# Notes on Life in East Africa and Tips for Future Missions --- *I will preface this article by saying that the following is based on my personal experiences traveling and working in East Africa, and I am not an authority on these subjects. I am a seasoned traveler though, having spent more than 450 days living or backpacking through nearly 35 countries in the last 10 years. This will serve as a catch-all article of things I wish I would have had a better handle on before arriving in East Africa.* In no particular order, I’d like to share my thoughts on life and travel in [East Africa](https://en.wikipedia.org/wiki/East_Africa), in hopes that some of this information will be helpful on future e-NABLE missions to this region. ### Transportation ##### Air Travel  ###### Twin engine PrecisionAir plane from Dar Es Salaam to Mwanza. --- My flight from [Dar Es Salaam](https://en.wikipedia.org/wiki/Dar_es_Salaam) ([Tanzania](https://en.wikipedia.org/wiki/Tanzania)) to [Mwanza](https://en.wikipedia.org/wiki/Mwanza) (Tanzania) was the only time I’ve ever experienced a plane leaving 20 minutes before its scheduled departure time. After reaching the airport with time to spare, I went to buy a snack before boarding time. Arriving back at the gate, I heard my name being called over the PA system — final call. Confused, I showed my ticket at the gate, walked out onto the tarmac and onto the plane. I was the last one on board! When I got settled in my seat on the little twin engine [PrecisionAir](https://en.wikipedia.org/wiki/Precision_Air) plane, I spoke to the flight attendant about the time discrepancy. It turns out that they are a little looser there with boarding process and scheduling. The plane was ready early so they opened up the gate for boarding early. When I got onto the plane, everyone on the manifest was then accounted for. There were no planes ahead of ours for takeoff, so they figured: why wait? ##### Bus Travel  ###### Vendors selling their wares at a bus stop in Tanzania. --- Bus travel was cramped and confusing in my experience. I took buses between Mwanza and [Musoma](https://en.wikipedia.org/wiki/Musoma) (Tanzania), and between [Kigali](https://en.wikipedia.org/wiki/Kigali) and [Nyanza](https://en.wikipedia.org/wiki/Nyanza,_Rwanda) ([Rwanda](https://en.wikipedia.org/wiki/Rwanda)). I know I wasn’t the first westerner to walk around these bus stations trying to figure out how to buy a ticket, but it sure felt like it at the time. There was no shortage of ‘entrepreneurs’ willing to help me buy a bus ticket for 10-times the price. In Tanzania, I paid less than $2.00 USD for the 4-hour bus ride between Mwanza and Musoma on Champion Express. For the first hour, a man with a portable PA system stood at the front of the bus and spoke passionately in [Swahili](https://en.wikipedia.org/wiki/Swahili_language) — I thought for sure it was a sermon. I kept my headphones in and watched a movie on my phone to drown out the man talking. It turns out that he was selling skin care products, and his speech was basically a one-hour infomercial. Afterward, he awkwardly went from seat to seat to see who was interested in buying his wares. This must be common on buses here because someone else was selling something on the return trip. At every bus stop, vendors selling anything from food and drink, to electronics, to live chickens, held their wares up above their heads to reach the bus windows. To Americans, this may seem a little odd, but in many places around the world the fast food simply comes to you. How convenient! The bus stops were never long enough to go and find a bathroom. In the 4-hour trip from Mwanza to Musoma, the bus stopped once along the side of the road, right outside of the gates to [Serengeti National Park](https://en.wikipedia.org/wiki/Serengeti_National_Park). Half of the bus got off, and I assumed this was another bus stop. Everyone headed for a separate bush — it turned out that this must have been a scheduled bathroom break that no one told the *[Mzungu](https://en.wikipedia.org/wiki/Mzungu)* (Western guy) about. In Rwanda, the bus ticket was was about $1.50 USD for the 3-hour ride from Kigali to Nyanza. The bus was small and cramped. I was one of the first to get on the bus, and the first thing I noticed was there was no place specifically designated for suitcases. There was no storage space underneath the vehicle, and no overhead shelves. I had a full-sized suitcase, and a 75 liter backpack I’ve taken all over the world with me, and seemingly no place to put them. The bus driver took my suitcase and put it right next to him by the gear stick, and told me to put the backpack on my lap. The bus had a rows of two seats to the left of the aisle, and single seats to the right of the aisle. This seemed perfect — I could sit by the window and stretch my legs out into the aisle at the same time. Within minutes, every seat was full, but more people kept getting on. I came to find out that there were little seats that fold out from the aisle seat on the left of the bus into the aisle. From back to front, people folded out the seats into the aisle and sat down until the bus was loaded to capacity. To me, this was a very claustrophobic situation. While the bus was cramped and hot, there was also no aisle to stand up in. And in the case of an emergency, there would be no way out of the bus until the passengers in the front exited. A few tips for bus travel in this part of the world: * **Do not let anyone ‘help’ you buy a ticket that you did not specifically request help from**. This is my boilerplate advice for doing anything while traveling anywhere you aren’t familiar with. The average person, anywhere, is generally good. But there is an industry of deception targeted at foreigners and tourists in many places. I’ve seen and read about enough scams around the world to know that the likelihood of you getting taken advantage of skyrockets when you engage with someone who ‘chooses you.’ So make sure to only engage with someone that ‘you choose.’ Though this is my default setting, exceptions exist obviously — use your best judgement. * **Ask a vendor or shop owner for help**. In my experience, vendors and shop owners tend to speak a little English, or at least more than the average person on the street. You can expect more accountability from a shop owner as well, because you know where to find them again if they were to give you poor advice. As payment for solid information, make sure to make a purchase before you leave. * **In Tanzania - Buy your ticket directly from the bus driver standing outside of the bus**. Also, people will stand next to you to make it appear as though they drove you toward that company and that bus for a commission. I made it clear when I bought bus tickets that I was alone and that no one was helping me. * **In Rwanda - Buy your ticket from the company counter.** * **Board early and get a window seat**. I’m a tall guy; on public transportation I tend to opt for an aisle seat so I can stand up, stretch, use the bathroom if there is one, etc. However, these buses were hot, they were packed with people, and they had no air conditioning. If I didn’t have control of the window for fresh, cool air, I’m sure I would have been sick. * **On small buses, get a seat toward the front (exit).** As the aisle fills with people using the fold-out seats, a spot toward the door of the bus at the front seems to be the best place to sit.  ###### Champion Express bus ticket from Mwanza to Musoma. --- ### Taxis I had mixed experiences with taxis in Rwanda and Tanzania. First, they are very expensive alternatives to mototaxis and [bajajis](https://en.wikipedia.org/wiki/Auto_rickshaw) (discussed below). A taxi ride from the airport in Kigali to a hotel across town (it’s a small city) was around 15,000 [FRw](https://en.wikipedia.org/wiki/Rwandan_franc) (\~$16.20 USD). While the same trip on a motorcycle taxi would run about 1,500 FRw. However, if you have suitcases you’re out of luck — you’ll need to take the taxi. This very quickly adds up, especially if you are uncomfortable taking an alternate form of public transportation. Taxis there were not metered, riders have to negotiate prices up front. This wasn’t generally a problem for me, but I did have one experience in which the driver changed the price once we reached my destination and the situation became heated. The safest way to get a taxi, albeit the most expensive, is to have a staff member at your accommodation call and negotiate a taxi for you. ### Motorcycles Motorcycle taxis (mototaxis) are very common in the places I visited in Africa, and cost 1/10th what a traditional taxi charges to get from point A to point B. A 15 minute mototaxi ride in Southern Rwanda was about 1,000 FRw (about $1.00 USD). In Musoma, I had a choice between abundant mototaxis and bajajis (discussed below), but in Gatagara, Rwanda, my choices were limited to taking a mototaxi, or walking. Taking a motorcycle taxi is intimidating at first. I read and heard many stories of frequent motocycle taxi accidents. I learned the word *poli poli!* in Swahili (“slowly, slowly!”) and it came in very handy on the back of many mototaxis. Like anything though, you get used to it, and I developed a few ways to maximize my safety when taking a mototaxi: 1. Mototaxi drivers can be very aggressive when someone looks like they are interested in a ride. I never gave my business to a driver who called out at me or drove up to me. **Always go with a mototaxi you chose yourself, not one that solicited you.** 2. Most mototaxi drivers carry a spare helmet for their passenger, but you wouldn’t believe the condition of a lot of those helmets (cracked, duct taped, scuffed, etc.) The last thing you want it to do is get on the back of a motorcycle with a cracked and scuffed up helmet…what happened to the last passenger? **Always inspect the helmet, and try it on for fit, before proceeding with the negotiation or getting on the back of the motorcycle.** I got so comfortable with choosing mototaxis that if I couldn’t see my face reflected in the helmet’s paint job, I took my business elsewhere. 3. By the same token, **inspect the tires on the motorcycle.** I was in Rwanda during the rainy season, and bald tires are bad news. 4. If you can help it, **don’t take a mototaxi in the rain.** It started raining the very first time I took a mototaxi in Rwanda. 60 km/hr may not seem fast in a car, but it’s terrifying on the back of a mototaxi in the rain with a fogged-up face mask. 5. If you don’t speak the local language, see if the driver speaks a little English. Speaking English is not a prerequisite for being a good driver (duh), but for a few minutes you are entrusting your life to this person. **Choose a driver you can communicate with.** At bare minimum, you should be able to communicate to the driver that you wish to stop, slow down, or turn. It is also necessary to confirm that you are both on the same page with the negotiated price. *Aside:* It never fails to amaze me how much stuff people can pack onto a motorcycle. In [China](https://en.wikipedia.org/wiki/China), I regularly saw families of 5 riding on one motorcycle or moped. In [Vietnam](https://en.wikipedia.org/wiki/Vietnam) I saw bags of recyclables stacked over 10 feet high and precariously strapped down. It was no different in Africa — impressive ingenuity!  ###### Have you ever wondered how many ducks you could fit on a motorcycle? ###### Source: https://www.businessinsider.com/people-overloaded-photos-2015-11 --- I never thought I would become this kind of person, but Tanzania forced my hand.  ###### Kyle Reeser, carrying a metal stand on the back of a mototaxi. --- ### Bajaj In Musoma there were no shortage of bajaj auto rickshaws—they were the primary way I got around while working at [LVDC](wiki:/u/kreeser1/wiki/Lake+Victoria+Disability+Centre "Lake Victoria Disability Centre"). Bajaj auto rickshaws (which I’ll shorten to bajaj(is)) are 3-wheeled vehicles, with a single seat in the front for the driver and a bench seat in the back for passengers. The bajaj controls look like motorcycle handlebars, a little disconcerting when you first see it, but it somehow feels safer than riding on the back of a mototaxi. That is, until the wind hits it — you feel as though one good, swift gust would blow you straight into the [lake](https://en.wikipedia.org/wiki/Lake_Victoria). Each bajaj reflects the personality of the driver — every bajaj I saw was customized in some way. Curiously (to me, at first), bajaj rides are not private, though you could pay extra for a solo ride. If there is room (and even if there isn’t) a driver will stop for anyone they think they can fit into the bajaj, to maximize their profit. While bajajis are relatively small, drivers really packed passengers in sometimes. I personally experienced a ride with 4 people on the bench seat in the back and another passenger sitting on the lap of the driver in front. Musoma lies along the shore of [Lake Victoria](https://en.wikipedia.org/wiki/Lake_Victoria), with a single main paved road stretching north-south and dirt side roads leading to adjacent homes, farms, and businesses. By default, bajaj operators drive along the main paved road, between the bus station uptown and the business, shopping, and dock areas downtown. The bajaj ride going downtown cost a flat rate of 1,000 [Tsh](https://en.wikipedia.org/wiki/Tanzanian_shilling) per person (about $0.44 USD). Any ride going uptown, or diverging from the main paved road costs extra and the price would be bartered for beforehand. If you were travelling with a group, you had the option of bartering a group rate. I never experienced paying more than 3,000 Tsh for any ride in a bajaj.  ###### A bajaj, the public transport of choice in Musoma, Tanzania. --- ### Utilities ##### Electricity **Tanzania**: 220V/50Hz | **Rwanda**: 230V/50Hz The electrical grid was very unstable in my experience both in Rwanda and Tanzania. During my time at both LVDC and [HVP-Gatagara](wiki:/u/kreeser1/wiki/HVP-Gatagara+and+ORTHOLAB%3A+An+Introduction "HVP-Gatagara and ORTHOLAB: An Introduction"), we lot power 15-30 times per day. The power outage would sometimes only last seconds, and at other times could last several hours. When the electricity was on, it was never stable. The lights flickered constantly. The ORTHOLAB at HVP-Gatagara was located in a building adjacent to the metal shop. The most severe instability in our electricity in the ORTHOLAB was when heavy machinery was being used next door, especially the welder. The buzzing of a far-off welder corresponded perfectly to the dimming and brightening of the lights overhead in the ORTHOLAB. Perhaps the most critical piece of machinery in the ORTHOLAB was an [uninterruptible power supply](https://en.wikipedia.org/wiki/Uninterruptible_power_supply) (UPS), which clicked on and off constantly as it maintained a steady power source for the 3D printers. I learned the hard way that grounded electrical sockets are not standard in the places that I stayed. One of my big projects in the first week at ORTHOLAB was to assemble and test a Modix3D Big 60 large format 3D printer. The print bed heater needs to be [grounded](https://en.wikipedia.org/wiki/Ground_(electricity)) as it creates a significant electric field that can shock the user and/or damage electrical components of the machine. Roberto and I were both shocked (literally) multiple times by the Modix3D Big 60 3D printer, and one component of the machine (a device for auto bed-leveling) was damaged. We determined that the electrical system in the building that the ORTHOLAB resides in was not grounded. This realization was hindered by the fact that all the outlets had a grounding pin, and also had three wires entering each outlet. Everything appeared to be in order. The electrician was called and explained that no one had asked him to ground the electrical in the building, so it was never done.  ###### Left: A standard plug in Rwanda. Note the hole in the plug for the ground pin. Middle: A standard outlet in Rwanda. Note the ground pin sticking out of the outlet. Right: Three wires leading from the outlet. --- After watching a grounding rod be pounded into the Earth and being told it had been tied into the electrical system, we were heavily shocked by the Modix3D Big 60 again. As it turned out, they had not tied the new ground into the breaker box as we had been told. It took several days to get this issue cleared up.  ###### The electrician at HVP-Gatagara pounds a grounding rod into the soil and attaches a ground wire to tie into the building’s electrical panel. The hole is back-filled with charcoal for drainage. --- In my accommodations at HVP-Gatagara, the outlets were not grounded either. It was a risk to plug anything in. The brushed metal exterior of my laptop must have been lightly charged on the rare occasions I had to plug it into these outlets, because it would hurt my skin to touch akin to touching a 9V battery to your tongue. In certain countries we can take for granted the stability of the electrical grid. We may plug our computers into a surge protector ‘just in case’, but our expectation is that when we flip the switch or plug something in, there will be no issues. This just isn’t so in other areas of the world. Electrical instability is a something that every volunteer needs to consider before going on a mission. With that said, I didn’t come across any place where I felt there was no electricity at all — even in areas with little development, I still saw satellite dishes on the side of mud and thatched-roof homes. That is to say, in these areas of great need you can always find a place to plug in, you just need to consider the quality of the electricity supplied. ##### Water Travelers to East Africa should not drink the water. Tap water should be used only to shower and wash your hands with; everything else should be done strictly with bottled water. Bottled water should be used to brush your teeth, and to cook with. Travelers should also not swim in Lake Victoria due to the risk of contracting [schistosomiasis](https://en.wikipedia.org/wiki/Schistosomiasis), a disease caused by [parasitic](https://en.wikipedia.org/wiki/Parasitism) [flatworms](https://en.wikipedia.org/wiki/Flatworm) known as [blood flukes](https://en.wikipedia.org/wiki/Schistosoma). While I was in Tanzania, we did not have running water for 9 days in a row, I never found out why the water stopped running. During this 9 day period I showered by filling several 1.5 L bottles with water from an outdoor rainwater [cistern](https://en.wikipedia.org/wiki/Cistern). I also washed my clothes in a bucket with water from the cistern, and used the dirty laundry water to flush the toilet to conserve. ### Cell Phone and Internet ##### Cell Phone Use Cell phones are ubiquitous in this region, and the cell network was surprisingly good. Many people in this part of the world do not have traditional bank accounts, and perform a lot of peer-to-peer, or peer-to-business, transactions from their phones. Monthly phone plans seemed to be uncommon; I experienced a mostly pay-as-you-go system, but it seemed very innovative. After purchasing a [SIM](https://en.wikipedia.org/wiki/SIM_card) card, I was able to buy ‘top-up’ cards to load funds onto my SIM card. These funds could then be transferred to someone else, or be used to purchase airtime or data through a sophisticated touch tone system. On every street corner in every city I traveled to, there would be a person sitting at a small table that sold SIM cards and top-up cards. Even faster, you could pay someone cash, and that person could send money to your phone, which could then be used at your discretion, cutting out the top-up card altogether. This system seems to work very smoothly: More than once, my mototaxi drivers would stop at a red light, wave for someone to come to them, give the person cash, and be instantly transferred some money to their phone — all in the space of 30 seconds before the light turned green. There are multiple cell phone companies in Tanzania and Rwanda to choose from. In Tanzania I used [Vodacom Tanzania](https://en.wikipedia.org/wiki/Vodacom_Tanzania), and in Rwanda I used [MTN](https://en.wikipedia.org/wiki/MTN_Group). In each country, foreigners have to fill out special paperwork to purchase a SIM card. While in Tanzania, a staff member at LVDC was nice enough to purchase a SIM card on my behalf, giving me instructions to break it in half and throw it away when I left the country, as it was registered in his name. In the two weeks I spent in Tanzania, I spent maybe $15.00 USD on data for my phone, using it as my sole access to the internet. Without WIFI, I used my phone as a hot spot in order to connect my laptop to the internet. I was able to video call from Tanzania without issue, and only ran into a bit of trouble when working on large files in [TinkerCAD](https://en.wikipedia.org/wiki/Tinkercad). In Rwanda, I had to make a special trip to the MTN Center in the middle of Kigali to purchase a SIM card. I should have been able to purchase one at a kiosk outside of the [airport](https://en.wikipedia.org/wiki/Kigali_International_Airport), but their system was down at the time. The SIM card was $1.00 USD, and I purchased 30 GB of data for 25,000 FRw (about $26.00 USD). The data and cell signal easily allowed for all the video calling, email, and web browsing I required while at HVP-Gatagara, where there was no WIFI. One quirk: I would say that more than 50% of people talking on their cellphones did so with the front of the phone facing away from their heads. I have NO idea why. ##### WIFI The WIFI was hit-or-miss at hotels and hostels in Tanzania and Rwanda. While it was sometimes present, it was always spotty. I learned — later into my trip than I wish — that cellular data is far more reliable, and not that expensive. ### ATM Machines One of the most frustrating experiences during my time in Africa was the ATM Russian roulette. Once every 2-3 times I would attempt to withdraw cash from an ATM, it would tell me “*transaction failed, contact bank”* and then spit out my card without a receipt and without the cash I requested. Several weeks into my trip, I was reviewing transactions on my banking app and realized that money had been taken from my account with every failed transaction at these ATMs. This was not fraud, it was some sort of a glitch in the ATM system. During my trip I had to file a total of 6 disputes with my bank for the return of over $1,200 USD. The only ATM that I had a 100% success rate with and came to trust was the Cogebanque ATM in the MTN center in Kigali. ### Food  ###### A woman selling vitumbua at a market in Mwanza, Tanzania. --- East Africa cuisine is very acceptable to the American palate — it is not particularly spicy, and most of the food that I came across was recognizable and delicious. I ate very well at HVP-Gatagara in Rwanda. Roberto and I ate with the religious brothers and other visitors to the facility almost every day for lunch and dinner. Each meal began with a soup, followed by a buffet with rice, beans, potatoes, plantains, a meat (based on what animal was recently dispatched), and sometimes a pasta. Each meal ended with an array of fruit, most often watermelon and passion fruit.  ###### A meal at HVP-Gatagara. --- In Musoma, I mostly lived off of rice and beans, [dagaa](https://en.wikipedia.org/wiki/Silver_cyprinid) (Lake Victoria sardines), and [chips mayai](https://en.wikipedia.org/wiki/Chipsi_mayai). I also had Vitumbua ($0.04 USD/each), which were kind of like a corn flour-based [takoyaki](https://en.wikipedia.org/wiki/Takoyaki) without the squid. I only came across them once and bought one, and they were so good that I doubled back for two more. In Musoma, there were few places to get anything else. I will admit that after a couple weeks of this diet with little variety, I felt a little cloudy-headed. Soda in East Africa comes in both plastic and glass bottles, but soda in a glass bottle costs half of what it costs in plastic. When you go to a shop and buy a soda in a glass bottle, you’re expected to drink it there and return the glass bottle to the shop owner before leaving. If you wanted to take the drink with you, it would cost you more than double. The labels on the Fanta and Coca Cola bottles were often worn way down, an indication of their commitment to reuse of these bottles. In Gatagara, I struck up a friendship with the owner of the local bar, and he let me purchase a few glass bottles of soda to take home with me at the “drink it there” price, under the condition that I bring the empty bottles back to him. I never let him down. ### Weather Musoma was hot every day, often reaching the high 80’s or low 90’s, and dropping only into the high 70’s at night. It rained several times when I was there, but the land was dry and the air was hot. How I wished I could go swimming in Lake Victoria! Though only 2 degrees or so South of the [equator](https://en.wikipedia.org/wiki/Equator), the weather in Rwanda was much more comfortable. Both Kigali and Gatagara stood at an elevation of more than 5,000 feet, making the temperature a very agreeable 60-80 degrees Fahrenheit each day. During the last few weeks of my trip, Rwanda entered a rainy season and there were heavy rains every day.  ###### A story day at Lake Victoria Disability Centre. --- ### Daily Life Mzungu! Mzungu! Mzungu means ‘foreigner’ in Swahili, and Tanzanians were not shy about reminding me that I was a guest and not a resident in their beautiful country. At the market in Mwanza, I would walk by children laughing and playing with bicycle tires and other found objects. When they noticed me, they would smile and wave and say, “bye bye mzungu!” Why it was ‘bye bye’ and not ‘hi’ is a mystery to me, but this greeting is apparently pretty common. From all directions I heard, “Mzungu—fish??” Or “Mzungu—buy cabbage!” In Musoma, I would take a Bajaj to work, or down town, every day. Even at road speeds, I would catch the eye of nearly everyone on the street and hear the word mzungu in the distance moments later. I would come to find out toward the end of my time in Tanzania that there has been a long history of [persecution of people with albinism](https://en.wikipedia.org/wiki/Persecution_of_people_with_albinism) in Tanzania. One reason that people stare at white foreigners is to figure out if they are white or [albino](https://en.wikipedia.org/wiki/Albinism). HVP-Gatagara sits at the end of a 2 km dirt road which winds through the village of Gatagara. The village is far away from the hustle and bustle of Kigali and they rarely see white visitors. When I would walk through town I would cause quite a stir. Invariably I would end up with a posse of children who would follow me the entire distance between the main road and the hospital. Sometimes I would bring them treats or soccer balls. It was hard to not be able to communicate with them as they only spoke [Kinyarwanda](https://en.wikipedia.org/wiki/Kinyarwanda).  ###### A group of children following Kyle Reeser through Gatagara village, Rwanda. --- ### Communication **Rwanda:** Kinyarwanda, English **| Tanzania:** Swahili, English At Lake Victoria Disability Centre in Musoma, Tanzania, many of the staff members happened to be [deaf](https://en.wikipedia.org/wiki/Hearing_loss) or hard of hearing. Most of the staff at LVDC therefore used [sign language](https://en.wikipedia.org/wiki/Tanzanian_sign_languages) to communicate, and I was able to pick up a few signs for basic communication. Most of the hearing staff at LVDC also spoke English, and Rajab kindly translated for me when a staff member or patient did not speak English. In Rwanda, many people I met on the street spoke a little English along with their native Kinyarwanda. At HVP-Gatagara, most of the staff and religious brothers spoke English and Roberto (who I believed only spoke [French](https://en.wikipedia.org/wiki/French_language) before I traveled there) also spoke enough English for us to communicate productively. ### Addresses As it turns out, street addresses are not really a thing in the places I visited. Houses and buildings do not have numbers, and most roads had no name. Local landmarks are used instead to help people find their way. When taking a taxi, motorcycle, or bajaj, you tell the driver you want to go to ‘Lake Victoria Disability Centre’ and if they know it, great — sit back and relax. If they didn’t know it, you have to tell them to “Go to the Lakeoil petrol station, and then I’ll tell you where to turn right.” Most businesses and some homes keep PO boxes at the local post office, but don’t get confused and think that a PO box listed on a hotel or business website is an address — I made that mistake once. In an area where there is no Google Street View, and no addresses in the traditional sense, I had to put a lot of faith in the local taxi drivers when I traveled to Nyanza by bus from Kigali. I can’t overstate this: I literally had no clue where HVP-Gatagara was before I left the USA, while I was in Kigali, and even after I arrived in Nyanza. But sure enough, when I found a taxi in Nyanza and said, “Can you take me to HVP-Gatagara, it’s a hospital in a town close to here”, he knew exactly where it was. The trip was 15 minutes along the only paved road in the region, followed by the 2 km bumpy ride on the dirt road leading to the hospital. It was easy to venture away and make it back to HVP-Gatagara after that, but it was a struggle to get anywhere the first time (e.g., it took several hours to find the local post office when I wanted to mail a post card). I got used to this system, but often I would need to have my colleagues at LVDC or HVP-Gatagara write down directions for a taxi driver to follow, or call someone to put them on the phone with the driver when we got lost. It was also very common for drivers to call the business phone number of the hotel or hostel I was trying to get to for directions. ### Safety ##### Rwanda Kigali is one of the cleanest cities in the world, and one of the safest cities in Africa. I felt perfectly comfortable walking the streets of Kigali at night. While I would get the Rwandan “3-o’clock” — the side eye — as I walked past most people, I never felt uncomfortable or in danger. Local women walked alone at all hours as well. In discussion with female employees at the hostels and hotels I stayed at in Kigali, they informed me that in the aftermath of [the 1994 genocide](https://en.wikipedia.org/wiki/Rwandan_genocide), the country has re-invented itself as clean and safe, and that for many young people this *de facto* level of safety is all that they have ever known. For a solo female traveler or volunteer, Kigali is a great option in terms of safety. In [Southern Rwanda](https://en.wikipedia.org/wiki/Southern_Province,_Rwanda), there is an extraordinary police and military presence. Historically there have been a lot of illegal crossings by people from the [Democratic Republic of the Congo](https://en.wikipedia.org/wiki/Democratic_Republic_of_the_Congo) into Rwanda through Nyungwe National Forest, and people are stopped constantly along the main, paved roads and asked for paperwork and identification. When I say an ‘extraordinary’ presence, I mean an officer every 200 meters standing on the side of the road with an assault rifle. A wave from any officer as you drive down the road means you must stop. I never felt like I was in particular danger in Tanzania, but it felt different than Rwanda. My guard was up a little more, and I went out less at night. There was a large police presence in Musoma, Tanzania, lining the main paved road every couple hundred meters as well. ### Legal From my conversations with staff at HVP-Gatagara and LVDC, both the Tanzanian and Rwandan governments do not approve of unsanctioned humanitarian efforts in their countries. Case in point: We were scheduled to drive to a village several hours from LVDC in Tanzania on an outreach mission during my time there. The proper permits to visit the village for this purpose did not come through in time, and we were forced to cancel the mission. e-NABLE members should not expect to be able to drop into either of these countries and visit a village on a humanitarian trip without filing extensive paperwork with the local government and obtaining an appropriate (volunteering) visa. ### Cosmetic Appeal of Devices The cosmetic appeal of prosthetic devices is very important to potential recipients in East Africa, I can’t overstate that fact. Rajab Hamis and the technicians at Lake Victoria Disability Centre, as well as Roberto Postelmans of ORTHOLAB, have treated hundreds of patients in their respective regions. From in-depth conversations with them, and first-hand experience working with patients at LVDC and HVP-Gatagara, it appears that patients will choose cosmetic appeal even over functionality. I’ll give it to you straight: The average recipient in these regions are not going to respond well to the brightly-colored, robotic-looking hands that e-NABLE is known for. That’s okay, e-NABLE has helped and will continue to help thousands of recipients around the world through our current range of devices. Roberto Postelmans has been experimenting recently with applying Ottobock SuperSkin to cosmetic prosthetic devices printed in white Filaflex elastic filament. Ottobock SuperSkin is a pigmented coating used to approximate a recipient’s skin tone, and can flex with the material it is applied to. I found the cosmetic hands printed in Filaflex to be superior to any 3D printed cosmetic hand I had seen previously, and could be thrown to the ground without breaking. The SuperSkin coating, while expensive, is a great opportunity to provide relatively low-cost cosmetic devices to the underserved.  ###### Color matching a 3D printed cosmetic hand at ORTHOLAB with Ottobock SuperSkin. --- ### Viability of a Portable e-NABLE Lab One of the premises of this project is the idea that everything necessary to create e-NABLE’s most popular devices could be contained in a carry-on size suitcase. One issue with this premise is that e-NABLE’s most popular devices would not be particularly popular in East Africa, where cosmetic appeal trumps all else. One then has to ask whether it makes sense to plan a mission to such an area with intentions or the skill set to only provide these devices. As I eluded to previously, in the 6 weeks I spent working at LVDC and HVP-Gatagara, there were no opportunities for creating or delivering hands in the current e-NABLE repertoire. In addition, the unstable electrical grid necessitates the use of an [uninterruptible power supply](https://en.wikipedia.org/wiki/Uninterruptible_power_supply), something that I did not know before my trip. As there regions also regularly experience power outages for longer than a UPS can provide backup power, prints are often lost if a battery bank is not present. Using a battery bank large enough to provide power long enough to matter (i.e., 6-12 hours for an e-NABLE prosthetic device) presents it’s own challenges as well. That is to say, it is not possible to fit everything needed for successful 3D printing in a remote, developing area into a single carry-on suitcase. The weight and volume of a UPS will necessitate at least a second suitcase. On the plus side, the availability of electricity that I saw during my time in Tanzania and Rwanda made me re-think the idea that the portable e-NABLE lab would ever need to be hooked up to a car battery to operate. This initial idea was based on two false premises: (1) electricity wouldn’t be guaranteed available outside of main cities, and (2) it would be reasonable to ask someone to keep their vehicle running for 6-12 hours while a 3D printer runs off of their battery. As I mentioned previously, electricity (and satellite TV) was ubiquitous in the regions I traveled to. At the very least, there were local bars and shops that I could see potentially allowing a volunteer to 3D print in if it came to it. After reconsideration, it would certainly ***not*** be reasonable to run a 3D printer off of a car battery for the amount of time that would be required to create a full prosthetic device. The idea of a portable e-NABLE lab is still viable overall, but the fact of the matter is the destination at which the portable 3D printer will be used should be fully considered prior to the start of a trip. The question should be asked if carrying this equipment to a remote region in another part of the world will provide value that cannot be achieved by simply carrying a suitcase full of spare e-NABLE prosthetic parts. With that said, a portable e-NABLE lab has great potential to provide value in a situation where there is known and stable electricity (such as traveling to a conference, presentation, or facility around the world that lacks a 3D printer), and/or where a humanitarian organization such as e-NABLE has the legal permission to provide our services. ### Takeaways East Africa is an incredible region, under-visited by tourists around the world. It is also developing and in great need of humanitarian health care services. While certain things may be done a different way here (i.e. lack of street addresses), with a little research and an adventurous spirit, work in this area does not have to be intimidating, and is instantaneously rewarding. ### e-NABLE Community Call to Action I learned in Africa that regaining some level of functionality in an amputated limb isn’t necessarily the goal. Often, a person’s quality of life can be vastly improved just by giving them an opportunity to feel ‘whole’ again. I would encourage the e-NABLE community to build a repository of scanned hands, both male and female, in a range of sizes and experiment with printing in flexible materials. If you have an upcoming e-NABLE mission that could benefit from having a portable 3D printer in a hard shell suitcase, contact the Rochester e-NABLE Lab to borrow it! (project will be complete within the next several weeks). If you have had a previous experience where a portable 3D printer would have been handy, let us know that too. Any potential or actual use case for the prototype helps us to gauge its viability and add features that will make it better for real life application. If you want more information about my time volunteering in Africa, or are planning your own mission, please feel free to contact me.