Part 2: This is the second entry in the blog series by Michella Otmar about the Nutrition for HIV-exposed Infants (NHI) home visits during the Summer of 2010.

Climbing a steep dirt path, we approached a newly build house with a stunning vista of the valley below.  I stopped for a second to catch my breath and take in the view.  We were in Coko, visiting Olive, one of the participants in the NHI program.  She walks two and a half hours each way from her home to Ruli District hospital to participate in the NHI program.  She does this in her flip-flop shoes, her infant child strapped to her back and her toddler in tow.  Though petite in stature, she is a strong and resilient woman.  At the time of our visit, she and her mother had just completed the construction of their new home, a project they completed by hand and on their own.  They built this new house to replace the home they lost in a landslide just a couple months before.  Though the house was cold, without a floor and built on yet another potential slide area, it was a vast improvement to the alternative.  This scenario was not unique to Olive.  Another participant also had lost her home in a landslide and was living in a new home, adjacent to the first house. In both cases, there was concern about damage that could come with the next rains.  One woman lived with her infant in a single windowless room no bigger than a walk-in closet.  Most of the women cook over an open flame indoors where they are exposed to the exhaust of the fire.  All the women dedicate hours to collecting water and preparing it for their children.  None have access to electricity in their homes.        

Completing home visits with NHI program participants was perhaps one of the most important components in helping shed light on the growing complexities of health as it relate to our patients.  Taking medication, receiving formula for one’s infant and food supplementation, is only one small part of improving or maintaining health for our participants and their children.  For many of them, access to the basic resources such as clean water, heat, shelter, food, and medical services, presents a profound challenge.  And yet these basic resources are instrumental in maintaining physical and emotional health. 

In working with NHI participants, one cannot simply look narrowly at just one aspect of health and ignore the rest.  And taking on all aspects of the problem at once would be impossible.  As we assess and address one area, we see a dozen more that need attention.  It seems that this is the heart of the challenges faced in global health and what can seem to be an overwhelming situation.  Completing the home visits certainly exposed “the dozen” additional issues, but is serves as a reminder to keep evolving the projects to include the interweaving factors of health.  They truly are interdependent.  At the year mark of the NHI program, participants were grateful to have been included and eager to continue with The Ihangane Project.  Many of them began a training program in basket weaving and handcrafts with TIP’s Women’s Association & Reinvestment Program.  This not only provides income generation for this vulnerable population but also social interaction and community building. While traveling in Rwanda, Wendy and I would often be told (and then we would remind each other)……. “buhoro, buhoro” meaning ‘little by little’. 

~Buhoro, Buhoro each step makes a difference~

This video shares some of our experiences with Olive and her family:

For most of us, April symbolizes the beginning of Spring. New growth, new beginnings….. For Rwandans, it marks a very dark time of their history: the Genocide of 1994. Every April is a time to honor those who were lost during this time. This year, in addition to honoring the tragic loss, we would like to focus on celebrating the resilience of incredible people who have risen above the tragedies they faced to create new lives for themselves, their families, and their communities.

On April 16th, please join us in this remembrance and celebration of life and empowerment!

Thank you for your support, and we hope to see you on April 16th! 

by: Michella Otmar Part 1: This is the first entry in the blog series about the Nutrition for HIV-exposed Infants (NHI) home visits during the Summer of 2010. In the summer of 2010, Wendy and I traveled to Ruli, Rwanda to work on many of The Ihangane Project (TIP) programs.  One of our central focuses was to evaluate the progress of TIP’s Nutrition for HIV exposed Infants (NHI) program and assess for its potential growth.  At this point, the program had been distributing food supplementation in the form of Sosoma and formula for approximately one year to the 7 participants in the pilot group of this project.  Upon our first meeting with the group since Wendy kicked off the program the year before, it was clear by visual assessment alone that the program was benefitting the nutritional status of the infants. These seven infants appeared to be of age appropriate growth, development and socialization. One of our objectives was to really look at the requirements of the program and see how much of a challenge it presented to the participants.  It was evident to us that the pilot group was actively participating, but we did not want to assume that their enthusiasm translated to mean that the requirements presented no hardship.  Some of the program requirements state that participants attend bi-monthly meetings with the VCT team, obtain a sippy cup for their infant and use boiled water when preparing the infant’s food.  But what did that mean for the group?  How far were people traveling to attend meetings and by what means did they get there? What sources of income did they have?  Where did they collect water and how was it prepared? Where did they collect firewood and how long did this take?  We had many questions about they way they lived and so we asked the group at our first meeting, “Can we come visit you at your homes?”  Everyone agreed and so over the next month, we visited the homes of each of the women.  This was perhaps the most insightful experience of the entire trip. Life has presented many circumstances in which the phrase ‘things aren’t always what they seem’ has been an appropriate statement, but at no other time in my recent memory has it been more apparent than it was during our home visits.  It was during our first meeting at the hospital that I had begun to formulate my judgments and opinions about the women and the program. As the women assembled together for our first meeting, I saw women dressed in bright African cloth.  The vivid colors covered their bodies and crowned their heads.  Children strapped to their backs, cleaned and primped in what seemed to me to be their Sunday best.  Based on my first judgments, it seemed to me that most if not all of the women had running water and perhaps even some electricity.  I had already seen some houses around Ruli and I was now imagining household scenarios for each of the women. Had I only met with the participants during our scheduled health center meetings, I would have kept my first judgments intact and maintained a blissful ignorance to the challenges these women faced.  I would have never learned that two lost their homes in the past year to landslides and both rebuilt their homes by hand.  None of them have electricity or running water for that matter.  All but one have dirt floors, all but two cook with an open flame in an enclosed space. Four of them have other children who have suffered with malnutrition in the past.  None of them are married and four of the women are heads of their household. And one participant walks 2.5 hours one-way to attend meetings at the health center. The shock of the situation was felt not only by the American team, but also our Rwandan counterparts. Karekezi Sylvere, the HV nurse who coordinates the program, explained, “Each of our patients comes to clinic clean and well dressed. They all do everything we ask, and they always arrive on time. I was very surprised to discover the ways that they are living. With each home visit, I saw a new and sad reality of what it means to be poor”.  The home visits exposed the true reality of hardship endured by rural Rwandan poor and has shed light on the numerous needs of our participants.  Click on the photo below to get a glimpse into our experiences:

In rural Rwanda, red clay covers everything. Not just the roads, but the cars, the plants, and all clothing. When driving to the city, men in their suits and women in their finest cover themselves from head to toe in hopes that they can avoid the red film of dust when they arrive at their destination.  They are occasionally successful, but usually have quite a bit of shaking out to do!  I always suggest that visitors bring red colored shoes to hide the stains. One intern asked me how long it would take for the red coloration of his toenails to go away! Ahhhh…..the red clay!  

When Michella, our project lead extraordinaire, gave me a Gillian Welch CD, the song “Red Clay Halo” was an immediate favorite. The song describes the experience of the people in the rural community of Ruli so well!  Although written as a folk song that describes life in rural America, it could have just as easily been written to describe rural life in Rwanda. To me, the song is a reflection of the commonality of rural life everywhere.

Many people ask me what draws me to Rwanda. My response is that I “feel like I am going home”. I’ve often wondered about this sense of familiarity. Then I think of my Gramma Minnie Lee- a tiny 91 year old spitfire who grew up dirt poor in southern New Mexico during the Great Depression.  Stoic, faithful, loving, and stubborn as a mule, she has always been grateful for everything she has and generous to anyone in need. She has very few expectations for herself, and holds a faith that I have always admired.  When prompted, she tells stories of moving from place to place while her father looked for work. She remembers picking cotton until her fingers bled, and being separated from her family after the only home they ever knew burnt to the ground in a fire.  She tells her stories in a matter of fact way without ever instilling a sense of self pity.

When I arrived in Ruli, Rwanda, I was met with a familiar sense of gratitude, generosity, and faith. I am not speaking just of faith as in a particular religion, but of a faith that sustains one through the toughest of times. I am not sure why these traits are such common threads amongst rural folk around the globe. Maybe they are essential to survival, or maybe they come from living close to the earth. Regardless, they fuel the resilience needed to walk through the challenges in life, and unites all of us as human beings.  

“When I pass through the pearly gates, my gown be gold instead, or just a red clay robe, with red clay wings, and a red clay halo for my head!” –Gillian Welch

The best of mankind is a farmer; the best food is fruit.    – Ethiopian Proverb

As many of you know, The Ihangane Project has been working with Nyange Health Center, Ruli District Hospital, Catapult Design and Solar Electric Light Fund to bring solar electricity to Nyange. Thanks to a collaborative grant with UCLA HIV Care Clinic, we are excited to announce that SELF completed installation of solar equipment at Nyange Health Center in September 2010. This video describes some of the process, as well as what electricity means to those who provide and receive health care services here.

While we were in Rwanda this summer, we performed electricity assessments for 4 more health sites. Thanks to the collaborative grant with UCLA, we will be able to provide solar power at these sites within the next 4 months. The following video provides a glimpse into what it means to be a rural health center without electricity!

Just in time for Holiday Shopping…..Please join The Ihangane Project in welcoming Pallavi Singh of Eyaas.com!

Eyaas.com empowers rural artisans who produce traditional handmade crafts in India and Cambodia by increasing their access to mainstream marketplaces.

*Wool & Silk stoles from North-East India

*Embroidered Stoles from Kashmir

*Lead-free Pottery

*Hand-knit products, Jewelry, Toys

*Dhokra (Wax-casting)

*Traditional Rwandan baskets, banana leaf cards, and handmade jewelry

Eyaas brings a diversity of products straight from the hands of the craftspeople who make them. It is an online platform for handmade products and crafts from different parts of Asia, and it facilitates an exchange between producers and consumers in such a way that maximizes the returns back to the producer.

Exemplifying Resilience

In 2002, Leonille was working as a secretary at the tribunal in Ruli Sector. One evening, she was returning to Ruli from Rushashi with her 3 month old son on a very crowded mini-bus when the vehicle crashed.  She saw nothing but blood and bodies all around her, and did not know if her son was alive or dead.

Leonille spent over a month in Ruli District Hospital’s intensive care unit, where she received many blood transfusions due to persistent internal bleeding. She was barely conscious during this time. When her mind finally cleared, she discovered that her back was broken.

“In fact”, describes Leonille, “I felt that every part of my body was broken”. She spent the following five months in the hospital trying to recover, as well as countless additional surgeries to repair damage to her broken bones. Knowledge that her son was indeed alive motivated her to continue living and healing.

Leonille discovered that she was HIV+ in 2007.  When she heard the words “HIV Positive”, Leonille felt as though she was dying a second death. She often asked God, “why am I not dead?”  She began to think about her future, and her son Joshua. One day, she woke up with renewed determination to survive.  She asked a friend to teach her how to bead so that she could work again.

“It is not good to just close my arms and die.  I must find a way to have the strength to live”

In the beginning, Leonille continued to feel as though her body refused to work. Every time she moved, it was like she was opening a wound. Gradually, she became stronger and more confident. Now, she finds inspiration everywhere. She looks at her son, who is now first in his class at school. She also looks at the board that displays her variety of beaded artwork, and she feels productive and proud. 

Leonille has developed a talent for creating beautiful earrings, necklaces, and beaded coasters. She is now expanding her skills to include beaded place mats to match her colorful coasters, and she is experimenting with a new design of purses. Through her work with the Ihangane Association, she is able to provide for herself, her son and her entire extended family. “God is number one”, proclaims Leonille “and everyone should believe”.

The spirit of generosity is a hallmark of the Rwandan people. Even those in the most difficult of circumstances share what they have with others in need. This spirit is best exemplified by the traditional Rwandan Agaseke basket. The Agaseke is so important to the culture of Rwanda that an image of this basket can be found on the Rwandan national emblem. Often referred to as wedding baskets, the Agaseke is a symbol of generosity, gratitude, and compassion. Whether transporting wedding gifts, offerings to the priests, or bringing food to a friend in need, the process of giving is always the common thread. While in Rwanda this summer, we had the great opportunity to meet with seven HIV + women who are participating in a pilot program aimed at preventing malnutrition amongst HIV-exposed children. We sat as a group to discuss the strengths and weaknesses that were noted over the first year of the project. At the end of our meeting, we were presented with a beautiful Agaseke basket that was filled to the brim with peanuts.

The gift became even more touching when we later visited the homes of each of these women. I was shocked to discover the extreme poverty in which these women live, and even more overwhelmed by their generous expression of gratitude. In a separate program, The Ihangane Project works with two women’s handicraft associations to strengthen their business skills and to improve access to markets for their beautiful crafts. Each group has unique visions for their futures. Association Ihangane, founded by Dusabyemaliya Madeleine, envisions itself to be a teaching institution that specializes in the production of traditional Rwandan crafts. When Madeleine heard of the dire circumstances of the HIV+ women in the pilot nutrition project, she immediately offered to begin training these women in the art of handmade Rwandan crafts at no cost. As we speak, these two groups are now merged together to support one another and to find ways to lift themselves out of extreme poverty. Now, you may wonder how this all relates back to weddings…..and to the wedding basket! These beautiful baskets reflect traditional Rwandan culture, and exemplify the resilience and generosity by which these women live their daily lives. Traditionally sized baskets can be integrated into a marriage ceremony, or miniature baskets can be provided as gifts to wedding guests. The Agaseke symbolizes the generosity and gratitude that each marriage would be blessed to have.   These beautiful baskets can be purchased through our online store at  http://www.shop.theihanganeproject.com/, or by sending an email to The Ihangane Project at info@theihanganeproject.com

Fall is here, and it is festival time! Please visit us at any or all of these upcoming events!

November 6-7, 2010
Saturday – 10am – 7pm
Sunday – 11am – 6pm

SF Concourse Exhibition Center
635 8th St (at Brannan St)
San Francisco, CA 94103

 When: September 25-26, 2010  10am-6pm           Where: Morgan Hill, California

Event Description: Arts & Crafts Festival featuring fine arts & quality crafts; variety of food with local restaurants; wine & microbrew garden; two stages of live music; “Kids Zone” with rides, crafts and children’s entertainment; “Business Expo” & community non-profit group displays; Custom & Classic Car Show; Quilt Show.