Once more, with pictures!

Hello again!  I'm checking in after a busy first month here in Rwanda, and everything is going well so far!  As I detailed in my last post, I've been working on learning about the way that the health care system works here, and how people exchange information to treat patients.  It's been an interesting process so far to learn a new system, meet dozens of new faces, and get out and about in the villages surrounding my home base of Ruli.

I spent the first week or two just getting used to the hospital, and learning my way around the system.  Ruli Hospital is a district hospital, the middle ground between the primary-care oriented health centers and the specialized referral hospitals in the capital, Kigali.  It's a busy place, averaging 40-60 outpatient visits daily, and performing around 60 surgeries, delivering close to 100 babies, and giving hundreds of vaccinations each month.  In addition, it offers physical therapy, dentistry, and ophthalmology services to the local population.  With all these resources and people in one place, it's a complicated machine.  For my first weeks at the hospital I found myself in a constant deluge of introductions and welcomes, and I was struggling just to keep up.  Simply remembering everyone's name and where they fit into the hospital system was a small victory in itself! 

Since then, I've gotten to know a number of people fairly well.  Though there are too many to list them all here, there is one who deserves special mention.  My partner in this project is Delphine, a Ruli native with great ideas and vision for our work.  In addition to lending her mental faculties to The Ihangane Project, she serves as a phenomenal translator and source of cultural understanding.  To top it off, she's finishing school to become a radiographer, and this experience allows her to come up with insights into the Rwandan medical system that a newcomer like me would take months or years to think of.  With her help, we've been able to make the most of our time here so far!

After taking time to acclimatize to the hospital environment, we have spent a few days traveling to some of the health centers that refer patients to Ruli Hospital.  We're spending most of our time in the village of Nyange, as this is where we hope to begin using the information that we're gathering about information and patient flow to create a tangible product: improvements to the referral system between health centers and the hospital. 

Once or twice a week, we have been making the trip to Nyange to build relationships there and gauge the best way to improve this process of communication.  The roads in Rwanda aren't the best.  In fact, in many cases, they are really “roads” only in the loosest sense of the word – and the road to Nange is particularly bad.  The village is only about 10km away, but it takes between an hour and 90 minutes to go each way.  Although I'm sure it will all be worth it in the end, the fact remains that four rides per week in this rough terrain takes a certain toll on a traveler's tailbone!

And so for now, I must go to nurse my injured coccyx and spend some time analyzing the heaps of data we've been collecting.  I'll be back in a week or two, internet-permitting, of course, with more East African updates!

Muraho Rwanda!

Murakaza neza! - Welcome to my blog, where I will be updating with news from my project here in Ruli, Rwanda. Like most of my WDI colleagues, I'll be working on a project in the field for the next 12 weeks. In my case, I'll be working with a district hospital and network of health centers to try to understand the complex chain of information flowing between clinicians and administrators and between different levels of the Rwandan health care system.

But first, a little background. I'm working with The Ihangane Project, a non-profit organization dedicated to making sustainable improvements in the lives of Rwandans through community-based projects in nutrition, sustainable energy, economic development, and patient-centered health care. As part of its continuing mission, in March and April of 2012, The Ihangane Project sponsored a team of students from the Ross School of Business to study ways to improve the flow and usage of data at Ruli District Hospital.

This summer, I will be building upon the base of analysis they have provided, and extending the scope to consider the flow of information and patients in the larger context of the hospital and a number of its affiliated health centers in the surrounding villages. In understanding the “big picture”, we will be able to characterize specific processes – the path of diagnosis and treatment of diabetes, or malnutrition, for example – and will be able to make recommendations and implement improvements that are congruent with and sustainable within the existing health care system.

I've been on the ground for about two weeks now, and have gotten off to a great start on the project. At the same time, I've also experienced a warm initiation into Rwandan culture. Everyone has been remarkably welcoming; the faces in Ruli are always friendly and everyone makes time to stop and chat. My skills in the native language, Kinyarwanda, are rapidly improving from dozens of these informal lessons each day. From sampling brochette, (the delicious local goat kebabs), to participating in 5-hour-long church services (at least 3 hours of which seem to be devoted to dancing), I'm learning a lot about how this community works and what makes it special. I already know that this will be a great summer living in Ruli, learning, and working for better delivery of health care in this amazing part of the world. I'll be posting here with updates and insights through the rest of the project, but for now, murabeho – goodbye until next time!