Final Reflections: Rwanda, Progress, and the Power of Youth

I’ve arrived safely back in Chicago to find Northwestern students gone for the holidays, GlobeMed staff disbursed all around the world with family and friends, and perpetually grey skies. The work day is a bit lonely, but luckily I have six weeks of sunshine and new friends to reflect on. There are so many things I learned in the past month and a half, and in a way I think Rwanda exemplifies many of them. 

As challenging as it was to coordinate 6 weeks of travel, I’m glad that I planned it the way I did, with Rwanda at the end. If it weren’t for my work there through GlobeMed at George Washington University, I probably would not be in this position today. It’s a country whose history and culture I’ve studied endlessly–through books, conversations, and friendship. It’s a history and culture that’s complex even in its simplicity, but there are a few factors that are particularly interesting that I want to share. All of them are evident in Rwandan life, but can also be tied to other countries and communities.

1. Rwandan solutions for Rwandan progress: Since 2000, nearly every single health indicator has improved in Rwanda. The government has allocated more of their annual budget to health than any other government in Africa and Asia. What’s interesting is that in many countries, the presence of international NGOs seems to be a sign of development for local governments. “Oh, Oxfam is here, so something must be changing.” But if you ask community members, they know better. To them, change comes through consistency, and international NGOs often do not represent consistency. In Rwanda, the average citizen’s voice seems to be represented at the highest levels of government. This year the federal government started phasing out international NGOs in the country. If an NGO is Rwandan-run, impacting the community in a sustainable way, and helping to achieve the country’s Vision 2020, they will continue working for the people; otherwise, they must move their operations elsewhere. This is a bold but impressive and important move. I hope that more African governments begin to recognize that change starts at home, and in the process I hope they will stop relying on big NGOs that tend to ignore the people and start supporting their own citizens’ efforts.
   
2. Who has control?: While the Rwandan government seems to have the best intentions for the country, it’s still fascinating and a bit disorienting how much control the government seems to have in all of the countries I visited. It’s a hard thing to describe, but over and over I heard that the causes of preventable deaths were poverty, and the causes of poverty were government inaction. And a country like Rwanda, where inaction is no longer in their vocabulary, leads one to believe that that’s possible. But then you have the Ugandan government. Uganda was the only country where I met people who need ARV treatment and cannot access it. There are people in the country who would pay for the locally manufactured drugs, but they can’t because hospitals don’t have them in stock, NGOs get a very limited supply, and they must wait for the free treatment to become available. So, there are children dying because the government doesn’t properly stock their pharmacies or employ people to oversee them. Back to my question: who really has control? It seems like the governments have control, but over and over during the last 6 weeks, I asked myself: where is the private sector? Yes, there are small businesses for vegetables and potatoes, necklaces and bracelets, chairs and bedframes. But where are the people starting the next Whole Foods or Costco? Where are the people starting the next Waste Disposal Services or General Electric? Why don’t people start a business to build water tanks across their whole district instead of waiting for charity:water to build them? When will the private sector demand action from the public sector, like it does in America? I believe that this requires a shift in mindset – from dependence to determination. International support should no longer come in the form of handouts and short-term fixes to long-term problems. It should come in the form of direct assistance to individuals on the ground, supporting them in sustainable, self-driven programs while providing technical training around business and leadership skills, connectivity and global citizenship, and empowerment. Only when this happens, I believe, will we see true sustainable change.
3. Investing in young people is essential: To make this point, I’ll share a story that’s very personal to me. In 2006, a group of Rwandan medical students saw a woman giving birth in the dirt. She was lying outside of what used to be a clinic, before the 1994 genocide. Feeling disturbed, they went back to school and started seeking out financial support for the organization they were a part of, the Rwanda Village Concept Project (RVCP). Shortly after, one student heard GlobeMed’s co-founder, Victor Roy, speak at the Global Health Council conference. A couple months later, Victor partnered RVCP with GlobeMed at GWU in order to rebuild the Huye Health Center. At first it started off small; Rwandan students working with American students, getting to know one another and talking about all the possibilities that such a partnership could bring to the world. The American students raised funds for electricity and running water, while the Rwandan students advocated for government support of 6 nurses. They both succeeded. The clinic was functional, so they conducted a needs assessment and found that child malnutrition, as a result of poor maternal health and nutrition education, was the greatest barrier to health. So they started an education curriculum in which groups of 50 women per year would get education, a goat, and a plot of land to cultivate healthy food that they could both eat and sell. The women were identified by the nurses as the mothers of the most malnourished children in southern Rwanda. Given the success of this initiative and the continued development of the clinic through fundraising for a waiting room and more exam rooms, the Rwandan students felt the need to go back to the district health office and make sure they were aware of the success. The local government was very pleased, and they lobbied the federal government to build a maternity ward at the clinic. Today, the maternity ward–which will be a staple for the entire region–is nearly complete. Because of the power of students, working hand in hand across borders and backgrounds, no woman will ever be seen giving birth on the dirt in Huye, Rwanda again. 

 

I feel so lucky that I was a part of the GlobeMed at GWU chapter and got the chance to work with RVCP and the incredible nurses and community at the Huye Health Clinic. I had a couple extra hours during my day in Huye, so I sat with Peter, the former Head of Initiatives who supported this program when I was Co-President, and we simply stared at the maternity ward for a while. We stared at the lush greenery peeking out from behind the orange brick walls, and the mothers in vibrant Rwandan cloth walking in and out of the clinic with their children. I couldn’t have asked for a more peaceful or gratifying way to spend one of my final days in Africa.

My trip has come to a close, but the work has just begun. I believe more than ever that our partnerships are making a difference–not only in the immediate impact they are making on poor families, but in the long-term impact they are making on the student and community leaders who have the power to impact the system in which global health is influenced. Our world is 7 billion+ strong, and more than ever these partnerships must thrive. Please consider supporting the continuation of these partnerships by contributing to GlobeMed. Your investment will go far. bit.ly/giveglobemed

 

Thank you to our incredible partner organizations for hosting me, to the GlobeMed National Office staff for holding down the fort and supporting my teams while I was gone, to Public Health Institute and USAID for making this work possible, and to all of you for following my journey! If you don’t already, be sure to follow the GlobeMed blog, Facebook, and Twitter for more updates.

With never-ending love and gratitude,

Alyssa

Community-Driven Solutions in Kabale

Here I am in the moment that I thought would come far too soon, and at times I thought would never come; I’m sitting in the airport of Kigali, Rwanda, preparing to fly to Brussels and then Chicago. What a whirlwind the past 6 weeks have been.

I have so much to share about this lovely country, its people, and its progress, but before I go there I can’t overlook one of my favorite places I’ve been on this trip: Kabale, Uganda. It seems like so long ago that I was there, but Kabale was one of the places that I knew least about before arriving; although Kigezi Healthcare Foundation (KIHEFO) is one of our network’s oldest partners, it has unfortunately been overlooked for far too long. Almost immediately upon arrival, I knew that we had been making a mistake in ignoring this organization’s success.

KIHEFO was founded, as one of their Board Members told me, because of other people’s mistakes. “The first mistake we are overcoming is development aid”, Caleb Rwakatungu stated frankly. The honesty of this organization and its people took me right back to holiday dinners with my big Italian family, and I immediately connected with them. We started sharing stories, which are always the most useful and telling form of data. I shared stories of students who sent medical supplies across borders and oceans, an empty clinic with bags of medical supplies from Chicago, and a group of students who discovered a new model to support organizations such as KIHEFO by listening. Caleb and Dr. Geoffrey Anguyo, KIHEFO’s founder and director, shared stories of organizations such as CARE International bringing 22 Land Rovers and 35 Mzungus (white people) to their community to ultimately leave the area exactly the same–if not poorer–four years later.

KIHEFO adamantly focuses on working with existing community structures, and it’s working. The organization will not accept grants from certain institutions because they want the communities themselves to be able to identify their own problems and create their own solutions. To overcome their lack of foreign assistance (at least at the institutional level), they have built an impressive sustainability plan by focusing on partnership. Dr. Anguyo runs two general health clinics in the Kabale District, the services of which allow for free service at the HIV clinic that KIHEFO runs. Additionally, KIHEFO has developed a partnership with a local tourism agency to provide housing to volunteers, as well as cultural immersion. A smart move, given that Kabale is by far one of the most beautiful places I visited – Lake Bunyonyi and its resorts, the Virunga mountains and volcanoes in the distance with their gorillas, and the extremely open, welcoming nature of the local people make it a perfect spot for a holiday. Through the funds generated by tourism, they are able to keep their essential Nutrition Program (which was started by GlobeMed at Bucknell nearly 4 years ago) up and running, as well as provide start-up grants to community groups in order to help them build upon small businesses they’ve already started. Overall, KIHEFO was an impressive organization that I grew to deeply love in my time with them.

I owe so much gratitude to Dr. Geoffrey, Carol, and the other staff at KIHEFO, as well as Dr. Geoffrey’s family and Patricia, who cooked my meals and offered me great company. They all taught me a lot about the importance of taking progress and happiness into your own hands. They’re living proof that providing direct support to community-based organizations is more important now than ever before.

America, here I come!

Alyssa

The Complexities of Disease in Kabwohe, Uganda

I have been silent for a few days due to a lack of internet in Southwestern Uganda; in some ways, it has been an extremely peaceful and necessary break from connectivity, and in other ways, it has been frustrating because I have had so many incredible experiences that I have wanted to share. I’ve finally arrived back in the country where I first got hooked on this work and this organization: Rwanda. But before I get started on that, I have two organizations to update you on. Each deserves its own post because of the complexity and importance of its work.

Last Tuesday I arrived in Kabwohe, Uganda to find a clinical lab that compared to the labs I saw as a student interning at the National Institutes for Health, a research center with 35 Ugandans hard at work trying to identify ways to prevent the spread of HIV, and a general clinic treating people with high quality care. I had arrived at the Kabwohe Clinical Research Center (KCRC).

KCRC is living proof that US programs such as the President’s Emergency Plan For AIDS Relief (PEPFAR) are changing the way that HIV is understood, prevented, and treated in partner countries like Uganda. Founded in 2005, KCRC is providing some of the most robust research in the region that is informing policies and advancing progress. One of their founders is now a member of Parliament and, therefore, they also have a crucial voice in the Ugandan government (an asset that many organizations strive for with little success). 

And yet, despite their connections and resources, the patients that I met–in their own communities and at their own homes–were facing some of the basic struggles that many families around the world face: Will I be able to pay for my children’s school next month? Will I be able to properly feed all my children AND pay for travel to the clinic to access my ARV treatment? These questions–and so many others that I have heard throughout my time in Africa–have proven to me that resources are not enough. KCRC recognized this shortly after they started providing treatment, which is why their partnership with GlobeMed at University of Missouri-Kansas City came at such a critical time.

GlobeMed at UMKC has partnered with KCRC to provide food security to families infected/affected by HIV through the provision of seeds and goats. I met a few of the families who have been a part of this program, and they are so grateful to have gardens that they own and love in their back yards. No longer do they have to worry about giving their children basic necessities like food. Their joy was inspiring. However, they also showed me that we have a long way to go in battling HIV and poverty. Yes, they have food now, but what is a healthy child if they are uneducated because there’s not enough food to sell for income? 

It gave me pride to meet the staff of KCRC and know that we are in partnership with them, and I think that their research will go a long way in helping to unravel the complexities of HIV. I can’t wait to see what they’re able to do for the families I met through their partnership with the insanely committed and brilliant students of GlobeMed at UMKC.

More to come soon!,

Alyssa

Lyantonde with ICOD Action Network

The past few days I have gotten the opportunity to spend time with ICOD Action Network, one of GlobeMed’s newest partner organizations. ICOD (Integrated Community efforts for Development) was founded by Michael Ahabwe in 2008. At the time Michael had just graduated with a degree in social work and had volunteered some of his time with the largest NGO in the Lyantonde District of Uganda, so he had some insight into the strengths and weaknesses of the NGO sector. It is clear that he utilized every bit of knowledge and experience he had acquired in his early years–from academia as well as the local knowledge he had from growing up in Lyantonde–in order to develop an innovative approach.

Today ICOD’s work is empowering a variety of people through unique projects across the district. There are two overarching values that I saw cut across all of their programs:

1. Bringing new, accurate knowledge to populations that otherwise could not access this knowledge
2. Empowering communities to identify their own needs and developing ways to ensure they own the resulting projects

ICOD runs an internet center–the only one in Lyantonde–in order to train farmers in new methods of sustainable agriculture. They also provide the internet free of charge to others involved in their programs, such as their HIV/AIDS beneficiaries that work in community-driven self-help groups. The center also acts as a sustainable business model by charging a small fee to other community members who may be interested in using a computer. 

Today I got to visit three families who have benefited from ICOD’s house construction project, which GlobeMed at Arizona State University will soon be expanding. This project is so critical to those benefiting from it, as many of them were previously living in one room huts with grass roofs that were about to collapse — many of them with up to six children. The families with the greatest housing need were identified by their community members and then shared with ICOD. While the three families who have received new homes had the greatest need, there are clearly so many more families who could also value from this program, and I’m honored to see GlobeMed at ASU providing this “blessing”, as one of the widowed mothers called her new home, to more hard working families. 

It’s been an interesting few days learning about ICOD Action Network’s work, as well as the town of Lyantonde. It’s a small town, but it has an extremely high prevalence of HIV, largely due to the high rates of prostitution (read more here). Truck drivers passing through East Africa typically stop in Lyantonde, line their trucks along the streets in the evenings, and spend time at one of the many bars/guesthouses. There, HIV spreads like wildfire. I feel strongly that ICOD Action Network will be at the forefront of addressing this issue in the years to come, and I hope that GlobeMed at ASU is standing right beside them for the journey. Thanks to everyone who shared your honest perspective with me in Lyantonde. Now on to Bushenyi to visit the Kabwohe Clinical Research Center!

With excitement for my last ten days in Africa,

Alyssa

**This post is coming 2 days late**

Innovation on the Path to Zero New AIDS Infections

The past two days have been spent with one of the most prominent organizations in East Africa. Kitovu Mobile AIDS Organization was one of the first organizations in Uganda to begin addressing the HIV/AIDS epidemic, along with The AIDS Support Organization. 

In 1987 an Irish nun was volunteering at Kitovu Hospital, about three hours outside of Kampala, Uganda. She started recognizing symptoms in patients that she had never seen before, so she decided to go to their homes and see what she could find. When she arrived in the village in the Rakai District, she found people dying in rapid numbers from an unusual, new disease. Their friends and family believed their community had been plagued by witchcraft. Somebody had clearly cursed them, and when a stranger with white skin appeared they believed she was a part of the curse. When she went back to the Hospital she was disturbed and decided to partner up with a Ugandan nurse and go back to the village. With a companion who knew the local language and could identify with the people, she started training people in hygienic practices that would allow their community members to at least die with dignity. Shortly after they started this endeavor, which villages quickly adapted to, they decided to start an organization that would continue this care. They called it Kitovu Mobile AIDS Organization.

Although its beginnings were humble, today Kitovu has over 85 full-time staff members and over 700 Community Health Workers, working in 8 Districts total. Its work is holistic, focusing on treatment and prevention of HIV/AIDS, as well as many innovative public health programs. For example, through their partnership with GlobeMed at Northeastern, Kitovu Mobile has started 81 Self-Help Groups (SHGs) made up of some of the poorest women in the region. These groups do a variety of activities, including the opening of a savings account and community education on sanitation & hygiene. However, what I found most interesting was the community-driven nature of the groups. Kitovu now sees themselves primarily as community facilitators and managers, allowing the community members themselves to act as the implementors. 

Through this unique structure, which was adapted from India, the 81 Self-Help Groups each appoint two people to represent them at the sub-county level in a Cluster. Each Cluster has 15-20 women represented, two of which are appointed to represent their sub-county at the Federation level. The SHGs primarily focus on individual needs, the Clusters primarily focus on community needs and try to identify solutions for collective action, and the Federation primarily plays an advocacy role to the local leaders. This structure gives the poorest women in the country a voice at the political level. It is fascinating, and it is clearly working. The women that I met are doing a variety of income generating activities, allowing them to save as individuals and as a group, and they are becoming examples for self-driven progress in the community.

This is just one of very many programs that Kitovu Mobile has running in communities all over this region of Uganda. It’s been a real honor to witness these innovative programs, and I look forward to seeing Kitovu Mobile recognized by Uganda’s President Museveni tomorrow at their World AIDS Day event. (Even more so, I look forward to seeing their awesome Director call Museveni out on not following through with promises he has made to them–and every Ugandan–in the past!)

With hope and a belief that together we can get to zero new AIDS infections,

Alyssa

A visit to GlobeMed’s newest partner

Uganda welcomed me on Tuesday morning with a huge smile from the newest GlobeMed partner I’ll be visiting, Pastor Aloysious Luswata from Adonai Child Development Centre.

Aloysious and his wife, Abby, founded the center to address the high rates of orphans in the village communities outside of Kampala due to war and HIV/AIDS. At one point just before they were registered as an NGO, they were living with about 20 children in their humble home. That is a testament to the kind of people they are.

Today, however, the center is thriving with almost 300 children. There is a nursery and primary school there, with high quality teachers who instill a sense of values and purpose in the children who come their way. There is also a home where some of the children stay if they do not have a caretaker family to live with. While there are some clear renovation needs in the dormitories – particularly the boy’s dormitory, which is currently not up to government housing standards – Adonai’s leaders have concrete plans and strategy for how they will strengthen all aspects of the center to provide a safe, loving home to the children in their programs. 

In particular, one of the biggest needs is stronger sanitation and hygiene measures. This is something that Adonai staff have recognized for quite a while, as they currently do not have a way to store water for the dry season, causing the children to trek for quite a while to get clean water. The children also have to travel outside and down a hill (which I found out gets very muddy when it rains!) to use the latrine. Through their new partnership with GlobeMed at Northwestern, the team will be able to provide two new water tanks and a new latrine structure right at the children’s home. This will be a crucial improvement to their quality of life, and I’m so proud of GlobeMed at Northwestern’s new partnership for being able to achieve this.

While the programmatic details of this organization are inspiring and compelling, what is even more inspiring are the people. I don’t know that I have ever met people more humbling and kind than the founders – and other leaders – of Adonai Child Development Center. They welcomed me to their home, despite the fact that they already live with 8 children (4 of their own and 4 adopted). They cooked me meals, warmed my tea, and shared their beautiful lives with me. I am honored to have met them, and I have so much confidence that they are the perfect new partner for GlobeMed at Northwestern.

To learn more about the partnership between Adonai and GlobeMed at Northwestern, click here.  

Now off to more visits with one of our oldest partners in Masaka, Uganda!

Alyssa

The Value of a GlobeMed Partnership

Kenya was an overwhelmingly wonderful experience in every way. In just 7 days I got the opportunity to visit three very unique, but equally amazing organizations. Throughout the week I was able to have a lot of conversations that led me to think about the true value of a GlobeMed partnership. By meeting with a partner that’s one year old, one that’s in it’s first couple of months, and a potential partner, I was able to see multiple perspectives on GlobeMed and get really honest feedback from these organizations.

First, over and over on this trip I have heard that there is great value in GlobeMed because we are one of the only organizations that stick around when the organization performs. Short-term aid has been so detrimental to the field of global health; it can lead to a lack of trust by the community or minimally effective programs. GlobeMed provides value by continually innovating, building on successes, and learning from failures — with the same organizations, year after year.

On Saturday afternoon we had a feedback meeting with our partner in Western Kenya, the Western Organization of People Living with HIV/AIDS. In this meeting, our main contact Edwin asked his colleagues if they have ever met a partner that asked as many questions as we had asked in the past couple days; if they had ever met a partner that was acting not on what they believed was best, but what the organization told them was best. The answer was an overwhelming no. In the past, large (and smaller) institutions have come to their community looking to implement a project that they believe will help the community. They start implementing, and they find that they don’t have the necessary knowledge of the community and its needs to do so, so they call on WOPLAH and other community-based organizations to implement. The big institution will pay their travel fee, thank them, and move on to the next community where they do the same. Not only has this led to ineffective projects, but it has led to false perceptions of Americans, and mzungus (white people) in general. Both communities and organizations have high expectations when international partners are on the ground, and you can’t blame them. GlobeMed is changing these perceptions by listening, discerning, and supporting implementation – not guiding it.

 

I’m so proud to be a part of GlobeMed after having learned so much from our partners the past three weeks, and I’m only half way done. I’m currently sitting in Kampala waiting to visit one of our newest Ugandan partners. While I’m really missing my travel buddy, Sarah, I’m so excited to get started with the second half of the trip. Thanks to everyone who made it awesome so far!

If you would like to contribute to the value of GlobeMed partnerships, please consider supporting us in the GlobalGiving Open Challenge here: bit.ly/giveglobemed  This impact depends on you! 

Asante!

Alyssa