Kigali, Rwanda

Saturday, April 4, 2009
By Ray Schmidt

It’s good to be back in Rwanda, the country of a thousand hills. I’m here as part of our partnership with GE and the Developing Health Globally project. This is our second phase in Rwanda and it will involve donating and installing medical equipment to six hospitals throughout the country, and providing training to hospital personnel. Our first two sites were completed last year at Nyamata and Mayange.

This week I will be working with a team of GE medical technicians and application specialists at hospitals in Rwamagana, Kibungo and Nemba. But first the equipment needs to get out of customs, so I came a few of days before the rest of team to make sure the equipment gets delivered to the hospitals in time. Because of various factors, the shipping and installation timelines are very close, and we had to ask the Ministry of Health if they could accommodate us on this short notice. They assured us that they could work with our schedule and make it happen.

So, I’m sitting in the car at the cargo area of the Kigali airport waiting for Primo from MOH to arrive with the trucks. He keeps saying he will be here shortly but my driver, John, and I have been waiting for over 90 minutes. I’ve finished my paperback fiction about the search for Alexander the Great’s body and the discovery of the cure for AIDS/HIV (yes, in the same book), a TIME magazine that declares that crisis is good for America, and a Sports Illustrated that featured the NCAA Sweet Sixteen (and a good article on Gonzaga University and their coach, Mark Few, whom I played against during high school).

The excitement of humanitarian work is always preceded by the minutia of shipping documents, customs clearance, trucking, and that always involves a healthy dose of waiting. Yesterday, John, Primo and I were at the main customs office in Kigali waiting for a couple of signatures. Primo was guiding the shipping documents through the various offices while John and I stood by, waiting. John is also my translator, well sort of. He speaks English better than I speak French or Kinyarwanda (the national languages of Rwanda). I would occasionally say something just so I could justify my presence at the Customs Office and John would faithfully translate, though I can’t vouch for the accuracy of the translation since many of my simple questions would lead to lengthy discussions between the various parties and so I finally stepped out into the lobby and let Primo do his work without my interference.

We were down to a final signature needed for a customs waiver but it would take a couple of hours to get that. John drove us to a little roadside café that featured a few plastic round tables and matching plastic chairs. It was sunny outside so we took a table under an awning. Good thing. Halfway through my second Coke the skies opened up. Raindrops the size of jawbreakers bombarded our covering, which promptly starting leaking. We retreated further into the little shop but the rain didn’t relent. We waited and waited for the rain to subside at least a little, but it was not about to quit. One of the waiters pulled out a large table umbrella and walked us to our car, but we were still drenched by the time we got to the Toyota.

I think my soaking elicited some sympathy from Primo—kind of how a wet dog looks so pathetic that you can’t but feel sorry for it—and he suggested that I go back to the hotel and he would call me when he received the final signature. I gladly agreed. After two hours Primo called with the news that all the paperwork was done and we could pick up the equipment on Saturday.
And now it’s Saturday and I’m waiting at the airport…

Primo finally did arrive with the trucks and they were loaded and on their way to the hospitals. The Rwanda Ministry of Health and their people did a great job and now we are set to begin the installation.

Sunday, April 5, 2009

A couple of days before I left for Rwanda, our office was informed that Tuesday, April 7, was a national holiday commemorating the genocide that occurred in 1994. It was too late to reschedule the trip and so we would have to work around that. That means we had to work at one of the hospitals today. Only one GE tech is here but we actually were able to install all the equipment at Rwamagana District Hospital and Kibungo District Hospital. It was a long day but I’m glad we were able to get it done.

Monday, April 6, 2009

We worked at the Nemba District Hospital today installing what equipment we had. We were missing four packages of equipment including the monitors, ultrasound, and infant warmer. I drove back to Kigali and went directly to the airport to see if the missing items were still in the warehouse. I met the company’s agent and she was reluctant to let me go in the cargo warehouse but I informed her that the offices of the cargo company in Amsterdam were blaming Kigali for the missing pieces. It was a small warehouse and in a few minutes I determined that our items were not there. I called the company’s office in Amsterdam and they insisted that the items were not in their facility. They had gone through their warehouse three different times and could not find any of the pieces. They said they would put out a worldwide search notice for the missing pieces.

The items were trucked from our warehouse in California to Atlanta. They were put on an aircraft and off-loaded in Amsterdam. A day or two later we received notice that all 21 of our pieces were on board a plane headed to Kigali. We gave the GE team the o.k. to travel to Kigali since all of our items were in route.

Later this afternoon I received an email from the cargo agent in Amsterdam. They found our equipment—in their warehouse. They were going to try and put our items on another carrier since they only flew into Kigali once a week, on Saturdays.

Tuesday, April 7, 2009

Today was a holiday marking the anniversary of the genocide. It’s hard to fathom that in 1994 nearly a million people were slaughtered in 100 days. The previous times I have been to Rwanda I visited different genocide memorials around the country. They were packed with bones, separated into skulls, arm bones, leg bones and so on. You could see where a machete whacked through a skull or where a bullet entered and departed someone’s head. You saw the cut marks on arms where people tried to protect themselves from the machetes. It is a vivid reminder of man’s cruelty to man.

Wednesday, April 8, 2009

Yesterday is still a blur. I got up and headed out with the team for Rwamagana. A few minutes from the hotel I had my driver turn around and take me back. I went back to my room and was sick the rest of the day. Sick like a dog sick. I’ve been traveling with Assist International for nearly 12 years and have never been this sick. I guess people had tried to call me throughout the day and I think I recall the phone ringing, but at times I thought I was delirious. Not a great way to pass the day.

Thursday, April 9, 2009
Kibungo

Today we were training the hospital staff at Kibungo District Hospital on the newly installed GE medical equipment. Rose Lesobre from Paris began training on the ultrasound, then moved on to the fetal monitor, patient monitors, incubators, and the infant warmer. Rose told me later that the hospital has an infant mortality rate around 15-20%. I corrected her and said 15-20 per 1,000 births—right? No, they had told her that the mortality rate is around 15-20%. Yesterday when Rose was at Rwamagana she was told that last year the infant mortality rate was 30%, but they brought on a new doctor and the rate is now at 20%. Those are incredibly high numbers.

A big part of the training involves using actual patients. Pregnant women were scanned with the ultrasound. A mother in labor had the fetal monitor on her, monitoring the baby. The vital signs monitors were put to use on patients. As Rose was training the staff on the new incubator, a newborn was brought in and handed to her and she slipped the baby in the incubator and continued with her teaching. By being hands on with real patients, it makes the hospital less fearful of using the equipment. One area of concern is no one on the staff is familiar with fetal monitoring. They now have a fetal monitor; they know how to hook it to the patient. Now they have to be able to interpret the information generated by the fetal monitor. It’s something that will have to be addressed.

I spent some time in the hospital’s sterilization room assembling an incubator cabinet. The radio has been playing all morning and all the songs were about the genocide of 1994.

Never, never, never again,
Let us keep alive, the memory of genocide.

A man working in the sterilization room told us that these songs have been playing all week as part of the genocide memorial activities.

Friday, April 10, 2009

It’s been a good week in Rwanda but I’m also glad to be headed home. I left Kigali this morning and have a layover in Nairobi. Overall, things went well in Rwanda. The equipment we installed and training that was given will save lives. There’s no doubt. Several images stand out in my mind:

• Two babies packed into a single incubator
• A pregnant woman seeing her baby for the first time through the magic of ultrasound.
• The Kibungo Hospital biomedical engineer excited about all the new equipment he is now responsible to maintain.

I appreciate the efforts of the GE team who put in some very long hours to make up for the day that we lost to the holiday. Mohammed, Sameed and Rose were great and I look forward to working with them again.

Ray

Kisumu, Keyna

In September, we were working at the Yala Sub-District Hospital in Siaya Region, Kenya, the home to Senator, now President elect, Barak Obama's father. This area is proud of their native Grandson, as they should be.

While working there we met a young abandoned boy, also named Senata Obama (they do not pronounce the r), named by the hospital staff that care for him. He is about 2 and a half years old and sleeps in the children's ward at night and hangs out near the kitchen during the day where he is able to get food from the cooks.

While we worked, he watched us and played around the job site. Levi Culbertson, one of our volunteer workers from Los Angeles had taken a special liking to the young Senator and carried him around a lot.

We are working on getting him adopted, either to my own family or to Levi's here in the U.S., but process is extremely difficult. It looks like he will actually get adopted by Joseph and Agnes Twoli who run the Aid Orphan Education Trust, organization in Kenya. While they work with orphan children, they will actually adopt him to be there own son.

Joseph and Agnes lost a boy in child birth about 6 month ago, so they have a hole in their heart and family made just for this young boy. We at Assist International will be following up to make sure the process doesn't stall due to a lack of funds and that Senator Obama has a great future.

How can he go wrong with a name sake that has set bar so high?

Tim

China: The Ceremony

May 15th

By Ray Schmidt

Ceremonies are a big part of Chinese culture. The ceremony for the CCU project proved this in spades. According to the program, the ceremony activities would begin at 8:48 AM and be completed at 10:28 AM. The number eight is very significant—I think it symbolizes success or good fortune or something.

So the ceremony began right at 8:48 AM in the large community square in the center of Taojiang. It’s difficult to describe the scene. There were banners, arches, flowers, music (including Elvis), VIPs and crowds of people. It really was a grand affair as far as ceremonies go. Everyone was very appreciative of the equipment that was donated and installed, as well as the training that was provided.

Following the ceremony in the center of town, people were transported to the hospital to view the equipment. This is always a fun part of the program. The doctors and nurses at the hospital share the details of the equipment with the VIPs, the press and all the other visitors. You can see a real sense of pride—this is their equipment and it is the finest equipment around.

For all the success of the project, the devastating earthquake is what sticks in my mind. As I’m writing this the death toll is over 25,000 and the hardest hit region is just now being reached by rescue workers. Dr. Zheng was able to get on a flight to Chengdu this evening and will soon be with her husband and parents. I don’t know how she made it through the past several days, but she did and her efforts will long be appreciated by us and the hospital staff.

China: Installation

May 14th,

By Ray Schmidt

The earthquake in China has now claimed over 12,000 lives. It’s an odd feeling to be here in Taojiang, 600 miles away from the epicenter of the quake, and it’s as if nothing catastrophic has happened. The streets are crowded, the hospital is a hive of activity, and we are continuing with our installation. Qing was finally able to contact her husband in Chengdu and he is alright. None of her family or friends was hurt by the earthquake.

Today we wrapped up the installation. We converted all the monitors to the Chinese language, tested them, and connected patients to the equipment. The new ultrasound was immediately put to use on twenty patients yesterday. The installation has gone very smoothly.

A group of Rotarians from California arrived today and visited the hospital. They represent Rotary District 5170, which encompasses a large part of the Bay Area. Rotary Clubs from that district sponsored this project and we were glad to show them what their support has brought about. The Taojiang County Hospital is one of the smaller hospitals in the region and there were some questions about why this particular hospital had been selected. One reason was that the hospital had a real need. It was a neglected hospital, largely ignored by the Ministry of Health, and it needed the medical equipment we could provide. The hospital also serves a large population of poor individuals. This particular region of China is isolated from the economic boom occurring in other parts of the country. The hospital also has a strong group of doctors and nurses that would be able to utilize the medical equipment. All these factors played a role in deciding to help this particular hospital.

Armin (pictured) has made a real effort to learn as much Chinese as possible. It’s an incredibly difficult language, but he’s been working at it everyday. His attempts at the language have been a good source of humor for the locals, who burst into laughter whenever he tries a new word or phrase, but then they quickly come to his aid and encourage him.

China: Earthquake

Monday, May 12th
By Ray Schmidt

I didn’t feel the earthquake, nor did Armin or Qing. Several people at the hospital felt a shaking but nothing major. Back at the hotel, Bob and Charlene Pagett, felt the earthquake in their seventh floor room and quickly went downstairs and left the building along with the rest of the hotel’s guests.

Qing was particularly worried since her family lives in Chengdu, which is about 60 miles from the epicenter of the earthquake. She tried for hours to reach her parents and her husband. At dinner she was able to reach her mom and then her father who are both safe, but I haven’t heard if she’s been able to reach her husband.

The earthquake is about 600+ miles northwest of Taojiang.

Taojiang, China

Sunday, May 11th
By Ray Schmidt

I arrived last night in Taojiang, China along with the rest of the AI team. Taojiang is a city of 830,000 residents located in the Hunan Province. This morning we began working at the Taojiang County Hospital. We are installing a 6-bed patient monitoring system with central station in the hospital’s Cardiac Care Unit (CCU), a 6-bed step down monitoring system, and an ultrasound.

The first action item for the day was meeting with the China Customs officials to go over the donated equipment. The customs officials agreed to not inspect the contents of the shipment until we arrived to unpack the items. We’ve had problems in the past where our shipments our inspected at the airport and we lose one or two pieces somewhere between the airport and the hospital. Not only did the customs officials agree to do their inspection at the hospital with the medical team present, they agreed to do it on a Sunday. This was very kind of them and enabled us to begin work right away.

The lead engineer on the project is Armin Sohrabil from Union City, California. He is a field service engineer for GE Healthcare and this is his second trip with Assist International. Armin is a great worker who adapts well to whatever situation we encounter at the hospital. He also relates well with the local hospital personnel and the rest of the team.

Our trainer is Dr. Qing Zhang (pictured above, left), a cardiologist from Hong Kong. In 1999 Assist International installed a patient monitoring system at her hospital in Chengdu, China. She learned the equipment quickly and by the end of the week she was training others in the hospital. Several years later we asked her to be our lead trainer for a project in Ili Kazak in western China. Naturally, we thought of her again for this project.

The project is being sponsored by the Santa Cruz Rotary Club, Rotary District 5170 and Rotary International.

The installation phase went very quickly since we had six workers from the hospital helping to mount the monitor brackets and string cable. There was also very little activity in the hospital because it was Sunday and we were able to work very quickly. By the end of the afternoon we had finished all the cabling and mounting the monitors.

Chile: One Last Item

We returned to the Dr. Lautaro Navarro hospital (pictured) late Saturday night after two days of relaxing in the mountains of Patagonia. The power supply for the central station came in and so we went down to install it and get the second central station up and running. It took only a few minutes to install the power supply and another few minutes to configure the central station. This now gave the hospital two central stations that would enable them to expand in the future.

And so ends another medical project. This was a great project. The hospital was wonderful. Our hosts, the Punta Arenas Rotary Club, treated us so well. The doctors and nurses were exceptional. There is no doubt in my mind that this equipment will serve the hospital well for many years. Not so much because of the equipment, but because the hospital personnel are truly outstanding and will be able to fully utilize these monitors for many years to come.

I have to add one more note on this project to Chile. Our bus driver, Sergio, was terrific. He would pick us up at any time during the day or night and deliver us to wherever we needed to go. Even last night when we called him to pick us up from the bus station (we were returning from our trip to the mountains), and take part of the group to the hotel and then some of us to the hospital. So at 9:30 PM he met us, and his daughter, Joseline, was with him. We met her several times before, but yesterday was a special day for her. It was her 13th birthday and when we found out we sang 'Happy Birthday' and that made her laugh. I can’t fault her for that—it was pretty bad.

So this morning, Sergio and Joseline met us at the hotel for our drive to the airport. Sergio shook each of our hands and seemed very emotional. After we got on the bus he presented the team with a gift—a large wood carved penguin. It is the first time that I have ever received a gift from our driver. It was quite humbling.