2010 Reflections

By Larry Keyser:

When I was given the opportunity to go to Rwanda, I expected it would be to do heart surgery and see a new country on a new continent I had never visited.  I did not expect to fall in love.  Some of you received a letter from me from the last Sunday before we left, after Elaine and I had been looking out from the balcony of the hospital at the little valley below.  The whole scene could not have been more perfect if it had been put together by a movie director.  People of all ages and styles of dress were streaming across the valley going to church, with church music, African style, making the soundtrack.  Little children running through the garden patches, women dressed in their finest colorful long dresses, carrying loads on their heads, men and boys walking hand in hand, or riding bikes.  Over here, an older lady with a baby on her back, tightly wrapped with a long cloth around the waist, hoeing her garden.  The morning fog was still lifting off the golf course along the valley floor and the neighborhood roosters were adding their voices to the many wild bird songs.


We went to Rwanda to teach the hospital staff all the complexities of caring for heart surgery patients.  Frankly, I think the actual doing of the surgery, which was well thought out and managed by our own team, was the easy part, in the context of the whole enterprise.  The preoperative glitches and post operative care, when we had to interface with the hospital services, made it clear where the work needs to be done in the future if King Faisal wants to run their own program.  All that said, we learned just as much from them, as far as subtleties of communication and etiquette.  I see the future challenge to make the Rwandan staff and ours to see one common goal, despite different styles and levels of learning.  Several members of the team rightly pointed out that, if the goal were to do heart surgery on a bunch of Rwandan patients, that it would be more cost effective, safer, and easier to bring them to Spokane. This, of course, is absolutely true but misses the point of the longer term goal.  Whether it is realistic to expect to build a successful heart surgery program in Rwanda, I frankly don’t know.  On the other hand, who would have thought, sixteen years ago, after the killing stopped, that the people would have gotten themselves to point they have now in building a viable country.


From the beginning, I sensed a positive energy and spirit of hope among the people.  I think my “aha” moment came when we drove to Akagera National Park and we saw the constant parade of humanity along the road. Children in droves going to school, a very good sign.  People generally happy and healthy-appearing, industrious, courteous to each other, hard working.  Busy markets on the hillsides, well attended and well stocked.  Even in the villages, Elaine noted, not a single spot of refuse or pile of garbage.  Mud huts with thatched roofs, with flowers planted in front and neatly swept.  Neatly tended gardens, carefully terraced hillsides for the coffee, hardly a piece of bare ground without something planted. The city of Kigali is, by far, the cleanest we have seen and puts many metropolitan centers in Europe to shame.  And, of course, we all will readily agree that the greatest resource and source of hope for the country is the people.  Never have I felt so safe, been treated so politely, or received so much genuine good will.  Again, the spirit of the people seems quite palpable.  If this can be maintained and nurtured (I hope to continue to make whatever small contribution I can), I think this country can achieve it’s goal of becoming the successful showpiece of East Africa.



Another day


It’s 8:20P local time and I’ve found this is a good time of day to get on line.  I have a free moment and I’m waiting for our second patient for tomorrow to arrive from Butare, about 1 1/2 hours south.  He said he would be here at 6, so he’s on Rwanda time.  Many of you will notice I’ve widened the recipient list.  I figured I would include a wider bunch for the news reports from here.

I will start right off by sounding very cliche.  In the few short days I have been here, my life has shifted a degree or two.  Rwanda is green, mountainous, and gorgeous beyond description.  The people are beautiful, gentle, polite, and physically handsome.  As we drove to Akagera National Park yesterday, a trip of abut 2 1/2 hours each way, we passed a constant stream of people on the road, walking, riding bikes piled high with firewood, bananas, sorghum, passengers, or carrying heavy loads balanced on their heads.  A man dressed in very traditional garb, including long skirt and shoulder blanket (I don’t know the official name of it), with a long switch in his hand, tending his cattle, talking on a cell phone.  Hoards of children dressed in brightly colored school uniforms.  There are quite a number of very nice and fairly new schools that are well attended.  It seems everything is timed as before or after the genocide, which is only occasionally mentioned.  Several of our patients lost siblings or, in one case, both parents.  It seems the orphans, the lucky ones anyway, were simply taken in by anyone who could care for them, so I have admitted two patients already who have been accompanied by “adopted” parents.  Despite this history, people seem, for the most part, happy, healthy, and positive in spirit.  I think this country has good potential based on that fact alone.  Along the trip to the eastern part of the country where the park is, we passed any number of secondary schools with signs indicating training programs in engine mechanics, welding, agronomy, forestry, nursing.  Everything you can think of that it would take to get a country up and running.  We drove on a pristine blacktop road the equal of any of the best roads in America.  Not surprising since most people can’t afford vehicles and traffic is very light, sharing with pedestrians in large volume.  Another odd vignette:  driving along in a rural part of the countryside, we passed four guys on fancy road bikes, all decked out and obviously serious, judging by their legs.  The mild frustration is that nothing less than a short book would do justice to the total experience, and short e-mails seem inadequate.  When |I get home, I’ll try to get Michael to help me post pictures of Flickr or one of those.  Got some good giraffes, baboons, and water buffalo.  Not to mention the patients.  Small in stature, big in spirit.


Last day


This morning after we finished rounds, I went out to the outside balcony off the telemetry unit and looked over the valley with the only golf course in Rwanda and watched people going to church on the other hillside.  Little kids running, ladies dressed in gorgeous long dresses, many with food piled on their heads.  Men riding bicycles or holding hands (common and accepted) From the church came amplified beautiful African church music.  As far as I can tell, the service consists entirely of singing, and the music, to my ear, all sounds worthy of being recorded on CD, complete with piano, guitar, and the usual large assortment of  percussion. The entire scene looked like a movie with an Oscar winning soundtrack. Do you think I cried?  yeah.  I didn’t mention the fog over the valley bottom, steaming off in the sunrise.  And the myriad bird songs like you’ve never heard, including the neighborhood roosters.  The surface impression one gets here, coupled with the history, makes for a bewildering, confusing, infuriating, heartbreaking, inconsistent hodge podge of sensory overload that is very difficult to put together into any kind of logic.  Like a very beautiful but difficult jig saw puzzle.  The temperature is a perfect 80 degrees or so, the rainy season is a few weeks away.  We have stimulated the local economy (“planted beans”, as Abraham said at our favorite shop), given away bicycles, made friends with Rwandan doctors who work with inadequate equipment for a monthly pittance.  I have given my stethoscope to Dr Jean Claude.  Truth be known, I would just as soon come home empty handed.  We will leave here Tues afternoon at 3PM and arrive in Spokane Wed PM around 7PM which would be 5AM Thurs locally.  I discharged two more patients today and that will leave us with three tomorrow who should all go home.  No one died and all left smiling.