I went to our offices, set in a very nice two story building with lots of doors that open onto a small hillside; there was a rondelle of Cosmos growing by the PSI sign and the welcome desk included a dry eraser board where our staff sign in and out. There were some small trucks with our medical goods’ brand names (primo, confiance, tazanet) painted on the side. Below the building is a garage that has been converted into a warehouse for our products, and is from here we begin to distribute them out to the poor people who need them. I saw boxes of long lasting insecticide treated bed nets, coartem, our artesmin based anti malaria drug, various methods of birth control, and sur eau, our point of use water purification product. Our staff in the warehouse consist of women we have sensitized via peer education about the risks of commercial sex work; most have been able to retire, as a result, from sex work altogether, and have created a co-op in which they pool their money to buy supplies to make crafts. It is really fascinating to see poverty reduction solutions in action, and how one good action opens the way for yet another to manifest.

I loved meeting everyone and am so proud we are able to employ so many smart, committed, compassionate locals. In this way, PSI helps contribute to the local economy, increases employability by adding to job experience, and of course more effectively creates and runs programs that appeal to Rwandans themselves, as they are created by Rwandans. This is our policy worldwide. One must understand each tiny micro culture and habit and dialect in order to create positive behavior change within it.

I sat down after a round of introductions (I always mention we have 5 cats and 2 dogs because it gets a shocked laugh, hungry societies don’t keep pets, and so the concept does not exist at all), and was prepared to be dazzled by the presentation our staff would make, et comme d’habitude, I was.

Rwanda is a country of 10 million people and it is growing at a terrifying rate. It has one of the fastest growth rates in all of Africa. They have already run out of space. As mentioned, every inch of earth is cultivated yet there is widespread food insecurity. There are the predictable environmental consequences: massive deforestation, erosion (Egypt is getting all Rwanda’s topsoil; the Nile has its spring source in Rwanda….fascinating), loss of biodiversity. I was warned that I would never be alone (something everyone knows I need daily) as even in the most remote parts of the country, people would be…everywhere. And it’s true, they are. Even unpaved rural roads are lined with folks walking somewhere, perhaps in a blue school uniform or with baskets of goods or a jerry can of water on their heads. Off on distant hillsides I can see people gardening. I will try to go pee behind some tree or bush and sure enough there is someone farming a few feet away!

At its current growth rate, which is 6.3 children per woman and outpaces economic growth by almost an entire point, Rwanda’s population will triple 2030, which surely means catastrophe. Famine is inevitable, the pressure on space to a crisis point, economic and public health collapse, infrastructure that cannot meet needs, and ultimately, political instability. It is this, political instability, above all things, Rwanda seeks to avoid, and therefore, family planning is at the very top of the government’s public health plan. However, even if the government, with PSI’s help, meets its most fantastic fertility regulation goals, by 2030 the population still will have doubled.

I find it wonderful that this government is smart enough to regard poverty as a key political issue. Sure, they want to reduce poverty for all the more socially recognized reasons, but having come out of genocide, and being intensely motivated to avoid bloodshed in the future, they get that poverty breeds instability. This is always something I try to bring to my talks in the U.S. when people say, “Why should we care about poor people abroad?” The One Campaign to End Poverty does a great job of articulating this.

So, we help the government with family planning. A variety of options are available to individuals and couples: oral, injectables, male and female condoms. We brand and socially market them and in cases of extreme poverty give them away (even though the cost for any product is extremely low, but some cannot afford to spend even those pennies) and we helped prevent unintended pregnancies since 1995. Even though only 1 in 10 women is using modern birth control, that number is still twice what it was in 2005!!!! We also do STI (sexually transmitted infection) and HIV-prevention education. Some products we receive at subsidized prices, but believe you me, there are plenty of manufacturers out there who will only sell to us at market rates. People who make money off poor people make me sick.

ALL CHAPTERS:
Day one — arrival
Day two — genocide memorial
Day three — the countryside
Day three — the PSI.org offices
Day three — malaria nets
Day four — you go, global girl
Day four — water purification
Day five — world malaria day
Day six — Women for Women International
Day six — Democratic Republic of Congo
Day six — heal Africa
Day seven — Sonrise
Day seven — Dushishoze
Day seven — reflections