Volcano Ventures in the Congo

At a height of nearly 3,500m, Nyiragongo volcano towers over the city of Goma in eastern DRC.  It is one of the most active volcanoes on the planet, as well as one of the least studied.

Nyiragongo last erupted in 2002 with a fissure eruption (like a bursting pipe, rather than a classic spouting-out-of-the-top eruption), destroying a large part of Goma.  But Scientists believe the volcano is capable of far greater fury, as a major eruption could release the huge volume of lethal gases trapped under nearby Lake Kivu.

With the geology facts in place, there was one task to complete before I could venture to the summit of Nyirogongo; I had to meet the Ambassador of DRC in Kigali to request a visa.  He asked all the expected questions: what I’d be doing in DRC, how long I intended to stay (fortunately, my French skills just about stretch that far)...  When in response to his question regarding my occupation I informed him that I am an Accountant, he gave me a huge grin and kindly welcomed me to DRC.

After crossing the boarder, we drove through Goma to the base of the volcano, passing UN peacekeeping troops along the way.  Despite the constant threat of another eruption that would likely follow a similar path, many homes have been built directly on top of the old lava flow.

Accompanied by armed guards, we hiked steeply uphill for 5 hours to reach the very windy summit.

From here, we looked over a crumbling sheer wall, down to a lake of lava, with a mesmerising kaleidoscopic surface.                                                              

                                                                 

          

We spent the night camping close to the summit, with a small fire of our own, and the glow and intimating roar of the bubbling lake in the background.  Just awesome.

Monkeying around in Volcanoes National Park

I love jokes but can never remember the punch line.  One of the few jokes that I’ve always remembered is one on a lollypop stick from when I was little: Where does a monkey cook his toast?  A. Under a gorilla!  
Well yes, perhaps it is a lame joke, but it seems like fate that I would one day meet a gorilla, and when I did, it was awesome!

The 3 hour hike in the Volcanoes National Park to find the gorillas was an adventure in itself; it is the rainy season at the moment, and we had to wade through thick mud.  At the start of the hike, I naively tried not to get too dirty but soon realised this was a pointless feat so just enjoyed the squelching and squishing.  As well as the mud, there were 6 ft stinging nettles (a key part of the gorillas’ diet), and as we ventured deeper and deeper into the bush, our guide had to use a machete to hack through the dense vegetation.  The excitement of the gorillas meant I didn’t think that much of it at the time, only realising after the adrenalin had worn off how stung my legs had got through my trousers.

We spent an hour watching the Amahoro group with great fascination.  Amahoro means peace in Kinyarwanda.  Before people are able to go and visit a group of gorillas, the group has to be habitualised to humans.  The Amahoro group is so named because it took a surprisingly short amount of time for the silver backs to get used to people.  Now, it just takes a deep “haaaaaaummmmm” sound from time to time to remind the gorillas that their human visitors are friendly and they go about their business of eating leaves, tidying their nests, etc, as if you aren’t even there.

There were 2 babies in the group, a tiny one month old who just clung to its mother and slept, and a very playful 4 month old, who swung from trees and generally performed for the audience until its mother grunted and it retreated back to the nest for a cuddle.

The Amahoro group is unusual in having 3 silver back males.  We were stood watching the 2^nd in command when he turned and decided he wanted to be exactly where we were standing.  We rushed to move out of the way, but he was quick and so passed by us very closely.  Ever the cool, calm naturalist, I clung onto a friend and tried not to look the gorilla in the eye.  Our guide just looked on and chuckled.  But he was HUGE...                   

How many accountants does it take to run a training day?

For an audience of 17, apparently 5 Rwandan Accountants and one Brit!

Having finally got the formal Rwandan greeting down to a fine art, we finished the last of the Health Centre audits just over a week ago.  Before coming, I certainly had not imagined that during these visits I’d sit through more than one meeting with an accountant while she was breast-feeding, or that I’d take a long, bumpy trip in an ambulance, wedged between a woman with a sick bucket and a man with a hacking cough...  It has certainly been a lot of fun exploring the country and working closely with the PIH finance team on this project.

Last week, to follow up our audit visits, we ran 3 training days (one in each district) on financial management for the Health Centre Accountants.  In preparation, I have spent the last few weeks writing up a summary of our observations and recommendations, finishing off the new financial monitoring and reporting templates for Health Centres to use, helping the finance team put together a finance manual for Health Centres, and preparing the training course.

For the first time since getting here, I felt properly stressed last Sunday night.  We hit printing issues - a small malfunctioning printer, no paper, and unsurprisingly, no one to help at 10pm on a Sunday evening.  And then there was the fact that I felt nervous about sitting through training courses that I have been so heavily involved in preparing and having absolutely no idea what’s being said.  But I need not have worried; we solved the printing problems early on Monday morning, and then the team did a wonderful job in presenting the course, a fact that was highlighted by the good understanding the Health Centre Accountants showed when they completed the training exercises, rather than a miraculous understanding of Kinyarwanda by me.

And here is the A-Team of the training world in action:

Gorilla and volcano adventures to follow shortly...

Food, glorious food!

Food is a much talked about topic in Rwinkwavu, so it seems worthy of a short blog entry...

Locals joke about the sugar intake of expats (which always amuses me, given I have seen multiple people put 5 teaspoons of sugar in a single cup of tea), while expats compare notes on how long it took before they stopped eating matoku (mashed plantain - I’m still eating it).

Meals mostly consist of a combination of vegetables, beans, rice, plantain, mashed/boiled/fried potatoes, and goat a few times a week.  We were even treated to goat pizza one night last month.  While it does get a little repetitive, I actually quite like the food, especially since discovering Akabanga (a super hot sauce, a few drops of which transform a dinner, or at least give you a slight burning sensation in your mouth!)  I should perhaps note one exception - goat intestine brochettes.  I did not deal well with them, but fortunately it seemed to go relatively unnoticed.

Hospital lunches (photo attached below), taken in the fresh air by the TB ward, require taking your teeth into your own hands as the beans frequently contain stones.  The other day we found one the same size as a kidney bean!  Rwinkwavu legend has it that one member of staff ended up having to go to South Africa for dental work when a hidden stone broke his tooth...

Stock takes, finance templates and lessons in debits and credits

The weather was decidedly British on Saturday; it was grey, cold and wet.  Such unusual weather for Rwanda was particularly unfortunate for the traditional wedding I attended!  In the hope that the weather would clear up, we sat eagerly waiting for two hours, but to no avail.  It did not stop raining all day long.  So the show went on, and the people I attended with did their best to interpret what was going on.  There was singing and dancing by cow herders, the timeless tradition of giving and receiving orange fanta, and a long process of witty negotiations between the two families (possibly lost in translation).  The groom’s family asked for the bride’s hand in marriage, the bride’s family pretended she had already been taken by another man, to which the groom’s family responded “oh, but don’t you remember, she was promised to a man, but he turned out to be a priest, so they never married!”  It went on...

At the weekends, I have been exploring the country as much as possible.  A few weeks back, we arrange a trip to Lake Kivu, and over 20 people ended up coming along.  I learnt that some Rwandans like to party hard so was almost relieved to go back to work on the Monday!  Last weekend, fancying a quieter weekend and long hike, we set off in the general direction of some coffee plantations.  Along the way, we came across a dozen or so prisoners sitting on the side of the road, wearing brightly coloured-coded jump suits depending on the offence they had committed, and seemingly unattended.  Hundreds of their fellow inmates were working in the paddy fields in the valley below.  It really intrigues me that none of them seem to run off.  After a hilly 15 km, we felt almost triumphant to come across a coffee washing station, run by a women’s co-operative.  One of the women kindly showed us around, acting out the process as we knew only a few shared words.  And then we set off to walk home.  But if I’m honest, we got pretty tired, so hitched a lift and visited our second co-op of the day, an ice-cream parlour back in Butare (the university town of Rwanda).

It can’t always be time for adventures; I need to earn my keep.  Having been here for over a month now, I feel like I might actually have started to be useful!  You were warned by the blog title...

The main project I am working on is the implementation of a reporting and monitoring process, which will support the recent expansion of PIH's activities to fund around 40 health centres.  The aim is for each health centre to submit a monthly financial return, with a budget summary, detailed breakdown of expenditure, petty cash count results and a bank reconciliation.  The PIH district accountants will then visit each health centre on a regular basis to verify the reported expenditure, and monitor controls over general expenditure, payroll and cash.

Having developed a proforma for the health centre monthly returns, and an audit template for the PIH teams to use, I spent last week out and about with the Burera district team performing our first audits, and teaching the health centre accountants how to complete their monthly returns, how to perform bank reconciliations, and so forth.  Initially, it was planned that I would do a couple of visits with each accountant until they are confident with the process, but they have decided they want me to attend as many of the first audits as possible, so I should be kept out of mischief for at least the next month!  This week I am working with the Kirehe district team.  It is pretty fun work as we get to go out and about and see some remote countryside (unfortunately the remoteness almost always makes for a very bumpy journey), and I’m collecting a stash of telephone numbers of new friends I make along the way.  After spending a day grilling one health centre accountant, she gave me a huge hug, thanked me for visiting her, and said she’d never had a British friend before.  Not quite how auditor independence is meant to work, but there we go!

The stock count went well a few weeks back.  We started by counting food packages, which were spot on, but I was sceptical that the stationary cupboard would be so well accounted for.  It is a small room, absolutely crammed full to the roof, with no apparent logic or order.  I was proved wrong.  When I called out 102 blue bic biros, there was a short period of rummaging but low and behold, they had exactly 102 biros!

Otherwise, Excel training continues, and I have been updating and creating finance forms for purchase orders, payment requests, petty cash withdrawals, etc.  We have also updated job descriptions for all the finance team, and have been working with them to ensure they are clear of their roles.  It is the first step towards introducing a performance appraisal system across the whole organisation, the success of which will be interesting to follow.

A doctor who is working on a new sister project in Mali has been visiting for the past few weeks to try and learn lessons from the project here.  He even seems interested in accounting and audit, so I’ve also been spending some time with him, teaching him debits and credits, discussing internal controls and explaining how to account for restricted funds!

A hospital fit for a President

My weekend started in Kigali, with the discovery the local drink of choice, Waraje (Rwandan gin), and an exploration of the city on the back of a moto.  Then early on Sunday morning, I set off with several colleagues on a road trip to the Northern Province.  We stopped along the way for a table football competition, a trip to “MacDonalds” (a small but very popular roadside bbq stall, which sells fried sweet potatoes and goat brochettes), a hike in Parc National des Volcans, and finally to enjoy an evening of wine and cheese by a log fire (given the altitude, it is surprisingly cold up in the north).

On Monday morning, we headed (rather indirectly) to Butaro for the opening of a new hospital by Paul Kagame, the President of Rwanda.  

PIH has been working in partnership with the Ministry of Health and the local community to build the hospital for the past two years, following a request by the Rwandan Government for help to bring health care facilities to Burera, the last district in Rwanda which did not have access to a hospital.

Luckily, the President was two hours late, so our detour meant we missed nothing more than an hour or so of sitting and waiting for things to kick off.  When they finally did, there was the token ribbon cutting, followed by speeches by the President, the Minister of Health and Dr Paul Farmer (founder of PIH).  The president then lead a rally down in the community, and the day ended with traditional drumming and dancing back at the hospital.

Since PIH started working in the district in 2008, in a temporary make-shift hospital, the rate of infant mortality in under 5s has more than halved and malnutrition has been cut by over 60%.  The project has also created over 3000 jobs for the population of Burera.  So there was such a buzz of excitement at what can be achieved now the new facilities have opened.  

The hospital really is impressive.  It is situated on top of a mountain, close to Lake Burera.

And rather than looking in at a room full of sick patients, every bed looks out at the wonderful views: 

In terms of facilities, the hospital hopes to become a model of how to deliver health care in rural Africa.  It features an innovative design intended to harmonise with the local environment and reduce the risk of hospital-acquired infections.  It has an emergency department, a full surgery ward with two operating rooms, a neonatal intensive care unit, the list goes on...  It will even be making use of the impressive hills to supply hydro-electricity.

 

I am certainly looking forward to spending some more time up in Burera in the coming months, but for the rest of the week at least, I’m back in Rwinkwavu, as the stock take started today!

Oh, and of course, no official opening celebration would be complete without a huge cake, with a photo of the new hospital on the top...

Week one at work - settling into an office outdoors

It is 6.30pm on Monday here, and I have just watched my first proper sunset since arriving, a nice treat before settling in for an evening of work (the mid-year budget reviews started today). 

I spent most of my first week settling in, getting to know the people and the organisation, and setting works objectives.

The offices are based around an open air quadrant, and there is a large working area which has a roof and one wall but is otherwise open to the environment.  Spending so much time outside is awesome.

We conducted our interviews for the position of Internal Auditor last Monday.  We used video-conferencing to enable the Boston-based team to participate, but to be heard clearly in Boston the candidates had to sit right in front of the monitor, with the rest of us circling them.  Not exactly an easy environment for an interview.  Unfortunately, we didn’t end up recruiting, so we are back on the hunt...

In the meantime, there is plenty to keep me busy, including: performing financial “healthcheck” audits on each of the 3 districts in which PIH operates (Kayonza, Kirehe and Burera), and then working with those teams to help strengthen controls over newly expanded and decentralised operations; reviewing the procurement and stock management systems for medical and non-medical supplies; and setting up a risk assessment process.

One afternoon a week the Finance Advisor delivers excel training in Kigali to the whole finance team.  Having had some practice of delivering training over the past 12 months, I was interested to attend and help out, so went along on Friday afternoon.  It was pretty tough given the range of abilities in the class and various distractions (sodas and snacks arrived so they didn’t have two free hands to learn shortcuts, phones rang, and were answered, people joined the class at various points right up until 20 minutes before the end).  Going forward, we have agreed to split them up into two smaller groups, and work with a group each.  Hopefully that will make the training more effective, and more manageable.  There is a strong culture of exams here, and so when we suggested a game to check their learning, they seemed disappointed and have willing opted for an old fashioned test!

Non-clinician staff aren’t allowed to just wander around the hospital, and I still haven’t arranged a proper tour with Dr Felix.  As soon as I have, I’ll describe what it is like.  I will start taking a few more photos and loading them to share my surroundings too.