Malaria in Rwanda: A success story?

This is a very number heavy post with lots of links, so please bear with me. :)  If you are interested in more information about this very important topic, then go ahead and click on any of the links. But I was a brief as I could be, with possible sacrifices in the economic and emotional impact of this devastating pandemic.

Malaria is an interesting disease partly because it is very possible to eradicate it from a country.  For example, the United States used to have widespread Malaria but eliminated it.  When I went to Ghana for six weeks in 2011, three people I knew got Malaria during that time and virtually everyone got it almost every year.  Before I’d been there, I thought you simply died from Malaria. The end. No chance for recovery.  However, there were constantly commercials on TV about how inexpensive treatment is, so please treat your kid when s/he gets it.  It was considered just a part of life, similar to the flu.  That is part of the reason Ebola is kind of hard to control in West Africa right now. People are thinking they simply have Malaria or other endemic diseases and are not too concerned.

However, it is not like that at all in Rwanda. I have asked several people in Nyamata and Kigali when they last had malaria and they all have to pause and think about it because it has been many years.  However, it has not always been this way, to illustrate their success, according to the National Institute of Statistics in Rwanda, in 2005 62% of all deaths under 5 were caused by Malaria (1,012 deaths). Comparatively, in 2010 only 13.05% of all deaths under 5 (175 deaths) were caused by Malaria.  That is a huge difference.  However, it is important to note that if you do the math, there were 1632.29 deaths in 2005 vs 1349.99 deaths in 2010.  That's unfortunately not a lot of progress in childhood mortality.  But I digress.

So how did they make so much progress in such a short time?  In 2005, President Bush started the President’s Malaria Initiative around the world which has been a huge help.  There are four main measures they take: 

1. Free Insecticide treated-mosquito nets

                 -I sleep under a mosquito net but I doubt it is treated anymore as it is fairly old

                -“83%of households nationwide own at least one mosquito net and 71% of children under five had slept under a mosquito net the night before the survey. Overall 73% of pregnant women age 15-49 slept under a mosquito net the night before the survey.”

2. Indoor residual spraying

3. Preventative treatment for pregnant women 

                -Free treated mosquito nets are distributed to women at their first antenatal doctor visit

4. Diagnosis with rapid testing and treatment 

-94% of all children diagnosed with Malaria are treated within 24 hours (compared to 62% in 2008)

My own contribution is that the country is very clean, which makes it harder for mosquitoes to find breeding grounds (although the buggers are still around to bite me!)  A big part is the outlawing of plastic bags in the country, which then can’t fill up with stagnant water.

Six districts account for 60% of the Malaria burden and the rest of the country is not as concerned about Malaria.  The goal is to achieve zero Malaria deaths in Rwanda by 2017, which is lofty, impressive and actually appears achievable if the progress is kept up. However, with this success comes the problem of complacency and the possibility of a resurgence.  Despite the statistics quoted above, I know many people (Rwandan and expat) in urban areas who do not use a mosquito net because they do not see Malaria as a problem.  Expats do not take Malaria preventative pills (I stubbornly refuse to stop, you can see the prescription bottle on my nightstand in the picture above).  At the same time, people are losing their immunity to Malaria as they get fast acting treatments or are not exposed to the pathogen at all. And the parasite and insects are starting to become resistant to the nets and the treatments.  But no one is too concerned right now because there is so much progress.

MGS Animals

So after the depressing account from my last post, let's look at bunnies!  Maranyundo owns several animals that always look super cute. I don't even have any words!

My worst experience in Rwanda- Helping a Sex Worker

So I have had an amazing experience in Rwanda. Everyone has been super friendly and accommodating and I love the culture. However, the longer I’m here, the more I see cracks in the perfect façade the government tries to portray.  This is especially true with the treatment of women and it is a post I’ve been planning to write for a few months now.  However, something happened last night that slapped me in the face and showed me just how far Rwanda has to go.

I should preface this story by saying that after dark, any Rwandan woman wearing shorts or a dress above the knees is said to be a prostitute. And because it is thought to be true, it becomes true. No Rwandan will wear that type of clothing if they know they will be treated like a hooker the whole night.

I was staying at a hostel in a fancy part of town Saturday night and came back around 1:00 AM. When I came back, I saw a Rwandan girl within steps of the gate.  She was wearing booty shorts and a tank top and sobbing and stumbling around while holding her head. It quickly became apparent that she had been hit by something and was bleeding from her head so I jumped out of the taxi and went to go help her.  She had blood all over her hair and shirt so I quickly got it all over my hands and white sweater as I grabbed her to keep her from falling.  My first thought was that she was quite possibly HIV positive because she was almost certainly a prostitute.

However, my second thought was that I needed to get her help and I tried to bring her into the hostel gate so she could sit down and I could call the emergency line.  As I’m walking in with her, the guard comes out and starts screaming at her and raising his baton as if he is going to hit her.  I started arguing with him about how she needs a doctor and is clearly hurt and needs to sit down.  His response was she is drunk and needs to leave.  I was so furious with him as he was roughly YANKING on her arm while I was trying to keep her standing. Meanwhile, my taxi driver parked and is asking for his money for the ride.

So I pay the driver and then help her make the few hundred yard walk to the main road so I can find someone else who might know more language and help me.  A taxi driver stopped his car and asked if I wanted to pay for a ride for her.  So many people were just WATCHING LIKE A MOVIE and doing nothing. Finally, I got her right by the road where she could sit on a small wall and tried to call the emergency line:112. It did not work for me but there were about five motorcycles crowded around me so I asked if I could borrow one of their phones. They all refused!  Two of them had a phone visible to me but they did not want to WASTE THEIR CREDIT on this girl!  I later found out that the emergency line was TURNED OFF that night. Imagine if they decided to just turn off 911.  At this point she passed out from either alcohol consumption or her blow to the head.  By this time, several motorcycles with passengers have passed (including female passengers), stopped to see what is going on, I plead for them to help me contact the authorities, and they continue on.

Finally, an SUV came up and I saw there was a woman in the car so I flagged it down and asked for the couple to help me.  He knew English and offered to go a half mile down the road to inform the police officer there of what is going on. I was very grateful because it was starting to feel so hopeless and frustrating.

Then another sex worker came up to see what was happening and actually knew her. She asked if I had enough money to bring her to the hospital in a taxi, but I did not. I find it so sad that they are unable to trust the authorities to actually arrive and then I started wondering if I should try to get the police involved at all because they might just throw her in jail for prostitution and ignore her bleeding gash.  The couple in the SUV came back and said the officer there DID NOT WANT TO COME and help.  But he shared a second emergency line that is working: 912. So the couple called and then they asked me to call also, so the ambulance would feel pressured to come.  When I called, I said a girl had been beaten and needed medical attention.  The couple told me the officer had said not to say that because then the POLICE WOULD NOT COME. They will not respond to violence against women?!?!

So after a few more calls and about twenty minutes later (about forty minutes after finding her), finally an ambulance arrives. The couple promptly left and suggested I do the same, but I stayed around to make sure something happened.  The EMTs had no flashlight so we used my phone. And she was in and out of consciousness.  When they tried to touch her head, she was wiggling away and the EMT hit her arm and starts YELLING at her. Terrible bedside manner.  I decided to leave because I didn't want to be stuck with paying for her care but told her friend to make sure that she goes to the hospital and they don’t just leave her on the road.

Then I went to the receptionist of the hostel and started scolding him about the behavior of the guard and that conversation was very shocking.  He told me that "GIRLS LIKE THAT" are not allowed in the hostel (even though I’m 80% sure she came out of it).  I said I know what she is and it absolutely does not matter and if I was hurt, I surely would hope that they would give me help. He paused, contemplating and finally answered, “Yes, she is still a human being.”  But then he proceeded to tell me how she was drunk and they have seen her hurt before and her friends had tried to get her home but she wanted to be a prostitute in Kigali. What does any of this have to do with the fact that she needed a doctor and no one but the foreigner cared enough to try to arrange that?  I was livid.

I went back out for a final check to make sure she was gone and her friend assured me she was taken to the hospital.  So that was a huge relief after all that turmoil, but this entire situation leaves so many questions for me.  Would she have gotten help if… I’d had liquor on my breath? …I’d been wearing a short dress? …I’d been Rwandan? What if I hadn’t been there at all?  The thing that brings me chills is the bastard who hit her was in close vicinity to me and no one cared enough to determine who he was and find him.

So yeah…women, especially those that don’t adhere to the correct life plan, are not treated well.

You are wrong!

An interesting, and sometimes honestly frustrating, part of Rwandan culture is the belief that there is only one correct way to do most things.  It creates a great sense of community and you know things will be the same no matter where you are in the country or who you are talking to, which can be comforting when immersed in a difference culture. But can also make for humorous incidences.

The salt shaker is only for salt.

I found myself with serious cravings for black pepper, so I went to a fancy grocery store in the capital and purchased some. Awesome. Now I just needed to find a table shaker to put it in.  We had a shaker container without the lid so I asked three different people if they knew where the lid. They all had the exact same response: That is a salt shaker and we already have one so why would I need another?  I explained that I wanted to use one for pepper, but all three shook their heads and informed me it is for salt.  Eventually I just went out and bought one myself.

There is only one correct way to prepare food.

This one is pretty interesting and I think it might be partly to prevent food borne illnesses. Every time I make pasta the American way, boiled until it is your preferred texture and then drained, I am told I added too much water. That’s because you are supposed to use a specific amount of water and boil it all away, like how you make rice.

For Rwandan salads, beats, cabbage, carrots and onions are soaked in vinegar (to make it safe to eat) after they are shredded. Then they are organized on a tray in sections and topped with mayonnaise covered sliced tomatoes.  I have had salads made by multiple people in different parts of Rwanda and they are all exactly the same. It is definitely a trademark of Rwandan food.

There is only one traditional dance move

Learning traditional dancing

Rwandans have been desperately trying to get me to learn the correct way to dance to traditional Rwandan music. And anyone who knows me understands that I’m a pretty terrible, uncoordinated, unenthusiastic dancer anyways. But you would think that with only one move, I’d be able to get it down. Not so.  The feet seem to be on a count of three while the arms are on a count of four and I just can’t do that. And since there is only one way, they know that I’m doing it wrong, just not attempting a creative interpretation.

There is only one correct answer to a test question

This one kind of bothers me because sometimes students will have the correct answer to a question, but it is not the teacher or book supplied answer so it is marked wrong.

Such as

John will have eaten by 7:00.

 vs

John will __eat__ by 7:00.

Both are correct but only one will get the points. 

Same with math questions. When I was in middle school, if you did everything wrong but simply had a math error (4+4=9) then you would get at least half credit. Here it will be marked completely wrong.

The MGS Garden

Everything is in season at the Maranyundo garden right now!  The school has a beautiful garden just outside my home.

Eggplants are eaten at least twice a week.

Bell peppers are added to EVERYTHING! They only come in the green variety here.

Kale is all over the garden. It seems to be the most common plant and take up the most space Which I love as green veggies are at a premium here. But I also find confusing because I have never seen a Rwandan eat it.  The only time I've seen it picked is for feeding the rabbits!

This plant is called Dodo. It honestly is not that special to be in season because it is ready all year round. But it is a special Rwandan food you can't find in the United States.  You can read more about the Rwandan diet here.

Construction in Rwanda

There is a ton of construction going on on campus right now.  Next year Maranyundo is going to expand from solely a middle school to also include the first year of high school.  So that requires dorms and classrooms to be built before the January start date. Honestly, when I look at the progress, I wonder how they will be done in time, but Rwandans are very good at sticking to their goals! You can read more about the construction and expansion HERE. 

I have really enjoyed watching the progress and the methods for building these structures and my favorite things to do is compare the work to the United States.

From a bystander’s point of view, there are three main differences:

1.       The most obvious is SAFETY!

Everything is built at the construction site, including haphazard bridges (this used to be turned over with the rusty nails just waiting to puncture through someone’s shoes, I do not want to know what motivated them to turn it again)

This is the Rwandan form of a construction ladder or bridge.

People just walk on these high beams without thinking twice. My stomach is always full of nervous butterflies when I visit the sites. Also, notice the lack of hard hats. And can we please talk about why I’m allowed to just waltz onto the site in a dress and flip flops without even seeking permission?

1.       2. Everything is done by HAND.

Very rarely have I ever seen any machines or construction vehicles at the sites. Huge holes are dug with shovels and the dirt is moved away in wheel barrels. It is really quite an impressive site to watch!  

Here he is laying concrete, which isn’t odd, but the mix is brought in on wheel barrels and filler rocks are carried on women’s heads (see below) in baskets. I can only imagine how exhausting all of this is.

Also, I must point out that both of the men in the above two pictures asked me to take a photo of them (quite a common request in Rwanda) and then went right back to working, that was clearly what they wanted to be known for. You have to respect that kind of work ethic!

1.       3. It is not uncommon to see WOMEN working alongside the men

I am so impressed by this. You very rarely see women doing manual labor in the United States, but here women are very tough.  I honestly feel pretty lame when standing next to them (just getting in the way and snapping photographs).  Not to mention they can carry things on their HEADS, something I will never be able to do.

Developing World Problem 4: Keeping in touch with American loved ones

A problem I had anticipated before I even left was keeping up with loved ones in the United States regularly. I knew the internet would not be very reliable (it is actually faster than I expected but also more intermittent, find more information here)  That’s a big reason I started the blog, because I knew people would be less likely to email me, even if they were interested, than to simply go to a website and read about my happenings.

However, my American roommate, Marcella, came with her iPhone to keep in touch with people. Although it was not unlocked and she couldn’t use it as her primary phone in Rwanda, she was still able to use Facetime, Skype, Mo+, iMessage, Whatsapp, and other apps to help keep in touch.  I’ll admit I was filled with the most jealousy when we went into the capital and would encounter internet. She could go on wifi with her phone and chat with friends and family, while I did not have my computer (nor did I ever wish to carry it around) so I was out of luck. 

My first picture with an iPhone. I love it because no on even notices I'm taking it. Although admittedly, I am in a very upscale place where they wouldn't get very excited if I was.

As a side note, it was also much easier to not attract a ton of attention when taking pictures because it is just a phone.

After I expressed my admiration for the smart little device for about the millionth time, she suggested I look to buy one in Rwanda, not expecting I would actually take that advice to heart.  But I right away started looking, wondering why I hadn't thought of it myself. 

It was a little confusing to me though, I was pretty anti-smart phone before this. I think they distract people from living in the moment, increase impatience, and make them too reliant on an external source rather than trusting themselves.  And my biggest beef with them is that in the process of trying to be more connected with others, you end up isolating yourself.

However, I wanted that connection with my friends and family and was not getting it at all at this time. So I found someone selling an iPhone and immediately contacted her, eventually buying the device.  And so far it has been awesome! It is factory unlocked so I can simply slip in my sim card and use it as an actual phone. I’ve been able to talk to people I haven’t had a full conversation with in months.

I’ll admit it was at first a bit of a disappointment. I’d always envisioned perfect internet at the coffee shops in Kigali when watching Marcella. However, it turns out Wi-Fi goes out every few minutes, which is extremely annoying when you are trying to add an app or register the device.  My advice to anyone coming to the developing world is to get a smart phone and set it up BEFORE you come.

Anyways, if anyone wants to chat with me, I am now more available! Get in touch!