Guayaquil and Cartagena

Many years we take a little trip after the mission.  This year we decided to visit Columbia, specifically

Cartagena.  We did consider other options in Columbia most of which involved a lot of travelling which means a lot of packing and unpacking and time in airports.  Going to Cartagena gave us the option of staying in one place and taking day trips.

To get there we have to go to Guayquil first.  We have never visited there before so it was a place we had to check off.

We finished our surgeries on Friday but Mary had to go in to the hospital for a couple of hours to look after the post-ops before we transferred those still in hospital to the local staff.  Many of the mission left earlier in the morning for Quito to spend some time there before flying home on the red-eye.

Many years leaving Ceunca has been a frantic adventure with late buses, large groups and crowded airports.  With just 3 of us this year and a 1430 departure we felt we had things in hand.  Unfortunately in Cuenca it was Carnivale a yearly festival perhaps corresponding to Mardi Gras.  Because of parades on Saturday, no taxi was able to get to our hotel.  The hotel staff were very helpful and helped us carry our bags a few blocks away, and flag a taxi that would take us to the airport.  We ended up arriving way to early and had to wait about an hour to check in but were eventually on our way to Guayquil. 

Cuenca while near the Equator is at 8000 feet and is quite temperate.  Guayaquil is at sea level and we were warned to expect hot and muggy conditions, which we found when we landed after a one hour flight.  We got our bags and tried to get a taxi to our airport.   In what seems to be an increasingly common event,  the taxi driver did not know where our hotel was but I now expect this and had the address which also didn't seem to help him but he radioed and somebody gave him directions and so about 10 minutes later we were at the Marriott Courtyard.   Some people may like authentic local hotels.   I do too but we had an early flight out in a day and besides I knew that without air conditioning we wouldn't sleep much.  

It was later in the afternoon when we arrived.  In the humidity we were content to just chill in our room. I did go up to the pool on the roof which was quite small, fairly warm and had a couple making out at one end so I didn't stay long.

The hotel directed us to a Peruvian restaurant at an adjacent large shopping mall which was really good for supper.

We had a day to explore Guayaquil before flying to Cartagena.  Based on advice from people who had been there before, we took a taxi to the Iguana Park.   This is square adjacent to the Cathedral with... Iguanas.  Lots of them.  Walking around, climbing trees, sunning themselves.  We spent a little time there then went off to look in the Cathedral which being Sunday was actually being used as a church, not as tourist attraction.  Not as nice as the Cathedral in Cuenca.

We then walked a couple of blocks over to the Maracon which is a long walkway adjacent to the river.  The river is in itself interesting just for the amount of vegetation floating slowly down it.  The Maracon itself was a bit of a disappointment.  Lots of fast food joints.  A parade came by on the adjacent street which we watched for about 15 minutes. 

We walked along it a km or so to Las Penas and then climbed the 400 steps getting a nice view of Guayquil from the top.  We walked down, stopping for a cerveza on the way down before catching a taxi at the bottom back to our hotel.

Sunday was Super Bowl Sunday and so we just had pizza in our room and watched the somewhat dull game.  We had an early flight the next day.

Monday morning we took the hotel shuttle to the airport.  We found out that our flight to Cartagena was not direct but rather that we changed planes in Panama City.  Confusing things was that both flights had the same number.  The airport was not that busy with none of the bustle and confusion of many South American airports.  We had an uneventful flight to Panama and after a brief stop flew to Cartagena.  

Arriving in Cartagena we learned that Canadians have to pay what is called a reciprocity fee.  That is a fee equivalent to what it costs for a Columbian to get a visa for Canada.  The US also requires a visa for Columbians but their citizens don't have to pay this fee.  Because we came from Panama they weren't expecting any Canadians and so had to get somebody from his siesta or lunch to process our payment. 

We were met at the airport by Brian our guide.  I have never met another Brian in Latin America.  He and the driver drove us to the walled old city and then through the busy, crowded streets to our hotel.

The Ananda Boutique Hotel is one of those Died-and-went-to-heaven places.  It is a hacienda style hotel with a courtyard pool at which I could have spent the entire visit and a rooftop patio with a refreshingly cool jacuzzi tub.  Our room came with a rain-fall shower and a large tub as well as its own small balcony.  The restaurant in the hotel is considered the best in Cartagena which is both good and bad.  Good because it is close and bad because you need to make reservations.  We couldn't get a reservation for the first night but the concierge got as one at a nearby restaurant.

We got out and walked the walls of Cartagena before venturing into the crowded streets.  Like Cuenca Cartagena is a Spanish Colonial town only the architecture is slightly different.  It is also quite flat.  Finding our hotel again we had a dip in both pools before heading out to Alma a nearby restaurant for the first of several excellent dinners in Cartagena.

Ecuador mission the rest.

Every year I vow to keep up on my blog however I never do and I am home now.  There are a number of factors. Firstly this year we were really busy, often not getting home until the evening and after dinner I just didn't have the energy to type.  I also blame Skype.  Whereas when I first went to Ecuador we used to make long distance calls from a call centre for a ridiculously low price; now many people on the mission communicate with their families by Skype which means that in the late afternoon and early evening, the Wifi in the hotel slows to a crawl.  

I normally don't like to criticize my hosts when doing missions in the developing world but it is hard this time not to.  Five years ago we moved to Santa Ines from Monte Sinai at the invitation of Santa Ines.  We did this because we were offered the use of 2 operating rooms which were larger than the one OR we had at Monte Sinai.  We felt that this would enable us to do more surgery and maybe finish earlier in the afternoon.  We met with the medical director and got the usual Latin American welcome, Mi Casa, su Casa.  This worked well for the past 5 missions.  A couple of years ago they took the monitors out of the rooms which meant scrambling to make sure we had monitors of our own but even that hadn't been a problem for the last two missions.

In December we got a letter from the medical director telling us we could only have the operating rooms from 1300 on.  This meant in order to have 8 hours of OR time we were really looking at 2100 hour finishes.  Keep in mind that the recovery room and floor nurses would stay 1-2 hours after the end of surgery.  Now you could say, okay you have the morning off but again the floor nurses have to be there in the morning and doctors have to round etc.  Makes for a long day.

We were able to get a compromise that maybe we could start one room a little earlier.  

It ended up however being a frustrating week, waiting around in the am to be able to start as soon as a room was ready and late days.  We also worked Sunday in order to get a few extra cases.  We ended up doing 34 or so total joints including 2 bilateral and one revision, which is only a little less than the 40 we normally get done but with a lot more time spent at the hospital much of it just sitting around.  

The hospital we work at is a for profit hospital like most in Ecuador.  In 10 years I haven't quite figured out the medical system which is a mixed public private system that right wing politicians would like for Canada.  There are public hospitals but a lot of public work gets contracted to private hospitals.  I often wondered how I would have reacted if our hospital told me that a surgical team from another country were taking over 2 ORs at my hospital for a week.   Probably with enough notice we would have just taken vacation as we do when the surgeons or the hospital close rooms for other reasons.  Anyway just saying that maybe with enough notice we could have accepted doing fewer patients or staffed differently to accommodate longer days.

The whole issue of voluntourism and should teams from the developed world even be doing surgery in the developing world is of course another topic.

I can't say enough about our team because as I say we worked some fairly long and irregular hours in order to accomplish what we did.  We do come down to help people but we also come down because we enjoy each other's company before, during and after hour and because we love hanging out in Cuenca.

Ecuador Mission 2016, getting there.

I am right now almost half way through my 10th mission to Ecuador.

This year our son Bill came down with us. I went down to Canmore a couple of days early to mostly chill but also to nag him about packing, making sure he had found his passport etc.  We left Canmore about 1700 on Wednesday to go to the Delta Airpot hotel.  Our plane was to leave at 0640 the next morning and quite frankly being able to just walk across to the airport is priceless.  We of course had the ubiquitous mission hockey bags 4 in total plus our own stuff.  In Calgary I was able to find long term parking quite close to the terminal.  There didn't seem to be a shuttle but there were luggage carts so we wheeled our bags about a km to our hotel.   Mary was coming down by Red Arrow and arrived just after 7.  We had an expensive meal in the hotel restaurant after which we tried to sleep.  We all awoke shortly after 3 am, got dressed,  drank some coffee and then checked out picking up our bags and rolled across the street to the departures.

Even just after 4 am there was a huge line to check.  Fortunately I had managed to get Prestige status which meant we all got to go the head of the line.  This didn't help much as it was a long slog through customs and security.  One wonders how much productivity is lost through the long process of crossing borders, especially having travelled in Europe.  The US departures area in Calgary is much inferior to that in Edmonton in terms of places to eat.  We had pastries of indeterminate age from Starbucks and sat down to wait for our flight.  Gradually other mission members trickled in including my work colleague John Soong from Edmonton, the Pediatric team from Calgary and a few members of our adult team who were flying through Calgary.

After finally boarding, it was a 3.5 hour flight to Houston which I spent trying to sleep or read.  In Houston we went to our usual go to place, Pappadeux for a feed of fish and of course a beer.  We had a 5 hour stopover in Houston so this only killed about an hour, the rest of the time we spend wandering around, reading etc.   It was a 5 hour flight to Quito which was long if uneventful.  We cleared customs in Quito in an acceptable time, picked up our bags without event and were outside.  We had to wait a bit for the bus to our hotel and also for the bus which would take our bags to Cuenca (they are too heavy for  the plane to take off).  We stayed at beautiful and comfortable Hacienda style hotel about 20 minutes from the airport and were in bed by shortly after 2 am.  

We got to "sleep in" as our flight wasn't until 1230 which meant leaving the hotel around 1030 so we awoke around 8 am got dressed, had a nice buffet breakfast before loading ourselves back on the bus to go back to the airport.  Our flight to Cuenca was a short hour flight.  Unfortunately it was cloudy and we couldn't see much until we approached Cuenca.  We landed, got our bags and were greeted by the Rotarians who help us out every year.  We went in two buses through the crowded streets of Cuenca to our hotel the Inca Real.  It sounds hackneyed but after 9 years I find Cuenca and the Inca Real to be a second home.

The Green Corner

I need to write about a restaurant that sustained me 4 years ago in Rwanda and that too my shame and regret I only visited this week (twice).

I speak of the Green Corner.

4 years ago on our first day here, dazed and confused we realized after dark that we had no groceries and knew of no local restaurant.  The volunteer guide said that they had heard that the Green Corner was okay and I found it on a map in the Bradt Guide and figured I could navigate us there, which I did by the long way staying on light busy streets.

Arriving there reminded me of the scene in Animal House where the gang go to see Otis Day and the Nights.  Nevertheless we were shown to a table.  I asked for a menu in French and was told "Poulet or Poisson".  I figured poisson was safe and order three along with beer and frites.  About 10 minutes later someone explained to me in broken English that the the Poisson was way to big for us to eat three and suggested we get only 2.

It took a while to arrive during which we drank beer.  The Green Corner is a typical Rwandan restaurant, painted plaster, concrete floors and resin chairs.  After about an hour, a man arrive with the kettle of warm water and a bar of soap and we were directed to wash our hands.  When the food arrived, we learned why, there was no cutlery.  They did give us fork when we asked.  The poisson was the best I had even tasted or have tasted since.  Cooked over a wood fire, exquisitely spiced.  I would kill for the spice mix, I suspect the only way they would give it to me would be if they killed me after.

We ate their 4 more times, eating the equally good poulet, sometimes both.  We took the residents there for our last teaching session.  We stopped using cutlery and tore the meat off with our clean hands  We started taking the short cut through the unpaved unlite streets.

What was interesting was that after the initial suspicion of our first visit, by the fifth visit we were welcomed as old friends.

It took me until my fourth week here to venture over there.  It had changed, bigger with TVs now.  Still the same excellent food and I took Simon my colleague there the next night to demolish a chicken and poissson.    They do have a menu now albeit just written on a white board.

Still the best place I have eaten in Rwanda maybe in the top 10 world wide.  Not in Trip Advisor.  Pity.

Mazunga

Being a Canadian of British heritage, I have never been subject to an ethnic  nickname.  True Canuck was a derogatory term for Canadian, however Canuck now is just an under-achieving hockey team with very fickle fans.

During my last visit to Rwanda I learned that white folk like me were referred to as "mazungas".   This term is used throughout East Africa  This either means "wandering person" as I am sure Africans couldn't figure why these people left their homes to live in a land where the Africans were eking out an existence.  Someone else told me that it means someone with money and that black Africans are eligible for mazungahood.  Whatever.

I had a most embarrassing encounter today.

I love the little bananas they have here more than life and generally eat them for breakfast.  The quality of the bananas in our local market or street vendors is pretty poor possibly due to the season or maybe I am being offered mazunga-grade bananas.   I usually walk home but on taking a taxi which because of one way streets had to use  road parallel to the NR, I noticed some excellent fruit markets along that street.  For that reason I made a detour to buy some bananas today.  I actually bought them off a lady's head and probably paid too much but proceeded uneventfully along the remaining 2 km carrying my bunch of bananas in my hand.

That was until 1700 when a rather large school got let out.  School in Rwanda goes until 1700 although I think they get a long lunch break.

Suddenly a group of pubescent school uniformed girls  followed me, giggling and yelling "give us your banana Mazunga".  Okay it was getting close to supper and maybe they were hungry but somehow I don't think that was what they meant.  Rwanda is a very conservative country where men and women rarely even hold hands in public and I was a little shocked (and really embarrassed).  Anyway eventually I slunk onto a side street and they fortunately didn't follow me.

Last weekend I was at Nyungwe.  I had always noticed that when we passed groups of children they would always yell and wave and act like our driving past at that moment  was the best thing that ever happened to them.  This time I actually listened to them and they were chanting "money Mazunga" because that is apparently what we have.

I don't blame Africans for distrusting whites.  Aside from colonizing them (I still resent the British); there are all the stupid things we made them do post colonization, all the kleptocratic dictators we propped up, all the weapons we sold them and all the money currently stashed in Mazunga banks.

I have now spent 7+ weeks in Rwanda.  I can walk the streets safely (it would be nice if they learned sidewalk etiquette) , people treat me like a prince and the only Rwandan who has taken advantage of me is an ex-patriot Rwandan who lives in Canada most of the time (our landlord).

I can take the odd name calling and the odd embarassment.

Butare and Nyungwe

Tuesday we left for Butare.  Kigali was getting very old and I was ready for a change of scene.  In true Rwandan fashion we had to wait until Monday afternoon to find out if somebody was actually going to pay for our little trip there but it came thru and Tuesday morning we got picked up outside our apartment.

It is a two hour drive from Kigali to Butare.  We swung west along the river but after a few km climbed up.  As in most of Rwanda the whole area was cultivated as far as the eye can see.  The roads were crowded with people walking and riding bicycles and we could see people working in the fields. We passed through 2 moderate sized towns before entering Butare.  We checked in to the Credo Hotel were I stayed last time.  Not really much has changed.  We then went to the hospital to present ourselves to the administrator who was quite pleasant and were then directed to the OR to meet Isaac one of the anaesthesiologists.  This was a bit of a reunion as Isaac was a junior resident the last time I was in Butare.  Isaac showed us around the hospital.  Currently Isaac is the only staff anaesthesiologists.  Dr. Theo the department head is in Sweden doing a post-graduate degree and another anaesthesiologist is in India doing ICU training.  Yet another staff anaesthesiologist is working as an administrator at the hospital.  Isaac seemed to be taking being the only staff anaesthesiologist quite well.

After we walked back to our hotel stopping for a coffee and a light lunch.  As has become usual when given the opportunity, I had a nap followed by a dip in the Credo's rather large pool which actually has a deep end and a diving board.  After a beer on the terrace overlooking the street Simon and I walked up to the Ibis hotel which is really the only good place to eat in Butare.

We worked in the OR the next two days trying to teach two brand new first year residents and one second resident.  Fortunately the anaesthetic techs are extremely good in Butare and I admired their patience in dealing with the junior staff.  Aside from there being fewer staff anaesthesiologists, things have improved a great deal in Butare.  When I was last there, they had a variety of older machines some with drawover vapourizers but in the past 4 years all the machines are new, donated as I learned by HRH an American organization funded by the state department.  On the last day we met an American surgeon who was spending a year there funded by HRH.  He was an interesting character, a retired cardiac surgeon now doing general surgery and had also done a lot of MSF work.  As cardiac surgeons are the uber-princesses of the OR it was interesting to see how he could work in what are quite adverse conditions.

Our teaching ended around noon on Friday and we were picked up by Magnifique our driver for our planned trip to Nyungwe National Forest.  Nyungwe is one of the last tracts of primal African forest left.  It also drains into both the Nile and Congo basins.  This was accessible by a very rough dirt road last time but the road is now paved.  We headed out of Butare first passing the prison farm.  Orange and pink pajamaed prisoners were working in the field.  Genocide prisoners have to wear pink pyjamas.  We then proceeded through heavily cultivated hilly country.  Along the way we passed a large refugee camp made up of refugees from the Congo.

After an hour or so we ended Nyungwe Forest.  The road was windy and hilly with thick jungle on both sides.  At the higher points on the road you can see the forest canopy to the side.  Although the road is paved now we came across at least 5 large trucks off the side of the road.  At one place a truck carrying pigs had overturned and they were trying to catch the pigs.

Our first stop was Uwinke lookout where we planned to do the canopy walk.  I had turned down the opportunity to do this 4 years but wanted to try it this time.  To take the walk we had to pay $60 US each.  A group of 6 of us headed down the trail.  The guide would stop it seemed about every 10 metres to point out some nature feature.  This was getting a little frustrating after a while because it was getting later in the day and rain was threatening.  When we got close to the canopy we found the reason for his stalling.  A large group of Rwandan school children were ahead of us and we had to wait for them to get off the skywalk.

The skywalk itself reminds me of one of those bridges than Indiana Jones has to cross to escape from the bad guys or the bridge where Sean Connery made his last stand singing The March of the Irish Brigade in the Man Who Would be King.  Actually it is a lot safer than that.  It is a metal platform about half a metre wide with mesh on either side to my waist level and two ropes.  Our guide explained that it had been designed by a team of Brazilian and Canadian engineers.  Having 3 engineers as first degree relatives did not reassure me.

Our guide had to finally go and clear the school kids off the skywalk so we could get on.  This gave us about 15 minutes to stare at the skywalk crossing the void and watch it sway.  There is first a 10 m section to the tower which gives you a chance to chicken out which I thought about but didn't.  We then had to wait about another 10 minutes for the final school kids to get off before our guide took across the 100 m or so walk.  Had I not been scared shitless I could had looked to the sides on downwards.  I could have even taken a picture but that would have meant relaxing my death grip on the cables.  To enhance the experience our guide stopped mid way.  Finally we were off the skywall onto the second tower.

Me looking very calm and collected.

We had another short 10 metre section to get back to the trail and by the time we had walked back to the top of the hill my sphincters had relaxed.

From there M drove us to the Gisakura Guest House where we were staying.  I had remembered this as a spartan but pleasant place to stay.  We also stopped at the adjacent Ranger Station to buy our chimp tickets.

We had a pleasant dinner.  There was only two other guests, a couple.  The husband turned out to be an American Internist visiting Rwanda with.... HRH.  We had a nice conversation about medical and Rwandan matters.  It was soon time to go to bed because we were leaving for the chimps at 0500.

We met M, the guide and six other people the following morning.  Taking the guide with us, we headed west on the paved road.  It was still dark but people were already out on the road.  After about 15 minutes we turned onto a very rough dirt road.  We passed a lot of people out on the road, more as the sun rose.  We were outside the National Park so we passed tea plantations and farms.  After an hour we reached the drop off point.  There we met the trackers and also the porters who would for $10 carry your pack.  After getting instructions we headed up a path which become steeper and steeper, as well as more slippery.  The group spread out quite a bit.  We started to head down quite a treacherous downhill. As we got to the bottom, our guide spoke with the trackers by walkie talkie and then announced that we would have to retrace our steps as the chimps had moved.  We climbed back up the hill which was actually easier to climb than to go down and after all while we stopped and the ranger announced that we would wait here the chimps.  Waiting seemed a lot better than chasing them.  Eventually we learned that two or three were headed our way and we headed down a bush path to intercept them.  We were rewarded as we soon saw three chimps in the trees above us, who  dropped to the ground and ran by us within 10 metres of us.  We went further along the trail and saw a number of chimps on the ground and in the trees including a mother and baby.  They were heading away from us so the ranger decided we would go back to the road and watch them as they crossed.  We did this but the trackers soon relayed to us that the chimps had stopped again.  We went about 200 metres back up the trail and were able to watch about 10 including the mother and baby crossed the trail in front of us.  It was then a run back to the road were we watched them cross the road finally.

All this took a couple of hours.  Ironically our best view of the chimps camp 100 m from our vehicle.

We then had a 1.5 hour trip back to the guest house.  The roads were really busy with people walking, the women and some men carrying firewood, water or sacks of something on their heads.  We stopped at a tea field to get a closer look and a small group of children surrounded us including two young boys carrying a stack of bricks on their heads.

It was only 1030 when we got back to the guest house.  I had a shower and drank an African coffee.  The guesthouse also has internet so was able to check up on the world from the dead centre of Africa.  After lunch, it was nap time.

Dian Fossey

Sunday we hiked to Dian Fossey's grave.  Dian Fossey as I noted in my previous post looked nothing like Sigourney Weaver.  She is still a very controversial figure and while there is a lot of hagiography about her, likewise there are a lot of nasty stories about her.  I am currently reading Bill Weber and Amy Vedder's book "In the Kingdom of the Gorillas" and they certainly have very little good to say about her.  You can read the book, read "Gorillas in the Mist" which   is Dian's book or watch the movie.  Or maybe you just don't care.

After eating an early breakfast at the Muhabera, Magnifique picked us up at 0630.  To do this hike you have to go to the same staging area as for the gorillas.  There we paid $75 each and were assigned a guide.  Our driver drove us and the guide to the drop off point for this particular hike.  This involved a fairly long drive up a very rocky road until we got too  the drop-off point.  There I hired  porter and we hiked through the farm fields to a gap in the stone wall.  The guide explained to us that Dian used to park her car there, paying a villager to watch it.  There we met 3 trackers including one with a gun who were to accompany us.  Keep in mind there was only Simon and me.  We set off on a steady uphill through the forest for about 30 minutes until we arrived at a clearing with benches to sit on.  At that point our guide informed us we were half way there.  The remainder was flatter but extremely muddy.  Logs had been laid across the path in a futile attempt however they were slippery and sometimes it just seemed safer too walk in the mud which went up to the top  of my boots in places.

We eventually arrived at the remains of the camp and the gravesite.  Most of the camp  is gone now except for the foundation stones and some stoves.  It has been reclaimed by the jungle and also was looted during  the genocide and aftermath.  The site is very muddy which according to Weber and Vedder is what it was like in the 1970s.  We walked somberly past the remains of several cabins which the ranger explained to us before arriving at the remains of DFs cabin.  This was bigger than the rest but of course she was the boss and lived there for quite some time.  This was where she was murdered.  The guide did point out that the camp was quite  spread out and her cabin was a ways away from the nearest cabin which may have accounted for why nobody heard the murder or tried to help her.

The whole area is very gloomy, shaded by large moss and vine covered trees that project out huge horizontal branches.  We proceeded to the grave site.

In addition to her grave marker, multiple  other gorillas are buried. These include Digit a silverback, whose death lead off Walter Cronkite's broadcast way back when, he having been featured in a National  Geographic Special.  According to the hagiography, Dian's body was at the airport ready to be taken back to the US when somebody found out that she had desired to be buried next to Digit.

Also buried there are the many gorillas she knew who have since died of natural or not so natural causes.  According to the guide only gorillas she knew get to be buried there and only 3 such gorillas are still alive.

It was sombre place, dark and damp and after paying what was a reasonable amount of respect we indicated to our entourage that we walked to leave and  so we proceeded back on the muddy path.  As we started down the steeper part which was a little damp, one of the porters would grab my hand during the sketchy parts and I didn't even feel insulted.

Magnifique met us at the bottom and with the guide we descended the rocky trail.  We stopped for lunch at a tourist lodge, a few steps up from the Muhabera.  They took our muddy boots and gave us flip flops and we ate a pretty decent buffet lunch.  It was a little expensive at $20 US each but when we came out and our boots had been cleaned it seemed like a fair deal.

I slept and gazed at the scenery on the 2 hour drive back to Kigali.