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.
- 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.
- 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.
- 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,