The Kigali Health Institute

You arrive in a city as a stranger; eyes wide and seeing the world differently, as if never having lived a day on it. You arrive as a spectator; aloof, apart and unconnected. If you want to stay, if you want to survive, however, you have to put aside the notion that you are not involved. Eventually, you have to submit to the will of a city, to its history, to its present, to its pulse, and put yourself, heart and soul, without hesitation to the whims of the new world. To make it count, you have to get involved...

It starts at the Kigali Health Institute (KHI), which lies in the heart of Kigali, and trains the future of Rwandan health professionals. In the middle of the institution lies the Nursing Office, where I type from now.

KHI: Making Nice Signs Since 1997

“You don’t choose nursing,” explained Ibrim, a fourth year student accompanying me on the bumpy bus ride out to the only psychiatric hospital in East Africa, “Nursing chooses you.” He began to give me a crash course on the health care system in Rwanda. The country joined the East African Community in 2007, whose goal is to increase trade and cooperation for the region. Like all other East African Communities, Rwanda needed to become English speaking, which is the third official language. Rural populations, which compose the majority of the population, still only speak Kinyarwandan, placing far more importance on escaping destitute poverty than learning second languages.

The New Bus No One Can Drive

As such, the majority of professors in Nursing here are from East African countries with developed health care systems (also English speaking). Together, we are given the task to create a recognizable, respectable Rwandan Nursing training program. With contracts ranging from six months (like mine) to two years, we hope to train and transfer our jobs over to Rwandans, creating a sustainable and long-term workforce.

The goal is noble, but riddled with problems:

1. Rwanda does not have a Masters in Nursing program, which causes nurses to leave the country to get their Masters. Usually, they do not return.

2. The recently introduced (as in 2009) 4 year Nursing Degree Program has yet to be recognized by the Minister of Health (Who need 4 years of school to be a nurse, anyway???) .

3. Kigali has more Non-Governmental Organizations (NGO's) than a lunch buffet has types of potatoes. With their various Western-mandates, NGO's offer Rwandan nurses double and triple the salary of government paid workers, leaving most city hospitals incredibly understaffed.

It is nearing the end of the semester, so part of my daily routine involves preparing an Adult Medical Surgical and a Health Assessment course to teach. As much as being a professor is a dream come true, I was quickly shaken to my senses that it will bring far more personal gain than help out the institution. Anyone could teach these courses. The internship was like putting a band-aid over a fracture.

To address this concern, I gathered the staff and we identified the greatest problem for the Nursing Department; consistency. Here, every time a teacher delivers a course, they invent it themselves, using a broad, vague curriculum to guide them. The content changes on a whim, the assignments are arbitrary, and the tests range from Kindergarden-esque to PhD impossible.

To help with this, together with my friend Adi (thank you, thank you, thank you) from Edmonton, we are creating an online database for all future teachers to access course information, assignments, tests, hand-drawings, etch-a-sketches... if it was done in a class in the past, it will be here.

As the work picked up it's pace, it was ground to a halt in it's entirety. A sombre memo had been circulated that there was to be an unscheduled two week break due to Genocide Memorial Commemoration.

It was then I decided not only to stay and survive in the city, but thrive in it. To give myself up to the city, to the work, the culture and the people of Rwanda involved seeing the past, witnessing the truth and learning from the ugly mark that history left on this country. I needed to know what happened.

It was time to see Genocide.