A Week in the East

Who knew how much one person (or three in this case) could accomplish in one week. I spent four days last week in Bugesera District in the Eastern Province, with Kitty, a fellow PCV, and Jean-Marie, the District Health Advisor of Bugesera. In those four days we visited 7 health centers, drafted a grant that will hopefully improve the maternal and reproductive health services offered at one health center, had a super secret field trip, delivered lots of equipment that was donated by General Electric, ate a lot of starches (ie pasta, rice and fries at every meal) accented by vegetables and mystery meat, realized how much Kinyarwanda I actually do know (including making a joke in front of a large group of Rwandans), and scouted out a fantastic resort on a lake that I hope to take my family to when they visit. Not bad for a week’s worth of work, huh?

For the record, I had never stepped foot into a working health center in a developing country before my site visit to Musanze last month. I must admit I was overwhelmed at first. Overwhelmed might even be an understatement. I was too caught up in the newness, in the unfamiliarity, to observe anything at all. But the more health centers I see and the more time I spend in them, the more I notice. I notice the similarities, I notice the differences, I notice the structures themselves and the endless amount of people who seem to be everywhere. People are waiting outside, they’re waiting inside, they’re waiting in whatever shade they can find from the scorching sunlight; at times it seems that the health centers will literally bust at the seams from the sheer amount of people. And I’m beginning to see the difference between the organized, well maintained health centers and those that are unfortunately, not. They look different, they smell different, they feel different. So if anything, this week has definitely opened my eyes to the wide variety of health centers that exist, even within the same district. I visited old, run down, ill-funded health centers; well run, organized, catholic church funded health centers; and then I saw the crème-de-la-crème: two new state of the art Access funded health centers, in the final stages of construction, pristine and clean and full of promise.

So what makes a health center good or bad? Well, with my limited experience, I’d have to say…I have no idea (yep, sorry, no awe-inspiring epiphanies here). At times it seems related to who the major funder of the health center is (I need to do more research on this, but it seems funding comes from a mixture of the Ministry of Health, a variety of churches and NGO’s like Global Fund, etc). Sometimes it seems to depend on the personality and management style of the titulaire (head of the health center). Other times it’s related to the economic prosperity of the area surrounding the health center; better economic situation, greater chance of community members going to the health center for treatment, more money going into the health center to make improvements in not only service offerings but infrastructure as well.

While the week provided a lot of information and observations, it was also supposed to provide me with an introduction to the Access Project and the eight domains that they work in: human resources, infrastructure, finance, community health insurance (Rwanda’s public insurance is called Mutuelle), pharmacy, health information systems, planning and coordination and information technology. The District Health Advisor (with PCVs as support) provide technical assistance to the health centers in each of these areas. So yes, it’s as overwhelming as it seems!! I’m honestly not sure where I’ll even start, except that I’m lucky to be taking over for another PCV, Jessica; so she will not only be a valuable resource, but also I’ll be able to follow-up on a lot of the activities she’s already done. Pretty sure the first few months will be spent doing a lot of assessing and evaluating and introducing myself a billion times and just getting my bearings. All this on top of settling into my house and attempting to integrate into my community (once I figure out exactly what I mean by “community” since I’m living in the 4th largest city in Rwanda). Not to say I’m not completely excited and totally up for the challenge! This is, after all, what I signed up for.

Well, this post seems more rambly than usual, I must admit my mind is going in a hundred different directions currently. And the caffeine from my delicious Rwandan coffee is starting to kick in. Time to be productive and research some things for work! Hopefully will have a new PO Box address for you all soon, but you can always send things to the Kigali address as well.