How did you experience the journey in general?
The journey was a great experience, to see and feel a total different country and a different culture. The journey started Friday, the second of January, that morning I took the plan to Kigali together with Endriean. After an eight hour flight, I stepped off the plane and I felt a haze of heat with a typical smell, the smell of Africa.
The first few days I could not come to the realization that I was really in Rwanda, but from the moment we went to explore the pharmaceutical field, the feeling of really being in Rwanda came fast. Because I had contact with the population, I had got a view of how health care was arranged and this sometimes led to intimate conversations, in which the history of the country was palpable.
It’s really great to see how the country and thus the whole population have created a new country in 20 years. Of course, everyone bears the scars of history, and that is why I find it so amazing that everyone is now so full of positive energy, particularly in the conversations I have had.
The population is very friendly and helpful, the country itself is very beautiful. I admire those three weeks and have had a travel from the east to the west and from the north to the south. The county showed many different landscapes and a beautiful nature with lots of big trees and small birds.
A country with a wonderful climate and impressive people, definitely a country I should visit again.
Can you give a global description of your daily activities during these three weeks?
For the three weeks, there were several locations in the program. The first week we stayed in Ruhango, a district 1,5 hour from Kigali, near the village of Ruhango where the District Pharmacy is located. In the District Pharmacy we met our contact person Adeline Kazayire, she is a hospital pharmacist at the Ruhango Hospital which is located in the village Kinazi. This first day we got more and more understanding of the public health care system. That continued the second day when we visited the Ruhango Hospital. Kinazi is a village, which is a 40 minute drive from Ruhango town, so every day we had to go there by motorbike. First I was a bit shocked, because I did not like the idea of sitting at the back of the motorbike, but after two days I began to like the drive in the early morning. During those drives there were some beautiful views.
We were at Kinazi till Friday the ninth of January, Adeline showed her tasks and we have got an image of her work at the hospital pharmacy. We were playing around with the stock management system (which I think is a difficult system), visited the wards and we had seen how the medication is given to the patient and how Adeline also visits some of the patients.
The first part of the second week took place in Huye (Butare), the student city of Rwanda. We spoke with the President of the Rwandan KNPSV, he was very busy working on the organization of a conference that will take place this summer in Rwanda. He also showed the university along with other board members, it was very kind of them that they have spent some time with us, while they were in the middle of their exams. Next to that, they even promoted our lecture, so many other students were there to attend our lecture on pain management.
After that we travelled to Kibogora located in the South west, there we visited another hospital pharmacy. This hospital pharmacy in Kibogora was more organized, mainly because the hospital has experienced more influence from the western world, some protocols were left behind by the Americans. In the last week we went back to the capital city Kigali, where a big pharmaceutical company called Kipharma showed us more about the private sector. Kipharma is a wholesale company, with a laboratory and it is the parent company of Unipharma, which is a smaller company inside Kipharma. Unipharma is the name of the company which is responsible for two community pharmacies, one next to Kipharma and one in another part of the city. We were allowed to see all the different facets of the company. It was the first time for me to see the inside of a wholesale company, so the story of buying and shipping was totally new for me.
The laboratory was also totally different from what we were used to, but it functions just as good. The counter in the community pharmacy felt more familiar, Kipharma mostly buys European products, so I recognized a lot of the medication packages.
In those three weeks, I mostly watched the work of the different pharmacists and asked a lot of questions to have a good image of the pharmacy field in Rwanda. It was difficult to work on projects, because of the short time I spent at the different places. But with our questions we could find out what they wanted to be changed and we were able to share knowledge and information, about how we handle certain things in the Netherlands. With this introductory internship we could give them new visions and we were also able to see how things are arranged in another country and conclude that their system also runs pretty good. Although some changes could be very useful, but the Dutch system we are using, is also not everything.
Kipharma: Location Kishimenti, from left to right a nurse, an intern pharmacy and the pharmacist J. Damascene Bigengimana.
Kibogora Hospital: Merel and me with the Hospital Pharmacist Kayitesi Eugene
With your questions you were able to find out what they wanted to change. Can you elaborate the things they wanted to change?
Many things they would like to change are difficult, because the government organizes those things. The health care system is divided into the public sector and the private sector, the public sector is supervised by the ministry of Health. This ministry plays an important role and is involved in many decisions. That is the difficult part, many things could be organized better, but it is too far away from us as just students. Things that could be organized better are the distribution, the purchasing of the medicines and the digital facilities.
Things like more knowledge about the clinical pharmacy could be arranged when a student will be there for a longer time than just two days. The hospital pharmacist would benefit if a student would teach them more about some medicines, especially pain medication.
The private sector would like to see changes in pharmacovigilance and they would like to have a system, which can recognize interactions. But that would be useful when patients are registered at one pharmacy. I suggested to Kipharma that they can start with a register system, and then they can follow the medication of the patients and create a patient history. Then a system about interactions can be useful.
What were your nicest experiences?
I surely had nice experiences! The nicest and perhaps also the most terrible experience were the bus trips through the country for hours. Loaded with two bags, seated tight for hours in a little bus and meandering through the mountains. But during the bus trips you are sitting among the people, which quickly leads to conversations.
They thought you as a Muzungu (white person) very strange and they like to talk with you. My first bus trip was a chaos, from Kayonza back to Kigali at a Sunday evening. With those two bags I went inside and placed one of the two bags guileless on a chair, people directly had comments that I had to pay for the chair. But one girl said no, and she took my bag and placed it next to her. Because she did so, we started talking. Eventually she helped me and Endriean to a hostel and she also helped us to find out how we could go to the District Pharmacy in Ruhango. This was difficult for us, because in Rwanda there are no street names of addresses. Thanks to her notes, we found the place the next morning.
Also the bus trip from Ruhango to Kigali was impressive. I had conversation with a women, she was a refugee twenty years ago. She stayed during the genocide in Burundi and told much about that period. It was massive to hear about it and I think it was special because normally you don’t talk about that subject, but now she started and I could feel it when she talked about it.
Another bus trip to Kibogora, there was a man he was also going to Kibogora and he knew the place where we had to leave the bus. From that place he travelled with us to Kibogora, there he helped us to find a place where we could stay.
The ease with which I could interact with people during the travel was a revelation for me. During the application, I preferred not to go alone to Rwanda. Richard said: you are not alone there. And he actually had a point. Nevertheless, I am still glad I was with Endriean and Merel. Just to talk about what you have seen, to inspire each other and to share your impressions of the day with one another.
Other experiences were of course the beautiful parks, I visited Akagera, Nyungwe and the volcano Bisoke. And I slyly liked the motor trips, it is a bit of a love-hate relationship, after some days I began to enjoy the trips to the Ruhango Hospital each day.
The motorbike, each day 40 minutes from Ruhango town to the hospital and 40 minutes back
What were your less pleasant experiences?
Less pleasant experiences … I almost want to say that I don’t have them, but that would be a lie. It’s only a bit different, not bad experiences, but I have seen unpleasant things. The patients at the hospitals, how they were lying there, I will not forget that image so quickly. In addition, the big difference between some people, it is unfair to see that some people are doing so well and look so good, in contrast to the many people around the public hospitals, who really need help.
Besides, the history of the country is still so palpable, it is stunning that the residents of Rwanda and the country have revived again.
Moments when I encountered myself were the moments when I was a little rushed, this was a big difference in contrast to the Rwandan mentality. I like to have control, in those three weeks, I learned to let go, some things you just can’t control.
Of course, a lot of things were very thrilling and it normally would not be my first choice. But I have learned that in certain things I don’t have a choice, but to take it as it is. I managed those things better than I expected.
If you could do this journey again, what would you do different?
If I would make this trip again I might want to stay at one place for a longer time, so I can actually do something, maybe a little project. Now it was quite nice to get an overall view, but you are not really useful. Often we were costing time and sometimes we just stood in the way. On the other hand, all the pharmacists liked our coming, because of the knowledge transfer. But a three-week journey with four places to visit, is just too much in too short a time, I think.
If I go another time, I would try to go on my own. Of course, I might be having many empty moments, but I have experienced how easy it is to make contact with other people and so you are not really alone. That is something I would like to ever experience, but if that would be in Rwanda, I do not know for sure. The country is extraordinarily beautiful and everyone is very kind and helpful, but I will always remain different, because I am a white girl and I don’t think I can really integrate.
Despite that, I have had a wonderful time and it was a great experience!
Wietske Hemminga – email@example.com
Huye: the lecture about pain management