The Last 3 Weeks

So this blog post is the most overdue yet… I started it on July 24th and it is now August 12…sorry guys. Mbabarira (my fault)!

Midway through the third week of July, our hospital work started to slow down.

 

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Chill’in in the workshop. But only briefly because we still had work to finish up.

It was mostly intentional though because that’s when Margo and I really began researching and gathering information to start our secondary project.

 

Just to recap something that’s important—all EWH Summer Institute locations allow students to repair medical equipment in developing world hospitals. The Rwanda location is “special” in the sense that there is a design portion where participants get to create something for their hospital. In years past, these projects have ranged from building a playground outside the pediatric ward to constructing an oxygen cylinder carrier.

My lovely partner Margo and I decided to build a biosand filter to provide clean drinking water for the entire hospital. The idea came from our interactions with patients, kids, and even our BMETs, all of whom were constantly asking us if they could have our bottled water, which happens to always be hanging out on the side of our backpacks everyday.

Currently, the hospital uses small electric kettles to boil water from the tap. I see them using it in the pharmacy all the time and they also have it in the surgery and maternity wards. In some places like the neonatology unit, there is a small distillation machine, but it takes up to 7 hours to distill the water!

In order to provide greater access to clean drinking water for everyone at the hospital, our idea was to build a large biosand filter, which is something almost all of us have probably made in a high school biology class at some point (I have at least). Basically, we constructed a column of separate layers containing gravel, sand, and activated charcoal (charcoal with air blown through it to create pores). The idea is that dirty water travels through each of the layers and gets filtered through the pores in the charcoal.

Seems weird to put water through charcoal, right? Everyone’s initial thought is that the water will turn black and carry the charcoal powder with it. In reality, the pathogens and other bad stuff in the water gets trapped in the pores of the charcoal. And as long as you put something below the charcoal layer, like cotton for example, the charcoal should never get trapped into the water. Eventually, the pores in the charcoal will all get clogged so when that happens, it means it is time to replace the filter, or in our case, the activated charcoal.

Did you know that Brita pitcher filters use “coconut-based activated carbon?” It’s pretty cool.

Anyhow, Margo and I started our secondary project by building a small prototype of it. Always start with a small scale prototype as a proof of concept experiment 🙂 When we first tested our biosand filter prototype, we could only analyze our results qualitatively. Our filter certainly didn’t make the water dirtier or more turbid so that was a good, first sign! Obviously, we couldn’t really proceed to the large scale filter without also quantitatively analyzing our filtered water because it had to be safe enough to drink. Clearly, the next step was to get some legit lab tests conducted on our water.

And that was probably the most difficult part of this project. Our hospital lab here does not test for microbes or metals, but rather focuses on analyzing clinical samples (as should be the case). They also couldn’t really provide us any materials to culture bacteria with… their fume hood was actually broken and we couldn’t fix it….

Fortunately, Margo was able to find a lab that could help us in Kicukiro—right on the college campus we studied at during the first month of the program. The testing wasn’t comprehensive (we could only do a chemical analysis of metals in our filtered water) but at least we had results. And they were good!

We still had to test for microbes though and for that, we had to go to the National Reference Lab in Kigali.

Lab Testing
Standing outside the National Reference Lab.
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Meeting with the director of the National Reference Lab in Kigali to conduct microbe testing for E. coli and other coliforms in our filtered water.

I think throughout this entire testing process, one thing that really just struck us is how expensive and time consuming it is to get data like this. It just seemed so ridiculous that something that could be tested so easily here in the US for around $20 costs more than $100 in Rwanda.

Because we were unsure if our results would ever get back to us in time, Margo and I also decided to work on a water distillation machine in case our biosand filter idea failed. Always have a plan B in mind! The kind-of-sucky thing about building the water distillation machine was finding the materials we needed. For instance, finding the copper tubing, which is necessary for rapid condensation of the water vapor, was difficult. I spent three hours walking around Kazi ni Kazi and the neighboring shops around that business district trying to find it. And I got so so overcharged for it, but I had no choice. I NEEDED it for the project.

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Working water distillation machine in the pharmacy. Tap water is boiled in the pressure cooker and the steam from the pressure release valve enters coiled copper tubing in the first blue bucket. As the steam condenses into liquid water, it is collected in the second blue bucket.

Let’s just say that by the end of this month, after buying some spare parts and materials for our secondary project, Margo and I both went way over the allotted $200 budget we were provided with by EWH… but it was all for the purpose of doing good, so I guess in the end it was alright.

I’m happy to say that the water distillation machine was working by the time Margo and I left, but the biosand filter still had to be washed out a few more times before it could be used. Constructing that thing out of plastic buckets and plumbing parts was a lot more difficult than we expected. At one point, water was just leaking everywhere, and our first run through the filter was pretty disgusting—the “filtered” water smelled and looked putrid. But, the good news is that the biosand filter has been successfully built AND we ended up getting really good results from our water quality testing.

Unfortunately, it took FOREVER to get the data and we also ended up having to pay a ton of money for it even though the director promised us it would be free, or in the worst case, just a small amount. LIES!!! Lesson learned.

At least our filtered water was of acceptable quality and completely safe to drink! Now, all that is left to do is to wash the biosand filter through a few times with water before actually using it to drink from. And our BMETs at the hospital can do that for us!

 

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Screen Shot 2017-08-12 at 10.32.54 AM
Crappy photo of our biosand filter. Gravel layer is at the top. Purple bucket contains sand and activated charcoal. Green bucket is the collection jar for the clean, filtered water.

So now that I’ve spent an unnecessarily long time explaining what I completed for the design portion of this program, let me also take some time here to tell you about some of our favorite equipment repairs at the hospital!

The best story I have to share is probably fixing the ultrasound machine that had been sitting in a corner of the echography room for more than a year. The keyboard and trackball weren’t working, and although we proposed the cheaper alternative of just plugging in a USB mouse and keyboard, we discovered that there were buttons on the keyboard not accessible via mouse.

 

We spent a few days troubleshooting the problem, suspecting a failure in one of the three PCBs. We had no idea which one was the problem but we replaced each of the boards separately by taking a board from a working machine of the same model, which we found in maternity, and re-installing it into our broken machine. We got it working on the second try, when we replaced the middle board on the side of the machine.

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The defective IO board in the ultrasound machine.

We were so excited that we had finally figured out the problem!! When we told our head of maintenance and the head of radiography about it, they told us the replacement board would be very expensive. On top of that, getting the hospital to procure the part and then reimburse the cost would be a hellishly long process. In Rwanda, potential products and services are procured through a tender management system. This means that companies or individuals can put out bids describing how they will provide a specific service or good and offer a competitive price for it.

Often, the buyer just chooses the lowest bid, but it takes a long time to figure out who will offer the cheapest price. It also involves a lot of research on the part of the buyer, and for organizations like public hospitals, which are highly regulated and entangled in administrative policies, acquiring things is very challenging and laborious.

After hearing that, Margo and I felt like there was nothing else we could do but just abandon the machine. That was a recurring scenario—having to stop working on pieces of equipment because there was no way we could obtain a spare or replacement part. It was a terrible feeling.

BUT, about a week later, I decided to visit the machine again because I had remembered seeing the label stuck to the side of it, which had “Hi-tech Industrial Park Shenzhen Mindray Bio-medical Electronics Co. LTD” printed in bold letters. I immediately thought about my aunt’s company in Shenzhen and remembered her talking about it being located in an industrial park/ business district of sorts. I knew it’d be a long shot but I called her and asked if she could help me check if the company was close to hers and maybe if she could help me ask the company for a replacement part free of charge. She said she would try but that there would be no guarantee. I was still feeling kind of hopeless and our conversation was coming to an end. We were about to hang up when my aunt suddenly asked me who the manufacturer was again. Previously, she had only been asking me for the model and part number. Turns out, she actually supplies Mindray ultrasound machines (what are the odds?!). She put me in touch with the manufacturer who then put me in contact with a local African distributor. I was told that I could pick up the part right here in Kigali.

But before going to Kigali to pick up the part, I met with one of the hospital administrators in person (they call her “the Sister”). I even had a powerpoint presentation prepared with some Kinywarwanda in it, which I delivered (it was still mostly English, but I wanted to at least try haha).

 

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The Sister and the hospital director are the only two people who can approve reimbursements and purchases, and I was so hopeful that she would be able to reimburse me once I picked up the part. But, she basically told me that I had done some good research and that unfortunately there was no telling when there would be room in the budget to allow them to be able to procure the part. Apparently, everything has to be audited and approved by the Ministry of Health and all these other legal/administrative organizations.

Getting this meeting arranged in the first place was a pain and an exercise in patience, but I at least felt successful knowing that I had done everything I could to ask for funding from the hospital. I knew the problem and exactly how to fix it. I even had the means to pay for the repair personally. So I embraced my inner Nike and told myself to Just Do It.

A few days later, I took a bus from Muhanga to Kigali to pick up the replacement IO board from AfriChem… it was right by Muhima Hospital, where I rotated through two times during the first month of my program. The part cost me 415,000 RWF which is about $528. And I did not get reimbursed for it…so it was kind of like a gift to my hospital. But don’t worry, I’m a cheerful giver! I was very happy to pay for it and re-install it.

The ultrasound machine works now, which means that the hospital can now put it in the emergency room! Yay!!!

My second favorite fix was probably the anesthesia machine that we got working (WOO!). So the problem with this machine was that the halothane gas was not coming out of the outlet valve. We didn’t know if the problem was with a tube connection or if the vaporizer canister itself was defective. It was the latter. We replaced the vaporizer with one from another model, tweaked it a little, and luckily it works now.

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The anesthesia machine we fixed in the operating theater. The problem was the little canister looking thing with red stickers on it. All better now!

The head of anesthesiology, Renatha, was so thrilled. She invited us to observe a surgery in the operating room a few days later so that we could be in the theater if the anesthesia machine were to malfunction again. The super cool thing that resulted from this fix is that I got to watch a surgery (my first ever observation of bilateral hydrocele on a 50 year old male) and “assist,” which basically meant pouring saline and iodide into an emesis basin, adjusting the operating lights, or plugging something in to an outlet.

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We took a photo with the head of anesthesiology pictured here in the middle. Her name is Renatha!

But the even cooler thing was gaining the trust of the surgery department. After Margo and I fixed their anesthesia machine, they sent us a kettle, surgery cart, and light to fix. It was awesome!

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Taking apart the electric kettle from surgery. We could not fix it, so we bought them a new kettle.

We even got invited to a surgery staff send-off party for a lady who was retiring from the department.

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Fun photo with the surgery department here at Kabgayi Hospital.

Something else that happened at our hospital during the month of July is that the water stopped running in the maternity ward. Our hospital is not too old, but most of the water pipes are made of iron. When our plumber, Sylvere, went to examine the source of the water problem, he found a significant amount of rust on the pipes and spent the next week replacing those pieces with PVC. I only got to help a little, but I learned so much about plumbing and the importance of using Teflon tape haha.

Another fun thing I got to do during my month in Muhanga is to formally tour the inside of the coveted Kabgayi Eye Hospital, which is adjacent to the general hospital here. I have never gone beyond the front lobby area, which is where I usually go to the bathroom (they have the nicest restrooms in the eye hospital), so it was so neat to see how expansive and pleasant the rest of the hospital was. The eye hospital is privately managed, so it’s a completely separate entity despite the fact that it is right next to Kabgayi District Hospital, a public health center.

I didn’t fix anything in the eye hospital mostly because my assignment was in the general hospital, but I got to meet the one technician who works at the eye hospital. His name is John and he functions as plumber, electrician, construction worker, and BMET. He is ALWAYS running around fixing things, but he spent some time showing me all of the equipment in the eye hospital. Unlike the district hospital, the eye hospital has many pieces of equipment which was purchased and not donated (though there is still some equipment that is donated like phaco machines for cataract surgery).

John even let me shadow a doctor, Dr. Elissa, for a few minutes as he operated the slit lamp on a patient. To my surprise, Dr. Elissa handed the slit lamp to me and said I could play with it. The slit lamp was such a hard machine for me to use, but it was so cool to test it. I actually couldn’t believe they were letting me use it on a patient—I was sweating the whole time and not just a little, but like alot lot!

Aside from all the work work work work work, I did manage to have a little fun on the weekends. On one Saturday, I traveled to the northern province to a city called Musanze, which is known for its volcanoes. I completed the most difficult hike of my life there while climbing Mt. Bisoke with the rest of the EWH team. I didn’t think I’d ever make it to the top, but I somehow did, though I admit there wasn’t a second where I wasn’t thinking about quitting!

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The crater lake at the top of Mt. Bisoke.

Thank goodness there were porters who trekked up the volcano with us. They were there to hold our hands (quite literally at times) and carry our bags if we were struggling. I was so stubborn about it at first—I kept saying “mfite intege na ingufu” which means “I have strength and energy.” But I totally caved near the middle of the hike and just handed my backpack over to the porter. I didn’t know this at the time because the rangers kept repeating that the hike wasn’t a race and that we had to pace ourselves according to our own bodies, but it turns out you actually had to keep up with a minimum time benchmark, otherwise they asked you to turn around and hike back down.

I think the only thing that kept me motivated was the little voice inside my head that kept saying that I paid way too much money for this and that I needed to get my money’s worth! I guess at the end of the day the crater lake at the top was cool. Kinda.

After the Musanze trip, I really didn’t want to do any more excursions because they are just so expensive, and every time I did leave to do a weekend activity, I’d always miss Muhanga. I know it’s so corny and cheesy and honestly probably slightly nauseating to hear this (sorry), but I genuinely missed all the people at my hospital whenever I left Muhanga to go somewhere else.

Even though I stayed in Muhanga (which has like no touristy activities) on most of the weekends, I still got to do some other fun things. For instance, on four of the Sundays during the month of July, I got to experience church for the first time in Rwanda! My first time was at a church in Muhanga, but the service was all in Kinyarwanda so I didn’t really understand anything save a for a few brief translations from my friend Innocent, who is a doctor here at Kabgayi Hospital. He’s actually from Burundi but he left the country due to political unrest there.

 

The following two Sundays, Innocent took me to church in Kigali (1 hour bus ride from Muhanga), where we attended back-to-back services where the first one had every part of the sermon translated from Kinywarwanda to English and the second had someone in the church sit next to me to translate.

 

At church here, people are very into body worship, and they love to praise the Lord with song and dancing! Actually, most of the worship team is just a dancing choir spread across the stage (with the instrumentalists there of course).

Another aspect of church here that I absolutely loved, although I must say it was a bit awkward at first, is how much emphasis is placed on fellowship and greetings. That meant shaking hands and hugging the people sitting on all sides of me. And at one of the churches, I had to stand up while the entire congregation sang a welcome song for me…

I was surprised to see that many of the churches in Kigali do the same things that I do here in Baltimore with my church. Here, they have Bible study, discipleship classes, and organized mission trips. And premarital counseling sessions are a huge thing here as well.

In general, people seemed really shocked to find out that I was a Christian. They didn’t understand how an umushinwakazi (Chinese person) could believe in Jesus… most people actually thought I was either atheist or Buddhist. But it’s okay! I’m glad they were pleasantly surprised.

I tried researching the religious demographics of Rwanda, but the statistics keep varying from source to source, so I’ll just say that the majority of Rwandans are Christian with the largest denomination being Roman Catholic followed by Protestant and then Seventh day Adventist. A very small percentage of the population is Muslim.

The services I attended all had excellent sermons, but it was still unusual for me to hear that some churches broadcast staged exorcisms on television and contribute to false prophecy by executing attention grabbing practices to reel people into the church/convince them to donate money. For example, pastors will invite other ministers to come to their church and “prophesize,” which is only made possible by the fact that the host pastor usually shares some kind of insider information about a few hand-picked church members with the guest pastor, who then regurgitates this material back to the congregation during the service. Some deals are made so that money is either exchanged immediately behind closed doors or there is some agreement to share the donations received after the service.

The churches I attended were totally fine though. Phew.

In addition to church, I also got to visit some super sweet families here in Rwanda. Margo and I met one of the midwives at the hospital, Sarah, while we were trying to fix the operating table in the maternal operating theater. She invited us to eat lunch at her home and then showed us how to get to the hospital via a couple of backroads. That day, Margo and I discovered a whole new part of the hospital that we had never seen before… a barn and vegetable garden behind the internal medicine ward!

Sarah has a beautiful home and Christ-centered family, and I’ll never forget some of the words we exchanged. Her husband Faustin told me that both he and Sarah were orphans but that they had agreed to be each other’s parents and each other’s support (so cute right?!). Even though the norm in Rwanda is for women to raise the children (kids tend to be closer to their mothers compared to their fathers), Faustin seemed to be really involved in the upbringing of his two ADORABLE daughters. Unfortunately, he is currently unemployed, as are many people in Rwanda due to general job shortages. And he has multiple graduate degrees—he even went to India to study!

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Family photo with Sarah and Faustin outside of their home.

Because of the high unemployment rate, the Rwandese government is encouraging people to start their own businesses, and the country has been doing a lot to promote many entrepreneurial initiatives. Faustin is actually expanding his home, little by little, so that he can raise 500 chickens in a large barn. He’s hoping to sell their eggs and meat.

Faustin also shared with me how he’s trying to come to America. He has applied for a green card several times and recently got rejected again a few months ago. I told him  that with the Trump Administration, it will be nearly impossible for most people to enter the US. But he told me that no matter what, he was going to make it to America the “right way”, via a green card through employment and not one through refugee or asylee status.

So many of the friends I have made in Rwanda really want to come to the US to pursue a graduate degree, and although I’m trying my best to help them find opportunities, scholarships, and grants, I’m already frustrated because I can’t even begin to explain how tough it is to find information on this stuff.

I’m still trying, and I will keep trying. But I just wish there was more that I could do to have an immediate impact.

Anyhow, in addition to visiting Sarah’s family, I also got to visit Sylvere’s! I forgot to mention this earlier but Sylvere’s wife is actually a tailor, and she made so many clothes, bags, and headbands for me before I left Rwanda. They invited me to their home for dinner, and I got to meet all three of their kids right when they started their break from school.

 

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This blog post is getting obnoxiously long, so I’m going to end it on a sentimental note with some personal reflection (I know, it’s good stuff).

But first, a few things I won’t forget about my experience in Rwanda:

  • The amount of traveling and time spent finding spare parts and components to fix our hospital equipment as well as materials for our secondary project.

 

  • The amount of bargaining I did in Kinyarwanda and how many times people tried to rip me off and charge me “umuzungu price.”

 

  • The number of emails and phone calls Margo and I made to manufacturers when we couldn’t find the service manual for a machine or needed help troubleshooting broken equipment. EVERYONE ignored us.

 

  • All the equipment Margo and I learned how to fix and actually did fix. I’m looking at the paperwork I’ve completed for this trip, and it’s so exciting to be able to say that I worked on 28 different pieces of equipment and returned 18 of these back to the floor! (Take a look at the work summary form below!)
  • Seeing small drones fly back and forth from our lab everyday as Zipline delivered blood products to our hospital. The patients are always looking up at the sky as they pass, and I actually saw the packaged blood with the Zipline label on it when a doctor in maternity was heating the packed red blood cells under an infant warmer. Check out Zipline’s awesome website here: http://flyzipline.com

 

  • All the friends I made in Kigali and Muhanga and all the home visits and  random weekend outings!

 

  • Learning how to use What’sApp, ask for cash power, and load air time onto my phone.

 

Notes Fixed Abandoned
1 Incubator (infant) Medix replaced the non-power supply related circuit board with a circuit board from another broken machine of the same model 1
2 Incubator (infant) Fanem replaced fuses and added new fuseholders 1
3 Ultrasound Machine (imaging) Mindray IO PCB board not working. We replaced this card with one from a working ultrasound machine of the same model to confirm that this PCB was the problem. Purchased the freaking $527.27 IO board at AfriChem in Kigali and installed. Machine working now. 1
4 Incubator (infant) Medix blown fuse, heating element issue where voltage is not reaching the relay (problem with circuit board) 1
5 Incubator (infant) Ningbo David Medical Device Co. Ltd flickering screen that will not bypass the start up process 1
6 Lamp, surgical Apertured replaced bulbs 1
7 Incubator (infant) Ningbo David Medical Device Co. Ltd one of the doors was sealed shut and caused temperature problems (overheating). Replaced with new door from another incubator. 1
8 Patient Monitor Philips fetal transducer not working 1
9 Patient Monitor BioCare 3 in 1 transducer not working, may be a probe problem (replacement needed) 1
10 Anesthesia Machine aeonmed vaporizer not working, was causing gas to leak so we replaced the vaporizer with an extra one from another machine (different model and manufacturer). There was user error as well because ambu bag was not being used during closed circuit 1
11 Aspirator/Suction Machine Michiels SA-Belgium could not get screws removed due to rust 1
12 Aspirator/Suction Machine Michiels SA-Belgium could not get screws removed due to rust 1
13 Oxygen Concentrator Everflo 1 OPI preventative maintenance (cleaning and replacing filter) 1
14 Oxygen Concentrator Everflo 1 OPI preventative maintenance (cleaning and replacing filter) 1
15 Oxygen Concentrator Invacare Corp re-wired tubing so that it was correct (previously, the gauge wasn’t working due to incorrect tube configuration) 1
16 Oxygen Concentrator Airsep preventative maintenance (cleaning and replacing filter) 1
17 Oxygen Concentrator Everflo 1 OPI replaced with new motor 1
18 Oxygen Concentrator Airsep preventative maintenance (cleaning and replacing filter) 1
19 Lamp, examination dentist light disconnected wire 1
20 X-Ray Machine x-ray machine in dentist’s office at one point, we had fixed the probe that contains the trigger (there was a loose wire connection). Then, the x-ray machine stopped working again. I think it is because the dentist may have pulled on the probe too hard and damaged the wires inside so a replacement probe might be necessary. there is also some liquid oozing from the machine… not really sure what it is. 1
21 Furniture (chairs, tables, and beds) operating table in maternity 2 of the leg cushions are no longer mounted to the supports because the screw holes have ripped 1
22 Other kettle from surgery voltage was reaching the hot plate but not the kettle due to rusty connection. We replaced the bad kettle with a new one. 1
23 Lamp, surgical light from the ineza clinic not really sure what the problem was. We tried to replace the bulb and replace the fuses but it still didn’t work. Perhaps the problem is the relay/transformer. 1
24 X-Ray Film View Box lightbox in surgery replaced fluorescent bulbs 1
25 Other maternity plumbing replaced rusty, iron pipes with PVC 1
26 Other fridge in pharmacy no coolant? Ernest said it was missing some kind of gas 1
27 Lamp, examination another light from dentistry damaged transformer/adapter 1
28 Other water pick in dentistry kinks in wiring. Fixed by unwinding kinks and keeping cables straight 1

Our work summary form for the month!

 

I will NEVER forget this summer and all the memories I made. And I will especially remember this quote from one of the homestay dads I met in Kigali:

“In Rwanda, we don’t have many natural resources. But our best resource is our people. We can improve our minds and we can try to keep innovating. That is why we love to talk to foreigners and exchange ideas. We think we can learn something from them.”

I wish I could have told him how much I also learned from him and his family, from the technicians at my hospital, and from all the conversations I had with strangers!

I’m graduating in 2018, and I’m thinking about returning to Rwanda… but maybe this time as the OTGC (on the ground coordinator)!

Thank you again Danaher, EWH, and Vredenburg Travel Fund for sponsoring my trip! I’ll keep it with me forever ❤

For now, I’m gonna be spending these next few months finishing my coursework, studying for the GRE, and applying for post-bacc programs as I wrap up my last year of university. Can you believe it, cuz I still can’t! Where did the time go? Ahhhhhh I’m not ready for the real world lol.

For those of you who managed to reach the end of this blog post, congrats!!! And thanks so much for reading!!

 

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Keep an eye out for some more spontaneous posts.

Love you guys!

Lauren

 

 

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