District-CCHIPs Workshop: ABAFATANYABIKORWA*

This year has already been a busy one for WWHPS-CCHIPs! I returned to Rwanda last week within 27 days of my previous visit in December to participate in the second workshop within the last year between WWHPS-CCHIPs and the Musanze District. The workshop, chaired by the Mayor of Musanze District, was held to help all stakeholders – from the Rwanda Ministry of Health to health center Titulaires – (1) better understand the CCHIPs Project and how we work; and (2) discuss a beneficial collaboration with all stakeholders.  I think the Workshop was a resounding success!

I was first to present (always a nerve-racking activity for me) explaining to the audience how I initially fell in love with Rwanda and its people and how this motivated me to help Rwanda after 1994. I described the evolution of the project and WWHPS’ philosophy of work and aid, stressing how our work approach might differ from other NGOs.  CCHIPs Project Director, Jeanne d’Arc Nyirajyambere presented the CCHIPs Model Overview (a 3-year, 3- phased approach) of horizontal integration and improvement of all health center services and activities. Data showing improvements and CCHIPs activities at Shingiro Health Center since 2008 and Kabere Health Center in 2010 were presented by each of the 5 CCHIPs’ Element  Coordinators--an executive decision of mine. I wanted the stakeholders to know this team and to understand how competent and hard-working they are since we must all work together (ABAFATANYABIKORWA) moving forward.  Their passion and excitement about the CCHIPs Project was evident in their Element presentations.  

Jean Bosco presenting about the Psychosocial Program.

Marvin presenting the CCHIPs Management Systems Element.

Jeanne d’Arc concluded the CCHIPs’ presentation by outlining our approach to moving forward and to working with all current and future stakeholders.   I was a proud “Mama WWHPS”! This led to a very animated and constructive Q&A period which the Mayor facilitated.

Most of the discussion was in Kinyarwanda so I had to rely on brief translations in my left ear and sign language from my CCHIPs team – who were giving me a thumbs-up and smiling. Eventually these meetings will all be in English—I hope I live that long!!

Agreement was reached on four key areas of concern to WWHPS and the District:

1. The District endorsed the CCHIPs Model/strategy for health center development. The next step is to present the Model to the Ministry of Health within the next two weeks for its official endorsement and support of the WWHPS-CCHIPs Project and Model.
2. The District approved WWHPS’ expansion of the CCHIPs Model to three more Musanze District health centers: Gashaki, Gasiza and Karwasa. This will test the viability of simultaneous implementation of the CCHIPs Model to multiple health centers and will require CCHIPs Team to modify its approach to introducing, implementing and mentoring its interventions. This is both exciting and challenging for our team. The catchment areas of these health centers where WWHPS-CCHIPs will work cover some 105,000 Rwandans!
3. The CCHIPs Project will work closely with each of the five health centers to develop an Annual Joint Action Plan for both capacity building and resources provision based on health center priorities and activities/resources that CCHIPs is able to fund each year.
4. Moving forward, CCHIPs will host Quarterly Update meetings for all relevant stakeholders to facilitate a closer working relationship, to inform on CCHIPs activities’ progress and, most importantly, to reiterate CCHIPs’ operating philosophy.

These concrete agreements represent exciting progress for CCHIPs within the Musanze District. The most exciting and gratifying parts of this meeting were the less-concrete and animated discussions. The Ministry of Health and Mayor expressed their support for CCHIPs. The Mayor moved me to tears as she pointed out that many people come to Rwanda to look at the gorillas and then go home. She personally thanked me and Bill for being different, for coming to look at the gorillas, and then returning to work with the people and help them grow. And finally, she said that we are all working together (ABAFATANYABIKORWA) for the same goal: to improve the health of the population. 

The Musanze District Mayor led the discussion at the end of the presentation.

I left the meeting elated. After a few months of confusion with the Ministry of Health, the District, and the health centers about the CCHIPs model and our activities, it now seems that all stakeholders not only understand who we are, but also understand the importance of the uniqueness of the CCHIPs model and how we work. They recognize how our capacity-building efforts and our philosophy of empowerment will help them grow professionally and give them the skills to sustain the primary healthcare delivery system of services for community health centers CCHIPs has delivered to them.

On behalf of the WWHPS Board of Trustees, my CCHIPs Project Team and the family of friends and donors who support and believe in this work, we are grateful to the Ministry of Health and the Musanze District for acknowledging the value of our work and supporting the continued expansion of our work here in Rwanda.

Murakoze cyane!

Working together with the (l to r) Musanze District Vice-Mayor, Musanze District Mayor, and the Rwanda Ministry of Health Supervisor for the Northern Province!

*Kinyarwanda for “partners working together”

Catching Up

Today is Sunday, and it is quiet.  The two surgeons from Dartmouth left this morning, which was a bit sad because they are great guys and got along really well with the team.  They have been working in Kosovo for seven years, but were stunned by the medical conditions here.  There are only 26 surgeons for 10 million people, and they are overwhelmed.  As a result, patients wait for weeks or even months to be operated on, even though they may have a bone sticking out of their skin.  Most of the operations that are done are done by general practitioners who have no training in operating techniques.  We are planning to start a partnership with the Docs to teach basic techniques for handing broken bones at three levels; the villages using our community health workers, the health center training our medical staff, and the district hospital by training the general practitioners.

The weather here is unbelievably good.  The temperature is always in the 70s or low 80s in the day, and low 60s or 50s at night.  Yesterday was an exception with rain most of the day, including torrential downpours for several hours.  We didn’t measure it, but we must have had at least 6-8 inches of rain!
The Docs took the team out to dinner last night, and we had a riotous time.  Two of us gambled on a fried fish…it was thin but 12” around…and delicious.   The team agreed it was the best restaurant food that they had had in Rwanda!

Our team is young: Jeanne D’Arc, the project leader, is 45, Elie (translator) 57, Zach 24, Lauren 24, Rene (engineer) 27, Alex (cinematographer) 23, Natalie (Doctor) 25, Amber (mental health) 33, and Anne (nutrition) 20.  You can imagine how challenging it is to keep up with them!  I drew the line on nightclubbing with them on Friday night…they left at 10:30 pm after dinner and returned in shifts from 4:30 to 6 am.  The team staggered out about 11 am…and then they worked until dinner at 7 pm! 

Education is very important here, both in prestige and in income, since pay scales are based on education.  Three of our four senior Rwandans (the fourth is Natalie, a Doctor) are going to school on weekends for advanced degrees.  This is after working Monday to Friday from 7 am to 6 pm.

OFF TO RWANDA!

I was trying to remember how many trips to Rwanda I’ve made. This is my tenth trip—I think! I look forward to every trip, but dread the preparations and the packing. This trip I’m travelling light. I only have 8 – 50lb bags to check. Here’s a sample:

•   2 cases of Crunchy Cheetos
•   3 extra large boxes of Rice Crispies
•   24 bars of Hershey Chocolate
•   4 jars of Fluff (to make Rice Crispy treats)
•   2 extra large boxes of Cheerios
•   Assorted chocolates: Hershey Kisses, Hershey snack bars, M&Ms
•   5lbs of pistachio nuts
•   5lbs of assorted cheeses that I carried in my backpack on board (caused Security search!—it was the 5lb wedge of Parmesan that confused them)
•   4 jars of Sun Butter
•   5lb box of crackers (to go with the cheese)
•   5lb box of Bisquick for pancakes
•   ½ gallon of real maple syrup
•   case of Nature’s Path Instant Oatmeal with Flax
•   5lbs of Betty Crocker Brownie Mixes
•   1 dozen Rawhide chews for Emi our project house dog
•   5 sets of sheets and blankets for Night Nurses for health centre
•   4 sets of sheets for project house
•   100 stainless steel mugs for Nutrition Program
•   21 flash lights with batteries
•   20 blankets for the health centre (each weighs 3 lbs!)
•   10 waterproof mattress covers for Maternity & Children’s Wards
•   flip flops for house staff
•   notebooks/folders for staff
•   label maker to label Pharmacy shelves for organizing supplies
•   3 wireless mice for staff computers
•   10lbs of pertinent files for meetings
•   selection of teas
•   3lbs of Dunkin Donuts coffee (I know, I know—Rwanda grows coffee!) 

Oh, don’t forget my 50lb bag of clothing! 

I fly Ethiopian Airlines out of Dulles to Addis Ababa to Kigali. It’s the fastest and least expensive. I leave from New Hampshire the day before. If I count that as the beginning of the trip the elapsed time until I’m in the project house in Ruhengeri is 2-1/2 days or approximately 56 hours, if there are no delays! I am on airplanes for 22 hours; and then 2 hours by car to our CCHIPs project in the Northern Province of Rwanda. 

The CCHIPs project house is at 6,000 feet elevation and our health centre work is at 8,500 feet at the foot of the Volcanoes National Park which is home to the endangered Mountain Gorillas of East Africa. It is a majestic landscape and takes my breath away every time I round that particular place in the road when the 5 volcanoes come into view.

Arriving at the project house is always a big event for the staff—mostly because of the food and needed items I bring. I would like to think it is me they are glad to see, but . . .

This is for the Grandchildren

Ro and I want them to know how different the world is from Hopewell, or Glenside or Westport or Chicago, and how hard some people have to fight to get a fair shake.

This is the story of Claudine, who works in Rwanda.  Her mother’s father, her grandfather, had twelve wives and 37 children; her mother was the youngest of 17 sisters and 19 brothers.  Her grandfather was quite rich with many cows and much land, and was very liberal minded for the time.  When he died shortly after she was born, he willed the land equally to all his wives, children and grandchildren, even though custom of that day was that only men could inherit property from their father.  However, her uncles and brothers refused to honor the will and took the land for themselves.  Her mother received nothing, and she moved into the town and started a small retail business.

When Claudine was 15, she went to the Chief of the family and said that what they did was wrong and she wanted her land.  This was a very brave thing to do, but the Chief said he could do nothing about it.  She asked for a family council, to plead her case.  At the meeting of the whole family, one of her mother’s brothers stood up and supported her, saying that woman had the same rights as the men.   A few days later, before a decision was made, he was murdered by his brothers.

At age 18, she went to the Chief again, and again pleaded her case, successfully this time.  She received her land and used the money from renting the land to pay for college to become a nurse.

Since then, 18 of her 20 uncles and 11 of her 19 aunts have been murdered in the genocide or died of disease, so she has inherited much more land.

It takes courage to stand up for what you believe. Today the Chief of the family is a woman.

This country is a place of extremes...in many dimensions.

Yesterday, we conducted the monthly training session with village health workers (animators).  It was a lively three hour session, after which the 50 participants spontaneously started to sing and dance in appreciation for what we are doing (and probably because they each got a flashlight as an incentive for attending!).  It was great!  Then, an hour later, we loaded our Land Cruiser with a very sick little boy to be rushed to the hospital.  He weighed 22 pounds…and was five years old.

You may recall how badly we all felt last week when we transported a 4-year-old boy to the hospital with a diagnosis of meningitis.  He had lost control of his legs and his head flopped around, and was very sick.  It turns out that he had cerebral malaria.  This morning, while we were at the hospital, he walked up to our American nurse volunteer to thank her for saving his life.

Our staff sees the most difficult human situations every day, and yet at the end of these days, in the Land Cruiser going back to the house, the back of the Cruiser is filled with laughter and conversation.  Their resilience is amazing.

Even the weather is extreme.  In this the rainy season, it often starts with a beautiful morning with a temperature of 72 and a light breeze.  By three o’clock we have severe thunderstorms and very heavy rain.