Tuesday, August 24, 2010

Project Updates from Rwanda

(Goat-giving Ceremony)

This past Friday marked the kick-off of the income generation project of our maternal healthcare education program. 31 of the 50 women participating in the program received goats. The first women to receive goats were selected based on their attendance at the previous teaching sessions, and the remaining women will receive the second generation of goats. Women also received hoes and inaugurated the two fields which have been rented for two years for their use. This culminated in a ceremony with speeches by members of RVCP, the head nun of the Huye Health Clinic, the Dean of the Faculty of Medicine of the National University of Rwanda, and the Huye Sector Executive Secretary. A mother and participant in the program also gave a testimony: "My child was 5 kgs. After attending teaching sessions about proper feeding the kid is now 14 kgs," and she said she will never stop coming to sessions because they were so helpful. In the grand scheme of things this is only small progress, but for these women it could mean a healthier life for their families.

Monday, August 23, 2010

Reflections


(Some of the mothers in our target group for the Maternal Healthcare Education Program)

(GlobeMed's G.R.O.W. Team - Sara, Kim, me, Blair, Carolin)

(With the caretakers at the L.L.C.M. orphanage)

(Residential street in Kigali)

(School children in Ruchira)

(All primary school girls where these uniforms)

(Mother/Participant in our program)

(Children outside the Huye Health Clinic)

(This give you a good idea of what the villages surrounding Butare look like)

Since my return from Rwanda I’ve had adequate time to reflect on my experiences, in fact I’ve spent exactly two months trying to deny thefact that Iever left. I never believed that reverse culture shock existed, but trust me when I say I am still feeling the lingering effects (good thing I’m headed for culture shock round two in threeweekswhen I leave for my semester abroad in Jordan).
(Her name is Rachel too...naturally we had to get a picture together)

Leaving Rwanda was hard. I removed myself from my comfort zone in going, but I had formed a new one Butare, with friends that welcomed me as if I were family and a project into which I could pour 100% of my effort. I was even starting to become a regular at several restaurants around town. I felt I was really starting to make this placemynew home. I shopped at the market with the locals, I had clothing made in a traditional Rwandan fashion, and I even went to the hospital for a malaria scare. On the weekends I went to MellowTwist, a nightclub, with the locals, and I was picking up a few words of Kinyarwanda (although they were mostly names of farm animals, and thus not very helpful). The nurses at he Huye Health Clinic were starting to recognize my face and the women in our education program had memorized my name. And as pathetic as it is, whenever we traveled around the country to see various sites I became
“homesick” for Butare. I even grew to love my bed, with its paper-thin mattress that molded around the bed boards and mosquito net that trapped mosquitos inside to buzz around my head more often than it actually kept them out.
(Leonard, the head of the L.L.C.M orphanage and family...plus the blatantly obvious G.R.O.W. team)

(Maternal Healthcare Education Seminar with RVCP - this is where we formed the basic premise of each of the 12 sessions of the program)

(Crossing a bridge on our way to see the beekeeping project, one of RVCP'S income generation projects)

(True Rwandan woman)

I was so in love with everything Rwanda had offered that on a whim I extended my stay an extra week. In my last few days I became violently illand was so weak that I could barely walk. My friends took me to the hospital for fear that it was malaria and secretly I hoped that it was so that I could extend my stay even longer than I already had. But to my chagrin it was not malaria, and two days later I was back on my feet and preparing for my return home.

(A ceremony in front of the Huye Health Clinic during which the clinic was presented with new beds from the hospital in Butare)

I had not expected to make friends while I was working withGlobeMed and RVCP on the project, but I made many, and they treated me as if I were just a fellow Rwandan instead of an American and a “muzungu.” Leaving them was the hardest part of my entire trip. Many of them teard-up when we parted ways and bade me farewell with a “see you soon” because I had promised that I will be back next year. When I got on the plane everything set in and I was a mess. I didn’t expect to get upset, but of course I cried the entire flight from Kigali to Ntebe. I guess I’m hyper sensitive about these kinds of things.

When I got home I was in denial. I spent my whole first day home uploading pictures while I listened to my playlist of Rwandan songs on repeat and Skyped almost every single one of my friends. Luckily, Rwandans are great at staying in to
uch and I still talk to many of them a few times a week. It felt weird going outside with shorts or short skirts on. And the excessiveness that characterizes
much of American culture was particularly glaring. I s
pent a week purging my belongings: I gave away over half of my clothes, books, and other miscellaneous items I had acquired over many years.

After this initial reverse-culture shock I started to appreciate my experience as I was able to look back at it as a whole. I wish I could say that it totally changed my life, but it didn’t, it only changed little parts here and there, which have led meto slightly alter my view of the world. For one thing my faith in humanity has been partially renewed. In America it is easy to become discontent, but remain complacent. My time in Rwanda showed me that action is essential, and that when someone truly cares about another person it can make all the difference. Instead of focusing on cultural differences, I realized that people are much more similar than one would expect; when it comes down to it we all want the same things. I also came home with a much needed boost of confidence. I dealt with situations that I previously believed I could never handle and came away a little stronger for it. I’m still processing some things, and continuing to make up my mind about others, but I know one thing for sure: I will return to Rwanda. Hopefully I will return next year to supervise the second year of the maternal healthcare education program or have some kind of internship with research on the side. I’m currently interested in studying the use of cooperatives for localized development or the effects of the genocide on religion. Whatever and whenever it may be, I can’t wait to return to this place that taught me so much, but from which I still have so much to learn.

(Nurses from the Huye Health Clinic being trained by a specialist in basic prenatal care)

(Goodbye card from our friend Christopher - one of the nicest things I have ever received)


Wednesday, June 9, 2010

Project

Sorry I haven't been keeping updated... I'm so so busy! but this is a little sample of what we've been working on: the introduction to our program manuel and the first session of which I am the team leader...
Overview of the Maternal Health Education Program

Rwanda Village Concept Project (RVCP) and GlobeMed GWU, two student organizations from the National University of Rwanda and The George Washington University respectively, have partnered together to form a maternal healthcare education program that is to be held at the Huye Health Center in the Huye Sector. In the summer of 2009, RVCP and GlobeMed surveyed 201 women attending the Huye Health Center to determine the scope of the women’s knowledge concerning maternal health related issues. In compiling these results, the team determined the following:

78.1% received prenatal care at the Huye Health Center, 46.3% of women surveyed drank alcohol while pregnant, 58.6% ate only starches and vegetables while pregnant, 48.3% do not use contraception, 67.7% received education about proper nutrition practices while pregnant.

Thus, the team established five areas of focus for substantial improvement, as follows: nutrition & alcohol consumption, women’s empowerment, knowledge of risk factors and dangerous behaviors, prioritization of prenatal care, and contraception use. These areas were formatted into a six-session education program with an emphasis on empowering the women in the village community of Butare to view their own health and the health of their children as an important facet of their lives. The program thus begins with a discussion-based session for the women to explore the role that they play within their community and family. The women are taught to uphold the saying, “umugore ni umutima w’urugo,” meaning, “a woman is the heart of the family.” The following sessions explore more specifically the aspects of maintaining a healthy pregnancy and infancy period, with a final session focused on instilling the importance of a safe motherhood. In the final session, each woman will verbally commit to being a safe mother, for the benefit of herself and her children. A minimum of two RVCP members will be conducting each session. The sessions will be held biweekly over a period three months. RVCP will then conduct an evaluation of the program by surveying both the women in attendance and the instructors for the sessions.

Two target groups for this program have been determined. Working with the Huye Sector Office, the team contacted pregnant and nursing women in the village to meet with us at the Huye Health Center. RVCP and the nurses from the Health Center indexed the malnutrition status of the women’s children, and prioritized the initial target group based on this information. 48 women were selected from this group. A second target group consisting of health workers in the village was contacted; we have asked them come to our sessions in order to be advocates for our program. It is our goal to expand this target group over the coming years.

The ultimate goal of the partnership between RVCP and GlobeMed is to enhance the health and well being of the villages surrounding Butare. We see this program as an integral part of this aim. We hope that in our evaluation of the women’s knowledge at the end of this program, we will find significant improvement in their general knowledge and habits regarding health and safety issues.

Session I
The Place and Value of Women
Traditions, Beliefs, and Taboos


Aims
• Encourage participants to think about their place and value in society and empower them to become advocates of safe motherhood
• Encourage participants to realize how social roles and traditional practices affect a mother and child’s health during pregnancy

Objectives
• Define difference between sex and gender
• Emphasize importance of equal role of husband and wife in family planning
• Promote spirit of mutual understanding between husband and wife
• Emphasize importance of women educating their children (both boys and girls) about sex, contraception, etc.
• Make women aware of why they are the targeted group and how they can be empowered through safe motherhood
• “Umugore ni umutima w’urugo”

Recommended Teaching Methods
The purpose of this first session is to open the conversation on the importance of maternal health. It should be conducted as a discussion rather than a lecture. Because we are not direct members of the targeted women’s community, we cannot define the “place and value of women” for them, nor can we make assumptions about “beliefs, traditions, and taboos.” Thus, it would be best to incite the women to discuss their opinions and grievances about their community and empower them to work towards improvement. Overall, when discussing their place and practices in their community, women should decide what they want to keep, what they should avoid, what they should change, and what should remain.

1. It is recommended that five (5) RVCP volunteers participate in this session.
2. Women should be separated into five (5) groups – one group per RVCP volunteer. Each RVCP volunteer should focus on one (1) of the first five (5) objectives.
3. Groups are divided based on each of the first five (5) objectives. Discussion should take place in each group for about twenty (20) minutes. When a discussion has finished, RVCP volunteers should rotate so that they introduce their objective to a new group. When each RVCP volunteer has facilitated discussion with each of the five (5) groups of women, the women should reconvene into one (1) group for the conclusion of the session. The conclusion is based on the last objective: “Umugore ni umutima w’urugo.”
4. Each RVCP volunteer should encourage discussion about traditional practices before, during, and after pregnancy and inform women of which practices may be harmful to their health and which practices are safe. He/She should encourage discussion about what women wish to change in their community and how they may go about achieving this change. Most importantly he/she should relate this topic back to maternal health and empower women to make safe decisions for the well being of themselves, their children, and their community as a whole.


The Place and Value of Women

Define the difference between sex and gender: begin by asking the women to define the difference themselves. Then give a more formal definition.
• What jobs do men traditionally hold? What jobs do women traditionally hold? Do you think you could perform the same jobs as men?
• What is the biggest difference between men and women in your community?
• Formal definition of sex vs. gender: Sex is a biological category determined at conception. Gender is a culturally constructed category that is not fixed and varies from culture to culture. Gender is a category that can be redefined through empowerment.



Importance of equal role of husband and wife in family planning: start by asking women what role they currently play in family planning. Then explain that it is important to a woman’s maternal health to play an active role in family planning.
• How involved have you been in decisions about family planning?
• How many children would you like to have in your lifetime? Have you discussed this with your husband?
• Are you more likely to let male or female children attend school? Why? Emphasize the importance of education for girls in order to become productive members of society and escape poverty
• Have you thought about how your economic situation should influence your decisions in family planning?


Promote spirit of mutual understanding between husband and wife: ask women about their role within their households. Then help them decide how they might achieve equality in the home.
• Do you communicate about how to manage your family?
• Do you make economic and health related decisions together with your husband?
• How many times per week do you discuss your concerns regarding issues of family management, economic situation, and health with your husband?
• Does your husband accept your ideas and opinions?
• How might you make your husband receptive to your ideas and opinions?


Importance of women educating their children about sex, contraception, etc.: start out by asking women if they received sex education from their parents. Then explain why educating their children will improve their children’s health and well-being. Encourage women to think about how their situation might be different had they been educated before engaging in sex.
• Did your mother educate you about sex? Do you perceive this education as important? Was it helpful in planning for your future?
• If your mother did educate you about sex what were the benefits and what were the drawbacks?
• Will you educate your own children about sex?
• Emphasize importance of educating both boys and girls about sex and the benefits this will have regarding the health of their children.


Why these women were included in the target group and how they can be empowered: start by asking women about their practices in the home and how they share tasks with their husbands. Encourage women to seek equality as mothers in their community.
• Do you share tasks with your husband and children in your home?
• How many hours/days per week does your husband help with housework? Would you like it if he helped you more often?
• How would you like your husband to help you?
• How can you encourage your husband to share household tasks with you?


Conclusion: “Umugore ni umutima w’urugo .”: ask women to make a general conclusion based on what they have discussed.
• What could you change and what could you continue doing in order to live in accordance with this saying?
• Give a general conclusion of how women’s empowerment can help achieve a safe and healthy motherhood.

Friday, May 21, 2010

So much to say, so little time!

I haven’t posted an entry in the past few days because I have either been too busy, too tired, or the internet has not been working. I regret having put this off because so much has happened and it’s hard for me to keep track of it all. Things are starting to prove less overwhelming and I’m starting to feel comfortable and very much at home. As our first week here draws to a close I am already getting sad that I will have to leave in three weeks. In fact, all of us have been joking around about returning next summer…If this were really possible I would jump at the chance.
Since my last post we have visited many more places in Butare. On Tuesday morning we took motorcycle taxis to the health clinic and the orphanage which is about a mile outside of town. We got a tour of the health center and the maternity ward and the make-shift lab. They explained to us that they can get malaria and HIV results within about 5 minutes by testing the ph of thin-smear slides...pretty amazing, huh? The clinic is where sessions for our program will be held and the nurses that work there will be trained to teach these sessions. The orphanage is interesting because the children are only there on Saturday (they are at school all other days), but the mothers, both adoptive and biological, were there yesterday doing work harvesting soy beans in return for food for themselves and the children. We talked to a few of the women with the help of Christophe, another RVCP member, about the work they were doing and about the children. We also met baby Naomi who was carried on her mother's back..she was one of the cutest babies I have ever seen. Yesterday was also the day that the women were given pigs and goats in return for their work. They are expected to raise and breed the animals as an income generation project. The women were so incredibly beautiful and strong and I can’t wait to start working with them for our maternal healthcare education project. They are so determined to provide for their families and it feels good to give back, even in this small way. Tomorrow morning we will return to meet all of the children and kick-start the program.
On Wednesday we didn’t have anything planned so we decided to walk around and explore. We ended up taking a trip to the market, which is filled with every kind of fruit you could ever imagine, a few dry-food goods, second-hand clothes, and the most vibrant fabrics of all patterns. I bought a papaya, a pineapple, and bananas for around $1. I finally get to fulfill my banana obsession with real Rwandan bananas, and best of all I got to exercise my French! We have been to the market everyday since Wednesday because the fruit is too good to resist. This weekend we plan on going to buy fabrics with which to have skirts made.
Yesterday we walked 30 minutes outside the town center to the National Museum. They take a lot of pride in their museums here, which made me feel a little guilty as a student that lives in the heart of D.C. and has only visited the Smithsonians once or twice. Much museum space was spent on displaying artifacts and stories from pre-colonial Rwanda at the time when Kingdoms were the ruling powers and cattle-rearing and subsistence agriculture formed the basis for the economy. Rwanda was the only African country that was not partitioned in the late 19th century, and this might have given it the chance to avoid conflict that has plagued other regions if Belgian colonial rule hadn’t stringently imposed ethnic divisions that mirrored much of Belgian society itself. Interestingly enough, the museum contained nothing at all about the genocide. I’m not sure why this is because the country is covered with genocide memorials and mass graves which people visit often; the students I have spoken to emphasize the fact that it is better to remember the horrors of ’94 than to let it be repeated. The youth here seems much more proactive…maybe I am just seeing a bigger concentration because of the small size of the country, but I don’t notice this as much at home. It seems that in the U.S. complacency is breed by comfort, and I wish more people recognized their potential.
Today we haven’t done much…I’ve just been sitting around reading. Right now I’m reading two books: We Wish to Inform You That Tomorrow We Will Be Killed With Our Families about the genocide and Half the Sky about women’s empowerment as a way to increase economic productivity in developing countries. I think they’re complimenting my time here well. Tonight we will have our first official meeting with the RVCP. Because most members are medical students they have been very busy with exams this week so we have taken the time to settle in and get adjusted, but today we will get down to business and come up with a time-table for the rest of our stay and begin collaboration on our project. I’m excited to be getting to work and to hear the input from the RVCP on something I have put so much time into this past semester. We have nothing to lose in our attempt to implement this program, and as of now our potential is limitless. Everyday here is an adventure, and I can’t wait to see what this next week of work will bring.

Monday, May 17, 2010

Day 1

Where to even begin? So much has happened since we landed in Kigali yesterday afternoon. After an hour of confusion in the airport, we finally met up with two members of the RVCP (Rwandan Village Concept Project) named Aurea and Otto that had come to pick us up. They took us to Bourbon Coffee to wait for the RVCP coordinator to meet up with us, which is somewhat ironic considering a Bourbon Coffee just opened recently a few blocks away from GW. After eating we walked to the bus station which was completely chaotic and unorganized. Thank god we had the RVCP's help buying tickets, otherwise I don't think we would have ever made it, and we finally caught a bus to Butare.
The bus was packed with people and traveling at scary speeds... luckily it was dark so I couldn't see what was going on because I think in daylight I would have been completely terrified. On the bus we sat next to a man a few years older than us named Jude who told us that he is coming to George Mason University in August to get his PhD in Economics. He then told us that he worked for the Ministry of Finance and is the head of Microfinance for the country. Really, I don't think it gets much cooler than that. He has never been to the States before but is very excited to come to D.C., so we told him we'd show him around the city. We talked for a long time about the economic development of Rwanda, and he had many questions about the new healthcare bill passed in the U.S. I never expected to have such an interesting conversation on my first night in Rwanda, but I think it goes to show that students and young people all around the world are interested in the same issues, and in this I find much comfort. We exchanged email addresses with Jude and when we finally arrived in Butare after a very bumpy journey he made sure that we were safely in the hands of RVCP members that had come to welcome us. At night the the town is almost pitch black (there are no city lights to cloud the night sky) and we stumbled with our luggage down a dirt road to our new home. There is also another girl staying at the house, Saskia, who is medical student from Germany that is doing a clerkship for 6 weeks. They call us all IP's or International Partners. The house we are staying at has 3 bedrooms with bunk-beds (clad with mosquito nets of course) a makeshift living room, a kitchen and a bathroom. The kitchen is very basic; there is no stove or refrigerator, only a sink. The bathroom is also fairly basic with a toilet and a bathtub and shower head, but its definitely nice to have running water considering that many restaurants and stores around town lack this. There is also a landlord of sorts named Nimwata, he speaks no English (only Kinyarwanda) but has one of the most gentle smiles I have ever encountered. He comes in and out of the house as he pleases and loves to have his radio on full volume while he works, but I don't mind this...I quite enjoy Rwandan music.
This morning we went to breakfast with Saskia to a little shop that sold muffins and African tea, which is a lot like the chai tea that we know in the U.S. After breakfast she gave us a short tour of the city. We wove our way through the market where many people called after us "muzungu" which means white person. Alfonse, the head of initiatives for RVCP, explained to us that this is not a derogatory term, but just a sign of interest. Nevertheless, I wish that I could be a little more inconspicuous. We then came home and I took a nap, I've been so exhausted...I think its a combination of traveling and culture shock. When we were all rested Alfonse took us to the National University of Rwanda, which is where all of the members of the RVCP go to medical school. The campus was lush and vibrant with students bustling around on their lunch break. The students are currently in their hardest week of exams and Alfonse tells us that they are all very stressed, but I could not tell beneath their warm welcomes and constant hospitality. Accompanied by Chrisopher and Ephrem (more RVCP members), we ended the day with dinner at a nearby hotel. For only 4USD we were served a full plate of plantains, rice, beans, frites, and a "Rwandan sized" Primus, which is a locally brewed beer. At dinner we were joined with more RVCP members, Getete and Hovaire who had just finished studying for the night. We chatted for a few hours over dinner and they made plans on to throw us a welcome party on Friday. I have never met so many generous and beautiful people in my life. They show as much interest in learning from us as we want to learn from them. It's hard to describe the connection I already feel with these people. Within 2 days I already feel that I can call them my friends.
Tomorrow we have planned a trip to the orphanage where we will be with the children for the afternoon and be introduced to the women with whom we will be working with for the next month. I can't wait to get our maternal healthcare education program up and running. With such driven and gifted students on both ends I have no doubt that we will be able to accomplish a lot in the next few weeks.

Saturday, May 15, 2010

En Route to Rwanda: Addis Ababa, Ethiopia

The adventure has officially begun! After a 5 hour delay out of Dulles, an 8 hour flight to Dakar, Senegal for refueling (and they wouldn't let us off the plane), and another 7 hour leg to Addis Ababa, we are finally able to have a little rest before the last stretch of our journey to Kigali and eventually Butare tomorrow. Excitement is overpowering my exhaustion at the moment, which is surprising considering the one hour of sleep I got before boarding the plane in D.C. It's been quite a long 24 hour with many unexpected curve balls thrown at us, and despite everything that we've been through we are already managing to have a good time and make friends. I just came upstairs after a free dinner provided to us by the airline after delaying our flight to Kigali for a day. I'm a little disappointed that dinner wasn't traditional ethiopian (injera bread is maybe one of my favorite things in the world), but it was nice to have a real meal after a day of only airplane food. After dinner we hung out in the bar and drank Castel, a traditional ethiopian beer, and made friends with some of the other hotel guests. One man, also stuck overnight on his way to visit his family in Sudan made a point to make sure that we were feeling welcome in Africa. Another, Frank, who we had met earlier at the airport and was on his way to visit his family in a town 6 hours from Kigali sat and chatted with us for a while. He gave us suggestions for things we could do in Kigali before our bus-ride to Butare and answered all the random questions we threw at him. I like that many people have been approaching us in attempt to make us as comfortable as possible...it's a big change from city life in D.C. where people don't dare to even look at each other in passing. We have to wake up at 6:30am tomorrow to catch our bus to the airport so I won't write a long entry tonight. I'm glad to finally be on our way to a month of excitement and experiences unlike anything I have ever encountered. A demain!