Archive | August, 2012

Rwanda’s Health Insurance

20 Aug

I’ve been thinking for some time that it’s about time I start writing more informational blogs on Rwanda’s Health Care structure and the like since it really is quite interesting. However, various things have kept me from it.

A fellow PCV’s dad forwarded this NY Times article and I just read it and thought it’d be a good starting place for future efforts to educate about the health system here. Hope you enjoy!

http://opinionator.blogs.nytimes.com/2012/07/03/rwandas-health-care-miracle/

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The Sweetest Moment

20 Aug

During training, before my English speaking younger host sister came to stay with us and I knew next to no Kinyarwanda, my older host sister and I communicated primarily in gestures. Our lack of verbal communication didn’t really register with me until one day when I finally heard her speak my name.

In the beginning it felt like my rather private host family and I were engaged in an awkward dance neither of us could get the hang of. There was a lot of coexisting and observation with a pinch of interaction here and there. When my sister spoke my name it marked a change in things, we (my family and I) had found the same rhythm and started to sync up.

Heidi can be rather tricky to pronounce for Rwandans. I get a lot of Hiriye and Hiliyes. So when my supervisor gave me my Kinyarwanda name during site visit I never really turned back. If you came to my village and asked for Heidi few people would have any idea who you were looking for (except for the fact that I’m the only American in the village). Ask for Mahoro from the hospital though and you’re in business.

A couple months ago the teenage girl working as the umukozi (housekeeper) was called home and one of the ladies who was around the house regularly stepped in and came to live with us. She also brought her two kids, one of whom is my favorite neighbor boy. The other, a little slip of a girl who would often cry at the site of me. Since coming to live with us, the kids eat a lot better and the girl’s temperament has improved. One day, it seemed overnight she started talking (later than most kids her mom says because of a problem with her palate I think) and sweetest moment number two happened when she started saying my Kinya name. She’s still getting the hang of speech so usually ‘Mahoro’ sounds more like ‘MA-ho’. Now whenever I’m outside every five minutes or so it’s ‘MA-ho book!’ ‘MA-ho sweet potato!’ ‘MA-ho Helena!’or whatever it is she sees. If you think baby talk is difficult to understand, imagine trying to decipher it in a language you only have some semblance of a grasp on. Her mom often has to play translator hahaha.

On my moto ride to get ready for camp last Friday I was seized by an overwhelming amount of gratitude. Sometimes it’s kind of a bummer that there’s no one in my village to have a beer with from time to time. Conversely, that means that on market day (Friday in my village) I don’t have to smell the moto drivers’ breath to see if they’re drunk, something they told us during training was important to do. In a lot of other places this is not the case. I was at one of the training sites on a market day and saw 3 or 4 moto drivers knocking back Mutzig. Alcoholism runs rampant in many parts of Rwanda, particularly the out of the way, hard to reach places, but it’s homebrew made from bananas or sorghum that they drink. Alcoholism certainly exists in my village, but the folks with a propensity for over imbibing tend to be the minority. Most of my coworkers don’t even drink.

I was also grateful that I could think of at least five of my friends/coworkers who I know would help me no questions asked if I really needed it and that there were probably as many more I didn’t think of who also would. Both the times I had money stolen my coworkers always made sure I had money to buy food.

I’m so late in writing about it, but my ‘new’ house is so awesome and I feel so blessed to live there. Mama wachu (our mom) is an amazing and kind woman with a lot of influence. It came up in a conversation with her early on that I don’t like being called an umuzungu, she reiterated that to all the kids within earshot, that I was to be called Mahoro only and from that day I’ve not been called umuzungu at my home by any of the dozens of people who come to fetch water. Nor do I get asked for money or food from people when Mama Wachu is at the house. She does a lot of business in Kigali and Kamembe so she’s frequently gone for a couple days at a time and occasionally the women will feel brave and ask me to give them something.

Since my work at the health center is seldom very fulfilling, it is definitely my relationships with people here that keep me going. My friends are always asking me when I’ll be returning back to America, will we keep in touch, will I tell them when I get married, and how much they will miss me. Not being very fond of goodbyes (just ask anyone I avoided saying goodbye to before I came here), I don’t like these conversations. My heart feels pulled in two directions, there’s home in America with family and friends who share the same culture, where I have anonymity and don’t belong to the ‘not fully human uuzungu’ class. Then there’s my home in Rwanda, where I have been warmly received, loved and supported in so many ways despite my American oddities. I have a love/hate relationship with Rwanda depending on the day, my emotional stability, and the number of people who have asked me to give them something. My relationship is further complicated by the fact that I’m half decent at navigating life here. Coming home after being away at GLOW camp, greeting and catching up with everyone feels so good. I have this sinking feeling that saying goodbye and leaving Rwanda is going to be much more difficult than I imagine.

When I said goodbye before I came here I knew that Peace Corps service is 27 months and that I’d be home after that, no questions. When I leave Rwanda, there’s no certainty in when I’ll be able to return. But I can’t imagine not coming back to see when the paved road finally reaches my village, how things will change and develop after the electricity finally comes, or how the babies I know now grow into kiddos. Keeping in touch with people will be reliant on them not changing their phone numbers, finding ways to check email, and not moving away or falling out of contact with the people I keep in contact with.

I’m so blessed to have people on TWO continents who love me so I suppose I ought to just quit complaining about it.

LET’S GO MAKE CHANGE!

13 Aug

This past week most of the Cyangugu Crew (what the volunteers in my region call ourselves) packed up, and headed to a volunteer’s school for our very first GLOW camp. There are a lot of jokes about our region of Rwanda basically being the Congo (out East is referred to as Lion King land), but this site might as well have been Burundi because of its proximity to the border and hot, dry climate.

What exactly is GLOW you might be wondering. It stands for Girls Leading Our World and is a life skills curriculum used to teach girls’ empowerment in Peace Corps countries the world over. All over the world, Peace Corps volunteers spend months preparing for week long camps, typically at the regional level. Many more volunteers work in their local secondary schools with girls in GLOW clubs, teaching important topics like self-esteem, refusal skills, HIV myths and facts, decision making, goal setting, and the list goes on.

Cyangugu has a relatively small concentration of PCVs compared to other regions of Rwanda so while other regions are in the second and third iterations of GLOW camp, and also putting on the boys’ equivalent BE (Boys Excelling), this was our region’s first go at a GLOW camp. Many thanks to PCV Jeff for leading the charge and hosting the camp at his site, basically in Burundi.

Typically the camps last around a week and some have as many as 100 girls in Rwanda. With only six PCVs, six Rwandan counterparts and eight or so junior facilitators we decided to keep the first go round manageable with just 30 girls, 10 from each of the three schools where PCVs work, a half day for opening activities, two full days of instruction, and another half day for closing activities.

There are definitely a lot of things we learned and will change for future camps, but overall the camp was an absolute success. We introduced the concept of camp culture to the girls and they took to it like white on rice. Learning the cheers and songs after just a few tries. Our camp was even complete with a spirit stick that we passed on at meals, recognizing groups’ enthusiasm, spirit of friendship, and participation in activities. On the second night we even had a bonfire where we introduced the girls to the American tradition of a bonfire and s’more making. Though, the homemade marsh mellows looked a little funky, they tasted all right and got the job done. The second night we had a talent show which mostly turned into the Shangi Girls Variety Hour.

The girls were split into five groups all named after powerful/influential women, 4/5 who happened to be black. Can you say HOLLER?! The women were; Michelle Obama, Marie Curie, Oprah, Maya Angelou, and Joycelyn Elders (first African-American US Surgeon General, worked under Clinton). Each group also had themed named tags, wore strips of igitenge (the fabric used here to make traditional clothing) specific to their group around their wrists, and made up group-specific cheers.

On the second and third days of camp the girls were split into three groups and rotated between three different sessions. Each of the sessions was taught by a PCV and a Rwandan facilitor, most of whom were colleagues of PCV teachers. The six sessions we covered were: Love and Sex, Peer Pressure, HIV Myths and Facts, Self-esteem, HIV/AIDS, and Goal Setting.

I co-taught Sex and Love with Jeff and a colleague of his. If you know me, then it’s no surprise that I volunteered to teach the sex portion of the session. It went over really well and I was pleased that I got to work in concepts like pleasure and consent. Part of the lesson was about setting a personal physical boundary and I stressed the point that the girls were able to stop at any point that they began to feel uncomfortable, no matter where it was. A concept it seems like many girls don’t learn early enough.

Highlights of my sessions included the girls’ responses to pressure lines, a group of girls who actually used the words ‘penis’ and ‘vagina’ in response to the question ‘what is sex?’ (most of the groups used euphemisms). My favorite one of all though was when one of the Shangi Superstar Girls stood up matter of factly and responded to the question, “What is the difference between love and sex?” with, “It’s my observation that love cannot cause HIV.”

In the afternoon we had craft activities, sport, and one afternoon I taught the girls the Macarena and the only line dance I remembered. They loved the line dance and each time the song was over they would clap and ask to do it again. I think we did it like four times in a row or something. I heard from other PCVs that the girls really loved learning the dances. I realized that teaching, even simple dances, is a lot harder than I thought. Also that somehow over the years I’ve forgotten how to count in to a song which made the Macarena interesting, but the girls didn’t really know any better.

We also had an affirmation wall which the girls really liked. I can’t even begin to fathom the number of trees we killed. I also received a lot of funny and sweet affirmations from the girls.

Our third year PCV leader is a camp culture guru and made up a cheer for camp that we taught the girls. The first part is a call and response and the second is a chant we did all together. I don’t spend a lot of time around groups of students but in my experience girls are mostly quiet, except occasionally when they laugh. Not the case at camp. It was so moving to hear the girls yelling proudly at the top of their voices such powerful words. We got the chants on video so I’m hoping to that I’ll be able to get them on my blog when a couple volunteers go home to visit in October. Tuzareba (we’ll see).

Here’s the chant we taught them:

Hey

Hey!

Who are you?

We’re the girls!

Who?

The girls!

What do you have?

POWER!

What are you going to do?

Change the world!

We (we)

We’re the girls (girls)

Of camp GLOW (GLOW)

Let’s go make change!

 

 

 

You Brought THAT on a Moto?

3 Aug

Being that taxi cars are rather expensive in Rwanda moto taxis are incredibly popular for whatever distance you can tolerate. As so, I’ve seen some pretty ridiculous things being carried on a moto, like rolled up mattresses, rollie suitcases, and other large items. No pets though.

I’ve wanted to start a series of blog posts called “You brought that on a moto? And am finally getting around to it. I’ve had some humdinger of loads myself but until this one, never took a picture.

This picture is from a trip to the post office which is out of the way, making it necessary to take a moto. The packages are for two other PCVs and we had a little rain delay before I could return to the house. Even with the rain and the gigantor boxes I didn’t get splashed with any mud because the moto driver I use is AWESOME! Cheers to Joesph.

I’ll try to have my camera ready for some of the more ridiculous ‘you brought that on a moto’ moments in the future. Feel free to email  me with any photos you have!

 

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Recipe: Lentils and Rice

3 Aug

I took dishes from two other PCVs and mixed them together with something that I believe is quite tasty and definitely got me out of my food rut.

Ingredients:

Lentils

Rice

Onions

Tomatos

Parsley (from my garden)/or what is grown in Rwanda ‘celery’

Spices: Maggi cube, salt, cumin, rosemary, pepper

Any other veggies on hand: green beans, carrots etc

Olive oil

Heat the pan with a little oil, saute the lentils and onions for 10 minutes or until they change color and become fragrant. Cover with water and lid for 10 more minutes. Add rice and water to cook. If using Maggi cubes, add when the water begins to boil. When the rice has 5-10 minutes left add chopped parsley, diced tomatoes and spices.

 

ENJOY! Maybe one of these days I’ll finish cooking it before dark and be able to take a picture. Here’s an even wilder idea…. maybe one day electricity will ACTUALLY arrive!

Army Week!

3 Aug

June 26th to July 29th was Army Week in Cyangugu. Staff from Rwanda’s Kanombe Military Hospital packed up, and came down to three health centers in Nyamasheke and Rusizi Districts. The health center I work at was the only site to host military personnel in Nyamasheke district.

Since I had been gone the previous two weeks I was pretty out of the loop with health center happenings. Thankfully my coworker filled me in on our walk to work Monday morning. Or at least he tried to. His explanation of, “Soldiers from the military hospital are coming to see all the indwara” was the extent of the explanation in English. From there I mistakenly teased out that the abaganga (doctors, but the word used by villagers for anyone associated with the health center. For example, my friend is called ‘umuganga wa Mutuelle’ or the doctor of health insurance) were coming to do a census of the illnesses of people in our sector. Like most things that don’t require special preparation on my part, I didn’t ask too many questions, knowing that all (well most) would be revealed to me shortly. The important thing was that we had visitors for the week.

The doctors were staying about 45 minutes by car South of my site at the fancy muzungu hospital because those were the nearest accommodations for the 30 or so of them. This means that they didn’t roll up until after 9 am, probably closer to 10 on Monday. In all fairness, to the road is not great would be a gross understatement and we did have a rain delay that morning, my coworker and I were even 30 minutes late because of the rain. Despite the rain there were A LOT of people waiting for a chance to be seen by doctors. Still, I got a chuckle out of the fact that apparently not even military personnel are immune from the phenomenon known as ‘African time’.

The medical staff from Kanombe were a mix of civilian and military personnel. There was one physician doing general consultations, also one of the two senior ranking military officials (I forget the different ranks), a couple of dental providers, a psychologist, a psychiatrist prescribing drugs, staff performing circumcisions (there’s been a big push lately in Rwanda), internal medicine docs, two ophthalmology technicians, nurses working handing out medications, and an overall logistics guy. In addition there were some nurses and a physician from Kibogora hospital and some nurses from neighboring health centers who were brought in to help manage the influx of patients. The patients weren’t just from our sector, but from neighboring sectors. Many people walking four hours or more and being told to come back the next day for follow-up.

Monday I just kind of kept to myself and held down the fort in the ARV office since many of my coworkers were had been roped into helping. It was a pretty boring day though since we’re typically through the rush of patients by 10 am. Not to mention ‘my office’ had been commandeered by the psychologist and the health center was over flowing with people everywhere you looked. So Tuesday after we finished handing out ARV meds I decided to ask my supervisor if he could find somewhere for me to work. I explained to him that everyone was really busy and I had already finished my work  and thought it would be good if I could help out in some way, as long as it wasn’t going to be too much trouble.

That’s how I wound up working with the second top ranking officer and another civilian ophthalmology tech for the rest of the week. At first it was a bit comical as we figured out exactly how I could help and I learned the ropes. Within a couple hours we had a system down. By the end of the week we were chit chatting (IN ENGLISH) like old friends. They couldn’t figure out why in the world I would choose to lie in a village or why I didn’t head into Kigali/Kamembe every weekend. By the end of the week I’d also become really good at figuring out the diagnoses and medications based on the symptoms causing jokes how I could work as a tech, except that I didn’t actually know how to diagnose the symptoms. The most common thing diagnosed was allergies the solution being prescription eye drops. There were also some older people with cataracts, some people who needed referrals to get glasses, as well as some other ocular oddities. Tuesday we saw around 40ish people, Wednesday around 60 I think, Thursday was the big day with 103 people, and Friday since they only worked until 2 we saw 80. My job was to write forms, sometimes as many as 3 forms per person. Suffice it to say that my hand felt like it was going to fall off, especially after Thursday.

Even if it was just filling out forms, something I frown upon doing on a daily basis, it felt good to be busy for the entire day and feel like I was contributing to an overall good. The whole goal of Army week is for people to be able to get medical care/referrals closer to home than would normally be possible. There are definitely a lot of benefits to such a program but there were also some drawbacks. Such as the fact that we quickly ran out of the prescriptions eye medicine and while people could pick up a month prescription for most the things immediately at the temporary pharmacy, refills would require the person or a family member to make the expensive trip to the fancy hospital because health center pharmacies are only qualified to carry a certain tier of drugs, which makes sense since there aren’t actually any doctors on staff.

Visitors in Rwanda are a pretty big deal, especially of the military/Kigali variety so the head of my health center provided lunch for everyone at his house, catered by some restaurant. After I started helping on Tuesday I was invited to lunch with the other army week workers. It gave me an opportunity to  learn a little more about the week and to field a plethora of personal questions of course. Including how many kilos I have, which I turned into a lesson on how American women do not like to be asked their age or weight.

During one of the lunches I was able to talk to the psychologist and clear up burning questions. Most people work with a counselor at a minimum for a couple of sessions, often for months or years. I couldn’t quite figure out what service he was providing in a one-off visit. He explained that mostly he was collecting information about the various ‘mental disorders’ that people have. This prompted a talk about how the government wants each health center to have a psychologist, but because of tight budgets, a lack of qualified personnel and the undesirable locations/distances from cities of most health centers this was not a reality.

I got permission from one of the senior officers to take pictures and to share them. It’s not acceptable to take pictures of military personnel, not to mention many Rwandans are suspicious when you want to take their picture. BUT I thought Army Week was too good of an opportunity to pass up sharing with folks. So, please pardon the poor quality of the photos, I was trying not to single any one/group of people out. Enjoy!

First stop for patients- one of the private rooms to have a photocopy of their insurance card made. Since we have only solar power they brought in a generator and one of the local elementary school’s copy machine.

 Dental services at the front of the health center. The front of the line for photocopying insurance cards is around the building to the left.

People waiting on paperwork in the large meeting room.

Students from the local schools came, some to see docs, many just to witness (and contribute to) the madness.

Outside the lab, through that doorway is the meeting room from the pictures above.

The makeshift pharmacy. Also the area where we do vaccinations every Friday.

This is normally just a walk way in the health center but in a pinch, it works as a place to vaccinate kids.

SO MANY PEOPLE! This is the waiting area of my health center. With the exception of Friday mornings before the market, it is seldom this full.