Rural Rwanda- Written Tuesday, August 28, 2007

To get a real look at developing nation’s challenges one has to leave the population center.  On Tuesday morning we drove for nearly three hours west of Kigali to visit the Rubengara Health Center.

Rwanda is about the size of Maryland. It has around nine million residents. Rwanda is called the land of a thousand hills. It reminds me of West Virginia in that way.  Everything is built on a hill, often a steep one. The roads are full of turns and often slow. Every scrap of ground is farmed, no matter how steep the grade or unyielding the soil.

Along the way I saw hundreds of people working the soil with hoes or picks.  What I didn’t see was farm equipment, not a single piece.  Surprisingly, I didn’t see any large animals either; no horses or cows.  Goats were prevalent.

Most everyone walks.  There are a few bikes. Anything being carried was generally balanced on their head carefully. Most loads appeared to be water, charcoal, sticks or leafy plants.

Those who didn’t walk or ride a bike rode in mini vans generally packed to overcapacity with ten or more people riding on three seats.

We drove on a paved highway the Ambassador said he thought had been built by the Chinese. The roadway is lined with banana trees and appeared well engineered.  Because it was built onto the side of a hill like everything else, a drainage system had been built to cleverly avert erosion of the road.

There was no water collection or distribution system.  Like so many things in remote areas, availability of basic necessities is made more difficult because of distribution problems. So it is with water.

Many of the road walkers carried yellow plastic water containers of various sizes to a series of water holes.  As we passed the filling spot there were always dozens of people standing in line.  It was clear this was both a necessary ritual to sustain life but served as a social event as well.

Small homes are scattered across the landscape.  Almost all of them are constructed of mud bricks made by the owner.  Some are covered with plaster; most have sheet metal roofs.

Rubengara Health Center

We arrived at the Rubengara Health Center which is operated by the Presbyterian Church of Rwanda.  The mayor and Provincial Governor were both there as well.

I had three purposes in my visit.  The first was to meet with representatives of two associations which have been formed by among people in that area who are living with HIV AIDS. Each group has about 120 members. They meet regularly to provide support and information. They each have arrangements where they cooperatively grow food which can be shared. We had an extremely candid conversation about their circumstances, how they got AIDS and emotional needs of the families.  As we talked, several of the people told me about their children, especially those born after they were positive. None of the children were positive.

I also viewed an exciting development called TRACnet.  This is a project the US Government is supporting through Columbia University.  It is an electronic tracking system on patient data.  The data can be input and accessed manually, over the internet or by cell phone.  The data will create a powerful set of management and research tools. It could be the foundation of an electronic medical record. I was pleased to find there is a significant level of collaboration being done on this in Africa so the same standards will be used across the continent and around the world.

Before I left, we presented to the two associations 50 goats that will serve as the foundation of a herd. It will become an important part of their food cooperative. It was a fun and emotionally touching moment as this entire community turned out to express appreciation to the United States of America.

Tomorrow, I will write about my visit to the Kigali Genocide Memorial and the people I met there.

Comments

Dear Mr. Secretary,

Thank you so much for joining the health care blogosphere. Your contribution has been very much appreciated.

This question is a off-topic as far as your last few posts, but I wondered if you had any reactions to the recent federal court ruling reported on today - August 30th - in the LA Times by Ricardo Alonso-Zaldivar, that would allow disclosure of certain specific physician information from the Medicare claims database. The press report refers to information that would help consumers when confronting a medical decision, learn how many similar procedures their physician has done.

The issue is whether the DHHS will appeal U.S. District Judge Emmet G. Sullivan's ruling. And if DHHS did appeal, how would that be consistant with the efforts of DHHS in pursuing transparency and value-based health care.

Thank you for your consideration.

Posted by: Alfred J. Fortin | August 30, 2007 at 09:15 PM

Hello,

My name is Emile, I am writing to let you know that I have been touched by your work and views on Rwanda and health care in general. You blog is really impressive.

I work in Rwanda as an Editor for a Rwanda's leading business magazine. I would be honored to publish some of your opinions or thoughts.

Kindly visit our website and blog. www.businessrwanda.com
www.businessrwanda.wordpress.com
or email personally using
babu.emile@yahoo.com

Posted by: | March 18, 2008 at 07:58 AM