Kosovo Follow Up

By Ray Schmidt

Saturday, October 31, 2009

I left this morning for Kosovo where I will be working with the American International Health Alliance (AIHA) as part of their program to improve maternal and infant care in that country. I have two primary assignments while there: to assist in repairing some medical equipment in five hospitals around the country and to assess a potential pediatric ICU/Emergency Room at one of these hospitals. I was last in Kosovo in March 2009 where I visited these same hospitals and did a general assessment of the equipment needs. This is a follow up to that initial visit.

I will be working with Greg Johnson, who is a volunteer biomedical engineer from North Carolina. This will be his first volunteer mission and I look forward to working with him.

It’s never easy to leave home. The past few months it seems that I have been away more than I’ve been home. I’m glad this will be my last overseas trip of the year—at least that is the plan. Leaving home never gets easy. I miss my family immensely.

Sunday, November 1, 2009

My celebration was too early. I should have waited before raising my arms in triumph as I saw my first suitcase come into view. I had some initial doubts about my bags actually making it. When I checked in at San Francisco yesterday morning, the counter attendant told me that I couldn’t check my bags all the way through to the Kosovo because my airline didn’t have an agreement with Croatia Airlines, which I was flying on the last part of my journey. So I would need to pick up my bags in Amsterdam and then re-check them with Croatia Airlines. I then flew to Portland and went to the NW/Delta desk and asked them to double check on this because it didn’t seem right. Sure enough, NW/Delta does have an agreement in place with Croatia Airlines. The attendant was extremely helpful and personally went down to make sure that my bags were routed all the way through to Kosovo. Great service.

But I still should have waited to celebrate the arrival of my baggage. But when your bag is the first one on the conveyor, it’s like your team scored a touchdown and you can’t stop yourself from raising your arms in celebration. That was me as the first bag (my bag) came down the conveyor. But the celebration didn’t last long. The suitcases shimmied by one by one. Greg found both his bags (no wild celebration on his part). I waited. The baggage claim area emptied of people and suitcases. Two bags left on the conveyor—neither of them mine. The baggage conveyor screeches to halt. Greg and I are left alone with ¾ of our bags. I feel like my touchdown was just overruled by the instant replay official. No touchdown. No bag. I settle for a field goal—one bag.

But it isn’t just any bag. It’s the suitcase that has most of the medical supplies and parts that I brought for the hospitals—not the bag with my clothes and toiletry items. But as a seasoned traveler, I am not worried. I always pack a toothbrush, toothpaste, deodorant, and an extra set of clothes in my carry-on bag so I’m good for at least a day. And I’m sure that my bag will show up tomorrow…

Our taxi driver didn’t speak English but he was fluent in German and so we had a good conversation on our drive to the hotel. I learned that ex-President Clinton had just left about two hours before our arrival. He was here for the dedication of a statue made in his honor to commemorate the U.S.’s support of the Kososvars during the war with Serbia. The bronze/gold image (the driver wasn’t sure which) of the President depicts him with his left arm raised and in his right arm he is holding a binder that is engraved with the date of the first bombing run by the U.S. against Serbia. Interesting choice of dates to remember but the people of Kosovo are truly grateful for the role America played in their protection and their eventual independence as a country. According to our driver Americans are greatly loved, a sentiment that I heard many times when I first visited in Kosovo in March.

I also learned from the driver that the people of Kosovo have long memories. “We will never forget what the Serbians did to our women, our children, our elderly,” explained the driver. “In 20 years we will still remember; in 30 years we will still remember; in 40 years we will still remember. We will never forget.”

Monday, November 2, 2009

I should introduce the cast of characters for this week’s activities:

Dr. Kate Schechter – Senior Program Officer for American International Health Alliance (AIHA)
Dr. Mary Packer – Program Coordinator for AIHA program in Kosovo. Mary and her husband Alan have lived in Kosovo for eight years.
Greg Johnson – Volunteer biomedical engineer, president of Southeastern Biomedical Associates in North Carolina.
Clay Buttemere – Volunteer biomedical engineer living in neighboring Macedonia (he will join us on Wednesday).
Valentina – Our translator and primary contact for the week. She works for AIHA Kosovo.
Nazmi – Our driver for the week. He speaks excellent German and only a little English. All around good guy.

Greg, Valentina, Nazmi and I went to Prizren Regional Hospital today. We also took with us the Chief of Biomedical Engineering from the University Hospital in Pristina, the primary hospital for the country. We started in the Labor & Delivery department evaluating and repairing equipment. As we started repairing some of the fetal monitors the nurses brought in more and more pieces of broken equipment in hopes that we could somehow miraculously resuscitate them. While we were able to repair or service many pieces, most remained broken. We had brought out parts and accessories for those items that we knew needed service. All we could do for these other pieces was find out the problem and then make a list of parts to send back.

We then moved to the neonatal intensive care unit (NICU) and serviced some of the equipment in that unit. The hospital biomedical engineer worked with us and was very skilled. He knew in most cases what the problem was and what was needed to fix it. Unfortunately, he has virtually no authority to purchase parts or accessories that would make the equipment operable. There were several fetal monitors that needed a new transducer in order to function. They have not been used in almost two years because the engineer cannot get approval to purchase $200 transducers. We had brought some of these with us and so we plugged them in the units and now they have two additional fetal monitors. In the NICU they had a pulse oximeter that is used to measure oxygen in the blood, a vital piece of information for doctors and nurses. A sensor that goes on a baby’s foot is needed to measure the blood oxygen, but they didn’t have any. They had a couple of sensors that they had kept serviceable by using electrical tape to hold them together, but finally they had stopped working. The sensor costs $120, but there is no budget for these items and so the engineer cannot purchase any. So a perfectly good piece of equipment, a vital piece of equipment, sits idle for the lack of a small but required accessory.

I felt bad for the engineer. He knew the problems, he knew how to fix them, but his hands were tied. Greg and I come in with our bag of goodies and leave looking like heroes. There were several things that Greg was able to show the engineer on several pieces of equipment, but if the engineer had a service manual, he would have been able to handle the repair himself. That’s another common problem: medical equipment is donated to these hospitals but they do not come with operator or service manuals. Once the equipment breaks down, the engineer is forced to repair the equipment in the dark. [Assist International always provides manuals with any piece of medical equipment that we donate]

Still no suitcase but I went out and did a little shopping so I’m good for another day. I’m sure my bag will show up tomorrow…

Tuesday, November 3, 2009

This morning on our way out to the Peja Regional Hospital, we stopped by the airport to see if my suitcase arrived. Croatia Airlines has a website that enables you to track your missing bags. I discovered the site yesterday evening and saw that my bag was scheduled to be a flight that arrived late last night. I checked the website this morning and, though there wasn’t a confirmation of arrival, I figured it was worth a try. Thankfully, it was there.

Of course the thought arose in my mind, “If they have the technology to track a lost bag, wouldn’t it be better to employ that same technology before the bag gets lost?” I was just thinking.

Peja is a beautiful city surrounded by mountains, most of them covered with a thin layer of snow. It was raining and the clouds were low so we didn’t get the full impact of the beauty like I did the last time I was here. The hospital has some great views of the mountains and if I had to be sick in Kosovo, I would want to stay at this hospital in a room that looks out on these mountains.

Greg and I started working in the NICU. It is a well run unit with excellent staff. The unit is clean, the doctors and nurses are engaged, and the atmosphere is very positive. The equipment is suffering. Same story as yesterday’s hospital. The engineer and staff do all they can to keep the equipment functioning without spare parts and accessories. One example is they took an adult SpO2 sensor, cut it in half carefully, and then taped it around the infant’s foot so that it would work. It’s a $100 sensor. There are two very good patient monitors that wouldn’t work because the battery in each was dead. No way for the engineer to buy the batteries. His hands are tied. He has requested funding for the batteries for a couple of years now. Nothing. Two monitors are working but they only had some of the cables. I opened up the our supply case and pulled out two sets of ECG cables, two blood pressure tubing sets and four boxes of infant blood pressure cuffs. It was like Christmas.

Greg had an interesting experience with some new infusion pumps that had been recently purchased. The NICU director was ready to send them back because they kept giving the same two error codes. She wanted Greg to check them out. He watched them place the tubing, set the parameters and alarms, and then press the start button. Sure enough, after a few minutes the alarm sounded, the error message came up. The unit was obviously broken—the same with the other four units. Well, not exactly. The infusion pumps were delivered by the local distributor and he gave a quick five minute demonstration and then left the devices. Ten minutes after he left, the error codes started showing up. He never came back. Repeated calls were placed to come and service the equipment. The distributor claimed it was operator error but wouldn’t come and show how the operators were in error.

Greg watched the doctor set up one of the infusion pumps and within 30 seconds he knew the problem. It was operator error but they didn’t know that because they weren’t properly trained on how to set up the infusion pump. Greg spent 30 minutes doing an inservice with 4-5 staff (what should have been done in the first place), watched them as they set it up, gave them some pointers, and finally did a test run with all five units. No problems.

After we returned from Peja we were invited to a jazz concert featuring Nicole Henry from Miami Beach. There is a jazz festival in Pristina this week featuring nine different artists. She was very good and the pianist was excellent. It was a nice way to end the day.

Wednesday, November 04, 2009

I was awakened this morning at 2:30 by a call from a technician in Uganda who couldn’t find the driver sent to pick up from the Entebbe airport. While I am in Kosovo this week, Jim Stunkel (a long-time Assist friend and volunteer) is working with a team of GE technicians to install equipment at Mbrara Regional Referral Hospital and Kabuyanda Hospital in Uganda as part of the GE Global Health Initiative. The engineer had my number and so when he couldn’t find the driver he called me. As I’m talking to him he sees his name on a sign—the driver is indeed there to pick up him and his colleagues.

I didn’t fall asleep again until 5:30 AM only to be awakened by the alarm at 7.

We spent our day at the University Hospital in Pristina (UCCK) repairing medical equipment as well and assessing equipment and design considerations for a pediatric emergency unit and pediatric intensive care unit (PICU). We again experienced the frustration that the hospital biomedical engineers in Kosovo have to live with each day. On malfunctioning medical equipment the engineers know what the problem is and how to repair it. They are able to troubleshoot effectively on most things and figure out exactly what is needed to get a piece of medical equipment operational again. But if a replacement part is needed to repair the equipment, forget about it. The engineer has a better chance of buying a whole new piece of equipment than buying a part to repair it. I wish I was joking.

For example, in the UCCK ObGyn NICU department there are three infant incubators that require batteries. Each incubator costs about $8,000. Batteries run about $400 each. The biomed was able to order 20 new incubators for the hospital’s NICU departments (they have two NICUs) but has not been able to order batteries for the three units sitting in the corner room. The NICU is desperate for more incubators but getting three batteries will take a miracle. The biomedical engineer must first submit a bid request to three vendors since the part costs more than 100 euros. Once he receives these three bids he then submits the request to the procurement officer of the hospital. If there is funding available the procurement officer selects one of the vendors that submitted a quote and issues a requisition for the part. The part is then purchased. It seems pretty straightforward. The breakdown occurs in the bid request process. The hospital must use approved Kosovo businesses to purchase their parts. If the local businesses do not have the parts, the hospital engineer looks for the part in Europe and finds a vendor for that part. He then goes to the local vendor and suggests where the part he needs can be found in Europe. He cannot solicit a bid from the European company himself. He must use a local Kosovo business. But many times the local business have no interest in providing the part because it isn’t worth their effort for a few dollars in profit. They make a lot more money selling new pieces of equipment to the hospital. UCCK isn’t the only hospital experiencing this. Prizren and Peja also have great difficulty getting parts.

I realize that this is only one perspective and that the procurement office and local vendors may have another viewpoint. But based on my experience in March and what I’ve heard and seen so far on this trip, when it comes to obtaining parts it’s mission impossible.

So we were able to repair a few pieces of equipment with some parts and accessories that we had brought with us, but there is so much more that needs to be done.

Later in the afternoon I looked at a potential area for a pediatric emergency unit and then did a needs assessment in the PICU. I use the word PICU lightly since it was virtually devoid of any equipment whatsoever. I admire the doctors and nurses in this unit who are trying their best but lack even fundamental intensive care equipment such as monitors or infusion pumps.

Thursday, November 5, 2009

We visited the hospital in Gjilan this morning and were able to fix several pieces of equipment and train the doctors and nurses on a infant warmer that had been sitting in a corner not being used because it lacked a sensor, which I brought with me. We ran into the same issue with supplies and parts. The biomedical engineer knew the warmer needed a sensor but he could never get approval to purchase it.

Later in the afternoon we drove to the small town of Kacanik where two donated ambulances were being stored. These ambulances were donated by Northern Ireland and are part of the AIHA program to provide transport for critical newborns from the regional hospitals to the tertiary hospital in Pristina. Currently there is no way to transport infants that require special care from the regional hospitals to UCCK where more acute care can be given to the baby. If a baby needs to go to UCCK, the regional hospitals put them in a car or ambulance without the necessary medical equipment to transport the baby. Many times the baby doesn’t survive the trip to Pristina. These ambulances will be outfitted for transporting critical care newborns from throughout Kosovo to UCCK in Pristina.

After we finished measuring and detailing what the ambulances needed, Nazmi invited us for pasteries and tea at his home in Kacanik. It was a nice experience. His wife had made some bakalav, a local pastry that tasted wonderful. We sat in their living room that was heated with a small woodstove and talked about his time in Germany, his family, and his mother’s upcoming trip to Mecca. I had forgotten that Islam is the primary religion throughout Kosovo, but it is practiced differently than in other parts of the world.

Friday, November 6, 2009

We were in Gjakova today, which sits near the Albanian border. Visiting the hospital was a frustrating experience though we were able to repair a few pieces of equipment and train them on how to use some infusion pumps that were giving them problems. It was “déjà vu all over again.” Parts. Seriously, does it have to be this tough to get parts? Aren’t the hospitals and the Ministry of Health and the Ministry of Finance ever going to figure it out? The hospital has four very good engineers that are able to troubleshoot a problem on any piece of equipment down to component level. But when the engineer requests the part, he can’t get it. He’s frustrated, the doctors and nurses are frustrated, but nothing gets done. It’s beyond their control.

Another classic example. The Labor and Delivery department have a fetal monitor that isn’t working properly. One of the connectors is faulty and it is a relatively simple repair—once you have the part. But the department doesn’t want to give the unit to the biomedical department to fix until they have a replacement unit, after all, the fetal monitor could sit in the biomedical shop for six months awaiting the part. Good news though. The hospital has a brand new fetal monitor that the L & D department can use while their current unit is being repaired. There is a problem though—there always is—the new unit does not have any recording paper and they can’t get any. When the hospital ordered the unit from the local vendor, they ordered several cases of paper with the fetal monitor. But the vendor never delivered the paper because he couldn’t obtain it. So he delivered a brand new fetal monitor without paper and has never returned. And he was paid! That’s what really gets me. So the hospital is asking if I can get them some paper, so they can use this fetal monitor in the L & D department, so their current unit can be repaired. Unbelievable.

Of course we are glad to help all the hospitals with whatever supplies and parts we can. But it won’t solve the greater problem. We can repair everything that needs repair today, but next week, next month, there will be more equipment that requires parts or accessories.

5 days in Sudan

Operations Vice President, Ray Schmidt spends 5 days in Sudan scouting a medical project on Aba Island, attending the dedication for the Dereige Primary School and getting eaten my mosquitoes.

Sunday, August 23, 2009 – Khartoum, Sudan

I arrived in Khartoum last night. The original plan was for my colleague, Steve Savelich, and I to travel to Sudan together to look at a potential hospital project and to commission a school in Darfur that Assist had built with funding from a generous donor. Unfortunately, Steve did not receive his visa in time. He was red listed/black listed and it will take a couple of days to work through that. Since I received my visa, I went ahead and traveled to Sudan and hoped that Steve would be able to join me Tuesday night.

Monday, August 24, 2009 – Kosti, Sudan

It rained last night. No, it poured last night. It was a first rate storm: thunder, lightening, strong winds, and buckets of water. I didn’t expect to experience this type of a storm in Sudan. The water was pouring through the ceiling into my room and I had to put out bowls to catch the rain. As we were driving out of town today we saw large billboards that had been blown over by the wind. I spoke with a man this morning who said he had never experienced a storm like last night’s. It was a good show.

I am being hosted by Dick Brogden of Aslan Associates, which is an NGO in Sudan that has partnered with us on previous medical projects in Sudan. Dick has lived in Khartoum for the past 14 years and speaks Arabic fluently and has an amazing understanding of the culture and the people of Sudan.

This morning we drove down to the South Nile Region, which includes Aba Island, Rabak (30 km south) and Kosti, which is across the river. We are looking at a potential medical project at the Abu Island Hospital. The island is about 35 km long and 3 km wide and has about 100,000 residents. There is remarkable history to the island dating back to 1870 when the first mahdi came to the island to seek Allah. He was a religious/revolutionary figure that led a revolt against the British that ended in the defeat of General Gordon. Aba Island is considered very important and sacred in the history of Sudan.

The Aba Island Hospital is a small hospital of around 80 beds and is the only hospital on the island. We were warmly welcomed by the hospital director and some local officials. As we toured the facility, I noticed that there we very few patients. I asked the director why there were so few patients and he informed me that the hospital is actually closed for renovation. The outpatient portion of the hospital was still open and there were also a few patients that required close attention. The renovation should be completed by the end of September.

The operating rooms had just been redone with new floor tile and paint. They were in very good condition, but the equipment was old. The two operating tables dated back to the 1950’s. They do not have anesthesia machines and so patients are put to sleep using the old hand applied method. The hospital needs a lot of help and I hope that we will be able to provide assistance in some manner.

Tuesday, August 25, 2009

We went back to the hospital this morning to ask a few more questions and to meet with some additional hospital staff. Yesterday, a local politician had taken the tour of the hospital with us and every time we asked a question he would give us an exaggerated answer. So we went back to get real answers to some of our questions. It went very well and I think that we could help this hospital improve the quality of healthcare that it provides.

A professor from the medical university next door to the hospital took us on a short tour of the island. We visited the site where the mahdi had dug a hole in the ground and spent time praying and seeking Allah. There is a small mosque built over it now. People will come and take a handful of the soil from the hole, and pour it over themselves or family members, believing it has healing power.

Later in the evening, Dick and I went to the Khartoum airport to pick up my co-worker, Steve Savelich. We had Steve’s visa and had to deliver it to the passport control office prior to Steve's landing. The security had us sit down and wait for someone to walk us to the passport control office. This is a fairly new procedure and the sole purpose is raise money for some official. For this walk to the passport office it costs about $10. Previously you could just walk to the office on your own. We sat in the waiting area for 45 minutes and Steve’s plane was to land at 10:35 PM and it was 10:40. Dick asked me if we should go on our own. Sure. Why not? And so we walked confidently to the passport control office without being stopped and questioned. The plane was late and so we sat in the office. One of the officials gave us a glass of cold tea and we chatted awhile. After about 30 minutes, the original security guard who had told us to wait found us and he was angry. He marched us out of the office back to the original waiting area and he threatened to call the police and so on. I don’t understand Arabic but Dick and the guard had a nice conversation after which he finally settled down. A couple of minutes later, he let Dick walk back to the passport control office—on his own.

Wednesday, August 26, 2009 – Nyala, Darfur, Sudan

I woke up this morning to pouring rain. It was raining as hard as Sunday night. Unbelievable. I’ve been in Sudan for four days and each day it has rained, at least a little. No one was in the streets. Standing water reached at least two feet in some places.

That morning, Steve and I were scheduled to depart for Nyala, Darfur at 11 AM, but Steve first had to register his passport and get a travel permit for Darfur. Normally it takes a couple of days, but a friend of Dick’s was able to get it done in two hours. We arrived at the airport (still pouring rain) and waited for the airline to open the desks so we could begin checking in. Around 11 they opened the desks and there was rush for the desks. No lines, no aisles, just a mass of people streaming to the desks with tickets in hand trying to get the attention of the agent. There was no rhyme or reason on whose ticket was processed. The agent would look up and grab one of the tickets being waved in front of his face. Meanwhile it is still raining outside but there’s water coming through the ceiling tiles into the room.

We finally received our boarding passes and then waited to depart. The 11 AM flight finally left at 3:30 PM and we arrived in Darfur around 6 PM. Steve’s suitcase didn't arrive and since he is 6’6”, my clothes wouldn't fit him. Surprisingly, Nyala isn’t too hot. It’s actually pleasant with temperatures in the high 80’s with minimal humidity.

Thursday, August 27, 2009 – Nyala, Darfur, Sudan

It was a rough night. I spent most of the night batting mosquitoes and flies. There was no mosquito net so I just had to make the best of it. I woke up this morning and there was little blood spots on the sheet from where I had killed mosquitoes that had been banqueting on my blood. I then looked at my feet and they were covered with red spots. There were hundreds and hundreds of little red dots that went from my toes up to my shins. They kind of look like freckles or like someone had spattered red paint on my feet. A little while later the red dots started to get white circles around them. Very bizarre. I was told that they are all mosquito bites. I guess I was the main course last night for hundreds of mosquitoes.

We went out to the Dereige Community Primary School for a school dedication ceremony. This was a school that Assist built with funds from a generous donor and through a local organization called EDOOS. What an experience. As soon as we stepped out of the car the students surrounded us and started shaking our hands. I think I shook the hands of every student two or three times. Then the students started giving the thumbs up gesture. It was a lot of fun. The dedication ceremony was nice and the students, teachers, local officials and the sheiks expressed their gratitude.

The Dereige school sits on the edge of an IDP (Internally Displaced People) camp of about 30,000 people outside the town of Nyala. The three classroom buildings are for grades 1 through 4 and plans are in place to add the 5th grade next year. The parents and the community were so effusive with their thanks.

Scary Flight for Assist International Communications Vice President

Steve Savelich, the Communications Vice President of Assist International expected some adventure when he joined the Assist team last Spring, but he didn't expect dramatic emergency plane landings.

Steve and his wife Jan were coming home from a successful trip to Jinja, Uganda, where they joined other Assist members and GE medical staff in installing a state of the art ICU monitoring system in the Jinja Regional Referral Hospital.

It had been a long and emotional draining week for the Savelichs. In addition to outfitting a medical clinic, they helped hand out new pairs of shoes to 2,500 orphans through AOET (donated by Soles4Souls) and distributed shoes to 400 former LRA "girl soldiers" (abducted for sex slaves) and their 150 children at an IDP camp.

"The extremes in hardship and the overwhelming need is still very fresh in my mind," said Steve. "We met with former girl soldiers and their children who were trying to put back together their lives after escaping from the LRA. These young women are just like you and me who are trying to live out their lives as caring and productive people," he said.

United Flight 949

The Savelichs, reflecting on their trip, began the long journey home to Ripon, California. In London, they boarded United flight 949 bound for Chicago. Steve was excited they were seated in the exit row, which meant a little more room for his 6'8" frame. Maybe he would even get a little sleep.

About 2 hours into the flight, people could smell something burning. It was an electrical fire and smoke began to pour out of the cockpit.

According to the first captain, the pilot's were having a hard time breathing and could not see the controls. They had to use their masks to help them guide the plane. The electrical circuits for everything on the airliner is located under the cockpit and the worry was that the fire would cut the wires that control the hydraulics.

The passengers noticed that the audio and video system went out very quickly with a 'pop'. The pilots began to check the flaps on the wings.

One man later said that no one on the flight was too worried until the PA system was left on (the pilots could not see the switch to turn it off), and they heard, “we need to get down now.”

There was an announcement from the crew that they would divert the plane to Iceland. No one was sure if this was to be a ground or a water landing.

"I didn't know if we'd make it to land or if we did that the landing gear would work," said Steve.

"I thought about Paul and his prayer on the ship and prayed in a similar vein."

Being located in the exit row, Jan and Steve were called upon to get ready for action. The steward took them through the emergency procedures again. People began to gather their passports and other valuables and put them in their pockets. Some figured it was for body identification, others were hoping to use them again to get out of Iceland.

The plane decreased in altitude and the passengers and crew could began to see Iceland in the distance. The entire plane exhaled a giant sigh of relief when the plane came to a halt on the runway. Surrounded by fire trucks and emergency vehicles, every one walked off the plane shaken but uninjured.

"I know that men far better than myself have gone down in plane crashes, but God who is merciful to the poor and pathetic had mercy on me and on all who were on the plane," laughed Steve. "It was quite an experience and of course, the upside is we've been to Iceland."

Read news story here.

Another first hand account of United flight 949 here.

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