A week in "the field"

Last week I spent working with the IntraHealth/Twubakane program in Family Planning in the regions west and south of Kigali called Muhanga, Kamonyi, and Ruhango. I tagged along with Dr. Jeanne (a general practice physician from Rwanda), Sophie (a nurse), Chantelle (a trainer), and Christian (our driver). Thankfully, they all speak English so I knew I would be able to communicate with out trainees. We left on Monday morning and were not supposed to return until Friday afternoon. However, I returned to Kigali on Tuesday evening to attend the Presidential Inauguration celebrations at the US Embassy and Heaven restaurant. (More on the inauguration later) We stayed in the town of Kabgayi, a little over 1 hr from Kigali via the main road/highway, at the Center de St. Andrew. The trip provided amazing views of the countryside. It is clear why Rwanda is "the land of 1000 hills." We traveled in a crew cab Toyota Hilux pickup truck with the "USAID from the American people" and Twubakane logos on the side. The road was winding and steep, but well paved and maintained. Alongside were many mud/clay/brick homes and some concrete structures. The landscape is very green and covered in crops of all kinds (banana, tea, coffee, cassava, avocado trees) regardless of how steep the hillside. Nearly all the roads leading away from the main one are dirt and in varying condition. Just before coming to Kabgayi, there is a sprawling town called Gitarama where we ate dinner most evenings. The only way I could tell what villages we were passing was by looking for the signs designating the local health center. Each sign has the Rwanda Ministry of Health, USAID, and Twubakane logos.

The Center de St. Andrew is a huge compound that has a Catholic Church (the oldest in Rwanda, built in 1925), a hotel, primary school, teaching center and more. The Kabgayi Hospital is also located on the grounds. The church is undergoing renovations after the roof collapsed a few months ago. The rooms were utilitarian and there was no hot water 2/3 nights I stayed there. The other night, there was only scalding hot water. It turns out that a cold shower is way better than a scalding hot one--at least you can take a shower without injury. Who knew?

On Monday, we provided lectures to the 6 family planning nurses who were our trainees.

From Rwanda-1st 2 weeks

We also used models for simulations of IUD insertion and subdermal contraceptive implant insertion. This teaching session was held in a classroom on the grounds of the Center. The irony of teaching about contraception within a Catholic center was not lost. In fact, many of the health centers and hospitals are affiliated with the Catholic Church. Because the Church feels that contraception is wrong, the patients who seek care at these places may or may not receive information about contraception, but are all referred to the secondary clinics that have been set up away from the Church grounds to provide family planning services. This is true throughout the country (as well as many other places throughout the world). Regardless of what the Vatican may feel is best, the people of Rwanda realize that fertility control is crucial to their individual and collective futures.

Each of the next 4 days we spent at health centers in some remote areas of these regions doing hands-on teaching with our trainees. Each center was unique in whether it had electricity, running water, sufficient space and more. I don't know the exact numbers, but at each center there were between 15-70 women present for the informational/counseling sessions on contraception at 6 different health centers. Many of the women had infants tied to their backs or were breastfeeding. They asked excellent questions and expressed concerns about some of the same myths & misconceptions American women have regarding contraception. The trainees did well. However, I struggled given that they primarily spoke French and Kinyarwanda. Most of the time I had someone nearby to translate, though. These trainees will now become family planning trainers in their local health centers. This creates a sustainable model of service delivery that was clearly lacking from the ultrasound course I taught the week prior.

Here is a table of the services we provided at the 6 health centers we visited:

Sophie & Dr. Jeanne & Chantelle are amazing, dynamic, committed providers who will revisit these health centers and trainees for reinforcement in the future as well. I learned a lot from them and am grateful. I am impressed by the level of care provided under the circumstances, but am most impressed by the distances and terrain traveled by our patients to obtain the care. Though these women happen to be born in a place where roads are not paved, electricity and clean water are luxuries, and they must work extremely hard for everything, they have access to contraceptive services that many American women don't.