I packed up all my stuff and ate a weird breakfast before going to the airport. After a confusing wait, we boarded a heifer of a helicopter, a giant military thing with bench seating lining the length of it. Some old Russian shitter, Dario had explained, rather in awe I signed a release saying I’d A) fly in and B) not get mad if it crashed.
The Minister of Health and I would be criss crossing Rwanda to celebrate World Malaria Day with PSI. During the flight, I took some quiet time to myself, did my daily spiritual readings, and listened to my favorite far out spiritual music on my iPod.
I admired the verdant hills below, and began to register what I heard, that every square inch of the land is tilled in the effort to feed all 10 million people living here. The land is intensively cultivated, gardened, terraced. It must be, or they’d go hungrier than they already are.
We landed in a giant field in the Est Province, greeted by hundreds of onlookers who were curious about the helicopter. Cries of “mazunga” erupted as my colleagues and I got into our cars. We jolted across rough, red dirt roads to visit to see a community health worker in action. In a small, poor home, we visited a broken woman holding a limp infant. The community health worker had diagnosed malaria, and was giving her education about her new impregnated net and proper use of Primo treatment. I sat with the woman, but she was not easy to engage, she herself was so ill and seemed very overwhelmed. I tried to squeeze in a few quiet moments with her, as I am not a “breeze in, breeze out” kind of gal. I like to learn the stories of the people I meet, to share in their lives as much as I can, form an emotional connection. My only real contact with her, however, was that she smelled so rotten I actually had a gag reflex, a first for me in 11 countries of slums, brothels, and hospices. It was very sad. I didn’t even get her name.
In a back of the miniscule house, a woman who rented the bedroom had her net hanging proudly over her bed. She was wearing a matchimg lavender outfit and we sat under her net giggling, unable to understand one another with words, but giddily connected somehow. She was really precious and very proud of herself, so proud everyone came to see how she uses her net. I saw her again later at the clinic and we gave each other a sparkly look. Jungian, those meetings.
The community health worker, as all are, was special. To gain the post, he had to explain to his fellow villagers, perhaps with some competition from others, why they should choose him for the job. I picture him standing on the grass, surrounded by cassava, corn, and beans, maybe some hedges in bloom, with rough finished shanty shacks around him, a few goats or cows near by, his community quietly assessing his ability. Once elected, he receives 5 days health services training (eventually I met the guy in charge of the hospital in Kigala where the folks who train the CHW’s are trained. The decentralization here is fascinating). In his kit he has life saving pharmaceuticals (antibiotics, i.e.), family planning methods, malaria treatment (PSI products), and some non pharmaceuticals. He is available in his home and goes to those who are too unwell to traverse the mountains. It is worth noting here that this job is unpaid, and when the CHW’s are asked by the government what they need, wellies [rain boots] are often mentioned, so they can keep walking to sick people in the rainy season. When I asked this CHW if people stop by at all hours of the night and day (my personal worst nightmare), he said no, that they all see each other fetching water at the river, searching for firewood, and in the fields. They chat informally during daily life to make their appointments.
And so we partly celebrated World Malaria Day in this home, showcasing how nets, treatment seeking behaviors, and Primo can reach every household in Rwanda, even the most remote and poor. It showed how to complement private sector and clinic availability of goods and messages with a creative, partnered government initiative. It was a good visit.
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