Family Planning in Rwanda

Rwanda is an amazing place! Less than 15 years after one of the worst possible breakdowns of law/order, government, culture, society and even concern for human life, Rwanda is quickly becoming the star example of how a developing country can succeed!

Though I came here "to teach family planning," I expected to learn more from my experience than anyone would learn from me. As I come to the end of my trip, I think I was right. My first experience in medical education in Rwanda came from fortunate timing--I was able to join a program teaching basic obstetrical ultrasound. At the end of this 3 day course, the midwives and doctors who participated had received an introductory experience with ultrasound. In the 6 weeks since, I have been able to arrange only one other teaching session to reinforce this newly acquired knowledge. My concern that such a brief introduction would not be adequate was justified by the difficulty I had in the follow-up session. This lack of follow through and training to competency in a new skill is a frequent flaw in educational programs. It was further highlighted by the effective model implemented by IntraHealth and sponsored by USAID.

In fact, the family planning teaching programs I participated in with IntraHealth/Twubakane are so well run that I learned a lot from them. I participated in a teaching session dedicated to long acting reversible contraceptives for 6 nurses who will work at rural health centers.
By the end of their week-long training session, each one was capable of effectively counseling a patient on her contraceptive options and competently performing the minor procedures required to place an intrauterine device or subdermal implant.
This photo says a lot about how important it is to have health care providers trained in family planning. The woman is in her mid-20's, holding her 10-month-old infant son while she follows through on the most basic promise of humanity: to provide the best possible future for herself and her family. When a woman uses contraception in Rwanda she is avoiding the very real chance (about 1/20 lifetime-risk ) she will die in childbirth during her next pregnancy while increasing the likelihood that she will be able to afford to pay for her child to attend secondary school. (For those who are interested, most recent maternal mortality statistics in Rwanda are from 2005, with 750 deaths per 100,000 live births. That is approximately 100 times greater than the US!) These are just 2 of of the most basic benefits she and her family will gain by using contraception. When you consider family planning from a community, country or society perspective the benefits are even greater.

To highlight the issues further, I'm finishing a 2-week educational program for general practice physicians who are stationed at district hospitals in the areas where IntraHealth/Twubakane has been working for the past 4 years. The doctors who attended the lectures last week, and are traveling to the rural health centers to provide family planning services this week, had nearly no training or experience in family planning. They have cared for patients who ask about contraception and have not been able to provide them the complete care they need. All of the physicians expressed gratitude on behalf of themselves and their patients that they have the opportunity to learn these vital skills.

Rwanda is doing a lot of things right in its rise from the ashes of war and genocide. I've been told it is the safest, most secure country in Africa and I believe it. Walking around Kigali at night can be dangerous because of traffic, but I don't have to worry about street crime. Rwanda's health care system is already doing something the US can't figure out: provide affordable health insurance for 100% of its citizens. This includes coverage for family planning services. Many international NGO's and the Rwandan government are responsible for these and other successes. My personal knowledge of the IntraHealth programs in Rwanda makes me feel strongly that they have contributed significantly to the increase in use of contraception from a low of 4% of married couples in the year 2000 to 27% in 2007.

Having spent a lot of time riding to/from rural health centers in Rwanda in a truck that has the USAID logo on the side has made me even more proud to be an American. Rwandans who I have met and cared for are extremely grateful for the assistance they receive from abroad, but they realize their future successes rely on more than international support. I have no doubt that Rwanda will continue to be the star of Africa.

As a former athlete, I've learned it is always more fun to play for the winning team. I hope I get the opportunity to return to Rwanda and participate in future victories.