Kanembwe Village Dance Rwanda March 2012 610.avi

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We woke up to the threat of thunderstorms on our last day in Rwanda. I guess the rainy season has finally arrived. Since I was up long before anyone else, I took the opportunity to get a few last photos of the Lake Kivu Serena in the early morning:

This tree was damaged in the heavy storms we had in the night. The winds were quite strong!

Not easy to see in this less than stellar quality photo, but the winds were stirring up white caps on Lake Kivu!

The tents are left over from a party on the beach. Unfortunately it was interrupted by a torrential downpour!

A view of the DRC (Democratic Republic of the Congo) across the lake.

We left the Serena and headed back to Kigali to catch our flight. On the way we saw more damage from the storm last night:

The billboard above had been folded in half by the winds….

and this one had blown over completely!

A last look at Lake Kivu and the Virunga Mountains before heading to Kigali and the airport.

And finally, we say our goodbyes to Yvan at the airport. I’ll see you next time, Yvan, my friend! Thanks for putting up with all of us for 10 days, we had a great time….I hope we didn’t drive you too crazy!

We began our second day at Gisenyi by jumping right into the oral test questions. These, again, took awhile because we had to wait for Yvan to translate, but they were able to answer the questions without problems and we got on with the skills testing.

We first gave a demonstration of the scenario they would be tested on, which included skills up through ventilating the baby and checking an umbilical pulse. We divided them into three groups with Yvan between the two groups who spoke less English.

Occasionally assistance was needed to get a tight seal around the baby’s face with the mask!

Pam takes a moment to show them how it’s done (surprising even herself because even WE had a hard time getting a tight seal on these manikins at times!)

Sara waits to give the baby a heartrate and start breathing.

While the others finished up the skills testing, I prepared the certificates.

Once everybody had completed their skills checks, we headed outside for a group photo before breaking for lunch:

After lunch we asked the group if they had any questions for us. At first they said no, but after we asked them a few questions, they started asking some of their own. We then presented their certificates:

While these are just a few photos of our learners getting their certificates, I am proud to say that they ALL received them! After the certificates were all presented, Dr. Emmanuel from the hospital spoke to all of us.

He first congratulated all of the new trainers from the Gisenyi hospital for their accomplishment. He then thanked us for providing the training.

He then told us how very important our work was and how much it would change the way they practiced at the hospital, and how many babies lives would be saved because of those changes in practice. What better validation could we receive than this?!?

Next Dr. Emmanuel said that while the trainings were important, he didn’t know how they could continue them without the kits we used. I then presented him with the two kits that we were leaving behind for them so they could continue training other birth attendants in the district. He was quite happy!

We’ve trained 48 Rwandan health workers in the past week. It’s been fun, challenging, and extremely rewarding. I’m looking forward to the next group of trainings later this year. Together, we WILL make a difference in the infant mortality rates in this country!

As you know if you have been following this blog, the district hospital in Gisenyi is one of my favorite places. I was excited to bring the HBB program to my friends here.

We began the trainings once again by explaining the program, the concepts behind it and going over the flipchart:

These trainings took a bit longer because not all of our learners were comfortable with English, so Yvan had to translate everything for them in Kinrwandan. It takes practice working with an interpreter! You have to know when to pause for interpretation so the interpreter doesn’t have to remember long phrases of information.

Again we had the learners hold their breath to demonstrate the concept of the Golden Minute. This time, since these learners were actually practicing health workers, they really took the message to heart. Many exclaimed how awful that must be for the poor little baby.

After going through the flip chart, we gave a demonstration of the program:

At each step of the demonstration, we paused for Yvan to translate. And….as often happens when curiosity is aroused….there were many questions. Some of the questions were beyond the scope of this program, but never to be one who ignores a good question, we tried to answer as many as possible. Some were questions concerning physical assessment, such as how the first assessment is done if you are trying to get the infant back to the mother as soon as possible for kangaroo care and breastfeeding. Sara, being our lone neonatal nurse practitioner, gave a brief demonstration on how to do a quick assessment of the baby during the drying and stimulating of a healthy (ie crying and breathing well) infant:

One thing led to another, and we finally had to remind our learners that they were getting far beyond the bounds of the HBB program. They finally settled back into the task at hand once we promised to return another time to teach physical assessment and more advanced neonatal resuscitation!

Once we were back on track with the program, Jennifer and Sara went through a whole scenario for them:

Yvan is being both the birthing momma and our interpreter! He has learned that we often wear many hats!

After the demonstration, “proud momma” Yvan explains to the group that we will be breaking for lunch (once again graciously provided by Michael and the Eos Visions team) and then returning to practice each of the scenarios in the afternoon to prepare for their skills check off the next day.

After lunch we broke up into smaller groups for practice. Yvan stood between the two groups of learners who did not understand English very well so he could translate, and the ones who were comfortable with all English teaching were in the third group.

And, again, we had FUN! Nurses are the same the world over it seems….we love to share our “stories” with each other, and these nurses were no different. They got very involved in their roles–especially as the birthing mommas, and each one was a better actress than the one before. In this particular shot our birth attendant is introducing herself, “Good day, Mademoiselle, how are you?” and our momma replies, “Oh not well. I am feeling I need to push!” after which there was much wailing and foot kicking before the baby was finally born!

And as our practice session was winding down, I took a moment to capture our photographer, Cait, in action. Thanks to her for all of the great pictures from this trip!

After we closed our training for the day, we were treated to a tour of the hospital’s new NICU–new since I was here in July 2011! I was pleased to see new equipment and a new 12 bed NICU which had someone minding the babies at all times! A big change from a few months ago.

Please know that the photos of the babies are a little less sharp than most of Cait’s photos and that is due to her not using a flash with these photos so she wouldn’t disturb the babies. Nice to know she was listening all those times I was “waxing poetic” on the virtues of developmental care in the NICU!

After our tour, it was back to the hotel for dinner and bed. Tomorrow will be a busy day of skills testing!

One of my favorite things to do is visit the people in the Kanembwe Village near Gisenyi. These people, whom I now consider friends, have been relocated to Kanembwe due to reforestation and flooding. They are considered a marginalized people, meaning essentially that they are not given the same consideration as others. Their plight is heartbreaking….many suffer from malaria, the nearest health center is a three hour walk away so many of their babies are born on the way. The rely on farming, so when the rainly season fails to be adequate, they go without food. The land the government relocated them to is on volcanic rock, so this adds another obstacle to their ability to farm. Yet, with all of this hardship, they have managed to keep a song in their hearts and a dance in their steps….which they are always ready to share with their visitors:

The septogenarian of the village even convinced Yvan to dance a little for us!

After the dancing, we took a walk through the village to a home of one of the families. On the way my daughter, Cait, got to realize her dream of carrying a child on her back like the Rwandan women do:

I’m happy to report that we had a tremendous thunderstorm that night….we like to think that God smiled on the crazy muzungu dancing fools and sent the rain to make up for our awkward embarrassment in front of our Kanembwe friends! Much blessings, dear friends, and we left our malaria medications with Yvan to give to you….it isn’t much, but it was something we could do at the time. Until we meet again…..

Monday morning found us back in Kigali at the Kigali Health Institute where we would begin our trainings in the HBB program. Our class for the next two days will be comprised of instructors in obstetrics and midwifery as well as students in nursing and midwifery. We are looking forward to this training and in interacting with the staff and students. It seemed like the best way to start with new trainers since the staff and students understand and speak English fairly well, and they have some experience in working with women who are giving birth.

Alex, one of the directors of the obstetrics and midwifery departments, introduced us and thanked me for returning to do the trainings as I had promised when we met in July.

We would be training 30 students over the next two days. Unfortunately, our trip coincided with one of their busy times at KHI, and many of the instructors were tied up in end of term meetings and planning sessions. Cathy, whom I had met in July was unable to attend the trainings due to meetings. Since KHI has decided to make the HBB program part of their curriculum for nursing and midwifery students, though, she will have plenty of opportunities to familiarize herself with the program!

We began the morning with introductions before starting the program:

Once the introductions were made, I began the program with explaining how it came about. I told them about Dr. Little and Dr. Keenan, both from the U.S. who are neonatologists and who both work in the international arena as well; Dr. Little in Africa and Dr. Keenan in China. I explained that this program was developed for resource limited areas and that it dealt specifically with just one minute in a newborn’s life….the Golden Minute.

Next I asked them to close their eyes and imagine that a baby is born, and the baby is not breathing. There is no one there to help the baby, and the baby dies. I pause for a few seconds for this to register, and watch the frowns that appear on their faces. I then ask them to imagine another birth, and again the baby is not breathing, but this time they are there and they know what to do, and that baby survives. At this point I use the hand squeaker in the kit which is supposed to sound like a crying baby, but really sounds a bit like a duck call. This, of course, sends them into a fit of giggles. But the message is clear….with the proper knowledge, they CAN make a difference.

At this point there were questions about when you used the resuscitation program they were familiar with, so I explained that the HBB program was designed to work with other neonatal resuscitation programs because it targets that very first 60 seconds after birth, which, unless the infant is extremely premature or has other complications, may be all the time it takes to get the baby breathing. I told them about primary and secondary apnea and why it is so important to catch the baby while it is still in that primary apnea phase and can often start breathing without advanced support.

The designers of this program are truly men after my own heart because they have included exercises that make the concepts real to the learner. I have always held fast to the belief that education should be based on “object lessons” that make the concepts real to the learner based on experiences they already have. So…..to give these learners a concept of the time frame we were talking about, I asked them to stand. Again there were sideways glances and giggles, but they stood. Next I told them that when I said “start” they should take a deep breath and hold it as long as they could, and when they no longer could hold their breath they should sit down. Now, Rwandans tend to be somewhat formal so this was asking them to do something that was totally out of their comfort zones, but thankfully, they are also extremely polite so they humored me! The last person took his seat at 36 seconds….amidst the claims of the others that he had cheated.

I then explained to them that the exercise they had just completed was what the Golden Minute was all about. I asked them if they had found it difficult to hold their breath for that long. There were many enthusiastic nods. I then told them that what they were feeling was what a baby who is born not breathing feels, and that the longer it takes to get them breathing, the longer they have to feel that way. I then reminded them of primary and secondary apnea, and drove home the point of why that Golden Minute is so very crucial in a newborn’s life. Powerful stuff……thanks George Little and Bill Keenan! (Did I mention that I had the extreme privilege to work with Dr. Keenan in St. Louis when I was fresh out of nursing school? He is second to none, and I’m pretty sure he walks on water when no one is looking!)

The rest of the morning was spent going over the flip chart and demonstrating the scenarios:

After demonstrating tying and cutting the umbilical cord, I remind them again of the Golden Minute on the Action Plan and stress the importance of getting the baby breathing within that 60 seconds.

Other points emphasized in our demonstration were good hand washing, drying and stimulating the baby, use of the aspirator to clear the airway of secretions, and keeping the baby warm by removing wet towels and blankets and replacing with dry ones. After the demonstration, I asked for a volunteer to come up and give a return demonstration. After some hesitation, one of the brave students came forward…..and did a spot on demo of what she had just watched!

Like a proud momma with her newborn baby, I am all smiles here because I was reminded of a conversation Michael from Eos Visions and I had had a few weeks earlier. We were talking about the work in Rwanda and the HBB program in particular, and he asked me a few questions aimed at determining the importance of what we are trying to do. The last question was “Is it sustainable?” I am smiling here because, Michael, KHI is providing that “missing link” to sustainability! By incorporating this program into their curriculum, they are not only ensuring sustainability, but they are ensuring replicability! I am happy, my friend, because we have just made a BIG difference in this country I love!

Because lunch, which was provided courtesy of Michael and the Eos Vision team, was not quite ready yet, I invited the instructors and students to come up and work with the simulator manikins so they would be ready to practice after lunch.

Curiosity is the basis for learning, and the cornerstone of evidence-based practice!

When lunch was ready, we went to down to the courtyard below and scattered ourselves among our students beneath the big tent! A fun way to “picnic” in Rwanda!

After lunch, it was back upstairs to the skills lab to practice the skills and scenarios they would be tested on the next day.

Whew! What a mental workout we got today! These instructors and students ask very good questions, and they want to know everything about the program and how to incorporate  it into their practice. All in all, it was a very good day!

After a little shopping (because we’re never too tired for that!), we returned to the hotel for dinner and bed–time to rest up for another busy day tomorrow!

Tuesday morning we arrived at KHI ready to go. We gave them the oral multiple choice test, rearranging the questions a bit because several of the students had written down the correct answers when we went over the test yesterday! This caused a few moments of confusion and angst among some of the students, but they quickly realized it didn’t matter because they really DID know the answers!

Sara read the questions and gave the answer choices (I didn’t have my reading glasses, and the light in the room was far too dim for me to even hope to make out the small print!)

After they passed the oral test, we gave a brief demonstration of the scenario they had to perform for their skills check off. This scenario took them through the program to the point of ventilating the baby and checking for an umbilical pulse.

Jennifer identifies her helper (Pam), prepares her area for the delivery…..

…checks her equipment…

…introduces herself and her helper to the momma (Laiecha)…..

…clears the airway, dries and stimulates the baby….

…ties and cuts the umbilical cord…

…replaces the wet blanket with a dry one and puts a hat on the baby…..

…begins ventilation….within that Golden Minute!…

….has her helper check an umbilical pulse….

…the baby begins to cry and is given to momma for kangaroo care, close monitoring, and will be referred for a consultation.

After the demonstration, the students break into small groups to check off their skills with the trainers.

Musimi was really getting into his role as the momma!

Once the skills check offs were completed, certificates were issued and we posed for a group photo:

Another long, but productive day which we ended with a little more shopping and dinner at “Heaven” outside on the mountain overlooking the night lights of the city of Kigali. What more could one want?

After arriving in Kigali on Thursday evening, March 22, we checked into our hotel and had a late dinner before going to our rooms for some long overdue sleep. We were excited that all of our luggage arrived without too much trouble….we did lose a few learner manuals due to customs forgetting to completely zip one of the bags, but we were able to retrieve a few of the missing ones from the luggage carousel! Friday morning found us all refreshed and ready to go:

Friday morning was spent by most of the group on a Kigali city tour and visit to a couple of the genocide memorials in Kigali. While they were touring, Cait (my daughter and our photographer), Helaina (from Eos Visions) and I spent the morning in meetings. First we met with people from USAID at the U.S. embassy and received some very helpful information about how best to approach the Ministry of Health concerning future trainings of the Helping Babies Breathe Program in Rwanda. Next it was on to a meeting with Lex Dev, an NGO in Rwanda,  where we once again received some great advice and helpful information from a Rwandan pediatrician.

After these meetings, Helaina, Cait and I decided to drop in on Dr. Ngabo from the Ministry of Health on the off chance that he would be available to speak with us for a few minutes. Dr. Ngabo is the Director of Maternal Child Health at the Ministry, and is my liaison with Dr. Binagwaho, the Minister. Fortunately, Dr. Ngabo had a few minutes to meet with us! We discussed the trainings we had scheduled for this trip and asked for his direction for future training sites that would be in accordance with the Ministry’s strategic plan for the implementation of the Helping Babies Breathe program throughout the country. I also presented him with the letter of endorsement for our trainings from the Council of International Neonatal Nurses (COINN) which he said he would pass on to the Minister. He also stated that we could draw up a Memorandum of Understanding with the Ministry for the future trainings. This was a huge success for us!

Buoyed by our successful morning, we met up with the rest of our group at a local Kigali restaurant called Afrika Bite for a lunch of traditional Rwandan food which was quite good.

After lunch we headed out to do some shopping at a Kigali co-op–and boosted the Rwandan economy! Then it was back to the hotel to get ready for dinner at Republica, a Kigali restaurant that sits on the side of a mountain overlooking the city. It was a fabulous view!

Above are Jennifer, Kaitlin, Laiecha, and Pam. They are the first-timers in our group.

After another good night’s sleep, we set off on Saturday for Akagera National Park to begin the trainings of the trainers. This concept of training the trainers who will then train the trainers in Rwanda was something Michael and I designed to add a little something extra to the trip, and to demonstrate that you can be a learner one day and a trainer the next. Michael chose Akagera as our training spot because it is very beautiful and relatively secluded and they have great facilities for what we needed for our trainings. We also could break up our trainings with a few game drives!

When we arrived at the park, a ranger informed us that they had just spotted a couple of giraffes and asked if we would like to alter our schedule a bit to start with a game drive rather than getting right to the trainings in the hopes of getting some good photos of the giraffes. Did she really need to ask?!?

After our impromptu safari, we returned to the lodge and checked in before having lunch. After lunch we forced ourselves to get down to work….I had to have these girls fully trained before we returned to Kigali so they would be prepared for their first class of Helping Babies Breathe (HBB) learners!

We spent a few hours going over the flip chart and practicing our demonstrations of the preparation for birth as well as answering the written test questions before calling it a day and heading out for our second game drive of the day.

When we went out to board our Jeeps, we saw a momma baboon and baby on the roof of the game lodge! I guess they were tired of waiting for us to visit them, so they came to us.

Our ranger told us that these storks actually have black legs, but they spread their feces on their legs to keep the bugs from biting them!

Our ranger, Denise, also told us that an elephant had been spotted nearby so the hunt was on! Unfortunately, when he crossed the road in front of us we got so excited we squealed and he went into the bushes. Not to be denied some sort of photograph, we snapped away and managed to get at least a glimpse of him.

And to show us what he really thought, he showed us his behind!

And after seeing a few more animals……

 

 

 

 

we ended our day with a beautiful sunset on Lake Akagera.

After breakfast on Sunday, we continued our HBB training session. Today we would be putting it all together with the skills required to get a baby breathing within the first minute, the “Golden Minute” of life.

We began by filling our babies with water:

And familiarizing ourselves with the equipment in our training kits:

Once our kits were ready and we had had the chance to check out the equipment, we began working through the scenarios.

And then it was time to put it all together before a final check off.

….and we laughed and had fun while we learned because I am a firm believer that they go hand in hand….

 

Yvan, our guide and interpreter, was drawn into the fun….because laughter is contagious, and our exercises intrigued him….so, we made him the birthing momma!!!!

But when all was said and done, we got down to the business of checking off skills so we would be trained and prepared for the next few days with our learners.

And so it went until all had checked off and even Yvan had a go at ventilating the baby!

Then certificates were awarded before we prepared to leave our savannah paradise to return to Kigali.

And as if on cue, as we were preparing to board the jeeps for our trip back to Kigali, a momma baboon walked across the grounds of the lodge carrying her baby with another little one trailing behind.

The drive between Akagera and Kigali is full of interesting sites!

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

  

 

We arrived safely in Kigali yesterday after a long flight with a couple of layovers and a small “glitch” in Brussels. Having purchased our tickets for the flight prior to the merger between Continental Airlines and United Airlines, we found that they had no record of us once we reached Brussels. Thanks to the tireless efforts of the Brussels ticket counter employee, we were soon issued new boarding passes and continued on our way without further issue.

Stepping off the plane in Kigali, as always, brings a sense of home rushing back to me. That first scent of open fires burning immediately puts me in a new frame of mind, and I slip back into the ease of Rwandan life.

Today, while the rest of the group took the Kigali city tour and visited the Kigali Genocide Memorial, Cait and I set off for a series of meetings with representatives from USAID, Lux Dev, and the Ministry of Health. They were very informative and productive meetings and we are well on our way to working under the umbrella of the Ministry to continue trainings in Rwanda.

Tomorrow we leave Kigali and travel to Akagera National Game Park where our nurse delegates will become trained in the Helping Babies Breathe program. Between trainings we will have an opportunity to take a couple of game drives before heading back to Kigali for our first round of trainings at the Kigali Health Institute on Monday and Tuesday.

Wednesday we will transfer to Gisenyi on Rwanda’s border with the DRC where we will visit our friends at the Kanembwe settlement. Thursday will be the start of our trainings in Gisenyi for two days. Then Saturday it’s back to Kigali for our return flight home. It’s going to be a busy week and a half, but so far has been productive and promising.

We will post pictures and details of our trianings each day providing we have good internet access. You can also follow us on our Facebook page, One Good Deed or for a more personal account of the trip, visit my blog: www.mymuzungujourney.blogspot.com.

Happy New Year! We’re sorry for the lack of posts during the holidays. We’ve had a lot going on as we get ready for our next trip to Rwanda in March. There are 8 confirmed traveling with us on the trip so far….still room for more if any of you are interested!

Our itinerary is set and it is going to be an amazing trip! I think we will be even busier than Lindsay and I were in July! Our trip will start off in Kigali with a city tour where we will learn about the history of Rwanda as we visit some of the historic sites, including some of the genocide memorials. Perhaps some time for shopping and a trip to see the neonatal unit at King Faisal Hospital.

Our second day we will transfer to the Akagera Game Lodge where members of the trip will be trained in the Helping Babies Breathe program. The Akagera Game Lodge is set in the Akagera National Park, and we will be treated to some late afternoon safaris after our training sessions. So watch for more photos of Rwanda’s wildlife!

After the training, we will return to Kigali to start training Rwandan healthcare workers in the Helping Babies Breathe program. This will allow our delegates to immediately use the training they receive on this trip. It will be an exciting time to have one-on-one time with Rwandan learners and share our experiences and practices with each other.

Next we will transfer to Gisenyi on the shores of Lake Kivu and bordering neighboring Democratic Republic of the Congo where we will train more Rwandan healthcare workers in the Helping Babies Breathe program. We’re hoping for a little down time as well so we can visit the Gisenyi district hospital and enjoy beautiful Lake Kivu! And of course, we have scheduled some time with our friends in Kanembwe village for an afternoon of traditional dance and fun! Watch for more awkward photos of the “muzungus” doing our best to dance with our friends!

After the training in Gisenyi, it will be back to Kigali for some last minute shopping at local co-ops for some of Rwanda’s beautiful handmade items before saying our farewells and heading back to the U.S.

Sound like a whirlwind of activity?!? It is, and we’ll LOVE it–and you could, too! Contact us if you are interested in joining this trip!

On March 22, 2012 we will leave Washington D.C. once again to go to Rwanda. This trip we will focus on training birth attendants in the Helping Babies Breathe Program. This program was designed specifically for developing countries and is a neonatal resuscitation program for resource limited areas. We first introduced the program to several hospitals and the Kigali Health Institute’s Nursing and Midwife Department last July. After receiving the endorsement of the Minister of Health, Dr. Binagwaho, we have been making plans for our return to begin training trainers in Rwanda.

The Helping Babies Breathe Program deals specifically with the “Golden Minute” after delivery, operating on the premise that getting an infant breathing in that first minute after delivery is crucial to their survival. As developing countries work toward achieving the Millennium Development Goals (MDGs) by 2015, this program targets MDG4 which is to reduce maternal and infant mortality by 2/3. We are committed to helping Rwanda achieve this goal.

Come be a part of our team as we first train those traveling with us and then immediately use that training in Rwanda as we “train the trainers.” For more information on how you can be a part of this team, contact Sherri at sbrown2126@kc.rr.com or sherri@onegooddeedkc.org. We will post the brochure for the trip as soon as it is available.