Rwanda

This past weekend we spent our four day Easter holiday in Rwanda. We flew into Kigali on Thursday night and stayed at the Hotel des Mille Collines, the hotel made famous by the film Hotel Rwanda. This was where more than a thousand Rwandans were kept hidden from the genocidaires during the 1994 genocide. The next day we went to a bus company and reserved some seats for our trip to Ruhengeri, the staging point for gorilla trekking in the Parc National des Volcans (Volcanoes National Park). We got a little wet standing in the rain that graciously decided not to wait for us to get on our bus. I guess it is the rainy season. We also got a lot of conflicting information on which bus we were supposed to board making the situation somewhat more tense, however we eventually found out way. I think some of the employees were as clueless as we were.

Rwanda is nicknamed the land of 1000 hills due to it's mountainous terrain. It is densely populated and the people are largely subsistence farmers leaving very little land which is not being used to grow crops. The country has come a long way from the horrors of 1994. The country is very clean (no plastic bags allowed), the motorcyle taxis are registered and seem to have some sort of regulations they have to follow, and the country is developing very quickly (lots of construction, restaurants and businesses not mentioned in our guide books from a couple years ago).

Ruhengeri isn't much besides the place to stay before gorilla trekking. When we arrived in town we accidentally stumbled upon our hotel while looking for the tourism office, so that worked out well. Addresses don't really exist here, so you do what you can. We had dinner and sampled a few of the Rwandan beers, which not surprisingly taste exactly like all the beers from Uganda. They love their lagers in East Africa...why they need numerous different brands of the same thing is beyond me. It sure would be nice to enjoy an India Pale Ale...


What? Goats need exercise too...

The next morning we got up pretty early and took a ride to the park headquarters for the gorillas. We spent some time enjoying the scenery, got briefed on the whole process and were split up into groups based on which gorillas we would be visiting. After traversing quite possibly the worst "road" I've ever experienced, we arrived close to the tree line which coincided with the park border. It was really interesting to hike through some of the farm land before getting to the stone fence (meant to keep the animals in) marking the start of the park. We walked about 10-15 minutes into the park and were met by the trackers who stay near the gorillas during all daylight hours as poaching is still a very real concern (even though these beautiful creatures are nearly extinct). I felt like a kid in a candy store and had a few brief chills as we walked upon our first gorilla, the vice president. Our group contained 19 gorillas total including 3 silverbacks...this was the #2. We followed him to the rest of the group and spent the next hour literally standing amongst the group who were having a grand old time just laying around, eating and playing (the youngsters). We were entertained by a mother with her breastfeeding baby, a little guy picking fights with the others while basically performing for our group, and various gorillas just doing their thing. It was quite entertaining and definitely worth the (fairly expensive) cost. The hour didn't last nearly long enough, but it'll be something I never forget.


I couldn't convince them I was the only weapon we needed...


Could it be the mythical kingdom of Care-A-Lot? (Bonus point if you get the reference.)


Ruhengeri in the morning fog




Someone needs a bib!


Got sawdust?







We went back into town, checked out of our hotel and purchased bus tickets to Gisenyi on the shores of Lake Kivu which forms part of the border with the Democratic Republic of Congo (DRC). The drive took around 1.5-2 hours and was just as amazing as the previous trip. When we arrived in Gisenyi we obtained a taxi this time choosing not to rely on fate to point us in the right direction of our hotel. We walked along the lake to check out the other hotels, which was somewhat confusing considering they all had different names (or had disappeared) than was represented in our guide books. It was getting pretty dark, so we decided to eat at our hotel and get to sleep early as we had been up since quite early.


Lake Kivu (the mountains in the background are the DRC)


Side street in Gisenyi

The next morning we were slowed down by rain but eventually were able to go out and explore Gisenyi. Of course the sun rode into town and handed out some swift justice, but my head is now nearly finished peeling. Some highlights of Gisenyi include the amazing views of Lake Kivu, the proximity to the DRC, a dump truck tipped over in the oversized rain gutter along the side of the road (he probably was trying to avoid potholes only to end up in the ditch...smooth). We purchased another bus ticket back to Kigali for our final night to be spent in Rwanda.

We stayed another night at the hotel Rwanda and went to New Cactus for dinner. They had pretty good pizza and are a popular expat hangout. We also were able to experience our first slightly "good" beer in E Africa. Turbo King, which is basically a lager with some food coloring masquarading as a dark ale, was not too bad but my standards are basically in the cellar considering what is normally available to us. At least there is South African wine!


Kigali

Our final day was spent walking around Kigali and experiencing the Rwandan genocide memorial. It was intense to say the least. Really made me disgusted with the international communities ignorance towards the plight of the African people even in the most dramatic of circumstances. The sad thing is that it still continues to this day.

Time Marches On

We have really gotten busy over the last few months and our blog has suffered the consequences. Work has really picked up, especially for Ann. Her Lumbar Puncture study is up and running and she's handling most of the work on her own. I help out with some database updating and helped a little with the patient interviews at Mulago Hospital. The Neuro-Cognitive Deficit Study for Patients with Cryptococcal Meningitis is nearing its beginning, so I have been working on preparing forms and making sure the study will begin smoothly. Ann also continues to prepare for the Antiretroviral timing trial. I have also been lending a hand in the creation of various forms (of which there are many) for this study. We will learn in April when the funding will arrive which will determine the start date.

We took a trip to Tanzania so that Ann could run in the Kilimanjaro (as in Mount) Marathon (she ran the half) which was in Moshi. It also offered the opportunity to visit some friends from the U of Mn who live in Arusha. The race was set against the backdrop of Mt. Kilimanjaro, which made for an amazing sight, unfortunately the clouds obscured the mountain most of the morning. Elvis, a ninja, and an albino in a lion suit took part in the various distance races offered. We went on a two day safari to Tiringiri National Park and the Ngorongoro Crater. Tiringiri was ok, but not any better than Murchison Falls NP in Uganda. The tsetse flies actually made it much worse. I seem to have an exaggerated reaction to their bites and was covered with terribly itchy welts for the next week or so. One bit me on my knuckle and my entire hand literally swelled up. It was very uncomfortable. The crater was by far the best safari experience I've had in Africa. It's largely grasslands populated with all kinds of exciting creatures. We saw lions (12 or so), black rhinos (9ish, all from a distance), elephants, zebras, african buffalo, various types of antelope-like animals, hyenas, flamingos, ostrich, and crested cranes (the national bird of Uganda in which I've seen zero).


Arriving in Tanzania


The runners and their fancy visors.


Safari truck


Crested crane in the Ngorongoro Crater


Mr. Monkey enjoying the view in Tiringire NP


Mr. Baboon


Somewhere in Tiringire NP


The safari crew above Lake Manyara


Papa lion


Funny looking cows in the Ngorongoro Crater


Young lion hanging out on the ridge of the crater


The horde

We attended the Irish Ball last weekend. It's in celebration of St. Patrick's Day and the (real) Guinness, Bailey's, and Jameson were free and in full effect. Not being a big fan of whiskey made it easy to avoid the Jameson but it's safe to say I could have used less guinness (and wine). Ann had a basketball tournament that weekend, so we called it a night around 12am so she could get some sleep for her games Sunday. Her team got 3rd in their first tournament/games of the year. She's definitely excited to be playing organized basketball again.


At our friend Sam's graduation dinner.

We paid for our gorilla tracking permits in Rwanda, where we'll be going over our 4 day Easter weekend (hopefully with a blog post soon to follow). We'll be spending some time in the capital Kigali, Lake Kivu, and Ruhengeri, the staging point for the gorillas. This is probably the one thing I absolutely have to do while in Africa even though it's not cheap. Rwanda is apparently beautiful in stark contrast to the devastation that took place in the 90's.

A long time coming...

I started interviewing patients yesterday. This may not seem like much, but it indicates that my very small project addressing perceptions of lumbar puncture (aka spinal tap aka LP) in Kampala, has begun! This is the project I originally came to work on in January 2009. Doing the right thing by applying to the Institutional Review Boards (research ethics committees, aka IRB) kept this project in limbo for a year and a half, but I now have approval from the University of Minnesota, the Infectious Diseases Institute, Makerere University, Mulago Hospital, and the Uganda National Council for Science and Technology. With a few letters and a nice research ID card, myself, two other medical students who are helping for a couple weeks , and a hired interpreter, went over to Ward 4A to start collecting data and interviewing patients and their family members about meningitis, LPs, assessing their medical knowledge (or lack of) and decision-making processes. We are also going to measure how long patients are in the hospital before (or if) they get a) an LP b) treatment c) a definitive diagnosis, and how they fare, whether or not they live and how long they were in the hospital. Ultimately, we want to use the information from the interviews to develop educational materials for patients and their families explaining meningitis and the spinal tap procedure and also to educate physicians as to why patients refuse and what they can do to prevent it from happening. Yay!

This project, aptly named “Perceptions of Lumbar Puncture for the Diagnosis and Treatment of Meningitis in Kampala, Uganda,” came to fruition just as so many other projects are also speeding up. I am currently collecting data from Mulago Hospital Records and the Microbiology department to see trends of a certain kind of fungal meningitis seen mostly in AIDS patients, Cryptococcal Meningitis (CM), over the past ten years. The deal is, drug therapy for AIDS became widely available in Uganda in 2004 and so we want to see whether the rates of CM have decreased since then because theoretically, more patients would have been on treatment and less would be sick. But on the Infectious Disease Ward at Mulago, we see a ton of CM and so we are checking out this theory. Another future project based on this would be that once we get the rates (by month and year), we could compare it to weather data and check the seasonal variation of the disease.

The Infectious Diseases Institute now has a low-tech kind of EMR (Electronic Medical Record), and a few databases tracking patient data. They want to cross-check these databases – specifically the pharmacy, clinic, and laboratory data – and find the real rates of certain infections that are common. A friend of mine has done this for Tuberculosis, and I will do this for CM. The public health courses I am taking right now through the University of Minnesota – Introduction to Epidemiology and Biostatistics – have definitely given me a better sense of what I am looking for and how to go about designing these new projects.

The big clinical trial that I am preparing for (the COAT trial) is chugging along. Last week we submitted many documents to be transformed into database-friendly forms to be barcoded and uploadable. There is this new program through the National Institutes of Health called DataFax, that scans all of our completed patient documents and automatically enters the info into a database. It may sound boring, but is going to save us a lot of time and prevent a lot of missing documentation. We also find out in April whether the trial will be funded and will have a better idea of when it could start.

Grant recently finished developing a bunch of documents for the neurocognitive assessment project that will be starting in March or April. Although we work together in the same office, we don’ t usually “work” on the same things. But his project will share patients with the COAT trial so we have been working together a bit to make sure it all flows together. Sometimes this can cause tense moments, as neither of us like being told what to do, and both of us are always right.

Our evenings have been pretty busy lately, but not like they normally are. We are making a concerted effort not to go out during the week. This isn’t too tough considering I have basketball practice two nights a week and my online public health courses take up the rest of the nights. And Grant makes it easy for me to get work done because he is busy playing poker, either at the casino or online. But we still manage to keep up with the Kampala crowd and accommodate visitors from all over. There is always a birthday celebration or going away party, rugby to watch and pork joints to patronize, and now that we have been here awhile we have house-warmings and baby showers to attend!

Decklin - the owner of Bubbles, watching 6 Nations Rugby

Grant and Friends at Guy and Allison's housewarming party

Grant, myself, and Rosie out at Emin Pasha for her birthday

Some of my basketball teammates and I out for pork

And then Grant did some surprise planning (with some help from our wonderful friends), and VOILA…a beautiful Valentines weekend. He sprang for a room at the Serena Hotel in Kampala on Saturday night, and we stayed through Sunday to use their workout facilities and huge pool. It was so nice that we thought about getting a membership at their gym…until we realized their corporate rate listed was per person. Ouch! We got home in time to clean up and head to a very romantic dinner at the Chapter One Restaurant at the Protea. Champagne, a bouquet of roses, live music, and amazing food provided a wonderful end to the weekend.

Dinner at Chapter One (Protea Hotel) - February 14, 2010

Cape Town, South Africa

We ended up buying some last minute plane tickets to Cape Town, South Africa following our trip to Zanzibar. We flew in on the 19th of January with a layover in Johannesburg. Maiken met us at the Cape Town airport and we decided to rent a car for the week…a tiny little Hyundai. Ann did all the driving and conquered the whole driving on the wrong side of the road using your left hand to shift thing. We all stayed at the Ashanti Lodge Gardens hostel, which was a nice hostel...although our room was right next to where everyone hung out at night making it difficult to fall asleep. We got settled in and went out to Long Street for dinner and drinks with Justin, who had been in Cape Town working a number of months at a few hospitals. Long St. is very much like Haight St. in San Francisco with lots of bars and interesting places to eat. Not as many head shops, but that’s California for you. Had probably the best burgers since we came to Africa at the Royale Eatery. Afterwards we went to the Dubliner and listened to a brother/sister combo perform covers of American music. I was amazed at this Westernized version of Africa. Cape Town is unlike anything I have seen in Africa (admittedly I haven't seen that much)and it felt like we had gone back to the states or maybe Europe.


It's got a hemi.

We went to the Victoria & Alfred Waterfront our first full day in the city. It’s a functioning port and there were plenty of ships around, however the area with the tourists is full of tour boats including a sweet replica of a pirate ship. We had some very good sushi at Wang Thai…another first in Africa. Unfortunately we were unable to take the ferry to Robben Island, the location of Nelson Mandela’s prison, as it was booked. Had some nice steaks at Nelson’s Eye, an old steakhouse which was conveniently a half a block from our hostel. Ann finally got some of her beloved crème brulee for dessert. It wasn't as good as we've had before, although it's something that we haven’t seen in a while.

The next day consisted of a wine tour to four wineries around Stellenbosch and Paarl in the heart of wine country, just east of Cape Town. The first was Fairview which had wine and cheese tasting. Good cheese is nearly impossible to find in sub-saharan Africa and that was possibly more delicious than the wine! For lunch we stopped at a winery with a restaurant and had some bibooti(sp?), a traditional Afrikaans dish. Also went to Solms, Tokara, and Villiera. At Villiera we were treated to some sparkling wine opened with a sword. Ann and I bought 7 bottles total, 5 of which we took back to Kampala. Also bought some cheese (garlic-parsley camembert and sun dried tomato chevin). Went to Tank in the Cape Quarter for dinner. We both had sushi again…mine was good, however I don’t think Ann was too impressed.


Wine country...


Sleep it off...

The 22nd of January marks the day Ann cut her hair, removing over a foot of length! It was quite a drastic change, but I love it. I almost forget that it used to be much longer. Made our way south to the Cape of Good Hope and Cape Point. Along the way we stopped to eat in Hout Bay at Mariner’s Wharf, which had some great seafood and shockingly good bread. I was introduced to the Grapetiser, a sparkling grape juice. I proceeded to drink these the rest of my time in South Africa. The drive south from Cape Town is quite beautiful. You’re basically driving on the side of the mountains following the coast to the southern most point of the peninsula. We stopped in Simonstown to see the penguins at Boulder Beach. Penguins are strange creatures and quite hilarious. Most of the time they stood there with their eyes closed and beaks open pointing upwards. When they would walk around I could hardly keep from laughing. A few were playing in the water and many were keeping their babies warm. For dinner we went to the the place Justin was staying (Ivor and Shifra, some of Justin’s family) for Shabat dinner. I even got to wear a yamukah. Since we had meat, there were no dairly products, however we had a non-dairy ice cream. It was surprisingly good.


Hout Bay


Absolutely no shaking hands with the penguins.


They used to be called jackass penguins...


...but that hurt their feelings. Please refer to them as African penguins.


You can see the road we were driving...


Random view heading south towards Cape Point.

The following day involved an early morning hike up Table mountain. It was a steep hike up large stone steps, like the ultimate stairmaster workout. Maiken and Ann handled it much better than I did…probably because I’m in much better shape than those two. Or maybe it’s the other way around. We took the cable car down, which was a quick 2 minutes compared to our 1.5 hour hike. Ann and I moved to a nice room in a different building, so the following nights allowed for much easier sleep than right next to the pool in our previous room. We drove to Camps Bay to enjoy Clifton 4th beach. It was very warm out and the water looked so nice. A few people were enjoying diving into the large waves breaking at the beach. Unfortunately, the best we could do was to put our feet in the water...once we did they instantly went numb. The ocean current in Cape Town comes directly from Antarctica, so it’s a tad bit like an ice bath. Saw a lawn bowling club near the beach with a bunch of old, white men in funny uniforms (goofy hats, polos and white trousers) rolling a ball towards other balls. That night we met a friend of a friend for dinner and jazz at the Rainbow Room. Before the show the host gave our group of medical professionals from America a shout out, which was cool and embarrassing. A group of teens from a local school performed first followed by Abigail Peterson, who was a wonderful singer/pianist. We had a good time, but were kind of falling asleep by the end. Apparently we're reaching that age...


On top of Table Mountain.


Cape Town from the top of Table Mountain.


Look at those athletes giving it their all.

The next day Ann and Maiken went for a 10 mile run along the coast and they say it was quite beautiful. We spent the day with Maiken and Justin at Canal Walk, a large shopping mall in a suburb. It was one of the nicer malls I’ve been in. The food court was very interesting with a large selection of things I’ve never seen before and of course McDonald’s and KFC, where everyone seemed to be eating. Had some tasty beef shwarma at a falafel place. When you ordered your meal they hit a button indicating what kind of meat the cooks should prepare…justin ordered the lamb and I had the beef. We both enjoyed the silly baaaa and mooooo recordings for our respective meats. Not sure if others see the humor in that, but we do. After searching all over Africa Ann finally was able to find a pair of basketball shoes. She has been practicing with her team, and their season starts in March. I’m excited to see her out there…I think she’ll be the only white person in the entire league, so she’ll probably have her own fan club! Of course I’ll be president. That night we ate at Arnold's, where I had the game platter containing an ostrich fillet, oryx fillet, crocodile ribs and warthog ribs. The oryx and warthog were especially good. Crocodile is a novelty, but not anything special. We then went to see Goldfish, a musical duo from Cape Town, who play a club night every Sunday at the same place right near the beach we had been to. It was packed and the indoor area was roasting. Luckily we were able to secure a nice spot at a table which allowed us to drink our illegally brought in box of wine. Nothing says classy like sneaking in a box of wine and drinking it with styrofoam cups.


Staying classy.


Dinner at Arnolds's.

The following day we flew back to Entebbe. It was a difficult transition as we both seemed to be a little homesick after being in a city so much like what we are used to back home. Although we're halfway through our time here...I imagine the rest of the time will fly by.

The past few weeks our two bosses from the U of Mn have been here along with the deans of our medical school and the school of public health and other high ranking officials from the U of Mn, so we’ve been involved in a few meetings and meals talking to the officials about our experience here. They’re exploring their connection with Makerere University and the IDI to see how it can be more significant. It was kind of fun to be ambassadors of a sort. Ann has started work on her public health certificate from the U of Mn. Between that, basketball, work and socializing she is quite busy. I don’t know how she does it, but she’s probably the most motivated person I know so I’m not surprised that she does!

We were dreaming of a White Christmas...

But all we had was this...

Sailboat on the Indian Ocean, on our journey to Stone Town, Zanzibar from Dar Es Salaam.

We spent 3 fun days in Dar courtesy of our friend Imee Cambronero. Imee recently finished her Masters in Public Health and is on a fellowship with the Centers for Disease Control (CDC) in Dar Es Salaam. We have known each other since our undergrad days working for Upward Bound. She has an amazing apartment on Masaki Peninsula in the north. We went out for good food, including Korean and Ethiopian, did some shopping and exploring, and lots of relaxing on her balcony and by the pool. Imee and I also attended an oceanside yoga class at the Golden Tulip. I could do that everyday - with the waves crashing below us and a nice Indian Ocean breeze coming in...

View from the Tower Top Restaurant (aka 236 Hurumzi, aka Emerson and Green), second highest point in Stone Town and a great place to relax with a biri biridi or G&T.

Just outside Fordhani Gardens, where you can get fresh seafood and Zanzibari pizza every night at the market, and where we had our Christmas Eve dinner.

On our spice tour with all of our accessories

In the past, spices were Zanzibar's largest export. There is still a large amount of cloves exported, but many others are grown for local use. The farm we visited was used mostly for education and sold spices to the tourists who came through. We saw all kinds of raw spices - turmeric, ginger, clove, nutmeg and mace (same plant), vanilla beans, cinnamon, peppercorn, lemongrass, and many more. Along the way, we were adorned with necklaces, bracelets, rings, ties, hats, and bags made from the long grass. We tried a variety of local fruits and then off to lunch, followed by a visit to a slave cave and some time on the beach. The cave was used by slave traders after the British abolished slavery in their colonies. The traders would hide the slaves in the cave until there were enough to march out to a waiting ship via a tunnel connecting the cave to the sea.

Fishermen cleaning their nets

Brandon, Christine, Grant, Ann, Katie, Ryan, Maiken and Phil on Christmas Day

After coming back from our spice tour, we met up with classmates and friends from MN. Katie, Maiken and Christine are working at Selian Hospital in Arusha, Tanzania and "Professor Brandon" is teaching at a university there. Ryan and Phil came from the frigid homeland, and with Katie and Maiken, had already gone on safari and climbed Kilimanjaro before meeting us in Stone Town on Christmas Eve.

The entire island had been without power for a few weeks before we arrived, and our accomodations in Stone Town, The Karibu Inn, did not run their generator at night. This made for rough sleeping conditions, but encouraged us to get up early everyday, and we started off Christmas Day with a run through town and along the beach. After breakfast and cleaning up we were ready to head to Jambiani when Maiken and Phil came down with exciting news - they were engaged!

Since we had so much to celebrate, we went in search of a dinner venue as soon as we arrived at the Visitors Inn on the Southeast coast in the village of Jambiani. We all shared an amazing meal of salads, soup, fish, lobster, beef, and apple pie with a few bottles of champagne and wine to wash it all down.

View from my oceanside lounge chair in Jambiani

We spent most of the next five days lounging on various hammocks and beach chairs reading, eating, and chatting. It was so nice to catch up, exchange stories, and compare our experiences in East Africa. Once in a while we got motivated and went snorkeling and sailing, or walked up and down the beach, I even played in a very sad game of beach volleyball one day.

Kizimkazi Music Festival

Sadly, we said goodbye to Ryan and Phil on Dec 28 as they began the 24+ hours of travel back to MN and the rest of us had to settle for the white sand beaches of Zanzibar. The next day was the kickoff to a music festival on the southwestern coast of the island in Kizimkazi. We got there early and played poker during all the sound checks, and Grant and Brandon were very patient with us ladies as we pondered whether to check or raise, by rocks and bottlecaps. Then came the good ol' college drinking games - a little P&A, some hockey - and a case each of Redd's and Savannah. We ended the night dancing in front of the stage to a Swedish band called Clockwise and some local bands before catching a ride back to our bungalows.

After 5 days in Jambiani, we packed our bags and moved 6 km up the beach to Paje and stayed at the Paradise Beach Bungalows. Paje is a slightly larger community and even though it was so close, the beach was nicer. We spent a couple nights here, including New Years Eve.

The ladies, Grant, and a Full Moon for NYE

(Brandon is behind the camera)

We had a big buffet dinner at Paradise Beach for NYE, including seafood, salads, sushi, skewers, and a couple fresh barracuda on the grill and then sat on the beach before heading out to find a party. We eventually found some loud music and settled in the ring in 2010. It was a little anticlimactic and it seemed we were forcing ourselves to stay awake, when the DJ announced "okay 3 minutes, 5-7, 5-8, 5-9, Happy New Year" and then went back to the music. There were some fireworks up and down the beach, and then we called it a night.

Sunrise, New Years Day 2010

The New Year came with a beautiful sunrise, but also some GI distress. Five of six got ill at some point that day and poor Brandon got it first and the worst. We got a ride to Stone Town and said goodbye to the Arusha crew as we headed up for a few more days in Nungwi, on the northern tip of the island. I would have to say, though, if I had to be sick somewhere, it was a good place to be.

Nungwi Village Beach Resort

Grant and I decided to splurge on our last few nights in Zanzibar and it was well worth it after a week of beautiful, but very hot accomodations. This place ran their generators 24 hours a day, with A/C, TV, internet and very comfortable digs. Nungwi is also a very happening part of the island, next door to Kendwa, and lots of restaurants, bars, and activity going on - although this did mean much more hassling whenever we left the confines of the resort. We did a lot of laying by the pool, and the ocean, and met some fun and interesting people from all over the world with whom we did our fair share of drinking. We also hung out with a friend from Kampala, Rosie, and her boyfriend Owen, who were staying at a resort just down the beach.

This was a great end to an relaxing vacation, and left me well-rested, newly motivated and ready to get some work done back in Kampala.