Looking forward to the weekend off - it is stressful working so far out of my comfort zone! Saturday we are going to lie in then I have arranged a car and driver to take us to the genocide memorial at Myamata inthe afternoon. Perhaps not everyone's idea of a relaxing day, but our guide has promised to take us to a restaurant with good food, beer, music and dancing on the way back!

Thursday, January 14, 2010

Working in Kigali

Been at work for two days now.
Its very strange. Many things are much better than I expected, other things are worse.
The residenets I am teaching are keen and enthusiastic. Some of them, at elast, are very well read and up to date, even about drugs which are not available to them. A few are very quiet so they are harder to assess. I am so glad I took some french lessons, as often they seem to get the wrong end of the stick and if I can explain in french, no matter how badly, it makes a difference.
The residents all seem to have new laptop computers. The surgeon I was working with today handed me his iPhone to take pictures of the operation!
The only case we did today wass a laparotomy on a three day old baby whcih took about three hours, ending with us sending the ventilated patient back to NICU. Fortunately one of the local staff anestehsiologists did the case and I only watched and learned!
But some simple things are so complicated. We were to be provided a lunch but by 1:45 there was no sign of it arriving so we went to the cafeteria. After we had eaten we came back to find there was a trolley with more food on it than we could eat.
Getting the driver to pick us up on time seems impossible. So far we have had one come 30 mins early and one 20 mins late.
Finally got the internet working in our apartemtn but its very buggy so I will stop now.

Wednesday, January 13, 2010


Made it.
Hung around three days in Belgium, left on direct flight to Kigali on Tuesday.
left hotel by taxi at 7:30, were through check in and security by 8:30.
Flight left a few minutes after the 10:40 schedule and arrived in Kigali around 8 pm, about 15 mins late. Great to walk across the tarmac in the hot dark.
Usual minor delays getting through passport control (Very friendly but also thorough) and picking up baggage.
There was a resident there with a sign to meet us. Threw our bags in the back of a hospital pick-up truck and drove swiftly into town. Stopped at big supermarket for essentials. Very well stocked, dozens of types of pasta, for example, at prices a bit higher than Canada. Drove on to apartment, They are doing construction so the dirt road was dug up and we did detours through the neighbourhood. Very similar to towns in the Caribbean.
Apartment is large and basically furnished but livable. Slept well under a mosquito net.
Now at Internet cafe after first day of work. More later when I get better set up.

Sunday, January 10, 2010


We arrived in Brussels about 11 am Saturday, after the Kigali flight had left. Had to collect our bags and go through immigration, which was quick and easy. Then we went to see what Plan B was.
The lady at the Jet counter had fixed things, but she admitted it was not a great fix.
She planned for us to wait seven hours, then fly Ethiopean via Paris, changing planes in Addis Abbaba, and continuing via Entebbe to Kigali over the next 17 hours to arrive Sunday afternoon.
We circled the airport for advice. The Ethiopean counter was staffed, literally, by a card-board cut-out until 4pm. The Departure Board had every flight for the next five hours delayed. The girl at the Brussels Air counter refused to make any comment at all about the activity of the airport or the weather: Was there a snow storm forecast for this afternoon? Would the weather be better for flying on Tuesday? She would not say. The airport counter staff said we should leave before a Sunday storm. They admitted that airlines never post flights as being delayed until the last moment, so we should not be fooled into thinking our Ethiopean flight was really oin time. My Blackberry said that there would be light snow and temperatures around freezing for the next four days. That did not sound bad, but such weather had already caused major problems.

We went back to Jet to ask to be rescheduled for the Tuesday direct flight to Kigali. She was not pleased. She insisted that Ethopian plane was already in Brussels. She insisted that the Paris Airport was functioning normally. She refused to pay for any accommodation in Brussels.

By now we were cynical and had no faith anything would happen as planned. A comfortable bed and a direct flight three days later seemed a much better idea.

We put dragged our bags to the train. The Frommers Guide I bought in Toronto listed the Hotel Mozart as being central, inexpensive, and within walking distance of the central station. We checked in and got a triple room for 100 euros. The place is a confection of tile and a warren of rooms. Ours has a bed, bathroom and desk downstairs and a tiny loft with two more beds above.

Brussels is nice, pretty in four inches of snow. We ate mussels with frites and beer. But they know how to party, and a local disco across the street kept us awake till 4 am. Today we took the train to Brugges, made more famous by a recent movie set there. It was very charming. The canals were frozen but there was no snow on the ground.

In other circumstances I would be happy to explore Belgium, but I feel like I am in exile here. Its not what I signed up for, and its not where I want to be, and should be, today. But for the moment there is nothing I can do except enjoy the waffles, the beer and the chocolate.