Monday, May 12, 2008

Health Care in Banda Before...

The only health care available in Banda is “The Strategy,” a 2-room outpatient health clinic. It is staffed by one nurse on rotation for two months at a time from the local health center. The office is only open weekdays, often for morning half-days only. There is no emergency health care available after hours.

Services offered are minimal. Vaccinations are brought monthly from the health center, and there are antibiotics for treatment of minor infections. There are no maternity services offered. The medication supply (pictured above) is minimal and unreliable.

The Strategy has a poor reputation amongst the community, and with good reason. It is understaffed, undersupplied, and has insufficient hours.

The nearest “referral center” is a 2 hour walk from Banda to the district health center. Pregnant women often make this hilly walk while in labor, only to find that there are no services available to manage a complicated pregnancy. The only choice for at risk or complicated deliveries is to continue the walk 4 more hours (6 hours total) to the district hospital.

During my month in Banda, 2 young children (that I knew of) died in the village, both complications of childbirth that would be easily treatable at a hospital. I would estimate that an average of 20-40 lives per year would be saved by the presence of an ambulance in Banda.

...And After!

Kageno has built a beautiful new clinic and pharmacy for the Banda community. The facility houses 3 examination rooms, a laboratory and sterilization room, pharmacy and insurance office, as well as medical offices.

Throughout the month, we met with local officials, referral centers and partners to help in the creation of an operating model for the clinic. We gained approval from the government to be run as a Poste De Sante, which will allow us to accept the government Mutuelle De Sante Health Insurance. For the equivalent of 2 dollars per year, a person is covered for their clinic and hospital visits, as well as medications. They need only to pay 10% of medication costs and a minimal fee for inpatient stays. The hope is that this system will allow access to the clinic for all members of the Banda village. In addition, the community has a program enlisting those in extreme poverty on Mutuelle through a social welfare program, extending this service to those most in need.

The government will be providing nurses and laboratory staff for the hospital providing the baseline government services. In addition to this, Kageno has hired 3 motivated Community Health Workers to supplement the government services. These health workers will receive training through Partners in Health, and will provide community health education, home visits, and assist in the day to day running of the clinic.

In addition to the clinic, the clean water project and school feeding program seek to drastically improve the level of health and quality of life in Banda. Thanks to your support, large strides have been made towards this goal.

...Back to Normal? Life Can Never Be "Normal"

After living with our 'Rwandan family' for a week; eating meals, going to church, taking walks around the neighborhood, I got lulled into feeling that life in Rwanda was "back to normal" after the genoside. But a few words was all it took to instantly be shocked out of this illusion.

After a night celebrating the birthday of a fellow volunteer over pizza with our Rwandan family, we were feeling right at home, life as normal. As we drove back to the house, our Rwandan mother and father were talking. We asked what they were talking about. Very nonchalantly our mother mentioned "Oh we were just noting that this was the place we were stopped by a road block while fleeing to Congo from the genocide. They were checking ID's for ethnicity and taking the Tutsis to be killed. They checked the first five IDs, those of my husband and children, which were all Hutu. Just before flipping to the next one, mine, which is Tutsi, the man said 'That's enough' and let us pass. God was with us that day."

Life as normal driving home from pizza quickly changed to life that can never be normal. I can't imagine trying to live a normal life when every time I look around my neighborhood I recall flashes of immensely painful memories.

Another normal night, another family dinner, this time at home... normal conversation, casual questions, "When will you come back to visit us?", casual replies, "We'd love come back as soon as we can." Normal dinner, normal conversation.
"Well we think within 2 years the rebels will come back across the border, so you better come back soon..."

Normal life shattered once again. The constant fear of renewed war... The persistent worries of rebels grouping outside neighboring borders storming back... The painful memories of her brothers and sisters murdered... her flight to Congo... her country torn apart.

The amazing people we have met here live as close as they can to a normal life. But in reality, life cannot be completely normal after living through the murder of a million of your fellow countrymen.

A New Life Celebrated; A New Life Cut Short

Erinne was born to two loving parents, Elize and Anastasia, who invited us to partake in the traditional ceremony welcoming their baby into the family and community. It was a joyous celebration, packed with friends, relatives, and neighbors. Cases of Coke and Fanta, plates filled with rice beans and potatos, and most importantly, jugs of urwagwa (locally produced banana beer) were passed amongst the crowd.

After the jugs made several rounds, the speeches began. One half of the room, the mother's side, addressed the other, the father's side, with thanks and gratitude; and gifts of urwagwa. The father's side answered with welcoming words. Each speech was greeted with rounds of clapping. Each speech ended with more gulps of urwagwa. Each speech got longer, louder, and more emotional.

Finally, long after dark, the celebration ended with a rousing song bringing everyone to their feet, clapping, dancing, stomping their feet to celebrate and welcome this new life to the family.
Coming down from this rowdy celebration as we walked back through the pitch dark, we were abruptly detoured by a man approaching saying "Baby sick". We were taken to a small house near the road where a crowd was gathered inside. My heart, previously racing from the dancing and singing was now racing from the concern for this newborn struggling to breathe in this remote valley. When we arrived at the house, we were told that we were too late. The infant had already died.

We entered the house. It was strikingly similar to the ceremony we had just left: a room packed with the family's closest friends, relatives, and neighbors passing a jug of urwagwa around the crowd. The only difference was the painful somber looks on all of the faces glowing in the lantern light.

One new life, one unfortunate death. Both the joy and the pain shared amongst the community in a uniquely African manner. While Erinne will hopefully live a healthy and happy life, the poor nameless child unlucky enough to be born in a place with no access to basic health care will never have that chance.

Genocide: Remembering and Reconciling 14 Years Later

After attending a beautiful church service, we were invited to attend the district's annual genocide memorial service. Each year the government designates a week dedicated to remembrance of the over 1 million killed in the 1994 genocide. Though the country has a week off of work, most people spend this time in quiet reflection around their homes. At the end of the week, all of the local towns gather for a public memorial service.

We walked nearly an hour to the nearest town, which was even more remote than Banda. Inside their local church gathered an overflow crowd of the surrounding villages. At the front of the ceremony was an impressive collection of local clergy from all of the local religions as well as local leaders. Heading the ceremony was a university educated man from Kigali, as part of the government program to lead the discussion.

The ceremony was much more than a remembrance; it was an interactive seminar, a thought-provoking discussion on how to make the post-genocide slogan of "Never Again" a reality. The moderator gave a history of genocide to educate the children who were too young to have lived through it. Then the community contributed to the discussion of the causes of genocidal ideology, and what can be done to move beyond genocide.

The theme throughout the discussion was to "remember and forgive" because "we are all Rwandans". The ceremony came to a powerful close as a young man orphaned by the genocide sung a stirring tribute to his family members who had been killed. This was followed by a woman who gathered a crowd of 7 people in front of her. "Can you tell who here is Tutsi and who is Hutu?" she asked the crown in Kinyarwandan. No one could. Then she asked those who had lost family members killed in the genocide to raise their hands. Four of the seven raised their hands. Next she asked those who had been released from prison after serving time for murder during the genocide. The other three raised their hands. They then stuck out their hands to each other and embraced.

Forgive and remember. I cannot imagine shaking the hand of someone who may have killed my family. But this powerful and effective ceremony demonstrated to me just how much must be done to move beyond genoside and revenge, and the proactive way the government and local communities have been addressing it.

Kageno, Banda: 2 years later

Two years ago, John and I had the pleasure of visiting Banda village and helping with the initial community assessment. What we found was a very special village tucked into a beautiful valley bordering the Nyungwe Forest. The people were enthusiastic and embracing of the idea of an organization to assist them in development. We visited the future site of the Kageno project, trying to envision what this area would look like in 2 years.

Two years later, I drove down the valley to Banda to find some amazing advances made by the cooperation of Kageno and the community. The continued enthusiasm of the Banda people was evident as they gave me a tour of the new Kageno clean water project. A groundwater source of water is now piped to various cisterns throughout the community, eliminating the spread of parasites and waterborne disease.

The community boasted of the new roads built through community service during public works days. Troups of men and women could be found on any given day digging out roads to assist in the construction of future community projects. The plot of land we visited 2 years ago now housed a new clinic, pharmacy, and office building, with the foundation for a nursery school being created. Plans for a community center and ecotourism lodge to bring in tourists to the area for income generation were also touted by the local people.

In just 2 years, Kageno and Banda have made great strides. It was exciting for me to return and see the progress made since my last visit. I look forward to returning in 3 more years to see the Banda community thriving.