Posted by Susan Bosworth - March 2014
People often ask “what is it that you do exactly?” and it’s sometimes difficult to come up with a short answer. In my experience working in global healthcare education I have found that our job is multifaceted and complex. We have an opportunity here in Rwanda to affect nursing education in many ways. In everything from direct student contact in both clinical and classroom to project management and systems changes within the hospital we are privileged to work with Rwandese counterparts and learn together. The below schedule may differ from facility to facility and from day to day… none of us do exactly the same thing, but this might give you a gist of an idea :)
5AM: Roll out of bed and stumble into the kitchen to make coffee to wake up…
6:15AM: walk up hill to the Payage bus stop and wait for an unfilled bus to come and pick us up…
7AM: arrive at work for report in A/E (Accident/Emergency)
7:30AM: Meet with twin and discuss ongoing projects, plans for the day, frequent interruptions by people using the copy machine, needing information on emergencies, reports being brought to office
9AM: check on students in A/E and Pediatrics, see if they have questions, discuss allocation for care, check with the nurses to see if there are any issues, and touch base with clinical instructor for the students if they are around for the day
10:30PM: chat with the nurses in the ward- get updates on families, babies, life events, etc
11AM: Work on procedures and assessments with students and nurses including starting IVs, giving meds, triaging emergency patients, documenting work, calling lab
12:30PM: head back to the office to catch up on emails and grab some quick lunch with my coworkers
13:30PM: sit with twin, have tea, pull out laptops and work on projects and reports and student assignments
1500PM: head back over to the wards, do some more procedures with students, discuss assignments and care plans and do some physical assessment and patient teaching
1600PM: get critical patient, review care, discuss ECG with doctors and nurses, review with student what was seen and debrief
1700PM: get back to the office and finalize some things for a presentation at Byumba nursing school. Write a powerpoint, respond to emails
1730PM: catch the bus home (or a lift with a friend if we are lucky)…
Start all over again the next day…
Working here is a unique opportunity to learn how to teach and to become a learner all at the same time. Daily I find myself challenged personally and professionally in how to resolve situations, manage time, work with individuals and groups, communicate well, be flexible when necessary and to become interdependent on one another. While at times the relationship building, project management and teaching investment can be exhausting and frustrating the exhilaration that comes with seeing the changes in both the system and in myself make it worthwhile. With these things in mind the answer to “what is it that you do exactly?” becomes much easier. We are here to build relationships, learn and teach one another and buhoro buhoro (slowly by slowly) to see Rwanda take the lead in nursing education and practice.
Posted by Kelly Burke - February 2014
It’s now been approximately six months since Year 2 Human Resources for Health faculty from University of Maryland School of Nursing and other universities have arrived in Rwanda. I have been based in Nyagatare, in the far northeast of Rwanda, at the District Hospital and the Nyagatare School of Nursing and Midwifery. As I look back at the past six months I immediately draw an analogy to my foray into ‘farming’ of soybeans and maize (corn) as an out of work hobby. I planted in September as the rains came, along with much Rwandan assistance. It wasn’t easy. I had to take time to learn, there were misunderstandings and language barriers, but with dedication from both me and Rwandan counterparts, progress was made. The planting and growing of the soybeans and maize has mirrored my work as an Adult Clinical Mentor in Nyagatare. As the soybeans and maize grew, so did my role as a Clinical Mentor. Relationships have been sewn, partnerships have been made and successes have been achieved. Working together both in the hospital with students and staff nurses, and in the School of Nursing with lecturers and Clinical Instructors has taken time, just as it has to grow crops.
Some activities I have been involved in are clinical teaching of students, education of nurses working in the District Hospital and incorporation of the developing Skills Lab into nursing courses, including making locally produced Nursing Procedures videos. Bimonthly Clinical Instructor meetings have been established to enhance clinical instruction of our students and outcome oriented evaluation tools have been created together with Rwandan colleagues. Assisting to promote the profession of nursing from a task oriented job to a profession characterized by critical thinking and a nursing process remains the focus. Culturally, when asked how a person is doing, ‘Amakuru?’, the person responds that he/she is fine,‘Nimeza’. Teaching nurses and nursing students how to use the nursing process to assess, plan, implement and evaluate the care for a patient who almost undoubtedly answers that they are fine remains one of my major tasks.
The soybeans and maize didn’t grow perfectly. Soybean plants faced insects and the maize was eaten by cows. My work has also faced challenges, but overall, the process has been successful. I look forward to more ‘growth’ at work and on the farm.
About the Nyagatare School of Nursing and Midwifery:
Posted by Lidya Admassu Melesse, BSN, BS, RN - Jan 2014
It’s a new year with new ideas and perspectives. As I sat on top of Mount Kigali, I watched the sunrise and the rays shine through the morning clouds. I pondered on the last five months and all the work I thought I did as well as what impact I really made. Sitting on top of that mountain gave me a different viewpoint on the busy streets and buzzing town of Kigali… It was unusually serene and peaceful up here. As I look out in the distance at the city center, I can see the musical symphony of old mixed with new. Like much of Africa, Rwanda is old tradition and history trying to rearrange and rewrite its future, and I, in some strange way, am one of many contributing authors to this novel that is the new healthcare in Rwanda.
The rolling hills in the distance appear quiet and peaceful at first glance. Taking a closer look though, you realize just how busy people are… how focused. They are ready and eager to learn and this metropolitan sprouting up all over Kigali is evidence of the rest of the world acknowledging their attempts at self-improvement. I came to Rwanda in August 2013 and frankly, I was terrified. I wondered if I had what it took to engage the students here and make them as passionate about nursing as I am. I kept questioning if the nurses in the hospital would accept me into their culture. I was the new kid on the block… or in this case… in the continent.
My fears were melted away by the warm smiles of my twins on the first day of work and over the first five months I quickly learned that us nurses, no matter where we are, all speak the same language. The King Faisal Hospital community embraced me and I quickly became one of family. During that time, my team worked along side many of our counterparts to conduct several BLS courses in the hospital where all incoming students have participated and received certificates of completion. We were encouraged by the openness of the staff to share their concerns and priorities. We worked to create a Nurse Leadership and Management Series, preceptor course, revamp nursing diagnoses sheets and create a standardized student orientation program for all incoming students. But at the end of 2013, I questioned if my work was effective.
It didn’t matter what I created or what programs we developed as a team, it mattered that it was sustainable. An epiphany occurred when I was sitting in a coffee shop in Morrisville, NC. I watched a father desperately attempt to get his son to sit quietly by offering him a cookie. The man smiled at his son and proudly displayed a chocolate chip cookie and his son, still running away, looked back and said he wasn’t interested. The father was confused, and I in the same manner was puzzled. How could this child not want a cookie? Glancing up once more, I see this boy run towards a magazine lying on another table, he climbed onto the chair and quickly became engrossed in the pictures as he flipped through the pages. Then is when I realized, it’s not about me or my presumptions of what I think the nurses need in Rwanda. It’s about my ability to apply the nursing process into my work and first assess my twin, hospital and population. I’m sure unconsciously I had done this somewhere along the road of presentations, policy developments and instruction but I still wondered if I made a difference. In this moment I realized the holiday away was not only rest, but also a mid-term exam if you will. How well did I really do? The only testament of success will be the sustainability of my projects.
Back in January, I stepped back onto Kigali ground and was nervous. I was in suspense to know if my work survived without me. I questioned if it made enough sense to them that they continued to carry it on although I wasn’t there. As I entered the reception area of the hospital, I was greeted with happy faces and conversations of how the new-year was passed. The excitement of students seeing me back was a wonderful feeling. I examined the unit, looking for evidence of failure and realized that the old Rwandese saying of “somehow, it will work” had true meaning. The policies were displayed and being used, the education sessions were in full swing and the nurses felt free to adjust projects to fit it into the context they deemed appropriate for them. I was pleasantly relieved and reenergized at the same time. Some things didn’t work but many others did.
Working in Rwanda has proven that the only constant is change and we can make a difference if we approach this work with an open mind. Where resources are low, creativity must be high. It isn’t easy thinking outside the box when it comes to teaching and caring for patients but this approach in many cases very necessary. Understanding the culture and appropriateness of teaching strategies has been my biggest lesson here. I’ve learned that I must step back from my personal viewpoint and respect the priorities of my counterparts. Seeing every positive as a success and moving towards a common goal is key and for 2014, it has become a rule.
Posted by Sarah Horwath, BSN, RN, CCRN - December 30, 2013
I took one last deep breath of fresh Kigali air and boarded the plane to end my 15-month journey in Rwanda. Although I had been preparing for this day for months, I still felt extremely emotional and as if I was leaving behind a family and a home that I had known for a lifetime.
Rwanda is special. The people have a warmth about them that makes you feel instantly welcome and they also have an endurance and resilience that is inspiring. I have learned so much from them.
One thing I was sure to mention in my farewell speech at the hospital was how this has been the best job I’ve ever had. I have always loved being a nurse and I’ve really enjoyed my previous positions as a bedside ICU nurse, but this job made me excited to get up at 4:45am, 5 days a week. This job, despite all its challenges, made me fall in love with nursing in a completely new way.
When I joined the HRH Program in year one I was assigned to Rwanda Military Hospital as a Critical Care Clinical Mentor. I arrived at a time when the hospital was renovating and transforming from a district level hospital to a referral hospital. The hospital had a vision to open their first Intensive Care Departments but they needed some support to realize that vision. I was extremely fortunate to be paired with my Rwandese counterpart, or “twin”, Idi, who was very experienced in critical and intensive care nursing. We communicated easily and quickly established a relationship that was built on respect, honesty and trust. From October of 2012 through July of 2013, Idi and I worked together, along with our HRH year one colleague, Vicky Albit, MSN, RN, CPNP, to establish an Adult, Pediatric, & Neonatal ICU nursing team. We began with a selection process, then a theory based training workshop, followed by some simulation practice and finally clinical practice training and team building social excursions. The ICU’s at RMH officially opened in April of 2013. The process was challenging and the barriers were significant but the nurses were outstanding. These were general nurses with no prior experience in critical or intensive care nursing and with a nursing education similar to that of a diploma program. I was energized and driven by their efforts to re-learn nursing in a way that was foreign to them and also very challenging when adding the specialty of critical care. Our expectations were high and although resource limitations were considered, standards were not compromised. Instead of saying “no, we can’t do that because we don’t have this medication or that consumable” we’d say “we will do everything with what we do have”, brainstorming, thinking of alternatives and how to make the best of what we had. This was one of the most valuable lessons that I learned from them. Here are a few examples of clinical and practical tips I learned from them:
Aside from the practical skills, they also taught me emotional skills. It took a while for me to throw out my old practice of “if you want it done right, do it yourself” but eventually I learned from them to be patient and calm in everything. It’s difficult to explain how my critical care pace remained the same yet I was speaking slowly and giving us time to think through concepts and giving them time to practice for themselves, even in critical situations. The benefits of this method were so profound and far outweighed the “fix it” methods I had previously attempted. In short, they taught me to be more patient and I was able to use that to help them learn in a way that was more effective for them.
I could go on about how they taught me about resilience, about appreciation of life through an acceptance of death, or something as simple as the importance of a friendly greeting; but in summary, I want to say that this experience was transformational. These nurses have challenged me, surprised me, and inspired me. My greatest success is to hear them say that they are so proud to be nurses.
I am back in the U.S. now but as they say in Rwanda “we are still together.” Thanks to the internet and great Apps, I’m able to communicate easily with them. Rwanda will always be a home to me and these nurses hold a permanent place in my heart.
Posted by Gail VanVoorhis, MSN, RNC-NNP, educator/advisor for simulation and skills labs - November 2013
I would like to share with you the tour of Rwanda that is my job going from school to school throughout the country. Here is a map so you get an idea of the geographical locations.
Just a little news from Rwanda: The University of Rwanda is now official and all the schools you will see are now the various campuses of the University of Rwanda. There are many Colleges within the University and we are now under the College of Medicine and Health Sciences. We have a new Principal over that College. This poses some changes because we are “One” university. The process has started to standardize curriculum and clinical experiences. All the schools of nursing are now under one Dean and so changing jobs is another daily process here. For HRH it means some changes in our twin’s titles but generally we are all doing the same jobs of helping improve education for nursing.
And here is a picture diary of Nursing and Medical Schools of Rwanda:
View of Lake Kivu on the way to the Kibuye School for health sciences and students heading to the community building for their orientation. This is the first year campus for Kigali Health Institute so all students are here for a year. This is a year of basic sciences. It is a tranquil beautiful place and I can honestly say if I worked here I would live longer! The road to get here from Kigali is long and very twisty. We arrived at night so I didn’t actually see the lake till I woke up in the morning. This is the only place I ran into pit toilets so far.
Kigali Health Institute (KHI): Just around the corner from CHUK and uphill a bit from the downtown area in Kigali. Students are here for 2-3 years for all healthcare schools except Medicine. It is the only BSN for nursing and as of October 7th BS in Midwifery in country. KHI also has the diploma courses for nursing and midwifery, radiology, physiotherapy, dentistry, ophthalmology. The picture on the left is dorms on the upper floor and classrooms on the ground floor. The building in the picture to the right is the School of Dentistry and also the skills labs for all on the 4th floor. We call the steps the “Death Stairs”. Steep and narrow. Keeps us in shape!
Rwamagana Hospital. About an hour east of Kigali this hospital has lots of new construction going on. A district hospital, they have lots of land and are spreading out a bit. Wards are separate buildings on the compound. The common Laundry for patient families on the right and you can see the field in the back that is planned to be a garden to supply food for patients and staff. May be an Umuganda day soon! (That is the last Saturday of the month when all are out for half a day doing community service).
Rwamagana School of Nursing and Midwifery is located just a couple of blocks from the hospital. Entrance to the school on the left and one of the two skills labs on the right. We spent an afternoon here going through the skills labs doing a picture inventory and helping to reorganize the equipment. Great skills lab staff and the rooms are set up so one is for midwifery and one for general nursing.
A rare site for us but not for Melody and Stewart! African Cranes are living in their front yard in Butare located about 2 hours south of Kigali. To the right is CHUB (Centre Hospital Universitaire de Butare) which is a referral hospital and home to the Former National University of Rwanda (Medical School).
More Pictures of CHUB. Left: looking out the back of CHUB toward the Medical School campus. Right: Walkways between the hospital wards are mostly covered so in this rainy season you can navigate between buildings.
Kabgayi (pronounced Cab Guy) School of Nursing and Midwifery. Located about an hour south of Kigali and half way to Butare. This is the first nursing school in Rwanda with Catholic roots.
On the path to go back to the school in Kabgayi and to the right is the church which was the first Catholic Church in Kabgayi, Rwanda. They celebrated their 100 year Jubilee the first weekend in October.
Byumba SON is located about 1 ½ hours north of Kigali. They have a very well equipped lab that has the only Noelle birthing simulator in country. On my day to visit here I was getting over a night of terrible stomach upset (the dysentery diet) so Susan Bosworth graciously took pictures of their lab for me.
I have Byumba, Nayagatare, and Kibungo to visit yet. There are also two private schools in the country which are on my list but are a grey area as far as the University of Rwanda goes. This last two weeks of October have been National Nursing License testing. The first week is written (paper and pencil) and the second week is the clinical testing. Many of the USI faculty are going to the districts to help with the clinical testing that will be a clinical skill on real patients that is observed by faculty.
I love that this job allows me to see all the schools and get to know the country and many of its people. All the districts have been welcoming and the HRH staff in each place has been gracious and make us feel like we are visiting relatives at home. The hospital staff are very happy to show us the improvements that are being made, and the faculty at each school are anxious for more help from USI faculty.
These last pictures are waking up (on the left) and the view outside of our house at sunrise and on the right a beautiful sunset from the dining room of Bamboo, a restaurant in downtown Kigali.
Murakoze Cyane for taking the tour. Uramuke ho from Rwanda!!!
Posted by Trish Martin - October 2013
Muraho! This is the Rwandan greeting for "Hello"! Welcome back to our blog of our experiences working with the wonderful people of Rwanda.
The Human Resources for Health (HRH) orientation was a great time to continue to meet people from the HRH program. We have met so many intelligent, highly motivated, passionate people from various interesting backgrounds. There are doctors, dentists, nurses, midwives, and human resource specialists. Some have made international service their life's work and some are new to international work. The camaraderie is infectious and supportive as we all find our way in a new country with its many challenges.
The University of Maryland cadre of nurses in Rwanda has been assigned to schools and hospitals throughout the country based on our qualifications and their needs. We are working as clinical mentors or nurse midwives in various hospitals or as advisors to schools of nursing and midwifery. We are proud to have the simulation lab specialist for the country as part of our distinguished UMSON group. The country of Rwanda is roughly the size of Maryland. To give you some perspective, we have been assigned to one of the following locations on this map as our home base: Kigali, Nyagatare, Kibungo, Kanombe (a Kigali suburb), Rwamagana, Butare, and Kibuye. We are affiliated with a school of nursing and midwifery in these towns to assist with teaching, transition of students to their clinical rotations and curriculum development.
There are four referral hospitals in the capital city of Kigali. These include University Central Hospital of Kigali (CHUK, pronounced Say-ahhsh-oou-kah), King Faisal, which is a privately owned hospital, University Teaching Hospital of Butare (CHUB, pronounced: Say-ahhsh-oou-bay), located in the southern province of Rwanda, and the Rwanda Military Hospital, located in Kigali near the airport.
Earlier this month the entire HRH group of clinical mentors and nurse midwives met for our first monthly meeting. The meeting started with introductions and allowed us to briefly describe our previous professional experience. The returning faculty from last year shared their experiences and advice. We discussed our evolving roles within the hospital and school of nursing environments. In an effort to avoid duplicity and to share our work with the entire group, we decided to create a community dropbox. Much discussion surrounded how to effectively engage students, techniques to avoid staff using students for tasks and the roles of school clinical instructors and hospital nurse preceptors.
We work collectively to share our expertise and also work individually based on our unit's needs. We certainly work hard but we also play hard! We played our first "Kigali Kings" baseball game with the local kids, started a monthly "Iron Chef" party (last month's ingredient was milk, this month's is avocado), ate a communal Ethiopian meal guided by two Ethiopian members of our HRH team and hosted a bachelorette party complete with a bridal veil made from the remnants of a mosquito net!
Check back next month for more of our adventures of working and living in Rwanda!