Rwanda

Pre-visit Research Meets First Impressions

“The hills are alive…” but it’s not the sound of music. Instead we find many sturdy houses, mostly accessible roads, and hordes of people going to and fro. Kigali, Rwanda’s capital, is a city built on several hills marked by trees, greenery, and beautiful scenic views.(see photo) It is known as one of the safest cities in all of sub-Saharan Africa and it is a symbol illustrating the amount of change possible when leaders, organizations, and people are willing to work together toward a common goal.

When I started my background research on Rwanda I did not know what to expect upon arrival. The facts that I usually look into (recent history, life expectancy, health risk etc) were not too encouraging. Recent history focused on the 1994 extremist genocide that saw 14% of the population brutally murdered. For a perspective driven juxtaposition: 14% of the US population would be 45 million people and Rwanda is only slightly larger than New Jersey. Life expectancy read: women 45 / men 42 (nearly 66% that of India). Health risks were plentiful: a nasty form of malaria, an HIV prevalence rate of 3%, and a slew of warnings about cholera, meningitis, and yellow fever. Switch gears to providing care - are there enough healthcare practitioners to combat or address these needs? Well the figures show 3,900 people per nurse and 50,000 per doctor. These stats should jump off of the page, but the point I emphasize is what I am seeing in light of what I read.

One cannot glance over Rwanda’s status as a developing country (its 2007 GDP is 1/10th of New Jersey’s 2007 state budget). Needless to say the country is very dependent on foreign aid. Moreover, threats and struggles are realized in varying arenas, such as border tension with the Congo, the growing global crisis on staple food prices, and the everyday ills of poverty, that make Rwanda’s successes fragile. For instance, poverty in Kigali is not as visible, or “in your face”, as in Mumbai or Surat, but that certainly does not mean poverty is not a problem or it does not exist in large numbers. Perhaps it is better hidden or more likely a layered issue that takes some time to piece together? With only four days in country I can only comment on what I observe. What I see is many beautifully groomed main roads lined with trees, trimmed bushes, and freshly cut grass. More importantly, I see direct responses or positive steps toward addressing my previous fact-finding results. I see HIV awareness billboards all over the paved streets (see photos). I open the newspaper and read about the government launching an integrated health system through Partners in Health and the Clinton Foundation. A measure that will train 21,000 health advisors and rise to 40,000 as time goes on. It is a joint style that believes in high quality medical services for all people and focuses on holistic approaches (infrastructure, provisions of water, electricity for health facilities etc). Also of note is the daily public reminders of the genocide but the approach is meant to build unity not make excuses or deny the past, which are jailable offenses.

Many of the daunting facts that built an impression before stepping foot in Rwanda are present in the media and appear to be an issue that a plethora of organizations are combating together. In all my travels I have never seen such a presence by the international community as I do in Kigali. Visibility is of course enhanced by Kigali’s small size, but it does not dismiss the shear volume of organizations. There is still much work to be done, but there is a sense that the direction and ingredients are here on the ground.