(ED NOTE: Neil Rens, the author of this post, is in Rwanda as part of a team to fix medical devices in hospital settings.  As seen in the photo above of his dorm room, Neil  used an ingenious way to get ready for his trip; he made a simulation of a jungle in his  dorm room, to acclimate to a jungle-like setting,   But, gosh, I hope his mom does not see that picture!)

by Neil Rens


With just one week left in Kigali, we’re starting to prepare for our five weeklong jobs of fixing hospital equipment full time. But that hasn’t stopped us from experiencing all that Rwanda has to offer. In addition to having two “hospital days,” we managed to squeeze in a volcano hike and a safari, all in addition to our regular schedule of French and medical device repair classes. Here’s a brief recap of some of the events:


Hospital Assignment

In preparation for the second month of the EWH Summer Institute, each ‘team’ was assigned their respective hospitals. Jonathan and I will be working in the Western Province at the Rubavu District Hospital near the city of Gisenyi. Although we do not know much about it yet, our current host family told us the city is a major tourist area and is “very nice.” We’ll find out more about the hospital and our lodging accommodations at our briefing tomorrow. Here’s a map I made of the hospital assignments.


Hospital Work Days

So far, we have had three ‘hospital days’ interspersed with our classroom studies. During these days, we had the opportunity to go to hospitals in Kigali and try our hand at actually fixing some medical equipment. We first went to CHUK (Centre Hospitalier Universitaire de Kigali), a teaching hospital and one of the best hospitals in the country. While there, Jonathan and I ‘fixed’ some equipment, which mostly just amounted to finding the correct chargers and then charging batteries. We also tried our hand at an ultrasound machine. This was the first time either of us had ever touched an ultrasound machine, let alone powered it on (luckily that part was pretty easy). Someone had sent the machine to the workshop because it was “displaying images twice.” What does that mean? Good question, we were wondering the same thing. Unfortunately, that is typical for repair requests. We realized that, in addition to the technical aspect of fixing equipment, this communication barrier could easily inhibit our ability to do our job. Since neither of us had used an ultrasound machine before, we didn’t know how it was supposed to work. So how can we fix it if we don’t even know what the problem is?

After powering it on, we realized the screen was flickering every second or so, which we fixed by adjusting the video cables between the monitor and the computer. Then it took us about an hour to figure out how to configure the device, select the proper mode (B mode, which is the mode usually shown for TV shows like House), adjust the gain, and select the different sensors. At first, we weren’t even getting an image when we pressed the sensor to our skin. We quickly realized that it was probably do to lack of conductivity (all of the ultrasound gel squirt bottles were empty, something we were learning to expect in Rwandan hospitals). After two hours we finally had the machine working as it was supposed to, or at least how we thought it was supposed to work. Then we saw how it was “displaying images twice.” Essentially, it was overlaying the image on top of itself, which can cause confusion for a physician trying to make a diagnosis. We troublshooted the problem and, since it occurred with all three sensors, decided it was probably a software issue rather than a hardware one. Thus, the next hour was spent testing every single setting (and there were probably over a hundred), but unfortunately we never found the fix. We sent an email to GE (the maker of the machine) but haven’t heard back yet.


The ultrasound machine with ‘double vision.’

In addition to working with medical equipment, we also got a chance to tour the hospital and speak with some doctors. I wrote about some of my interactions and perceptions in my monthly article for the Hopkins Biotech Network publication, The Transcript, which can be found here.

Tomorrow, we will be going to Kanombe Military Hospital—hopefully we’ll have better luck!


Volcano Hike

Two Saturdays ago we hiked Mount Bisoke, one of the volcanoes in Rwanda. Although not the tallest, it still towers at over 12,000 feet. Fortunately, we didn’t have to ascend all 12,000 feet because the base of the mountain is around 8,000 feet. But the ascent was brutal. It was incredibly steep, but the real challenge was navigating the mud. Most of the trail was either very slippery or so thick with mud that your shoes would get stuck without being careful. After about an hour of intense hiking we took a rest break at a small clearing. Our guide smiled at us and said, “That was the easy part.” It’s great when you know your guide well enough that they can joke with you like that. Unfortunately he wasn’t joking. Somehow it managed to get steeper and muddier. At the top of Bisoke is a beautiful crater lake that makes the trek worth it. Supposedly. We didn’t get to see the lake because when we reached the top (after around three hours of hiking), it was so foggy you could only see ten feet in front of you. On the way down we had apparently gotten to know our guide well enough that he felt comfortable joking with us. At one point he shushed us and whispered, “Gorilla!” The volcano is one of the few regions in Rwanda where the gorillas live. For at least three to four minutes we stood as still as possible, our boots sinking into the mud. It was then that our guide said, “Gotcha! There’s no gorilla!” As funny as it was, it was tough to smile. When we reached the bottom, the clouds at the top were just starting to part. I tried to get a group interested in going back up to see the lake, but for some reason no one felt compelled to do the hike all over again.

As it turns out, Jonathan and I’s hospital is about thirty minutes away from Mount Bisoke. Although it’s tempting, we probably won’t do the hike again.


Mud, mud, and more mud. This picture doesn’t do justice to the steep incline of the mountain.


Akagera Safari

This past Saturday we went on a safari through the Akagera National Park. The trip lasted about six hours, most of which we spent sitting atop our Land Cruisers enjoying the wildlife. We started out in the densely vegetated southern part of the park and made our way northeast along the Tanzanian border. Initially, we only saw some water buffalo and baboons. But as we made our way onto Lake Shore Road (the park is scattered with lakes) we began to see hippos, a massive Nile crocodile, and some African eagles (they look very similar to bald eagles). The winding road eventually led to the savanna, but before we could get there our vehicles suddenly stopped. Just twenty feet in front of us there stood a family of giraffes, right in the middle of the road. Seeing them run was quite a spectacle—their legs seemed to barely move but their heads glided rapidly some eighteen feet above the ground. By the time we reached the open savanna, there were dozens of zebras and impalas grazing with each other in harmony. There were also wart hogs trotting across the savanna (they had a striking resemblance to Pumba, but sadly there was no meerkat to serve as Timon).


My favorite was probably the impala—they were jumping as high as ten feet in the air, virtually from a stand still!

During the evenings I’ve been keeping busy with a range of different activities. Sometimes we play ultimate Frisbee or basketball with some of the locals (despite ever having seen a Frisbee before they pick it up very quickly). I also taught my host family how to play some card games—Crazy 8’s, Black Jack, Egyptian War, and even Killer. They love playing cards. Last night Jonathan and I made peanut butter cookies for them, which was a real treat since they don’t have an oven and thus rarely have baked goods. The cookies didn’t taste quite like they usually do, but they still brought smiles to our host family—mission accomplished.

Last week I met Herve Kubwimana, a friend of a friend of a friend. Herve is the director of the Africa Innovation Prize, a nonprofit that strives to “inspire university entrepreneurship in Africa” with annual business plan competitions. He offered some great insights into the economy of Rwanda and how the unemployment rate, even for university graduates, is quite high. One major problem, he said, is the prevalence of humanities majors—economics, language, business management—and lack of technically trained workers. At some point I want to visit The Office, which Herve described as a co-working space for people trying to build businesses in Rwanda. Sounds pretty cool!

It’s hard to believe that the trip is 1/3 over, but I’m excited to get to the hospital to start fixing medical equipment.

Bonus Picture:


People traveling on bikes hitch rides up the steep hills. The really scary part is when the car they are holding onto tries to pass another one (Rwandans like to cut it REALLY close when it comes to driving).


Muarho! (“Hello!”)

On Saturday our entire group ventured out to the Eastern District to visit the Millennium Village. This region was historically forested and fertile but is now the most infertile due to deforestation that occurred in the 1950s. In that time, the Tutsi people (~25% of the population) were sent there by the newly empowered Hutu (~74% of the population) with the hopes that they would die of disease in the jungle. This started Rwanda’s bloodied history of ethnic tension. [note: the other 1% is the Twa, a pygmy people who were largely forest dwellers] The Hutu’s ‘superiority complex’ (a vast oversimplification of the complex ethnic tensions rooted in the Belgium colonialism) was sadly promoted by doctrines taught by Belgian colonists and reinforced by religious teachings by missionaries. This tension resulted in multiple massacres of Tutsi people by Hutu people, which culminated in the 1994 genocide. Starting on April 7th and lasting 100 days, the genocide took the lives of over 1 million Rwandans, the vast majority being Tutsi who were brutally murdered.


On the way to the Millennium Village. Rwanda has a beautiful landscape.


This backstory is pertinent because most things in Rwanda exist against the looming backdrop of the genocide. This is certainly true of the Millennium Village. The genocide displaced 2/3 of the Rwandan people and destroyed the infrastructure, governing system, and economy in general. This Millennium Village was started by the UN as an example of how the Millennium Goals can be reached in places like Rwanda.


At least half of the buildings here seem to have the “tigo,” “Mutzig,” or “Primus” logos and paint colors. Tigo is a cellular provider and the latter two are beer companies.


The UN support has helped tremendously. The village school has doubled in size, now serving over 1,000 students, and the teaching staff has grown (although still rather understaffed by American standards!). As with all Rwandan schools, only English is spoken while at school (this changed from French about 6 years ago).



The school’s enrollment and one of its classrooms, respectively.


The Health Center’s nursing staff (health centers don’t have doctors, only hospitals do) increased from 5 to 19 with the Millennium support. This was accompanied by the addition of a new maternity ward, which has allowed all local births to take place in a professional medical setting rather than in the home.


The health center and some of its lab equipment.


The Village also sponsors co-ops for farmers, artisans, and other skilled workers. These co-ops help the people sell their goods in markets, which helps drive the local economy (historically the economy has involved a lot of subsistence farming). The farm we visited was about 2 hectares and maintained by one man. He had two cows, a couple pigs, a goat, and a few hens. He didn’t have a single power tool to help with the work.


The farm and some of the livestock.


Midway through our day we visited a genocide memorial (one of many in the country). This one was located at what used to be a Catholic church where 11,000 Tutsi were murdered in just 1-2 days. It was a sobering experience. The pews in the sanctuary are filled with the clothes of victims, and the altar bears the weapons used- spears, guns, machetes, and blunt sticks. Beneath the sanctuary, there is a glass case housing the skulls of hundreds of victims, a graphic reminder of the gruesome atrocities committed at this site and throughout the country. Outside, there were stairs descending down to a mass grave located beneath a cement slab. It is impossible to encapsulate the anguish and anger the site evoked. Again, there were piles of bones of unidentified victims. Many of the skulls were shattered by blunt objects, sliced by machete, or bored through by a bullet. No one left the memorial unaffected.


The memorial- no photos allowed inside.


How could people be so filled with hate that they could gruesomely kill so many people? How could a person kill his neighbor? How could a father kill his wife and children because they were of a ‘different’ ethnic group? Where was the rest of the world when this was happening? And why does this keep happening throughout history (the Holocaust, Armenian genocide, Cambodian genocide, and many others) with some being as recent as just a decade or two ago? I am convinced that I am no better than the Rwandans I have met. Does that mean that I too am capable of such heinous actions under the right social priming?


Although the emotions still pervade my mind even now, they were quickly countered by the wonder and awe I experienced upon our visit to a ‘reconciliation village.’ At this site and many others like it throughout the country, victims and perpetrators of the genocide live together. The nation pursued an avenue of reconciliation over retaliation, which involved the daunting challenges of people forgiving each other and forgiving themselves. I desperately want to learn more about the social forces that helped bring about this largely successful reconciliation, and why it has not occurred after other conflicts. But the wonder and awe wasn’t over for the day.


As it happened, it was also the last Saturday of the month. In Rwanda, that means the day is reserved for Umuganda, or “coming together in common purpose to achieve an outcome.” The tradition started in 1995, the first year following the genocide. It is a day where Rwandans come together to improve their communities through activities like picking up trash or even building new homes. We met up with one community that was building mud-brick houses for refugees from Tanzania. These were actually refugees of the genocide from 20 years ago that are just now returning to their homeland. The event is an impressive showing of national unity and pride. I am amazed and perplexed at how it was first instituted, especially so quickly after the genocide when tensions between ethnic groups were high. But it has undoubtedly helped with the reconciliation process. I am interested to see how the model can be used in different communities throughout the world.


It was a day filled with confusion, anger, and amazement at the genocide and the events that have taken place since. On Sunday, I visited the Kigali Genocide Memorial and learned more about the history preceding and following the genocide. Even with more context, I still cannot fully comprehend the events that transpired. Rwandans, too, seem to struggle with their past, though they have made tremendous strides in terms of economic development and social reconciliation. These intertwined advancements have been significantly influenced by the introspection encouraged by the nation each year during the 100 days following April 7th, which commemorate the genocide.


Again, no pictures allowed inside.


In my next post I’ll talk about our visit to a local hospital—the people we met, the equipment we saw, and how differs from the hospitals most of us have seen. Stay tuned!




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