Ubuzima bwiza (good health)

As I began writing this blog, several people (and by several, I mean at least six of you…thanks!) forwarded me a link to a New York Times article about the health care system in Rwanda. If you would like to read it (and you should, trust me) here’s the link: http://www.nytimes.com/2010/06/15/health/policy/15rwanda.html (Sorry blogspot is acting up and not letting me put it as an actual link, blah) But, imagine my surprise, considering the blog I was beginning to draft was about…the health care system in Rwanda. Coincidence? I think not.

So, I’ve been in Rwanda for almost four months and there has been what I can only describe as an excruciatingly steep learning curve; I am still, in fact, learning. Every day, every hour, every minute. Constant learning. Learning the language, learning the culture, learning how to survive and take care of myself without all of the creature comforts of American life. But most recently my learning has consisted entirely of wrapping my head around the health care system that exists in Rwanda, how the health centers are structured, how they function and how they continue day in and day out to provide medical care to the millions of Rwandan citizens in need.

Considering I will be here for two years, I’m sure this will be one of countless posts on the topic, so I’ll attempt to keep it to an introductory level. And again, as I am still learning, apologies in advance if any of my information is 1) accidentally wrong or 2) seems biased in anyway; I’ve really only observed the health system in three districts (out of 30ish) so what I’ve seen in all honesty might not be representative of the entire Rwandan system.

Health care here is provided at three levels, and is a mixture of public, private, and government/church/NGO funded. Wait, I’ll take that back, it’s more like four levels (and in all honesty I’m still quite confused by the funding structure that exists, but I’ll learn, buhoro buhoro).

1) At the umudugudu (or village, for you non-Kinyarwanda speakers) level, there are community health workers (CHWs). These are community members, who volunteer their time as CHWs, and there are at least three in each umudugudu (one for men, one for women, and one who specializes in maternal and child health). They make home visits or hold community meetings, informing, sensitizing and educating the community about different health issues (particularly nutrition, malaria, HIV/AIDS and other infectious diseases that are present in the community or region). They also refer people to the next level of health care: health centers.

2) At the sector level (much like a county back in America) there are health centers. They are headed by a Titulaire, who is usually a nurse (you rarely see doctors at health centers, they work mostly at district or national hospitals) and usually see at least 100-200 patients a day. The services that a health center provides depends a lot on what their main funding source is (be it the government, an NGO, or a church), but I’ll come back to this. All health centers have consultation rooms, where cases are reviewed and the appropriate tests and treatments are discussed. They have a laboratory which usually has at least one microscope, and other lab equipment if they are lucky. There are hospitalization rooms, with separate rooms for women, men and children. There is a maternity ward (which continues to be the most difficult place for me to walk into, though I did see an incredibly adorable set of newborn twins the other day) and a room for vaccinations. Each health center has a pharmacy (both a stock pharmacy as well as a distribution pharmacy) and then administrative offices for the data managers, Mutuelle managers (the community health insurance that the NYT article was about) and other staff. Most health centers have family planning services, though some health centers that are funded by churches do not provide such services (if this is the case the sector is required to also have a health post, where contraception methods can be provided). Also, most health centers have HIV/AIDS services, including Voluntary Counseling and Testing (VCT) and Prevention of Mother to Child Transmission (PMTCT) as well as ARV distribution, usually housed in a separate building funded and beautifully constructed by the Global Fund. Some health centers have nutrition programs, which include educational talks and sometimes a garden and demonstration kitchen, as well as food distribution programs for severely malnourished children.

3) Often, people are referred to the district level, where there is a District Hospital. While my “office” is at the district hospital, I haven’t been able to spend enough time there to walk around, ask questions and get an overall sense of exactly what goes on there. But from what I can see, it’s much bigger, the equipment is often more sophisticated, they have greater diagnosing and treatment capabilities, and can even perform some basic surgeries. I promise I’ll come back to this in a future post, as I know I’m not doing it justice whatsoever.

4) Then there are a couple of national referral hospitals, where I was lucky enough to be a patient once, but you already know that story. More on this level in a future post too.

So that’s your basic roadmap to the physical health system structure in Rwanda (sorry for not being more informative, but I’m going to go back to my defense that I’ve only been here four months and I still have A LOT to learn). I’ll try and put some photos up soon of the health centers and hospitals that I’ve visited, to give you a better visual. But until then, let’s just consider this one to be continued.


But of course I had a happy week...so...

Things that made me happy this week:
- Relaxing with Kitty, including dragging my heavy living room furniture into my driveway so we could watch a movie while attempting to simultaneously get a tan. We succeeded in getting sunburned while only being able to listen to Notting Hill on my tiny glare-filled laptop screen. But I still loved every minute of it.
- The woman who came to a training wearing a dress so fancy and beautiful that most Americans would have reserved it only for prom or an outing to the opera. There were ruffles, there were rhinestones; now that is “serious” and “smart” dressing.
- After 13 painful hours (spaced out over two weeks of internet visits) I successfully downloaded and am finally the proud owner of Microsoft Office. I’m beyond excited to once again spend hours playing with Excel and Powerpoint, and as always fully embrace my inner-nerd.
- When my water came back on after countless days without it. I (and my dishes, clothes and house were getting extremely dirty). Unfortunately, this sudden blessing of water was balanced by my electricity going out, once again supporting my hypothesis that I cannot have both at the same time.
- Epicly long, rambly, random, hilarious, shocking, gut-wrenching, wonderful emails from Jigga. Drinking games included.
- My easiest (and may I say, most successful) market experience to date
- Spending about 30 minutes attempting to pull down plantains from the tree in my backyard, using a 10 foot long stick that I’m assuming was only in my yard for that exact task. (They were delicious, by the way)
- Sleeping from 11pm to 9am. Amazing.
- The night my kerosene stove blew up in my face (don't worry, I'm fine, and no, that's not what made me happy) and I was still able to cook a fantastically tasty stir-fry dinner.
- Completing my first District Health Newsletter for work!! It’s mostly just photos, but hey, it’s somethin.
- Looking forward to an amazing weekend in Kigali with amazing friends.